Neurological Disorders
Answer 3 could immediately be elimi- elimi-nated because the child is having a
seizure, not a cardiac arrest.
19. 1. Absence seizures occur frequently and last less than 30 seconds. The child ex-periences a brief loss of consciousness where she may have a change in activ-ity. These children rarely fall, but they may drop an object. The condition is often confused with daydreaming.
2. Akinetic seizures occur when the young child experiences a brief loss of conscious-ness and postural tone and falls to the
experiencing a generalized seizure as it in-creases the risk of injury and aspiration.
4. Stopping the seizure with rectal diazepam takes priority over placing a nasogastric tube.
TEST-TAKING HINT:The test taker needs to consider the current situation and the level of difficulty establishing intravenous access in a child experiencing a general-ized seizure.
23. 1. Children who experience a febrile seizure are likely to experience another febrile seizure.
2. Most children over the age of 5 years do not have febrile seizures.
3. Antipyretics are administered to prevent the child’s temperature from rising too rapidly.
4. Most children are not prescribed anticon-vulsant medication after experiencing a febrile seizure.
TEST-TAKING HINT:There is an increased risk in siblings, but the 7-year-old child is above the usual age of febrile seizures.
24. 1. Although many children with epilepsy require more than one medication to achieve seizure control, it is recommended that only one medication be begun at a time so that the child’s reaction to the specific medication can be observed.
2. One medication is the preferred way to achieve seizure control. The child is monitored for side effects and drug levels.
3. Rectal gels are used to stop a seizure once it has begun; they are not used to prevent seizures.
4. The route of choice for the prevention of seizures is oral. There is no reason to assume that compliance will be an issue prior to beginning anticonvulsant therapy.
TEST-TAKING HINT:The test taker should eliminate answer 4 because IV medica-tions are not included in the initial home medication regimen.
25. 1. Swimming does not need to be avoided as long as there is someone else with her to call for help in the event of an emergency.
2. The rhythmic reflection of other car lights can trigger a seizure in some children.
3. There is no reason to avoid strenuous activity.
4. It is important for adolescents to be with their peers in order to reach developmen-tal milestones.
ground. The child quickly regains consciousness.
3. A non-epileptic seizure is a seizure that occurs secondary to another disorder, such as a fever or increased ICP.
4. A simple spasm seizure is not a diagnosis.
TEST-TAKING HINT:“Daydreaming” is the classic description of an absence seizure.
20. 1. An atonic seizure is characterized by a loss of muscular tone, whereby the child may fall to the ground.
2. It is important to evaluate the child for life stressors, but suspected seizure activity needs immediate evaluation.
3. An absence seizure is characterized by a change in activity whereby the child appears to be daydreaming or staring straight ahead. The child usually contin-ues basic simple movements but loses an awareness of surroundings.
4. The preschool years are a not a time of rapid growth. Many children in this age group appear clumsy, but suspected seizure activity needs immediate evaluation.
TEST-TAKING HINT:The test taker should recognize the description as seizure activ-ity and, therefore, could immediately eliminate answers 3 and 4.
21. 1. High fat and low carbohydrates are the components of the ketogenic diet.
2. High fat and high carbohydrates are the components of the ketogenic diet.
3. Low fat and low carbohydrates are the components of the ketogenic diet.
4. Low fat and high carbohydrates are the components of the ketogenic diet.
TEST-TAKING HINT:The test taker needs to be familiar with the components of a ketogenic diet.
22. 1. It is very difficult and time-consuming to establish an intravenous line on a child who is experiencing a generalized seizure.
Rectal diazepam is first administered in an attempt to stop the seizure long enough to establish a line, and then medication is administered intravenously.
2. Rectal diazepam is first administered in an attempt to stop the seizure long enough to establish an IV, and then IV medication is administered.
3. Although the child may become hypo-glycemic due to increased metabolic demands, stopping the seizure with rectal diazepam is the first priority. Medication is not placed in the mouth of a child
TEST-TAKING HINT:The test taker should consider the answers that can lead to a seizure. Answer 2 is the only answer that includes a common trigger.
26. 1. Nothing should be placed in the child’s mouth as he is at risk for aspiration. Rescue valium is usually administered rectally.
