Question 1

The pediatric nurse caring for patients in a trauma center examines a patient who has increased intracranial pressure as a result of a motor vehicle crash.The nurse is aware that secondary brain injuries can result from which factor?
A)Acidosis
B)Ischemia
C)Infections
D)Reduced oxygen

Accepted Answer

Primary brain injury is irreversible,immediate,and can result from traumatic injuries (e.g.,a blow to the head)or nontraumatic injuries (e.g.,a tumor or infection).Secondary brain injuries include ischemia from hypoxia,hypercapnia,hypotension,acidosis,and reduced oxygen delivery.

Question 2

A hospitalized child is having a seizure.Which action by the nurse takes priority?
A)Apply oxygen and oximeter.
B)Give anti-seizure medications.
C)Pad the side rails of the bed.
D)Turn the child on his or her side.

Accepted Answer

All actions are appropriate when a patient has a seizure.The priority,however,is on maintaining the child's airway.Placing the child in a side-lying position decreases the risk of aspiration and airway obstruction.

Question 3

The student nurse studying anatomy and physiology understands which of the following to be the function of axons?
A)Bringing information to the brain
B)Maintaining myelin sheaths on nerves
C)Protecting sensory and motor pathways
D)Taking information away from the brain

Accepted Answer

Axons take information away from the brain.

Question 4

A child is prescribed baclofen (Lioresal)via intrathecal pump to treat severe muscle spasms related to cerebral palsy.What teaching does the nurse provide the child and parents?
A)Do not let this prescription run out.
B)The medication may cause gingival hyperplasia.
C)Periodic serum drug levels are needed.
D)Watch for excessive facial hair growth.

Accepted Answer

Abrupt discontinuation of intrathecal baclofen can cause drastic effects,such as high fever,altered mental status,and exaggerated rebound spasticity and muscle rigidity.The parents should ensure there is a supply of this drug on hand at all times to avoid these effects.Gingival hyperplasia and hirsutism are side effects of phenytoin (Dilantin).Serum drug levels are not obtained with an intrathecal medication.

Question 5

A school-aged child wishes to learn embroidery from her grandmother,but the grandmother reports that the child can only concentrate on the projects for a short time and seems frustrated.What action by the nurse is the most appropriate?
A)Advise that the child needs more physical activity.
B)Explain that the child is too young for this project.
C)Suggest that the child have a routine vision exam.
D)Teach behavior modification to the grandmother.

Accepted Answer

The most common refractive disorder in children is hyperopia (farsightedness).Symptoms include reports of objects being unclear at close range and clearer at a distance.Younger children may have trouble focusing on a project that requires close vision work.The nurse should suggest that the child have a routine eye examination.The other options may or may not be beneficial,but do not address the potential visual problem.

Question 6

A student nurse is tutoring another student on anatomy and physiology.What does the tutor explain is the function of myelin sheaths on certain nerves?
A)Allow rapid transmission of nerve impulses
B)Assist in long-term storage of memories
C)Prevent "cross-communication" between nerves
D)Protect the nerves from temperature changes

Accepted Answer

White matter in the brain consists of nerves coated with myelin sheaths,which allow nerve impulses to travel rapidly.

Question 7

The pediatric nurse caring for a patient with encephalitis explains to the parents that the most common origin of encephalitis is which of the following?
A)Bacterial
B)Fungal
C)Parasitic
D)Viral

Accepted Answer

Encephalitis is usually viral in origin and occurs with an acute febrile illness that is characterized by cerebral edema and infection of surrounding meninges.Less common etiologies are fungal,bacterial,and parasitic infections;exposure to toxins or drugs;and cancer.

Question 8

A nurse is caring for a child with suspected epilepsy.Which diagnostic test does the nurse facilitate as the priority for this child?
A)Cerebral angiogram
B)Electrocardiogram (ECG)
C)Electroencephalogram (EEG)
D)Lumbar puncture (LP)

Accepted Answer

The EEG is the gold standard diagnostic test for a seizure disorder.

Question 9

An ophthalmologist examining the eyes of a patient explains to the nurse that the patient has an irregular curvature or uneven contour of the eye,resulting in impaired light refraction that causes blurred vision at all distances.Which condition does the nurse inform the parents about?
A)Astigmatism
B)Hyperopia
C)Myopia
D)Strabismus

Accepted Answer

In myopia,light rays do not reach the retina,causing blurred vision at a far range and clear vision at a close range.In hyperopia,vision is unclear at a close range and is clearer at a far range.Strabismus,or crossed-eye appearance,results in misalignment of the eyes.Astigmatism may be present at birth or acquired.Light rays are unevenly distributed in the eyes,causing blurred vision at all distances.This condition is associated with birth hyperopia and myopia.

