PrepU Chapter 16: Nursing Care of the Child with a Neurologic Disorder

Question: Put the following events of a generalized epileptic seizure in correct order: Postictal period Prodromal period Clonic stage Tonic stage

2 4 3 1 A tonic-clonic seizure is characterized by the following events: 1) prodromal period, 2) tonic stage, 3) clonic stage, and 4) postictal period.

The nurse is observing an infant who may have acute bacterial meningitis. Which finding might the nurse look for? a) Irritability, fever, and vomiting b) Jaundice, drowsiness, and refusal to eat c) Negative Kernig's sign d) Flat fontanel

A Findings associated with acute bacterial meningitis may include irritability, fever, and vomiting along with seizure activity. Fontanels would be bulging as intracranial pressure rises, and Kernig's sign would be present due to meningeal irritation. Jaundice, drowsiness, and refusal to eat indicate a GI disturbance rather than meningitis

The eyes of a 9-year-old who suffered a head injury are crossed. Besides checking ICP, which of the following interventions would be most important for the nurse to perform? a) Assess the child's level of consciousness. b) Help the child cope with an altered appearance. c) Monitor core body temperature. d) Pull up the side rails on the bed

A Decreased level of consciousness is frequently the first sign of major neurologic problems after head trauma. While body temperature is an important indicator of infection, it is not a priority here. Preventing harm by setting the side rails is more important for a seizure patient. The child's eyes will correct themselves when ICP is reduced.

Which of the following age groups of children have the highest actual rate of death from drowning? a) Toddlers b) School-age children c) Preschool children d) Infants

A Toddlers and older adolescents have the highest actual rate of death from drowning.

A 9-year-old girl who is suspected of having an infection of the central nervous system is undergoing a lumbar puncture to withdraw cerebrospinal fluid for analysis. The nurse knows that the needle will be introduced into the subarachnoid space at the level of which of the following vertebrae? a) L4 or L5 b) L1 or L2 c) T3 or T4 d) C1 or C2

A Lumbar puncture, the introduction of a needle into the subarachnoid space (under the arachnoid membrane) at the level of L4 or L5 to withdraw CSF for analysis, is used most frequently with children to diagnose hemorrhage or infection in the CNS or to diagnose an obstruction of CSF flow.

A child is home with the caregivers following a treatment for a head injury. If the child makes which of the following statements, the caregiver should contact the care provider. a) "You look funny. Well, both of you do. I see two of you." b) "I am glad that my headache is getting better." c) "It will be nice when you will let me take a long nap. I am sleepy." d) "My stomach is upset. I feel like I might throw up."

A The caregiver should notify the health-care provider immediately if the child vomits more than three times, has pupillary changes, has double or blurred vision, has a change in level of consciousness, acts strange or confused, has trouble walking, or has a headache that becomes more severe or wakes him or her from sleep. These instructions should be provided in written form to the caregiver. Just feeling naueauted is not a reason to notify the provider.

A child has been diagnosed with a basilar skull fracture. The nurse identifies ecchymosis behind the patient's ear. This would be documented as which of the following? a) Battle sign b) Rhinorrhea c) Otorrhea d) Raccoon eyes

A Two signs of basilar skull fracture include Battle sign (bruising or ecchymosis behind the ear) and "raccoon eyes" (blood leaking into the frontal sinuses causing an edematous and bruised periorbital area). Rhinorrhea is CSF leakage from the nose. Otorrhea is CSF leaking from the ear.

Dexamethasone is often prescribed for the child who has sustained a severe head injury. Dexamethasone is a(n) a) antihistamine. b) steroid. c) anticonvulsant. d) diuretic.

B A steroid may be prescribed to reduce inflammation and pressure on vital centers.

The best way to evaluate a child's level of consciousness is through conversation. a) False b) True

B The best way to evaluate a child's level of consciousness is through conversation. Note any drowsiness or lethargy. Allow the child to answer questions without prompting, and listen carefully to be certain the answer is appropriate to the question.

During the physical assessment of a 2½-month-old infant, the nurse suspects the child may have hydrocephalus. Which of the following signs or symptoms was observed? a) Pupil of one eye dilated and reactive b) Vertical nystagmus c) Dramatic increase in head circumference d) Posterior fontanel is closed

C A dramatic increase in head circumference is a symptom of hydrocephalus, suggesting that there is a build-up of fluid in the brain. Only one pupil that is dilated and reactive is a sign of an intracranial mass. Vertical nystagmus indicates brain stem dysfunction. A closed posterior fontanel would be frequently seen by this age.

During the physical assessment of a 2½-month-old infant, the nurse suspects the child may have hydrocephalus. Which of the following signs or symptoms was observed? a) Posterior fontanel is closed b) Vertical nystagmus c) Dramatic increase in head circumference d) Pupil of one eye dilated and reactive

C A dramatic increase in head circumference is a symptom of hydrocephalus, suggesting that there is a build-up of fluid in the brain. Only one pupil that is dilated and reactive is a sign of an intracranial mass. Vertical nystagmus indicates brain stem dysfunction. A closed posterior fontanel would be frequently seen by this age

An 8-year-old girl is diagnosed as having tonic-clonic seizures. You would want to teach her parents that a) their daughter should be kept quiet late in the day when she is most likely to have a seizure. b) if their daughter shows symptoms of beginning a seizure, immediately give her medication. c) their daughter should maintain an active lifestyle. d) their daughter should carry a padded tongue blade with her at all times.

