PEDS NEURO
The nurse is assessing a 4-year-old child whose mother reports that the child is more irritable lately. Which of the following questions would the nurse ask to elicit information suggesting possible increased intracranial pressure (ICP)? 1. "Does she have headaches when she gets out of bed?" 2. "Does she vomit frequently?" 3. "Has there been a change in your child's hearing?" 4. "What immunizations has she had?"
1. "Does she have headaches when she gets out of bed?" Headache is a common symptom of increased intracranial pressure at all ages. Increased intracranial pressure is frequently accompanied by morning headaches caused by the child moving from the bed to a standing position. Although increased ICP can cause vomiting, frequent vomiting might indicate Chiari malformation. Immunization status provides information about infection and meningitis. A change in the level of hearing is not associated with most conditions that cause increased ICP.
A child diagnosed with a seizure disorder has been prescribed topiramate as part of the treatment regimen. The nurse is teaching the parents about the medication. Which statement by the parent requires intervention by the nurse? 1. "Taking this medication may cause our child to gain weight." 2. "The dosage may need to be changed as our child grows." 3. "We may notice our child has difficulty problem solving." 4. "Antacids should be avoided while taking this medication."
1. "Taking this medication may cause our child to gain weight."
A 6-year-old child with hydrocephalus had a ventriculoperitoneal (VP) shunt placed 6 weeks ago and now has experienced a seizure, is vomiting, and has loss of appetite. Which of the following interventions would be most appropriate for the child at this time? 1. Administer intravenous antibiotics as ordered. 2. Pad and raise the rails on the child's bed. 3. Educate the parents about seizure precautions. 4. Prepare a menu with the child's favorite foods.
1. Administer intravenous antibiotics as ordered.
To detect complications as early as possible in a child with meningitis who's receiving IV fluids, monitoring for which condition should be the nurse's priority? 1. Cerebral edema 2. Renal failure 3. Left-sided heart failure 4. Cardiogenic shock
1. Cerebral edema The child with meningitis is already at increased risk for cerebral edema and increased intracranial pressure due to inflammation of the meningeal membranes; therefore, the nurse should carefully monitor fluid intake and output to avoid fluid volume overload. Renal failure and cardiogenic shock aren't complications of IV therapy. The child with a healthy heart wouldn't be expected to develop left-sided heart failure.
A nurse is providing care for a 2-year-old child hospitalized with a diagnosis of increased intracranial pressure (ICP) secondary to hydrocephalus. Which nursing action(s) will promote comfort and rest for the child? Select all that apply. 1. Cushion bony prominences with rolls and pillows. 2. Encourage parents to participate in care whenever possible. 3. Position on the side with the chin extended. 4. Keep side rails up and padded. 5. Administer sedatives and analgesics as prescribed.
1. Cushion bony prominences with rolls and pillows. 2. Encourage parents to participate in care whenever possible. 5. Administer sedatives and analgesics as prescribed.
The nurse is preparing hospital discharge instructions for a 7-year-old girl recovering from head trauma and receiving gastrostomy feedings. Which activity is most important before the child is discharged home? 1. Determining the parents' ability to administer the enteral feedings. 2. Assessing the parents' emotional status. 3. Preparing a list of home equipment and supplies needed. 4. Helping the family to access financial resources.
1. Determining the parents' ability to administer the enteral feedings.
A nurse on the neurology unit is monitoring an 8-year-old child admitted with seizures. The child experiences a prolonged tonic-clonic seizure. Complete the following sentence(s) by choosing from the lists of options. The nurse should first _____________ 1. Ensure proper oxygenation 2. Insert an airway into the clients mouth 3. Suction the clients airway followed by ________________ 1. Do not allow the client to sleep once the seizure has ended 2. Administer an antiepileptic by mouth 3. Administer intravenous or intramuscular benzodiazepine
1. Ensure proper oxygenation then 3. Administer intravenous or intramuscular benzodiazepine
The nurse is caring for a child with an external ventricular drainage device. The nurse is concerned about the minimal drainage in the past few hours. What action(s) by the nurse should be performed now? Select all that apply. 1. Ensure the tubing is not kinked. 2. Check tubing clamps to ensure they are open. 3. Check the child's temperature. 4. Ensure the drip chamber is below the child's clavicles. 5. Encourage the child to cough and deep breathe to facilitate drainage.
