Neurological Disorders

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Neurological Disorders
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Rules

• Everyone must participate meaning attempt to
  answer questions.

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When assessing a newborn admitted to the
pediatric unit with upper lumbar
myelomeningocele, which of the following would
the nurse anticipate finding?

1. Minimal movement of the lower extremities.
2. Upper extremity paralysis.
3. Urinary bladder prolapse.
4. Respiratory problems.

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Answer and Rationale

• 1. Clinical manifestations of myelomeningocele
  are related to the anatomic level of the defect
  and the nerves involved.

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2. When developing the plan of care for an
infant diagnosed with myelomeningocele and the
parents who have just been informed of the
infants diagnosis, which of the following would
the nurse include as the priority when the
parents visit the infant for the first time?

1. Emphasizing the infants normal and positive
   features.
2. Encouraging the parents to discuss their fears
   and concerns.
3. Reinforcing the doctors explanation of the
   defect.
4. Having the parents feed their infant.

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Answer and Rationale

• 1. The parents should see the neonate as soon as
  possible, because the longer they must wait to
  see him/her, the more anxiety they will feel.
  The nurse should emphasize the neonates normal
  and positive features during the visit.

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3. A mother of a newborn with myelomeningocele
asks if her baby is likely to have any other
defects. The nurse responds based on the
understanding that myelomeningocele is frequently
associated with which of the following?

1. Excessive cerebrospinal fluid within the cranial
   cavity.
2. Abnormally small head
3. Congenital absence of the cranial vault.
4. Overriding of the cranial sutures.

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Answer and Rationale

• 1 hydrocephalus and the most common anomaly
  associated with myelomeningocele.

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4. The parents of an infant with
myelomeningocele ask the nurse about their
childs future mental ability. Which of the
following would be the nurses best response?

1. About one-third are mentally retarded, but its
   too early to ell about your child.
2. About two-thirds are significantly retarded, and
   youll know soon if this will occur.
3. Your child will probably be of normal
   intelligence since he demonstrates signs of it
   now.
4. Youll need to talk with the doctor about that,
   but you can ask later.

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Answer and Rationale

• 1 Approximately 1/3 of infants diagnosed with
  myelomeningocele are mentally retarded, but the
  degree of retardation is variable and it is
  difficult to predict intellectual functioning in
  neonates.

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5. After placing an infant with myelomeningocele
in an isolette shortly after birth, which of the
following would the nurse use as the best
indicator to determine the effectiveness of this
intervention?

1. The arterial PO2 remains between 945 and
   100mm/Hg.
2. The axillary temp remains between 97 98 F.
3. The bilirubin level remains stable.
4. Weight increases by about 1 oz per day.

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Answer and Rationale

• 2 Placing a neonate in an isolette helps
  maintain the infants temp.

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6. When positioning the neonate with an
unrepaired myelomeningocele, which of the
following positions would be most appropriate?

1. Supine with the hips at 90-degree flexion.
2. Right side-lying position with knees flexed.
3. Prone with hips in abduction.
4. Semi-Fowlers position with chest and abdomen
   elevated.

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Answer and Rationale

• 3 before surgery, the infant is kept flat in
  the prone position to decrease tension on the
  sac. This allows for optimal positioning of the
  hips, knees and feet because orthopedic problems
  are common.

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12. Before placement of a ventriculoperitoneal
shunt for hydrocephalus, an infant is irritable,
lethargic, and difficult to feed. To maintain
the infants nutritional status, which of the
following actions would be most important?

1. Feeding the infant just before doing any
   procedures.
2. Giving the infant small, frequent feedings.
3. Feeding the infant in a horizontal position.
4. Scheduling the feedings every 6 hours.

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Answer and Rationale

• 2 An infant with hydrocephalus is difficult to
  feed because of poor sucking, lethargy, and
  vomiting, which are associated with increased
  ICP.

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13. A 4 y/o with hydrocephalus is scheduled to
have a VP shunt in the right side of the head.
When developing the childs postoperative care,
the nurse would expect to place the preschooler
in which of the following positions immediately
after surgery?

1. On the right side, with the foot of the bed
   elevated.
2. On the left side, with the head of the bed
   elevated.
3. Prone, with the head of the bed elevated.
4. Supine, with the head of the bed flat.

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Answer and Rationale

• 13 For at least the first 24 hours after
  insertion of a VP shunt, the child is positioned
  supine with the head of the bed flat to prevent
  too rapid a decrease in CSF pressure.

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14. Which of the following would the nurse do
when providing postoperative nursing care to a
child after insertion of a VP shunt?

1. Administer narcotics for pain control.
2. Check the urine for glucose and protein.
3. Monitoring for increased temp.
4. Test CSF leakage for protein.

