Deck 52: The Child with a Neurologic Alteration

Question 1

When a 2-week-old infant is seen for irritability,poor appetite,and rapid head growth with observable distended scalp veins,the nurse recognizes these signs as indicative of which disorder?

A) Hydrocephalus
B) Syndrome of inappropriate antidiuretic hormone (SIADH)
C) Cerebral palsy
D) Reye's syndrome

Answer 1

Hydrocephalus

Question 2

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 nursing assessment to detect early signs of a worsening condition?

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

Answer 2

Level of consciousness

Question 3

How much folic acid does the nurse tell female patients is recommended for women of childbearing age?

A) 1.0 mg
B) 0.4 mg
C) 1.5 mg
D) 2.0 mg

Answer 3

0.4 mg

Question 4

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

A) "You won't be able to move your head 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 5

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 6

Which type of fracture describes traumatic separation of cranial sutures?

A) Basilar
B) Linear
C) Comminuted
D) Depressed

Question 7

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 8

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) ICP and level of consciousness.

Question 9

A mother reports that her child has episodes where he appears to be staring into space.This behavior is characteristic of which type of seizure?

A) Absence
B) Atonic
C) Tonic-clonic
D) Simple partial

Question 10

The nurse teaches parents to alert their health care provider about which adverse effect when a child receives valproic acid (Depakene)to control generalized seizures?

A) Weight loss
B) Bruising
C) Anorexia
D) Drowsiness

Question 11

A recommendation to prevent neural tube defects is the supplementation of

A) vitamin A throughout pregnancy.
B) multivitamin preparations as soon as pregnancy is suspected.
C) folic acid for all women of childbearing age.
D) folic acid during the first and second trimesters of pregnancy.

Question 12

Latex allergy is suspected in a child with spina bifida.Appropriate nursing interventions include which of the following?

A) Avoiding using any latex product
B) Using only non-allergenic latex products
C) Administering medication for long-term desensitization
D) Teaching family about long-term management of allergic manifestations

Question 13

Nursing care of the infant who has had a myelomeningocele repair should include

A) securely fastening the diaper.
B) measurement of pupil size.
C) measurement of head circumference.
D) administration of seizure medications.

Question 14

What is a sign of increased intracranial pressure (ICP)in a 10-year-old child?

A) Headache
B) Bulging fontanel
C) Tachypnea
D) Increase in head circumference

Question 15

A child with a head injury sleeps unless aroused,and when aroused responds briefly before falling back to sleep.What should the nurse chart for this child's level of consciousness?

A) Disoriented
B) Obtunded
C) Lethargic
D) Stuporous

Question 16

What is the best response to a father who tells the nurse that his son "daydreams" at home and that his teacher has observed this behavior at school?

A) "Your son must have an active imagination."
B) "Can you tell me exactly how many times this occurs in one day?"
C) "Tell me about your son's activity when you notice the daydreams."
D) "He is probably overtired and needs more rest."

Question 17

Which finding in an analysis of cerebrospinal fluid (CSF)is consistent with a diagnosis of bacterial meningitis?

A) CSF appears cloudy.
B) CSF pressure is decreased.
C) Few leukocytes are present.
D) Glucose level is increased compared with blood.

Question 18

The most common problem of children born with a myelomeningocele is

A) bladder incontinence.
B) intellectual impairment.
C) respiratory compromise.
D) cranioschisis.

Question 19

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 20

What finding should cause the nurse to suspect a diagnosis of spastic cerebral palsy?

A) Tremulous movements at rest and with activity
B) Sudden jerking movement caused by stimuli
C) Writhing, uncontrolled, involuntary movements
D) Clumsy, uncoordinated movements

Question 21

Which type of seizure involves both hemispheres of the brain?

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

Question 22

The nurse should expect a child who has frequent tension-type headaches to describe headache pain as which of the following?

A) "There is a rubber-band squeezing my head."
B) "It's a throbbing pain over my left eye."
C) "My headaches are worse in the morning and get better later in the day."
D) "I have a stomachache and a headache at the same time."

Question 23

What should the nurse teach parents when the child is taking phenytoin (Dilantin)to control seizures?

A) The child should use a soft toothbrush and floss the teeth after every meal.
B) The child will require monitoring of renal function while taking this medication.
C) Dilantin should be taken with food because it causes gastrointestinal distress.
D) The medication can be stopped when the child has been seizure free for 1 month.