Question 10

A nurse is caring for a child who has intracranial pressure (ICP)monitoring.The nurse assesses the child and notes that the ICP is 9 mm Hg.Which action by the nurse is most appropriate?
A)Activate the rapid response team.
B)Document the finding in the chart.
C)Hyperventilate the patient.
D)Prepare to administer mannitol (Osmotrol).

Accepted Answer

A normal ICP is 0-10 mm Hg.This finding is normal and the nurse needs only to document it and continue monitoring.No other actions are needed.

Question 11

A nurse is caring for a child who only awakens to painful stimuli and produces no verbal responses.Which term is the most appropriate when documenting this child's status?
A)Lethargy
B)Obtundation
C)Persistent vegetative state
D)Stupor

Accepted Answer

A child who is stuporous only responds to painful stimuli and has verbal responses that are either absent or slow.A lethargic patient opens his or her eyes to loud voices and appears confused and falls asleep without continued stimulation.Obtundation is demonstrated when a person is aroused by tactile stimulation,such as gentle shaking,but does not show great interest in surroundings.A persistent vegetative state is a coma-like condition that has lasted for over 4 weeks.

Question 12

A nurse admits a child experiencing drowsiness and vomiting who has had a seizure at home.The parents state the child was healthy until 2 weeks ago when she had a viral illness.Which diagnostic testing does the nurse facilitate as a priority?
A)Complete blood count
B)Liver biopsy
C)Lumbar puncture
D)Serum glucose

Accepted Answer

This child has manifestations of Reye syndrome.The definitive diagnosis of this disease is made via a liver biopsy.

Question 13

The pediatric nurse explains to the parents of a comatose child that which structure controls the child's level of consciousness?
A)Basal ganglia
B)Brainstem
C)Central nervous system
D)Reticular activating system

Accepted Answer

Level of consciousness is controlled by the reticular activating system and the cerebral hemispheres of the brain.

Question 14

A neonate receives a diagnosis of hydrocephalus.The pediatric nurse assesses for congenital anomalies related to this condition.Which condition is inconsistent with the nurse's knowledge of hydrocephalus?
A)Aqueductal stenosis
B)Chiari I and II malformations
C)Dandy-Walker malformation
D)Folic acid deficiency

Accepted Answer

Hydrocephalus develops when an impedance to cerebrospinal fluid (CSF)flow or absorption is present.It rarely occurs as a result of the overproduction of CSF.Congenital anomalies,including Chiari I and II malformations,Dandy-Walker malformation,and aqueductal stenosis,are the most common causes of hydrocephalus during the neonatal and early infancy periods.Acquired hydrocephalus occurs after birth and in infancy,usually resulting from intraventricular hemorrhage due to prematurity.Folic acid deficiency is related to neural tube deficits.

Question 15

A pediatric nurse performs a physical examination on a neonate and notes a spinal lesion with the meninges protruding through the defect that contains spinal cord elements.The nurse documents which condition as being present?
A)Hydrocephalus
B)Meningitis
C)Meningocele
D)Myelomeningocele
E)Spina bifida occulta

Accepted Answer

A myelomeningocele is the most severe form of spina bifida and is evident on delivery.The meninges protrude through the defect,and they contain spinal cord elements.It appears as a very pronounced skin defect,usually covered by a transparent membrane,and neural tissue may be attached to the inner surface.

Question 16

A nurse admits a 5-year-old child with bacterial meningitis to the pediatric intensive care unit.Which information obtained by the nurse during the intake history is most helpful for the nurse to document?
A)Fell off swing hitting head 2 months ago
B)History of recent sinus infection
C)Mother with history of herpes simplex
D)Sibling with upper respiratory infection

Accepted Answer

In a child this age,common causes of bacterial meningitis include septicemia,surgical procedures involving the CNS,penetrating wounds,otitis media,sinusitis,cellulitis of the scalp or face,dental cavities,pharyngitis,and orthopedic diseases.Blunt trauma from falling off a swing and a sibling with a URI are noncontributory.Herpes simplex is an important cause of neonatal viral meningitis.

Question 17

What would the nurse assess for in a child with a disturbance in the basal ganglia?
A)Ataxia
B)Hyperthermia
C)Hypotension
D)Incontinence

Accepted Answer

Ataxia,or uncoordinated movements,may been seen in a child with a problem of the basal ganglia,which controls movement.Changes in temperature and blood pressure are more likely related to problems with the hypothalamus,and incontinence could signify a spinal cord problem.

