A nurse is assessing a five-month-old Infant. The nurse should recognize that which of the following manifestations is associated with a central nervous system (CNS) Infection?
Oliguria
Negative Kernig's sign
Bulging fontanel
Negative Brudzinski sign
The Correct Answer is C
A. Oliguria (decreased urine output) may be a sign of dehydration or kidney dysfunction but is not typically the primary symptom of a CNS infection.
B. A negative Kernig's sign (no resistance to leg extension) is a reassuring sign and suggests that meningitis or other CNS infections are less likely. A positive sign would suggest possible meningitis.
C. Bulging of the fontanel is a sign of increased intracranial pressure, which can occur in CNS infections such as meningitis. This is a critical finding that requires immediate attention.
D. A negative Brudzinski sign means there is no neck stiffness or pain when the neck is flexed, which is a good finding. A positive sign would suggest the presence of meningitis.
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Related Questions
Correct Answer is D
Explanation
A. A child with a fever due to a viral infection may pose an infection risk to the immunocompromised leukemia patient.
B. A child recovering from surgery may have a wound or infection risk, which could also be a concern for a child receiving chemotherapy.
C. A child with chickenpox is highly contagious and should not be in the same room as an immunocompromised child.
D. A child with asthma is not immunocompromised and is less likely to pose an infection risk to a child undergoing chemotherapy.
Correct Answer is C
Explanation
A. This is important for mobility, but after casting, the priority is to monitor for complications such as compartment syndrome, which can be life-threatening if not addressed.
B. While body image and emotional well-being are important, the priority immediately following a fracture and cast placement is physical monitoring for complications.
C. Worsening pain after a fracture or cast placement may indicate complications such as compartment syndrome, a medical emergency that requires prompt intervention. Monitoring for signs of increased pain is crucial.
D. Range of motion is a later consideration after ensuring the child does not have complications such as compartment syndrome. The priority is evaluating the affected limb for issues like worsening pain or signs of nerve damage.
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