chapter 50-cerebral dysfunctions

Question 1

Which term is used to describe the level of consciousness when a child can be aroused with stimulation?
a. Stupor
b. Confusion
c. Obtundation
d. Disorientation

Answer 1

C

Question 2

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

Answer 2

B

Question 3

Which does the Glasgow Coma Scale assess?
a. Pupil reactivity and motor response
b. Eye-opening, verbal, and motor responses
c. Level of consciousness and verbal response
d. Intracranial pressure and level of consciousness

Answer 3

B

Question 4

The nurse is closely monitoring a child who is unconscious after a fall and notices that he suddenly has a fixed and dilated pupil. How should the nurse interpret this finding?
a. Eye trauma
b. Neurosurgical emergency
c. Severe brainstem damage
d. Indication of brain death

Answer 4

B

Question 5

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 is the basis of the nurse’s response?
a. Pain medication will be administered prior to the scan.
b. CT scans do not cause pain.
c. Movement is allowed once the equipment is in place.
d. No one is able to remain in the room with the child during the test.

Answer 5

B

Question 6

Which neurological 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)

Answer 6

C

Question 7

What is the priority nursing intervention when a child is unconscious after a fall?
a. Establish adequate airway.
b. Perform neurological assessment.
c. Monitor intercranial pressure.
d. Determine whether a neck injury is present.

Answer 7

A

Question 8

Which drug is used to treat a child who has increased intracranial pressure (ICP) resulting from cerebral edema?
a. Mannitol
b. Epinephrine hydrochloride
c. Atropine sulphate
d. Sodium bicarbonate

Answer 8

A

Question 9

Which of the following describes a concussion?
a. Petechial hemorrhages that cause amnesia and cognitive delay
b. Visible bruising and tearing of cerebral tissue occurs
c. An alteration in neurological or cognitive function with or without loss of consciousness
d. A slight lesion that develops remote from the site of trauma with immediate loss of consciousness

Answer 9

C

Question 10

What type of fracture involves fragmented bone that is pushed inward and causes pressure on the brain?
a. Basilar
b. Compound
c. Open
d. Depressed

Answer 10

D

Question 11

Which statement best describes a subdural hematoma?
a. Bleeding occurs between the dura and the skull.
b. Bleeding occurs between the dura and the arachnoid membrane.
c. Bleeding is generally arterial, and brain compression occurs rapidly.
d. The hematoma commonly occurs in the parietotemporal region.

Answer 11

B

Question 12

When providing discharge teaching to the mother of a child with a slight head injury, which symptom should the nurse tell the parent to seek medical attention for immediately?
a. Sleepiness
b. Vomiting, even once
c. Headache, even if slight
d. Confusion or abnormal behaviour

Answer 12

D

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 his blood pressure. Pupils are dilated and fixed. What type of head injury should the nurse suspect?
a. Brainstem injury
b. Skull fracture
c. Subdural hemorrhage
d. Epidural hemorrhage

Answer 13

A

Question 14

A toddler fell out of a second-story window. She briefly lost 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.” What knowledge should the nurse base her response on?
a. She may have a brain injury.
b. She needs this because of her age.
c. She may start having seizures.
d. She probably has a skull fracture.

Answer 14

A

Question 15

The nurse is assessing a child who was just admitted to the hospital for observation after a head injury. What is the most essential part of the nursing assessment to detect early signs of a worsening condition?
a. Posturing
b. Vital signs
c. Focal neurological signs
d. Level of consciousness

Answer 15

D

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 they think their child is in pain because of periodic crying and restlessness. What is the most appropriate action for the nurse to take?
a. Discuss with the parents the child’s previous experiences with pain.
b. Discuss with the practitioner what analgesia can be safely administered.
c. Explain that analgesia is contraindicated with a head injury.
d. Explain that analgesia is unnecessary when a child is not fully awake and alert.

Answer 16

B

Question 17

A 3-year-old child is hospitalized after a submersion injury. The child’s mother complains to the nurse, “This seems unnecessary when he is perfectly fine.” What is the basis for the nurses’ response?
a. Supplemental oxygen is required after submersion injuries.
b. Hospitalization is probably not required.
c. Complications can occur after a submersion injury.
d. Observation is required for possible central nervous system problems.

Answer 17

C

Question 18

Which statement best describes a neuroblastoma?
a. The 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 tumour in young children.
d. It is the most common benign tumour in young children.