1. Ensure the tubing is not kinked. 2. Check tubing clamps to ensure they are open.
The nurse is preparing a presentation for a group of parents at a local elementary school about seizures. Which information would the nurse likely include when describing this topic? Select all that apply. 1. Generalized seizures involve a loss of consciousness 2. Focal seizures may or may not involve a type of movement 3. Absence seizures are a type of focal seizure. 4. Seizures are classified by the area of the brain affected. 5. Epilepsy is another term used to describe a seizure.
1. Generalized seizures involve a loss of consciousness 2. Focal seizures may or may not involve a type of movement 4. Seizures are classified by the area of the brain affected.
After teaching a group of nursing students about seizures, the instructor determines that the teaching was successful when the students identify which of the following about status epilepticus? 1. It is a common neurologic emergency in children. 2. Children older than the age of 3 years are more likely to develop status epilepticus. 3. Seizure activity lasts less than 30 minutes. 4. The most common cause is flashing lights.
1. It is a common neurologic emergency in children.
A nurse is providing postoperative care for a newborn diagnosed with hydrocephalus. Which intervention should the nurse include in the plan of care? 1. Monitor for signs of peritonitis. 2. Use supine positioning. 3. Measure head circumference biweekly. 4. Elevate the head of the bed 45 degrees.
1. Monitor for signs of peritonitis. Peritonitis is a potential complication for which the nurse should monitor. The nurse should include daily, not biweekly, head circumference measurements. The head of the bed should not be elevated more than 30 degrees. The newborn should be positioned on the nonoperative side, not the supine position, to prevent pressure on the surgical site.
Which of the following would a nurse assess in a child with pneumococcal meningitis? 1. nuchal rigidity 2. productive cough 3. chills 4. otitis media
1. Nuchal rigidity
The nurse is caring for a 4-year-old client presenting to the emergency department with suspected meningitis. What will the nurse include in the plan of care? Select all that apply. 1. Provide fever management. 2. Institute seizure precautions. 3. Admit the client and family to a private room. 4. Administer IV antibiotics as prescribed. 5. Assess the client using the pediatric Glasgow Coma scale (GCS).
1. Provide fever management. 2. Institute seizure precautions. 4. Administer IV antibiotics as prescribed. 5. Assess the client using the pediatric Glasgow Coma scale (GCS).
The nurse is preparing to administer a prescribed medication to a 5-year-old child with a neurologic disorder. The medication has not been tested in children. Which action(s) will the nurse take? Select all that apply. 1. Teach the child's parents how to use an oral syringe. 2. Hold the medication until the health care provider is notified of off-label use. 3. Anticipate the same complications as would occur in an adult client. 4. Administer the medication after referencing a drug guide. 5. Question why the medication is prescribed.
1. Teach the child's parents how to use an oral syringe. 4. . Administer the medication after referencing a drug guide. 5. Question why the medication is prescribed.
