Peds EAQ - CNS
The nurse is discussing long-term care with the parents of a child who has a ventriculoperitoneal shunt to correct hydrocephalus. An important part of the discussion with the parents is ensuring that the parents understand that: 1 Most usual childhood activities must be restricted 2 Cognitive impairment is to be expected with hydrocephalus 3 Shunt malfunction or infection requires immediate treatment 4 Parental protection is essential until the child reaches adulthood
ANSWER: 3 Because of the potentially severe sequelae, symptoms of shunt malfunction or infection must be assessed and treated immediately if present. Limits should be appropriate to the child's developmental age. Except for contact sports, the child will have few restrictions. The development of cognitive impairment depends on the extent of damage before the shunt was placed. Limits should be appropriate to the child's developmental age.
The nurse assesses a child for the doll's-head maneuver. What does the absence of the doll's-head maneuver indicate? 1 Dysfunction of the brainstem 2 Dysfunction of the parietal lobe 3 Dysfunction of the frontal cortex 4 Dysfunction of the temporal lobe
Answer: 1 Absence of doll's head maneuver suggests dysfunction of the brainstem or oculomotor nerve (cranial nerve III). Absence does not suggest dysfunction of the parietal lobe, frontal cortex, or temporal lobe.
What is the purpose of a lumbar puncture (LP)? 1 To analyze cerebrospinal fluid 2 To rule out subdural effusions 3 To detect electrical activity 4 To relieve intracranial pressure
Answer: 1 An LP is done to obtain cerebrospinal fluid (CSF) for laboratory analysis. A subdural tap is performed to rule out subdural effusions. It is also done to remove CSF to relieve pressure. Electrical activity or spikes are detected by an electroencephalography (EEG). This test indicates the potential for seizures. LP is contraindicated in patients with increased intracranial pressure. A subdural tap or ventricular puncture may be done to remove CSF to relieve pressure.
Type 1 diabetes mellitus has just been diagnosed in a teenage boy who is actively involved in sports. What important instruction should the nurse include in the teaching plan? 1 Because exercise can lower the blood glucose level, blood glucose needs to be closely monitored. 2 Because exercise can increase the blood glucose level, blood glucose needs to be closely monitored. 3 Because exercise can increase the blood glucose level, additional insulin should be taken before physical activity. 4 Because exercise can lower the blood glucose level, additional insulin should be taken before physical activity.
Answer: 1 Because exercise can lower, not increase, the blood glucose level, blood glucose needs to be closely monitored. Additional insulin should not be administered before physical activity, because both insulin and physical activity lower blood glucose.
What is the most appropriate nursing intervention in the care of a child experiencing a seizure? 1 Describing and documenting the seizure activity observed 2 Suctioning the child during the seizure to prevent aspiration 3 Restraining the child when a seizure occurs to prevent bodily harm 4 Placing a padded tongue blade between the teeth if they become clenched
Answer: 1 The priority nursing intervention is to observe the child and document the seizure activity. To prevent aspiration, the child should be placed on the side if possible to facilitate drainage. The child should not be restrained, because this could cause an injury. Nothing should be placed in the child's mouth, because this could cause injury not only to the child but to the nurse as well.
A child is admitted to the hospital for treatment of suspected bacterial meningitis. What the priority of care for this child? 1 Providing environmental stimulation to keep child awake 2 Administering antibiotic therapy as soon as it is available 3 Initiating isolation precautions as soon as diagnosis is confirmed 4 Administering sedatives and analgesics on a preventative schedule to manage pain
Answer: 2 Administering antibiotic therapy is the priority action. Antibiotics are begun as soon as possible to prevent death and avoid resultant disability. The nurse should keep the room as quiet as possible. Isolation should be instituted as soon as diagnosis is anticipated. It is important to decrease the external stimuli.
What does the nurse recognize as the primary clinical manifestations of diabetes insipidus? 1 Nausea and vomiting 2 Polyuria and polydipsia 3 Oliguria and facial edema 4 Glycosuria and ketonuria
Answer: 2 Diabetes insipidus results from the hyposecretion of antidiuretic hormone (ADH). Because insufficient amounts are produced, excessive amounts of urine are produced. When allowed access to fluids, the child maintains balance with an almost insatiable thirst. Oliguria is diminished urinary output. Children with diabetes insipidus have increased urine output. Glycosuria and ketonuria are manifestations not of diabetes insipidus but, more likely, of diabetes mellitus.
What is the most serious complication of placement of a ventriculoperitoneal shunt used to correct hydrocephalus? 1 Leakage 2 Infection 3 Malfunction 4 Brain damage
Answer: 2 Infection is the most serious complication of placement of a ventriculoperitoneal (VP) shunt to correct hydrocephalus. Leakage and malfunction are common complications after VP shunt insertion but not the most common. Brain damage is not a common complication of VP shunt insertion.
A patient who has sustained a head injury exhibits rhinorrhea. What immediate nursing intervention is appropriate for the patient? 1 Reassure the patient, as it is an insignificant finding. 2 Test the discharge for presence of glucose. 3 Sedate the patient and administer antihistamine. 4 Ask the patient to report immediately if the nose bleeds.
Answer: 2 Patients with head injury may have leakage of cerebrospinal fluids. The watery nasal discharge is tested for presence of glucose to rule out cerebrospinal fluid (CSF) leakage. Reassurance is given only after excluding CSF leakage. Sedating by administering an antihistamine is not appropriate in managing rhinorrhea of head injury. The patient is asked to report nasal bleeding, but priority is given to check for CSF leakage.
