Peds Ch. 46 Cerebral Dysfunction

Which questions does the nurse ask the parents in an effort to identify the possible causes of cerebral dysfunction in a child? Select all that apply. 1 "What was the child's Apgar score at birth?" 2 "Was the child attacked by animals or insects?" 3 "How often do you smoke near or around the child?" 4 "Which neurologic disorders are present in the family?" 5 "How often did you consume alcohol during pregnancy?"

1, 2, 4, 5 The nurse asks about neurologic disorders in the child's family members to identify the possibility of genetic influences. The child's Apgar score helps the nurse understand any complications present at the time of birth that may have resulted in cerebral dysfunction. The nurse also assesses for any infections caused by animal or insect encounters. The nurse assesses prenatal influences on the child by asking about alcohol consumption patterns during pregnancy. The nurse assesses the smoking habits of the parents in case the child is at risk for bronchial diseases.

Which type of skull fracture occurs when the bone is broken locally into several irregular fragments and results in a pressure on the brain? 1 Linear 2 Depressed 3 Comminuted 4 Basilar

2 Depressed fracture is suspected when the child's head looks misshapen. The bone is broken locally into several irregular fragments that are pushed inward, resulting in a pressure on the brain. Linear fracture is a single fracture line that does not cross suture lines. Comminuted fracture is caused by intense impact resulting in multiple associated linear fractures. Basilar fracture involves the basilar portion of the frontal, ethmoid, sphenoid, temporal, or occipital bones.

Which nursing intervention is used to prevent increased intracranial pressure (ICP) in an unconscious child? 1 Suctioning child frequently 2 Providing environmental stimulation 3 Turning head side to side every hour 4 Avoiding activities that cause pain or crying

4 Nursing interventions should focus on assessment and interventions to minimize pain. These activities can cause the intracranial pressure to increase. Suctioning is a distressing procedure. In addition, the resultant decrease in carbon dioxide can increase ICP. Environmental stimulation should be minimized. The child's head should not be turned side to side. If the jugular vein is compressed, ICP can rise.

The nurse is performing an assessment of a 14-month-old infant with meningitis. The nurse finds that the baby cannot extend the knee more than 135 degrees and cries when in the supine position with the hip and knee flexed at 90 degrees. What is an appropriate interpretation by the nurse? 1 Kernig sign 2 Babinski reflex 3 Chvostek sign 4 Cremasteric reflex

1 A positive Kernig sign is indicative of meningitis. If the patient cannot extend the knee more than 135 degrees in the supine position, with the hip and knee flexed at 90 degrees, a Kernig sign is said to be present. Pain is also felt in the hamstrings. A positive Babinski reflex is a dorsiflexion and fanning of the toes resulting from stroking the sole of the foot; adults with neuromuscular impairment and healthy infants exhibit this sign. Chvostek sign is elicited by tapping on the facial nerve in the region of the parotid gland; spasm indicates tetany and hypocalcemia. In a male, the cremasteric reflex is elicited by stroking on the inner thigh causing the testes to retract into the scrotal sac.

The nurse is planning care for a school-age child with bacterial meningitis. What should the plan include? 1 Keeping environmental stimuli at a minimum 2 Avoiding giving pain medications that could dull sensorium 3 Measuring head circumference to assess developing complications 4 Having child move head side to side at least every 2 hours

1 Children with meningitis are sensitive to noise, bright lights, and other external stimuli. The nurse should keep the room as quiet as possible, with a minimum of external stimuli. After consultation with the practitioner, pain medications can be used if necessary. A school-age child will have closed sutures. Head circumference should not change. The child is placed in side-lying position with the head of the bed slightly elevated. The nurse should avoid measures such as lifting the child's head that would increase discomfort.

