Question 1

A 5 year old sustained a concussion when falling out of a tree.In preparation for discharge,the nurse is discussing home care with the mother.Which statement made by the mother indicates a correct understanding of the teaching?

Accepted Answer

The parents are advised of probably posttraumatic symptoms that may be expected,including difficulty concentrating,and memory impairment.If the child has episodes of vomiting,sleep disturbances,or diplopia,they should be immediately reported for evaluation.

Question 2

The nurse,closely monitoring a child who is unconscious after a fall,notices that the child suddenly has a fixed and dilated pupil.The nurse should interpret this as the indication of what occurrence?

Accepted Answer

The sudden appearance of a fixed and dilated pupil(s)is a neurosurgical emergency.The nurse should immediately report this finding.Although a dilated pupil may be associated with eye trauma,this child has experienced a neurologic insult.Pinpoint pupils or fixed,bilateral pupils for more than 5 minutes are indicative of brainstem damage.The unilateral fixed and dilated pupil is suggestive of damage on the same side of the brain.One fixed and dilated pupil is not suggestive of brain death.

Question 3

What is the common vector reservoir for agents causing viral encephalitis in the United States?

Accepted Answer

Viral encephalitis,not attributable to a childhood viral disease,is usually transmitted by mosquitoes and ticks.The vector reservoir for most agents pathogenic for humans and detected in the United States are mosquitoes and ticks; therefore,most cases of encephalitis appear during the hot summer months.Tarantulas,carnivorous wild animals,and domestic animals are not reservoirs for the agents that cause viral encephalitis.

Question 4

Which type of fracture describes traumatic separation of cranial sutures?

Accepted Answer

Diastatic skull fractures are traumatic separations of the cranial sutures.A basilar fracture involves the basilar portion of the frontal,ethmoid,sphenoid,temporal,or occipital bone.A compound fracture has the bone exposed through the skin.A depressed fracture has the bone pushed inward,causing pressure on the brain.

Question 5

Which term is used to describe a child's level of consciousness when the child can be aroused with stimulation?

Accepted Answer

Obtundation describes a level of consciousness in which the child can be aroused with stimulation.Stupor is a state in which the child remains in a deep sleep,responsive only to vigorous and repeated stimulation.Confusion is impaired decision making.Disorientation is confusion regarding time and place.

Question 6

Which neurologic diagnostic test gives a visualized horizontal and vertical cross section of the brain at any axis?

Accepted Answer

A CT scan provides visualization of the horizontal and vertical cross sections of the brain at any axis.A nuclear brain scan uses a radioisotope that accumulates where the blood-brain barrier is defective.Echoencephalography identifies shifts in midline structures of the brain as a result of intracranial lesions.MRI permits visualization of morphologic features of target structures and tissue discrimination that is unavailable with any other techniques.

Question 7

A 3-year-old child is hospitalized after a near-drowning accident.The child's mother complains to the nurse,"This seems unnecessary when he is perfectly fine." What is the nurse's best reply?

Accepted Answer

All children who have a near-drowning experience should be admitted to the hospital for observation.Although many children do not appear to have suffered adverse effects from the event,complications such as respiratory compromise and cerebral edema may occur up to 24 hours after the incident.Aspiration pneumonia is a frequent complication that occurs about 48 to 72 hours after the episode.Stating that,"He still needs a little extra oxygen" does not respond directly to the mother's concern.Why is her child still receiving oxygen? The nurse should clarify that different complications can occur up to 24 hours later and that observations are necessary.The nurse should not provide statements that provide unfounded information,like "I'm sure he is fine."

Question 8

A school-age child has sustained a head injury and multiple fractures after being thrown from a horse.The child's level of consciousness is variable.The parents tell the nurse that they think their child is in pain because of periodic crying and restlessness.What is the most appropriate nursing action in response to the parent's concern?

Accepted Answer

A key nursing role is to provide sedation and analgesia for the child.Consultation with the appropriate practitioner is necessary to avoid conflict between the necessity to monitor the child's neurologic status and to promote comfort and relieve anxiety.Gathering information about the child's previous experiences with pain should be obtained as part of the assessment,but because of the severity of injury,analgesia should be provided as soon as possible.Analgesia can be used safely in individuals who have sustained head injuries and can decrease anxiety and resultant increased intracranial pressure.

Question 9

Which statement best describes a subdural hematoma?

Accepted Answer

A subdural hematoma is bleeding that occurs between the dura and the cerebrum as a result of a rupture of cortical veins that bridge the subdural space.An epidural hemorrhage occurs between the dura and the skull,is usually arterial with rapid brain concussion,and occurs most often in the parietotemporal region.

Question 10

What is the priority nursing intervention when a child is unconscious after a fall?

