Chapter 16: Alterations of Neurologic Function in Children My Nursing Test Banks

Huether and McCance: Understanding Pathophysiology, 5th Edition

Chapter 16: Alterations of Neurologic Function in Children

Test Bank

MULTIPLE CHOICE

1. The nurse is assessing a 2-month-old infant. Which reflex of infancy will disappear first?

a.

Stepping

b.

Rooting

c.

Palmar grasp

d.

Moro reflex

ANS: A

The stepping reflex should no longer be obtainable at 6 weeks.

The rooting reflex should no longer be obtainable at 4 months.

The palmar grasp should no longer be obtainable at 6 months.

The Moro reflex should no longer be obtainable at 3 months.

REF: p. 410

2. A 10-month-old infant presents for a well-baby visit. Which of the following reflexes should be present at this age?

a.

Stepping

b.

Sucking

c.

Landau

d.

Palmar grasp

ANS: C

The Laundau reflex would be present up until 24 months.

The stepping reflex should no longer be obtainable at 6 weeks.

The sucking reflex should have disappeared by 10 months.

The palmar grasp should no longer be obtainable at 6 months.

REF: p. 410

3. The parents ask, During infancy, what is the fastest growing part of the body? How should the nurse respond?

a.

Spinal cord

b.

Limb bones

c.

Head

d.

Vertebral column

ANS: C

The head is the fastest growing part of the body during infancy.

The head, not the spinal cord, is the fastest growing part of the body during infancy.

The head, not the limb bones, is the fastest growing part of the body during infancy.

The head, not the vertebral column, is the fastest growing part of the body during infancy.

REF: p. 409

4. A nurse is preparing to teach about the most common defects of neural tube closure. Which one should the nurse discuss?

a.

Anterior

b.

Posterior

c.

Lateral

d.

Superior

ANS: B

Posterior neural tube defects are the most common.

Posterior, not anterior, neural tube defects are most common.

Posterior, not lateral, neural tube defects are most common.

Posterior, not superior, neural tube defects are most common.

REF: p. 411

5. An infant has an anterior midline defect of neural tube closure. What term will the nurse observe written on the chart?

a.

Anencephaly

b.

Myelodysplasia

c.

Cyclopia

d.

Hydrocephalus

ANS: C

Cyclopia is an example of an anterior midline defects that may cause brain and face abnormalities.

In anencephaly, the soft, bony component of the skull and part of the brain are missing.

Myelodysplasia is a posterior neural tube disorder.

Hydrocephalus is associated with accelerated head growth.

REF: p. 410

6. What nutrient should the nurse encourage a woman in the early stages of pregnancy to consume to prevent neural tube defects?

a.

Protein

b.

Iron

c.

Vitamin D

d.

Folic acid

ANS: D

Folic acid deficiency during early stages of pregnancy increases the risk for neural tube defects.

Protein does not lead to neural tube defects; folic acid does.

Iron does not lead to neural tube defects; folic acid does.

Vitamin D does not lead to neural tube defects; folic acid does.

REF: p. 410

7. A newborn child has a herniation of brain and meninges through a defect in the occipital area of the skull. What will the pediatrician call this condition?

a.

Encephalocele

b.

Meningocele

c.

Myelomeningocele

d.

Craniosynostosis

ANS: A

An encephalocele refers to a herniation or protrusion of brain and meninges through a defect in the occipital region of the skull, resulting in a saclike structure.

A meningocele is a saclike cyst of meninges filled with spinal fluid, a mild form of posterior neural tube closure defect. These can occur throughout the cervical, thoracic, and lumbar spine areas.

A myelomeningocele is a hernial protrusion of a saclike cyst (containing meninges, spinal fluid, and a portion of the spinal cord with its nerves) through a defect in the posterior arch of a vertebra in the lower spine.

Craniosynostosis is the premature closure of one or more of the cranial sutures (saggital, coronal, lambdoid, metopic) during the first 18 to 20 months of the infants life.