Answer 18

A

Question 19

The mother of a 2-month-old infant tells the nurse that she worries her baby will get meningitis like her oldest son did when he was an infant. What knowledge should the nurse base her response on?
a. Meningitis rarely occurs during infancy.
b. Often there is a genetic predisposition to meningitis.
c. Vaccination to prevent all types of meningitis is now available.
d. Administration of Hib vaccine has decreased the frequency of bacterial meningitis.

Answer 19

D

Question 20

What agents are implicated for causing viral encephalitis?
a. Tarantula spiders
b. Mosquitoes and ticks
c. Carnivorous wild animals
d. Domestic and wild animals

Answer 20

B

Question 21

What 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 for children with varicella or influenza

Answer 21

D

Question 22

When taking the history of a child hospitalized with Reye’s syndrome, which would the nurse anticipate that the child experienced in the recent past?
a. Measles
b. Varicella
c. Meningitis
d. Hepatitis

Answer 22

B

Question 23

What is the priority nursing intervention when caring for a child with Reye’s syndrome?
a. Monitor intake and output.
b. Prevent skin breakdown.
c. Observe for petechiae.
d. Do range-of-motion (ROM) exercises.

Answer 23

A

Question 24

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 basis of the nurses’ response?
a. Epilepsy is an easily treatable disease.
b. Very few children have actual epilepsy.
c. The seizure may or may not be an indication of epilepsy.
d. Reassure the father that his child probably does not have epilepsy.

Answer 24

C

Question 25

Which type of seizure involves both hemispheres of the brain?
a. Focal
b. Partial
c. Generalized
d. Acquired

Answer 25

C

Question 26

What is the initial clinical manifestation of generalized seizures?
a. Being confused
b. Feeling frightened
c. Losing consciousness
d. Seeing flashing lights

Answer 26

C

Question 27

What type of seizure may be difficult to detect?
a. Absence seizure
b. Generalized seizure
c. Simple partial seizure
d. Complex partial seizure

Answer 27

A

Question 28

What is one 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 the 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.

Answer 28

A

Question 29

What clinical manifestations would suggest hydrocephalus in a newborn?
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

Answer 29

A

Question 30

Which is used in the treatment of brain tumours in children?
a. Radiation
b. Bone marrow transplantation
c. Myelography
d. Stem cell transplantation

Answer 30

A

Question 31

What is a clinical manifestation of increased intracranial pressure (ICP) in an infant?
a. Low-pitched cry
b. Sunken fontanel
c. Increased blood pressure
d. Irritability

Answer 31

D

Question 32

An infant with hydrocephalus is hospitalized for surgical placement of a ventriculoperitoneal shunt. What intervention should be included in the child’s postoperative care?
a. Monitor for abdominal distension.
b. Pump the shunt reservoir to maintain patency.
c. Administer sedation to decrease irritability.
d. Maintain Trendelenburg position to decrease pressure on the shunt.

Answer 32

A

Question 33

What symptoms were present in the child for the nurse to document the child’s level of consciousness as a stupor? Select all that apply. Express answer with small letters followed by a comma and a space—e.g., a, b, c.
a. Limited spontaneous movement
b. Responds to vigorous and repeated stimulation
c. Sluggish speech
d. Falls asleep very quickly
e. Moaning responses to stimulation

Answer 33

B,E

Question 34

When assessing a child with increased intracranial pressure (ICP), which are considered late signs? Select all that apply. Express answer in small letters followed by a comma and a space—e.g., a, b, c.
a. Vomiting
b. Bradycardia
c. Diplopia
d. Lethargy
e. Flexion posturing
f. Cheyne-Stokes respirations

Answer 34

B,E,F

Question 35

Which are the key reflexes that demonstrate healthy neurological status in young infants? Select all that apply. Express answer in small letters followed by a comma and a space—e.g., a, b, c.
a. Plantar reflex
b. Moro reflex
c. Tonic neck reflex
d. Corneal reflex
e. Withdrawal reflex
f. Babinski reflex

Answer 35

B,C,E

Question 36

Place the levels of consciousness descriptor terms in order, beginning with most alert state.
a. Confusion
b. Disorientation
c. Coma
d. Stupor
e. Persistent vegetative state
f. Obtundation
g. Lethargy

Answer 36

A,B,G,F,D,C,E