Question 1

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.

Accepted Answer

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

Question 2

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

Accepted Answer

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

Question 3

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)

Accepted Answer

A CT scan provides a 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 permits tissue discrimination that is unavailable with any other techniques.

Question 4

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."

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.Someone is able to remain with the child during the procedure.

Question 5

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.

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 bilateral fixed 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 6

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

Accepted Answer

Periodic or irregular breathing is an ominous sign of brainstem (especially medullary)dysfunction that often precedes complete apnea.Papilledema is edema and inflammation of optic nerve.It is commonly a sign of increased ICP.Delirium is a state of mental confusion and excitement marked by disorientation for time and place.The doll's head maneuver is a test for brainstem or oculomotor nerve dysfunction.

Question 7

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.

Accepted Answer

The child's history of the fall,brief loss of consciousness,and vomiting four times necessitates 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.The need for the CT scan is related to the injury and symptoms,not the child's age.The CT scan is necessary to determine whether a brain injury has occurred.

Question 8

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

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,subdural hemorrhage,and epidural hemorrhage are not consistent with brainstem injuries.

Question 9

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 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.

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.The child's position should be changed frequently to avoid complications such as pneumonia and skin breakdown.Narcotics and sedatives should be used as necessary to reduce pain and discomfort,which can increase ICP.Antipyretics are the method of choice for fever reduction.

Question 10

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

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.Vital signs and focal neurologic signs are later signs of progression when compared with level-of-consciousness changes.

Question 11

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).

Accepted Answer

Watery discharge from the nose that is positive for glucose suggests leaking of CSF from a skull fracture and is not associated with diabetes or respiratory tract infection.The fluid is probably CSF from a skull fracture and does not signify whether the brainstem is involved.

Question 12

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.

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 13

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)

Accepted Answer

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

Question 14

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

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.Doll's head maneuver,funduscopic examination for papilledema,and assessment of pyramidal tract lesions can be performed on awake children.

Question 15

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

Accepted Answer

The Glasgow Coma Scale (GCS)consists of a three-part assessment: eye opening,verbal response,and motor response.Numeric values of 1 through 5 are assigned to the levels of response in each category.The sum of these numeric values provides an objective measure of the patient's level of consciousness (LOC).A person with an unaltered LOC would score the highest,15.The child who opens eyes spontaneously,obeys commands,and is oriented is scored at a 15.

Question 16

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.

Accepted Answer

Medical attention should be sought if the child exhibits confusion or abnormal behavior,loses consciousness,has amnesia,has fluid leaking from the nose or ears,complains of blurred vision,or has an unsteady gait.Sleepiness alone does not require evaluation.If the child is difficult to arouse from sleep,medical attention should be obtained.Vomiting more than three times requires medical attention.Severe or worsening headache or one that interferes with sleep should be evaluated.

Question 17

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

Accepted Answer

The nurse should assess the child with a head injury and decreasing level of consciousness first (LOC).Assessment of LOC remains the earliest indicator of improvement or deterioration in neurologic status.The next child the nurse should assess is a toddler in a persistent vegetative state with a low-grade fever.The school-age child in a coma with stable vital signs and the adolescent admitted to the hospital who is oriented to his surroundings would be of least worry to the nurse.

Question 18

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

Accepted Answer

Obtunded 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 19

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 to
A)place on side.
B)take blood pressure.
C)stabilize neck and spine.
D)check scalp and back for bleeding.

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.Less urgent,but an important assessment,is inspection of the scalp for bleeding.

Question 20

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.

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.

Quiz 28: The Child with Cerebral Dysfunction

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

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

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

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?

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:

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 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?

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?

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

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 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:

Which statement best describes a subdural hematoma?

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

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?

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?

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

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

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

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 to

The nurse is planning care for an 8-year-old child with a concussion.Which is descriptive of a concussion?