Pediatric Neurological and Sensory Disorders Exam | Answered with Rationales

Pediatric Neurological and Sensory Disorders Exam | Answered with Rationales The nurse is assessing a 7-year-old child at a pediatric clinic. The nurse notices that several developmental milestones have been missed or are late during previous visits. The parent states, "I know she is a little slow, but she will catch up quickly." Which action by the nurse is warranted? 1. Explain to the parent that rapid development takes place in infancy and early childhood. 2. Suggest activities in the home that may improve mental and physical development. 3. Recommend that the child be placed in special classes aimed at promoting development. 4. Ask the parent detailed questions about the pregnancy, birth, and early childhood health. 1 This is incorrect. Explaining the expected periods and timeframes when development rapidly occurs is not beneficial to the parent. 2 This is incorrect. Suggesting home activities that improve mental and physical development may or may not be effective. Further assessment is needed to better define the findings. 3 This is incorrect. It is premature for the nurse to recommend special classes for the child. 4 This is correct. The nurse needs to further assess for possible contributing factors for the child's developmental delays. Along with information about the pregnancy, birth, and early childhood health, the nurse will explore the family health history and home environment. The nurse is assessing a 4-month-old infant during a routine well-baby visit. During the neurological assessment, which finding is a reason for concern? 1. When the cheek is brushed, the head is turned toward the stimuli. 2. Toes fan out when the sole of the food is stroked upward. 3. Placing a small object in the palm inconsistently elicits a grasp. 4. A light puff of air in the face causes the eyes to close. 1 This is correct. The nurse is assessing for the presence of the rooting reflex, which disappears by the age of 3 to 4 months. The presence of this reflex at 4 months is a reason for concern. 2 This is incorrect. The nurse is checking for the presence of the Babinski sign, which is elicited by stroking the sole of the foot upward, causing the toes to fan out. The sign should disappear between 9 and 12 months of age. 3 This is incorrect. The nurse is checking the presence of a palmer grasp reflex, which should weaken by 3 months and completely disappear by 6 months of age. The ability to elicit an inconsistent grasp is not a reason for concern. 4 This is incorrect. At birth, one permanent reflex is the blinking (glabellar) reflex. The reflex is elicited when a light puff of air hits the face. The nurse is performing a developmental assessment on a toddler at age 3 years. The nurse notices a variety of mixed developmental milestones that have been missed during the visit. Which delay does the nurse expect to be of greatest concern to the parent? 1. Difficulty putting small objects into a bottle 2. An inability to kick a ball back to the nurse 3. Difficulty with and reluctance to self-dress 4. An inability to express needs with language 1 This is incorrect. At the age of 3 years, it is expected that the child will have the fine motor control needed to place small objects in a bottle. The lack of this ability may or may not be the parent's greatest concern. 2 This is incorrect. At the age of 3 years, the inability to kick a ball back to the nurse is an indication of gross motor delay. This may or may not be the parent's greatest concern. 3 This is incorrect. Difficulty with and reluctance to self-dress indicates a delay in adaptive skills. This may or may not be the parent's greatest concern. 4 This is correct. Language is an important developmental milestone, and the inability to verbally express needs by the age of 3 years is a real concern. The most common parental concern is delayed development of expressive language. The nurse is presenting a class to high school females about decreasing the developmental risks related to pregnancy. Which information does the nurse consider to be most important? 1. Young women should begin taking 600 mg of calcium twice a day. 2. All females of child-bearing age should take 0.4 mg of folic acid daily. 3. Early prenatal care is essential for a healthy pregnancy and baby. 4. Important fetal development occurs before pregnancy is suspected. 1 This is incorrect. Women at a young age should begin taking calcium supplements to promote lifelong bone health. However, calcium is not the most important information to decrease developmental risks during pregnancy. 2 This is correct. Because neural tube closure occurs before most women even know they are pregnant, it is important to teach adolescent girls to begin taking folic acid supplements before pregnancy occurs. Teen pregnancies are usually unplanned, which makes folic acid intake very important. 3 This is incorrect. It is true that early prenatal care is important for a healthy pregnancy and baby; however, the most important information is about folic acid and preventing neural tube defects. 