VERSION 1
NR 328 PEDIATRIC EXAM 3 STUDY GUIDE
Head Injury
Tommy is a 6-year-old boy who fell off the swing yesterday and hit the back of his head
on the pavement. He is now in the hospital in the intensive care unit, unresponsive. He
has symptoms of increased intracranial pressure (ICP) from the fall.
1. What are the clinical symptoms of increased ICP in a child Tommy's age?
The correct answers are:
Headache, nausea, forced vomiting, diplopia, blurred vision, and seizures
2. When cerebral blood flow is decreased, what symptoms frequently occur?
Correct Answer
The correct answers are:
Nausea, fainting, and dizziness
3. Identify the vital sign changes listed below that are associated with brainstem
injury following acute head trauma. (Select all that apply.)
A. Rapid or intermittent respirations
B. Wide fluctuations in pulse
C. Widening pulse pressure
D. Extreme fluctuations in blood pressure
E. Elevated temperature
Correct Answer
The correct answers are A, B, C, D, and E.
4. One of Tommy's nursing diagnoses is Risk for Injury related to physical
immobility, depressed sensorium, and intracranial pathologic condition. List four
nursing interventions for this nursing diagnosis that focus on maintaining a stable
ICP.
Correct Answer
The correct answer is:
, o Elevate the head of the bed 15 to 30 degrees.
o Maintain the head in a midline position.
o Avoid pressure on neck veins.
o Avoid flexion or hyperextension of the neck.
o Avoid respiratory procedures such as suctioning.
o Prevent constipation.
o Minimize emotional stress and crying.
o Prevent or relieve pain.
o Monitor ICP.
5. What is the expected outcome related to the nursing diagnosis presented in
question 4?
Correct Answer
The correct answer is:
ICP will remain within safe limits. The child will show no evidence of increased
ICP.
6. Complete the following table describing the diagnostic tests used to assess the
extent of Tommy's head injury.
Diagnostic Test Rationale for Test How Test Is Performed
Brain computed
tomographic (CT) scan
without contrast
Skull radiography
Cervical spine radiograph
Brain perfusion test
7. Correct Answer
8. The correct answers are:
Diagnostic Test Rationale for Test How Test Is Performed
Brain CT scan without To evaluate for blood in CT scan of brain
contrast the cranium
Skull radiography To evaluate for fractures Radiography of skull
Cervical spine radiograph To evaluate for fractures Radiography of spine
Brain perfusion test To determine whether Inject dye intravenously
the brain is receiving to trace blood flow
blood flow
9. Describe the pathology of acute head injury in a child by matching the following
terms.
____ Causes mass movement of the brain
, ____ Causes bruising at the point of brain
impact
____ Caused by unequal movement of the
brain on impact
____ Bleeding between the dura and cerebrum
A. Acceleration ____ Causes greatest cerebral injury at the
B. Deceleration point of impact
C. Subdural hematoma
D. Shearing forces
10. Correct Answer
11. The correct answers are A, E, D, C, B.
Chapter 32: The Child with Cerebral Dysfunction
Meningitis
Marshall is a 9-month-old child admitted to the pediatric nursing unit for
Haemophilus influenzae meningitis. He has had no childhood immunizations.
1. What clinical behaviors are expected in an infant with meningitis?
The correct answers are:
o Fever
o Poor feeding
o Vomiting
o Irritability
o Seizures
o High-pitched cry
o Bulging fontanel
o Nuchal rigidity
Rationale:
The classic presentation of meningitis is rarely seen in infants and children
between 3 months and 2 years; thus, the symptoms seen in an infant include fever,
poor feeding, vomiting, marked irritability, toxic appearance, and frequent
seizures accompanied by a high-pitched cry. The most significant findings include
a bulging fontanel and nuchal rigidity.
2. Definitive diagnosis of meningitis is made on the basis of what test?
Correct Answer
The correct answer is:
Examination of cerebrospinal fluid by means of lumbar puncture.
Rationale:
Spinal fluid is analyzed for culture, Gram stain, blood cell count, and
determination of glucose and protein count. These findings are usually diagnostic:
the culture and Gram stain identify the causative organism, the white blood cell
count is usually elevated and the glucose level is reduced, and the protein
concentration is usually increased.
, 3. Marshall may be kept on low-maintenance levels of fluids to prevent what two
conditions?
The correct answer is:
Cerebral edema and increased intracranial pressure (ICP)
Rationale:
Increased ICP is avoided because it results in the reduction of cerebral perfusion
pressure, which causes harmful neurologic consequences of the illness.
4. Could this case of meningitis have been prevented?
The correct answer is:
Yes, by immunization with Hib vaccine.
Rationale:
Routine vaccinations for H. influenzae type b are recommended for all children
beginning at 2 months of age. A significant decline in the incidence of H.
influenzae type b disease has occurred since the introduction of the Hib vaccine.
Chapter 31: The Child with Cancer
Acute Lymphoblastic Leukemia
Todd is a 3-year-old child who has acute lymphoblastic leukemia. He is being seen in the
oncology clinic for chemotherapy.
1. Todd asks the nurse, "What is wrong with my blood?" The nurse's response
should be based on knowledge that leukemia results in increased
A. platelets.
B. red blood cells.
C. mature white blood cells.
D. immature white blood cells.
Correct Answer
The correct answer is D.
Rationale:
A-D. Bone-marrow dysfunction causes a proliferation of immature cells, which
depress bone marrow production of the formed elements of the blood by
competing for and depriving the normal cells of the essential nutrients for
metabolism; thus, platelet, red blood cell, and mature white blood cell production
is decreased.
