Neuro Practice Questions

List five infectious processes common for causing febrile seizures in infants and children between 6 months and 5 years of age:

Urinary tract infections

Upper respiratory infections

Meningitis

Pneumonia

Otitis media

True or false: Febrile seizures are usually self-limiting and have a postictal period lasting for less than 10 to 15 minutes.

true

The clinical manifestations associated with bacterial meningitis include:

1 Malaise

2 Myalgia

3 Anorexia

4 Skin rashes

5 Nuchal rigidity

6 Positive Kernig’s pointed nose

7 Negative Brudzinski

8 Fevers greater than 104° F

1, 2, 3, 4, 5, 6

When a 6-month-old is admitted to the hospital with suspected meningitis and the infant is crying, irritable, and in an opisthotonic position, which nursing intervention is priority?

A. Educating the family on the prevention of meningitis in children

B. Initiating isolation precautions and intravenous antibiotics

C. Encouraging the parents to hold, feed, and care for their infant

D. Assessing the infant’s fontanels along with a head-to-toe assessment.

b

The nurse understands that children with infectious diseases require treatment with antipyretics for fever management to prevent febrile seizures, and that aspirin or aspirin by-products should not be administered to children. Which complication can be life-threatening to children when given aspirin during viral infections?

A. Cardiovascular disease

B. Upper respiratory infections

C. Urinary tract infections

D. Reye syndrome

d

List five nursing interventions that are a priority for injury prevention and seizure precautions with children.

Pad the side rails of the bed

Do not place anything in the mouth

Do not restrain a child

Maintain a patent airway

Keep the bed in a low and locked position

Which explanation is an incorrect description of the acronym AVPU for assessing a child’s level of consciousness (LOC)?

A. A = Alert and awake

B. V = Visual disturbances

C. P = Responsive to painful stimuli

D. U = Unresponsive

b

True or false: Encephalitis can be caused by bacteria, viruses, fungi, or protozoa, but most are caused by protozoa.

false

The late signs of increased intracranial pressure include:

1 Decreased systolic blood pressure

2 Cushing’s triad

3 Papilledema

4 Tachycardia

5 Respiratory distress

6 Deteriorating LOC

7 Dilated pupil(s)

8 Fixed pupil(s)

2, 3, 5, 6, 7, 8

List the ABCDE assessment of a neurologically injured child

A = Airway

B = Breathing

C = Circulation

D = Disability or neurological status

E = Exposure of body

Which symptom is not an early sign of increased intracranial pressure?

A. Sunsetting eyes

B. Vomiting episodes

C. Cheyne-Stokes respirations

D. Headache worse when awakening

c

The emergency department has an infant brought in by both parents with assessment findings of vomiting, failure to thrive, and a decreased level of consciousness. Which occurrence should the nurse suspect?

A. Immunization reaction

B. Metabolic syndrome

C. Haemophilus influenzae

D. Shaken-baby syndrome

d

True or false: Many brain injuries with infants and children involve coup and contrecoup impact. The contrecoup injury results from secondary impact as the brain moves forward and then backward within the skull.

true

which type of brain injury (concussion/mild, moderate, or severe): Coma, increased intracranial pressure with seizures

severe

which type of brain injury (concussion/mild, moderate, or severe): Easily irritated, changes in eating

concussion/mild

which type of brain injury (concussion/mild, moderate, or severe): Loss of consciousness, amnesia

moderate

List three complications associated with ventriculoperitoneal shunts used for preventing hydrocephaly.

Infections

Obstruction

Need for revision with growth

The clinical manifestations common to ventriculoperitoneal shunt malfunction include:

1 Changes or decreases in LOC

2 Complaints of headaches

3 Nausea and vomiting

4 Visual disturbances

5 Increased head circumference

6 Bulging anterior fontanel

1, 2, 3, 4, 5, 6

During a well child visit in the pediatrician’s office, the nurse would suspect hydrocephalus in an infant with which assessment finding?

A. Sunken fontanels

B. Narrow suture lines

C. Increase in head circumference

D. Weight gain since last visit

c

True or false: The signs of a shunt infection include negative blood cultures, decrease in white blood cell count and protein, and an increase in glucose.

false

what is the neural tube defect: Failure of vertebral arches to fuse

spina bifida occulta

what is the neural tube defect: Sac-like herniation with meninges

meningocele

what is the neural tube defect: Sac-like extrusion of spinal cord

myelomeningocele

\
The nurse is caring for a 16-year-old female client who was brought to the emergency room after having several seizures at home. \n

Admission Notes: 1000 \n

The client was brought to the emergency room via ambulance. Parents state their adolescent "had 3 seizures this morning starting about 20 minutes ago; they seemed to last about few minutes with not much time between the next seizure activity. Our adolescent became very stiff and seemed to flail about. Before our adolescent had the first seizure, they said they smelled something funny." \n

The parents also report that there was a recent change in the adolescent's medication regimen from carbamazepine to phenytoin. The client is drowsy, opens their eyes to verbal stimuli and follows simple commands such as squeeze my hands; speech is soft and low; client able to state first name before falling back to sleep. \n

Skin is warm, moist and intact except for bilateral reddened elbows with a small skin tear on right elbow. Client is incontinent of urine. Vital signs: temperature, 99.1°F (37.3°C); heart rate, 92 beats/min, regular; blood pressure, 86/58 mmHg; respiratory rate, 14 breath/min, shallow; oxygen saturation, 92% on room air. \n

The parents are concerned about their adolescent's safety, because the adolescent is earning a driver's permit. Paramedics inserted a 20 gauge catheter in the client's right antecubital and administered 5 mg of diazepam when the client started to have another tonic–clonic seizure.

