The nurse reviews the plan of care for a child with Reye's syndrome. The nurse plans to monitor for which priority complication of this syndrome?

The presence of protein in the urine

Signs of increased intracranial pressure

Signs of hyperglycemia

Signs of a bacterial infection

Answer and Explanation

The Correct Answer is B

B. Reye's syndrome is characterized by swelling of the brain (cerebral edema), which can lead to increased intracranial pressure (ICP). Monitoring for signs of increased ICP, such as changes in level of consciousness, headache, vomiting, and altered pupil size and reactivity, is crucial for early detection and intervention to prevent neurological deterioration.

A. Reye's syndrome primarily affects the liver and brain, leading to liver dysfunction and encephalopathy. While renal involvement can occur in some cases, the priority complication typically relates to liver dysfunction and neurological manifestations rather than renal impairment.

C. Hyperglycemia may be present due to liver dysfunction and altered glucose metabolism, but it is not the primary concern compared to neurological complications and hepatic failure.

D. Reye's syndrome is not caused by a bacterial infection; it is typically associated with viral illnesses, particularly influenza and varicella (chickenpox).

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Correct Answer is D

Explanation

D. The aim is to focus on the child's strengths and abilities while addressing limitations and challenges associated with the condition. This approach emphasizes maximizing the child's potential for development, independence, and participation in daily activities, education, and social interactions, while also providing support and resources to address any limitations or barriers they may encounter.

A. Another goal of treatment and care is to maximize the child's functional abilities by improving muscle control, coordination, and mobility through various therapies, such as physical therapy, occupational therapy, and speech therapy. However, this is not the primary goal.

B. Cerebral palsy is a neurological condition caused by damage to the developing brain, often occurring before birth. While efforts to prevent cerebral palsy are important, once the condition has developed, the focus shifts to managing symptoms and optimizing the child's functioning rather than eliminating the cause.

C. Emotional well-being is an important aspect of overall health for children with cerebral palsy but it is not typically the primary goal of care. Emotional disturbances may occur in some children with cerebral palsy due to various factors such as coping with the challenges of the condition, social interactions, or other comorbidities, but the primary focus of the care plan is usually on addressing physical and functional impairments.

A. Prepare the client for liver biopsy B. Put the client in a protective environment C. Position the client dorsal recumbent D. Place the client on NPO status

Correct Answer is D

Explanation

D. The correct action would be to place the client on NPO (Nothing by Mouth) status, option D. This is because a decreased level of consciousness can increase the risk of aspiration.

A. Liver biopsy is not indicated for suspected meningitis with a decreased level of consciousness. Liver biopsy is a procedure used to obtain a sample of liver tissue for diagnostic purposes, typically to evaluate liver function or diagnose liver diseases.

B. A protective environment (option B) is more related to immunocompromised patients. In the case of decreased level of consciousness, preventing aspiration is key.

C. Dorsal recumbent position refers to lying on the back with the knees flexed. While this position may be suitable for certain medical procedures or examinations, it is not specifically indicated for a client with suspected meningitis and a decreased level of consciousness.

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The nurse reviews the plan of care for a child with Reye's syndrome. The nurse plans to monitor for which priority complication of this syndrome?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Which is the primary goal that would be included in the plan of care for a child who has cerebral palsy?

Correct Answer is D

Explanation

A nurse is assisting with the care of a client who has suspected meningitis and a decrease level of consciousness. Which of the following actions should the nurse take?

Correct Answer is D

Explanation

The nurse is providing instructions about how to treat a sprained ankle. What statement by the mother does the nurse recognize as indicative of a need for additional teaching?

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A nurse is caring for a child who has Kawasaki disease. Which of the following systems is primarily affected by this disease?

A parent comments that her infant has had several ear infections in the past few months. Why are infants more susceptible to otitis media?