Question 18

The pediatric nurse carefully monitors a patient's status by assessing the child's level of consciousness.The nurse understands that the Glasgow Coma Scale provides clues to which of the following?
A)Encephalitis
B)Irreversible coma
C)Neurological impairment
D)Neurological status

Accepted Answer

The child's level of consciousness and the use of the Pediatric Glasgow Coma Scale,pupil response,and overall activity provide clues to the child's neurological status

Question 19

The student nurse studying the neurological system learns that areas of gray matter are found deep in the brain.To determine damage to the basal ganglia,what will the nurse assess?
A)Blood pressure
B)Homeostasis
C)Movement
D)Sensory impulses

Accepted Answer

Areas of gray matter are found deep in the brain.These areas include the basal ganglia (affect movement),the hypothalamus (maintains homeostasis and regulates blood pressure,heart rate,and temperature),and the thalamus (processes sensory impulses and sends them to the cerebral cortex).

Question 20

The pediatric nurse caring for hearing-impaired children teaches parents the recommended guidelines for communicating with their children.Which instruction is inconsistent with current guidelines?
A)Ignoring any related stigmas
B)Obtaining the child's attention before speaking
C)Positioning yourself at the child's eye level
D)Talking slowly and loudly to the child

Accepted Answer

The following guidelines are used when communicating with the hearing-impaired child: obtain the child's attention prior to speaking,face the child when talking,position yourself at the child's eye level,talk slowly and loudly,modify the environment to reduce noise,and offer emotional support because the child may face stigmas related to his or her hearing loss.

Quiz 28: Caring for the Child With a Neurological or Sensory Condition

The pediatric nurse caring for patients in a trauma center examines a patient who has increased intracranial pressure as a result of a motor vehicle crash.The nurse is aware that secondary brain injuries can result from which factor?

A hospitalized child is having a seizure.Which action by the nurse takes priority?

The student nurse studying anatomy and physiology understands which of the following to be the function of axons?

A child is prescribed baclofen (Lioresal) via intrathecal pump to treat severe muscle spasms related to cerebral palsy.What teaching does the nurse provide the child and parents?

A school-aged child wishes to learn embroidery from her grandmother,but the grandmother reports that the child can only concentrate on the projects for a short time and seems frustrated.What action by the nurse is the most appropriate?

A student nurse is tutoring another student on anatomy and physiology.What does the tutor explain is the function of myelin sheaths on certain nerves?

The pediatric nurse caring for a patient with encephalitis explains to the parents that the most common origin of encephalitis is which of the following?

A nurse is caring for a child with suspected epilepsy.Which diagnostic test does the nurse facilitate as the priority for this child?

An ophthalmologist examining the eyes of a patient explains to the nurse that the patient has an irregular curvature or uneven contour of the eye,resulting in impaired light refraction that causes blurred vision at all distances.Which condition does the nurse inform the parents about?

A nurse is caring for a child who has intracranial pressure (ICP) monitoring.The nurse assesses the child and notes that the ICP is 9 mm Hg.Which action by the nurse is most appropriate?

A nurse is caring for a child who only awakens to painful stimuli and produces no verbal responses.Which term is the most appropriate when documenting this child's status?

A nurse admits a child experiencing drowsiness and vomiting who has had a seizure at home.The parents state the child was healthy until 2 weeks ago when she had a viral illness.Which diagnostic testing does the nurse facilitate as a priority?

The pediatric nurse explains to the parents of a comatose child that which structure controls the child's level of consciousness?

A neonate receives a diagnosis of hydrocephalus.The pediatric nurse assesses for congenital anomalies related to this condition.Which condition is inconsistent with the nurse's knowledge of hydrocephalus?

A pediatric nurse performs a physical examination on a neonate and notes a spinal lesion with the meninges protruding through the defect that contains spinal cord elements.The nurse documents which condition as being present?

A nurse admits a 5-year-old child with bacterial meningitis to the pediatric intensive care unit.Which information obtained by the nurse during the intake history is most helpful for the nurse to document?

What would the nurse assess for in a child with a disturbance in the basal ganglia?

The pediatric nurse carefully monitors a patient's status by assessing the child's level of consciousness.The nurse understands that the Glasgow Coma Scale provides clues to which of the following?

The student nurse studying the neurological system learns that areas of gray matter are found deep in the brain.To determine damage to the basal ganglia,what will the nurse assess?

The pediatric nurse caring for hearing-impaired children teaches parents the recommended guidelines for communicating with their children.Which instruction is inconsistent with current guidelines?