Signs & Symptoms
What is the earliest indicator of neurologic change in a child with suspected increased intracranial pressure?
Answer: Change in level of consciousness (LOC).
Rationale: LOC is the first sign that the brain’s regulation is failing before vital signs change.
Which class of drugs is used emergently to abort prolonged seizures (status epilepticus)?
Answer: Benzodiazepines (e.g. lorazepam, diazepam).
Rationale: They potentiate GABA, suppress neuronal hyperactivity quickly.
What diagnostic test is definitive for diagnosing meningitis (bacterial or viral)?
Answer: Lumbar puncture (LP).
Rationale: Analyzes CSF for WBCs, protein, glucose, and organisms.
When caring for a child with increased ICP, what is the recommended head-of-bed position?
Answer: Elevate head of bed 15–30°, keep head midline.
Rationale: Facilitates venous drainage and reduces intracranial pressure.
What should parents do at home if their child experiences a febrile seizure?
Answer: Keep child safe (remove hazards), place on side, time the seizure, seek medical evaluation.
Rationale: Most febrile seizures stop spontaneously but require monitoring and evaluation.
In an infant, which sign suggests rising intracranial pressure?
Answer: Bulging tense fontanel, widening sutures, increased head circumference.
Rationale: Because infants’ skull bones aren’t fused, rising pressure causes fontanel bulge and expansion.
What is a major nursing consideration for phenytoin administration?
Answer: Do not give with milk; monitor gums.
Rationale: Milk decreases absorption; gingival hyperplasia is a side effect.
Before performing an LP, what key assessment must a nurse check?
Answer: Signs of increased intracranial pressure or herniation risk (e.g. Cushing triad, bulging fontanel).
Rationale: Performing an LP when ICP is high can precipitate brain herniation.
What is the priority nursing action during a seizure?
Answer: Maintain airway and safety (turn to side, clear environment).
Rationale: Safety and airway are immediate concerns; never restrain or place objects in mouth.
What home safety measures should families of children with epilepsy adopt?
Answer: Padded furniture/rails, supervision during bathing, helmet for risky activities.
Rationale: Reduces risk of injury during unpredictable seizure events.
What is Cushing’s triad and what does it signal?
Answer: Hypertension with widening pulse pressure, bradycardia, and irregular respirations.
Rationale: It signals severe intracranial hypertension and possible brain herniation.
Why should aspirin be avoided in febrile children?
Answer: Risk of Reye’s syndrome.
Rationale: Aspirin + viral infection → liver & brain swelling.
What imaging is useful in infants for detecting hydrocephalus and why?
Answer: Cranial (transfontanel) ultrasound.
Rationale: The open fontanel allows ultrasound waves to visualize ventricles and fluid accumulation.
What must the nurse document after a seizure?
Answer: Time (start and end), type of movements, level of consciousness, postictal behavior, any injury.
Rationale: Accurate records support diagnosis, care plans, and medication adjustments.
After VP shunt placement, what signs should parents immediately report?
Answer: Vomiting, headache, lethargy, swelling, redness along shunt tract.
Rationale: These are early signs of shunt malfunction or infection.
In bacterial meningitis, what posture might an infant adopt, and what sign in an older child might appear?
Answer: Infant: opisthotonic posture; Older child: neck stiffness (nuchal rigidity) and photophobia.
Rationale: Infants often arch the back (opisthotonus) under meningeal irritation; older kids show classical signs of meningeal irritation.
What is the role of mannitol in intracranial pressure management?
Answer: Osmotic diuretic to draw fluid from brain tissue into the vascular space, reducing cerebral edema.
Rationale: It decreases ICP by shifting water out of brain cells.
What does an EEG detect in a child with suspected seizure disorder?
Answer: Abnormal electrical discharges / seizure activity in the brain.
Rationale: EEG measures brain wave patterns to locate epileptogenic foci.
What action is necessary if CSF leakage occurs post neurosurgery?
Answer: Keep child flat, avoid activities that increase pressure, notify provider.
Rationale: Prevents additional CSF loss, infection, and pressure shifts.
How should parents support the psychosocial needs of a child with a chronic neurologic condition?
AAnswer: Encourage normal routines, peer interaction, independence, and reassure open communication.
Rationale: Promotes self-esteem, coping, and developmental growth.
A child demonstrates decerebrate posturing. What does this indicate about the location of brain injury?
Answer: Injury to the brainstem (below the level of the midbrain).
Rationale: Decerebrate (extension) indicates more serious brainstem involvement, versus decorticate which suggests cortical damage.
In a child treated for hydrocephalus with a VP shunt, what prophylactic measure is essential to prevent shunt infection?
Answer: Administer antibiotics as prescribed and maintain aseptic shunt care (sterile technique).
Rationale: Shunts are a frequent site for infection; prevention is critical.
Why is CT preferred over MRI in emergencies?
Answer: CT is faster and more sensitive to acute bleeding (hemorrhage).
Rationale: Quick detection of intracranial hemorrhage is vital in acute settings; MRI, though detailed, is slower.
For an infant with a new diagnosis of craniosynostosis, what nursing priority should you include?
Answer: Reposition head every 2 hours, monitor head growth, protect surgical site post-op.
Rationale: Prevent skull deformation, promote symmetry, and reduce pressure effects.
What detailed teaching should parents receive about seizure management at home?
Answer: Administer meds regularly, avoid abrupt discontinuation, have rescue plan (e.g. rectal diazepam), record all seizures.
Rationale: Consistency prevents breakthrough seizures; documentation helps provider in adjusting therapy.