Nokea
An injury to which part of the brain will cause a coma?
- A. Brainstem
- B. Cerebrum
- C. Cerebellum
- D. Occipital lobe
Correct Answer: A
Rationale: Brainstem injury disrupts consciousness, leading to stupor or coma. Cerebral injuries cause specific deficits like memory loss, cerebellar injuries impair coordination, and occipital lobe injuries affect vision, none of which directly cause coma.
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A 10-year-old boy on a bicycle has been hit by a car in front of a school. The school nurse immediately assesses airway, breathing, and circulation. What should be the next nursing action?
- A. Place the child on his side.
- B. Take the childs blood pressure.
- C. Stabilize the childs neck and spine.
- D. Check the childs scalp and back for bleeding.
Correct Answer: C
Rationale: After ensuring airway, breathing, and circulation, stabilizing the neck and spine prevents further trauma in a suspected head or spinal injury. Positioning, blood pressure checks, or bleeding assessments follow to avoid exacerbating potential spinal injuries.
What nursing intervention is appropriate when caring for an unconscious child?
- A. Avoid using narcotics or sedatives to provide comfort and pain relief.
- B. Change the childs position infrequently to minimize the chance of increased intracranial pressure (ICP).
- C. Monitor fluid intake and output carefully to avoid fluid overload and cerebral edema.
- D. Give tepid sponge baths to reduce fevers above 38.3 C (101 F) because antipyretics are contraindicated.
Correct Answer: C
Rationale: Monitoring fluid intake and output prevents overhydration, which can cause cerebral edema in unconscious children. Narcotics and sedatives are used for comfort, frequent repositioning prevents complications, and antipyretics are preferred over sponge baths for fever.
What statement best describes a subdural hematoma?
- A. Bleeding occurs between the dura and the skull.
- B. Bleeding occurs between the dura and the cerebrum.
- C. Bleeding is generally arterial, and brain compression occurs rapidly.
- D. The hematoma commonly occurs in the parietotemporal region.
Correct Answer: B
Rationale: Subdural hematoma involves bleeding between the dura and cerebrum from ruptured cortical veins. Bleeding between dura and skull is epidural, arterial bleeding with rapid compression is typical of epidural hematomas, and parietotemporal location is more common in epidural cases.
The nurse is assessing a child who was just admitted to the hospital for observation after a head injury. What clinical manifestation is the most essential part of the nursing assessment to detect early signs of a worsening condition?
- A. Posturing
- B. Vital signs
- C. Focal neurologic signs
- D. Level of consciousness
Correct Answer: D
Rationale: Level of consciousness is the earliest and most sensitive indicator of worsening neurologic status post-head injury. Posturing and focal signs appear later, and vital sign changes are less immediate or specific in children with head injuries.
What is a nursing intervention to reduce the risk of increasing intracranial pressure (ICP) in an unconscious child?
- A. Suction the child frequently.
- B. Turn the childs head side to side every hour.
- C. Provide environmental stimulation.
- D. Avoid activities that cause pain or crying.
Correct Answer: D
Rationale: Avoiding pain or crying prevents ICP increases, as these raise intracranial pressure. Frequent suctioning, head turning, and environmental stimulation can elevate ICP and are contraindicated or require careful management, such as pre-suction hyperventilation.