C It is important for children with seizures to maintain as near normal a lifestyle as possible to maintain self-esteem and achievement. Most seizure medications must create a therapeutic level before they are effective.

The nurse is preparing a toddler for a lumbar puncture. For this procedure, the nurse should place the child in which position? a) Sitting up, with the back straight b) Lying prone, with the feet higher than the head c) Lying on one side, with the back curved d) Lying prone, with the neck flexed

C Lumbar puncture involves placing a needle between the lumbar vertebrae into the subarachnoid space. For this procedure, the nurse should position the client on one side with the back curved because curving the back maximizes the space between the lumbar vertebrae, facilitating needle insertion. Prone and seated positions don't achieve maximum separation of the vertebrae.

Which nursing action should be included in the care plan to promote comfort in a 4-year-old child hospitalized with meningitis? a) Have the child's 2-year-old brother stay in the room b) Keep the lights on brightly so that he can see his mother c) Avoid making noise when in the child's room d) Rock the child frequently

C Meningeal irritation may cause seizures and heightens a child's sensitivity to all stimuli, including noise, lights, movement, and touch. Frequent rocking, presence of a younger sibling, and bright lights would increase stimulation.

The nurse is collecting data from a child who may have a seizure disorder. Which of the following is a description of an absence seizure? a) Sudden, momentary loss of muscle tone, with a brief loss of consciousness b) Brief, sudden contracture of a muscle or muscle group c) Muscle tone maintained and child frozen in position d) Minimal or no alteration in muscle tone, with a brief loss of consciousness

D A child with an elevated temperature is at high risk for having seizures and therefore actions by the nurse include keeping the child in a safe situation to prevent any injury if the child should have a seizure.

Which of the following is most correct regarding the nervous system of the child? a) The child has underdeveloped fine motor skills and well-developed gross motor skills. b) The child's nervous system is fully developed at birth. c) The child has underdeveloped gross motor skills and well-developed fine motor skills. d) As the child grows, the gross and fine motor skills increase.

D As the child grows, the quality of the nerve impulses sent through the nervous system develops and matures. As these nerve impulses become more mature, the child's gross and fine motor skills increase in complexity. The child becomes more coordinated and able to develop motor skills

The treatment for children with seizures disorders is most often which of the following? a) Strict exercise regimen b) Restricted fat diet c) Surgical intervention d) Use of anticonvulsant medications

D Complete control of seizures can be achieved for most people through the use of anticonvulsant drug therapy. A few children may be candidates for surgical intervention but, in most cases, surgery is not the treatment. Ketogenic diets (high in fat and low in carbohydrates and protein) cause the child to have high levels of ketones, which help to reduce seizure activity. Exercise is not a treatment for seizure disorders.

The nurse has developed a nursing plan for the care of a 6-year-old girl with congenital hydrocephalus whose shunt has become infected. The most important discharge teaching point for this family is: a) maintaining effective cerebral perfusion. b) encouraging development of motor skills. c) establishing seizure precautions for the child. d) ensuring the parents know how to properly give antibiotics.

D ensuring the parents know how to properly give antibiotics. Explanation: Educating parents how to properly give the antibiotics would be the priority intervention because the child's shunt has become infected. Maintaining cerebral perfusion is important for a child with hydrocephalus, but the priority intervention for the parents at this time is in regards to the infection. Establishing seizure precautions is an intervention for a child with a seizure disorder. Encouraging development of motor skills would be appropriate for a microcephalic child.

A pregnant client asks if there is any danger to the development of her fetus in the first few weeks of her pregnancy. How should the nurse respond? a) "During the first 3 to 4 weeks of pregnancy brain and spinal cord development occur and are affected by nutrition, drugs, infection, or trauma." b) "As long as you were taking good care of your health before becoming pregnant, your fetus should be fine during the first few weeks of pregnancy." c) "The respiratory system matures during this time so good prenatal care during the first weeks of pregnancy is very important." d) "Bones begin to harden in the first 5 to 6 weeks of pregnancy so vitamin D consumption is particularly important."

A Brain and spinal cord development occur during the first 3 to 4 weeks of gestation. Infection, trauma, teratogens (any environmental substance that can cause physical defects in the developing embryo and fetus), and malnutrition during this period can result in malformations in brain and spinal cord development and may affect normal central nervous system (CNS) development. Good health before becoming pregnant is important but must continue into the pregnancy. Hardening of bones occurs during 13 to 16 weeks gestation, and the respiratory system begins maturing around 23 weeks' gestation.

In caring for a child with a seizure disorder, the highest priority goal is which of the following? a) The child will be free from injury during a seizure. b) The child will have an understanding of the disorder. c) The family will understand seizure precautions. d) The family caregivers anxiety will be reduced.

A Keeping the child free from injury is the highest priority goal. The other choices are important, but keeping the child safe is higher than the anxiety or knowledge deficit concerns. The physical always is a priority over the psychological.

A mother has brought her 5-month-old son to the clinic because he has been drowsy and unresponsive. The child has hydrocephalus and had a shunt placed about a month previously. Which of the following symptoms indicate that the shunt is infected? a) The child is not responding or eating well. b) The fontanels are bulging or tense. c) The child's pupil reaction time is rapid and uneven. d) The child has a high-pitched cry.

