Question 1

What type of seizure may be difficult to detect?
A) Absence
B) Generalized
C) Simple partial
D) Complex partial

Accepted Answer

Absence seizures may go unrecognized because little change occurs in the child's behavior during the seizure.Generalized,simple partial,and complex partial all have clinical manifestations that are observable.

Question 2

A child is admitted for revision of a ventriculoperitoneal shunt for noncommunicating hydrocephalus.What is a common reason for elective revision of this shunt?
A) Meningitis
B) Gastrointestinal upset
C) Hydrocephalus resolution
D) Growth of the child since the initial shunting

Accepted Answer

An elective revision of a ventriculoperitoneal shunt would most likely be done to accommodate the child's growth.Meningitis would require an emergent replacement or revision of the shunt.Gastrointestinal upset alone would not indicate the need for shunt revision.Noncommunicating hydrocephalus will not resolve without surgical intervention.

Question 3

The nurse is teaching the parents of a 3-year-old child who has been diagnosed with tonic-clonic seizures.What statement by the parent should indicate a correct understanding of the teaching?
A) "I should attempt to restrain my child during a seizure."
B) "My child will need to avoid contact sports until adulthood."
C) "I should place a pillow under my child's head during a seizure."
D) "My child will need to be taken to the emergency department [ED] after each seizure."

Accepted Answer

Parents should try to place a pillow or folded blanket under the child's head for protection.The parent should not try to restrain the child during the seizure.The child does not need to go to the ED with each seizures; the nurse can teach parents certain criteria for when their child would need to be seen.Discussing what will happen in adulthood is not appropriate at this time.

Question 4

What clinical manifestations suggest hydrocephalus in an infant?
A) Closed fontanel and high-pitched cry
B) Bulging fontanel and dilated scalp veins
C) Constant low-pitched cry and restlessness
D) Depressed fontanel and decreased blood pressure

Accepted Answer

Bulging fontanels,dilated scalp veins,and separated sutures are clinical manifestations of hydrocephalus in neonates.A closed fontanel,high-pitched cry,constant low-pitched cry,restlessness,a depressed fontanel,and decreased blood pressure are not clinical manifestations of hydrocephalus,but all should be referred for evaluation.

Question 5

A child has been seizure free for 2 years.A father asks the nurse how much longer the child will need to take the antiseizure medications.How should the nurse respond?
A) Medications can be discontinued at this time.
B) The child will need to take the drugs for 5 years after the last seizure.
C) A step-wise approach will be used to reduce the dosage gradually.
D) Seizure disorders are a lifelong problem. Medications cannot be discontinued.

Accepted Answer

A predesigned protocol is used to wean a child gradually off antiseizure medications,usually when the child is seizure free for 2 years.Medications must be gradually reduced to minimize the recurrence of seizures.The risk of recurrence is greatest within 6 months after discontinuation.

Question 6

What is a priority of care when a child has an external ventricular drain (EVD)?
A) Irrigation of drain to maintain flow
B) As-needed dressing changes if dressing becomes wet
C) Frequent assessment of amount and color of drainage
D) Maintaining the EVD below the level of the child's head

Accepted Answer

The EVD is inserted into the child's ventricle.Frequent assessment is necessary to determine amount of drainage and whether an infection is present.The EVD is a closed system and is not opened for irrigation.Antibiotics may be administered through the drain,but this is usually done by the neuropractitioner.The dressing is not changed.If it becomes wet,then the practitioner should be notified that cerebrospinal fluid (CSF)may be leaking.Unless ordered,maintaining the EVD below the level of the child's head position will create too much pressure and potentially drain too much CSF.

Question 7

What is the initial clinical manifestation of generalized seizures?
A) Confusion
B) Feeling frightened
C) Loss of consciousness
D) Seeing flashing lights

Accepted Answer

Loss of consciousness is a frequent occurrence in generalized seizures and is the initial clinical manifestation.Being confused,feeling frightened,and seeing flashing lights are clinical manifestations of a complex partial seizure.

Question 8

After a tonic-clonic seizure,what symptoms should the nurse expect the child to experience?
A) Diarrhea and abdominal discomfort
B) Irritability and hunger
C) Lethargy and confusion
D) Nervousness and excitability

Accepted Answer

In the postictal phase,after a tonic-clonic seizure,the child may remain semiconscious and difficult to arouse.The average duration of the postictal phase is usually 30 minutes.The child may remain confused or sleep for several hours.He or she may have mild impairment of fine motor movements.The child may have visual and speech difficulties and may vomit or complain of headache.

Question 9

What intervention should be beneficial in reducing the risk of Reye syndrome?
A) Immunization against the disease
B) Medical attention for all head injuries
C) Prompt treatment of bacterial meningitis
D) Avoidance of aspirin for children with varicella or those suspected of having influenza

Accepted Answer

Although the etiology of Reye syndrome is obscure,most cases follow a common viral illness,either varicella or influenza.A potential association exists between aspirin therapy and the development of Reye syndrome,so use of aspirin is avoided.No immunization currently exists for Reye syndrome.Reye syndrome is not correlated with head injuries or bacterial meningitis.

