Author Question: A nurse is assessing a 1-year-old child for increased intracranial pressure (ICP). Which sign should ... (Read 44 times)

fnuegbu · **on:** Jun 27, 2018

A nurse is assessing a 1-year-old child for increased intracranial pressure (ICP). Which sign should the nurse assess for with this age of child?

a. Headache
b. Bulging fontanel
c. Tachypnea
d. Increase in head circumference

Question 2

Which assessment finding in a preschooler would suggest the need for further investigation?

a. The child is able to dress independently.
b. The child rides a tricycle.
c. The child has an imaginary friend.
d. The child has a 2-pound weight gain in 12 months.

jrpg123456 · **Reply #1 on:** Jun 27, 2018

Answer to Question 1

A
Headaches are a clinical manifestation of increased ICP in children. A change in the child's normal behavior pattern may be an important early sign of increased ICP. A bulging fontanel is a manifestation of increased ICP in infants. A 10-year-old child would have a closed fontanel. A change in respiratory pattern is a late sign of increased ICP. Cheyne-Stokes respiration may be evident. This refers to a pattern of increasing rate and depth of respirations followed by a decreasing rate and depth with a pause of variable length. By 10 years of age, cranial sutures have fused so that head circumference will not increase in the presence of increased ICP.

Answer to Question 2

D
Preschool children gain an average of 5 pounds a year. A gain of only 2 pounds is less than half of the expected weight gain and should be investigated. A preschool child should be able to dress independently and be able to ride a tricycle. Imaginary friends are common for preschoolers.