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

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Question 1

Multiple Choice

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A nurse is caring for a child and notes Battle's sign during the assessment.Which action by the nurse is the most appropriate?

A) Assist with obtaining laboratory studies.
B) Document the findings in the child's chart.
C) Measure the child's abdominal girth.
D) Notify the provider and facilitate a CT or an MRI.

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Question 2

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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

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Question 3

Multiple Choice

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An adolescent has frequent headaches accompanied by nausea and vomiting.What item is most appropriate for the nurse to include in the teaching plan for this adolescent patient?

A child's chart indicates he has leukocoria and a hyphema in the right eye.Which teaching does the nurse implement for the child and parents?

A nurse is caring for an 8-year-old with Guillain-Barré Syndrome (GBS) .On hourly rounds,the nurse assesses that the child's lung sounds are diminished,respiratory rate is 8 breaths/min and shallow,and pulse oximeter is 88%.What action by the nurse takes priority?

A nurse is caring for a 10-year-old child with a brain injury.On assessing the child,the nurse finds the following data: opens eyes only to pain,mutters inappropriate words,has abnormal extension to stimulation.Which action by the nurse takes priority?

A child who is intubated and mechanically ventilated has an intracranial pressure monitoring device in place.The child is agitated.Which medication order would the nurse question based on the assessment data?

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

A nurse is teaching a parent group about caring for their infants and toddlers.What does the nurse teach to prevent a serious neurological problem in infants?

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

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 pediatric nurse caring for patients in an emergency room performs an assessment of a child who survived a drowning incident.Which does the nurse assess when using the Orlowski scale on this child?

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?

During assessment of a 6-year-old child with meningitis,the nurse places the child supine and attempts to put the child's chin on her chest.The child cries out in pain and flexes her knees.How does the nurse document this assessment finding in the medical record?

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 nurse in a well-child clinic notes that a 5-month-old is not able to hold her head up.Which action by the nurse is the most appropriate?

A nurse is caring for a child who had a sudden onset of muscle weakness beginning in the legs and progressing in an ascending fashion,but who otherwise appears healthy.Which laboratory result would confirm the nurse's suspicion about the origin of this problem?

A new nurse is caring for a child who had a ventriculoperitoneal shunt placed 2 days ago for hydrocephalus.Which action by the new nurse causes the experienced nurse to intervene?

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?