Deck 28: The Child With Cerebral Dysfunction

Question 1

The nurse should suspect brainstem damage in a child when which of the following clinical manifestations is present?

A)Opisthotonus
B)Bilateral fixed pupils
C)Acetone odor of breath
D)Hyperventilation (deep and rapid breathing)

Answer 1

Bilateral fixed pupils

Question 2

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. The nurse should interpret this as which of the following?

A)Eye trauma
B)Neurosurgical emergency
C)Severe brainstem damage
D)Indication of brain death

Answer 2

Neurosurgical emergency

Question 3

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

A)"Pain medication will be given."
B)"The scan will not hurt."
C)"You will be able to move once the equipment is in place."
D)"Unfortunately no one can remain in the room with you during the test."

Answer 3

"The scan will not hurt."

Question 4

Which of the following is a clinical manifestation of increased intracranial pressure in children?

A)Low-pitched cry
B)Sunken fontanel
C)Diplopia, blurred vision
D)Increased blood pressure

Question 5

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

A)Place on side.
B)Take blood pressure.
C)Stabilize neck and spine.
D)Check scalp and back for bleeding.

Question 6

The Glasgow Coma Scale consists of an assessment of:

A)Pupil reactivity, motor response.
B)Eye opening, verbal and motor response.
C)Level of consciousness, verbal response.
D)Intracranial pressure and level of consciousness.

Question 7

The procedure transillumination is performed to show:

A)Intracranial lesions.
B)Calcifications of head bones.
C)Abnormal fluid accumulation in head areas.
D)Areas where blood-brain barrier is defective.

Question 8

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

A)Papilledema
B)Delirium
C)Doll's head maneuver
D)Periodic and irregular breathing

Question 9

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

A)Nuclear brain scan
B)Echoencephalography
C)CT scan
D)Magnetic resonance imaging (MRI)

Question 10

The nurse should recommend medical attention if a child with a slight head injury experiences which of the following?

A)Sleepiness
B)Vomiting, even once
C)Headache, even if slight
D)Confusion or abnormal behavior

Question 11

Which of the following types of fractures describes traumatic separation of cranial sutures?

A)Basilar
B)Compound
C)Diastatic
D)Depressed

Question 12

Which of the following tests is never performed on an awake child?

A)Oculovestibular response
B)Doll's head maneuver
C)Funduscopic examination for papilledema
D)Assessment of pyramidal tract lesions

Question 13

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. The nurse should suspect what type of head injury.

A)Brainstem
B)Skull fracture
C)Subdural hemorrhage
D)Epidural hemorrhage

Question 14

An appropriate nursing intervention when caring for an unconscious child would be which of the following?

A)Change the child's position infrequently to minimize the chance of increased ICP.
B)Avoid using narcotics/sedatives to provide comfort and pain relief.
C)Monitor fluid intake and output carefully to avoid fluid overload and cerebral edema.
D)Give tepid sponge baths to reduce fever, because antipyretics are contraindicated.

Question 15

Which of the following terms is used to describe a child's level of consciousness when the child is arousable with stimulation?

A)Stupor
B)Confusion
C)Obtundation
D)Disorientation

Question 16

Which of the following is the priority nursing intervention when a child is unconscious after a fall?

A)Establish adequate airway.
B)Perform neurologic assessment.
C)Monitor intercranial pressure.
D)Determine whether a neck injury is present.

Question 17

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

A)Mannitol
B)Epinephrine HCl
C)Atropine sulfate
D)Sodium bicarbonate

Question 18

Which of the following terms is used when a patient remains in a deep sleep, responsive only to vigorous and repeated stimulation?

A)Coma
B)Stupor
C)Obtundation
D)Persistent vegetative state

Question 19

Which of the following statements best describes a subdural hematoma?

A)Bleeding occurs between the dura and the skull.
B)Bleeding occurs between the dura and the cerebrum.
C)Bleeding is generally arterial, and brain compression occurs rapidly.
D)The hematoma commonly occurs in the parietotemporal region.

Question 20

Which of the following is descriptive of a concussion?

A)Petechial hemorrhages cause amnesia.
B)Visible bruising and tearing of cerebral tissue occur.
C)It is a transient and reversible neuronal dysfunction.
D)A slight lesion develops remote from the site of trauma.

Question 21

The vector reservoir for agents causing viral encephalitis in the United States is which of the following?

A)Tarantula spiders
B)Mosquitoes and ticks
C)Carnivorous wild animals
D)Domestic and wild animals

Question 22

A child is brought to the emergency department after experiencing a seizure at school. There is no previous history of seizures. The father tells the nurse that he can't believe the child has epilepsy. The nurse's best response is which of the following?

A)"Epilepsy is easily treated."
B)"Very few children have actual epilepsy."
C)"The seizure may or may not mean that your child has epilepsy."
D)"Your child has had only one convulsion; it probably won't happen again."

Question 23

A young child's parents call the nurse after their child was bitten by a raccoon in the woods. The nurse's recommendation should be based on which of the following?

A)Child should be hospitalized for close observation.
B)No treatment is necessary if thorough wound cleaning is done.
C)Antirabies prophylaxis must be initiated.
D)Antirabies prophylaxis must be initiated if clinical manifestations appear.

Question 24

A toddler fell out of a second-story window. She had brief loss of consciousness and vomited 4 times. Since admission, she has been alert and oriented. Her mother asks why a CT scan is required when she "seems fine." The nurse should explain that she:

A)May have a brain injury.
B)Needs this because of her age.
C)May start having seizures.
D)Probably has a skull fracture.

Question 25

The mother of a l-month-old infant tells the nurse she worries that her baby will get meningitis like her oldest son had when he was an infant. The nurse should base her response on which of the following?

