A child with spastic cerebral palsy is to receive botulin toxin.

The nurse prepares the child for administration of this drug by which route?

Choice A rationale

While a shunt insertion for hydrocephalus aims to drain excess cerebrospinal fluid and reduce intracranial pressure, thereby minimizing brain damage, it does not completely eliminate the risk of developmental problems. The extent of pre-existing neurological damage influences long-term outcomes, and some children may still experience learning disabilities or motor deficits requiring ongoing therapy and support.

Choice B rationale

The risk of shunt infection is present throughout the device's life, although the greatest risk does occur in the early post-operative period, typically within the first few months. Infections can be caused by skin flora introduced during surgery and can lead to serious complications like ventriculitis or septicemia, often requiring shunt removal and IV antibiotics.

Choice C rationale

Shunts have a fixed length; as the child grows, the distal catheter (the end draining the fluid) may no longer reach the peritoneal cavity or atrium, leading to shunt malfunction. Furthermore, components can fail over time due to wear or blockage, necessitating surgical revisions or replacement throughout the individual's lifetime to maintain proper cerebrospinal fluid drainage.

Choice D rationale

A ventriculoperitoneal or ventriculoatrial shunt is a palliative measure that manages the primary complication of hydrocephalus, which is increased intracranial pressure. However, shunts are prone to complications such as malfunction due to blockage, disconnection, or infection, and they do not cure the underlying cause, meaning that further complications remain a possibility.

Choice A rationale

Antiemetics are most effectively used by administering them proactively, before the chemotherapy agent is started, which is known as prophylactic use. This method allows the medication to achieve therapeutic serum levels and occupy receptors before the emetogenic chemicals stimulate the vomiting center in the brain, thus blocking the nausea pathway.

Choice B rationale

Waiting for nonpharmacologic methods to fail before using antiemetics is ineffective management. Chemotherapy-induced nausea and vomiting are best controlled with aggressive, scheduled pharmacologic intervention from the start, as it is far harder to stop vomiting once the emetic cycle has been established.

Choice C rationale

Starting antiemetics only when nausea begins is reactive and allows the patient to experience unnecessary distress and potential nutritional compromise. The goal in chemotherapy management is prevention; therefore, antiemetics must be started before the patient's exposure to the emetogenic stimuli.

Choice D rationale

Providing antiemetics as needed, or PRN, is a less effective strategy for chemotherapy-induced nausea and vomiting. The intensity of this type of emesis necessitates a scheduled regimen to consistently maintain therapeutic drug levels and prevent the overwhelming onset of nausea and vomiting, which can be difficult to manage once it starts.