REF: p. 411

8. A newborn child has a hernial protrusion of a saclike cyst through a defect in the posterior arch of a vertebra. This condition is referred to as:

a.

Craniosynostosis

b.

Meningocele

c.

Encephalocele

d.

Myelomeningocele

ANS: D

A myelomeningocele is a hernial protrusion of a saclike cyst (containing meninges, spinal fluid, and a portion of the spinal cord with its nerves) through a defect in the posterior arch of a vertebra in the lower spine.

Craniosynostosis is the premature closure of one or more of the cranial sutures (saggital, coronal, lambdoid, metopic) during the first 18 to 20 months of the infants life.

A meningocele, a saclike cyst of meninges filled with spinal fluid, is a mild form of posterior neural tube closure defect. These can occur throughout the cervical, thoracic, and lumbar spine areas.

An encephalocele refers to a herniation or protrusion of brain and meninges through a defect in the occipital region of the skull, resulting in a saclike structure.

REF: p. 412

9. A 19-month-old boy developed a premature closure of one or more of the cranial sutures. Which diagnosis will the nurse observe on the chart?

a.

Craniosynostosis

b.

Congential hydrocephalus

c.

Microcephaly

d.

Acrania

ANS: A

Craniosynostosis is the premature closure of one or more of the cranial sutures.

Congenital hydrocephalus is characterized by enlargement of the cerebral ventricles.

Microcephaly is lack of brain growth with retarded mental and motor development.

In acrania, the cranial vault is almost completely absent; an extensive defect of the vertebral column often is present.

REF: p. 413

10. A baby is stillborn after 6 hours of labor. Autopsy reveals hydrocephalus caused by cystic dilation of the fourth ventricle and aqueductal compression. Which of the following is the most likely diagnosis?

a.

Congenital hydrocephalus

b.

Microcephaly

c.

Dandy-Walker deformity

d.

Macewen sign

ANS: C

The Dandy-Walker malformation is a congenital defect of the cerebellum characterized by a large posterior fossa cyst, which communicates with the 4th ventricle, and an atrophic upwardly rotated cerebellar vermis.

Congenital hydrocephalus is characterized by enlargement of the cerebral ventricles.

Microcephaly is lack of brain growth with retarded mental and motor development.

Macewen sign is characterized by separation of the cranial sutures with a resonant sound

when the skull is tapped.

REF: p. 414

11. The parents of an infant born with true microcephaly ask what caused this. How should the nurse respond? True microcephaly can be caused by:

a.

Viral infection

b.

An autosomal recessive gene

c.

Fetal trauma

d.

Hydrocephalus

ANS: B

True (primary) microcephaly is usually caused by an autosomal recessive genetic or chromosomal defect.

Viral infections can lead to microcephaly, but is not the true cause.

Fetal trauma can lead to microcephaly, but is not the true cause.

Hydrocephalus does not lead to microcephaly.

REF: p. 413

12. An infant is diagnosed with congenital hydrocephalus. Which of the following characteristics would the nurse expect to find?

a.

Enlarged ventricles

b.

Decreased cerebrospinal fluid (CSF) production

c.

Increased resorption of CSF

d.

Smaller than average head circumference

ANS: A

Congenital hydrocephalus is characterized by enlargement of the cerebral ventricles.

Increased, not decreased, CSF production would lead to hydrocephalus.

Decreased resorption of CSF would lead to hydrocephalus, not increased CSF.

An infant with congenital hydrocephalus would have increased head circumference.

REF: p. 415

13. An aide asks what the most common type of cerebral palsy is. What is the nurses best response?

a.

Ataxic

b.

Dystonic

c.

Spastic

d.

Mixed

ANS: C

Spastic cerebral palsy accounts for approximately 70% to 80% of cerebral palsy cases.

Ataxic cerebral palsy accounts for 5% to 10% of cerebral palsy cases.

Dystonic cerebral palsy accounts for 10% to 20% of cerebral palsy cases.