Accepted Answer

Respiratory effectiveness is the primary concern in the care of the unconscious child.Establishing an adequate airway is always the first priority.A neurologic assessment and determination of neck injury are performed after breathing and circulation are stabilized.Intracranial,not intercranial,pressure is monitored if indicated after airway,breathing,and circulation are maintained.

Question 11

The mother of a 1-month-old infant tells the nurse that she worries that her baby will get meningitis like her oldest son did when he was an infant.On what information should the nurse's response be based upon?

Accepted Answer

H.influenzae type B meningitis has virtually been eradicated in areas of the world where the vaccine is administered routinely.Bacterial meningitis remains a serious illness in children.It is significant because of the residual damage caused by undiagnosed and untreated or inadequately treated cases.The leading causes of neonatal meningitis are the group B streptococci and Escherichia coli organisms.Meningitis is an extension of a variety of bacterial infections.No genetic predisposition exists.Vaccinations are not available for all of the potential causative organisms.

Question 12

An adolescent boy is brought to the emergency department after a motorcycle accident.His respirations are deep,periodic,and gasping.There are extreme fluctuations in blood pressure.Pupils are dilated and fixed.What type of head injury should the nurse suspect?

Accepted Answer

Signs of brainstem injury include deep,rapid,periodic or intermittent,and gasping respirations.Wide fluctuations or noticeable slowing of the pulse,widening pulse pressure,or extreme fluctuations in blood pressure are consistent with a brainstem injury.Skull fracture and subdural and epidural hemorrhages are not consistent with these signs.

Question 13

Which statement is most descriptive of a concussion?

Accepted Answer

A concussion is a transient,reversible neuronal dysfunction with instantaneous loss of awareness and responsiveness resulting from trauma to the head.Petechial hemorrhages along the superficial aspects of the brain along the point of impact are a type of contusion but are not necessarily associated with amnesia.A contusion is visible bruising and tearing of cerebral tissue.Contrecoup is a lesion that develops remote from the site of trauma as a result of an acceleration/deceleration injury.

Question 14

The Glasgow Coma Scale consists of an assessment of what functions?

Accepted Answer

The Glasgow Coma Scale assesses eye opening and verbal and motor responses.Pupil reactivity is not a part of the Glasgow Coma Scale but is included in the pediatric coma scale.Level of consciousness and ICP are not part of the Glasgow Coma Scale.

Question 15

A toddler,who fell out of a second-story window,had brief loss of consciousness and vomited 4 times.Since admission,the child has been alert and oriented.The mother asks why a computed tomography (CT)scan is required when the child "seems fine." The nurse should base the response on the need to monitor for what possible complication?

Accepted Answer

The child's history of the fall,brief loss of consciousness,and vomiting 4 times necessitate evaluation of a potential brain injury.The severity of a head injury may not be apparent on clinical examination but will be detectable on a CT scan.All the remaining options are a result of varying degrees of brain injury.

Question 16

The nurse is assessing a child who was just admitted to the hospital for observation after a head injury.What is the most essential part of the nursing assessment to detect early signs of a worsening condition?

Accepted Answer

The most important nursing observation is assessment of the child's level of consciousness.Alterations in consciousness appear earlier in the progression of head injury than do alterations of vital signs or focal neurologic signs.Neurologic posturing indicates neurologic damage.Vital signs and focal neurologic signs are later signs of progression when compared with level-of-consciousness changes.

Question 17

The nurse is preparing a school-age child for a computed tomography (CT)scan to assess cerebral function.When preparing the child for the scan,which statement should the nurse include?

Accepted Answer

For CT scans,the child will not be allowed to move and must be immobilized.It is important to emphasize to the child that at no time is the procedure painful.Pain medication is not required; however,sedation is sometimes necessary.Someone is able to remain with the child during the procedure.

Question 18

Which term is used when a patient remains in a deep sleep,responsive only to vigorous and repeated stimulation?

Accepted Answer

Stupor exists when the child remains in a deep sleep,responsive only to vigorous and repeated stimulation.Coma is the state in which no motor or verbal response occurs to noxious (painful)stimuli.Obtundation describes a level of consciousness in which the child can be aroused with stimulation.Persistent vegetative state describes the permanent loss of function of the cerebral cortex.

Question 19

Which drug would be used to treat a child who has increased intracranial pressure (ICP)resulting from cerebral edema?

Accepted Answer

For increased ICP,mannitol,an osmotic diuretic,administered intravenously,is the drug used most frequently for rapid reduction.Epinephrine,atropine sulfate,and sodium bicarbonate are not used to decrease ICP.

Question 20

Which test is never performed on a child who is awake?

Accepted Answer

The oculovestibular response (caloric test)involves the instillation of ice water into the ear of a comatose child.The caloric test is painful and is never performed on a child who is awake or one who has a ruptured tympanic membrane.Doll's head maneuver,funduscopic examination,and assessment of pyramidal tract lesions can be performed on children who are awake.

Quiz 46: The Child With Cerebral Dysfunction