Deck 52: The Child With a Neurologic Alteration

Question 1

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

Answer 1

Measurement of head circumference

Question 2

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."

Answer 2

"You will lie on your side and bend your knees so that they touch your chin."

Question 3

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."

Answer 3

"Your head will be restrained during the procedure."

Question 4

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

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

Question 5

Latex allergy is suspected in a child with spina bifida.Appropriate nursing interventions include

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

Question 6

How much folic acid is recommended for women of childbearing age?

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

Question 7

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 8

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 9

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 10

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 11

What is the best response to a father who tells the nurse that his son "daydreams" at home and 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 12

Which type of fractures describes traumatic separation of cranial sutures?

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

Question 13

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 14

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 15

The most common problem of children born with a myelomeningocele is

A) Neurogenic bladder
B) Intellectual impairment
C) Respiratory compromise
D) Cranioschisis

Question 16

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 17

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

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

Question 18

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 19

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 20

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 21

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 22

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 23

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 24

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 25

Which type of seizures involves both hemispheres of the brain?

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

Question 26

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 27

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 D51/2NS.
B) The child will require monitoring of therapeutic serum levels while taking this medication.
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 28

What is the most appropriate nursing response to the father of a newborn infant with myelomeningocele who asks about the cause of this condition?

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 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 30

A 14-year-old girl 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 31

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 32

The nurse should expect a child who has frequent tension type of headaches to describe headache pain as

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 33

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 34

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 35

Prolonged seizure activity,in the form of either a single seizure lasting 30 minutes or recurrent seizures lasting more than 30 minutes,with no return to a normal level of consciousness is known as _________________.

Question 36

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 37

A child is brought to the emergency department in generalized tonic-clonic 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 38

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 pharmacologic headache relief measures.
D) Assess for nausea and vomiting.

Question 39

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 40

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 41

If a child has a concussion,a second concussion will have no further ill effects.Is this statement true or false?