Question 1

Which nursing intervention is appropriate when caring for a child who has experienced a seizure?

Accepted Answer

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. 
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.

Question 2

A 5 year old sustained a concussion when falling out of a tree.In preparation for discharge,the nurse is discussing home care with the mother.Which statement made by the mother indicates a correct understanding of the teaching?

Accepted Answer

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 difficulty concentrating for a while." 
D)  "If I notice diplopia, I will have my child rest for 1 hour." 
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 difficulty concentrating for a while." 
D)  "If I notice diplopia, I will have my child rest for 1 hour."

Question 3

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?

Accepted Answer

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." 
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 4

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?

Accepted Answer

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

Question 5

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

Accepted Answer

A)  Stupor 
B)  Confusion 
C)  Obtundation 
D)  Disorientation 
A)  Stupor 
B)  Confusion 
C)  Obtundation 
D)  Disorientation

Question 6

It is appropriate,when caring for an unconscious child,to implement which intervention?

Accepted Answer

A)  Change the child's position infrequently to minimize the chance of increased intracranial pressure (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 because antipyretics are contraindicated. 
A)  Change the child's position infrequently to minimize the chance of increased intracranial pressure (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 because antipyretics are contraindicated.

Question 7

Which term is used when a patient remains in a deep sleep,responsive only to vigorous and repeated stimulation?

Accepted Answer

A)  Coma 
B)  Stupor 
C)  Obtundation 
D)  Persistent vegetative state 
A)  Coma 
B)  Stupor 
C)  Obtundation 
D)  Persistent vegetative state

Question 8

What is the common vector reservoir for agents causing viral encephalitis in the United States?

Accepted Answer

A)  Tarantula spiders 
B)  Mosquitoes 
C)  Carnivorous wild animals 
D)  Domestic and wild animals 
A)  Tarantula spiders 
B)  Mosquitoes 
C)  Carnivorous wild animals 
D)  Domestic and wild animals

Question 9

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

Accepted Answer

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

Question 10

The nurse has received report on four children.Which child should the nurse assess first?

Accepted Answer

A)  A school-age child in a coma with stable vital signs. 
B)  A preschool child with a head injury and decreasing level of consciousness. 
C)  An adolescent admitted after a motor vehicle accident who is oriented to person and place. 
D)  A toddler in a persistent vegetative state with a low-grade fever. 
A)  A school-age child in a coma with stable vital signs. 
B)  A preschool child with a head injury and decreasing level of consciousness. 
C)  An adolescent admitted after a motor vehicle accident who is oriented to person and place. 
D)  A toddler in a persistent vegetative state with a low-grade fever.

Question 11

The nurse,closely monitoring a child who is unconscious after a fall,notices that the child suddenly has a fixed and dilated pupil.The nurse should interpret this as the indication of what occurrence?

Accepted Answer

A)  Eye trauma 
B)  Neurosurgical emergency 
C)  Severe brainstem damage 
D)  Indication of brain death 
A)  Eye trauma 
B)  Neurosurgical emergency 
C)  Severe brainstem damage 
D)  Indication of brain death

Question 12

A 3-year-old child is hospitalized after a near-drowning accident.The child's mother complains to the nurse,"This seems unnecessary when he is perfectly fine." What is the nurse's best reply?

Accepted Answer

A)  "He still needs a little extra oxygen." 
B)  "I'm 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." 
A)  "He still needs a little extra oxygen." 
B)  "I'm 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."

Question 13

The Glasgow Coma Scale consists of an assessment of what functions?

Accepted Answer

A)  Pupil reactivity and motor response. 
B)  Eye opening and verbal and motor responses. 
C)  Level of consciousness and verbal response. 
D)  Intracranial pressure (ICP) and level of consciousness. 
A)  Pupil reactivity and motor response. 
B)  Eye opening and verbal and motor responses. 
C)  Level of consciousness and verbal response. 
D)  Intracranial pressure (ICP) and level of consciousness.

Question 14

Which statement best describes a subdural hematoma?

Accepted Answer

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. 
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 15

MATCHING
A 6-year-old child is having a generalized seizure in the classroom at school. Place in order the interventions the school nurse should implement, starting with the highest-priority intervention and sequencing to the lowest-priority intervention.

-Fifth priority

Accepted Answer

A) Take vital signs 
B) Ease child to the floor 
C) Allow child to rest 
D) Turn child to the side 
E) Integrate child back into the school environment 
A) Take vital signs 
B) Ease child to the floor 
C) Allow child to rest 
D) Turn child to the side 
E) Integrate child back into the school environment

Question 16

Which test is never performed on a child who is awake?

Accepted Answer

A)  Oculovestibular response 
B)  Doll's head maneuver 
C)  Funduscopic examination for papilledema 
D)  Assessment of pyramidal tract lesions 
A)  Oculovestibular response 
B)  Doll's head maneuver 
C)  Funduscopic examination for papilledema 
D)  Assessment of pyramidal tract lesions

Question 17

The nurse is monitoring an infant for signs of increased intracranial pressure (ICP).Which are late signs of increased ICP in an infant? (Select all that apply.)

Accepted Answer

A)  Tachycardia 
B)  Alteration in pupil size and reactivity 
C)  Increased motor response 
D)  Extension or flexion posturing 
E)  Cheyne-Stokes respirations 
A)  Tachycardia 
B)  Alteration in pupil size and reactivity 
C)  Increased motor response 
D)  Extension or flexion posturing 
E)  Cheyne-Stokes respirations

Question 18

The nurse is caring for a neonate with suspected meningitis.Which clinical manifestations should the nurse prepare to assess if meningitis is confirmed? (Select all that apply.)