The nurse is assessing a child who has suffered a head injury. Which assessment finding would indicate loss of midbrain functioning? 1. arms adducted and extended with pronation of wrists with fingers flexed 2. arms adducted and flexed on the chest with hands fisted 3. no response to verbal statements 4. loss of deep tendon reflexes
1. arms adducted and extended with pronation of wrists with fingers flexed
A 4-year-old child is brought to the emergency department after being in a motor vehicle accident. The child experienced head trauma in the accident. When assessing the child, which will be the first change noted in the presence of increasing intercranial pressure? 1. change in level of consciousness 2. reduction in heart rate 3. decline in respiratory rate 4. increase in heart rate
1. change in level of consciousness
The nurse is caring for a 10-year-old child who was admitted to the unit after experiencing a tonic-clonic seizure. When developing this child's plan of care, the nurse identifies the need to teach the child about diagnostic testing that may be prescribed. Which test(s) would the nurse include in the teaching plan? Select all that apply. 1. computed tomography 2. cerebral angiography 3. magnetic resonance imaging 4. electroencephalogram 5. brain scan
1. computed tomography 3. magnetic resonance imaging 4. electroencephalogram
The nurse is assessing a 2-year-old for signs and symptoms of increased intracranial pressure. Which of the following would the nurse expect to assess? Select all that apply. 1. resistance to being held 2. bulging fontanel (fontanelle) 3. narcolepsy 4. emotional lability 5. increased appetite
1. resistance to being held 2. bulging fontanel (fontanelle)
A child with a seizure disorder is being admitted to the inpatient unit. When preparing the room for the child, what should be included? Select all that apply. 1. suction at bedside 2. oxygen gauge and tubing 3. tongue blade 4. padding for side rails 5. smelling salts
1. suction at bedside 2. oxygen gauge and tubing 4. padding for side rails
A nurse is providing discharge teaching to the parents of a child hospitalized with hydrocephalus, who had a ventriculoperitoneal (VP) shunt placed. The nurse should intervene if the parents make which statement? 1. "The shunt will need to stay in place for the rest of our child's life." 2. "We expect our child to continue engaging in normal activities, including sports." 3. "We will report any changes in behavior or signs of infection immediately." 4. "The shunt may need to be repositioned as our child grows."
2. "We expect our child to continue engaging in normal activities, including sports."
The nurse is discussing with a parent the difference between a breath-holding spell and a seizure. Which of the following would the nurse include as characteristic of a seizure? Select all that apply. 1. The client is bradycardic. 2. Convulsive activity occurs. 3. Cyanosis occurs at the onset of the seizure. 4. Crying is not typically noted. 5. The EEG is normal.
2. Convulsive activity occurs. 4. Crying is not typically noted.
A nurse is providing care for a 6-year-old child admitted to the hospital for meningitis. The child's past medical history shows recent mild-to-moderate hearing loss secondary to recurrent ear infections. Which intervention is most important for the nurse to implement? 1. Provide the family with information on community support groups. 2. Determine an effective method of communicating with the child. 3. Coordinate hearing rehabilitation and speech therapy services. 4. Educate the parents about antibiotics to treat infection
2. Determine an effective method of communicating with the child.
A nurse is providing preoperative care for a newborn with hydrocephalus. What intervention(s) will the nurse include in the newborn's plan of care? Select all that apply. 1. Avoid repositioning the head. 2. Measure abdominal circumference. 3. Administer furosemide therapy. 4. Administer antibiotic therapy. 5. Measure head circumference to the nearest centimeter.
2. Measure abdominal circumference.3. Administer furosemide therapy.4. Administer antibiotic therapy.
The nurse is performing a neurological assessment on a child. The previous examination noted the child to be alert but answering questions inappropriately. In this exam, the child only responds to vigorous stimuli. Which action should the nurse take first? 1. Have another nurse verify the results. 2. Notify the health care provider. 3. Document the findings on the hourly assessment tool. 4. Reassess in 1 hour.
2. Notify the health care provider. The level of consciousness is the earliest indicator of improvement or deterioration of the neurological status. Consciousness includes alertness, the ability to respond to stimuli, and cognition. If the child is alert but responding to questions inappropriately, then the child is said to be in a confused state. When the child only responds to vigorous stimuli, then the child is in a state of stupor. The change indicates a worsening state of consciousness. The health care provider should be notified of the change. The nurse can have a second nurse assess the child, but this does not get the child much needed help or intervention. The nurse would certainly document the findings, but only after calling the health care provider. The nurse should be alert to the changes and not wait to reassess.
The nurse is providing care for a 14-year-old child hospitalized after a motor vehicle accident that resulted in blunt head trauma. The nurse notes that the client appears to be sleeping and is lying with upper limbs flexed at the elbow and wrists while lower limbs are extended. Which action should the nurse take next? 1. Notify the health care provider. 2. Utilize the Glasgow Coma scale (GCS). 3. Allow the client to sleep undisturbed. 4. Reposition the client.
