Seizure Pediatric Practice Questions (Test #2, Fall 2020)

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JamieNTT_Preview Pediatric Neurological Practice Que...28 terms cheyenne_hutcheson Preview Cerebral Palsy MNL/NCLEX 46 terms sknewell1Preview Pediatr 32 terms SN_ A child is to receive phenytoin (Dilantin) 100 mg IV for seizure prophylaxis. Which intervention is appropriate when administering this drug?

• Mix it in dextrose 5% in water and give over 1 hour.
• Administer no faster than 2 mg/kg/min.
• Do not use an inline filter.
• Monitor temperature prior to and after administration.
• Mix intravenous doses in normal saline as mixtures precipitate with dextrose 5%

in water.

• Phenytoin (Dilantin) should be given slowly (1-2 mg/kg/min) via pump. Rapid

infusion may cause hypotension, arrhythmias, and circulatory collapse.

• An inline filter is recommended.
• Continuous monitoring of electrocardiogram, blood pressure, and respiratory

status is essential because of potential side effects.

TEST-TAKING HINT: The test taker must know both the side effects of the drug

and how to administer it safely.A newborn develops tetany and has a seizure prior to discharge from the nursery. The newborn is diagnosed with hypocalcemia secondary to hypoparathyroidism and is started on calcium and vitamin D. Which information would be most important for the nurse to teach the parents?

• They should observe the baby for signs of tetany and

seizures.

• They should observe for weakness, nausea, vomiting,

and diarrhea.

• They should administer the calcium and vitamin D daily

as prescribed.

• They should call the clinic if they have any questions

about care of the newborn.

• The baby has hypocalcemia and is being treated for this condition by the team.

This should be reviewed with the family.

• Vitamin D toxicity (weakness, nausea, vomiting, and diarrhea) is a serious

consequence of therapy and should be the top priority in teaching.

• Reminding the family to give the medication as prescribed is helpful and should

be a basic part of discharge care, but it is not the most important information.

• Giving the family the phone number for calling the clinic is part of basic care for

discharge to home, but it is not the most important information.

TEST-TAKING HINT: Going over the side effects and risks of vitamin D treatment

educates the family about what to watch for when giving the new medications.

Which signs best indicate increased intracranial pressure (ICP) in an infant? Select all that apply.

• Sunken anterior fontanel.
• Complaints of blurred vision.
• High-pitched cry.
• Increased appetite.
• Sleeping more than usual.
• The anterior fontanel is usually raised and bulging in infants with increased ICP.
• The infant is not able to comprehend blurred vision or make any statements.
• A high-pitched cry is often indicative of increased ICP in infants.
• The infant with increased ICP usually has a poor appetite and does not feed

well.

• The infant may be sleeping more than usual because of increased ICP.

TEST-TAKING HINT: The test taker needs to be familiar with hydrocephalus and

how increased ICP is manifested in infants. Answer 2 can be eliminated because an infant cannot specifi cally verbalize.A child with a ventriculoperitoneal (VP) shunt complains of headache and blurry vision and now experiences irritability and sleeping more than usual. The parents ask the nurse what they should do. Select the nurse 's best response.

• "Give her some acetaminophen (Tylenol), and see if her

symptoms improve. If they do not improve, bring her to the health-care provider 's office."

• "It is common for girls to have these symptoms,

especially prior to beginning their menstrual cycle. Give her a few days, and see if she improves."

• "You are probably worried that she is having a problem

with her shunt. This is very unlikely because it has been working well for 9 years."

• "You should immediately take her to the emergency

department because these may be symptoms of a shunt malfunction."

• These are symptoms of a shunt malfunction and should be evaluated

immediately.

• Although these symptoms may be associated with the start of a girls menstrual

cycle, they are symptoms of a shunt malfunction and require immediate evaluation.

• A shunt can malfunction at any point and should be evaluated when signs of

increased ICP are evident.

• These are symptoms of a shunt malfunction and should be evaluated

immediately.

TEST-TAKING HINT: The test taker should recognize these symptoms as signs of a

shunt malfunction and can eliminate answers 1, 2, and 3 because they do not address the situation as an emergency Which position initially is most beneficial for an infant who has just returned from having a ventriculoperitoneal (VP) shunt placed?

• Semi-Fowler in an infant seat.
• Flat in the crib.
• Trendelenburg.
• In the crib with the head elevated to 90 degrees.
• A semi-Fowler position in an infant seat may allow the ventricles to drain too

rapidly in the immediate postoperative period.

• Flat in the crib is the position usually used initially, with the angle gradually

increasing as the child tolerates.

• The Trendelenburg position is not used immediately after ventriculoperitoneal

shunt placement because it would increase ICP.

• The head elevated to 90 degrees will allow the ventricle of the brain to drain

too quickly.TEST-TAKING HINT: The test taker should note the word "initially" and consider why the position would be immediately benefi cial. Answer 3 can be eliminated because that position could increase ICP.

