Neurological Disorders
A 9-year-old child is recovering from influenza. The child's parent reports giving the child aspirin several times a day for fever. The child suddenly develops repeated vomiting, confusion, and increasing drowsiness. What serious condition should the nurse suspect?
Reye Syndrome
A premature infant born at 29 weeks' gestation is in the NICU. The nurse notices that the infant has episodes of apnea, decreased muscle tone, and changes in level of consciousness. The infant is at increased risk for bleeding because of the fragility of the blood vessels in the developing brain. What neurologic complication should the nurse be concerned about?
Intraventricular hemorrhage (IVH)
A 6-month-old infant is brought to the pediatric clinic. The parent reports that the baby does not consistently turn toward sounds or respond when their name is called. The nurse observes that the infant does not startle when a loud sound is made behind them. What should the nurse be most concerned about and what should you do?
Possible hearing loss requiring further hearing evaluation.
A 7-year-old child falls from a bicycle and lands on their outstretched arm. The child has pain, swelling, and tenderness of the forearm. An X-ray shows that the bone has bent and partially cracked, but the bone is not completely broken through. What type of fracture does this child have?
Greenstick fracture
A child weighs 20kg. How many lbs?
44 lbs
A 6-year-old child has epilepsy that remains poorly controlled despite multiple antiseizure medications. The healthcare team recommends a ketogenic diet. The parents ask what foods the patient should eat. What would you teach? Give an example of a meal plan.
a diet high in fat and very low in carbohydrates (ketones can help reduce seizure activity)
A newborn is diagnosed with myelomeningocele. During assessment, the nurse observes a fluid-filled sac protruding from the infant's lower back. What is the nurse's priority intervention?
Protect the sac from injury and infection by positioning the infant appropriately and covering the lesion with a sterile, moist, nonadherent dressing according to the care plan.
During an eye assessment of a 4-month-old infant, the nurse notices that the child's eyes make repetitive, involuntary, rhythmic movements from side to side. The movements continue even when the child attempts to focus on an object. What abnormal finding is the nurse observing?
Nystagmus
A 9-year-old child is admitted with a femur fracture and placed in traction. During your assessment, you notice that the weights are resting on the floor, the ropes are not aligned correctly, and the child reports increasing pain. What is the priority nursing intervention?
Notify the provider. Correct the traction setup so that the weights hang freely and the ropes remain properly aligned, then reassess the child's neurovascular status and pain.
weight: 18 kg. The provider orders acetaminophen 15 mg/kg/dose PO. The medication is available as 160 mg/5 mL. How many mL should be given per dose?
8.4 mL
A 2-year-old child is being evaluated because they have delayed motor milestones, abnormal muscle tone, and difficulty maintaining balance. The parent reports that the child has had difficulty sitting and walking compared with other children of the same age. What condition should the nurse suspect (BE SPECIFIC: 2 types)?
Cerebral palsy (ataxic or hypotonic)
A 5-year-old child is brought to the emergency department with a high fever, severe headache, vomiting, photophobia, and a stiff neck. The child is increasingly irritable and difficult to console. What condition should the nurse suspect, what two specific signs would you check and how do you perform these?
Meningitis; Kernig sign (extend one leg at a 90 degree angle) & Brudzinski sign (lift legs causes neck to lift)
A 3-year-old child has a history of recurrent otitis media and recently had tympanostomy tubes placed. The parent asks the nurse what to do if the child develops drainage from the ear. What should you teach them and when should the parent report the drainage to the healthcare provider?
Persistent or concerning ear drainage (otorrhea) <48 hours or accompanied by fever, pain, or worsening symptoms.
A 13-year-old adolescent is being evaluated for possible scoliosis. During a forward-bend assessment, the nurse observes that one side of the child's rib cage is noticeably higher than the other by 45 degrees. The child denies pain but says one shoulder appears higher than the other. What condition should the nurse suspect, and what intervention would be required?
Scoliosis and surgical intervention <40 degrees
A child weighs 25 kg. The prescribed medication dose is 30 mg/kg/day, divided into 3 equal doses. How many mg per dose should the child receive?
250 mg/dose
A 10-year-old child with a severe head injury is being monitored for increased intracranial pressure (ICP). The child becomes increasingly lethargic and develops unequal pupils. The nurse prepares to reposition the child. Which intervention is most appropriate to help reduce ICP?
Elevate the head of the bed approximately 30 degrees, promote comfort to prevent crying and keep the head and neck in a neutral, midline position.
Two children are being evaluated after seizure episodes.
Child A: Suddenly loses consciousness, becomes stiff, and then develops rhythmic jerking of all four extremities.
Child B: Remains partially aware but repeatedly smacks their lips and makes repetitive hand movements. Afterward, the child is confused.
How would the nurse classify these two seizures?, and explain what clinical findings are indicative?
A generalized tonic-clonic seizure involves widespread brain activity and typically causes loss of consciousness followed by tonic stiffening and clonic movements.
Focal seizures begin in a specific area of the brain and may produce localized motor, sensory, or behavioral symptoms (usually appear to look off).
A 5-year-old child presents with red, irritated eyes and thick yellow-green discharge. The child's eyelids are stuck together when waking in the morning. The parent says the child's sibling recently had similar symptoms. What condition should the nurse suspect, and what teaching is important?
Conjunctivitis (pink eye); emphasize good hand hygiene, avoiding touching/rubbing the eyes, use a different towel for each eye and not sharing towels or other personal items.
A 6-year-old child is brought to the clinic because the parents report that the child has difficulty climbing stairs, a waddling gait and frequently falls. During the assessment, the nurse notices that the child uses their hands to push against their thighs when standing up from the floor. What condition is most consistent with this and what sign are they presenting with?
Duchenne muscular dystrophy (DMD); Gowers sign
A child weighs 16 kg. A medication is ordered at 10 mg/kg/dose. The recommended safe dose is 5–10 mg/kg/dose. The medication is available as 100 mg/5 mL. How many mL should be administered?
8 mL
A 7-year-old child is admitted after experiencing several seizures. The nurse prepares the room before the child has another seizure. Which intervention is the priority when establishing seizure precautions?
Ensure the child has a safe environment, including a padded bed/side rails as appropriate, suction and oxygen available, and removal of objects that could cause injury.
A nurse is performing a neurologic assessment on an 8-year-old child following a head injury. The nurse asks the child to smile, raise their eyebrows, close their eyes tightly, stick out their tongue, and shrug their shoulders against resistance. What is the nurse assessing with each movement (BE SPECIFIC)?
The nurse is assessing multiple cranial nerves, including CN VII (facial):smile, eyes and eyebrows, CN XII (hypoglossal):stick out tongue, and CN XI (accessory): shrug shoulders.
The nurse is performing an ear assessment on a 7-year-old child. How would you properly visualize the ear canal and tympanic membrane with the otoscope?
In children older than 3 years (including this 7-year-old), the pinna is pulled upward and backward to help straighten the ear canal for examination.
What acronym do you use to check the pt post cast application, what does it stand for and how would you assess each? If the findings are abnormal what condition could be expected?
5Ps: Pain, Pallor, Pulselessness, Paresthesia & Paralysis
-ask the pt, palpation, check cap refill, ROM
A pediatric patient needs 150 mL of IV fluid infused over 2 hours. The IV tubing has a drop factor of 15 gtt/mL. What is the IV flow rate in gtt/min?
19 gtt/min