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A 5 yr old presents with fever, irritability, and decreased LOC. The child demonstrates a positive Kernig and Brudzinski's signs. The nurse knows these sings indicate:
A) Increased intracranial pressure B) Cerebrovascular accident C) Meningeal irritation D) Non-accidental trauma
C) Meningeal irritation
Brudzinski's sign is demonstrated when the provider flex's the child's neck while applying gentle pressure to the chest. Involuntary flexion of the hips indicates that the body is attempting to reduce stress on irritated meninges. Kernig sign is demonstrated by the inability to straighten the legs when the hip is flexed at 90 degrees.
The nurse is assessing an infant with an increased head size, shiny skin, and the "setting sun" sign. The nurse suspects which of the following diagnoses?
A) Spina bifida B) Cerebral Palsy C) Hydrocephalus D) Down syndrome
C) Hydrocephalus
Increased head size, shiny skin, and "setting sun" sign (sclera seen above the pupils) are classic signs of hydrocephalus. Other signs include bulging fontanelles, and in older children, headaches.
A 15 month old male presents with a history of ventricular shunt. The mother reports he has been increasingly irritable and sleepy over the past 2 days. This morning, he was difficult to rouse and returned to sleep rapidly. The nurse suspects:
A)Glioma B) Meningitis C) Increased intracranial pressure D) Encephalitis
C) Increased intracranial pressure - Patients with ventricular shunt are at high risk for shunt malfunction/displacement during periods of rapid growth. This often leads to the need for frequent shunt revisions. (Symptoms are similar to meningitis and encephalitis, but no fever or other associated symptoms)
Which of the following patients has an abnormal intracranial pressure?
A) A 6 day old with an ICP of 1mmHg B) A 4 mo old with an ICP of 3mmHg C) A 12 mo old with an ICP of 5mmHg D) A 2 yr old with an ICP of 10mmHg
D) A 2yr old with an intracranial pressure of 10mmHg
A young child should have an ICP in the range of 3 to 7 mmHg. A neonate should have an ICP of less than 3mmHg. A newborn should have an ICP of 1.5-6mmHg
The nurse is caring for a 7mo old who suffered a TBI. Throughout the day, the infant became lethargic. A CT scan did not reveal any subdural hematomas or other abnormalities. The nurse's next BEST step is to:
A)Administer 3% saline solution IV B) Check the infant's blood glucose level C)Initiate enteral feeding D)Administer IM glucagon
B) Check the infant's blood glucose level
Infants with TBI are at increased risk for complications. A lethargic child may be hypoglycemic. It is important to avoid hypoglycemia to maintain proper brain functions.
The nurse is assessing a 6mo old who cannot hold his head upright and midline. The nurse recognizes that the infant may be experiencing:
A) A cerebral injury B) Weak neck muscles C) Hyperextension D) Hyperopia
A) A cerebral injury
Infants should develop the ability to hold their heads midline by the age of 4mo. If they are unable to hold their head upright, it may be a sign of a serious underlying cerebral injury.
The nurse is caring for a patient who is being treated with levetiracetam (Keppra) for new on-set epileptic activity. For which lab would the nurse obtain a baseline value?
A) Hematocrit B) Creatinine C) Blood glucose level D) Aspartate transaminase
B) Creatinine
Levetiracetam can be nephrotoxic, so it is important to establish a baseline creatinine level.
The nurse is caring for a patient with a Chiari malformation. The MRI shows the cerebellum and brain step tissue protruding into the foremen magnum. The nurse recognizes the patient has:
A) Chiari malformation type I B) Chiari malformation type II C) Chiari malformation type III D) Chiari malformation type IV
B) Chiari malformation type II - Chiari malformations are structural defects in the base of the skull and cerebellum. They are classified by the severity of the disorder and the parts of the brain that extend into the spinal column.
During a well-child visit, the nurse would suspect hydrocephalus in an infant with which of the following assessment findings:
A) Increase in head circumference B) Weight gain since last visit C) Narrow suture lines D) Sunken fontanels
A) Increase in head circumference - Hydrocephalus is the buildup of fluid in the ventricles deep within the brain. Common signs include a rapid increase in head circumference, an unusually large head, and a bulging fontanel
A 16 yr old make struck his head while attempting a dive into a local pond. EMS reports that he lost consciousness following the accident. After his return from radiology, the patient has a Glasgow Coma Scale score of 7. The nurse should:
A)Call for help and prepare for intubation B) Call for help and prepare for 3% hypertonic saline C) Turn the patient to his left side and place him in the recovery position D) Apply the defibrillator and prepare for transcutaneous pacing
A) Call for help and prepare for intubation - A patient with a Glasgow Coma Scale score of less than 8 meets the criteria for airway management and intubation.
Which of the following would be lowest priority when caring for a patient with a seizure disorder?
