Chapter 46: The Child With Cerebral Dysfunction Perry: Maternal Child Nursing Care, 6th Edition

Chapter 46: The
Child With
Cerebral
Dysfunction
Perry: Maternal
Child Nursing
Care, 6th Edition
1. 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.
2. 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
3. The Glasgow Coma Scale consists of an assessment of
what functions?
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
4. The nurse, closely monitoring a child who is
unconscious after a fall, notices that the child
suddenly has a fixed and dilated pupil. The nurse should
interpret this as the indication of
what occurrence?
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.
5. 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 (calNorUicRSteINstG)
TinBv.CoOlvMes 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.