Question 10

A young adolescent experiences infrequent migraine episodes.What pharmacologic intervention is most likely to be prescribed?
A) Opioid
B) Lorazepam
C) Ergotamine
D) Sumatriptan

Accepted Answer

Sumatriptan is a serotonin agonist at specific vascular serotonin receptor sites and causes vasoconstriction in large intracranial arteries.Opioids are used infrequently because they rarely work on the mechanism of pain.Lorazepam is a benzodiazepine that acts as an anxiolytic and sedative.It is not indicated for treatment of migraine episodes.Ergotamine,an a-adrenergic blocker,is used for adult vascular headaches,but it is not used in adolescents because of the side effects.

Question 11

A 10-year-old child,without a history of previous seizures,experiences a tonic-clonic seizure at school that lasts more than 5 minutes.Breathing is not impaired.Some postictal confusion occurs.What is the most appropriate initial action by the school nurse?
A) Stay with child and have someone else call emergency medical services (EMS).
B) Notify the parent and regular practitioner.
C) Notify the parent that the child should go home.
D) Stay with the child, offering calm reassurance.

Accepted Answer

Because this is the child's first seizure and it lasted more than 5 minutes,EMS should be called to transport the child,and evaluation should be performed as soon as possible.The nurse should stay with the recovering child while someone else notifies EMS.

Question 12

What term refers to seizures that involve both hemispheres of the brain?
A) Absence
B) Acquired
C) Generalized
D) Complex partial

Accepted Answer

Clinical observations of generalized seizures indicate that the initial involvement is from both hemispheres.Absence seizures have a sudden onset and are characterized by a brief loss of consciousness,a blank stare,and automatisms.Acquired seizure disorder is a result of a brain injury from a variety of factors; it is not a term that labels the type of seizure.Complex partial seizures are the most common seizures.They may begin with an aura and be manifested as repetitive involuntary activities without purpose,carried out in a dreamy state.

Question 13

A young child's parents call the nurse after their child is bitten by a raccoon in the woods.The nurse's recommendation should be based on what knowledge?
A) Antirabies prophylaxis must be initiated immediately.
B) The child should be hospitalized for close observation.
C) No treatment is necessary if thorough wound cleaning is done.
D) Antirabies prophylaxis must be initiated as soon as clinical manifestations appear.

Accepted Answer

Current therapy for a rabid animal bite consists of a thorough cleansing of the wound and passive immunization with human rabies immunoglobulin (HRIG)as soon as possible.Hospitalization is not necessary.The wound cleansing,passive immunization,and immunoglobulin administration can be done as an outpatient.The child needs to receive both HRIG and rabies vaccine.

Question 14

What is important to incorporate in the plan of care for a child who is experiencing a seizure?
A) Describe and record the seizure activity observed.
B) Suction the child during a seizure to prevent aspiration.
C) Place a tongue blade between the teeth if they become clenched.
D) Restrain the child when seizures occur to prevent bodily harm.

Accepted Answer

When a child is having a seizure,the priority nursing care is observation of the child and seizure.The nurse then describes and records the seizure activity.The child is not suctioned during the seizure.If possible,the child should be placed on the side,facilitating drainage to prevent aspiration.

Question 15

A pregnant woman asks about prenatal diagnosis of hydrocephalus.The nurse's response should be based on which knowledge?
A) It can be diagnosed only after birth.
B) It can be diagnosed by chromosome studies.
C) It can be diagnosed with fetal ultrasonography.
D) It can be diagnosed by measuring the lecithin-to-sphingomyelin ratio.

Accepted Answer

Hydrocephalus can be diagnosed by fetal ultrasonography as early as 14 weeks of gestation.Most incidents of hydrocephalus are not chromosomal in origin.The lecithin-to-sphingomyelin ratio can be used to determine fetal lung maturity.

Question 16

A 6-year-old child is admitted for revision of a ventriculoperitoneal shunt for noncommunicating hydrocephalus.What sign or symptom does the child have that indicates a revision is necessary?
A) Tachycardia
B) Gastrointestinal upset
C) Hypotension
D) Alteration in level of consciousness

Accepted Answer

In older children,who are usually admitted to the hospital for elective or emergency shunt revision,the most valuable indicators of increasing intracranial pressure are an alteration in the child's level of consciousness,complaint of headache,and changes in interaction with the environment.

Question 17

The nurse is caring for a 10-year-old child who has an acute head injury,has a pediatric Glasgow Coma Scale score of 9,and is unconscious.What intervention should the nurse include in the child's care plan?
A) Elevate the head of the bed 15 to 30 degrees with the head maintained in midline.
B) Maintain an active, stimulating environment.
C) Perform chest percussion and suctioning every 1 to 2 hours.
D) Perform active range of motion and nontherapeutic touch every 8 hours.