A) Teaching family about anticonvulsant therapy B) Assessing for signs and symptoms of increased ICP C) Ensuring safety and protection from injury D) Observing and recording all seizures
B) Assessing for signs and symptoms of increased ICP
Signs and symptoms of increased ICP are not associated with seizure disorders and therefore are the lowest priority.
Which of the following would not be a focus of a teaching plan for an adolescent with a seizure disorder?
A) Ability to obtain a drivers license B) Increased risk of infection C) Drug and alcohol use D) Peer pressure
B) Increased risk for infection - Adolescents with seizure disorders are at no greater risk of infection than other adolescents.
Which of the following is the most common permanent disability in childhood?
A) Developmental dysplasia of the hip B) Cerebral Palsy C) Muscular dystrophy D) Scoliosis
B) Cerebral Palsy - it is a group of disabilities caused by injury or insult to the brain either before or during birth or in early infancy.
Which of the following would the nurse expect to assess as a common early manifestation of meningitis in a two-month old infant?
A) Opisthodomos B) Nuchal rigidity C) Kernig's sign D) Hypothermia
D) Hyothermia
Hypothermia and hyperthermia are early signs of meningitis in the young infant. Nuchal rigidity and Kernig's sign are seen in older children and adults.
Neural tube defects result from malformations of the neural tube during embryonic development. One type of neural tube defect, anencephaly, occurs when meningeal and cerebral tissue protrudes in a sac through a defect in the skull, with the occiput being the most common site.
True or False
False - Encephalocele occurs when meningeal and cerebral tissue protrudes in a sac through a defect in the skull, with the occiput being the most common site.
Anencephaly is a severe defect involving absence of the entire brain or cerebral hemispheres. The brainstem and cerebellum may be present.
The most important nursing goal for a neonate born in the last 24 hours with myelomeningocele is:
A) Ensure adequate hydration B) Provide adequate nutrition C) Prevent contractures D) Prevent infection
D) Prevent infection
A previously healthy 15 month old, febrile (103F), experiences a 7 minute long tonic clonic seizure. What would be the most appropriate advice for the caregivers in regards to seizures of this type?
A) Reassure that these seizures are usually benign B) Seek immediate medical attention C) Administer acetaminophen around the clock D) Keep the child quiet and calm
B) Seek immediate medical attention
You are providing teaching to a family of an 8yr old that recently started Dilantin for epilepsy. What possible side effects should you discuss with the family?
A) Respiratory acidosis B) Hearing loss C) Gum hypoplasia D) Tachycardia
C) Gum hyperplasia
A child with spina bifida is being admitted for a shunt revision. The nurse admitting the patient should expect what kind of precautions for this patient?
A) Fall risk B) Bleeding C) Latex D) Seizure
C) Latex
Children with spina bifida are at high risk of developing latex allergy due to frequent exposure to latex during catheterizations, shunt placements, and other operations
A child is admitted into the hospital with spastic cerebral palsy. The nurse will assess for which manifestations associated with this disorder?
A) Tremulous movements at rest and with activity B) Sudden jerking movement caused by stimuli C) Writhing, uncontrolled involuntary movements D) Clumsy, uncoordinated movements
B) Sudden jerking movement caused by stimuli
Spastic cerebral palsy is the most common type of CP. Manifestations include increased muscle tone through a joints ROM, exaggerated deep tendon reflexes, clonus
Which of the following children require referral for further vision evaluation?
A) 4yr old with visual acuity of 20/30 in both eyes B) newborn who keeps eyes closed when a bright light is shown C) 3 yr old with bilateral symmetric light reflection D) 6yr old with 20/40 vision in left eye and 20/20 in right eye
D) A 6yr old with 20/40 vision in left eye and 20/20 in right eye
A referral is indicated for any child over the age of 3 yrs with a two line difference between eyes even if the results are within normal passing range.
Which finding is an analysis of cerebral spinal fluid (CSF) is consistent with a diagnosis of bacterial meningitis?
A) CSF appears cloudy B) CSF pressure is decreased C) Few leukocytes are present D) Glucose level is increased compared with blood
A) CSF appears cloudy
In acute bacterial meningitis, the CSF appears cloudy/milky or yellowish in color
This is an acute inflammation of the brain often caused by a virus that is transmitted by a mosquito, such as West Nile virus or herpes simplex 1, and has a high mortality rate. Presenting signs include a severe headache, fever, altered LOC, and vomiting
Encephalitis
Viral meningitis in most cases is not as virulent than bacterial meningitis, and the child with viral meningitis appears less ill than the child with bacterial meningitis.
True or False
True
An infant is brought to the ED with assessment findings of failure to thrive, vomiting, and decreased LOC. Which should the nurse suspect?
A) Influenza B) Reaction to the Dtap immunization C) Shaken baby syndrome D) A malabsorption syndrome
C) Shaken baby syndrome
Clinical manifestations of shaken baby syndrome include seizures, lethargy, failure to thrive, and vomiting. It is caused by the tearing of the nerve fibers as the brain moves and forth.