Chapter 028wong S Essentials of Pediatrics Test Bank

Hockenberry & Wilson: Wongs Essentials of Pediatric Nursing,
8th Edition
Pub Review
Chapter 28: The Child with Cerebral Dysfunction
MULTIPLE CHOICE
1. Which of the following terms is used to describe a childs level of consciousness when
the child is arousable with stimulation?
a. Stupor
b. Confusion
c. Obtundation
d. Disorientation
ANS: C
Obtundation describes a level of consciousness in which the child is arousable with
stimulation.
DIF: Cognitive Level: Comprehension REF: Page 976
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation
2. Which of the following terms 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
ANS: B
Stupor exists when the child remains in a deep sleep, responsive only to vigorous and
repeated stimulation.
3. 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.
ANS: B
The Glasgow Coma Scale assesses eye opening and verbal and motor responses.
DIF:
Cognitive Level: Comprehension
REF: Page 976
Copyright 2009 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Pub Review
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MSC: Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential
4. 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 which
of the following?
a. Eye trauma
b. Neurosurgical emergency
c. Severe brainstem damage
d. Indication of brain death
ANS: B
The sudden appearance of a fixed and dilated pupil(s) is a neurosurgical emergency. The
nurse should immediately report this finding.
DIF: Cognitive Level: Analysis
REF: Page 978
5. The nurse is caring for a child with severe head trauma after a car accident. Which of the
following is an ominous sign that often precedes death?
a. Papilledema
b. Delirium
c. Dolls head maneuver
d. Periodic and irregular breathing
ANS: D
Periodic or irregular breathing is an ominous sign of brainstem (especially medullary)
dysfunction that often precedes complete apnea.
DIF: Cognitive Level: Application
REF: Page 977
6. Which of the following tests is never performed on an awake child?
a. Oculovestibular response
b. Dolls head maneuver
c. Funduscopic examination for papilledema
d. Assessment of pyramidal tract lesions
ANS: A
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 an awake
child or one who has a ruptured tympanic membrane.
REF: Page 978
TOP: Integrated Process: Nursing Process: Implementation
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7. The nurse is preparing a school-age child for computed tomography (CT scan) to assess
cerebral function. The nurse should include which of the following statements in
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.
ANS: B
For CT scans, the child must be immobilized. It is important to emphasize to the child
that at no time is the procedure painful.
REF: Page 979
TOP: Integrated Process: Teaching/Learning
MSC: Area of Client Needs: Health Promotion and Maintenance: Growth and
Development
8. Which of the following neurologic diagnostic tests gives a visualized horizontal and
vertical cross section of the brain at any axis?
a. Nuclear brain scan
b. Echoencephalography
c. CT scan
d. Magnetic resonance imaging (MRI)
ANS: C
A CT scan provides a visualization of the horizontal and vertical cross sections of the
brain at any axis.
9. Which of the following is the priority nursing intervention when a child is unconscious
after a fall?
a. Establish adequate airway.
b. Perform neurologic assessment.
c. Monitor intracranial pressure.
d. Determine whether a neck injury is present.
ANS: A
Respiratory effectiveness is the primary concern in the care of the unconscious child.
Establishment of an adequate airway is always the first priority.
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10. Which of the following drugs would be used to treat a child who has increased ICP
resulting from cerebral edema?
a. Mannitol
b. Epinephrine hydrochloride
c. Atropine sulfate
d. Sodium bicarbonate
ANS: A
For increased ICP, mannitol, an osmotic diuretic, administered intravenously, is the drug
used most frequently for rapid reduction.
MSC: Area of Client Needs: Physiologic Integrity: Pharmacologic and Parenteral
Therapy
11. An appropriate nursing intervention when caring for an unconscious child would be
which of the following?
a. Change the childs position infrequently to minimize the chance of increased ICP.
b. Avoid using narcotics or sedatives to provide comfort and pain relief.
c. Monitor fluid intake and output carefully to avoid fluid overload and cerebral
edema.
d. Give tepid sponge baths to reduce fever, since antipyretics are contraindicated.
ANS: C
Often comatose patients cannot cope with the quantity of fluids that they normally
tolerate. Overhydration must be avoided to prevent fatal cerebral edema.
REF: Page 980
12. Which of the following 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. A slight lesion develops remote from the site of trauma.
ANS: C
A concussion is a transient, reversible neuronal dysfunction with instantaneous loss of
awareness and responsiveness resulting from trauma to the head.
13. Which of the following types of fractures describes traumatic separation of cranial
sutures?
Pub Review
a.
b.
c.
d.
28-5
Basilar
Compound
Diastatic
Depressed
ANS: C
Diastatic skull fractures are traumatic separations of the cranial sutures.
14. Which of the following statements 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.
ANS: B
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.
15. The nurse should recommend medical attention if a child with a slight head injury
experiences which of the following?
a. Sleepiness
b. Vomiting, even once
c. Headache, even if slight
d. Confusion or abnormal behavior
ANS: D
Medical attention should be sought if the child exhibits confusion or abnormal behavior,
loses consciousness, has amnesia, has fluid leaking from the nose or ears, complains of
blurred vision, or has an unsteady gait.
16. A 10-year-old boy on a bicycle has been hit by a car in front of the school. The school
nurse immediately assesses airway, breathing, and circulation. The next nursing action
should be which of the following?
a. Place on side.
b. Take blood pressure.
c. Stabilize neck and spine.
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d. Check scalp and back for bleeding.