A Poor feeding and decreased responsiveness are signs of an infection. The nurse might also observe localized inflammation along the shunt tract. Bulging or tense fontanels suggest a shunt malfunction that is causing increased intracranial pressure. A high-pitched cry suggests increased intracranial pressure due to a shunt malfunction. Decreased and uneven pupil reaction times are symptoms of a shunt malfunction that is causing increased intracranial pressure.

A 6-month-old infant is admitted with a diagnosis of bacterial meningitis. The nurse would place the infant in which room? a) A private room near the nurses' station b) A two-bed room in the middle of the hall c) A room with a 12-month-old infant with a urinary tract infection d) A room with an 8-month-old infant with failure to thrive

A A child who has the diagnosis of bacterial meningitis will need to be placed in a private room until that child has received I.V. antibiotics for 24 hours because the child is considered contagious. Additionally, bacterial meningitis can be quite serious; therefore, the child should be placed near the nurses' station for close monitoring and easier access in case of a crisis.

The nurse knows that the heads of infants and toddlers are large in proportion to their bodies, placing them at risk for which of the following? a) Head trauma b) Positional plagiocephaly c) Congenital hydrocephalus d) Intracranial hemorrhaging

A A larger head size in relation to the rest of their body size gives young children a higher center of gravity, which causes them to hit their head more readily, thus placing them at risk for head trauma. Fragile capillaries in the periventricular area of the brain put preterm infants at risk for intracranial hemorrhage. Congenital hydrocephalus may be caused by abnormal intrauterine development or infection. Positional plagiocephaly is caused by an infant's head remaining in the same position for too long.

The nurse caring for a patient with a cranial injury knows that broad-spectrum antibiotics are used to reduce cerebral edema. a) False b) True

A Antibiotics or antivirals are used to treat infectious disease processes. Glucocorticoids and diuretics are used to reduce cerebral edema.

An otherwise healthy 18-month-old child with a history of febrile seizures is in the wellchild clinic. Which statement by the father would indicate to the nurse that additional teaching should be done? a) "I always keep phenobarbital with me in case of a fever." b) "The most likely time for a seizure is when the fever is rising." c) "I have ibuprofen available in case it's needed." d) "My child will likely outgrow these seizures by age 5."

A Anticonvulsants, such as phenobarbital, are administered to children with prolonged seizures or neurologic abnormalities. Ibuprofen, not phenobarbital, is given for fever. Febrile seizures usually occur after age 6 months and are unusual after age 5. Treatment is to decrease the temperature because seizures occur as the temperature rises.

Which of the following is most correct regarding the nervous system of the child? a) As the child grows, the gross and fine motor skills increase. b) The child has underdeveloped gross motor skills and well-developed fine motor skills. c) The child's nervous system is fully developed at birth. d) The child has underdeveloped fine motor skills and well-developed gross motor skills.

A As the child grows, the quality of the nerve impulses sent through the nervous system develops and matures. As these nerve impulses become more mature, the child's gross and fine motor skills increase in complexity. The child becomes more coordinated and able to develop motor skills.

A child is diagnosed with aseptic meningitis. The child's mother states, "I don't know where she would have picked this up." The nurse prepares to respond to the mother, based on the understanding that this disorder is most likely caused by which of the following? a) Enterovirus b) Escherichia coli c) Streptococcus group B d) Haemophilus influenza type B

A Aseptic meningitis is the most common type of meningitis, and if a causative organism can be identified, it is usually a virus such as enterovirus. E. coli is a cause of bacterial meningitis. H. influenza type B is a cause of bacterial meningitis. Streptococcus group B is a cause of bacterial meningitis.

In caring for a child with a seizure disorder, the highest priority goal is which of the following? a) The child will be free from injury during a seizure. b) The family caregivers anxiety will be reduced. c) The family will understand seizure precautions. d) The child will have an understanding of the disorder.

A Keeping the child free from injury is the highest priority goal. The other choices are important, but keeping the child safe is higher than the anxiety or knowledge deficit concerns. The physical always is a priority over the psychological.

Any individual taking phenobarbital for a seizure disorder should be taught a) never to discontinue the drug abruptly. b) never to go swimming. c) to avoid foods containing caffeine. d) to brush his or her teeth four times a day.

A Phenobarbital should always be tapered, not stopped abruptly, or seizures from the child's dependency on the drug can result.

A child is home with the caregivers following a treatment for a head injury. If the child makes which of the following statements, the caregiver should contact the care provider. a) "You look funny. Well, both of you do. I see two of you." b) "It will be nice when you will let me take a long nap. I am sleepy." c) "My stomach is upset. I feel like I might throw up." d) "I am glad that my headache is getting better."

A The caregiver should notify the health-care provider immediately if the child vomits more than three times, has pupillary changes, has double or blurred vision, has a change in level of consciousness, acts strange or confused, has trouble walking, or has a headache that becomes more severe or wakes him or her from sleep. These instructions should be provided in written form to the caregiver. Just feeling naueauted is not a reason to notify the provider.

In understanding the nervous system, the nurse recognizes that the central nervous system is made up of which of the following? a) The brain and spinal cord b) Fluid that flows through the brain c) Nerves throughout the upper body d) A protective cushion for nerve cells

A The central nervous system is made up of the brain and spinal cord. The peripheral nervous system is made up of the nerves throughout the body. A fluid known as cerebrospinal fluid (CSF) flows through the chambers of the brain and through the spinal cord, serving as a cushion and protective mechanism for nerve cells.