4 This is incorrect. High school females need to be aware that all essential fetal development occurs before pregnancy is even suspected. Neural tube closure normally occurs around the 28th day after fertilization. The nurse is performing well-baby checks in a pediatric clinic. During physical examination of a 1-month-old infant, the nurse notices a dimple with a tuft of hair in the lumbar sacral area indicative of spina bifida. Which developmental delays does the nurse expect for this infant? 1. There may be issues related to bowel and bladder control. 2. Some degree of paralysis of the lower limbs is expected. 3. The infant is not expected to experience physical delays. 4. Muscles of the legs will be flaccid with some sensory loss. 1 This is incorrect. The infant is exhibiting the characteristics of spina bifida occulta. Issues related to bowel and bladder control are seen in spina bifida cystica or with a meningocele. 2 This is incorrect. Some degree of paralysis is common with spina bifida cystica or a meningocele. 3 This is correct. The infant is exhibiting the characteristics of spina bifida occulta, which occurs from a section of the spinal vertebrae being malformed, but the spinal cord and nerves are normal. No developmental delays are expected with this condition. 4 This is incorrect. Flaccid leg muscles and sensory loss are associated with spina bifida cystica or a meningocele. The nurse in the newborn nursery is providing care for a neonate with an open spinal cord defect. The neonate will be transported to a pediatric surgery hospital as soon as possible. Which description of the nurse's care of the neonate is correct? 1. Using aseptic technique, place a sterile plastic bag around the defect and loosely tie it closed. 2. Place the newborn prone on a loose diaper and cover the defect with a second saline-moistened diaper. 3. Position the newborn on the side with a moistened dressing on the defect; wrap the defect and newborn in a blanket. 4. Cover the defect with a sterile dressing moistened with warm sterile normal saline, using aseptic technique. 1 This is incorrect. A sterile bag is not placed around the defect and loosely tied closed. 2 This is incorrect. The nurse will use aseptic technique; the defect is not covered by a second saline moistened diaper, which can be clean but is not likely to be sterile. 3 This is incorrect. The defect must remain as sterile as possible and the neonate is positioned to prevent any pressure on the defect. A side-lying position is not used, and the defect and neonate are not wrapped in a blanket. Body heat will be preserved by placing the newborn in a warmer. 4 This is correct. The nurse must exercise caution to keep the defect covered and protected until surgical correction can occur. Using aseptic technique, the nurse should cover the defect with a sterile dressing moistened with warm sterile normal saline. The neonate will be positioned prone and lying on an open diaper. The nurse is gathering health information on a child who is 8 years of age. The parent reports the child is extremely difficult to wake in the morning. Which other information will prompt the nurse to recommend screening for a sleep disorder? 1. The bedroom is shared with a sibling. 2. The nurse validates the child is obese. 3. There is a TV in the child's bedroom. 4. It is difficult to get the child to bed. 1 This is incorrect. The fact that the patient's bedroom is shared with a sibling is an environment factor that can interrupt sleep. 2 This is correct. Obesity in a child can cause sleep apnea, which can result in heavy snoring or choking sounds during sleep, as well as daytime fatigue, irritability, or learning problems in school. This finding will prompt the nurse to recommend screening for sleep disorder. 3 This is incorrect. TV in the bedroom is a distraction that delays sleep; this is an environmental factor. 4 This is incorrect. Children who are difficult to get to bed are likely to have sleep deprivation because of resisting sleep or falling asleep late at night. This is a behavioral factor. A third-grade teacher discusses behavioral problems with a student. The teacher states, "He walks around class making horrible sucking noises. He does not respond to me." Which information does the nurse seek from the student's parents? 1. Ask if the student has been tested by a physician for seizure disorder. 2. Inquire if the student is either diagnosed or medicated for ADHD. 3. Ascertain if the student has experienced recent illness or a fever. 4. Suggest the student be screened for possible developmental delays. 1 This is correct. The student's behavior is commonly seen with complex partial seizures; the nurse needs to ask if the student has been tested for seizure disorder. Manifestations include automatisms such as lip smacking, chewing, sucking, repetitive and involuntary movements, walking, and restlessness. Consciousness is altered, but the person remains awake. 2 This is incorrect. The student's altered consciousness while remaining awake does not fit a diagnosis of ADHD. 3 This is incorrect. Complex partial seizures do not occur as a result of illness or fever; there is no identification of the cause. 