2. The nurse should remain with the child and observe the seizure. The child should be protected from his environ-ment, and clothing should be loosened.
3. A tongue blade should never be placed in the child’s mouth, as it can cause injury or increase the risk of aspiration.
4. The nurse should remain with the child and call for help. An 8-year-old child can be injured if carried during a seizure.
TEST-TAKING HINT:The test taker should eliminate answers 1 and 3 because noth-ing should ever be placed in the mouth of a child having a seizure.
27. 1. The child who has a closed-head injury has decreased perfusion to the brain and increased metabolic needs that lead to is-chemia and brain damage.
2. The child who has a closed-head injury has decreased perfusion to the brain and increased metabolic needs that lead to is-chemia and brain damage.
3. The child who has a closed-head injury has decreased perfusion to the brain and increased metabolic needs that lead to is-chemia and brain damage.
4. Decreased perfusion of the brain and increased metabolic needs of the brain.
TEST-TAKING HINT:The test taker needs to be familiar with the mechanics of a head injury.
28. 1. It is not a priority of care to find out if anyone else was injured.
2. Although open-ended questions are im-portant, the nurse needs specific informa-tion, and the anxious parent may need to be guided during triage assessment.
3. Asking specific questions will give the nurse the information needed to deter-mine the level of care for the child.
4. Although it is important to provide safety education, this information should be given in a nonjudgmental manner at a point when the parents and child are less stressed.
TEST-TAKING HINT:The test taker needs to consider the role of a triage nurse.
Specific information needs to be obtained
quickly. Answer 4 can be eliminated be-cause it implies judgment and does not help the current situation.
29. 1. Cushing triad is characterized by a decrease in heart rate, an increase in blood pressure, and changes in respira-tions. The triad is associated with severely increased ICP. Mannitol is an osmotic diuretic that helps decrease the increased ICP.
2. The child’s vital signs need to be moni-tored, but a fluid bolus will increase the circulating volume and lead to an increase in the child’s ICP. Fluid boluses are neces-sary in cases of shock but must be admin-istered carefully and the child closely observed.
3. An antihypertensive will not help decrease the ICP.
4. The child will benefit from supplemental oxygen, but it will not help decrease the ICP.
TEST-TAKING HINT:The test taker should recognize the signs of Cushing triad. If not recognized, the child’s condition should be seen as deteriorating and emer-gent. Answer 2 and 4 can be eliminated because they are only partially correct.
30. 1. Even if the child is unresponsive, the child can still feel pain.
2. If pain medication is administered cau-tiously, the child can still be monitored, and signs of improvement will be evident.
3. Pain medication promotes comfort and ultimately decreases ICP.
4. Pain medication decreases the demand for oxygen.
TEST-TAKING HINT:The test taker needs to consider the presence and significance of pain in the unresponsive child. Answer 1 can be immediately eliminated because the unresponsive child does feel pain.
31. 1. A cooling blanket will help cool the child quickly and at a controlled temperature.
2. Tylenol should be administered after the cooling blanket has been applied. Tylenol is an effective medication, but a cooling blanket will begin to be effective before the medication is absorbed.
3. Tylenol should be administered after the cooling blanket has been applied. Tylenol is an effective medication, but a cooling blanket will begin to be effective before the medication is absorbed.
4. Although the myelination is immature, the immature musculoskeletal support places the infant at risk.
TEST-TAKING HINT:Answer 4 should be eliminated because superficial vessels do not lead to SBS.
35. 1. A meningocele is a sac that contains a portion of the meninges and the CSF.
2. A myelomeningocele is a sac that con-tains a portion of the meninges, the CSF, and the nerve roots.
3. Spinal bifida occulta is a failure of the ver-tebral arches to fuse. There is no sac, and no defect is visible.
4. Anencephaly occurs when the brain does not develop above the brainstem.
TEST-TAKING HINT:The test taker could eliminate answer 4 because anencephaly is a brainstem abnormality and does not involve the spine.
36. 1. Because a meningocele does not con-tain any nerve endings, most children experience no neurological problems after surgical correction.
2. Corrective surgery is done as soon as pos-sible to minimize the risk of infection.
3. Because a meningocele does not contain any nerve endings, most children experi-ence no neurological problems after surgical correction.