Question 24

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

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

Question 25

Which change in status should alert the nurse to increased intracranial pressure (ICP)in a child with a head injury?

A) Rapid, shallow breathing
B) Irregular, rapid heart rate
C) Increased diastolic pressure with narrowing pulse pressure
D) Confusion and altered mental status

Question 26

What should be the nurse's first action when a child with a head injury complains of double vision and a headache,and then vomits?

A) Immobilize the child's neck.
B) Report this information to the physician.
C) Darken the room and put a cool cloth on the child's forehead.
D) Restrict the child's oral fluid intake.

Question 27

What is an appropriate nursing intervention for the child with a tension headache?

A) Assess for an aura.
B) Maintain complete bed rest.
C) Administer mild pain medication.
D) Assess for nausea and vomiting.

Question 28

The father of a newborn infant with myelomeningocele asks about the cause of this condition.What response by the nurse is most appropriate?

A) "One of the parents carries a defective gene that causes myelomeningocele."
B) "A deficiency in folic acid in the father is the most likely cause."
C) "Offspring of parents who have a spinal abnormality are at greater risk for myelomeningocele."
D) "There may be no definitive cause identified."

Question 29

What nursing actions are indicated when the nurse is administering phenytoin (Dilantin)by the intravenous route to control seizures? (Select all that apply.)

A) It must be given with D₅1/2 NS.
B) Occasional blood levels will be assessed.
C) Dilantin should be given with food because it causes gastrointestinal distress.
D) It must be given in normal saline.
E) It must be filtered.

Question 30

A 5-year-old sustained a concussion after falling out of a tree.In preparation for discharge,the nurse is discussing home care with the parents.Which statement made by the parents 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 31

A 62-pound child has a spinal cord injury and is to receive steroid therapy.How much medication does the nurse draw up for the bolus dose? Record your solve in a whole number.Administer _____ mg.

Question 32

What is the most appropriate nursing action when a child is in the tonic phase of a generalized tonic-clonic seizure?

A) Guide the child to the floor if standing and go for help.
B) Turn the child's body on the side.
C) Place a padded tongue blade between the teeth.
D) Quickly slip soft restraints on the child's wrists.

Question 33

After a tonic-clonic seizure,it would not be unusual for a child to display

A) irritability and hunger.
B) lethargy and confusion.
C) nausea and vomiting.
D) nervousness and excitability.

Question 34

Which statement by an adolescent indicates an understanding about factors that can trigger migraine headaches?

A) "I should avoid loud noises because this is a common migraine trigger."
B) "Exercise can cause a migraine. I guess I won't have to take gym anymore."
C) "I think I'll get a migraine if I go to bed at 9 PM on week nights."
D) "I am learning to relax because I get headaches when I am worried about stuff."

Question 35

A nurse is explaining to parents how the central nervous system of a child differs from that of an adult.Which statement accurately describes these differences?

A) The infant has 150 mL of CSF compared with 50 mL in the adult.
B) Papilledema is a common manifestation of ICP in the very young child.
C) The brain of a term infant weighs less than half of the weight of the adult brain.
D) Coordination and fine motor skills develop as myelinization of peripheral nerves progresses.

Question 36

A child is brought to the emergency department in status epilepticus.Which medication should the nurse expect to be given initially in this situation?

A) Clorazepate dipotassium (Tranxene)
B) Fosphenytoin (Cerebyx)
C) Phenobarbital
D) Lorazepam (Ativan)

Question 37

A 14-year-old is in the intensive care unit after a spinal cord injury 2 days ago.Nursing care for this child includes (Select all that apply.)

A) monitoring and maintaining systemic blood pressure.
B) administering corticosteroids.
C) minimizing environmental stimuli.
D) discussing long-term care issues with the family.
E) monitoring for respiratory complications.

Question 38

What is the priority nursing intervention for the child with ascending paralysis as a result of Guillain-Barré syndrome (GBS)?

A) Immunosuppressive medications
B) Respiratory assessment
C) Passive range-of-motion exercises
D) Anticoagulant therapy

Question 39

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) MRI

Question 40

The nurse is preparing a school-age child for computed tomography (CT scan)to assess cerebral function.Which statement should the nurse include when 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 41

A 62-pound child has a spinal cord injury and has completed the bolus dose of IV steroids.The nurse is preparing to hang an IV infusion of steroids for the next 23 hours.How much medication should this child get per hour? Record your solve using 1 decimal place.Administer _______ mg/hour.