Mixed cases accounts for 13% of cerebral palsy cases.

REF: p. 415

14. A child is diagnosed with cerebral palsy, characterized by extreme difficulty in fine motor coordination and purposeful movement. Which of the following types of cerebral palsy is the child experiencing?

a.

Ataxic

b.

Dystonic

c.

Spastic

d.

Mixed

ANS: B

Dystonic cerebral palsy is associated with extreme difficulty in fine motor coordination and purposeful movements.

Ataxic cerebral palsy manifests with gait disturbances and instability. The infant with this form of cerebral palsy may have hypotonia at birth, but stiffness of the trunk muscles develops by late infancy.

Spastic cerebral palsy is associated with increased muscle tone, persistent primitive reflexes, hyperactive deep tendon reflexes, clonus, rigidity of the extremities, scoliosis, and contractures.

Mixed cerebral palsy may have symptoms of each of the disorders.

REF: p. 415

15. Which of the following diseases does the nurse screen for in all newborns?

a.

Epilepsy

b.

Tay-Sachs disease

c.

Pica

d.

Phenylketonuria (PKU)

ANS: D

All newborns are screened for PKU.

All newborns are screened for PKU, not epilepsy.

All newborns are screened for PKU, not Tay-Sachs.

All newborns are screened for PKU, not pica.

REF: p. 416

16. Parents of a 3-month-old infant bring him to the emergency room (ER) after he has had a seizure. He has muscle rigidity, and the parents report they are of Jewish ancestry. For what genetic disease should this infant be screened?

a.

Juvenile myoclonic epilepsy

b.

Congenital encephalopathy

c.

Tay-Sachs disease

d.

PKU

ANS: C

Perhaps the best known of the lysosomal storage disorders is Tay-Sachs disease, an autosomal recessive disorder related to a deficiency of the enzyme hexosaminidase A (HEX A). Approximately 80% of individuals diagnosed are of Jewish ancestry.

The infant should be screened for Tay-Sachs, due to the Jewish ancestry, not epilepsy.

The infant should be screened for Tay-Sachs, due to the Jewish ancestry, not encephalopathy.

All children are screened for PKU, but children of Jewish ancestry should be screened for Tay-Sachs.

REF: p. 416

17. A child is brought to the ER. Initial examination documents the following assessment findings: tissue ischemia, anemia, and an apparent decrease in normal growth rate. Which of the following poisons should the nurse determine to be the most likely cause?

a.

Ethyl alcohol

b.

Lead

c.

Mercury

d.

Carbon monoxide

ANS: B

High blood levels of lead occur in lead poisoning. If lead poisoning is untreated, lead encephalopathy results and is responsible for serious and irreversible neurological damage.

The child is experiencing symptoms of lead poisoning, not ethyl alcohol.

The child is experiencing symptoms of lead poisoning, not mercury.

The child is experiencing symptoms of lead poisoning, not carbon monoxide.

REF: p. 418

18. To prevent Reye syndrome in infants, which of the following instructions should the nurse give to parents?

a.

Breast-feed infants as long as possible.

b.

Treat fevers with acetaminophen, not aspirin.

c.

Lock up hazardous cleaning agents.

d.

Remove lead paint from the home.

ANS: B

Reye syndrome is associated with treating fever with aspirin.

Reye syndrome is associated with aspirin use and is not related to breast-feeding.

It is important to lock up hazardous cleaning agents, but aspirin is the contributing factor for Reye syndrome.

Removing lead paint is important, but lead is not associated with Reye syndrome.

REF: p. 418

19. A child presents to his primary care provider with disorientation, delirium, aggressiveness, and stupor. His parents report that he was recently ill with an upper respiratory infection, which they treated with aspirin. Which of the following is the most likely diagnosis?

a.

Epilepsy

b.

Reye syndrome

c.

Tay-Sachs

d.

PKU

ANS: B

The manifestations of the Reye syndrome are disorientation, delirium, aggressiveness and combativeness, central neurological hyperventilation, shallow breathing, hyperactive reflexes, and stupor. It is associated with the taking of aspirin.