Accepted Answer

A)  Headache 
B)  Photophobia 
C)  Bulging anterior fontanel 
D)  Weak cry 
E)  Poor muscle tone 
A)  Headache 
B)  Photophobia 
C)  Bulging anterior fontanel 
D)  Weak cry 
E)  Poor muscle tone

Question 19

Clinical manifestations of increased intracranial pressure (ICP)in infants are: (Select all that apply.)

Accepted Answer

A)  Low-pitched cry 
B)  Sunken fontanel 
C)  Drowsiness 
D)  Irritability 
E)  Distended scalp veins 
F) Increased blood pressure 
A)  Low-pitched cry 
B)  Sunken fontanel 
C)  Drowsiness 
D)  Irritability 
E)  Distended scalp veins 
F) Increased blood pressure

Question 20

MATCHING
A 6-year-old child is having a generalized seizure in the classroom at school. Place in order the interventions the school nurse should implement, starting with the highest-priority intervention and sequencing to the lowest-priority intervention.

-Fourth priority

Accepted Answer

A) Take vital signs 
B) Ease child to the floor 
C) Allow child to rest 
D) Turn child to the side 
E) Integrate child back into the school environment 
A) Take vital signs 
B) Ease child to the floor 
C) Allow child to rest 
D) Turn child to the side 
E) Integrate child back into the school environment

Exam 46: The Child With Cerebral Dysfunction

Which nursing intervention is appropriate when caring for a child who has experienced a seizure?

A 5 year old sustained a concussion when falling out of a tree.In preparation for discharge,the nurse is discussing home care with the mother.Which statement made by the mother indicates a correct understanding of the teaching?

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?

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?

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

It is appropriate,when caring for an unconscious child,to implement which intervention?

Which term is used when a patient remains in a deep sleep,responsive only to vigorous and repeated stimulation?

What is the common vector reservoir for agents causing viral encephalitis in the United States?

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

The nurse has received report on four children.Which child should the nurse assess first?

The nurse,closely monitoring a child who is unconscious after a fall,notices that the child suddenly has a fixed and dilated pupil.The nurse should interpret this as the indication of what occurrence?

A 3-year-old child is hospitalized after a near-drowning accident.The child's mother complains to the nurse,"This seems unnecessary when he is perfectly fine." What is the nurse's best reply?

The Glasgow Coma Scale consists of an assessment of what functions?

Which statement best describes a subdural hematoma?

MATCHING A 6-year-old child is having a generalized seizure in the classroom at school. Place in order the interventions the school nurse should implement, starting with the highest-priority intervention and sequencing to the lowest-priority intervention. -Fifth priority

Which test is never performed on a child who is awake?

The nurse is monitoring an infant for signs of increased intracranial pressure (ICP).Which are late signs of increased ICP in an infant? (Select all that apply.)

The nurse is caring for a neonate with suspected meningitis.Which clinical manifestations should the nurse prepare to assess if meningitis is confirmed? (Select all that apply.)

Clinical manifestations of increased intracranial pressure (ICP)in infants are: (Select all that apply.)

MATCHING A 6-year-old child is having a generalized seizure in the classroom at school. Place in order the interventions the school nurse should implement, starting with the highest-priority intervention and sequencing to the lowest-priority intervention. -Fourth priority

21st Century Maternity Nursing

The Family, culture, spirituality, and Home Care

Assessment and Health Promotion

Reproductive System Concerns

Infertility, contraception, and Abortion

Genetics, conception, and Fetal Development

Anatomy and Physiology of Pregnancy

Nursing Care of the Family During Pregnancy

Maternal and Fetal Nutrition

Assessment of High-Risk Pregnancy

High-Risk Perinatal Care: Preexisting Conditions

High-Risk Perinatal Care: Gestational Conditions

Labor and Birth Processes

Maximizing Comfort for the Laboring Woman

Fetal Assessment During Labor

Nursing Care of the Family During Labor and Birth

Labor and Birth Complications

Postpartum Physiologic Changes

Nursing Care of the Family During the Postpartum Period

Transition to Parenthood

Postpartum Complications

Physiologic and Behavioral Adaptations of the Newborn

Nursing Care of the Newborn and Family

Newborn Nutrition and Feeding

The High-Risk Newborn

21st Century Pediatric Nursing

Family, social, cultural, and Religious Influences on Child Health Promotion

Developmental and Genetic Influences on Child Health Promotion

Communication and Physical Assessment of the Child and Family

Pain Assessment and Management in Children

The Infant and Family

The Toddler and Family

The Preschooler and Family

The School-Age Child and Family

The Adolescent and Family

Impact of Chronic Illness, disability, or End-Of-Life Care for the Child and Family

Impact of Cognitive or Sensory Impairment on the Child and Family

Family-Centered Care of the Child During Illness and Hospitalization

Pediatric Variations of Nursing Interventions

The Child With Respiratory Dysfunction

The Child With Gastrointestinal Dysfunction

The Child With Cardiovascular Dysfunction

The Child With Hematologic or Immunologic Dysfunction

The Child With Cancer

The Child With Genitourinary Dysfunction

The Child With Endocrine Dysfunction

The Child With Musculoskeletal or Articular Dysfunction

The Child With Neuromuscular or Muscular Dysfunction

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