To detect complications as early as possible in a child with meningitis who's receiving I.V. fluids, monitoring for which condition should be the nurse's priority? a) Cerebral edema b) Cardiogenic shock c) Renal failure d) Left-sided heart failure

A 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 I.V. therapy. The child with a healthy heart wouldn't be expected to develop left-sided heart failure.

The nurse is reinforcing teaching with the caregivers of a child who has had a head injury and is being discharged. Which of the following statements made by the caregiver indicate an accurate understanding of the follow-up care for their child? a) "Even if the flashlight bothers him, we will check his eyes." b) "If he vomits again, we will bring him back immediately." c) "We can give him Tylenol for a headache, but no aspirin." d) "If he falls asleep, we will wake him up every 15 minutes."A

A The child's pupils are checked for reaction to light every four hours for 48 hours. If the child falls asleep, he or she should be awakened every one to two hours to determine that the level of consciousness has not changed. No analgesics or sedatives should be administered during this period of observation. The caregiver should observe the child for at least six hours for vomiting or a change in the child's level of consciousness. The caregiver should notify the health-care provider immediately if the child vomits more than three times, but if the child vomits once, returning to the care provider immediately is not needed.

A group of nursing students are reviewing cerebral vascular disorders and risk factors in children. The students demonstrate understanding of the material when they identify which of the following as a risk factor for hemorrhagic stroke? a) Arteriovenous malformations (AVMs) b) Sickle cell disease c) Meningitis d) Congenital heart defect

A Vascular malformations such as intracranial AVMs are a risk factor for hemorrhagic stroke. Sickle cell disease is a risk factor for ischemic stroke. Congenital heart defects are risk factors for ischemic stroke. Meningitis or other infection is a risk factor for ischemic stroke.

When caring for a child who has a history of seizures, which of the following nursing interventions would be appropriate? (Select all that apply) a) The nurse has oxygen available to use during a seizure. b) The nurse positions the child on the side during a seizure. c) The nurse places a washcloth in the mouth to prevent injury during seizure. d) The nurse goes for help as soon as a seizure begins. e) The nurse pads the crib or side rails before a seizure. f) The nurse teaches the caregivers regarding seizure precautions.

A B E F Pad the crib sides and keep sharp or hard items out of the crib. Position the child to one side to prevent aspiration of saliva or vomitus. Have oxygen and suction equipment readily available for emergency use. Teach family caregivers seizure precautions so they can handle a seizure that occurs at home. Do not put anything in the child's mouth; doing so could cause injury to the child or to you. Stay with the patient

Choice Multiple question - Select all answer choices that apply. A nurse is providing information to the parents of a child diagnosed with absence seizures. Which of the following would the nurse expect to include when describing this type of seizure? Select all that apply. a) This type of seizure is usually short, lasting usually for no more than 30 seconds. b) The child will commonly report a strange odor or sensation before the seizure. c) You might see a blank facial expression after a sudden stoppage of speech. d) Your child will probably sleep deeply for ½ to 2 hours after the seizure. e) You might have mistaken this type of seizure for lack of attention. f) This type of seizure is more common in girls than it is in boys.

A C E F Absence seizures are more common in girls than boys and are characterized by a sudden cessation of motor activity or speech with a blank facial expression or rhythmic twitching of the mouth or blinking of the eyelids. This type of seizure lasts less than 30 seconds and may have been mistaken for inattentiveness because of the subtle changes. Absence seizures are not associated with a postictal state.

The nurse and an adolescent are reviewing the adolescent's record of her headaches and activities surrounding them. Which of the following would the nurse identify as a possible trigger? a) Drinking three cans of diet cola b) Swimming twice a week c) 11 p.m. bedtime; 6:30 a.m. wake-up d) Use of nonscented soap

A Cola contains caffeine, which is an associated trigger. Intense activity, not regular exercise, may be a trigger. Odors, such as strong perfumes, may be a trigger. Changes in sleeping patterns may be a trigger.

Choice Multiple question - Select all answer choices that apply. The nurse determines that a child is experiencing late signs of increased intracranial pressure based on assessment of which of the following? Select all that apply. a) Fixed dilated pupils b) Increased blood pressure c) Irregular respirations d) Sunset eyes e) Bradycardia

A E C Late signs of increased intracranial pressure include bradycardia, fixed and dilated pupils, and irregular respirations. Increased blood pressure and sunset eyes are early signs of increased intracranial pressure.

The nurse is caring for a 6-year-old child who has a history of febrile seizures and is admitted with a temperature of 102.2° F(39° C). The highest priority nursing intervention for this child would be which of the following? a) The nurse will encourage the child to do his or her own self-care. b) The nurse will institute safety precautions. c) The nurse will offer age appropriate activities. d) The nurse will provide family teaching related to the child's history.

B A child with an elevated temperature is at high risk for having seizures and therefore actions by the nurse include keeping the child in a safe situation to prevent any injury if the child should have a seizure.

The nurse is collecting data from the caregivers of a child admitted with seizures. Which of the following statements indicates the child most likely had an absence seizure? a) "His arms had jerking movements in his legs and face." b) "He was just staring into space and was totally unaware." c) "He kept smacking his lips and rubbing his hands." d) "He usually is very coordinated, but he couldn't even walk without falling."

B Absence seizures rarely last longer than 20 seconds. The child loses awareness and stares straight ahead but does not fall. Absence seizures rarely last longer than 20 seconds. The child loses awareness and stares straight ahead but does not fall. Myoclonic seizures are characterized by a sudden jerking of a muscle or group of muscles, often in the arms or legs, without loss of consciousness. Complex partial seizures cause nonpurposeful movements, such as hand rubbing and lip smacking. During the prodromal period of the tonic-clonic seizure, the child might have a lack of coordination.

