Which symptom would warrant immediate reevaluation in a child with a concussion?
Mild headache.
Vomiting.
Alertness.
Normal gait.
The Correct Answer is B
Choice A rationale
A mild headache is a very common and expected symptom following a concussion, resulting from the temporary biomechanical injury to brain tissue or surrounding structures. This symptom alone typically does not indicate an immediate neurological deterioration or an expanding intracranial lesion, provided it doesn't rapidly worsen in severity or become refractory to simple analgesics. Management generally involves rest and observation.
Choice B rationale
Vomiting, especially if persistent or projectile, suggests a significant increase in intracranial pressure (ICP) due to brain swelling or an intracranial hemorrhage. This pressure irritates the vomiting center in the medulla, a critical area of the brainstem. Given that normal ICP is 5-15 mmHg in adults and slightly lower in children, new or worsening emesis warrants prompt clinical and possibly neuroimaging reevaluation.
Choice C rationale
Alertness indicates an intact reticular activating system (RAS), which is crucial for consciousness. Maintaining an alert mental status is a positive sign that suggests the primary brain centers are functioning adequately and the ICP is not critically elevated. A decreased level of consciousness would be a much more concerning indicator of neurological decline.
Choice D rationale
A normal gait reflects proper coordination of motor, sensory, and cerebellar functions. Gross neurological integrity suggests that the cerebral and cerebellar pathways, which govern balance and movement, are not significantly compromised. An abnormal gait, like ataxia, would be a sign of focal neurological deficit or severe intracranial pressure.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
The ultimate hemodynamic consequence of a left-to-right shunt through an unrepaired Atrial Septal Defect (ASD) is chronic volume overload in the pulmonary vasculature. The most appropriate long-term goal is to decrease pulmonary vascular resistance (PVR) to prevent the progression of pulmonary hypertension and eventual reversal of the shunt (Eisenmenger syndrome). Normal PVR is low, typically ∼0.5-1.5 Wood units.
Choice B rationale
An Atrial Septal Defect (ASD) results in a left-to-right shunt and is an acyanotic heart defect, meaning the child is not expected to have cyanotic episodes unless Eisenmenger syndrome (shunt reversal due to severe pulmonary hypertension) develops, which is a late-stage complication. Therefore, "remaining free from cyanotic episodes" is an expected baseline, not the most appropriate primary therapeutic goal.
Choice C rationale
Atrial enlargement, particularly of the right atrium, is a consequence of the chronic volume overload caused by the left-to-right shunting across the Atrial Septal Defect (ASD). It is an undesirable pathophysiological finding, not an appropriate goal of care. The goal is to prevent or minimize these structural changes by addressing the underlying shunt.
Choice D rationale
While maintaining normal blood pressure is a general health goal, the primary problem with an Atrial Septal Defect (ASD) is pulmonary volume overload and subsequent pulmonary hypertension, not systemic hypotension. The goal blood pressure for a child varies significantly by age and is not the most specific or critical hemodynamic parameter for this particular congenital heart defect.
Correct Answer is D
Explanation
Choice A rationale
Administering half the dose is inappropriate and lacks a scientific basis unless ordered by the provider, as it would likely be sub-therapeutic and fail to achieve the desired effect of improving myocardial contractility and reducing heart rate. Digoxin administration should be all or none based on parameters.
Choice B rationale
The acceptable apical pulse rate for administering digoxin to an infant is typically above 90-110 beats per minute (bpm). An apical pulse of 88 bpm falls below this generally accepted cutoff, indicating potential drug toxicity or the therapeutic effect lowering the rate too much, necessitating withholding the dose.
Choice C rationale
Administering double the dose is a dangerous, unscientific action that would significantly increase the risk of digoxin toxicity, which can cause severe cardiac arrhythmias, gastrointestinal symptoms, and potential cardiac arrest, particularly in infants who are highly susceptible to small dose changes.
Choice D rationale
The normal heart rate for an infant is significantly higher than 88 bpm. Holding the dose and notifying the provider is the required action. Bradycardia in an infant receiving digoxin is the cardinal sign of potential toxicity or an excessively deep therapeutic effect, and the provider must assess the situation before further dosing.
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