A nurse is collecting data from an 8-month-old infant who has increased intracranial pressure (ICP). Which of the following manifestations should the nurse expect?
Insomnia
Positive Babinski reflex
Bulging fontanel
Low-pitched cry
The Correct Answer is C
A. Insomnia: Infants with increased ICP are more likely to be lethargic than to have insomnia.
B. Positive Babinski reflex: A positive Babinski reflex is normal in infants under 2 years and does not indicate ICP.
C. Bulging fontanel: A bulging fontanel is a classic sign of increased ICP due to the accumulation of fluid or swelling inside the skull.
D. Low-pitched cry: Infants with ICP typically have a high-pitched cry, not a low-pitched one.
Free Nursing Test Bank
- Free Pharmacology Quiz 1
- Free Medical-Surgical Quiz 2
- Free Fundamentals Quiz 3
- Free Maternal-Newborn Quiz 4
- Free Anatomy and Physiology Quiz 5
- Free Obstetrics and Pediatrics Quiz 6
- Free Fluid and Electrolytes Quiz 7
- Free Community Health Quiz 8
- Free Promoting Health across the Lifespan Quiz 9
- Free Multidimensional Care Quiz 10
View Related questions
Correct Answer is D
Explanation
A. Pulling a wagon with toys in the hallway: A child on airborne precautions cannot leave the room to prevent the spread of infection.
B. Watching a video game in the playroom: Access to communal areas like the playroom is prohibited for children on airborne precautions.
C. Constructing a model airplane: While constructive, small parts in models can be hazardous and inappropriate for some children in a hospital setting.
D. Putting a puzzle together: Puzzles are a safe, quiet activity that can be done independently in the isolation room.
Correct Answer is ["A","C","E"]
Explanation
A. Febrile episode: Fever is a common trigger for febrile seizures in children, especially between 6 months and 5 years.
B. Low blood lead levels: Elevated, not low, blood lead levels can increase the risk of seizures due to neurotoxicity.
C. Sodium imbalance: Both hyponatremia and hypernatremia can cause seizures by disrupting neuronal function.
D. Presence of diphtheria: Diphtheria does not directly increase the risk of seizures. Neurological complications are rare and secondary.
E. Hypoglycemia: Low blood sugar levels deprive the brain of energy, which can lead to seizures.