Absence seizures are marked by which of the following clinical manifestations? a) Sudden, brief jerks of a muscle group b) Loss of motor activity accompanied by a blank stare c) Loss of muscle tone and loss of consciousness d) Brief, sudden onset of increased tone of the extensor muscle

B An absence seizure consists of a sudden, brief arrest of the child's motor activity accompanied by a blank stare and loss of awareness. A tonic seizure consists of a brief onset of increased tone or muscle. A myoclonic seizure is characterized by sudden, brief jerks of muscle groups. An atonic seizure involves a sudden loss of muscle tone and loss of consciousness.

Which statement about cerebral palsy would be accurate? a) "Cerebral palsy occurs because of too much oxygen to the brain." b) "Cerebral palsy is a condition that doesn't get worse." c) "Cerebral palsy means there will be many disabilities." d) "Cerebral palsy is a condition that runs in families."

B By definition, cerebral palsy is a nonprogressive neuromuscular disorder. It can be mild or quite severe and is believed to be the result of a hypoxic event during pregnancy or the birth process and doesn't run in families

Which of the following is consistent with increased ICP in the child? a) Increased appetite b) Bulging fontanel c) Emotional lability d) Narcolepsy

B Children with increased ICP exhibit bulging fontanels. They typically have a decreased appetite, are restless, and have trouble sleeping.

The treatment for children with seizures disorders is most often which of the following? a) Restricted fat diet b) Use of anticonvulsant medications c) Strict exercise regimen d) Surgical intervention

B Complete control of seizures can be achieved for most people through the use of anticonvulsant drug therapy. A few children may be candidates for surgical intervention but, in most cases, surgery is not the treatment. Ketogenic diets (high in fat and low in carbohydrates and protein) cause the child to have high levels of ketones, which help to reduce seizure activity. Exercise is not a treatment for seizure disorders.

A child is diagnosed with bacterial meningitis. The nurse would suspect which abnormality of cerebrospinal fluid (CSF)? a) Decreased pressure b) Cloudy appearance c) Elevated sugar d) Decreased leukocytes

B In the CSF of clients diagnosed with bacterial meningitis, the pressure is elevated, the appearance is cloudy, and the leukocytes are elevated. A decreased sugar content is noted.

The nurse is preparing a toddler for a lumbar puncture. For this procedure, the nurse should place the child in which position? a) Lying prone, with the feet higher than the head b) Lying on one side, with the back curved c) Lying prone, with the neck flexed d) Sitting up, with the back straight

B Lumbar puncture involves placing a needle between the lumbar vertebrae into the subarachnoid space. For this procedure, the nurse should position the client on one side with the back curved because curving the back maximizes the space between the lumbar vertebrae, facilitating needle insertion. Prone and seated positions don't achieve maximum separation of the vertebrae.

Which nursing action should be included in the care plan to promote comfort in a 4-year-old child hospitalized with meningitis? a) Rock the child frequently b) Avoid making noise when in the child's room c) Have the child's 2-year-old brother stay in the room d) Keep the lights on brightly so that he can see his mother

B Meningeal irritation may cause seizures and heightens a child's sensitivity to all stimuli, including noise, lights, movement, and touch. Frequent rocking, presence of a younger sibling, and bright lights would increase stimulation.

The mother of a 12-year-old with Reye syndrome approaches the nurse wanting to know how this happened to her child, saying, "I never give my kids aspirin!" What could the nurse say to begin educating the woman? a) "Don't worry; you're in good hands. We have it under control now." b) "Sometimes it's hard to tell what products may contain aspirin." c) "Do you think that maybe your child took aspirin on his own?" d) "Aspirin in combination with the virus will make the brain swell and the liver fail."

B Salicylates are in a wide variety of products, so consumers must read the small print very carefully or they will miss the warning. The parent needs to be receptive to further education, and raising the possibility the child was responsible does not accomplish that goal. Don't state the obvious, but also don't minimize the situation. Encouraging the mother to ask for information and offering explanations in terms she will understand are important, but this response does not address the mother's assertion.

Any individual taking phenobarbital for a seizure disorder should be taught a) to brush his or her teeth four times a day. b) never to discontinue the drug abruptly. c) never to go swimming. d) to avoid foods containing caffeine.

B Phenobarbital should always be tapered, not stopped abruptly, or seizures from the child's dependency on the drug can result.

The nurse and an adolescent are reviewing the adolescent's record of her headaches and activities surrounding them. Which of the following would the nurse identify as a possible trigger? a) Use of nonscented soap b) Drinking three cans of diet cola c) Swimming twice a week d) 11 p.m. bedtime; 6:30 a.m. wake-up

B Cola contains caffeine, which is an associated trigger. Intense activity, not regular exercise, may be a trigger. Odors, such as strong perfumes, may be a trigger. Changes in sleeping patterns may be a trigger.

The nurse is caring for a 6-year-old child who has a history of febrile seizures and is admitted with a temperature of 102.2° F(39° C). The highest priority nursing intervention for this child would be which of the following? a) The nurse will encourage the child to do his or her own self-care. b) The nurse will institute safety precautions. c) The nurse will offer age appropriate activities. d) The nurse will provide family teaching related to the child's history

B A child with an elevated temperature is at high risk for having seizures and therefore actions by the nurse include keeping the child in a safe situation to prevent any injury if the child should have a seizure.