4. Because a meningocele does not contain any nerve endings, most children experi-ence no neurological problems after surgical correction.
TEST-TAKING HINT:The test taker should consider the risks of infection and imme-diately eliminate answer 2 because the surgery is not postponed but performed as soon as possible.
37. 1. Although it is important to measure the head circumference of all babies, children with myelomeningocele are at increased risk for hydrocephalus, which can be manifested with an increase in head circumference.
2. Children with myelomeningocele are at increased risk for hydrocephalus, which can be manifested with an in-crease in head circumference.
3. Although a defect in the spine can be a portal of entry for infection, children with myelomeningocele often have hydrocephalus as well.
4. Children with myelomeningocele are not at risk for microcephaly.
4. Ice packs will cause the child to shiver, which will increase oxygen consumption and possibly increase ICP. Shivering can also cause the child to experience a rebound increase in temperature.
TEST-TAKING HINT:The test taker should consider the cause of the increased temperature and how to cool the child quickly. Answer 4 should be eliminated because ice packs are no longer recom-mended to treat increased temperatures.
32. 1. Although peers play an important role in the adolescent’s development, this particu-lar patient is at risk for increased ICP and should have decreased stimulation.
2. Loud speaking may cause the child’s ICP to increase.
3. A bright, lively environment may lead to increased ICP.
4. A dark, quiet environment and minimal stimulation will decrease oxygen con-sumption and ICP.
TEST-TAKING HINT:The test taker should consider the causes of ICP and select an-swers that will not increase ICP. Anan-swers 1, 2, and 3 cause an increase in ICP and should be eliminated.
33. 1. A computed tomography scan of the head will reveal trauma. Dilating the eyes is performed to check for retinal hemorrhages that are seen in an infant who has experienced SBS.
2. An EEG is not usually done as a priority test in an infant displaying symptoms of SBS.
3. Although close monitoring of vital signs are important, further testing is required.
4. X-rays of all long bones may be per-formed to rule out any old or new frac-tures, but CT and pupil examinations are the priority for this patient.
TEST-TAKING HINT:The test taker should consider child abuse (SBS) as the story does not match the injury. The pupils are always dilated to rule out SBS.
34. 1. An open anterior fontanel allows for swelling, therefore decreasing the risk of injury.
2. Insufficient musculoskeletal support and a disproportionate head places the infant at risk because the head cannot be supported during a shaking episode.
3. Superficial veins and arteries do not place the infant at a higher risk for injury.
TEST-TAKING HINT:The test taker should consider the diagnosis and choose a response that best fits the current diagnosis.
38. 1. Some children with myelomeningocele ex-perience learning disabilities, but it is not the most common complication.
2. Urinary tract infections are the most common complication of
myelomeningocele. Nearly all children with myelomeningocele have a neuro-genic bladder that leads to incomplete emptying of the bladder and subse-quent urinary tract infections. Fre-quent catheterization also increases the risk of urinary tract infection.
3. Many children with myelomeningocele experience hydrocephalus, but it is not the most common complication.
4. Children with myelomeningocele are at risk for skin breakdown and decubitus ulcers, but they are not the most common complications.
TEST-TAKING HINT:The test taker needs to be familiar with the complications of myelomeningocele. Neurogenic bladder is the most common complication, so the test taker should be led to select answer 2.
39. 1. Placing the child in the prone position is correct. A dry dressing may adhere to the defect, causing irritation.
2. A dry dressing may adhere to the defect, causing irritation.
3. Oral gastric feedings are not usually started unless there is going to be a delay in surgery. The defect is usually corrected immediately to avoid infection.
4. The child is placed in the prone posi-tion to avoid any pressure on the de-fect. A sterile moist dressing is placed over the defect to keep it as clean as possible. Intravenous fluids are begun after the surgery.
TEST-TAKING HINT:The test taker should consider the location of the defect and eliminate answer 1. Answer 2 should be eliminated as a dry dressing could cause irritation.
40. 1. The child with a neurogenic bladder will never be able to spontaneously empty it completely. Most girls learn to self-catheterize at a young age.
