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 C

Explanation

C. The priority during a seizure is to protect the patient from harm, particularly from aspiration if they vomit or have excessive saliva production. Turning the client to a lateral position helps maintain an open airway and prevents aspiration. This action should be taken immediately after lowering the client to the floor to ensure their safety.

A. Providing oxygen is important for a patient experiencing a seizure. However, it's not the first action to take. The priority is to ensure the patient's safety and protect them from injury during the seizure.

B. Administering anticonvulsant medication during an active seizure is not appropriate. Anticonvulsants are typically prescribed as maintenance therapy to prevent seizures or to manage seizure disorders in a controlled manner, not during an acute seizure episode.

D. Monitoring oxygen saturation is important but it's not the first action to take during an active seizure. Ensuring the patient's safety and protecting them from injury take precedence. Oxygen saturation can be assessed once the patient is in a safe position.

A. Cerebral palsy is an infectious disease of the central nervous system. B. Cerebral palsy is an inflammation of the brain as a result of a viral illness. C. Cerebral palsy is a chronic disability characterized by a difficulty in controlling the muscles. D. Cerebral palsy is a congenital condition that results in moderate to severe intellectual disability.

Correct Answer is C

Explanation

C. Cerebral palsy is a chronic condition that affects muscle control and movement. It is caused by damage to or abnormal development of the parts of the brain that control movement, balance, and posture. This damage can occur before, during, or shortly after birth, and it results in difficulties with muscle coordination, balance, and motor skills.

A. Cerebral palsy is not caused by an infectious agent; it is a non-progressive neurological disorder that affects movement, posture, and muscle coordination. It is primarily caused by abnormal development or damage to the brain before, during, or shortly after birth, rather than by an infectious disease.

B. Cerebral palsy is not caused by inflammation of the brain due to a viral illness. While viral illnesses can lead to complications, such as encephalitis (inflammation of the brain), cerebral palsy itself is not caused by inflammation but rather by neurological damage or abnormal development.

D. Cerebral palsy primarily affects movement and muscle control but it does not necessarily result in intellectual disability. Intellectual disability can occur in some cases of cerebral palsy, but it is not a defining characteristic of the condition.

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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?

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Naxlex Comprehensive Predictor Exams

A nurse enters a school age child's room to administer morning medications and finds the client sitting in a chair having a seizure. After lowering the client to the floor, which of the following actions should the nurse take first?

Correct Answer is C

Explanation

The nurse is caring for a child recently diagnosed with cerebral palsy. The parents of the child ask the nurse about the disorder. The nurse bases the response to the parents on the understanding that cerebral palsy is best described by which statement?

Correct Answer is C

Explanation

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