2. Utilize the Glasgow Coma scale (GCS).
A 15-year-old boy is in the clinic for a regular check-up. The child is receiving daily medication for seizure control. The nurse plots his height and weight on a growth chart and notices a significant growth spurt over the past year. Which of the following would be most important? 1. asking the client about his eating habits 2. asking the client about the effects of the medication he is currently taking 3. assessing the client's social relationships 4. assessing the client's knowledge of his daily medication
2. asking the client about the effects of the medication he is currently taking
A 4-month-old infant is admitted to the pediatric intensive care unit with increased intracranial pressure resulting from hydrocephalus. When assessing this child, the nurse would expect to document which finding(s)? Select all that apply. 1. sunken fontanel 2. dilated scalp veins 3. sunsetting eyes 4. 10th cranial nerve palsy 5. frontal bossing
2. dilated scalp veins 3. sunsetting eyes 5. frontal bossing
The nurse is administering carbamazepine in a 4-year-old client with epilepsy. For which adverse effect(s) will the nurse monitor? Select all that apply. 1. confusion 2. nausea 3. hyperactivity 4. gingival hyperplasia 5. drowsiness
2. nausea 5. drowsiness
After experiencing a head injury the child keeps falling asleep when no one is rousing him. When documenting this in the medical record which term is most appropriate? 1. unconscious 2. obtunded 3. stupor 4. lethargic
2. obtunded Obtunded is defined as a state in which the child has limited responses to the environment and falls asleep unless stimulation is provided. Stupor exists when the child only responds to vigorous stimulation. Lethargic refers to being without energy and relaxed.
The nurse is caring for a hospitalized infant at risk for developing increased intracranial pressure. Which assessment finding(s) would the nurse communicate to the health care provider for further intervention? Select all that apply. 1. blood pressure decreased from baseline 2. parent states, "My infant does not act right." 3. pulse rate of 60 beats/min and regular 4. vomiting 5. increased head circumference
2. parent states, "My infant does not act right." 3. pulse rate of 60 beats/min and regular 4. vomiting 5. increased head circumference
The nurse is caring for an infant with increased intracranial pressure. The mother is preparing to feed the child. What action by the mother indicates an understanding of the proper care of this infant? 1. placing the infant supine in the crib after feeding the infant 2. placing the infant in an infant car seat after feeding the infant 3. placing the infant prone in the crib after feeding the infant 4. placing the infant in a Sims position in the crib after feeding the infant
2. placing the infant in an infant car seat after feeding the infant Placing a child or infant in the semi-Fowler position can help reduce cerebral edema and pressure. Using an infant child seat helps to simulate the raised head of the bed. In the supine position, the client is completely flat on his or her spine. Prone is face down and flat. Sims is a side-lying position with one leg flexed. All of the described positions place the client flat, not with the head raised; that would be in the semi-Fowler position.
The nurse is preparing a care plan for a child who has a seizure disorder. The child experiences tonic-clonic seizures. Which nursing diagnosis will the nurse identify as having the highest priority? 1. Risk for ineffective tissue perfusion: cerebral 2. Risk for injury 3. Risk for delayed development 4. Risk for self-care deficit: bathing and dressing
2. risk for injury
The parents of a 17-year-old adolescent diagnosed with bacterial meningitis tell the nurse, "We just do not understand how this could have happened. Our adolescent has always been healthy and just received a booster vaccine last year." How should the nurse respond? 1. "Meningococcal conjugate vaccine covers only two types of bacterial meningitis." 2. "Your child may have been exposed to the type of meningitis that is not covered by the vaccine received." 3. "I understand your frustration. Unfortunately, immunizations are not 100% effective in preventing the infection." 4. "Maybe your child's immune system is not strong enough to fight off the infection, even with having received the vaccine."
3. "I understand your frustration. Unfortunately, immunizations are not 100% effective in preventing the infection."
The nurse is reviewing discharge planning instructions with the parents of a child who had a ventriculoperitoneal (VP) shunt placed. Which statement by the parents requires further follow-up by the nurse? 1. "Our child should be monitored for poor feeding." 2. "If our child has vomiting, something may be wrong with the shunt." 3. "Our child may have occasional lethargy." 4. "We will watch for changes in behavior at home."