A school-aged girl with seizures is prescribed phenytoin sodium, 75 mg four times a day. An instruction you would want to give her parents regarding this is a) watching television while taking the drug may cause seizures. b) their child will have to practice good tooth brushing. c) even small doses may cause noticeable dizziness. d) numbness of the fingers is common while taking this drug.

B A side effect of phenytoin sodium is hypertrophy of the gumline. Good tooth brushing helps prevent inflammation under the hypertrophied tissue.

Absence seizures are marked by which of the following clinical manifestations? a) Brief, sudden onset of increased tone of the extensor muscle b) Loss of motor activity accompanied by a blank stare c) Sudden, brief jerks of a muscle group d) Loss of muscle tone and loss of consciousness

B An absence seizure consists of a sudden, brief arrest of the child's motor activity accompanied by a blank stare and loss of awareness. A tonic seizure consists of a brief onset of increased tone or muscle. A myoclonic seizure is characterized by sudden, brief jerks of muscle groups. An atonic seizure involves a sudden loss of muscle tone and loss of consciousness.

The mother of a newborn with a caput succedaneum asks the nurse how this happened to her baby. Which response by the nurse would be most appropriate? a) "The forceps used during delivery caused this to happen." b) "During delivery, your vaginal wall put pressure on the baby's head." c) "It's normal for this to happen, but they don't really know why." d) "Your baby's head became blocked inside your vagina while you were pushing."

B Caput succedaneum results from pressure from the uterus or vaginal wall during a head-first delivery The use of forceps is associated with a cephalohematoma. Caput succedaneum is not due to the baby's head becoming blocked inside the vagina. The cause of caput succedaneum is known; it is caused by pressure from the uterus or vaginal wall during a head-first delivery.

The eyes of a 9-year-old who suffered a head injury are crossed. Besides checking ICP, which of the following interventions would be most important for the nurse to perform? a) Help the child cope with an altered appearance. b) Assess the child's level of consciousness. c) Monitor core body temperature. d) Pull up the side rails on the bed.

B Decreased level of consciousness is frequently the first sign of major neurologic problems after head trauma. While body temperature is an important indicator of infection, it is not a priority here. Preventing harm by setting the side rails is more important for a seizure patient. The child's eyes will correct themselves when ICP is reduced.

The nurse is discussing with a parent the difference between a breath-holding spell and a seizure. The nurse would be correct in telling the parent which of the following with regards to seizures? a) The patient is bradycardiac. b) Convulsive activity occurs. c) Cyanosis occurs at the onset of the seizure. d) The EEG is normal.

B During seizures convulsive activity is typically noted. During a breath-holding spell, the child is bradycardiac, cyanosis occurs at the onset, and the EEG is normal.

The nurse is educating the family of a 7-year-old epilepsy patient about care and safety for this child. Which of the following comments will be most valuable in helping the parent and the child cope? a) "If he is out of bed, the helmet's on the head." b) "Use this information to teach family and friends." c) "You'll always need a monitor in his room." d) "Bike riding and swimming are just too dangerous."

B Families need and want information they can share with relatives, childcare providers, and teachers. Wearing a helmet and having a monitor in the room are precautions that may need to be modified as the child matures. The boy may be able to bike ride and swim with proper precautions.

A child is diagnosed with bacterial meningitis. The nurse would suspect which abnormality of cerebrospinal fluid (CSF)? a) Elevated sugar b) Cloudy appearance c) Decreased leukocytes d) Decreased pressure

B In the CSF of clients diagnosed with bacterial meningitis, the pressure is elevated, the appearance is cloudy, and the leukocytes are elevated. A decreased sugar content is noted

A 1-year-old has just undergone surgery to correct craniosynostosis. Which of the following comments is the best psychosocial intervention for the parents? a) "I told you yesterday there would be facial swelling." b) "The surgery was successful. Do you have any questions?" c) "I'll be watching hemoglobin and hematocrit closely." d) "This only happens in 1 out of 2,000 births."

B Often what parents need most is someone to listen to their concerns. Although this is a good time for education, let the parents adjust to their baby's appearance and adapt your teaching to their questions, comments, and knowledge level.

The nurse is educating parents of a male infant with Chiari type II malformation. Which of the following statements about their child's condition is most accurate? a) "Lay him down after feeding." b) "Take your time feeding your baby." c) "You won't need to change diapers often." d) "You'll see a big difference after the surgery."

B One of the problems associated with Chiari type II malformation is poor gag and swallowing reflexes, so the infant must be fed slowly. There is a great risk of aspiration, requiring that the child be placed in an upright position after feeding. The goal of surgery is to prevent further symptoms, rather than to relieve existing ones. Infrequent urination is a problem associated with type I malformations.

The nurse is caring for an 8-year-old girl who was in a car accident. Which symptom suggests the child has a cerebral contusion? a) Bleeding from the ear b) Trouble focusing when reading c) Vomiting d) Difficulty concentrating

B Signs and symptoms for cerebral contusions include disturbances to vision, strength, and sensation. A child suffering a concussion will be distracted and unable to concentrate. Vomiting is a sign of a subdural hematoma. Bleeding from the ear is a sign of a basilar skull fracture.

The nurse is interviewing the caregivers of a child brought to the emergency unit. The caregiver states, "She has a history of seizures but this time it lasted more than 30 minutes and she just keeps having them." The most accurate description of this child's condition would be which of the following? a) The child's history indicates she has infantile seizures. b) The child is in status epilepticus. c) The child is having generalized seizures. d) The child may begin to have absence seizures every day.