\
Which four findings require follow-up? \n 1 Vital signs \n 2 Laboratory Values \n 3 Medication \n 4 Skin integrity \n 5 Renal function \n 6 Hydration status \n 7 Neurological status

1, 2, 3, 7

S/S of generalized seizures:

1 Multiple consecutive seizures

2 Event amnesia

3 Aura

4 Impaired consciousness

5 Postictal state

6 Jerky, rhythmic muscle spasms

2, 3, 4, 5, 6

S/S of simple focal seizure:

1 Multiple consecutive seizures

2 Event amnesia

3 Aura

4 Impaired consciousness

5 Postictal state

6 Jerky, rhythmic muscle spasms

2, 3, 6

S/S of convulsive status epilepticus:

1 Multiple consecutive seizures

2 Event amnesia

3 Aura

4 Impaired consciousness

5 Postictal state

6 Jerky, rhythmic muscle spasms

1, 2, 3, 4, 5, 6

1000

The client was brought to the emergency room via ambulance. Parents state their adolescent "had 3 seizures this morning starting about 20 minutes ago; they seemed to last about few minutes with not much time between the next seizure activity. Our adolescent became very stiff and seemed to flail about. Before our adolescent had the first seizure, they said they smelled something funny."

The parents also report that there was a recent change in the adolescent's medication regimen from carbamazepine to phenytoin. The client is drowsy, opens their eyes to verbal stimuli and follows simple commands such as squeeze my hands; speech is soft and low; client able to state first name before falling back to sleep.

Skin is warm, moist and intact except for bilateral reddened elbows with a small skin tear on right elbow. Client is incontinent of urine. Vital signs: temperature, 99.1°F (37.3°C); heart rate, 92 beats/min, regular; blood pressure, 86/58 mmHg; respiratory rate, 14 breath/min, shallow; oxygen saturation, 92% on room air.

The parents are concerned about their adolescent's safety, because the adolescent is earning a driver's permit. Paramedics inserted a 20 gauge catheter in the client's right antecubital and administered 5 mg of diazepam when the client started to have another tonic–clonic seizure.

1030

Client difficult to arouse. Vital signs: temperature, 98.2°F (36.8°C); pulse rate, 82 beats/min; blood \n pressure, 88/54 mm Hg; respiratory rate, 10 breaths/min; oxygen saturation, 91% 2 liters by nasal \n cannula.

For each potential nursing intervention, which are indicated?

1 Administer diazepam 5mg STAT

2 Recheck oral temperature

3 Administer flumazenil 0.2mg IVP

4 Continue to monitor neuro status

5 Maintain NPO status

6 Start IV infusion of NS at 100ml/hr

7 administer loading dose of phenytoin 10-15 mg/kg

3, 4, 5, 6, 7

1000

The client was brought to the emergency room via ambulance. Parents state their adolescent "had 3 seizures this morning starting about 20 minutes ago; they seemed to last about few minutes with not much time between the next seizure activity. Our adolescent became very stiff and seemed to flail about. Before our adolescent had the first seizure, they said they smelled something funny."

The parents also report that there was a recent change in the adolescent's medication regimen from carbamazepine to phenytoin. The client is drowsy, opens their eyes to verbal stimuli and follows simple commands such as squeeze my hands; speech is soft and low; client able to state first name before falling back to sleep.

Skin is warm, moist and intact except for bilateral reddened elbows with a small skin tear on right elbow. Client is incontinent of urine. Vital signs: temperature, 99.1°F (37.3°C); heart rate, 92 beats/min, regular; blood pressure, 86/58 mmHg; respiratory rate, 14 breath/min, shallow; oxygen saturation, 92% on room air.

The parents are concerned about their adolescent's safety, because the adolescent is earning a driver's permit. Paramedics inserted a 20 gauge catheter in the client's right antecubital and administered 5 mg of diazepam when the client started to have another tonic–clonic seizure.

1030

Client difficult to arouse. Vital signs: temperature, 98.2°F (36.8°C); pulse rate, 82 beats/min; blood \n pressure, 88/54 mm Hg; respiratory rate, 10 breaths/min; oxygen saturation, 91% 2 liters by nasal \n cannula.

\
The nurse reviews the health care provider's orders. Which four orders that the nurse should perform right away.

\n 1 Apply simple face mask at 6 liters per minute \n 2 Administer flumazenil 0.1 mg IVP for symptoms of benzodiazepine toxicity \n 3 Administer phenytoin 10 mg/kg at 25 mg/minute IV bolus then maintenance 100 mg IV every 6 hours \n 4 Regular diet \n 5 Start normal saline at 100 ml/h \n 6 Administer diazepam 2 mg IVP prn for prolonged seizure activity

1, 2, 3, 5