Week 5 practice questions Flashcards
10 peds, 9 adult
A nurse is caring for a pediatric patient who has a history of epilepsy. The parents
express concern about the child having seizures while at school. Which is the most
appropriate response by the nurse?
a. “Your child should avoid all physical activities to prevent seizures.”
b. “It is important to notify the school and teachers about your child’s condition and
provide them with a seizure action plan.”
c. “Make sure your child stays home from school if they are at risk of a seizure.”
d. “As long as your child takes medication, they will not have any seizures.”
B.
A 7-year-old with epilepsy is being discharged home after an overnight hospital stay. The
nurse knows that further teaching is necessary when the parent states:
a. “I will make sure my child gets plenty of rest.”
b. “I should give my child their medication as prescribed, even if they are feeling
well.”
c. “I can give my child an extra dose of their anti-seizure medication if they seem at
risk of a seizure.”
d. “I will supervise my child closely during activities like swimming.”
C.
A nurse is caring for an infant diagnosed with hydrocephalus. Which clinical sign would
the nurse expect to find during the assessment?
a. Depressed fontanels
b. Increased head circumference
c. Poor muscle tone
d. Increased heart rate
B.
Which of the following is a priority nursing intervention for an infant with hydrocephalus
who had VP shunt placement within the last two months?
a. Position the infant in a Trendelenburg position to decrease intracranial pressure.
b. Keep the infant’s head elevated at a 45-degree angle.
c. Monitor for signs of infection, such as fever or irritability.
d. Measure the infant’s abdominal girth every 8 hours.
C.
A nurse is assessing an infant postoperatively following the placement of a
ventriculoperitoneal (VP) shunt for hydrocephalus. Which of the following findings
would be most concerning?
a. The infant’s head circumference has gone down slightly.
b. The infant is lethargic and has a high-pitched cry.
c. The infant’s anterior fontanel is slightly bulging when crying.
d. The infant is breastfeeding less than usual
B.
The parents of an infant with hydrocephalus ask the nurse about the purpose of the VP
shunt. What is the nurse’s best response?
a. “It helps monitor the pressure inside your baby’s head.”
b. “It drains excess cerebrospinal fluid from the brain to the abdomen to reduce
pressure.”
c. “It provides nutrients to the brain to help it grow.”
d. “It helps to prevent long-term complications.
B.
10-year-old child is admitted to the emergency department after falling from a tree and
sustaining a head injury. The nurse knows that the most critical sign of increased
intracranial pressure (ICP) to monitor for is:
a. Nausea
b. Bradycardia
c. Increased urination
d. Irritability
B.
A nurse is providing discharge instructions to the parents of a child who suffered a mild
head injury. Which of the following symptoms should prompt the parents to seek
immediate medical attention?
a. Sleepiness
b. Mild headache
c. Projectile vomiting
d. Irritability
C.
A child with a head injury is admitted to the hospital for observation. The nurse knows
that the following assessment finding is most indicative of early increased intracranial
pressure:
a. Decreased heart rate
b. Unequal pupils
c. Hypotension
d. Hyperactivity
B.
- A nurse is conducting an assessment of an infant suspected of non-accidental head
trauma. Which of the following findings would raise suspicion of this condition?
a. The baby is lethargic and has poor feeding.
b. The baby has a low-grade fever and congestion.
c. The baby has a history of frequent ear infections.
d. The baby exhibits jittery movements but no neurological deficits.
A.
A patient with a diagnosis of increased intracranial pressure (ICP) has a cerebral
perfusion pressure (CPP) of 55 mmHg (reference range 70-100 mmHg). Which of the
following interventions does the nurse expect to implement to improve the patient’s CPP?
a. Administering mannitol
b. Restricting IV fluids
c. Lowering the head of the bed to 10 degrees
d. Increasing sedation to reduce activity
A.
A patient with a traumatic brain injury (TBI) is being treated in the ICU. Which of the
following actions by the nurse will help prevent secondary brain injury?
a. Maintain a PaCO₂ of 55 mmHg
b. Administer sedatives to prevent agitation
c. Encourage early mobilization and physical therapy
d. Restrict fluid intake to avoid cerebral edema
B.
A patient is admitted to the emergency department with symptoms of a transient ischemic
attack (TIA). Which of the following is the nurse’s priority intervention?
a. Administer aspirin as ordered
b. Prepare the patient for immediate surgery
c. Place the patient on strict bed rest for 48 hours
d. Perform passive range-of-motion exercises to prevent contractures
A.
A nurse is caring for a patient who is receiving tissue plasminogen activator (tPA) for an
acute ischemic stroke. Which of the following actions is a priority for the nurse during
tPA administration?
a. Monitor the patient’s blood glucose levels every 15 minutes
b. Keep the patient on bed rest for the first 24 hours
c. Assess for signs of bleeding every 15 minutes during the first hour
d. Administer anticoagulants immediately following tPA
C.
A patient is admitted to the hospital with a diagnosis of hemorrhagic stroke. Which of the
following interventions should the nurse anticipate?
a. Administer thrombolytic therapy within 4.5 hours of symptom onset
b. Maintain blood pressure within a target range as ordered by the physician
c. Perform frequent deep suctioning to prevent aspiration pneumonia
d. Begin anticoagulant therapy to prevent further clot formation
B.