4 This is incorrect. Certain conditions that cause seizure activity can also be the cause of developmental delay; however, not all seizure activity is caused by or results in developmental delays. The school nurse is present at a school assembly when a student falls to the floor with a seizure. Which intervention does the nurse initiate when providing care to the student during the seizure? 1. Protect the student from injury related to seizure movement. 2. Remove or loosen any tight clothing around the neck or waist. 3. Provide comfort and promote resting in a quiet environment. 4. If incontinent, cover the student with a blanket or sheet. 1 This is correct. During the seizure, the nurse needs to protect the student from injury caused by seizure movement. 2 This is incorrect. Tight clothing around the neck should be loosened to keep the airway unimpaired. The clothing around the waist is not loosened, and no clothing is removed. 3 This is incorrect. After the seizure, the student should be comforted, reoriented, and allowed to rest. 4 This is incorrect. The student may experience bladder or bowel incontinence during a seizure; however, the student should not be covered with any item that can become entangled from seizure activity. Once the seizure is over, the student can be assisted with cleaning up. The nurse is providing care for an infant at 3 months of age. The parent reports sudden flexor or extensor movements of the neck, trunk, and extremities occurring multiple times a day. The infant is diagnosed with infant spasms and is prescribed corticotropin (Acthar jell) therapy. Which instruction is most important for the nurse to provide for the parent? 1. Reason for weekly laboratory visits 2. Expected medication side effects 3. Signs and symptoms of infections 4. How to administer IM medication 1 This is incorrect. Corticotropin therapy requires weekly monitoring of glucose and electrolytes during therapy. The nurse will share the importance of keeping these appointments; however, another option is most important. 2 This is incorrect. The nurse will inform the parent of expected side effects, such as increased appetite, weight gain, irritability, edema, hypertension, and risk for infections. However, another option is most important. 3 This is incorrect. Because the infant on corticotropin therapy is at greater risk for infections, the nurse will instruct the parent about signs and symptoms and when to contact the physician. However, another option is most important. 4 This is correct. Corticotropin (Acthar jell) is administered IM, so the most important information for the nurse to provide to the parent is how to administer the medication. The nurse is collecting information about a school-age patient brought to a pediatric clinic by a parent. The parent reports several incidences of syncope. Which assessment question helps the nurse to identify a possible diagnosis of vasovagal syncope? 1. "Has your daughter been diagnosed with diabetes mellitus?" 2. "Did your child feel strange and faint after standing up?" 3. "Was your child in a stressful situation before fainting?" 4. "Does your daughter have any cardiac conditions?" 1 This is incorrect. This question rules out metabolic syncope, which is when a person faints in response to metabolic conditions such as hypoglycemia or hyperventilation. 2 This is correct. This question is appropriate for identifying vasovagal syncope, which is the most common type of syncope. Blood pressure drops quickly, reducing the blood flow to the brain. Standing results in a flow of blood in the lower extremities, and the autonomic nervous system needs to act in conjunction with the heart to normalize blood pressure. 3 This is incorrect. This question rules out psychogenic syncope, fainting in response to anxiety or panic. 4 This is incorrect. This question rules out cardiac syncope, a loss of consciousness because of a heart condition that interferes with blood flow to the brain. The nurse is providing care for a pediatric patient who received a concussion while playing football. The patient had brief loss of consciousness and now reports a headache with a pain level of 6 on a 0 to 10 scale. The patient states, "My team plays again in five days and I should be better." Which information is vital for the patient and parents to understand? 1. A realistic timeframe regarding complete recovery 2. Type of equipment to prevent a second head injury 3. The risk of acquiring second impact syndrome 4. The potential for long-term headaches 1 This is incorrect. The nurse needs to inform the patient and parents that full recovery from a concussion may take days, weeks, or months. This information is important, but it is not considered vital. 2 This is incorrect. Information about the type of equipment is needed to avoid a second head injury is important; however, it is not vital. 3 This is correct. There is risk for a lethal condition known as second impact syndrome, in which the brain swells rapidly and the person succumbs quickly if a second concussion occurs before the first concussion has resolved. The patient's remark makes this information vitally important. 4 This is incorrect. Head injuries may or may not cause long-term headaches. The pediatric nurse is examining the skin of a young child and notices eight café-au-lait spots between 1.5 and 3 inches in diameter on the body, along with axillary freckling. Which recommendation does the nurse make to the parent? 