ANS: C
After determining that the child is breathing and has adequate circulation, the next action
is to stabilize the neck and spine to prevent any additional trauma.
REF: Page 989
17. 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. The nurse should suspect what type of head injury?
a. Brainstem
b. Skull fracture
c. Subdural hemorrhage
d. Epidural hemorrhage
ANS: A
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.
18. A child is unconscious after a motor vehicle accident. The watery discharge from the nose
tests positive for glucose. The nurse should recognize that this suggests:
a. diabetic coma.
b. brainstem injury.
c. upper respiratory tract infection.
d. leaking of cerebrospinal fluid (CSF).
ANS: D
Watery discharge from the nose that is positive for glucose suggests leaking of CSF from
a skull fracture.
REF: Page 989
19. 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 CT scan is required when she seems fine. The nurse should explain that she:
a. may have a brain injury.
b. needs this because of her age.
c. may start having seizures.
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d. probably has a skull fracture.

ANS: A
The childs history of the fall, brief loss of consciousness, and vomiting four times
necessitates 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.
20. The nurse is assessing a child who was just admitted to the hospital for observation after
a head injury. Which of the following 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
ANS: D
The most important nursing observation is assessment of the childs level of
consciousness. Alterations in consciousness appear earlier in the progression of an injury
than do alterations of vital signs or focal neurologic signs.
REF: Page 991
21. A school-age child has sustained a head injury and multiple fractures after being thrown
from a horse. The childs 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 which of the following?
a. Discuss with parents the childs previous experiences with pain.
b. Discuss with practitioner what analgesia can be safely administered.
c. Explain that analgesia is contraindicated with a head injury.
d. Explain that analgesia is unnecessary when child is not fully awake and alert.
ANS: B
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 childs neurologic status and the promotion of comfort and relief of anxiety.
REF: Page 992
Therapy
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22. 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 of the following
statements 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.
ANS: C
The parents are advised of probable posttraumatic symptoms that may be expected. These
include behavioral changes and sleep disturbances.
23. A 3-year-old child is hospitalized after a near-drowning accident. The childs mother
complains to the nurse, This seems unnecessary when he is perfectly fine. The nurses
best reply would be which of the following?
a. He still needs a little extra oxygen.
b. Im sure he is fine, but the doctor wants to make sure.
c. The reason for this is that complications could still occur.
d. It is important to observe for possible central nervous system problems.
ANS: C
All children who have a near-drowning experience should be admitted to the hospital for
observation. Although many children do not appear to have suffered adverse effects from
the event, complications such as respiratory compromise and cerebral edema may occur
24 hours after the incident.
REF: Page 994
24. The most common clinical manifestation(s) of brain tumors in children is which of the
following?
a. Irritability
b. Seizures
c. Headaches and vomiting
d. Fever and poor fine motor control
ANS: C
Headaches, especially on awakening, and vomiting that is not related to feeding are the
most common clinical manifestation(s) of brain tumors in children.
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25. Five-year-old Jos is being prepared for surgery to remove a brain tumor. Nursing actions
should be based on which of the following?
a. Removal of tumor will stop the various symptoms.
b. Usually the postoperative dressing covers the entire scalp.
c. He is not old enough to be concerned about his head being shaved.
d. He is not old enough to understand the significance of the brain.
ANS: B
Jos should be told what he will look and feel like after surgery. This includes the size of
the dressing. The nurse can demonstrate on a doll the expected size and shape of the
dressing.
REF: Page 997