The nurse is performing a neurologic assessment on a child whose level of consciousness has been variable since sustaining a cervical neck injury 12 hours ago. What is the most appropriate nursing assessment in this case? 1 Reactivity of pupils 2 Doll's head maneuver 3 Oculovestibular response 4 Funduscopic examination to identify papilledema

1 Pupil reactivity is an important indication of neurologic health. The pupils should be assessed for no reaction, unilateral reaction, and rate of reactivity. Doll's head maneuver should not be performed if there is a cervical spine injury. Oculovestibular response is a painful test that should not be done on a child who is having variable levels of consciousness. Papilledema does not develop until 24 to 48 hours into the course of unconsciousness.

Which is a priority nursing action while providing care for a child who undergoes repeated subdural taps? 1 Monitor the child's hematocrit. 2 Monitor for dehydration. 3 Administer opioids for pain. 4 Evaluate the child's gag reflexes.

1 The nurse monitors the child's hematocrit to detect excessive blood loss from the procedure. The nurse monitors the child for dehydration if the child is unconscious and fluids are supplied intravenously. Opioids are not administered to children for pain; however, pain control is not an immediate concern in this case. The nurse evaluates the gag reflexes in a child to assess the level of consciousness.

Which is a priority nursing intervention for a child who is breathing spontaneously after a submersion event? 1 Restore oxygen delivery to the cells. 2 Administer intravenous fluids. 3 Administer sedatives. 4 Monitor temperature.

1 The nursing priority for a child who is breathing spontaneously after a submersion event is to restore oxygen delivery to the cells to prevent further hypoxia. The child is in need of oxygen, not fluids. Therefore the nurse need not administer fluids. Sedatives are administered to manage seizure activity, not after a submersion injury. The child's temperature is not a concern at this stage because the child is hypoxic and needs oxygen first.

Which interventions does the nurse implement in the plan of care for a child with bacterial meningitis? Select all that apply. 1 Ensuring a quiet environment in the room 2 Ensuring maximum exposure to sunlight 3 Placing the child in a side-lying position 4 Using a pillow to lift the child's head 5 Assessing whether the child is febrile

1, 3, 5 The nurse ensures that the environment is quiet and peaceful, because the child is sensitive to noise. The child is placed in a side-lying position because of nuchal rigidity. The nurse assesses whether the child is febrile, because it indicates infection. The child is sensitive to bright lights, so exposure to sunlight is avoided. The nurse avoids lifting the child's head, because doing so increases pain and discomfort.

What pattern on an electroencephalogram (EEG) indicates the presence of absence seizure in a child? 1 High-voltage spike discharges 2 A three-per-second spike and wave pattern 3 Absence of electrical activity in an area 4 Abnormal patterns in the discharge intervals

2 An EEG is used to evaluate a seizure disorder. Various seizure types produce characteristic EEG patterns. A three-per-second spike and wave pattern on EEG indicates an absence seizure. High-voltage spike discharges indicate tonic-clonic seizures. Absence of electrical activity in an area indicates a large lesion such as an abscess or subdural collection of fluid. Abnormal patterns in the discharge intervals indicate tonic-clonic seizures.

The nurse is caring for an infant who sustained a head injury during a fall. The infant presents with signs of increased intracranial pressure (ICP). What is an appropriate nursing action in this context? 1 Weighing the infant daily before feeding 2 Elevating the infant's head higher than the hips 3 Checking the infant's reflexes every 15 minutes 4 Providing stimulation to check the level of consciousness

2 Elevation of the head helps decrease intracranial pressure by promoting venous return through gravity. The child is usually placed with the head of the bed elevated slightly and the child's head in midline position. Weighing daily is done routinely for many ill infants because it is an accurate measure of hydration status, but this is not specific to increased ICP. Checking reflexes frequently may be disturbing to the infant and impair the ability to rest. Frequent stimulation may further irritate an already traumatized central nervous system.

Which is an ideal medication or treatment to prevent cerebral edema in a comatose child? 1 Sedatives 2 Osmotherapy 3 Corticosteroids 4 Barbiturates

2 Osmotherapy involves administering osmotically active substances to the child to prevent cerebral edema. Sedatives are administered to reduce intracranial pressure. Corticosteroids are used for inflammatory conditions. Barbiturates are used for reducing intracranial pressure when other medications fail.

