A preschooler has been having periods during which

Question 1 of 5

A preschooler has been having periods during which he suddenly falls and appears weak for a short time after the event. The preschool teacher asks what she should do. Select the nursbest response.

A. Have the parents follow up with his pediatrician as this is likely an atonic seizure. B. Find out if there have been any new stressors in his life, as it could be attention-seeking behavior. C. Have the parents follow up with his pediatrician as this is likely an absence seizure. D. The preschool years are a time of rapid growth, and many children appear clumsy. It would be best to watch him, and see if it continues.

Correct Answer: A

Rationale: Follow up with the pediatrician for a likely atonic seizure is best, per epilepsy texts. Sudden falls with brief weakness suggest atonic seizur(tone loss), needing evaluation. Stressors dont fit; absence lacks falls; growth dismisssymptoms. As specificity makes itthe correct answer.

Question 2 of 5

A 6-month-old infant diagnosed with meningitis is placed supine. When the infants neck is flexed, he also flexhis kneand hips. This sign is referred to as:

A. Brudzinski sign. B. Cushing triad. C. Kernig sign. D. Nuchal rigidity.

Correct Answer: A

Rationale: Brudzinski sign is neck flexion causing knee/hip flexion in meningitis, per infectious disease texts, indicating meningeal irritation. Cushing is ICP triad; Kernig leg extension pain; nuchal stiffness. As specificity makes itthe correct answer.

Question 3 of 5

An adolescent remains unconscious 24 hours after sustaining a closed-head injury in an MVA. She responds to deep, painful stimulation with decorticate posturing, and an intracranial monitor shows periodic increased ICP. With all other vital signs stable, what is the most appropriate nursing action?

A. Encourage the teens peers to visit and talk about school and events. B. Encourage the teens parents to hold her hand and speak loudly in an attempt to help her regain consciousness. C. Attempt to keep a normal day/night pattern by keeping the teen in a bright, lively environment during the day and a dark, quiet environment at night. D. Attempt to keep the environment dark and quiet, and encourage minimal stimulation.

Correct Answer: D

Rationale: Dark, quiet with minimal stimulation is most appropriate for unconsciousness with ICP, per neurocritical care, reducing oxygen demand and ICP spikes. Stimulation (A, B) or day/night cycling worsens it. Ds focus makes itthe correct answer.

Question 4 of 5

The nurse knows that young infants are at risk for injury from shaken baby syndrome (SBS) because:

A. The anterior fontanel is open. B. They have insufficient musculoskeletal support and a disproportionate head-to-body ratio. C. They have an immature vascular system with veins and arterithat are more superficial. D. There is immature myelination of the nervous system in a young infant.

Correct Answer: B

Rationale: Insufficient support and head-to-body ratio explain SBS risk, per pediatrics. Large heads and weak necks amplify shaking injury. Fontanel allows expansion, not cause; vascular and myelination are secondary. Bs mechanics make it the correct answer.

Question 5 of 5

The parents of a 12-month-old with a neurogenic bladder ask if their child will always have to be catheterized. Select the nursbest response.

A. Your child will never feel when her bladder is full, so she will always have to be catheterized. Because she is female, she will always need assistance. B. As your child ages, she will likely be able to sense when her bladder is full and will be able to empty it on her own. C. Although your child will not be able to feel when her bladder is full, she can learn to urinate every 4 to 6 hours and therefore not require catheterizations. D. Your child will never be able to completely empty her bladder spontaneously, but there are alternativto traditional catheterization, such as a vesicostomy.

Correct Answer: D

Rationale: Alternativlike vesicostomy is best, per urology texts. Neurogenic bladder prevents full emptying; vesicostomy offers drainage without catheters. Always catheterized limits options; sensation (B, C) unlikely. Ds practicality makes itthe correct answer.

A preschooler has been having periods during which he suddenly falls and appears weak for a short time after the event. The preschool teacher asks what she should do. Select the nursbest response.

Nurselytic

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