MSC: Area of Client Needs: Health Promotion and Maintenance: Growth and
Development
26. Which of the following best describes a neuroblastoma?
a. 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 tumor in young children.
d. It is the most common benign tumor in young children.
ANS: A
Neuroblastoma is a silent tumor with few symptoms. In more than 70% of cases,
diagnosis is made after metastasis occurs, with the first signs caused by involvement in
the nonprimary site.
REF: Page 997
27. The mother of a 1-month-old infant tells the nurse she worries that her baby will get
meningitis like her oldest son did when he was an infant. The nurse should base her
response on which of the following?
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. Vaccination to prevent Haemophilus influenzae type b meningitis has decreased
the frequency of this disease in children.
ANS: D
H. influenzae type b meningitis has been virtually eradicated in areas of the world where
the vaccine is administered routinely.
REF: Page 998
Pub Review
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28. The vector reservoir for agents causing viral encephalitis in the United States is which of
the following?
a. Tarantula spiders
b. Mosquitoes and ticks
c. Carnivorous wild animals
d. Domestic and wild animals
ANS: B
Viral encephalitis, not attributable to a childhood viral disease, is usually transmitted by
mosquitoes and ticks. The vector reservoir for most agents pathogenic for humans and
detected in the United States are mosquitoes and ticks; therefore most cases of
encephalitis appear during the hot summer months.
TOP: Integrated Process: Nursing Process: Planning
29. Which of the following may 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 and ibuprofen for children with varicella or those suspected
of having influenza
ANS: D
Although the etiology of Reye syndrome is obscure, most cases follow a common viral
illness, either varicella or influenza. A potential association exists between aspirin therapy
and the development of Reye syndrome, so use of aspirin is avoided.
30. When taking the history of a child hospitalized with Reye syndrome, the nurse should not
be surprised that a week ago the child had recovered from which of the following?
a. Measles
b. Varicella
c. Meningitis
d. Hepatitis
ANS: B
Most cases of Reye syndrome follow a common viral illness such as varicella or
influenza.
Pub Review
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31. When caring for the child with Reye syndrome, the priority nursing intervention would
be which of the following?
a. Monitor intake and output.
b. Prevent skin breakdown.
c. Observe for petechiae.
d. Do range-of-motion exercises.
ANS: A
Accurate and frequent monitoring of intake and output is essential for adjusting fluid
volumes to prevent both dehydration and cerebral edema.
REF: Page 1004
32. A young childs parents call the nurse after their child was bitten by a raccoon in the
woods. The nurses recommendation should be based on which of the following?
a. Child should be hospitalized for close observation.
b. No treatment is necessary if thorough wound cleaning is done.
c. Antirabies prophylaxis must be initiated.
d. Antirabies prophylaxis must be initiated if clinical manifestations appear.
ANS: C
Current therapy for a rabid animal bite consists of a thorough cleansing of the wound and
passive immunization with human rabies immune globulin (HRIG) as soon as possible.
33. 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. The nurses best response is which of the following?
a. Epilepsy is easily treated.
b. Very few children have actual epilepsy.
c. The seizure may or may not mean that your child has epilepsy.
d. Your child has had only one convulsion; it probably wont happen again.
ANS: C
Seizures are the indispensable characteristic of epilepsy; however, not every seizure is
epileptic. Epilepsy is a chronic seizure disorder with recurrent and unprovoked seizures.
REF: Page 1005
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34. Which of the following types of seizures involves both hemispheres of the brain?
a. Focal
b. Partial
c. Generalized
d. Acquired
ANS: C
Clinical observations of generalized seizures indicate that the initial involvement is from
both hemispheres.
35. Which of the following is the initial clinical manifestation of generalized seizures?
a. Being confused
b. Feeling frightened
c. Losing consciousness
d. Seeing flashing lights
ANS: C
Loss of consciousness is a frequent occurrence in generalized seizures and is the initial