2. The child with a neurogenic bladder will never be able to spontaneously empty it completely.
3. Placing the child with a neurogenic bladder on a bladder training program is not helpful, as the child with a neurogenic bladder will never be able to spontaneously empty it completely.
4. A vesicostomy is an example of an op-tion for children with myelomeningo-celes where alternatives to traditional catheterizations are created.
TEST-TAKING HINT:The test taker should recognize that the neurogenic bladder in a child with myelomeningocele is irre-versible, and answers 2 and 3 should be eliminated.
41. 1. Children with myelomeningocele are prone to latex allergies and therefore should not eat bananas.
2. Children with myelomeningocele are prone to latex allergies and therefore should not be exposed to balloons.
3. Preventing skin breakdown is important in the child with myelomeningocele, as pressure points are not felt easily.
4. It is always important to provide education on dietary needs, but it is not the priority in the immediate postoperative period.
TEST-TAKING HINT:The test taker should consider that children with myelomeningo-cele are prone to latex allergies and there-fore should eliminate answers 1 and 2.
42. 1. Although there is a cosmetic benefit, the surgery is done to reconstruct the skull to allow the brain to grow properly. There are potential complications associated with this surgery, such as increased ICP.
2. The surgery is done to reconstruct the skull to allow the brain to grow prop-erly. Because there are potential com-plications associated with this surgery, such as increased ICP, the child is usually closely observed in the PICU.
3. The surgery is not usually postponed as it will allow for brain growth.
4. The surgery is not usually postponed as it will allow for brain growth.
TEST-TAKING HINT:The test taker should consider the importance of allowing room for brain growth. Answers 3 and 4 can be eliminated because the surgery is per-formed sooner than later.
43. 1. The infant needs to wear the helmet 23 hours daily. It is removed for bathing, but not sleeping.
2. The helmet is most effective when the child is younger, as the bones in the skull
TEST-TAKING HINT:The test taker should be familiar with normal developmental milestones and eliminate answers 1, 3, and 4 because they are all developmen-tally appropriate.
47. 1. CP is diagnosed based on clinical charac-teristics and developmental findings. It is not diagnosed with any type of radiological examination.
2. Although most cases of CP are developed during the neonatal period, some children can develop CP at a later age.
3. The child will be given a chance to recover and will be monitored closely before a diagnosis is made.
4. Although many children develop CP after having complications of meningitis, many do not. Although the parents should not be given false hope, they should not be led to lose hope for a complete recovery.
TEST-TAKING HINT:The test taker should be led to answer 3 because it explains the process and does not state that the child definitely will or will not develop CP.
48. 1. The nurse cannot assume that the child will have speech difficulties. Speech therapy does not guarantee vocalization at a developmentally appropriate age.
2. Although speech therapy will assist with babbling at a later age, its primary purpose is to assist with feeding.
3. It is important to involve speech therapy to strengthen tongue and jaw movements to assist with feeding. The infant who is at risk for CP may have weakened and uncoordinated tongue and jaw movements.
4. Members of a multidisciplinary team become involved in a child’s care based on specific needs, not hospital routine.
TEST-TAKING HINT:The test taker should immediately eliminate answer 4 because it does not consider the child’s individual needs.
49. 1. Baclofen is not given for postoperative pain control.
2. Baclofen is not given for seizures.
3. Baclofen is given to help control the spasms associated with CP.
4. Baclofen is not given for bladder control.
TEST-TAKING HINT:The test taker needs to be familiar with the medication baclofen.
50. 1. CP is a nonprogressive disorder.
2. CP can be manifested in different ways as the child grows. It does not progress, are more malleable. The child is less likely
to need the helmet when upright and mo-bile as there is less pressure in one area.
3. The helmet is worn 23 hours every day and removed only for bathing.
4. Most children wear the helmet for 3 months.
TEST-TAKING HINT:The test taker should recognize that the helmet is worn 23 hours daily and can eliminate answers 1, 2, and 4.
44. 1. The incidence of CP has increased partly due to the increased survival of extreme low-birth-weight and premature infants.
2. The incidence of CP has increased since the 1960s.
3. The incidence of CP has increased since the 1960s.
4. There is no evidence to suggest that CP
4. There is no evidence to suggest that CP