B Status epilepticus is the term used to describe a seizure that lasts longer than 30 minutes or a series of seizures in which the child does not return to his or her previous normal level of consciousness. The child likely is having generalized seizures, but the most accurate description of what is happening is status epilepticus. With infantile spasms, muscle contractions are sudden, brief, symmetrical, and accompanied by rolling eyes. With absence seizures the child loses awareness and stares straight ahead but does not fall.

When assisting a child while she is having a tonic-clonic seizure, it would be important to a) turn the child onto her back and observe her. b) protect the child from hitting her arms against furniture. c) place a tongue blade between the child's teeth. d) restrain the child from all movement.

B protect the child from hitting her arms against furniture.

A nurse is assessing a 3-year-old child for possible bacterial meningitis. Which sign would indicate irritation of the meninges? a) Negative Kernig's sign b) Positive Kernig's sign c) Positive Homans' sign d) Negative Brudzinski's sign

B A positive Kernig's sign can indicate irritation of the meninges. A positive Brudzinski's sign also is indicative of the condition. A positive Homans' sign may indicate venous inflammation of the lower leg.

When assessing a neonate for seizures, which of the following would the nurse expect to find? Select all that apply. a) Tonic-clonic contractions b) Elevated blood pressure c) Ocular deviation d) Jitteriness e) Tachycardia

B C D E Neonatal seizures may be difficult to recognize but may be manifested by tremors, jitteriness, tachycardia and elevated blood pressure, and ocular deviation. Tonic-clonic contractions typically are more common in older children.

The mother of a 12-year-old with Reye syndrome approaches the nurse wanting to know how this happened to her child, saying, "I never give my kids aspirin!" What could the nurse say to begin educating the woman? a) "Aspirin in combination with the virus will make the brain swell and the liver fail." b) "Sometimes it's hard to tell what products may contain aspirin." c) "Do you think that maybe your child took aspirin on his own?" d) "Don't worry; you're in good hands. We have it under control now."

B Salicylates are in a wide variety of products, so consumers must read the small print very carefully or they will miss the warning. The parent needs to be receptive to further education, and raising the possibility the child was responsible does not accomplish that goal. Don't state the obvious, but also don't minimize the situation. Encouraging the mother to ask for information and offering explanations in terms she will understand are important, but this response does not address the mother's assertion.

The nurse is caring for a child who had a seizure, fell to the ground, and hit and injured his face, head, and shoulders. This information indicates the child likely had which of the following types of seizures? a) Absence b) Myoclonic c) Atonic d) Infantile

C Atonic or akinetic seizures cause a sudden momentary loss of consciousness, muscle tone, and postural control and can cause the child to fall. They can result in serious facial, head, or shoulder injuries. In absence seizures the child loses awareness and stares straight ahead but does not fall. Myoclonic seizures are characterized by a sudden jerking of a muscle or group of muscles, often in the arms or legs, without loss of consciousness. With infantile spasms, muscle contractions are sudden, brief, symmetrical, and accompanied by rolling eyes.

A 6-month-old infant is admitted with suspected bacterial meningitis. She is crying, irritable, and lying in the opisthotonic position. Which of the following interventions should the nurse take initially? a) Encourage the mother to hold and comfort the infant. b) Educate the family about preventing bacterial meningitis. c) Institute droplet precautions in addition to standard precautions. d) Palpate the child's fontanels.

C Bacterial meningitis is a medical emergency. The child must be placed on droplet precautions until 24 hours of antibiotics have been given. Encouraging the mother to hold and comfort the child is an intervention but not the priority one: the focus is to get the infant the appropriate medications to fight the infection and to prevent its spread. Educating the family about preventing bacterial meningitis would be appropriate later on once the initial infection has been controlled. Palpating the fontanels is used to assess for hydrocephalus.

In caring for the child with meningitis, the nurse recognizes that which of the following nursing diagnoses would be the most important to include in this child's plan of care? a) Delayed growth and development related to physical restrictions b) Risk for acute pain related to surgical procedure c) Risk for injury related to seizure activity d) Ineffective airway clearance related to history of seizures

C Keeping the child free of injury would be an appropriate nursing diagnosis. Surgery is not indicated for the child with meningitis, and the history of seizures does not impact the airway clearance. Growth and development issues are a concern but not likely delayed due to this diagnosis.

A 1-year-old has just undergone surgery to correct craniosynostosis. Which of the following comments is the best psychosocial intervention for the parents? a) "This only happens in 1 out of 2,000 births." b) "I'll be watching hemoglobin and hematocrit closely." c) "The surgery was successful. Do you have any questions?" d) "I told you yesterday there would be facial swelling."

C Often what parents need most is someone to listen to their concerns. Although this is a good time for education, let the parents adjust to their baby's appearance and adapt your teaching to their questions, comments, and knowledge level.

Signs of increased intracranial pressure for which you would assess are a) decreased level of consciousness, increased respiratory rate. b) numbness of fingers, decreased temperature. c) increased temperature, decreased respiratory rate. d) increased pulse rate, decreased blood pressure.

C Pressure on the vital-sign centers causes an elevated temperature and a decreased respiratory rate. Blood pressure increases; pulse decreases.