1. Refrain from having additional children without counseling. 2. Make an appointment with a physician for testing and evaluation. 3. Agree to blood testing of the child to identify a defect in the NF1 gene. 4. Arrange for psychological therapy to address self-esteem problems. 1 This is incorrect. Without a valid diagnosis, it is not appropriate for the nurse to recommend the parents refrain from having additional children. 2 This is correct. The nurse may recognize that the child's skin manifestations are related to a strong possibility of neurofibromatosis. The nurse needs to recommend seeing a physician for testing and evaluation. 3 This is incorrect. Part of the routine testing on the child is likely to involve a blood test to evaluate for a defect in the NF1 gene. 4 This is incorrect. Once a valid diagnosis is obtained, the nurse will recommend that psychological therapy may become necessary for self-esteem issues from the presence of visible skin tumors. A parent brings a child who is 8 years of age to the pediatric clinic and tells the nurse, "I think he has Tourette's syndrome. He recently began some eye-blinking and grimacing actions." Which information does the nurse provide to help the parent distinguish between transient tic of childhood and Tourette's syndrome? 1. Vocal tics frequently become chronic in children with transient tic of childhood diagnosis. 2. Transient tic of childhood begins with a high level of tic activity and usually disappears completely by age 12. 3. Tourette's syndrome is a disorder of complex motor and vocal tics that have been present for more than 1 year. 4. Tourette's syndrome is a disorder of complex motor and vocal tics that develop between the ages of 3 to 8 years. 1 This is incorrect. Transient tic of childhood is typically a disorder of motor or vocal tics that may last for several months but not greater than 1 year. 2 This is incorrect. Transient tic of childhood occurs before the age of 10 years, may worsen around age 12 years, and usually disappears completely by age 18. 3 This is correct. Tourette's syndrome is a disorder of complex motor and vocal tics that have been present for more than 1 year and began before the child's 18th birthday. 4 This is incorrect. Transient tic of childhood is usually a simple tic that appears between the ages of 3 and 9 years and lasts for less than 1 year. The pediatric nurse in an acute care facility is providing care for a patient who is 12 years of age with a history of sickle cell anemia. During this hospitalization, it is determined that the patient has experienced a stroke. Which teaching is most important for the nurse to provide to the patient and parents? 1. A need for intensive physical and speech therapies 2. Reasons to have a designated social worker 3. The necessity for an individualized education plan 4. Manifestations of increased intracranial pressure 1 This is incorrect. The patient and family need teaching regarding physical, occupational, and speech therapies, which may be required for the patient's recovery. However, another need is most important. 2 This is incorrect. Caring for a child after a stroke is emotionally, physically, and financially exhausting, and the nurse needs to provide information about the benefit of having a designated social worker. However, another need is most important. 3 This is incorrect. After a pediatric patient experiences a stroke, an individualized education plan may be needed to assist the patient with academic achievement. However, another need is most important. 4 This is correct. Screening for the development of hydrocephalus in indicated, because it is a common complication of pediatric stroke. Important teaching for the patient and parents is related to the manifestations of increased intracranial pressure, which occurs with hydrocephalus. The nurse in the emergency department of a pediatric hospital is providing care for a toddler with a sudden high fever. The parent states, "She has been grumpy all day and I thought she just needed a nap." Which finding does the nurse recognize as an indication of an immediate medical emergency? 1. The toddler keeps eyes closed or covered at all times. 2. The nurse elicits a positive Brudzinski's sign. 3. A rash of scattered red bumps is found on the skin. 4. The toddler cries when head and neck are moved. 1 This is incorrect. Meningitis should always be suspected in acutely ill infants and children with fever and lethargy until proven otherwise; photophobia is a positive sign for meningitis. Meningitis can be a life-threatening infection and must be treated as a medical emergency; however, there is another finding that is more serious. 2 This is incorrect. Brudzinski's sign is positive for meningitis when flexion of the neck causes involuntary flexion of the knee and hip; however, there is another finding that is more serious. 3 This is correct. The scenario describes the existence of a specific bacterial infection such as Neisseria meningitides. This infection results in a purpuric rash, often combined with sepsis. Death can occur in hours after the rash appears. This finding is an immediate medical emergency. 