pediatric cerebral dysfunction NCLEX questions

pediatric cerebral dysfunction (NCLEX questions) 5.0 (2 reviews) Students also studied Terms in this set (64) George Brown College Nursing Save Peds Cerebral Evolve Ed10 24 terms ciel_bleu_09Preview pediatric genitourinary (nclex questi...22 terms Amanda_Armstrong12 Preview N6 cerebral dysfunction case study...

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kaley91702Preview Pediatr 28 terms che Which term is used to describe a child's level of consciousness when the child can be aroused with stimulation?

• Stupor
• Confusion
• Obtundation
• Disorientation
• Obtundation

Obtundation describes a level of consciousness in which the child can be aroused 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.Which term is used when a patient remains in a deep sleep, responsive only to vigorous and repeated stimulation?

• Coma
• Stupor
• Obtundation
• Persistent vegetative state
• Stupor

Stupor exists when the child remains in a deep sleep, responsive only to vigorous and repeated stimulation. Coma is the state in which no motor or verbal response occurs to noxious (painful) stimuli. Obtundation describes a level of consciousness in which the child can be aroused with stimulation. Persistent vegetative state describes the permanent loss of function of the cerebral cortex.

The Glasgow Coma Scale consists of an assessment of:

• Pupil reactivity and motor response.
• Eye opening and verbal and motor responses.
• Level of consciousness and verbal response.
• Intracranial pressure (ICP) and level of consciousness.
• Eye opening and verbal and motor responses.

The Glasgow Coma Scale assesses eye opening and verbal and motor responses.Pupil reactivity is not a part of the Glasgow Coma Scale but is included in the pediatric coma scale. Level of consciousness and ICP are not part of the Glasgow Coma Scale.

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:

• Eye trauma.
• Neurosurgical emergency.
• Severe brainstem damage.
• Indication of brain death.
• Neurosurgical emergency.

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 fixed, bilateral 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.Which test is never performed on a child who is awake?

• Oculovestibular response
• Doll's head maneuver
• Funduscopic examination for papilledema
• Assessment of pyramidal tract lesions
• Oculovestibular response

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 a child who is awake or one who has a ruptured tympanic membrane. Doll's head maneuver, funduscopic examination, and assessment of pyramidal tract lesions can be performed on children who are awake.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 statement should the nurse include?

• "Pain medication will be given."
• "The scan will not hurt."
• "You will be able to move once the equipment is in

place."

• "Unfortunately no one can remain in the room with you

during the test."

• "The scan will not hurt."

For CT scans, the child will not be allowed to move and 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.Which neurologic diagnostic test gives a visualized horizontal and vertical cross-section of the brain at any axis?

• Nuclear brain scan
• Echoencephalography
• Computed tomography (CT) scan
• Magnetic resonance imaging (MRI)
• Computed tomography (CT) scan

A CT scan provides 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 tissue discrimination that is unavailable with any other techniques.What is the priority nursing intervention when a child is unconscious after a fall?

• Establish an adequate airway
• Perform neurologic assessment
• Monitor intercranial pressure
• Determine whether a neck injury is present
• Establish an adequate airway

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

Which drug would be used to treat a child who has increased intracranial pressure (ICP) resulting from cerebral edema?

• Mannitol
• Atropine sulfate
• Epinephrine hydrochloride
• Sodium bicarbonate
• Mannitol

For increased ICP, mannitol, an osmotic diuretic, administered intravenously, is the drug used most frequently for rapid reduction. Epinephrine, atropine sulfate, and sodium bicarbonate are not used to decrease ICP.Which type of fracture describes traumatic separation of cranial sutures?

• Basilar
• Compound
• Diastatic
• Depressed
• Diastatic

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

• Petechial hemorrhages cause amnesia.
• Visible bruising and tearing of cerebral tissue occur.
• It is a transient, reversible neuronal dysfunction.
• A slight lesion develops remote from the site of trauma.
• It is a transient, reversible neuronal dysfunction.

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.Which statement best describes a subdural hematoma?

• Bleeding occurs between the dura and the skull.
• Bleeding occurs between the dura and the cerebrum.
• Bleeding is generally arterial, and brain compression

occurs rapidly.

• The hematoma commonly occurs in the

parietotemporal region.

• Bleeding occurs between the dura and the cerebrum.

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.The nurse should recommend medical attention if a child

with a slight head injury experiences:

• Sleepiness.
• Headache, even if slight.
• Vomiting, even once.
• Confusion or abnormal behavior.
• Confusion or abnormal behavior.

Medical attention should be sought if the child exhibits confusion or abnormal behavior; loses consciousness; or has amnesia, fluid leaking from the nose or ears, blurred vision, or 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.

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. What type of head injury should the nurse suspect?

• Brainstem
• Subdural hemorrhage
• Skull fracture
• Epidural hemorrhage
• Brainstem

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 and subdural and epidural hemorrhages are not consistent with these signs.A toddler fell out of a second-story window. She had 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." The nurse should explain that the

toddler:

• May have a brain injury.
• May start having seizures.
• Needs this because of her age.
• Probably has a skull fracture.
• May have a brain injury.

The child's history of the fall, brief loss of consciousness, and vomiting four times necessitate 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, and is necessary to determine whether a brain injury has occurred.The nurse is assessing a child who was just admitted to the hospital for observation after a head injury. The most essential part of the nursing assessment to detect early

signs of a worsening condition is:

• Posturing.
• Focal neurologic signs.
• Vital signs.
• Level of consciousness.
• Level of consciousness.

The most important nursing observation is assessment of the child's level of consciousness. Alterations in consciousness appear earlier in the progression of head injury than do alterations of vital signs or focal neurologic signs. Neurologic posturing indicates neurologic damage. Vital signs and focal neurologic signs are later signs of progression when compared with level-of-consciousness changes.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. The most appropriate

nursing action is to:

• Discuss with parents the child's previous experiences

with pain.

• Discuss with practitioner what analgesia can be safely

administered.

• Explain that analgesia is contraindicated with a head

injury.

• Explain that analgesia is unnecessary when child is not

fully awake and alert.

• Discuss with practitioner what analgesia can be safely administered.

A key nursing role is to provide sedation and analgesia for the child. Consultation with the appropriate practitioner is necessary to avoid conflict between the necessity to monitor the child's neurologic status and to promote comfort and relieve anxiety. Gathering information about the child's previous experiences with pain should be obtained as part of the assessment, but because of the severity of injury, analgesia should be provided as soon as possible. Analgesia can be used safely in individuals who have sustained head injuries and can decrease anxiety and resultant increased intracranial pressure.