The nurse is aware that cloudy cerebrospinal fluid (CSF)

most likely indicates:

• Viral meningitis.
• Bacterial meningitis.
• No infection, because CSF is usually cloudy.
• Sepsis.
• The CSF in viral meningitis is usually clear.
• The CSF in bacterial meningitis is usually cloudy.
• The CSF in healthy children is usually clear.
• Sepsis is an infection of the bloodstream.

TEST-TAKING HINT: The test taker can eliminate answer 4 because an infection of

the bloodstream would not be detected in the CSF.A child is being admitted with the diagnosis of meningitis.

Select the procedure the nurse should do first:

• Administration of intravenous antibiotics.
• Administration of maintenance intravenous fluids.
• Placement of a Foley catheter.
• Send the spinal fluid and blood samples to the

laboratory for cultures.

• Administration of intravenous antibiotics should not be started until after all

cultures have been obtained.

• Administration of maintenance IV fluids can wait until after the cultures have

been obtained.

• Placement of a Foley catheter is not a priority procedure.
• Cultures of spinal fluid and blood should be obtained, followed by

administration of intravenous antibiotics.TEST-TAKING HINT: The test taker needs to think about priority of care. Answer 3 can be immediately eliminated because it is not a priority. Answer 4 should be considered a priority because antibiotics should not be started before the samples have been obtained and sent for culturing The nurse is caring for a 6-month-old infant diagnosed with meningitis. When the child is placed in the supine position and flexes his neck, the nurse notes he flexes his

knees and hips. This is referred to as:

• Brudzinski sign.
• Cushing triad.
• Kernig sign.
• Nuchal rigidity.
• Brudzinski sign occurs when the child responds to a flexed neck with an

involuntary flexion of the hips and/or knees.

• Cushing triad is a sign of increased ICP and is manifested with an increase in

systolic blood pressure, decreased heart rate, and irregular respirations.

• Kernig sign occurs when there is resistance or pain in response to raising the

childs flexed leg.

• Nuchal rigidity occurs when there is a resistance to neck flexion.

TEST-TAKING HINT: The test taker should be familiar with terms used to describe

meningeal irritation

Select the best room assignment for a newly admitted child with bacterial meningitis.

• Semiprivate room with a roommate who also has

bacterial meningitis.

• Semiprivate room with a roommate who has bacterial

meningitis but has received intravenous antibiotics for more than 24 hours.

• Private room that is dark and quiet with minimal

stimulation.

• Private room that is bright and colorful and has

developmentally appropriate activities available.

• The child with bacterial meningitis should be placed in a private room isolated

from all other patients. Bacterial meningitis is caused by many pathogens, and patients should be isolated from each other.

• The child with bacterial meningitis should be placed in a private room isolated

from all other patients. Bacterial meningitis is caused by many pathogens, and patients should be isolated from each other.

• A quiet private room with minimal stimulation is ideal because the child with

meningitis should be in a quiet environment to avoid cerebral irritation.

• A bright room with developmental activities may cause irritation and increase

ICP.

TEST-TAKING HINT: The test taker should consider what contributes to cerebral

irritation and should not be infl uenced by the developmental requirements of a healthy child.Which order would the nurse question for a child just admitted with the diagnosis of bacterial meningitis?

• Maintain isolation precautions until 24 hours after

receiving intravenous antibiotics.

• Intravenous fluids at 1½ times regular maintenance.
• Neurological checks every hour.
• Administer acetaminophen (Tylenol) for temperatures

higher than 38°C (100.4°F)

• Isolation precautions must be maintained for at least the first 24 hours of

intravenous antibiotic therapy.

• Intravenous fluids at 1½ times regular maintenance could cause fluid

overload and lead to increased ICP.

• Neurological checks are usually made at least every hour.
• Acetaminophen (Tylenol) is usually administered when the child has a fever, as

increased temperature can lead to increased ICP.

TEST-TAKING HINT: The test taker should consider the answers and eliminate

those that may increase ICP. Intravenous fluids are often given at less than maintenance unless the child is hemodynamically unstable.The nurse is caring for a 1-year-old who has just been diagnosed with viral encephalitis. The parents ask if their child will be admitted to the hospital. Select the nurse's best response.

• "Your child will likely be sent home because

encephalitis is usually caused by a virus and not bacteria."

• "Your child will likely be admitted to the pediatric floor

for intravenous antibiotics and observation."

• "Your child will likely be admitted to the PICU for close

monitoring and observation."

• "Your child will likely be sent home because she is only
• year old. We see fewer complications and a shorter

disease process in the younger child."

• Although encephalitis is usually caused by a viral infection, the child is usually

admitted for close observation.

• Intravenous antibiotics are not given to the child with viral encephalitis.
• The young child with encephalitis should be admitted to a PICU where close

observation and monitoring are available. The child should be observed for signs of increased ICP and for cardiac and respiratory compromise.

• The child would not be discharged because observation for complications is

necessary. As a general rule, younger children tend to have more complications and require a PICU admission.

TEST-TAKING HINT: The test taker should be familiar with the diagnosis and

treatment of encephalitis. The test taker should not be influenced by the word "viral" but should realize that the sequelae of encephalitis require close monitoring in an ICU environment.