pediatric cerebral dysfunction (NCLEX questions and
answers) 2024-2025
Which term is used to describe a child's level of consciousness when the child can be aroused with
stimulation?
*a.* Stupor
*b.* Confusion
*c.* Obtundation
*d.* Disorientation - ANSWER- *c.* 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?
*a.* Coma
*b.* Stupor
*c.* Obtundation
*d.* Persistent vegetative state - ANSWER- *b.* 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:
,*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. - ANSWER- *b.* 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:
*a.* Eye trauma.
*b.* Neurosurgical emergency.
*c.* Severe brainstem damage.
*d.* Indication of brain death. - ANSWER- *b.* 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?
*a.* Oculovestibular response
*b.* Doll's head maneuver
,*c.* Funduscopic examination for papilledema
*d.* Assessment of pyramidal tract lesions - ANSWER- *a.* 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?
*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." - ANSWER- *b.* "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?
*a.* Nuclear brain scan
*b.* Echoencephalography
*c.* Computed tomography (CT) scan
*d.* Magnetic resonance imaging (MRI) - ANSWER- *c.* 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?
*a.* Establish an adequate airway
*b.* Perform neurologic assessment
*c.* Monitor intercranial pressure
*d.* Determine whether a neck injury is present - ANSWER- *a.* 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?
*a.* Mannitol
*b.* Atropine sulfate
*c.* Epinephrine hydrochloride
*d.* Sodium bicarbonate - ANSWER- *a.* 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
answers) 2024-2025
Which term is used to describe a child's level of consciousness when the child can be aroused with
stimulation?
*a.* Stupor
*b.* Confusion
*c.* Obtundation
*d.* Disorientation - ANSWER- *c.* 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?
*a.* Coma
*b.* Stupor
*c.* Obtundation
*d.* Persistent vegetative state - ANSWER- *b.* 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:
,*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. - ANSWER- *b.* 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:
*a.* Eye trauma.
*b.* Neurosurgical emergency.
*c.* Severe brainstem damage.
*d.* Indication of brain death. - ANSWER- *b.* 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?
*a.* Oculovestibular response
*b.* Doll's head maneuver
,*c.* Funduscopic examination for papilledema
*d.* Assessment of pyramidal tract lesions - ANSWER- *a.* 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?
*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." - ANSWER- *b.* "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?
*a.* Nuclear brain scan
*b.* Echoencephalography
*c.* Computed tomography (CT) scan
*d.* Magnetic resonance imaging (MRI) - ANSWER- *c.* 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?
*a.* Establish an adequate airway
*b.* Perform neurologic assessment
*c.* Monitor intercranial pressure
*d.* Determine whether a neck injury is present - ANSWER- *a.* 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?
*a.* Mannitol
*b.* Atropine sulfate
*c.* Epinephrine hydrochloride
*d.* Sodium bicarbonate - ANSWER- *a.* 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