Epilepsy is manifested by jerking motions.

Tay-Sachs is manifested by exaggerated startle to loud noise, seizures, developmental regression, dementia, and blindness.

PKU is manifested by brain damage.

REF: p. 418

20. A child was recently diagnosed with varicella, for which her parents gave her aspirin. The child is now in a coma, is hyperventilating, and has decorticate rigidity. Pupil response is within normal limits. The child is diagnosed with Reye syndrome at stage:

a.

1

b.

2

c.

3

d.

4

ANS: C

Stage 3 is manifested by obtundation, coma, hyperventilation, and decorticate rigidity.

Stage 1 is manifested by vomiting, lethargy, and drowsiness.

Stage 2 is manifested by disorientation, delirium, aggressiveness and combativeness, central neurological hyperventilation, shallow breathing, hyperactive reflexes, and stupor.

Stage 4 is manifested by deepening coma, decerebrate rigidity, loss of ocular reflexes, large fixed pupils, and divergent eye movements.

REF: p. 418

21. A 3-year-old has bacterial meningitis. What should the nurse expect to find on the lab report for the most common cause of this bacterial meningitis?

a.

Haemophilus influenzae

b.

Neisseria meningitidis

c.

Streptococcus pneumonia

d.

Escherichia coli

ANS: B

The most common cause of bacterial meningitis in children under 5 is Neisseria meningitidis.

Haemophilus influenzae formerly was the most common cause of bacterial meningitis but vaccines have decreased this. The most common cause is now Neisseria meningitidis.

Streptococcus pneumonia can cause meningitis, but the most common cause of bacterial meningitis in children under 5 is Neisseria meningitidis.

Escherichia coli is the most common cause of meningitis in the newborn, but the most common cause of bacterial meningitis in children under 5 is Neisseria meningitidis.

REF: p. 418

22. A nurse is teaching the staff about viral meningitis. Which information should the nurse include? Viral meningitis:

a.

Is always sudden in onset

b.

Often occurs with measles, mumps, or herpes

c.

Is effectively treated with antibiotics

d.

Causes increased sugar in the CSF

ANS: B

Viral meningitis may result from a direct infection of a virus, or it may be secondary to

disease, such as measles, mumps or herpes.

Onset may be sudden or gradual.

Treatment is symptomatic; antibiotics are not used.

Glucose in the CSF is normal.

REF: p. 418

23. A 3-year-old African-American child was diagnosed with sickle cell disease. She is now suffering from meningitis. Which is the most likely microorganism the nurse will find on the lab report?

a.

Virus

b.

Haemophilus influenzae type B

c.

Streptococcus pneumonia

d.

Neisseria meningitidis

ANS: C

1 in every 24 children with sickle cell disease develops pneumococcal meningitis by the age of 4 years.

1 in every 24 children with sickle cell disease develops pneumococcal meningitis by the age of 4 years, not a virus.

1 in every 24 children with sickle cell disease develops pneumococcal meningitis by the age of 4 years, not Haemophilus influenzae.

1 in every 24 children with sickle cell disease develops pneumococcal meningitis by the age of 4 years not Neisseria meningitidis.

REF: p. 418

24. When should be the best time for the nurse to assess for the vomiting and headache that are symptoms of a brain tumor in children?

a.

Morning

b.

Early afternoon

c.

As the sun goes down and darkness begins

d.

During the middle of the night

ANS: A

Headache and vomiting occur more commonly in the morning. Vomiting is not preceded by nausea and may become projectile.

Headache and vomiting occur more commonly in the morning, not the early afternoon.

Headache and vomiting occur more commonly in the morning, not as the sun goes down.

Headache and vomiting occur more commonly in the morning, not at night.

REF: p. 419

25. A nurse recalls the most frequent location of a neuroblastoma is:

a.

Retroperitoneal region

b.

Mediastinum

c.

Cervical ganglion

d.

