Deck 27: The Child with Cerebral Dysfunction

Question 1

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

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

Answer 1

Periodic and irregular breathing

Question 2

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

A) Change the child's position infrequently to minimize the chance of increased ICP
B) Avoid using narcotics or 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

Answer 2

Monitor fluid intake and output carefully to avoid fluid overload and cerebral edema

Question 3

The nurse is planning care for an 8-year-old child with a concussion. Which 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 remotely from the site of trauma.

Answer 3

It is a transient and reversible neuronal dysfunction.

Question 4

Which drug should the nurse expect to administer to a preschool child who has increased intracranial pressure (ICP) resulting from cerebral edema?

A) Mannitol (Osmitrol)
B) Epinephrine hydrochloride (Adrenalin)
C) Atropine sulfate (Atropine)
D) Sodium bicarbonate (Sodium bicarbonate)

Question 5

Which neurologic diagnostic test 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 6

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. What is the next nursing action?

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

Question 7

The nurse is performing a Glasgow Coma Scale on a school-age child with a head injury. The child opens eyes spontaneously, obeys commands, and is oriented to person, time, and place. Which is the score the nurse should record?

A) 8
B) 11
C) 13
D) 15

Question 8

The nurse is assessing a child who was just admitted to the hospital for observation after a head injury. Which 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 9

When should the nurse recommend medical attention for a child with a slight head injury?

A) Experiences sleepiness
B) Vomits
C) Has a headache
D) Is confused or has abnormal behavior

Question 10

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 which type of head injury?

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

Question 11

The nurse is teaching nursing students about childhood fractures. Which describes a compound skull fracture?

A) Involves the basilar portion of the occipital bone
B) Bone is exposed through the skin
C) Traumatic separations of the cranial sutures
D) Bone is pushed inward, causing pressure on the brain

Question 12

The nurse has documented that a child's level of consciousness is obtunded. Which describes this level of consciousness?

A) Slow response to vigorous and repeated stimulation
B) Impaired decision making
C) Arousable with stimulation
D) Confusion regarding time and place

Question 13

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 these findings?

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

Question 14

The nurse has received report on four children. Which child should the nurse assess first?

A) A school-age child in a coma with stable vital signs
B) A preschool child with a head injury and decreasing level of consciousness
C) An adolescent admitted after a motor vehicle accident is oriented to person and place
D) A toddler in a persistent vegetative state with a low-grade fever

Question 15

A toddler fell out of a second-story window. She had a brief loss of consciousness and vomited four times. Since admission, she has been alert and oriented. Her mother asks why a computed tomography (CT) scan is required when she "seems fine." Which explanation should the nurse give?

A) Your child may have a brain injury and the CT can rule one out.
B) The CT needs to be done because of your child's age.
C) Your child may start to have seizures and a baseline CT should be done.
D) Your child probably has a skull fracture and the CT can confirm this diagnosis.

Question 16

The nurse is taking care of a child who is alert but showing signs of increased intracranial pressure. Which test is contraindicated in this case?

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

Question 17

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

Question 18

Which is the priority nursing intervention for an unconscious child after a fall?

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

Question 19

A child is unconscious after a motor vehicle accident. The watery discharge from the nose tests positive for glucose. What does this finding suggest?

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

Question 20

Which statement 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 21

What is 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 to treat fever associated with influenza

Question 22

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 intervention 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 lifelong problem. Medications cannot be discontinued.

Question 23

Which is the initial clinical manifestation of generalized seizures?

A) Being confused
B) Feeling frightened
C) Losing consciousness
D) Seeing flashing lights

Question 24

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:

A) measles.
B) varicella.
C) meningitis.
D) hepatitis.

Question 25

What are the vector reservoirs for agents causing viral encephalitis in the United States?

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

Question 26

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 statement?

A) The 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 27

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 cannot believe the child has epilepsy. What is the nurse's best response?

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 28

What is an important nursing intervention when caring for a child who is experiencing a seizure?

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 29

A 3-year-old child is hospitalized after a submersion injury. The child's mother complains to the nurse, "Being at the hospital seems unnecessary when he is perfectly fine." What is the nurse's best reply?

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 30

Children taking phenobarbital (phenobarbital sodium) and/or phenytoin (Dilantin) may experience a deficiency of:

A) calcium.
B) vitamin C.
C) fat-soluble vitamins.
D) vitamin D and folic acid.

Question 31

Which clinical manifestations would suggest hydrocephalus in a neonate?

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

Question 32

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 statement made by the mother indicates a correct understanding of the teaching?

A) "I should expect my child to have a few episodes of vomiting."
B) "If I notice sleep disturbances, I should contact the physician immediately."
C) "I should expect my child to have some behavioral changes after the accident."
D) "If I notice diplopia, I will have my child rest for 1 hour."

Question 33

Which type of seizure involves both hemispheres of the brain?

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

Question 34

Which are clinical manifestations of increased intracranial pressure (ICP) in infants? (Select all that apply.)

A) Low-pitched cry
B) Sunken fontanel
C) Diplopia and blurred vision
D) Irritability
E) Distended scalp veins
F) Increased blood pressure

Question 35

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. What is the most appropriate initial action by the school nurse?

A) Stay with child and have someone 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 36

When caring for the child with Reye syndrome, what is the priority nursing intervention?

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

Question 37

An infant with hydrocephalus is hospitalized for surgical placement of a ventriculoperitoneal shunt. Which interventions should be included in the child's postoperative care? (Select all that apply.)

A) Observe 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.
E) Maintain an accurate record of intake and output.
F) Monitor for abdominal distention.

Question 38

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

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

Question 39

The mother of a 1-month-old infant tells the nurse she worries that her baby will get meningitis like her oldest son did when he was an infant. The nurse should base her response on which statement?

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 40

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?

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 41

The nurse is evaluating the laboratory results on cerebral spinal fluid (CSF) from a 3-year-old child with bacterial meningitis. Which findings confirm bacterial meningitis? (Select all that apply.)

A) Elevated white blood cell (WBC) count
B) Decreased glucose
C) Normal protein
D) Elevated red blood cell (RBC) count

Question 42

The nurse is monitoring an infant for signs of increased intracranial pressure (ICP). Which are late signs of increased intracranial pressure (ICP) in an infant? (Select all that apply.)

A) Tachycardia
B) Alteration in pupil size and reactivity
C) Increased motor response
D) Extension or flexion posturing
E) Cheyne-Stokes respirations

Question 43

A 6-year-old child is having a generalized seizure in the classroom at school. Place in order the interventions the school nurse should implement starting with the highest-priority intervention sequencing to the lowest-priority intervention. Provide the answer using lowercase letters separated by commas (e.g., a, b, c, d, e).

A) Take vital signs.
B) Ease child to the floor.
C) Allow child to rest.
D) Turn child to the side.
E) Integrate child back into the school environment.

Question 44

The nurse is caring for a neonate with suspected meningitis. Which clinical manifestations should the nurse prepare to assess if meningitis is confirmed? (Select all that apply.)

A) Headache
B) Photophobia
C) Bulging anterior fontanel
D) Weak cry
E) Poor muscle tone