N412 final exam questions with correct answers
Neuro difference and children and the significance (KNOW THIS)
neuro problems are common in peds bc of variations Correct Answer-
Top heavy, head is large in proportion to body; neck muscles not well
developed = Prone to head injuries with falls; neck may not be able to
support large head
Thin cranial bones that are not well developed; unfused sutures = Not
prone to fracture until ossification occurs (Access injuries carefully in
case of abuse, story fits injury)
Highly vascular brain; subarachnoid space small; dura firmly attached
but can slip away from pericranium = Brain prone to hemorrhage; there
is less cerebrospinal fluid to cushion the brain
Excessive spinal mobility; muscles, joint capsules and ligaments of
cervical spine immature = Greater risk for high cervical spine injury at
C1-C2 level
Wedge-shaped cartilaginous vertebral bodies; ossification of vertebral
bodies incomplete = Greater risk for compression fractures of vertebrae
with falls
Development of Neuro system Correct Answer-Brain and spinal cord
develop early in gestation from the neural tube.
,Insults during early gestation can result in central nervous system
malformation.
- Infants are born with all the nerve cells they will have but they are
immature and glial cells and myelination of the nerve fibers continue to
mature throughout childhood.
- Brain cells continue to develop so drug, alcohol abuse, and brain
injuries should be educated upon in adolescents, esp bc they think they
are incapable of bad things happening to them.
Peds Neuro Exam Correct Answer-•Vital Signs: 3 main neuro ones =
HR, RR, BP (these change with change in neuro status or increase in
ICP)
- increased systolic pressure and widened pulse pressures along with
brady cardia and irregular respirations with neuro issues and increased
ICP
•Cognitive Function: posture and movement through Glasgow Coma
Scale
•Posture/Movement: decerebrate/decorticate
•Level of Consciousness: one of the most important. Responsiveness and
awareness to stimuli
- 2 parts: alertness and arousal to stimuli, ability to respond to that data
,•Pupils
•Fontanel/Suture lines
Pediatric Glasgow Coma Scale Correct Answer-Score of 15: unaltered
LOC
Score of 3: extremely decreased level of consciousness (worst
possible score on the scale)
- divided up between infants and children
- will have copy of scale on exam
- should know scores of memory
3 main sections: eye opening, motor response, verbal response
13-14 = mild brain injury
9-12 = moderate injury
8 or less = severe injury
3-4 = vegetative state
GCS Case Study
3 year old child hit by a car as he ran out to get this ball that had rolled
into the street. He is agitated, only makes grunting sounds and opens his
, eyes when mother calls his name and locally withdraws to pain Correct
Answer-Eye opening = to verbal command (3)
Motor response = localize pain (5)
- withdraws to pain is not the same as localized pain. withdraw is
moving pain area away.
- typically start nail bed pressure on left hand with kids, the kids starts to
get his right hand to push your hand off or moves his body away =
localized pain
- nail bed pressure on left hand = tries to move his left hand away
without attempt to remove stimulus= withdrawal
Verbal response = grunts (2)
total = 10
localized pain Correct Answer-- press on nail bed on left hand and they
take their right hand to move away the pressure, trying to get rid of
stimulus.
withdrawal pain (flexion-withdrawal) Correct Answer-- press on nail
bed on left hand, they try to move left hand away
- typically see them flex to remove stimulus
Documentation example of GCS: KNOW THIS! Correct Answer-E3 M5
V2 = GCS 10
Neuro difference and children and the significance (KNOW THIS)
neuro problems are common in peds bc of variations Correct Answer-
Top heavy, head is large in proportion to body; neck muscles not well
developed = Prone to head injuries with falls; neck may not be able to
support large head
Thin cranial bones that are not well developed; unfused sutures = Not
prone to fracture until ossification occurs (Access injuries carefully in
case of abuse, story fits injury)
Highly vascular brain; subarachnoid space small; dura firmly attached
but can slip away from pericranium = Brain prone to hemorrhage; there
is less cerebrospinal fluid to cushion the brain
Excessive spinal mobility; muscles, joint capsules and ligaments of
cervical spine immature = Greater risk for high cervical spine injury at
C1-C2 level
Wedge-shaped cartilaginous vertebral bodies; ossification of vertebral
bodies incomplete = Greater risk for compression fractures of vertebrae
with falls
Development of Neuro system Correct Answer-Brain and spinal cord
develop early in gestation from the neural tube.
,Insults during early gestation can result in central nervous system
malformation.
- Infants are born with all the nerve cells they will have but they are
immature and glial cells and myelination of the nerve fibers continue to
mature throughout childhood.
- Brain cells continue to develop so drug, alcohol abuse, and brain
injuries should be educated upon in adolescents, esp bc they think they
are incapable of bad things happening to them.
Peds Neuro Exam Correct Answer-•Vital Signs: 3 main neuro ones =
HR, RR, BP (these change with change in neuro status or increase in
ICP)
- increased systolic pressure and widened pulse pressures along with
brady cardia and irregular respirations with neuro issues and increased
ICP
•Cognitive Function: posture and movement through Glasgow Coma
Scale
•Posture/Movement: decerebrate/decorticate
•Level of Consciousness: one of the most important. Responsiveness and
awareness to stimuli
- 2 parts: alertness and arousal to stimuli, ability to respond to that data
,•Pupils
•Fontanel/Suture lines
Pediatric Glasgow Coma Scale Correct Answer-Score of 15: unaltered
LOC
Score of 3: extremely decreased level of consciousness (worst
possible score on the scale)
- divided up between infants and children
- will have copy of scale on exam
- should know scores of memory
3 main sections: eye opening, motor response, verbal response
13-14 = mild brain injury
9-12 = moderate injury
8 or less = severe injury
3-4 = vegetative state
GCS Case Study
3 year old child hit by a car as he ran out to get this ball that had rolled
into the street. He is agitated, only makes grunting sounds and opens his
, eyes when mother calls his name and locally withdraws to pain Correct
Answer-Eye opening = to verbal command (3)
Motor response = localize pain (5)
- withdraws to pain is not the same as localized pain. withdraw is
moving pain area away.
- typically start nail bed pressure on left hand with kids, the kids starts to
get his right hand to push your hand off or moves his body away =
localized pain
- nail bed pressure on left hand = tries to move his left hand away
without attempt to remove stimulus= withdrawal
Verbal response = grunts (2)
total = 10
localized pain Correct Answer-- press on nail bed on left hand and they
take their right hand to move away the pressure, trying to get rid of
stimulus.
withdrawal pain (flexion-withdrawal) Correct Answer-- press on nail
bed on left hand, they try to move left hand away
- typically see them flex to remove stimulus
Documentation example of GCS: KNOW THIS! Correct Answer-E3 M5
V2 = GCS 10
