Question 1

The nurse is doing a neurologic assessment on a 2-month-old infant after a car accident.Moro,tonic neck,and withdrawal reflexes are present.How should the nurse interpret these findings?

Accepted Answer

Moro,tonic neck,and withdrawal reflexes are three reflexes that are present in a healthy 2-month-old infant and are expected in this age group.

Question 2

What are quick,jerky,grossly uncoordinated,irregular movements that may disappear on relaxation called?

Accepted Answer

Quick,jerky,grossly uncoordinated,irregular movements that may disappear on relaxation are called choreiform movements.Twitching is defined as spasmodic movements of short duration.Spasticity is the prolonged and steady contraction of a muscle characterized by clonus (alternating relaxation and contraction of the muscle)and exaggerated reflexes.Associated movements are the voluntary movement of one muscle accompanied by the involuntary movement of another muscle.

Question 3

A 5-year-old girl sustained a concussion when she fell out of a tree.In preparation for discharge,the nurse is discussing home care with her mother.What sign or symptom is considered a manifestation of postconcussion syndrome and does not necessitate medical attention?

Accepted Answer

The parents are advised of probable posttraumatic symptoms that may be expected.These include behavioral changes,sleep disturbances,emotional lability,and alterations in school performance.If the child is vomiting,has blurred vision,or has temporary loss of consciousness,she should be seen for evaluation.

Question 4

What term is used to describe a child's level of consciousness when the child is arousable with stimulation?

Accepted Answer

Obtundation describes a level of consciousness in which the child is arousable 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 5

The nurse is caring for a child with severe head trauma after a car accident.What is an ominous sign that often precedes death?

Accepted Answer

Periodic or irregular breathing is an ominous sign of brainstem (especially medullary)dysfunction that often precedes complete apnea.Delirium is a state of mental confusion and excitement marked by disorientation for time and place.Papilledema is edema and inflammation of the optic nerve.It is commonly a sign of increased intracranial pressure.Flexion posturing is seen with severe dysfunction of the cerebral cortex or of the corticospinal tracts above the brainstem.

Question 6

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

Accepted Answer

For CT scans,the child 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.The child will not be allowed to move and will be immobilized.Someone is able to remain with the child during the procedure.

Question 7

An 18-month-old child is brought to the emergency department after being found unconscious in the family pool.What does the nurse identify as the primary problem in drowning incidents?

Accepted Answer

Hypoxia is the primary problem because it results in global cell damage,with different cells tolerating variable lengths of anoxia.Neurons sustain irreversible damage after 4 to 6 minutes of submersion.Severe neurologic damage occurs from hypoxia in 3 to 6 minutes.Aspiration of fluid does occur,resulting in pulmonary edema,atelectasis,airway spasm,and pneumonitis,which complicate the anoxia.Hypothermia occurs rapidly,except in hot tubs.Electrolyte imbalances do result,but they are not a major cause of morbidity and mortality.

Question 8

A 10-year-old boy on a bicycle has been hit by a car in front of a school.The school nurse immediately assesses airway,breathing,and circulation.What should be the next nursing action?

Accepted Answer

After determining that the child is breathing and has adequate circulation,the next action is to stabilize the neck and spine to prevent any additional trauma.The child's position should not be changed until the neck and spine are stabilized.Blood pressure is a later assessment.A less urgent but important assessment is inspection of the scalp for bleeding.

Question 9

What finding is a clinical manifestation of increased intracranial pressure (ICP)in children?

Accepted Answer

Diplopia and blurred vision are signs of increased ICP in children.A high-pitched cry and a tense or bulging fontanel are characteristic of increased ICP.Increased blood pressure,common in adults,is rarely seen in children.

Question 10

The nurse is closely monitoring a child who is unconscious after a fall and notices that the child suddenly has a fixed and dilated pupil.How should the nurse interpret this?

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.One fixed and dilated pupil is not suggestive of brain death.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.

Question 11

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?

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.Analgesia can be safely used in individuals who have sustained head injuries.The child's previous experiences with pain should be obtained as part of the assessment,but because of the severity of the injury,analgesia should be provided as soon as possible.Analgesia can decrease anxiety and resultant increased intracranial pressure.

Question 12

What 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 is arousable with stimulation.Persistent vegetative state describes the permanent loss of function of the cerebral cortex.

Question 13

What 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 an awake child or one who has a ruptured tympanic membrane.The doll's head maneuver,assessment of pyramidal tract lesions,and funduscopic examination for papilledema are not considered painful and can be performed on awake children.

Question 14

The nurse is assessing a child who was just admitted to the hospital for observation after a head injury.What clinical manifestation 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 an injury than do alterations of vital signs or focal neurologic signs.Neurologic posturing is indicative of neurologic damage.

Question 15

What is a nursing intervention to reduce the risk of increasing intracranial pressure (ICP)in an unconscious child?

Accepted Answer

Unrelieved pain,crying,and emotional stress all contribute to increasing the ICP.Disturbing procedures should be carried out at the same time as therapies that reduce ICP,such as sedation.Suctioning is poorly tolerated by children.When necessary,it is preceded by hyperventilation with 100% oxygen.Turning the head side to side is contraindicated for fear of compressing the jugular vein.This would block the flow of blood from the brain,raising ICP.Nontherapeutic touch and environmental stimulation increase ICP.Minimizing both touch and environmental stimuli noise reduces ICP.

Question 16

An injury to which part of the brain will cause a coma?

Accepted Answer

Injury to the brainstem results in stupor and coma.Signs of damage to the cerebrum are specific to the involved area.Individuals with frontal lobe injury may have impaired memory,personality changes,or altered intellectual functioning.Individuals with damage to the cerebellum have difficulties with coordination of muscle movements,including ataxia and nystagmus.Impaired vision and functional blindness result from injury to the occipital lobe.

Question 17

What 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 18

What statement is 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 on 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 19

The mother of a 1-month-old infant tells the nurse she worries that her baby will get meningitis like the child's younger brother had when he was an infant.The nurse should base a response on which information?

Accepted Answer

H.influenzae type B meningitis has been virtually 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 20

What nursing intervention is appropriate when caring for an unconscious child?

Accepted Answer

Often comatose patients cannot cope with the quantity of fluids that they normally tolerate.Overhydration must be avoided to prevent fatal cerebral edema.Narcotics and sedatives should be used as necessary to reduce pain and anxiety,which can increase ICP.The child's position should be changed frequently to avoid complications such as pneumonia and skin breakdown.Antipyretics are the method of choice for fever reduction.

Quiz 32: The Child With Cerebral Dysfunction