The parents of a child with a history of seizures who has been taking phenytoin (Dilantin) ask the nurse why it's difficult to maintain therapeutic plasma levels of this medication. Which statement by the nurse would be most accurate? a) "A drop in the plasma drug level will lead to a toxic state." b) "The capacity to metabolize the drug becomes overwhelmed over time." c) "Small increments in dosage lead to sharp increases in plasma drug levels." d) "Large increments in dosage lead to a more rapid stabilizing therapeutic effect."

C Within the therapeutic range for phenytoin, small increments in dosage produce sharp increases in plasma drug levels. The capacity of the liver to metabolize phenytoin is affected by slight changes in the dosage of the drug, not necessarily the length of time the client has been taking the drug. Large increments in dosage will greatly increase plasma levels, leading to drug toxicity.

Which nursing assessment data should be given the highest priority for a child with clinical findings related to meningitis? a) Occurrence of urine and fecal contamination b) Degree and extent of nuchal rigidity c) Signs of increased intracranial pressure (ICP) d) Onset and character of fever

C Assessment of fever and evaluation of nuchal rigidity are important aspects of care, but assessment for signs of increasing ICP should be the highest priority due to the life-threatening implications. Urinary and fecal incontinence can occur in a child who's ill from nearly any cause but doesn't pose a great danger to life.

A 6-month-old infant is admitted with suspected bacterial meningitis. She is crying, irritable, and lying in the opisthotonic position. Which of the following interventions should the nurse take initially? a) Educate the family about preventing bacterial meningitis. b) Encourage the mother to hold and comfort the infant. c) Institute droplet precautions in addition to standard precautions. d) Palpate the child's fontanels.

C Bacterial meningitis is a medical emergency. The child must be placed on droplet precautions until 24 hours of antibiotics have been given. Encouraging the mother to hold and comfort the child is an intervention but not the priority one: the focus is to get the infant the appropriate medications to fight the infection and to prevent its spread. Educating the family about preventing bacterial meningitis would be appropriate later on once the initial infection has been controlled. Palpating the fontanels is used to assess for hydrocephalus.

Which of the following is consistent with increased ICP in the child? a) Narcolepsy b) Emotional lability c) Bulging fontanel d) Increased appetite

C Children with increased ICP exhibit bulging fontanels. They typically have a decreased appetite, are restless, and have trouble sleeping

The nurse is caring for a child admitted with complex partial seizures. Which of the following clinical manifestations would likely have been noted in the child with this diagnosis? a) The child was dizzy and had decreased coordination. b) The child had jerking movements and then the extremities stiffened. c) The child was rubbing the hands and smacking the lips. d) The child had shaking movements on one side of the body.

C Complex partial seizures, also called psychomotor seizures, change or alter consciousness. They cause memory loss and staring and nonpurposeful movements, such as hand rubbing, lip smacking, arm dropping, and swallowing. In the tonic phase of tonic-clonic seizures, the child's muscles contract, the child may fall, and the child's extremities may stiffen. During the prodromal period of the tonic-clonic seizure, the child might have a lack of coordination. Simple partial motor seizures cause a localized motor activity such as shaking of an arm, leg, or other part of the body

The nurse is caring for a near-term pregnant woman who has not taken prenatal vitamins or folic acid supplements. Which congenital defect is most likely to occur based on the mother's prenatal history? a) Neonatal conjunctivitis b) Incomplete myelinization c) A neural tube defect d) Facial deformities

C Folic acid supplementation has been found to reduce the incidence of neural tube defects by 50%. The fact that the mother has not used folic acid supplements puts her baby at risk for spina bifida occulta, one type of neural tube defect. Neonatal conjunctivitis can occur in any newborn during birth and is caused by virus, bacteria, or chemicals. Facial deformities are typical of babies of alcoholic mothers. Incomplete myelinization is present in all newborns.

The nurse is discussing with a parent the difference between a breath-holding spell and a seizure. The nurse would be correct in telling the parent which of the following with regards to seizures? a) The patient is bradycardiac. b) Cyanosis occurs at the onset of the seizure. c) Convulsive activity occurs. d) The EEG is normal.

C During seizures convulsive activity is typically noted. During a breath-holding spell, the child is bradycardiac, cyanosis occurs at the onset, and the EEG is normal.

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? a) Take vital signs every 4 hours b) Monitor temperature every 4 hours c) Encourage the parents to hold the child d) Decrease environmental stimulation

D 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 collecting data from the caregivers of a child admitted with seizures. Which of the following statements indicates the child most likely had an absence seizure? a) "He kept smacking his lips and rubbing his hands." b) "He usually is very coordinated, but he couldn't even walk without falling." c) "His arms had jerking movements in his legs and face." d) "He was just staring into space and was totally unaware."

D Absence seizures rarely last longer than 20 seconds. The child loses awareness and stares straight ahead but does not fall. Absence seizures rarely last longer than 20 seconds. The child loses awareness and stares straight ahead but does not fall. Myoclonic seizures are characterized by a sudden jerking of a muscle or group of muscles, often in the arms or legs, without loss of consciousness. Complex partial seizures cause nonpurposeful movements, such as hand rubbing and lip smacking. During the prodromal period of the tonic-clonic seizure, the child might have a lack of coordination.

Any individual taking phenobarbital for a seizure disorder should be taught a) never to go swimming. b) to avoid foods containing caffeine. c) to brush his or her teeth four times a day. d) never to discontinue the drug abruptly.

D Phenobarbital should always be tapered, not stopped abruptly, or seizures from the child's dependency on the drug can result.