3. "Our child may have occasional lethargy."
The nurse provides education to the parent of an infant being treated for hydrocephalus with a ventriculoperitoneal (VP) shunt. Which statement by the parent indicates the need for further instruction? 1. "I will watch my baby for irritability and difficulty feeding." 2. "The VP shunt will help drain fluid from my baby's brain." 3. "This shunt is the only surgery my baby will need." 4. "My baby's cerebrospinal fluid is increasing intracranial pressure."
3. "This shunt is the only surgery my baby will need." Hydrocephalus results from an imbalance in the production and absorption of CSF. In hydrocephalus, CSF accumulates within the ventricular system and causes the ventricles to enlarge, and increases in ICP subsequently occur. A VP shunt can be used to drain excess CSF, but it will need to be replaced as the child grows, requiring shunt revision surgery at various times during the client's life. The parent should be taught to monitor for signs and symptoms of increased ICP, which include irritability and vomiting. Increased ICP indicates the shunt is not functioning properly.
The nurse is caring for a child diagnosed with aseptic meningitis. When explaining the treatment plan to the parents, which information would the nurse likely include? 1. "Your child will need high doses of antibiotics to treat the infection." 2. "Until your child improves, we cannot give your child anything to eat." 3. "We will monitor your child closely and keep your child comfortable." 4. "We will need to move your child to the intensive care unit for care."
3. "We will monitor your child closely and keep your child comfortable." Aseptic meningitis is not as severe as bacterial meningitis and is usually self-limiting, requiring only supportive care. It is caused by a virus so antibiotics would not be needed. Antibiotics would be used to bacterial meningitis. Food would be withheld (NPO) if nausea and vomiting were prominent. Intensive care would be likely if the child had bacterial meningitis leading to sepsis.
he nurse is caring for a school-age child who has been having a continuous seizure for the last 40 minutes. What is the priority action by the nurse? 1. Observe and document the length of time of the seizure and type of movement observed. 2. Administer carbamazepine as prescribed. 3. Administer lorazepam IV as prescribed. 4. Perform a glucose finger stick to determine the child's blood sugar level.
3. Administer lorazepam IV as prescribed. A seizure lasting longer than 30 minutes is considered status epilepticus and is an emergency situation. An IV benzodiazepine such as lorazepam is administered to help stop the seizure. Checking blood glucose levels, monitoring length and type of seizure, and administration of anti-seizure medication such as carbamazepine all are correct interventions for clients with seizures, but these are not the priority action.
The eyes of a 9-year-old who suffered a head injury are crossed. In addition to checking intracranial pressure (ICP), which of the following would the nurse most likely do? 1. Help the child cope with an altered appearance. 2. Monitor core body temperature. 3. Assess the child's level of consciousness. 4. Pull up the side rails on the bed.
3. Assess the child's level of consciousness.
Which nursing action should be included in the care plan to promote comfort in a 4-year-old child hospitalized with meningitis? 1. Have the child's 2-year-old brother stay in the room. 2. Keep the lights on brightly so that he can see his mother. 3. Avoid making noise when in the child's room. 4. Rock the child frequently.
3. Avoid making noise when in the child's room.
The nurse is assessing a 9-year-old child who is suspected of having meningitis. The nurse assesses the child for meningeal irritation using the Kernig sign. Which result would the nurse interpret as positive? 1. Child reports pain when head is raised toward the chest. 2. Child flexes hips when placed in the supine position. 3. Child reports pain behind the knee when leg is extended. 4. Child immediately flexes the knees when chin touches chest.
3. Child reports pain behind the knee when leg is extended. When testing for the Kernig sign, the nurse would lay the child supine with the hips flexed and then try to straighten a leg out. The test is positive if pain behind the knee is experienced when the leg is extended. Younger children may cry out or resist leg extension. Another test for meningeal irritation is the Brudzinski sign. With this test, the nurse lays the child flat and then attempts to raise the child's head toward the chest and place the chin on the chest. Meningeal irritation is present if the child indicates pain or resistance or the child immediately flexes the hips and knees.
