Deck 32: The Child with Cerebral Dysfunction

Question 1

What statement 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) It is a slight lesion that develops remote from the site of trauma.

Answer 1

It is a transient and reversible neuronal dysfunction.

Question 2

What term 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

Answer 2

Obtundation

Question 3

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?

A) Neurologic health
B) Severe brain damage
C) Decorticate posturing
D) Decerebrate posturing

Answer 3

Neurologic health

Question 4

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?

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

Question 5

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

A) Avoid using narcotics or sedatives to provide comfort and pain relief.
B) Change the child's position infrequently to minimize the chance of increased intracranial pressure (ICP).
C) Monitor fluid intake and output carefully to avoid fluid overload and cerebral edema.
D) Give tepid sponge baths to reduce fevers above 38.3° C (101° F) because antipyretics are contraindicated.

Question 6

What 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 7

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?

A) Eye trauma
B) Brain death
C) Severe brainstem damage
D) Neurosurgical emergency

Question 8

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

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

Question 9

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

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

Question 10

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?

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) Vaccinations to prevent pneumococcal and Haemophilus influenzae type B meningitis are available.

Question 11

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?

A) Hypoxia
B) Aspiration
C) Hypothermia
D) Electrolyte imbalance

Question 12

What 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 13

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?

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

Question 14

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?

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

Question 15

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

A) Twitching
B) Spasticity
C) Choreiform movements
D) Associated movements

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. What is the most appropriate nursing action?

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

Question 17

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

A) Suction the child frequently.
B) Turn the child's head side to side every hour.
C) Provide environmental stimulation.
D) Avoid activities that cause pain or crying.

Question 18

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

A) Delirium
B) Papilledema
C) Flexion posturing
D) Periodic or irregular breathing

Question 19

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

A) Brainstem
B) Cerebrum
C) Cerebellum
D) Occipital lobe

Question 20

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?

A) "The scan will not hurt."
B) "Pain medication will be given."
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 21

A young adolescent experiences infrequent migraine episodes. What pharmacologic intervention is most likely to be prescribed?

A) Opioid
B) Lorazepam
C) Ergotamine
D) Sumatriptan

Question 22

The nurse is teaching the parents of a 3-year-old child who has been diagnosed with tonic-clonic seizures. What statement by the parent should indicate a correct understanding of the teaching?

A) "I should attempt to restrain my child during a seizure."
B) "My child will need to avoid contact sports until adulthood."
C) "I should place a pillow under my child's head during a seizure."
D) "My child will need to be taken to the emergency department [ED] after each seizure."

Question 23

A child is admitted for revision of a ventriculoperitoneal shunt for noncommunicating hydrocephalus. What is a common reason for elective revision of this shunt?

A) Meningitis
B) Gastrointestinal upset
C) Hydrocephalus resolution
D) Growth of the child since the initial shunting

Question 24

A 6-year-old child is admitted for revision of a ventriculoperitoneal shunt for noncommunicating hydrocephalus. What sign or symptom does the child have that indicates a revision is necessary?

A) Tachycardia
B) Gastrointestinal upset
C) Hypotension
D) Alteration in level of consciousness

Question 25

A toddler is admitted to the pediatric unit with presumptive bacterial meningitis. The initial orders include isolation, intravenous access, cultures, and antimicrobial agents. The nurse knows that antibiotic therapy will begin when?

A) After the diagnosis is confirmed
B) When the medication is received from the pharmacy
C) After the child's fluid and electrolyte balance is stabilized
D) As soon as the practitioner is notified of the culture results

Question 26

A pregnant woman asks about prenatal diagnosis of hydrocephalus. The nurse's response should be based on which knowledge?

A) It can be diagnosed only after birth.
B) It can be diagnosed by chromosome studies.
C) It can be diagnosed with fetal ultrasonography.
D) It can be diagnosed by measuring the lecithin-to-sphingomyelin ratio.

Question 27

What type of seizure may be difficult to detect?

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

Question 28

What is the initial clinical manifestation of generalized seizures?

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

Question 29

After a tonic-clonic seizure, what symptoms should the nurse expect the child to experience?

A) Diarrhea and abdominal discomfort
B) Irritability and hunger
C) Lethargy and confusion
D) Nervousness and excitability

Question 30

What is important to incorporate in the plan of care for a child who is experiencing a seizure?

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

Question 31

What clinical manifestations suggest hydrocephalus in an infant?

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

Question 32

The nurse is discussing long-term care with the parents of a child who has a ventriculoperitoneal shunt. What issues should be addressed?

A) Most childhood activities must be restricted.
B) Cognitive impairment is to be expected with hydrocephalus.
C) Wearing head protection is essential until the child reaches adulthood.
D) Shunt malfunction or infection requires immediate treatment.

Question 33

A young child's parents call the nurse after their child is bitten by a raccoon in the woods. The nurse's recommendation should be based on what knowledge?

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

Question 34

What term refers to seizures that involve both hemispheres of the brain?