clinical manifestation.
36. Which of the following types of seizures may be difficult to detect?
a. Absence
b. Generalized
c. Simple partial
d. Complex partial
ANS: A
Absence seizures may go unrecognized because little change occurs in the childs
behavior during the seizure.
37. An important nursing intervention when caring for a child who is experiencing a seizure
would be which of the following?
a. Describe and record the seizure activity observed.
b. Restrain the child when 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.
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ANS: A
When a child is having a seizure, the priority nursing care is observation of the child and
seizure. The nurse then describes and records the seizure activity.
REF: Page 1010
38. A 10-year-old child, without a history of previous seizures, experiences a tonic-clonic
seizure at school. Breathing is not impaired, but some postictal confusion occurs. The
most appropriate initial action by the school nurse is which of the following?
a. Stay with child and have someone call emergency medical service (EMS).
b. Notify parent and regular practitioner.
c. Notify parent that child should go home.
d. Stay with child, offering calm reassurance.
ANS: A
The EMS should be called to transport the child because this is the childs first seizure.
REF: Page 1014
39. 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. The nurse includes which of the
following in the response?
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 life-long problem. Medications cannot be discontinued.
ANS: C
A predesigned protocol is used to wean a child gradually off antiseizure medications,
usually when the child is seizure free for 2 years and has a normal electroencephalogram
(EEG).
Therapy
40. Children taking phenobarbital and/or phenytoin may experience a deficiency of:
a. calcium.
b. vitamin C.
c. fat-soluble vitamins.
d. vitamin D and folic acid.
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ANS: D
Deficiencies of vitamin D and folic acid have been reported in children taking
phenobarbital and phenytoin.
Therapy
41. What clinical manifestations would suggest hydrocephalus in a neonate?
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
ANS: A
Bulging fontanels, dilated scalp veins, and separated sutures are clinical manifestations of
hydrocephalus in neonates.
REF: Page 1018
MULTIPLE RESPONSE
1. The treatment of brain tumors in children consists of which of the following therapies?
(Select all that apply.)
a. Surgery
b. Bone marrow transplantation
c. Chemotherapy
d. Stem cell transplantation
e. Radiation
f. Myelography
ANS: A, C, E
Treatment for brain tumors in children may consist of surgery, chemotherapy, and
radiotherapy alone or in combination.
2. Which of the following is a clinical manifestation of increased intracranial pressure (ICP)
in infants? (Select all that apply.)
a. Low-pitched cry
b. Sunken fontanel
c. Diplopia and blurred vision
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d. Irritability
e. Distended scalp veins
f. Increased blood pressure
ANS: C, D, E
Diplopia and blurred vision, irritability, and distended scalp veins are signs of increased
ICP in infants.
REF: Page 976
3. An infant with hydrocephalus is hospitalized for surgical placement of a
ventriculoperitoneal shunt. Which of the following interventions should be included in
the childs postoperative care? (Select all that apply.)
a. Observe closely for signs of infection.
b. Pump the shunt reservoir to maintain patency.
c. Administer sedation to decrease irritability.
d. Maintain Trendelenburg position to decrease pressure on the shunt.
e. Maintain an accurate record of intake and output.
f. Monitor for abdominal distention.
ANS: A, E, F
Infection is a major complication of ventriculoperitoneal shunts. Observation for signs of
infection is a priority nursing intervention. Intake and output should be measured
carefully. Abdominal distention could be a sign of peritonitis or a postoperative ileus.
REF: Page 1020

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Hockenberry & Wilson: Wongs Essentials of Pediatric Nursing,

Cognitive Level: Comprehension

REF: Page 976

TOP: Integrated Process: Nursing Process: Assessment

d. Check scalp and back for bleeding.

d. probably has a skull fracture.

MSC: Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential

MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

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