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Answer and Rationale

• 3monitoring for temp allows the nurse to assess
  for infection, the most common and most hazardous
  postop complication after shunt placement.

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15. The nurse evaluates the discharge teaching
as successful when the parents of a school-aged
child with a VP shunt insertion identify which of
the following as signaling a blocked shunt?

1. Decreased urine output with stable intake.
2. Tense fontanel and increased head circumference.
3. Elevated temp. and reddened incisional site.
4. Irritability and increasing difficulty with
   eating.

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Answer and Rationale

• 4In a school-aged child, irritability, lethargy,
  vomiting, difficulty with eating, and decreased
  level of consciousness are signs of increased
  intracranial pressure caused by a blocked shunt.

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28. During the acute stage of meningitis, a 3
y/o child is restless and irritable. Which of
the following would be most appropriate to
institute?

1. Limiting conversation with the child.
2. Keeping extraneous noise to a minimum.
3. Allowing the child to play in the bathtub.
4. Performing treatments quickly.

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Answer and Rationale

• 2a child in the acute stage of meningitis is
  irritable and hypersensitive to loud noise and
  light.

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29. Which of the following would lead the nurse
to suspect that a child with meningitis has
developed DIC?

1. Hemorrhagic skin rash.
2. Edema
3. Cyanosis
4. Dyspnea on exertion

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Answer and Rationale

• 1DIC is characterized by petechiae and purpuric
  skin rash caused by spontaneous bleeding into the
  tissues.

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31. A preschooler with pneumonococci meningitis
is receiving IV AB tx. When discontinuing the IV
tx, the nurse allows the child to apply a
dressing to the area where the needle is removed.
The nurses rationale for doing so is based on
the interpretation that a child in this age group
has a need to accomplish which of the following?

1. Trust those caring for her.
2. Find diversional activities.
3. Protect the image of an intact body.
4. Relieve the anxiety of separation from home.

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Answer and Rationale

• 3 Preschool aged children worry about having an
  intact body.

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30. When interviewing the parents of a 2 y/o
child, a history of which of the following
illnesses would lead the nurse to suspect
pneumococcal meningitis?

1. Bladder infection.
2. Middle ear infection.
3. Fractured clavicle.
4. Septic arthritis.

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Answer and Rationale

• 2organisms that cause bacterial meningitis such
  as pneumococci or meningococci are commonly
  spread by vascular dissemination from a middle
  ear infection.

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37. Which of the following assessments would be
most important for the nurse to make initially in
a school-aged child being seen in the clinic for
c/o sore throat, muscle tenderness, arms feeling
weak, and generally not feeling well.

1. Difficulty swallowing.
2. Diet intake for the last 24 hours.
3. Exposure to illnesses.
4. Difficulty urinating.

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Answer and Rationale

• 1Most children with sore throat have some
  difficulty swallowing, so it is important for the
  nurse to determine the extent of difficulty to
  aid in determining what action is necessary.

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38. Which of the following actions would be the
priority when caring for a school-aged child
admitted to the pediatric unit with the dx of GB?

1. Assessing the childs ability to follow simple
   commands.
2. Evaluating the childs bilateral muscle strength.
3. Making a game of the ROM exercises.
4. Providing the child with a diversional activity.

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Answer and Rationale

• 2with GB, progressive ascending paralysis occurs.

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39. The nurse asks the school-aged child with GB
to cough and also assess the childs speech for
decreased volume and clarity. The underlying
rationale for these assessments is to determine
which of the following?

1. Inflammation of the larynx and epiglottis.
2. Increased ICP.
3. Involvement of facial and cranial nerves.
4. Regression to an earlier developmental phase.

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Answer and Rationale

• 3In a child with GB, decreased volume and
  clarity of speech and decreased ability to cough
  voluntarily indicate ascending progression of
  neural inflammation, specifically affecting the
  cranial nerves.

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40. Assmt of a school-aged child with BG reveals
absent gag and cough reflexes. Which of the
following nursing dx would receive the highest
priority during the acute phase?

1. Risk for Infection due to altered immune system.
2. Ineffective breathing pattern r/t neuromuscular
   impairment.
3. Impaired swallowing r/t neuromuscular impairment.
4. Total urinary incontinence r/t fluid losses.

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Answer and Rationale

• 2-ineffective breathing pattern caused by the
  ascending paralysis of the disorder interferes
  with the childs ability to maintain an adequate
  oxygen supply.

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7-13. Which of the following is the most
appropriate nursing intervention for a child with
increased intracranial pressure?

1. Keep the childs head turned to the side so that
   the airway will remain open if the child vomits.
2. Perform ROM q 4hr while awake to prevent nuchal
   rigidity from bed rest.
3. Perform airway sx at the same time vital signs
   are taken so that the child will have undisturbed
   rest.
4. Play gentle, soothing background music in the
   room.