The nurse recognizes that a hemoglobin A1C value of 9.0% for a toddler is: 1 Too low 2 Too high 3 A high risk for hypoglycemia 4 Within the recommended range
Answer: 2 The goal value set by American Diabetes Association for hemoglobin A1C in a toddler is 8.5% or less, but no lower than 7.5%. A hemoglobin A1C value of 9.0% is too high, putting the child at risk for the complications of hyperglycemia, not hypoglycemia.
What is the best position for a child after a supratentorial craniotomy? 1 Position the child on either side with the bed flat. 2 Elevate the head of the bed 20 to 30 degrees. 3 Place pillows against the child's head and back. 4 Place the child in Trendelenburg position.
Answer: 2 When a supratentorial craniotomy is performed, the head of bed should be elevated 20 to 30 degrees with the child positioned on either side or on the back. Elevating the head facilitates cerebrospinal fluid (CSF) drainage and decreases excessive blood flow to the brain to prevent hemorrhage. The child with an infratentorial procedure is usually positioned on either side with the bed flat, and pillows are placed against the child's back, not head, to maintain the desired position. Ordinarily, the head and neck are kept in midline with the body, and the neck should not be flexed to support venous drainage. Trendelenburg position is contraindicated in both infratentorial and supratentorial surgeries because it increases intracranial pressure and the risk of hemorrhage.
The nurse is caring for a comatose child with multiple injuries. The nurse should recognize that pain: 1 Cannot occur if the child is comatose 2 May occur if the child regains consciousness 3 Requires astute nursing assessment and management 4 Is best assessed by family members who are familiar with the child
Answer: 3 Because the child cannot communicate pain through one of the standard pain rating scales, the nurse must focus on physiologic and behavioral manifestations to accurately assess pain. Pain can occur in the comatose child. The child can be in pain while comatose. The family can provide insight into the child's different responses, but the nurse should be monitoring physiologic and behavioral manifestations.
A nurse caring for a child with brain dysfunction notes that the child is exhibiting rigid flexion with the arms held tightly to the body and the legs extended and internally rotated. What posturing is this child demonstrating? 1 Normal 2 Rotating 3 Decorticate 4 Decerebrate
Answer: 3 Decorticate posturing includes rigid flexion with the arms held tightly to the body; flexed elbows, wrists, and fingers; plantarflexed feet; legs extended and internally rotated; and sometimes a fine tremor. These findings are not normal; they indicate decorticate posturing. Rotating posturing is not a medical term. Decerebrate posturing is characterized by rigid extension and pronation of the arms and legs, flexed wrists and fingers, a clenched jaw, an extended neck, and possibly an arched back.
The nurse is assessing the level of consciousness of a patient who has received a high dose of morphine. How can the nurse reverse the effects of morphine in this patient? 1 Administer fentanyl (Duragesic) 2 Administer midazolam (Versed) 3 Administer naloxone (Narcan) 4 Administer vecuronium (Norcuron)
Answer: 3 Naloxone is a morphine antagonist and is useful in reversing the effects of morphine. Fentanyl is another opioid drug and is not suitable for reversing the effect of morphine. Midazolam is a sedative and does not reverse the morphine effect. Vecuronium is a paralyzing agent.
A young child is having a seizure that has lasted 35 minutes. There is a loss of consciousness. The nurse, drawing on knowledge of seizures, recognizes this as: 1 Status epilepticus 2 An absence seizure 3 A generalized seizure 4 A simple partial seizure
Answer: 3 Status epilepticus is a generalized seizure that lasts more than 30 minutes. This is considered a medical emergency and requires immediate treatment. Absence seizures are generalized seizures that are characterized by brief loss of consciousness, blank staring, and fluttering of the eyelids. Generalized seizures are the most common form of seizures. They include tonic-clonic (grand mal) seizures and absence (petit mal) seizures. Tonic-clonic seizures involve tonic-clonic activity and loss of consciousness and affect both hemispheres of the brain. Simple partial seizures are characterized by varying sensations and motor behaviors.
What is a priority nursing consideration for a child with suspected bacterial meningitis? 1 Supporting the family 2 Instituting standard precautions 3 Administering antibiotics as soon as possible 4 Administering pain medications around the clock
Answer: 3 The priority nursing consideration in a child with suspected bacterial meningitis is to administer antibiotics as soon as possible. Supporting the family is important, but the priority nursing consideration for a child with suspected bacterial meningitis is to administer antibiotics as soon as possible. Early isolation, rather than standard precautions, is recommended. Administering pain medications around the clock is important for children who are in pain, but the priority nursing consideration for a child with suspected bacterial meningitis is to administer antibiotics as soon as possible.
The postoperative care of a preschool child who has had a brain tumor removed should include: 1 No administration of analgesics 2 Recording of colorless drainage as normal on the nurses' notes 3 Placement of the child on the right side in the Trendelenburg position 4 Close supervision of the child while he or she is regaining consciousness
Answer: 4 The child must be observed closely, with careful and frequent assessment of the vital signs and monitoring for signs of increasing intracranial pressure. Any changes should be reported immediately to the practitioner. Colorless drainage may represent cerebrospinal fluid leaking from the incision site. This needs to be reported to the practitioner immediately. The child should not be positioned in the Trendelenburg position after surgery. Analgesics may be used for postoperative pain as needed.