Antibiotic therapy to treat meningitis should be instituted immediately after which event? 1. Initiation of IV therapy 2. Admission to the nursing unit 3. Collection of cerebrospinal fluid (CSF) and blood for culture 4. Identification of the causative organism
3. Collection of cerebrospinal fluid (CSF) and blood for culture Antibiotic therapy should always begin immediately after the collection of CSF and blood cultures. After the specific organism is identified, bacteria-specific antibiotics can be administered if the initial choice of antibiotic therapy isn't appropriate. Admission and initiation of IV therapy aren't, by themselves, appropriate times to begin antibiotic therapy.
A preschool-age child has just been admitted to the pediatric unit with a diagnosis of bacterial meningitis. The nurse would include which recommendation in the nursing plan? 1. Encourage the parents to hold the child 2. Take vital signs every 4 hours 3. Decrease environmental stimulation 4. Monitor temperature every 4 hours
3. Decrease environmental stimulation A child with the diagnosis of meningitis is much more comfortable with decreased environmental stimuli. Noise and bright lights stimulate the child and can be irritating, causing the child to cry, in turn increasing intracranial pressure. Vital signs would be taken initially every hour and temperature monitored every 2 hours. Children with bacterial meningitis are usually much more comfortable if allowed to lie flat because this position doesn't cause increased meningeal irritation.
The nurse is performing a neurologic assessment on a 7-month-old infant. Which task should the nurse perform last? 1. Palpate the anterior fontanelle. 2. Move a toy through the field of vision. 3. Elicit the gag reflex. 4. Shine a penlight in each eye.
3. Elicit the gag reflex
The nurse is caring for a child with suspected increased intracranial pressure (ICP). Which assessment finding would indicate increased ICP? 1. hyperthermia 2. tachypnea 3. hypertension 4. poor handwriting
3. Hypertension Symptoms of increased intracranial pressure include slowing of both pulse and respirations, increasing blood pressure, and the development of hypothermia. All of these symptoms result from the increased ICP putting pressure on the cranial vessels and the hypothalamus. Double vision, or diplopia, also occurs as a result of increasing ICP.
The nurse is collecting data from a child who may have a seizure disorder. Which nursing observations suggest an absence seizure? 1. Brief, sudden contracture of a muscle or muscle group 2. Sudden, momentary loss of muscle tone, with a brief loss of consciousness 3. Minimal or no alteration in muscle tone, with a brief loss of responsiveness or attention 4. Muscle tone maintained and child frozen in position
3. Minimal or no alteration in muscle tone, with a brief loss of responsiveness or attention
A nurse is assessing a 3-year-old child for possible bacterial meningitis. Which sign would indicate irritation of the meninges? 1. Negative Brudzinski sign 2. Negative Kernig sign 3. Positive Kernig sign 4. Positive Chadwick sign
3. Positive Kernig sign
The nurse is planning care for a preschool-age child diagnosed with bacterial meningitis. What should the nurse identify as a priority goal for this client's care? 1. Inspect the teeth for obvious caries. 2. Increase stimulation opportunities to prevent coma. 3. Reduce the pain related to nuchal rigidity. 4. Provide an opportunity for therapeutic play
3. Reduce the pain related to nuchal rigidity.
The nurse is providing care to an infant with hydrocephalus who has had a ventriculoperitoneal shunt inserted. The nurse documents the infant's assessment. Which finding(s) would lead the nurse to notify the health care provider about the possibility that the child has developed a paralytic ileus? Select all that apply. 1. level of consciousness 2. temperature 3. abdomen 4. incisional sites 5. abdominal circumference 6. bowel sounds
3. abdomen 5. abdominal circumference 6. bowel sounds
The nurse is teaching a group of parents in the community about accident prevention. When describing accidental head trauma resulting in traumatic brain injury (TBI), the nurse would focus safety education on which age group(s)? Select all that apply. 1. preschoolers 2. school-age children 3. adolescents 4. infants 5. toddlers
3. adolescents 5. toddlers Although any age group can be affected, the Centers for Disease Control and Prevention (CDC) reports that the incidence of TBI is distinctly elevated in two age groups: adolescents and toddlers. Motor vehicle accidents remain the number one cause of TBI in adolescents, whereas falls contribute to most of the TBI cases in toddlers. Therefore, safety education on accident prevention would focus on these two age groups.