The postoperative care of a preschool child who has had a brain tumor removed should include which information? 1 Colorless drainage is to be expected. 2 Close supervision is needed while the child is regaining consciousness. 3 Positioning is on the side in the Trendelenburg position. 4 Analgesics are contraindicated because of altered consciousness.

2 The child needs to be observed closely. Vital signs must be assessed carefully, and signs of increasing intracranial pressure need to be monitored. Colorless drainage may be leakage of cerebral spinal fluid from the incision site. This needs to be reported as soon as possible. The child should not be positioned in the Trendelenburg position after surgery. Analgesics can be used for postoperative pain.

Which test is used to understand the staging criteria for Reye's syndrome in a child? 1 Magnetic resonance imaging (MRI) 2 Computed tomography (CT) scan 3 Liver biopsy 4 Electroencephalogram (EEG)

3 Reye's syndrome causes fatty changes of the liver and liver dysfunction. Hence, liver biopsy is used to understand the staging criteria for Reye's syndrome in a child. MRI is used to detect tumors or cerebral edema. CT scan is used to assess the injuries of the brain or skull. EEG provides important information about the brain, such as suppressed cortical function, hematoma, or brain death.

A young child is having a seizure that has lasted 35 minutes. There is a loss of consciousness. The nurse should recognize that this is what? 1 An absence seizure 2 A generalized seizure 3 Status epilepticus 4 A simple partial seizure

3 Status epilepticus is a generalized seizure that lasts more than 30 minutes. Absence seizures are brief losses of consciousness. Generalized seizures are the most common of seizures. They have a tonic phase of approximately 10 to 20 seconds. They involve both hemispheres of the brain. Simple partial seizures are characterized by varying sensations.

The nurse is caring for a 10-year-old child with a history of diabetes mellitus who recently had brain surgery. On assessment, the nurse finds that the body temperature has risen to 103° F. What is an appropriate interpretation by the nurse? 1 Children with diabetes mellitus usually develop an infection after surgery. 2 High body temperature is common in children after surgical procedures. 3 Cerebral edema after brain surgery exerts pressure on the hypothalamus. 4 Excessive viscid secretions result in inadequate respiratory ventilation.

3 Temperature measurement is needed because of hyperthermia caused by surgical intervention in the hypothalamus or brainstem. This also happens as a result of some types of general anesthesia. Pressure on the hypothalamus, the temperature-regulating center of the brain, causes temperature imbalances. Infection after surgery is not expected, even if the child has diabetes. Infection occurs when proper procedures are not followed. After an operation, a temperature increase caused by an inflammatory response rarely exceeds 101° F. A high fever is not expected after surgical procedures. Viscid secretions do not cause an elevated temperature unless an infection is present.

Which is the most important nursing intervention while providing care for a child with endotracheal intubation who is in a deep comatose state? 1 Ask family members to be always present. 2 Monitor hematocrit often. 3 Assess respiratory effectiveness. 4 Perform suctioning every day.

3 The nurse assesses the respiratory effectiveness in an unconscious child because secretions tend to pool in the throat and pharynx, which may obstruct the airway. The nurse does not ask the parents to be present at all times because it is not required that they be present. The nurse monitors hematocrit in a child who undergoes repeated subdural taps to detect blood loss from the procedure. Suctioning is performed only when needed to prevent an increase in the intracranial pressure.

The nurse is discussing long-term care with the parents of a child who has a ventriculoperitoneal shunt to correct hydrocephalus. In the discussion, what should the nurse include? 1 Parental protection is essential until the child reaches adulthood. 2 Cognitive impairment is to be expected with hydrocephalus. 3 Shunt malfunction or infection requires immediate treatment. 4 Most usual childhood activities must be restricted.