4 This is incorrect. Meningitis is commonly associated with a stiff neck; crying when the head and neck is moved is indicative of pain. The nurse in a pediatric unit is providing care for a 2-month-old infant just diagnosed with spinal muscle atrophy. Which characteristics of the condition does the nurse expect to find during physical assessment? Select all that apply. 1. Hyperreflexia in deep tendons 2. Few spontaneous movements 3. Deep, rapid respirations 4. Fasciculations of the tongue 5. Proximal muscle atrophy 1. This is incorrect. SMA type 1 begins in utero or early infancy and is the most serious type. The infant will exhibit a loss of deep tendon reflexes, not hyperreflexia. 2. This is correct. The infant with SMA type 1 will exhibit few spontaneous movements and will be unable to lift their head. 3. This is incorrect. The respiratory muscles are weak, and death occurs by age 3 years because of respiratory compromise. Infants who display symptoms at birth usually have a shorter life span and die before they are 12 months old. 4. This is correct. Fasciculations, or constant, wormlike movements of the tongue, are noted in the infant diagnosed with SMA type 1. 5. This is incorrect. Proximal muscle atrophy is seen in SMA type 3, a juvenile form of the disease. This manifestation is not seen with SMA type 1. The NICU nurse is providing care for a neonate exhibiting manifestations of congenital Zika syndrome. Which distinct features does the nurse associate with the syndrome? Select all that apply. 1. Partially collapsed skull 2. Decreased brain tissue 3. Damage to the back of the eyes 4. Multiple joint contractures 5. Agitated body movement 1. This is correct. A neonate with Zika virus syndrome will exhibit severe microcephaly in which the skull has partially collapsed. 2. This is correct. A neonate with Zika virus syndrome will have decreased brain tissue with a specific pattern of brain damage, including subcortical calcifications. 3. This is correct. A neonate with Zika syndrome will exhibit damage to the back of the eye, including macular scarring and focal pigmentary retinal mottling. 4. This is correct. A neonate with Zika virus syndrome will have congenital contractures such as clubfoot or arthrogryposis, a condition in which the infant is born with multiple joint contractures throughout the body. 5. This is incorrect. A neonate with Zika virus syndrome will exhibit hypertonia, which restricts body movement soon after birth. A parent brings an infant to the pediatric clinic and expresses concern about irritability and poor feeding, along with recent symptoms of flu lasting a few days. The nurse notices multiple raised mosquito bites on the infant. Which additional knowledge causes the nurse to suspect encephalitis? Select all that apply. 1. A recent local outbreak of West Nile fever 2. Bulging fontanels when in a quiet state 3. Signs of facial and eyelid weakness 4. Loss of deep tendon reflexes 5. Drooling instead of swallowing saliva 1. This is correct. Encephalitis is an acute infection of the brain related to viral infections such as the herpes simplex virus and West Nile virus. 2. This is correct. Symptoms of encephalitis in infants are irritability, poor feeding, bulging fontanels, vomiting, and body stiffness. 3. This is incorrect. Acute flaccid myelitis symptoms include weakness in the face or eyelids. 4. This is incorrect. Loss of deep tendon reflexes is associated with acute flaccid myelitis. 5. This is incorrect. Difficulty swallowing is associated with acute flaccid myelitis, which can be exhibited in an infant with drooling instead of swallowing their saliva. A parent brings an adolescent who is 16 years of age to the pediatric clinic, because the patient is experiencing unusual sensations in the feet. The nurse learns the patient was diagnosed with type 1 diabetes mellitus as a toddler; glucose levels have always been erratic and difficult to control. Which assessment findings does the nurse expect based on the health history? Select all that apply. 1. Inability to identify a sharp or blunt sensation on the sole of the foot 2. Feet warm to the touch and capillary refill within normal limits 3. Problems with balance when standing without support 4. Toe nails smooth in appearance and nail beds pink in color 5. Signs of weakness during neuromuscular checks to the lower legs 1. This is correct. The nurse is likely to suspect neuropathy, which is a condition of peripheral nerve damage resulting from a metabolic or endocrine disorder such as diabetes. The inability to distinguish between a sharp or blunt sensation on the sole of the foot supports the nurse's suspicion. 2. This is incorrect. The nurse does not expect to find feet that are warm to the touch, and capillary refill to be normal with suspected diabetic neuropathy. Compromised circulation is most likely. 3. This is correct. When neuropathy of the feet is present, balance can be adversely affected by pain, tingling, and loss of sensation. This finding supports the nurse's suspicions. 4. This is incorrect. Smooth toe nails and nail beds that are pink in color indicate good circulation. 