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Answer and Rationale

• 4-soothing music may help.

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7-33. A child with spastic CP is admitted for
surgery. The most appropriate nsg dx for this
child is

1. Potential impaired swallowing
2. Altered tissue perfusion cerebral
3. Decreased cardiac output.
4. Potential fluid volume deficit.

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Answer and Rationale

• 1tight muscles of spastic cerebral palsy can
  include those associated with effecive
  swallowing. Furthermore, the childs surgery,
  anesthesia and analgesia can affect muscle use
  and coordination.

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7-35. A 7 y/o is suspected of having meningitis.
What are the classic symptoms of meningitis for
which you will assess? (choose all that apply).

1. Fever
2. Severe HA
3. Increased pulse pressure
4. Bradycardia
5. Nuchal rigidity

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Answer and Rationale

• 1,2,5-fever, severe HA, and nuchal rigidity are
  the three classic symptoms of meningitis.
  Irritability, nausea, and vomiting can be
  symptomatic for a variety of illnesses.

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7-40. What is a tonometer?
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Answer and Rationale

• An instrument used for measuring intraocular
  pressure.

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7-42. To confirm a tentative diagnosis of
myasthenia gravis, the drug neostigmine will be
administered. Should the client have mg, the
action of this drug will cause

1. An immediate decrease in bp.
2. An escalation of symptoms.
3. A temporary increase in muscle strength.
4. A temporary drying of the mouth and throat.

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Answer and Rationale

• 3-A client receives temporary muscle strength
  following the administration of neostigmine
  (Prostigmin), it will confirm that the client has
  mg.

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7-48. A 4 y/o with average intelligence and
spastic cerebral palsy is to be admitted to the
pediatrics unit. The plan of care most likely to
be included in the nursing diagnoses is

1. Decreased cerebral tissue perfusion.
2. Gas exchange impaired.
3. Sensory/perceptual alteration.
4. Sleep pattern disturbance.

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Answer and Rationale

• 3-The most likely nursing diagnosis would include
  sensory/perceptual alteration that can affect
  swallowing, vision, and speech.

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7-49. A newborn with a myelomeningocele is to
have a surgical repair 24-48 hours after birth.
The most important ongoing assessment in the
preoperative period is assessment for

1. Fontanel status.
2. Hip dysplasia
3. Bowel incontinence.
4. Pain sensation below the defect.

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Answer and Rationale

• 1preoperative assessment should include ongoing
  fontanel status. Hydrocephalus is a common
  condition developing pre- or postoperatively with
  children who have a myelomeningocele. Ongoing
  fontanel assessment, along with HC would help
  monitor.

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7-50. The most appropriate nursing intervention
for an infant with possible bacterial meningitis
is to

1. Measure weight and head circumference each shift.
2. Monitor behavior at each encounter.
3. Evaluate Kernigs sign each shift.
4. Monitor fontanel tenseness daily.

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Answer and Rationale

• 2meningitis causes an inflammation of the
  meninges of the brain and spinal cord due to
  bacteria or viruses. The infants behavior
  should be monitored at each encounter. Behavior
  is a good indicator of intracranial pressure and
  is often an early sign of changes in ICP.

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1. T or F Trigeminal neuralgia affects the
sensory branches of the trigeminal nerve while
Bells palsy affects the motor branches of the
facial nerve.
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Answer and Rationale

• True

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Which of the following is strongly associated
with the development of Bells Palsy?

1. Herpes simplex virus
2. Staphylococcal infection

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Answer and Rationale

• 1-herpes simplex

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True or false Antiseizure drugs are the drugs
of choice for treatment of Bells palsy.
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Answer and Rationale

• False corticosteroids are.

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True or false Gentle upward massage of the face
may be indicated to maintain circulation in the
patient with trigeminal neuralgia.
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Answer and Rationale

• False will work with Bells palsy.

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True or false A special need of patients with
both TN and BP is oral hygiene.
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Answer and Rationale

• True

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True or False Severe withdrawal behaviors and
suicidal tendencies may be seen in patients with
trigeminal neuralgia.
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Answer and Rationale

• True

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28-44. The vector reservoir for agents causing
viral encephalitis in the U.S. is which of the
following

1. Tarantula spiders
2. Mosquitoes and ticks
3. Carnivorous wild animals
4. Domestic wild animals.

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Answer and Rationale

• B- mosquitoes and ticks (p 1095 wong)

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28-45. Which of the following may be beneficial
in reducing the risk of Reye syndrome?

1. Immunization against disease
2. Medical attention for all head injuries.
3. Prompt treatment of bacterial meningitis.
4. Avoidance of aspirin for children with varicella
   or those suspected of having influenza.

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Answer and Rationale

• 4-p1096 Wong.

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