Chapter 52: The Child with a Neurologic Alteration
Test Bank
MULTIPLE CHOICE
1. What is a sign of increased intracranial pressure (ICP) in a 10-year-old child?
a. Headache
b. Bulging fontanel
c. Tachypnea
d. Increase in head circumference
ANS: A
Feedback
A Headaches are a clinical manifestation of increased ICP in children. A change in
the child’s normal behavior pattern may be an important early sign of increased
ICP.
B This is a manifestation of increased ICP in infants. A 10-year-old child would
have a closed fontanel.
C A change in respiratory pattern is a late sign of increased ICP. Cheyne-Stokes
respiration may be evident. This refers to a pattern of increasing rate and depth
of respirations followed by a decreasing rate and depth with a pause of variable
length.
D By 10 years of age, cranial sutures have fused so that head circumference will
not increase in the presence of increased ICP.
PTS: 1 DIF: Cognitive Level: Application REF: p. 1418 | Box 52-1
OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity
2. Which information should the nurse give to a child who is to have magnetic resonance
imaging (MRI) of the brain?
a. “Your head will be restrained during the procedure.”
b. “You will have to drink a special fluid before the test.”
c. “You will have to lie flat after the test is finished.”
d. “You will have electrodes placed on your head with glue.”
ANS: A
Feedback
A To reduce fear and enhance cooperation during the MRI, the child should be
made aware that the head will be restricted to obtain accurate information.
B Drinking fluids is usually done for gastrointestinal procedures.
C A child should lie flat after a lumbar puncture, not during an MRI.
D Electrodes are attached to the head for an electroencephalogram.
PTS: 1 DIF: Cognitive Level: Application REF: p. 1415
OBJ: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity
,3. 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
ANS: B
Feedback
A Coma is the state in which no motor or verbal response occurs to noxious
(painful) stimuli.
B Stupor exists when the child remains in a deep sleep, responsive only to vigorous
and repeated stimulation.
C Obtundation describes a level of consciousness in which the child is arousable
with stimulation.
D Persistent vegetative state describes the permanent loss of function of the
cerebral cortex.
PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 1419
OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity
4. 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
Feedback
A Pupil reactivity is not a part of the Glasgow Coma Scale but is included in the
pediatric coma scale.
B The Glasgow Coma Scale assesses eye opening, and verbal and motor responses.
C Level of consciousness is not a part of the Glasgow Coma Scale.
D Intracranial pressure and level of consciousness are not part of the Glasgow
Coma Scale.
PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 1419 | Table 52-1
OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity
5. Nursing care of the infant who has had a myelomeningocele repair should include
a. Securely fastening the diaper
b. Measurement of pupil size
c. Measurement of head circumference
d. Administration of seizure medications
ANS: C
Feedback
A A diaper should be placed under the infant but not fastened. Keeping the diaper
, open facilitates frequent cleaning and decreases the risk for skin breakdown.
B Pupil size measurement is usually not necessary.
C Head circumference measurement is essential because hydrocephalus can
develop in these infants.
D Seizure medications are not routinely given to infants who do not have seizures.
PTS: 1 DIF: Cognitive Level: Application REF: p. 1422
OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity
6. The most common problem of children born with a myelomeningocele is
a. Neurogenic bladder
b. Intellectual impairment
c. Respiratory compromise
d. Cranioschisis
ANS: A
Feedback
A Myelomeningocele is one of the most common causes of neuropathic
(neurogenic) bladder dysfunction among children.
B Risk of intellectual impairment is minimized through early intervention and
management of hydrocephalus.
C Respiratory compromise is not a common problem in myelomeningocele.
D Cranioschisis is a skull defect through which various tissues protrude. It is not
associated with myelomeningocele.
PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 1423
OBJ: Nursing Process: Problem Identification
MSC: Client Needs: Physiologic Integrity
7. A recommendation to prevent neural tube defects is the supplementation of
a. Vitamin A throughout pregnancy
b. Multivitamin preparations as soon as pregnancy is suspected
c. Folic acid for all women of childbearing age
d. Folic acid during the first and second trimesters of pregnancy
ANS: C
Feedback
A Vitamin A does not have a relation to the prevention of spina bifida.
B Folic acid supplementation is recommended for the preconceptual period, as
well as during the pregnancy.
C The widespread use of folic acid among women of childbearing age is expected
to decrease the incidence of spina bifida significantly.
D Folic acid supplementation is recommended for the preconceptual period, as
well as during the pregnancy.