5. This is correct. The presence of neuropathy in the lower extremities can be manifested by weakness. The autonomic nervous system is responsible for: 1. Digesting a meal of hotdogs and chips. 2. Monitoring the heart rate while running. 3. Causing the body to perspire in the hot sun. 4. All of the above are part of the autonomic nervous system. 1. The ANS helps with the digestion of food. 2. The heart is regulated by the ANS. 3. Perspiration occurs because of the ANS for the purpose of thermoregulation. 4. The ANS helps with the digestion of food. The heart is regulated by the ANS. Perspiration occurs because of the ANS for the purpose of thermoregulation. The responsibilities of the central nervous system include: 1. Deciding to walk instead of run. 2. Helping to understand a math problem. 3. Digesting the food in the stomach. 4. Keeping the hand on a hot stove. 1. The brain is part of the CNS, which helps make decisions about body movements. 2. The CNS does not help with cognitive abilities. 3. Food digestion is part of the ANS. 4. The CNS would tell the hand to move. The blood-brain barrier of an infant is: 1. Less permeable than that of an adult. 2. Impermeable for glucose. 3. Permeable for large proteins. 4. Permeable for large molecules 1. There is no difference between the adult and infant blood-brain barrier. 2. Glucose is permeable for the blood-brain barrier. 3. Large proteins are impermeable for the blood-brain barrier. 4. Large molecules are able to cross the blood-brain barrier. The first assessment a child receives to identify neurological development is: 1. APGAR scores. 2. Scoliosis testing. 3. The Denver II study. 4. Kindergarten testing. 1. APGAR stands for Appearance, Pulse, Grimace, Activity, Respiration, indicating responses of the neurological system. This testing is done right after birth. 2. Scoliosis testing does not occur until the child is a preteen. 3. The Denver II test is not used until the infant is older. 4. Kindergarten testing occurs later in the child’s life. Questions about neurological function are raised when a child: 1. Snores. 2. Shows aggression when previously none was shown. 3. Wants attention from a parent. 4. Refuses to follow adult instruction. 1. Snoring presents a concern for the airway, not neurological functioning. 2. Changes in personality are signs of abnormal behaviors and should be investigated. 3. Attention-seeking behaviors indicate psychosocial need, not a neurological change. 4. This is normal behavior for a child and does not qualify as a neurological issue. A neonate is born with anencephaly. The prognosis for a neonate with this condition is: 1. A normal outcome. 2. A high risk for hydrocephaly. 3. Can be death. 4. Mental handicap. 1. The neonate will not have a brain, thus this is not a normal outcome. 2. The child lacks brain tissue, and hydrocephaly is not common. 3. Death is inevitable for a neonate with anencephaly because of the lack of brain structure. 4. A child with anencephaly has a very short life span, and evaluation for mental handicap is not needed. A child with severe mental and physical handicaps is at risk for: 1. Developing neurocutaneous lesions. 2. A dysmorphic nose and ears. 3. Abnormal cranial nerve function. 4. All of the above are correct. 1. Neurocutaneous lesions occur because of high risk for lack of physical movement. 2. Bone structure may be dysmorphic because of chronic abnormal muscle movements and contractures. 3. Because of neurological dysfunction, cranial nerve function will be abnormal. 4. Neurocutaneous lesions occur because of high risk for lack of physical movement. Bone structure may be dysmorphic because of chronic abnormal muscle movements and contractures. Because of neurological dysfunction, cranial nerve function will be abnormal. Neural tube defects can be linked to: 1. A mothers drug habit while pregnant. 2. A mothers lack of folic acid while pregnant. 3. A fetus exposure to environmental toxins. 4. A mothers alcohol consumption while pregnant. 1. Drug habits can be linked to neurological damage and growth retardation. 2. Folic acid is needed for neural tube closure and should be taken as a prenatal vitamin. 3. Exposure to toxins can cause various cognitive and physical anomalies. 4. Alcohol can cause cognitive and physical anomalies if taken while pregnant. A nurse is attempting to position a newborn with a myelomeningocele in the lower lumbar region. The best position for the newborn would be: 1. Prone. 2. Laying the newborn on his/her side with support provided to the myelomeningocele. 3. Supine. 4. Any position is acceptable for a neonate with a myelomeningocele. 1. Prone does not allow for support of the sac. 2. Laying the newborn on his/her side will provide support for the sac and decrease the chance of a rupture. 3. Supine places too much pressure on the sac and increases the risk for a rupture. 4. Laying the newborn on his/her side will provide the most support for the sac and decrease the chance of a rupture. A neonate was born to a 28-year-old mother with an uneventful pregnancy two hours ago. The baby was delivered via cesarean section and taken directly to the neonatal intensive care unit because of an encephalocele. The mother is coming to see the baby. The nurse should: 1. Be prepared to answer questions about the baby’s care and condition. 