3 Because of the potentially severe sequelae, symptoms of shunt malfunction or infection must be assessed and treated immediately if present. Limits should be appropriate to the developmental age of the child. Cognitive impairment depends on the extent of damage before the shunt was placed. Except for contact sports, the child will have few restrictions.

Which medication helps reduce intracranial pressure (ICP) elevations greater than 20 to 25 mm Hg in a child? 1 Phenytoin (Dilantin) 2 Rectal diazepam (Valium) 3 Mannitol (Osmitrol) 4 Ibuprofen (Motrin)

3 Mannitol (Osmitrol) is an osmotic diuretic that is administered intravenously to lower the ICP in 1 to 5 minutes. Phenytoin (Dilantin) is prescribed for the management of status epilepticus. Rectal diazepam (Valium) is used for safe, quick, and effective treatment of status epilepticus. Ibuprofen (Motrin) is used to reduce the temperature during a febrile seizure.

What are the most appropriate nursing interventions when caring for a child experiencing a seizure? Select all that apply. 1 Restraining the child when a seizure occurs to prevent bodily harm 2 Placing a padded tongue between the teeth if they become clenched 3 Avoiding the suctioning of the child during the seizure 4 Describing and documenting the seizure activity observed 5 Applying supplemental oxygen after inserting an artificial oral airway

3, 4 The priority nursing intervention is to observe the child and seizure, document the activity observed, and avoid suctioning the child during the seizure. The child should not be restrained, because this may cause an injury. Nothing should be placed in the child's mouth, because this may cause an injury not only to the child but also to the nurse. To prevent aspiration, the child should be placed on the side if possible to facilitate drainage.

The nurse is doing a neurologic assessment on a 2-month-old infant following a car accident. Moro, tonic neck, and withdrawal reflexes are present. What should the nurse recognize that these reflexes suggest? 1 Neurologic health 2 Severe brain damage 3 Decorticate posturing 4 Decerebrate posturing

1 The Moro, tonic neck, and withdrawing reflexes are usually present in infants younger than 3 to 4 months of age. Therefore, the presence of these reflexes indicates neurologic health. Decorticate posturing indicates severe dysfunction of the cerebral cortex. Decerebrate posturing indicates dysfunction at the level of the midbrain.

The nurse is assessing a 9-year-old child for the presence of Reye's syndrome (RS). What information about the child is most useful for the nurse during the assessment? 1 The child reports having a rash recently. 2 The child had an episode of acute tonsillitis. 3 The child reports having a recent viral infection. 4 The child has had a fractured radius and ulna.

3 The etiology of RS is not well understood, but most cases follow a common viral illness, typically influenza or varicella. A rash is not a symptom of Reye's syndrome. Tonsillitis is not specifically related to Reye's syndrome. It is an inflammation of the tonsils most commonly caused by a viral or bacterial infection. Fractured bones are not specifically related to Reye's syndrome. They indicate physical trauma.

What action does the nurse take when caring for a child who is having a tonic-clonic seizure? 1 Administers oxygen 2 Administers sedatives 3 Monitors temperature 4 Places the child on the side

4 When a child is having a tonic-clonic seizure, the nurse places the child on the side to facilitate drainage and help maintain a patent airway. Oxygen is administered to the child who is at risk for having hypoxia. Sedatives are not usually administered, because the child is integrated into the environment as soon as possible. Temperature is assessed when the child has febrile seizures, because medications are administered to reduce the temperature.

Which site is used for inserting the intraventricular catheter for monitoring intracranial pressure? 1 The lateral ventricle 2 The subarachnoid space 3 The third ventricle 4 The space between the dura and the skull

1 The lateral ventricle on the non-dominant side is used for inserting the intraventricular catheter. If the catheter cannot be cannulated in the ventricle, then the subarachnoid bolt is placed in the subarachnoid space. The third ventricle is not used to insert the catheter because it is filled with cerebrospinal fluid. The epidural sensor is placed between the dura and the skull for monitoring the intracranial pressure.