PTS: 1 DIF: Cognitive Level: Analysis REF: p. 1422
OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity
8. How much folic acid is recommended for women of childbearing age?
Test Bank
MULTIPLE CHOICE
1. What is a sign of increased intracranial pressure (ICP) in a 10-year-old child?
a. Headache
b. Bulging fontanel
c. Tachypnea
d. Increase in head circumference
ANS: A
Feedback
A Headaches are a clinical manifestation of increased ICP in children. A change in
the child’s normal behavior pattern may be an important early sign of increased
ICP.
B This is a manifestation of increased ICP in infants. A 10-year-old child would
have a closed fontanel.
C A change in respiratory pattern is a late sign of increased ICP. Cheyne-Stokes
respiration may be evident. This refers to a pattern of increasing rate and depth
of respirations followed by a decreasing rate and depth with a pause of variable
length.
D By 10 years of age, cranial sutures have fused so that head circumference will
not increase in the presence of increased ICP.
PTS: 1 DIF: Cognitive Level: Application REF: p. 1418 | Box 52-1
OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity
2. Which information should the nurse give to a child who is to have magnetic resonance
imaging (MRI) of the brain?
a. “Your head will be restrained during the procedure.”
b. “You will have to drink a special fluid before the test.”
c. “You will have to lie flat after the test is finished.”
d. “You will have electrodes placed on your head with glue.”
ANS: A
Feedback
A To reduce fear and enhance cooperation during the MRI, the child should be
made aware that the head will be restricted to obtain accurate information.
B Drinking fluids is usually done for gastrointestinal procedures.
C A child should lie flat after a lumbar puncture, not during an MRI.
D Electrodes are attached to the head for an electroencephalogram.
PTS: 1 DIF: Cognitive Level: Application REF: p. 1415
OBJ: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity
,3. 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
ANS: B
Feedback
A Coma is the state in which no motor or verbal response occurs to noxious
(painful) stimuli.
B Stupor exists when the child remains in a deep sleep, responsive only to vigorous
and repeated stimulation.
C Obtundation describes a level of consciousness in which the child is arousable
with stimulation.
D Persistent vegetative state describes the permanent loss of function of the
cerebral cortex.
PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 1419
OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity
4. 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
Feedback
A Pupil reactivity is not a part of the Glasgow Coma Scale but is included in the
pediatric coma scale.
B The Glasgow Coma Scale assesses eye opening, and verbal and motor responses.
C Level of consciousness is not a part of the Glasgow Coma Scale.
D Intracranial pressure and level of consciousness are not part of the Glasgow
Coma Scale.
PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 1419 | Table 52-1
OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity
5. Nursing care of the infant who has had a myelomeningocele repair should include
a. Securely fastening the diaper
b. Measurement of pupil size
c. Measurement of head circumference
d. Administration of seizure medications
ANS: C
Feedback
A A diaper should be placed under the infant but not fastened. Keeping the diaper
, open facilitates frequent cleaning and decreases the risk for skin breakdown.
B Pupil size measurement is usually not necessary.
C Head circumference measurement is essential because hydrocephalus can
develop in these infants.
D Seizure medications are not routinely given to infants who do not have seizures.
PTS: 1 DIF: Cognitive Level: Application REF: p. 1422
OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity
6. The most common problem of children born with a myelomeningocele is
a. Neurogenic bladder
b. Intellectual impairment
c. Respiratory compromise
d. Cranioschisis
ANS: A
Feedback
A Myelomeningocele is one of the most common causes of neuropathic
(neurogenic) bladder dysfunction among children.
B Risk of intellectual impairment is minimized through early intervention and
management of hydrocephalus.
C Respiratory compromise is not a common problem in myelomeningocele.
D Cranioschisis is a skull defect through which various tissues protrude. It is not
associated with myelomeningocele.
PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 1423
OBJ: Nursing Process: Problem Identification
MSC: Client Needs: Physiologic Integrity
7. A recommendation to prevent neural tube defects is the supplementation of
a. Vitamin A throughout pregnancy
b. Multivitamin preparations as soon as pregnancy is suspected
c. Folic acid for all women of childbearing age
d. Folic acid during the first and second trimesters of pregnancy
ANS: C
Feedback
A Vitamin A does not have a relation to the prevention of spina bifida.
B Folic acid supplementation is recommended for the preconceptual period, as
well as during the pregnancy.
C The widespread use of folic acid among women of childbearing age is expected
to decrease the incidence of spina bifida significantly.
D Folic acid supplementation is recommended for the preconceptual period, as
well as during the pregnancy.
PTS: 1 DIF: Cognitive Level: Analysis REF: p. 1422
OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity
8. How much folic acid is recommended for women of childbearing age?