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

Question 35

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. How should the nurse respond?

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 36

The nurse is planning care for a school-age child with bacterial meningitis. What intervention should be included?

A) Keep environmental stimuli to a minimum.
B) Have the child move her head from side to side at least every 2 hours.
C) Avoid giving pain medications that could dull sensorium.
D) Measure head circumference to assess developing complications.

Question 37

A 10-year-old child, without a history of previous seizures, experiences a tonic-clonic seizure at school that lasts more than 5 minutes. Breathing is not impaired. Some postictal confusion occurs. What is the most appropriate initial action by the school nurse?

A) Stay with child and have someone else call emergency medical services (EMS).
B) Notify the parent and regular practitioner.
C) Notify the parent that the child should go home.
D) Stay with the child, offering calm reassurance.

Question 38

What intervention should 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 for children with varicella or those suspected of having influenza

Question 39

What is a priority of care when a child has an external ventricular drain (EVD)?

A) Irrigation of drain to maintain flow
B) As-needed dressing changes if dressing becomes wet
C) Frequent assessment of amount and color of drainage
D) Maintaining the EVD below the level of the child's head

Question 40

The nurse is caring for a 10-year-old child who has an acute head injury, has a pediatric Glasgow Coma Scale score of 9, and is unconscious. What intervention should the nurse include in the child's care plan?

A) Elevate the head of the bed 15 to 30 degrees with the head maintained in midline.
B) Maintain an active, stimulating environment.
C) Perform chest percussion and suctioning every 1 to 2 hours.
D) Perform active range of motion and nontherapeutic touch every 8 hours.

Question 41

The nurse is preparing to admit a 5-year-old with an epidural hemorrhage. What clinical manifestations should the nurse expect to observe? (Select all that apply.)

A) Headache
B) Vomiting
C) Irritability
D) Cephalhematoma
E) Pallor with anemia

Question 42

The nurse is preparing to admit an adolescent with encephalitis. What clinical manifestations should the nurse expect to observe? (Select all that apply.)

A) Malaise
B) Apathy
C) Lethargy
D) Hypoactivity
E) Hypothermia

Question 43

The nurse is caring for a child with a subdural hematoma. The nurse should assess for what signs that can indicate brainstem compression? (Select all that apply.)

A) Coma
B) Lethargy
C) Hemiplegia
D) Hemiparesis
E) Unequal pupils

Question 44

A 2-year-old child starts to have a tonic-clonic seizure. The child's jaws are clamped. What is the most important nursing action at this time?

A) Place a padded tongue blade between the child's jaws.
B) Stay with the child and observe his respiratory status.
C) Prepare the suction equipment.
D) Restrain the child to prevent injury.

Question 45

If an intramuscular (IM) injection is administered to a child who has Reye syndrome, the nurse should monitor for what?

A) Bleeding
B) Infection
C) Poor absorption
D) Itching at the injection site

Question 46

The nurse is preparing to admit a neonate with bacterial meningitis. What clinical manifestations should the nurse expect to observe? (Select all that apply.)

A) Jaundice
B) Cyanosis
C) Poor tone
D) Nuchal rigidity
E) Poor sucking ability

Question 47

A 23-month-old child is admitted to the hospital with a diagnosis of meningitis. She is lethargic and very irritable with a temperature of 102° F. What should the nurse's care plan include?

A) Observing the child's voluntary movement
B) Checking the Babinski reflex every 4 hours
C) Checking the Brudzinski reflex every 1 hour
D) Assessing the level of consciousness (LOC) and vital signs every 2 hours

Question 48

The nurse is preparing to admit a 6-month-old infant with increased intracranial pressure (ICP). What clinical manifestations should the nurse expect to observe in this infant? (Select all that apply.)

A) High-pitched cry
B) Poor feeding
C) Setting-sun sign
D) Sunken fontanel
E) Distended scalp veins
F) Decreased head circumference

Question 49

What cerebrospinal fluid (CSF) analysis should the nurse expect with viral meningitis? (Select all that apply.)

A) Color is turbid.
B) Protein count is normal.
C) Glucose is decreased.
D) Gram stain findings are negative.
E) White blood cell (WBC) count is slightly elevated.

Question 50

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

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

Question 51

A child has a seizure disorder. What test should be done to gather the most specific information about the type of seizure the child is having?

A) Sleep study
B) Skull radiography
C) Serum electrolytes
D) Electroencephalogram (EEG)

Question 52

A child develops syndrome of inappropriate antidiuretic hormone secretion (SIADH) as a complication to meningitis. What action should be verified before implementing?

A) Forcing fluids
B) Daily weights with strict input and output (I and O)
C) Strict monitoring of urine volume and specific gravity
D) Close observation for signs of increasing cerebral edema

Question 53

What is the antiepileptic medication that requires monitoring of vitamin D and folic acid?

