A nurse is collecting data from a 5-month-old infant who has increased intracranial pressure (ICP) resulting from hydrocephalus. Which of the following manifestations should the nurse expect?
Low-pitched cry
Positive Babinski reflex
Insomnia
Bulging fontanel
The Correct Answer is D
A. Low-pitched cry: A high-pitched cry, not a low-pitched one, is more typical of increased ICP in infants. A low-pitched cry is not a common sign of ICP and may be more related to other conditions.
B. Positive Babinski reflex: The Babinski reflex is normal in infants up to about 1 year of age and is not indicative of increased ICP. It is a normal finding and not specific to increased intracranial pressure.
C. Insomnia: Infants with increased ICP may exhibit irritability and changes in sleeping patterns, but insomnia (difficulty sleeping) is not a classic symptom. The focus should be on other more specific signs like changes in cry and physical appearance.
D. Bulging fontanel: A bulging fontanel is a key sign of increased ICP in infants. It occurs due to pressure within the skull causing the soft spot on the head to protrude. This is a classic symptom of increased intracranial pressure in infants.
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Related Questions
Correct Answer is C
Explanation
A. "SIDS is directly correlated to diphtheria, tetanus, and pertussis vaccines." This statement is incorrect and misleading. There is no direct correlation between SIDS and vaccinations like the diphtheria, tetanus, and pertussis (DTP) vaccines. In fact, immunizations are an important part of a child's health and can help prevent diseases that could lead to complications, including those that might be indirectly related to SIDS risk factors.
B. "SIDS rates have been rising over the last 10 years." This statement is false. SIDS rates have generally been decreasing, especially since the introduction of public health campaigns promoting safe sleep practices, such as placing infants on their backs to sleep.
C. "You should place your baby on her back when sleeping to decrease the risk of SIDS." This is the correct and evidence-based recommendation. Placing a baby on their back to sleep significantly reduces the risk of SIDS. This practice is part of the "Back to Sleep" campaign, which has been shown to lower the incidence of SIDS.
D. "Sleep apnea is the main cause of SIDS." This statement is incorrect. While sleep apnea has been studied as a potential risk factor, it is not considered the main cause of SIDS. The exact cause of SIDS is still unknown, but it is believed to be related to multiple factors, including sleep environment and infant physiology.
Correct Answer is D
Explanation
A. "My parents treat me like a baby sometimes." This statement reflects a common adolescent feeling of striving for independence and experiencing frustration when treated as a child. It is a normal part of adolescent development and not a cause for immediate concern.
B. "There's a pimple on my face, and I worry that everyone will notice it." Concern about appearance is typical for adolescents due to the increased focus on body image and peer perception. This statement is a normal expression of adolescent self-consciousness.
C. ``I start taking ibuprofen a few days before my period starts." Using ibuprofen preemptively for menstrual cramps is a reasonable self-care practice for adolescents experiencing menstrual discomfort. This statement does not indicate any immediate health concern.
D. "None of the kids at my school like me, and I don't like them either." This statement indicates social isolation and potential issues with peer relationships, which can be a red flag for emotional distress or depression. It may suggest that the adolescent is experiencing significant difficulties in their social life that could lead to more serious mental health concerns.
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