A)Meningitis rarely occurs during infancy.
B)Often a genetic predisposition to meningitis is found.
C)Vaccination to prevent all types of meningitis is now available.
D)Vaccination to prevent Haemophilus influenzae type b meningitis has decreased the frequency of this disease in children.

Question 26

Five-year-old José is being prepared for surgery to remove a brain tumor. Nursing actions should be based on which of the following?

A)Removal of tumor will stop the various symptoms.
B)Usually the postoperative dressing covers the entire scalp.
C)He is not old enough to be concerned about his head being shaved.
D)He is not old enough to understand the significance of the brain.

Question 27

Which of the following best describes a neuroblastoma?

A)Diagnosis is usually made after metastasis occurs.
B)Early diagnosis is usually possible because of the obvious clinical manifestations.
C)It is the most common brain tumor in young children.
D)It is the most common benign tumor in young children.

Question 28

Which of the following types of seizures may be difficult to detect?

A)Absence
B)Generalized
C)Simple partial
D)Complex partial

Question 29

Which of the following types of seizures refers to seizures that involve both hemispheres of the brain?

A)Focal
B)Partial
C)Generalized
D)Acquired

Question 30

The most common clinical manifestation(s) of brain tumors in children is which of the following?

A)Irritability
B)Seizures
C)Headaches and vomiting
D)Fever and poor fine motor control

Question 31

A child is unconscious after a motor vehicle accident. The watery discharge from the nose tests positive for glucose. The nurse should recognize that this suggests:

A)Diabetic coma.
B)Brainstem injury.
C)Upper respiratory infection.
D)Leaking of cerebrospinal fluid (CSF).

Question 32

Which of the following may be beneficial in reducing the risk of Reye syndrome?

A)Immunization against the disease
B)Medical attention for all head injuries
C)Prompt treatment of bacterial meningitis
D)Avoidance of aspirin and ibuprofen for children with varicella or those suspected of having influenza

Question 33

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." The nurse's best reply would be which of the following?

A)"He still needs a little extra oxygen."
B)"I'm sure he is fine, but the doctor wants to make sure."
C)"The reason for this is that complications could still occur."
D)"It is important to observe for possible central nervous system problems."

Question 34

An important nursing intervention when caring for a child who is experiencing a seizure would be which of the following?

A)Describe and record the seizure activity observed.
B)Restrain the child when seizure occurs to prevent bodily harm.
C)Place a tongue blade between the teeth if they become clenched.
D)Suction the child during a seizure to prevent aspiration.

Question 35

Which of the following is the initial clinical manifestation of generalized seizures?

A)Confusion
B)Feeling frightened
C)Loss of consciousness
D)Seeing flashing lights

Question 36

A school-age child has sustained a head injury and multiple fractures after being thrown off 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. The most appropriate nursing action is which of the following?

A)Discuss with parents the child's previous experiences with pain.
B)Discuss with practitioner what analgesia can be safely administered.
C)Explain that analgesia is contraindicated with a head injury.
D)Explain that analgesia is unnecessary when child is not fully awake and alert.

Question 37

When taking the history of a child hospitalized with Reye syndrome, the nurse should not be surprised that a week ago the child had recovered from which of the following?

A)Measles
B)Varicella
C)Meningitis
D)Hepatitis

Question 38

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

A)Posturing
B)Vital signs
C)Focal neurologic signs
D)Level of consciousness

Question 39

When caring for the child with Reye syndrome, the priority nursing intervention would be which of the following?

A)Monitor intake and output.
B)Prevent skin breakdown.
C)Observe for petechiae.
D)Do range-of-motion exercises.

Question 40

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. Which of the following is considered a manifestation of postconcussion syndrome and does not necessitate medical attention?

A)Vomiting
B)Diplopia
C)Behavioral changes
D)Temporary loss of consciousness

Question 41

A child has been seizure free for 2 years. A father asks the nurse how much longer the child will need to take the antiseizure medications. The nurse includes which of the following in the response.

A)Medications can be discontinued at this time.
B)The child will need to take the drugs for 5 years after the last seizure.
C)A step-wise approach will be used to reduce the dosage gradually.
D)Seizure disorders are a life-long problem.Medications cannot be discontinued.

Question 42

Children taking phenobarbital and/or phenytoin may experience a deficiency of:

A)Calcium.
B)Vitamin C.
C)Fat-soluble vitamins.
D)Vitamin D and folic acid.

Question 43

What clinical manifestations would suggest hydrocephalus in a neonate?

A)Bulging fontanel, dilated scalp veins
B)Closed fontanel, high-pitched cry
C)Constant low-pitched cry, restlessness
D)Depressed fontanel, decreased blood pressure

Question 44

A 10-year-old child, without a history of previous seizures, experiences a tonic-clonic seizure at school. Breathing is not impaired, but some postictal confusion occurs. The most appropriate initial action by the school nurse is which of the following?

A)Call emergency medical service (EMS).
B)Notify parent and regular practitioner.
C)Notify parent that child should go home.
D)Stay with child, offering calm reassurance.

Question 45

The treatment of brain tumors in children consists of which of the following therapies? (Select all that apply.)

A)Surgery
B)Bone marrow transplantation
C)Chemotherapy.
D)Stem cell transplantation
E)Radiation.

Question 46

An infant with hydrocephalus is hospitalized for surgical placement of a ventriculoperitoneal shunt. Postoperative nursing care should include which of the following?

A)Monitor closely for signs of infection.
B)Pump the shunt reservoir to maintain patency.
C)Administer sedation to decrease irritability.
D)Maintain Trendelenburg position to decrease pressure on the shunt.