Ch.52- The Child with a Neurologic Alteration

What is a sign of increased intracranial pressure (ICP) in a 10-year-old child?

• Headache

• Bulging fontanel

• Tachypnea

• Increase in head circumference

Answer explanation

Headaches are a clinical manifestation of increased ICP in children. A change in the child’s normal behavior pattern may be an

important early sign of increased ICP. Bulging fontanel or increased head circumference is seen in infants. A change in respiratory

pattern is a late sign of increased ICP. Cheyne–Stokes respiration may be evident. This refers to a pattern of increasing rate and

depth of respirations followed by a decreasing rate and depth with a pause of variable length.

Which information should the nurse give to a child who is to have magnetic resonance imaging (MRI) of the brain?

• “You won’t be able to move your head during the procedure.”

• “You will have to drink a special fluid before the test.”

• “You will have to lie flat after the test is finished.”

• “You will have electrodes placed on your head with glue.”

Answer explanation

To reduce fear and enhance cooperation during the MRI, the child should be made aware that head movement will be restricted to

obtain accurate information. The child does not need to drink special liquids, lie on the back afterward, or have electrodes placed.

Which term is used when a patient remains in a deep sleep, responsive only to vigorous and repeated stimulation?

• Coma

• Stupor

• Obtundation

• Persistent vegetative state

Answer explanation

Stupor exists when the child remains in a deep sleep, responsive only to vigorous and repeated stimulation. Coma is the state in

which no motor or verbal response occurs to noxious (painful) stimuli. Obtundation describes a level of consciousness in which the

child is arousable with stimulation. Persistent vegetative state describes the permanent loss of function of the cerebral cortex.

The Glasgow Coma Scale consists of an assessment of

• pupil reactivity and motor response.

• eye opening and verbal and motor responses.

• level of consciousness and verbal response.

• ICP and level of consciousness.

Answer explanation

The Glasgow Coma Scale assesses eye opening, and verbal and motor responses. Pupil reactivity is not a part of the Glasgow Coma

Scale but is included in the pediatric coma scale. Level of consciousness is not a part of the Glasgow Coma Scale. Intracranial

pressure and level of consciousness are not part of the Glasgow Coma Scale.

Nursing care of the infant who has had a myelomeningocele repair should include

• securely fastening the diaper.

• measurement of pupil size.

• measurement of head circumference.

• administration of seizure medications.

Answer explanation

Head circumference measurement is essential because hydrocephalus can develop in these infants. A diaper should be placed under

the infant but not fastened. Keeping the diaper open facilitates frequent cleaning and decreases the risk for skin breakdown. Pupil

size measurement is usually not necessary. Seizure medications are not routinely given to infants who do not have seizures.

The most common problem of children born with a myelomeningocele is

• bladder incontinence.

• intellectual impairment.

• respiratory compromise.

• cranioschisis.

Answer explanation

Myelomeningocele is one of the most common causes of neuropathic (neurogenic) bladder dysfunction among children, leading to

incontinence. Risk of intellectual impairment is minimized through early intervention and management of hydrocephalus.

Respiratory compromise is not a common problem in myelomeningocele. Cranioschisis is a skull defect through which various

tissues protrude. It is not associated with myelomeningocele.

A recommendation to prevent neural tube defects is the supplementation of

• vitamin A throughout pregnancy.

• multivitamin preparations as soon as pregnancy is suspected.

• folic acid for all women of childbearing age.

• folic acid during the first and second trimesters of pregnancy.

Answer explanation

The widespread use of folic acid among women of childbearing age is expected to decrease the incidence of spina bifida

significantly. Vitamin A, multivitamins, and folic acid only during specific points during the pregnancy have not been shown to

prevent neural tube defects.

How much folic acid does the nurse tell female patients is recommended for women of childbearing age?

• 1.0 mg

• 0.4 mg

• 1.5 mg

• 2.0 mg

Answer explanation

It has been estimated that a daily intake of 0.4 mg of folic acid in women of childbearing age has contributed to a reduction in the

number of children with neural tube defects. The other doses are not the recommended dose.

Latex allergy is suspected in a child with spina bifida. Appropriate nursing interventions include which of the following?

• Avoiding using any latex product

• Using only non-allergenic latex products

• Administering medication for long-term desensitization

• Teaching family about long-term management of allergic manifestations

Answer explanation

Care must be taken that individuals who are at high risk for latex allergies do not come in direct or secondary contact with products

or equipment containing latex at any time during medical treatment. Latex allergy is estimated to occur in 75% of this patient

population. There are no non-allergenic latex products. At this time, desensitization is not an option. There are no treatment options

for long-term management of allergic symptoms for latex allergy.

When a 2-week-old infant is seen for irritability, poor appetite, and rapid head growth with observable distended scalp veins, the

nurse recognizes these signs as indicative of which disorder?

• Hydrocephalus

• Syndrome of inappropriate antidiuretic hormone (SIADH)

• Cerebral palsy

• Reye’s syndrome

Answer explanation

The combination of signs is strongly suggestive of hydrocephalus. SIADH would not manifest in this way. The child would have

decreased urination, hypertension, weight gain, fluid retention, hyponatremia, and increased urine specific gravity. The

manifestations of cerebral palsy vary but may include persistence of primitive reflexes, delayed gross motor development, and lack

of progression through developmental milestones. Reye’s syndrome is associated with an antecedent viral infection with symptoms

of malaise, nausea, and vomiting. Progressive neurologic deterioration occurs.