The nurse who is concerned about increased intracranial pressure in an infant should assess for what? 1 Irritability 2 Photophobia 3 Pulsating anterior fontanel 4 Vomiting and diarrhea

1 Irritability is one of the changes that may indicate increased intracranial pressure. Photophobia does not indicate increased intracranial pressure in infants. Frequently pulsations are visible in the anterior fontanel. They are not an indication of increased intracranial pressure. Vomiting is one of the signs in children but, when present with diarrhea, indicates a gastrointestinal disturbance.

Which interventions does the nurse implement while feeding a comatose child? Select all that apply. 1 Carefully monitors the intravenous fluid infusions 2 Regularly examines the skin and the mucous membranes 3 Evaluates the child's pituitary function tests 4 Provides same amount of fluids that the child took when healthy 5 Monitors feeding when a nasogastric tube is used

1, 2, 3, 5 The nurse carefully monitors intravenous fluid infusions to prevent dehydration or overhydration. The nurse examines the child's skin and mucous membranes for signs of dehydration. The child's pituitary function tests are evaluated to assess the fluid balance. The nurse monitors feedings when a nasogastric tube is used for preventing overfeeding, which may cause vomiting or risk for aspiration. A comatose child cannot tolerate the same amount of fluids that the child took when healthy. Therefore the nurse monitors for overhydration to prevent cerebral edema.

Which cerebral complications is a child at risk for after a head trauma? Select all that apply. 1 Hemorrhage 2 Edema 3 Brain tumors 4 Infection 5 Brain herniation

1, 2, 4, 5 After a head trauma, the child is at risk for epidural and subdural hemorrhage. An epidural hemorrhage is bleeding between the dura and the skull. A subdural hemorrhage is bleeding between the dura and the arachnoid membrane. The child may be at risk for edema resulting from direct cellular injury that leads to intracellular swelling or vascular injury. The child is at risk for infection resulting from open injuries. Head trauma also poses a risk for brain herniation through the brainstem. Brain tumors are not caused by head trauma but arise from any cell within the brain.

Which diagnostic tests does the nurse evaluate to confirm the presence of bacterial meningitis in a child who shows symptoms of infection such as headache, photophobia, and nuchal rigidity? Select all that apply. 1 Lumbar puncture 2 Magnetic resonance imaging (MRI) 3 Blood cell count 4 Cerebrospinal fluid (CSF) glucose 5 Computed tomography (CT) scan

1, 3, 4 Lumbar puncture helps to diagnose bacterial meningitis in a child by indicating an elevation in the spinal fluid pressure. The child's white blood cell count is also elevated. CSF glucose level is reduced as a result of bacterial consumption of glucose. MRI is used to detect tumors or cerebral edema. CT scan is used to assess the severity of injuries to the brain or skull.

Which diagnostic tests does the nurse evaluate to confirm cerebral dysfunction in a child with increased intracranial pressure (ICP)? Select all that apply. 1 Electroencephalogram (EEG) 2 Lumbar puncture 3 Visual evoked potentials 4 Computed tomography (CT) 5 Magnetic resonance imaging (MRI)

1, 3, 4, 5 EEG provides important information about the brain, such as suppressed cortical function, hematoma, or brain death. Visual evoked potentials are helpful to evaluate visual abnormalities from the retina to the visual cortex. A CT scan and MRI scans are used to visualize the soft tissues and solid matter and help to diagnose the disease. Lumbar puncture is usually avoided in children with increased ICP because of its potential for tentorial herniation.

Which interventions does the nurse implement to prevent the elevation of intracranial pressure (ICP) in an unconscious child? Select all that apply. 1 Provides dim lights in the room 2 Asks many relatives to visit often 3 Prevents sudden movements in the child 4 Administers prescribed pain medications 5 Monitors the child's temperature frequently

1, 3, 4, 5 The nurse provides dim lights in the room because the child is sensitive to bright lights. The nurse also prevents sudden jarring movements in the child, such as head banging, because it may result in an increase in ICP. The nurse administers the prescribed pain medications for pain because unrelieved pain causes stress and increases ICP. The nurse also monitors the child's temperature every 2 to 4 hours because brainstem disorders affect the child's thermoregulation. The nurse provides a quiet environment in the child's room by limiting the visitors.