NR 328 PEDIATRIC EXAM 3 STUDY GUIDE
Head Injury
Tommy is a 6-year-old boy who fell off the swing yesterday and hit the back of his head
on the pavement. He is now in the hospital in the intensive care unit, unresponsive. He
has symptoms of increased intracranial pressure (ICP) from the fall.
1. What are the clinical symptoms of increased ICP in a child Tommy's age?
The correct answers are:
Headache, nausea, forced vomiting, diplopia, blurred vision, and seizures
2. When cerebral blood flow is decreased, what symptoms frequently occur?
Correct Answer
The correct answers are:
Nausea, fainting, and dizziness
3. Identify the vital sign changes listed below that are associated with brainstem
injury following acute head trauma. (Select all that apply.)
A. Rapid or intermittent respirations
B. Wide fluctuations in pulse
C. Widening pulse pressure
D. Extreme fluctuations in blood pressure
E. Elevated temperature
Correct Answer
The correct answers are A, B, C, D, and E.
4. One of Tommy's nursing diagnoses is Risk for Injury related to physical
immobility, depressed sensorium, and intracranial pathologic condition. List four
nursing interventions for this nursing diagnosis that focus on maintaining a stable
ICP.
Correct Answer
The correct answer is:
, o Elevate the head of the bed 15 to 30 degrees.
o Maintain the head in a midline position.
o Avoid pressure on neck veins.
o Avoid flexion or hyperextension of the neck.
o Avoid respiratory procedures such as suctioning.
o Prevent constipation.
o Minimize emotional stress and crying.
o Prevent or relieve pain.
o Monitor ICP.
5. What is the expected outcome related to the nursing diagnosis presented in
question 4?
Correct Answer
The correct answer is:
ICP will remain within safe limits. The child will show no evidence of increased
ICP.
6. Complete the following table describing the diagnostic tests used to assess the
extent of Tommy's head injury.
Diagnostic Test Rationale for Test How Test Is Performed
Brain computed
tomographic (CT) scan
without contrast
Skull radiography
Cervical spine radiograph
Brain perfusion test
7. Correct Answer
8. The correct answers are:
Diagnostic Test Rationale for Test How Test Is Performed
Brain CT scan without To evaluate for blood in CT scan of brain
contrast the cranium
Skull radiography To evaluate for fractures Radiography of skull
Cervical spine radiograph To evaluate for fractures Radiography of spine
Brain perfusion test To determine whether Inject dye intravenously
the brain is receiving to trace blood flow
blood flow
9. Describe the pathology of acute head injury in a child by matching the following
terms.
____ Causes mass movement of the brain
, ____ Causes bruising at the point of brain
impact
____ Caused by unequal movement of the
brain on impact
____ Bleeding between the dura and cerebrum
A. Acceleration ____ Causes greatest cerebral injury at the
B. Deceleration point of impact
C. Subdural hematoma
D. Shearing forces
10. Correct Answer
11. The correct answers are A, E, D, C, B.
Chapter 32: The Child with Cerebral Dysfunction
Meningitis
Marshall is a 9-month-old child admitted to the pediatric nursing unit for
Haemophilus influenzae meningitis. He has had no childhood immunizations.
1. What clinical behaviors are expected in an infant with meningitis?
The correct answers are:
o Fever
o Poor feeding
o Vomiting
o Irritability
o Seizures
o High-pitched cry
o Bulging fontanel
o Nuchal rigidity
Rationale:
The classic presentation of meningitis is rarely seen in infants and children
between 3 months and 2 years; thus, the symptoms seen in an infant include fever,
poor feeding, vomiting, marked irritability, toxic appearance, and frequent
seizures accompanied by a high-pitched cry. The most significant findings include
a bulging fontanel and nuchal rigidity.
2. Definitive diagnosis of meningitis is made on the basis of what test?
Correct Answer
The correct answer is:
Examination of cerebrospinal fluid by means of lumbar puncture.
Rationale:
Spinal fluid is analyzed for culture, Gram stain, blood cell count, and
determination of glucose and protein count. These findings are usually diagnostic:
the culture and Gram stain identify the causative organism, the white blood cell
count is usually elevated and the glucose level is reduced, and the protein
concentration is usually increased.
, 3. Marshall may be kept on low-maintenance levels of fluids to prevent what two
conditions?
The correct answer is:
Cerebral edema and increased intracranial pressure (ICP)
Rationale:
Increased ICP is avoided because it results in the reduction of cerebral perfusion
pressure, which causes harmful neurologic consequences of the illness.
4. Could this case of meningitis have been prevented?
The correct answer is:
Yes, by immunization with Hib vaccine.
Rationale:
Routine vaccinations for H. influenzae type b are recommended for all children
beginning at 2 months of age. A significant decline in the incidence of H.
influenzae type b disease has occurred since the introduction of the Hib vaccine.
Chapter 31: The Child with Cancer
Acute Lymphoblastic Leukemia
Todd is a 3-year-old child who has acute lymphoblastic leukemia. He is being seen in the
oncology clinic for chemotherapy.
1. Todd asks the nurse, "What is wrong with my blood?" The nurse's response
should be based on knowledge that leukemia results in increased
A. platelets.
B. red blood cells.
C. mature white blood cells.
D. immature white blood cells.
Correct Answer
The correct answer is D.
Rationale:
A-D. Bone-marrow dysfunction causes a proliferation of immature cells, which
depress bone marrow production of the formed elements of the blood by
competing for and depriving the normal cells of the essential nutrients for
metabolism; thus, platelet, red blood cell, and mature white blood cell production
is decreased.