A) Topiramate (Topamax)
B) Valproic acid (Depakene)
C) Gabapentin (Neurontin)
D) Phenobarbital (Luminal)

Question 54

A child has been admitted with status epilepticus. An emergency medication has been ordered. What medication should the nurse expect to be prescribed?

A) Lorazepam (Ativan)
B) Phenytoin (Dilantin)
C) Topiramate (Topamax)
D) Ethosuximide (Zarontin)

Question 55

The nurse is caring for a child with increased intracranial pressure (ICP). What interventions should the nurse plan for this child? (Select all that apply.)

A) Avoid jarring the bed.
B) Keep the room brightly lit.
C) Keep the bed in a flat position.
D) Administer prescribed stool softeners.
E) Administer a prescribed antiemetic for nausea.

Question 56

The nurse is preparing to admit a 7-year-old child with complex partial seizures. What clinical features of complex partial seizures should the nurse recognize? (Select all that apply.)

A) They last less than 10 seconds.
B) There is usually no aura.
C) Mental disorientation is common.
D) There is frequently a postictal state.
E) There is usually an impaired consciousness.

Question 57

The nurse is preparing to admit an adolescent with bacterial meningitis. What clinical manifestations should the nurse expect to observe? (Select all that apply.)

A) Fever
B) Chills
C) Headache
D) Poor tone
E) Drowsiness

Question 58

The nurse is caring for a child with meningitis. What acute complications of meningitis should the nurse continuously assess the child for? (Select all that apply.)

A) Seizures
B) Cerebral palsy
C) Cerebral edema
D) Hydrocephalus
E) Cognitive impairments

Question 59

A lumbar puncture (LP) is being done on an infant with suspected meningitis. The nurse expects which results for the cerebrospinal fluid that can confirm the diagnosis of meningitis?

A) ­WBCs; ¯glucose
B) ­RBCs; normal WBCs
C) ­glucose; normal RBCs
D) Normal RBCs; normal glucose

Question 60

A child is on phenytoin (Dilantin). What should the nurse encourage?

A) Fluid restriction
B) Good dental hygiene
C) A decrease in vitamin D intake
D) Taking the medication with milk

Question 61

MATCHING
Match the level of consciousness to its description.

Arousable with stimulation

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

Question 62

The health care provider has prescribed fosphenytoin (Cerebyx) 4 mg/kg/day divided every 12 hours for a child with a seizure disorder. The child weighs 55 lb. The nurse is preparing to administer the 1200 dose. Calculate the dose the nurse should administer in milligrams. Record your answer below in a whole number.
______________

Question 63

MATCHING
Match the level of consciousness to its description.

No motor or verbal response to noxious stimuli

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

Question 64

MATCHING
Match the level of consciousness to its description.

Confusion regarding time and place

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

Question 65

What effects of an altered pituitary secretion in a child with meningitis indicates syndrome of inappropriate antidiuretic hormone (SIADH)? (Select all that apply.)

A) Hypotension
B) Serum sodium is decreased
C) Urinary output is decreased
D) Evidence of overhydration
E) Urine specific gravity is increased

Question 66

The nurse is preparing to admit a 10-year-old child with absence seizures. What clinical features of absence seizures should the nurse recognize? (Select all that apply.)

A) There is no aura.
B) There is a postictal state.
C) They usually last longer than 30 seconds.
D) There is a brief loss of consciousness.
E) There is an occasional clonic movement.

Question 67

MATCHING
Match the level of consciousness to its description.

Remaining in a deep sleep, responsive only to repeated stimulation

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

Question 68

The health care provider has prescribed carbamazepine (Tegretol) 20 mg/kg/day divided bid for a child with a seizure disorder. The child weighs 33 lb. The nurse is preparing to administer the 0900 dose. Calculate the dose the nurse should administer in milligrams. Record your answer below in a whole number.
__________

Question 69

MATCHING
Match the level of consciousness to its description.

Impaired decision making

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

Question 70

The nurse is caring for a child with an epidural hematoma. The nurse should assess for what signs that can indicate Cushing triad? (Select all that apply.)

A) Fever
B) Flushing
C) Bradycardia
D) Systemic hypertension
E) Respiratory depression

Question 71

The health care provider has prescribed valproic acid (Depakene) 30 mg/kg/day divided bid for a child with a seizure disorder. The child weighs 77 lb. The nurse is preparing to administer the 0900 dose. Calculate the dose the nurse should administer in milligrams. Record your answer below in a whole number.
__________

Question 72

The health care provider has prescribed gabapentin (Neurontin) 30 mg/kg/day divided q 8 hours for a child with a seizure disorder. The child weighs 110 lb. The nurse is preparing to administer the 1200 dose. Calculate the dose the nurse should administer in milligrams. Record your answer below in a whole number.
_________

Question 73

The nurse is teaching the parents of a child with a seizure disorder about the triggers that can cause a seizure. What should the nurse include in the teaching session? (Select all that apply.)

A) Cold
B) Sugared drinks
C) Emotional stress
D) Flickering lights
E) Hyperventilation