2. Leave the room and give the family time with the neonate. 3. Prepare the mother prior to entering the room about the dysmorphic features and discuss the supportive care being provided. 4. Not let the mother see the child at this point. 1. The nurse should be ready to answer questions and needs to prepare the mother for the appearance of her neonate. 2. Time with the neonate is important, but support is the priority for parents at this time. 3. Prior information before seeing the child can help reduce the shock and foster more acceptance of the neonate. 4. The mother needs to see the neonate to help create a bond. A child born with Dandy Walker malformation is receiving palliative care in the pediatric unit. A nurse should: 1. Provide the parents, patient, and family members with supportive care during this time. 2. Ask the parents to be part of the plan of care as much as possible. 3. Attempt to provide a primary nurse for this particular patient on each shift. 4. All of the above are correct. 1. Family support is important in order to provide a high quality of life in a limited amount of time. 2. Parental involvement will create a bond with the child and empower the parents. 3. A primary nurse is able to form a bond with the family and understand the needs of the child because of frequent interactions. 4. Family support is important in order to provide a high quality of life in a limited amount of time. Parental involvement will create a bond with the child and empower the parents. A primary nurse is able to form a bond with the family and understand the needs of the child because of frequent interactions. A head circumference is being measured at a 4 month olds well-baby checkup. It is noted that the head circumference has not grown since the previous assessment. The nurse should: 1. Ask the mother about the child’s nutrition. 2. Notify the doctor. 3. Re-measure the head circumference, check developmental milestones, assess the nutritional status, and discuss the findings with the doctor. 4. Document the normal findings. Feedback 1. Nutritional assessment is important, but not the priority intervention at this time. 2. The doctor will receive the information after a re-measurement is taken to validate the findings. 3. Re-measurement is needed to validate findings, and assessing milestones will indicate the cognitive and physical abilities of the child. Nutritional information will indicate if adequate nutrition is being given. The doctor will be able to prescribe the best course of action after this information is reported. 4. The findings are abnormal, and further investigation is needed. A child with a diagnosis of schizencephaly is assigned to a new nurse on the pediatric floor. The new nurse has not worked with a child with this diagnosis before. A career nurse discusses the plan of care needed for the child with the new nurse. It will be important to: 1. Assess the side of the body that has paralysis for any lesions or sores. 2. Let the patient do as much as possible for activities of daily. 3. Discourage the patient to move the paralyzed side of the body. 4. Provide full care for the patient. Feedback 1. Skin breakdown can occur because of the lack of mobility for the affected side of the body. 2. The child may be lower functioning and not be able to understand how to do ADLs or have the physical ability to do them. 3. Movement is important, but not the priority. 4. Encouragement to do as much as possible is important for independence, but the child will need supervision. A nurse is assessing a 6-month-old boys suture lines. The nurse notes that the baby has craniosynostosis. The nurse should be concerned because: 1. The suture line closure will not allow the brain to grow. 2. This can lead to hydrocephalus. 3. The child will have immediate developmental delays because of the lack of space for the brain to grow. 4. The child will not require surgery. Feedback 1. Early closure of the sutures will inhibit brain growth. 2. Fluid buildup is not a concern at this time. 3. A progression of developmental delay, rather than immediate delay, will occur. 4. Surgery may be needed to relieve pressure and allow for growth to occur. A child that had a shunt placed four years ago for hydrocephalus is in the emergency room complaining of a rapid onset of vomiting and increased lethargy. The nurse knows that the child will need: 1. Nothing, as this is a normal complication and not an emergency. 2. To be placed on IV fluids to help maintain an electrolyte balance. 3. Small amounts of fluids until the vomiting has subsided. 4. To consider this a neurological medical emergency and check the childs head circumference. Feedback 1. This should be considered a neurological emergency, and the child should be checked. 2. Electrolyte imbalances are more apt to occur when fluid is removed. 3. The history of having a shunt needs to be addressed first to prevent any neurological damage. 4. Measuring the head circumference will give an indication as to the amount of fluid not draining with the shunt and should be considered a medical emergency. Night terrors can occur in adolescents because of: 1. Emotional stress. 2. Alcohol use.