Which conditions can occur from infection in the nervous system? Select all that apply. 1 Rabies 2 Seizures 3 Meningitis 4 Hydrocephalus 5 Reye's syndrome

1, 3, 5 Meningitis is caused by a bacterial infection that causes acute inflammation of the meninges. Rabies is an acute infection of the nervous system caused by a virus. Reye's syndrome causes impaired consciousness and disordered hepatic function, which usually follows viral illness, such as influenza or varicella. Hydrocephalus causes enlargement of the skull and dilation of the ventricles. Seizures are not caused by infections in the nervous system. They are a neurologic disorder, which results in abnormal electrical activity in the brain.

The nurse is caring for a 5-year-old child who had a craniotomy. The nurse is assessing the neurologic status of the child. The nurse has checked the level of consciousness, pupillary activity, and reflexes. What else does the nurse assess in the patient? 1 Blood pressure 2 Motor function 3 Rectal temperature 4 Head circumference

2 The nurse should observe for motor functions such as spontaneous activity, gait, and response to painful stimuli. This provides clues to the location and extent of cerebral dysfunction, if any. Assessment of motor function is an important component of a neurologic examination. Even subtle movements (e.g., the outward rotation of a hip) should be noted. Blood pressure is not a direct measure of neurologic status. Temperature is not a direct measure of neurologic status. Head circumference provides information as to skeletal development and brain growth, not neurologic data. A change in head circumference as a result of increased intracranial pressure is not expected in a 5-year-old whose cranial bones are fused.

What teaching does the nurse give to the parents about the computed tomography (CT) scan that is prescribed for a child with head trauma? 1 "This scan helps detect structural brain abnormalities." 2 "This scan helps detect the severity of the trauma." 3 "This scan is done to assess cerebral edema." 4 "This scan will help identify any seizure activity."

2 The severity of an injury is not evident during a clinical examination, but it is detected through a CT scan. Magnetic resonance imaging (MRI) is used to detect structural brain abnormalities or to assess cerebral edema. Electroencephalogram (EEG) helps identify any seizure activity.

Which signs and symptoms indicate an increase in intracranial pressure (ICP) in a child? Select all that apply. 1 Excessive thirst 2 Increased sleeping 3 Forceful vomiting 4 Seizures

2, 3, 4 Increased ICP in a child is indicated by increased sleeping or an altered level of consciousness such as lethargy, disorientation, and stupor. Forceful vomiting may be caused by abnormalities in the brainstem as a result of increased ICP. Seizures indicate an abnormal electrical discharge in the brain as a result of increased intracranial pressure. Excessive thirst is seen in children with diabetes insipidus, not in children with increased ICP.

Which diet does the nurse recommend for a child for management of epilepsy? 1 Low-fat diet 2 High-fiber diet 3 Liquid diet 4 Ketogenic diet

4 The ketogenic diet is a high-fat, low-carbohydrate, and adequate-protein diet that helps to utilize glucose as the primary energy source. This helps develop a state of ketosis and reduce seizures. A low-fat and high-fiber diet is usually recommended to lower cholesterol levels. A liquid diet is usually prescribed for diabetic patients.

Why are infants particularly vulnerable to acceleration-deceleration head injuries? 1 The anterior fontanel is not yet closed. 2 The nervous tissue is not well developed. 3 The scalp of the head has extensive vascularity. 4 Musculoskeletal support of head is insufficient.

4 The relatively large head size coupled with insufficient musculoskeletal support increases the risk to the infant. The anterior fontanel not being closed does not have an effect on this type of injury. The nervous tissue not being well developed does not have an effect on this type of injury. The scalp having extensive vascularity does not have an effect on this type of injury.