The nurse is assessing a child with a suspected traumatic brain injury. The child is disoriented to place and time, but not person, and is having difficulty following commands. The nurse would use which terminology to document the child's level of consciousness? 1. obtundation 2. clouding of consciousness 3. confusion 4. stupor
3. confusion
A child is brought to the emergency department and is experiencing status epilepticus. The nurse would expect to administer which treatment as first-line therapy? 1. midazolam 2. fosphenytoin 3. lorazepam 4. phenytoin
3. lorazepam In the acute care setting, first-line therapy is a benzodiazepine (lorazepam as first choice) given intravenously, followed by phenytoin or fosphenytoin, then phenobarbital, valproate, or levetiracetam. If the seizures persist, an infusion of midazolam, pentobarbital, or propofol may be started.
A 17-year-old is brought to the emergency department with a fever, headache, and stiff neck. Bacterial meningitis is suspected. The nurse would anticipate preparing the adolescent for which test to confirm the diagnosis? 1. complete blood count 2. computed tomography 3. lumbar puncture 4. magnetic resonance imaging
3. lumbar puncture Although a complete blood count may be done to evaluate for an elevated white blood cell count and clotting deficiencies, bacterial meningitis is diagnosed with a lumbar puncture to analyze the cerebrospinal fluid and identify the organism. Computed tomography or magnetic resonance imaging are not used to confirm the diagnosis.
The nurse is assessing a child following a head injury sustained in a bicycle accident. The child falls asleep frequently unless the parents are talking to the child or the nurse is asking the child questions. How should the nurse document the child's level of consciousness? 1. stupor 2. fully conscious 3. obtunded 4. decreased level of consciousness
3. obtunded
A 12-year-old child has been prescribed phenytoin. What information should be included in discussion about this medication? 1. Take medication on an empty stomach. 2. Increase intake of citrus foods to promote absorption. 3. Use a soft toothbrush. 4. Avoid excessive sunlight.
3. use a soft toothnrush Phenytoin is an anticonvulsant medication. It can be used in the management of seizure disorders. This medication is associated with gingival hyperplasia. This may result in tender and bleeding gums. The use of a soft toothbrush will reduce pain, bleeding and discomfort. There is no need to take this medication on an empty stomach or with citrus foods and beverages. The medication does not make an individual photosensitive.
The nurse is caring for a child who has suffered a febrile seizure. While speaking with the child's parents, which statement by a parent indicates a need for further education? 1. "When he gets his next set of immunizations, I need to make sure I give him some ibuprofen so he doesn't spike a fever." 2. "I need to set an alarm to wake up and check his temperature during the night when he is sick." 3. "The next time he has a fever, I need to make sure I read the dosage on the acetaminophen bottle carefully." 4. "I hate to think that I will need to be worried about my child having seizures for the rest of his life."
4. "I hate to think that I will need to be worried about my child having seizures for the rest of his life." Febrile seizures occur most often in preschool children but can occur as late as 7 years of age. They occur when the child has a rapid rise in temperature and are not associated with the development of seizures later in life. Administering correct dosages of acetaminophen and ibuprofen, checking temperatures at night, and anticipating fevers associated with the administration of live vaccines are all ways to prevent the development of febrile seizures.
The nurse is caring for an infant who is at risk for increased intracranial pressure. What statement by the parent would alert the nurse to further assess the child's neurological status? 1. "She is a pretty happy baby, unless her diaper is wet, then she cries until we change her diaper." 2. "She always cries when the person holding her has on glasses...I guess glasses scare her." 3. "She typically breastfeeds, but lately we have had to supplement with some oat cereal." 4. "She has been irritable for the last hour....seems like she is just upset for some reason."
