Deck 45: Cerebral Dysfunction

Question 1

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

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

Answer 1

Level of consciousness.

Question 2

Which type of fracture describes traumatic separation of cranial sutures?

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

Answer 2

Diastatic

Question 3

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

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

Answer 3

Mannitol

Question 4

The Glasgow Coma Scale consists of an assessment of:

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

Question 5

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

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

Question 6

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?

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 7

Which statement is most descriptive of a concussion?

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

Question 8

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)Computed tomography (CT) scan
D)Magnetic resonance imaging (MRI)

Question 9

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 is:

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 10

Which term 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 11

A toddler fell out of a second-story window.She had 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." The nurse should explain that the toddler:

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 12

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 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.The nurse should interpret this as:

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

Question 14

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?

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

Question 15

The nurse should recommend medical attention if a child with a slight head injury experiences:

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

Question 16

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.The most appropriate nursing action is to:

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 17

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

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

Question 18

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 19

The priority nursing intervention when a child is unconscious after a fall is to:

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

Question 20

The most common clinical manifestation of brain tumors in children is:

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

Question 21

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.The nurse's best response is:

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 22

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

Question 23

When taking the history of a child hospitalized with Reye's 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 24

The vector reservoir for agents causing viral encephalitis in the United States is:

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

Question 25

The initial clinical manifestation of generalized seizures is:

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

Question 26

An important nursing intervention when caring for a child who is experiencing a seizure is to:

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 27

An appropriate nursing intervention when caring for an unconscious child should be to:

A)Change the child's position infrequently to minimize the chance of increased intracranial pressure (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.

Question 28

When caring for the child with Reye's syndrome,the priority nursing intervention is to:

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

Question 29

Which information should the nurse give to a child who is to have magnetic resonance imaging (MRI)of the brain?

A)"Your head will be restrained during the procedure."
B)"You will have to drink a special fluid before the test."
C)"You will have to lie flat after the test is finished."
D)"You will have electrodes placed on your head with glue."

Question 30

What action may be beneficial in reducing the risk of Reye's 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 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

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.The nurse should base her response on knowing that:

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 33

Which type of seizure involves both hemispheres of the brain?

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

Question 34

Which type of seizure may be difficult to detect?

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

Question 35

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 who is oriented to person and place
D)A toddler in a persistent vegetative state with a low-grade fever

Question 36

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 knowing that:

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 37

How should the nurse explain positioning for a lumbar puncture to a 5-year-old child?

A)"You will be on your knees with your head down on the table."
B)"You will be able to sit up with your chin against your chest."
C)"You will be on your side with the head of your bed slightly raised."
D)"You will lie on your side and bend your knees so that they touch your chin."

Question 38

Which statement 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 39

The nurse is performing a Glasgow Coma Scale (GCS)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 40

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

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

Question 41

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 and sequencing to the lowest-priority intervention.

Second priority

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 42

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 and sequencing to the lowest-priority intervention.

Third priority

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 43

Clinical manifestations of increased intracranial pressure (ICP)in infants are (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 44

The nurse is monitoring an infant for signs of increased intracranial pressure (ICP).Which are late signs of increased 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 45

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 and sequencing to the lowest-priority intervention.

Fourth priority

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 46

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 and sequencing to the lowest-priority intervention.

First priority

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 47

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 and sequencing to the lowest-priority intervention.

Fifth priority

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 48

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

Question 49

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 tract infection.
D)Leaking of cerebrospinal fluid (CSF).

Question 50

A nurse should expect which cerebrospinal fluid (CSF)laboratory results on a child diagnosed with bacterial meningitis (Select all that apply)?

A)Elevated white blood cell (WBC) count
B)Decreased protein
C)Decreased glucose
D)Cloudy in color
E)Increase in red blood cells (RBCs)

Question 51

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 52

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 stepwise approach will be used to reduce the dosage gradually.
D)Seizure disorders are a lifelong problem. Medications cannot be discontinued.

Question 53

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

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