Accepted Answer

Nursing activities for children with head trauma and increased intracranial pressure (ICP)include elevating the head of the bed 15 to 30 degrees and maintaining the head in a midline position.The nurse should try to maintain a quiet,nonstimulating environment for a child with increased ICP.Chest percussion and suctioning should be performed judiciously because they can elevate ICP.Range of motion should be passive and nontherapeutic touch should be avoided because both of these activities can increase ICP.

Question 18

The nurse is discussing long-term care with the parents of a child who has a ventriculoperitoneal shunt.What issues should be addressed?
A) Most childhood activities must be restricted.
B) Cognitive impairment is to be expected with hydrocephalus.
C) Wearing head protection is essential until the child reaches adulthood.
D) Shunt malfunction or infection requires immediate treatment.

Accepted Answer

Because of the potentially severe sequelae,symptoms of shunt malfunction or infection must be assessed and treated immediately.Limits should be appropriate to the child's developmental age.Except for contact sports,the child will have few restrictions.Cognitive impairment depends on the extent of damage before the shunt was placed.

Question 19

The nurse is planning care for a school-age child with bacterial meningitis.What intervention should be included?
A) Keep environmental stimuli to a minimum.
B) Have the child move her head from side to side at least every 2 hours.
C) Avoid giving pain medications that could dull sensorium.
D) Measure head circumference to assess developing complications.

Accepted Answer

The room is kept as quiet as possible and environmental stimuli are kept to a minimum.Most children with meningitis are sensitive to noise,bright lights,and other external stimuli.The nuchal rigidity associated with meningitis would make moving the head from side to side a painful intervention.If pain is present,the child should be treated appropriately.Failure to treat can cause increased intracranial pressure.In this age group,the head circumference does not change.Signs of increased intracranial pressure would need to be assessed.

Question 20

A toddler is admitted to the pediatric unit with presumptive bacterial meningitis.The initial orders include isolation,intravenous access,cultures,and antimicrobial agents.The nurse knows that antibiotic therapy will begin when?
A) After the diagnosis is confirmed
B) When the medication is received from the pharmacy
C) After the child's fluid and electrolyte balance is stabilized
D) As soon as the practitioner is notified of the culture results

Accepted Answer

Antimicrobial therapy is begun as soon as a presumptive diagnosis is made.The choice of drug is based on the most likely infective agent.Drug choice may be adjusted when the culture results are obtained.Waiting for culture results to begin therapy increases the risk of neurologic damage.Although fluid and electrolyte balance is important,there is no indication that this child is unstable.Antibiotic therapy would be a priority intervention.

Quiz 32: The Child With Cerebral Dysfunction

What type of seizure may be difficult to detect?

A child is admitted for revision of a ventriculoperitoneal shunt for noncommunicating hydrocephalus.What is a common reason for elective revision of this shunt?

The nurse is teaching the parents of a 3-year-old child who has been diagnosed with tonic-clonic seizures.What statement by the parent should indicate a correct understanding of the teaching?

What clinical manifestations suggest hydrocephalus in an infant?

A child has been seizure free for 2 years.A father asks the nurse how much longer the child will need to take the antiseizure medications.How should the nurse respond?

What is a priority of care when a child has an external ventricular drain (EVD) ?

What is the initial clinical manifestation of generalized seizures?

After a tonic-clonic seizure,what symptoms should the nurse expect the child to experience?

What intervention should be beneficial in reducing the risk of Reye syndrome?

A young adolescent experiences infrequent migraine episodes.What pharmacologic intervention is most likely to be prescribed?

A 10-year-old child,without a history of previous seizures,experiences a tonic-clonic seizure at school that lasts more than 5 minutes.Breathing is not impaired.Some postictal confusion occurs.What is the most appropriate initial action by the school nurse?

What term refers to seizures that involve both hemispheres of the brain?

A young child's parents call the nurse after their child is bitten by a raccoon in the woods.The nurse's recommendation should be based on what knowledge?

What is important to incorporate in the plan of care for a child who is experiencing a seizure?

A pregnant woman asks about prenatal diagnosis of hydrocephalus.The nurse's response should be based on which knowledge?

A 6-year-old child is admitted for revision of a ventriculoperitoneal shunt for noncommunicating hydrocephalus.What sign or symptom does the child have that indicates a revision is necessary?

The nurse is caring for a 10-year-old child who has an acute head injury,has a pediatric Glasgow Coma Scale score of 9,and is unconscious.What intervention should the nurse include in the child's care plan?

The nurse is discussing long-term care with the parents of a child who has a ventriculoperitoneal shunt.What issues should be addressed?

The nurse is planning care for a school-age child with bacterial meningitis.What intervention should be included?

A toddler is admitted to the pediatric unit with presumptive bacterial meningitis.The initial orders include isolation,intravenous access,cultures,and antimicrobial agents.The nurse knows that antibiotic therapy will begin when?