Chapter 50: Cerebral Dysfunction
MULTIPLE CHOICE
1. Which term is used to describe the level of consciousness when a child can be aroused with
stimulation?
a. Stupor
b. Confusion
c. Obtundation
d. Disorientation
ANS: C
Obtundation describes the 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 indicated by impaired decision making.
Disorientation is confusion regarding time and place.
DIF: Cognitive Level: ComprehensionREF: p. 1586 | Box 50-2 OBJ:
Nursing Process: Assessment
2. What term is used when a patient remains in a deep sleep, responsive only to vigorous and
repeated stimulation?
a. Coma
b. Stupor
c. Obtundation
ANS: B
When the child remains in a deep sleep, responsive only to vigorous and repeated stimulation,
he or she is in a stupor. 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.
DIF: Cognitive Level: ComprehensionREF: p. 1586 | Box 50-2 OBJ:
Nursing Process: Assessment
3. Which does the Glasgow Coma Scale assess?
, a. Pupil reactivity and motor response
b. Eye-opening, verbal, and motor
responses
c. Level of consciousness and verbal
response
d. Intracranial pressure and level of
consciousness
ANS: B
The Glasgow Coma Scale assesses eye-opening, 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 intracranial pressure are not measured by the Glasgow Coma Scale.
DIF: Cognitive Level: Comprehension REF: p. 1586
OBJ: Nursing Process: Assessment
4. The nurse is closely monitoring a child who is unconscious after a fall and notices that he
suddenly has a fixed and dilated pupil. How should the nurse interpret this finding?
a. Eye trauma
b. Neurosurgical emergency
c. Severe brainstem damage
d. Indication of brain death
ANS: B
Pupils that suddenly appear fixed and dilated indicate 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 neurological insult. Pinpoint pupils or bilateral pupils that
remain fixed 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.
DIF: Cognitive Level: Analysis REF: p. 1589 |Nursing Alert
OBJ: Nursing Process: Assessment
5. 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 is the basis of the nurse’s
response?
a. Pain medication will be administered
prior to the scan.
b. CT scans do not cause pain.
c. Movement is allowed once the
equipment is in place.
d. No one is able to remain in the room
with the child during the test.
ANS: B
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.
DIF: Cognitive Level: Application REF: p. 1590
OBJ: Nursing Process: Implementation
6. Which neurological 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)
ANS: C
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. An MRI provides visualizations of
morphological features of target structures and tissue discrimination that is unavailable
with any other technique.
MULTIPLE CHOICE
1. Which term is used to describe the level of consciousness when a child can be aroused with
stimulation?
a. Stupor
b. Confusion
c. Obtundation
d. Disorientation
ANS: C
Obtundation describes the 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 indicated by impaired decision making.
Disorientation is confusion regarding time and place.
DIF: Cognitive Level: ComprehensionREF: p. 1586 | Box 50-2 OBJ:
Nursing Process: Assessment
2. What term is used when a patient remains in a deep sleep, responsive only to vigorous and
repeated stimulation?
a. Coma
b. Stupor
c. Obtundation
ANS: B
When the child remains in a deep sleep, responsive only to vigorous and repeated stimulation,
he or she is in a stupor. 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.
DIF: Cognitive Level: ComprehensionREF: p. 1586 | Box 50-2 OBJ:
Nursing Process: Assessment
3. Which does the Glasgow Coma Scale assess?
, a. Pupil reactivity and motor response
b. Eye-opening, verbal, and motor
responses
c. Level of consciousness and verbal
response
d. Intracranial pressure and level of
consciousness
ANS: B
The Glasgow Coma Scale assesses eye-opening, 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 intracranial pressure are not measured by the Glasgow Coma Scale.
DIF: Cognitive Level: Comprehension REF: p. 1586
OBJ: Nursing Process: Assessment
4. The nurse is closely monitoring a child who is unconscious after a fall and notices that he
suddenly has a fixed and dilated pupil. How should the nurse interpret this finding?
a. Eye trauma
b. Neurosurgical emergency
c. Severe brainstem damage
d. Indication of brain death
ANS: B
Pupils that suddenly appear fixed and dilated indicate 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 neurological insult. Pinpoint pupils or bilateral pupils that
remain fixed 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.
DIF: Cognitive Level: Analysis REF: p. 1589 |Nursing Alert
OBJ: Nursing Process: Assessment
5. 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 is the basis of the nurse’s
response?
a. Pain medication will be administered
prior to the scan.
b. CT scans do not cause pain.
c. Movement is allowed once the
equipment is in place.
d. No one is able to remain in the room
with the child during the test.
ANS: B
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.
DIF: Cognitive Level: Application REF: p. 1590
OBJ: Nursing Process: Implementation
6. Which neurological 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)
ANS: C
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. An MRI provides visualizations of
morphological features of target structures and tissue discrimination that is unavailable
with any other technique.