4. "She has been irritable for the last hour....seems like she is just upset for some reason."
A child presents to the pediatrician's office for a routine visit. The parent tells the nurse that the child has been having frequent headaches recently. Which statement by the parent requires immediate follow-up by the nurse? 1. "My child has been anxious about starting a new school." 2. "We all have had colds over the past month." 3. "My child has been spending a lot of time on the computer." 4. "The headaches usually occur in the morning and sometimes there is vomiting."
4. "The headaches usually occur in the morning and sometimes there is vomiting."
The nurse is providing discharge teaching to the parents of a child recently diagnosed with a seizure disorder. The nurse determines learning has occurred with which statement(s) by the parents? Select all that apply. 1. "We will activate EMS immediately when a seizure begins." 2. "We will keep an oral airway on hand and insert it into our child's mouth to maintain an open airway even if the teeth are clenched." 3. "We will be sure to hold our child snugly during the seizure so no injuries occur." 4. "We will be sure to keep the area safe and turn our child on the side during seizure activity." 5. "We should time the seizure and write down what happens during the seizure."
4. "We will be sure to keep the area safe and turn our child on the side during seizure activity." 5. "We should time the seizure and write down what happens during the seizure."
The nurse is performing a neurologic assessment on a 5-month-old infant. Which task should the nurse perform first? 1. Whisper a word in the ears. 2. Run a cotton swab over the extremities. 3. Blow on the face. 4. Palpate the cranium.
4. Palpate the cranium. Palpating the cranium is the least invasive assessment activity and should be performed first. Blowing on the face, running a cotton swab over the extremities, and whispering a word in the infant's ears are all part of the neurologic assessment, but are more invasive and should be performed later in the assessment.
The nurse is caring for a 4-year-old child who is unconscious. Which action by the nurse is priority? 1. Cushion bony prominences. 2. Administer IV fluids. 3. Keep the side rails up and padded. 4. Position on the side with the chin extended.
4. Position on the side with the chin extended.
The nurse is caring for a preschooler who has developed a high fever and has just had a seizure. What is the best action by the nurse? 1. Apply ice packs to the child's axillary and groin area. 2. Administer acetaminophen by mouth as prescribed. 3. Place the child in a bathtub filled with cool water. 4. Remove any blankets or heavy clothing and replace with a thin sheet
4. Remove any blankets or heavy clothing and replace with a thin sheet The child should not have any blankets or clothing that would elevate the temperature further. Removing them is helpful in allowing the heat to dissipate. The child should not be placed in a bathtub because he or she may suffer another seizure and slip underwater. Using ice packs or alcohol can be a shock to an immature nervous system. Antipyretics should be administered as a suppository rather than PO to reduce the risk of aspiration while the child is in the postictal or drowsy state following the seizure.
A child is brought to the emergency department after experiencing a series of continuous seizures. The nurse is reviewing the orders for care and treatment. Which order would be of the highest priority? 1. urinalysis 2. white blood cell count 3. hemoglobin level 4. serum glucose level
4. Serum glucose level Status epilepticus is the occurrence of repetitive seizures in an individual. This is a neurological emergency. The events of the repetitive seizures greatly expend energy. This will result in rapid drops in serum glucose level, making this the priority laboratory value to review.
A nurse suspects that a child has developed pneumococcal meningitis based on assessment of which of the following? 1. chills 2. productive cough 3. otitis media 4. nuchal rigidity
4. nuchal rigidity
A nurse is caring for a 4-year-old child who presents to the emergency department with suspected meningitis. The nurse suspects the child has septic meningitis. Which assessment finding supports this suspicion? 1. report of a stiff neck 2. presence of photophobia 3. recent influenza infection 4. purple skin rash
4. purple skin rash A purple skin rash is associated with meningitis caused by Neisseria meningitidis and indicates a high bacterial load consistent with sepsis. A recent influenza infection would be associated with viral meningitis, which is considered aseptic. Reports of a stiff neck and photophobia are classic symptoms that would be present in both septic and aseptic meningitis.