Lung

ANS: A

65% of neuroblastomas occur in the retroperitoneal region.

15% of neuroblastomas occur in the mediastinum.

4% of neuroblastomas occur in the cervical ganglion.

Neuroblastomas do not occur in the lung.

REF: p. 421

26. A nurse is preparing to teach about brain tumors. Which information should the nurse include? The most common type of brain tumor in children is:

a.

Neuroblastoma

b.

Astrocytoma

c.

Meningioma

d.

Glioma

ANS: B

Astrocytoma is the most common type of brain tumor in children.

Astrocytoma is the most common type of brain tumor in children, not neuroblastoma.

Astrocytoma is the most common type of brain tumor in children, not meningioma.

Astrocytoma is the most common type of brain tumor in children, not glioma.

REF: p. 419

27. When a nurse is asked where the most common location of brain tumors in children is found, how should the nurse respond?

a.

In the area always above the cerebellum

b.

In the posterior fossa

c.

In the cerebrum

d.

In the ventricular lining

ANS: B

Two-thirds of all pediatric brain tumors are found in the posterior fossa.

Two-thirds of all pediatric brain tumors are found in the posterior fossa, not above the cerebellum.

Two-thirds of all pediatric brain tumors are found in the posterior fossa, not in the cerebrum.

Two-thirds of all pediatric brain tumors are found in the posterior fossa, not in the ventricular lining.

REF: p. 419

28. A 10-year-old male presents with headache and seizures. CT scan reveals a tumor that is located near the optic chiasm. Which of the following is the most likely tumor type?

a.

Astrocytoma

b.

Craniopharyngioma

c.

Ependymoma

d.

Medulloblastoma

ANS: B

A craniopharyngioma originates from the pituitary gland or hypothalamus. Symptoms include headache, seizures, diabetes insipidus, early onset of puberty, and growth delay.

Astrocytomas are located on the surface of the right or left cerebellar hemisphere and cause unilateral symptoms (occurring on the same side as the tumor), such as head tilt, limb ataxia, and nystagmus.

Ependymoma develops in the fourth ventricle and arises from the ependymal cells that line the ventricular system. Because both tumors are located in the posterior fossa region along the midline, presenting signs and symptoms are similar and are usually related to hydrocephalus and increased intracranial pressure.

Medulloblastoma occurs as an invasive malignant tumor that develops in the vermis of the cerebellum and may extend into the fourth ventricle.

REF: p. 421

MULTIPLE RESPONSE

1. A newborn child is diagnosed with a vertebral arch defect, spina bifida. This condition would lead the nurse to suspect the child may have which of the following as well? (Select all that apply)

a.

Type II Chiari malformation

b.

Myelomeningocele

c.

Meningocele

d.

Acrania

e.

Craniosynostosis

ANS: B, C

When meningocele and myelomeningocele occur, they are related to an accompanying vertebral defect that allows the protrusion of the neural tube contents. When meningocele and myelomeningocele occur, they are related to an accompanying vertebral defect that allows the protrusion of the neural tube contents. Type II Chiari malformation is a complex malformation of the brain stem and cerebellum in which the cerebellar tonsils are displaced downward into the cervical spinal canal. This does not occur through a spina bifida. In acrania, the cranial vault is almost completely absent; an extensive defect of the vertebral column often is present. Craniosynostosis is the premature closure of one or more of the cranial sutures.

REF: p. 412

2. Assessment signs of neuroblastoma include (select all that apply):

a.

Weight loss

b.

Irritability

c.

Fatigue

d.

Fever

e.

Constipation

ANS: A

B, C, D

Systemic signs of neuroblastoma include weight loss, irritability, fatigue, fever, and intractable diarrhea, not constipation.

REF: p. 422

COMPLETION

1. The percent of retinoblastomas that are inherited as an autosomal dominant trait is ____%.

ANS: 40

REF: p. 423

Mosby items and derived items 2012 Mosby, Inc., an imprint of Elsevier Inc.

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