[Ex4] - C18 - AP

Question 1

18-1. Which reflex of infancy will disappear first?

a. Stepping
b. Rooting
c. Palmar grasp
d. Moro reflex

Answer 1

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.

Question 2

18-2. 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

Answer 2

ANS: C

The Landau 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.

Question 3

18-3. During infancy, what is the fastest growing part of the human body?

a. Spinal cord
b. Limb bones
c. Head
d. Vertebral column

Answer 3

ANS: C

The head, not the spinal cord, limb bones, or vertebral column, is the fastest growing part of
the body during infancy.

Question 4

18-4. 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

Answer 4

ANS: B

Posterior neural tube defects are the most common. Neural tube defects associated with the
other options are not as common.

Question 5

18-5. 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

Answer 5

ANS: C

Cyclopia is an example of an anterior midline defect 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.

Question 6

18-6. 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

Answer 6

ANS: D

Folic acid deficiency during early stages of pregnancy increases the risk for neural tube
defects. Neural tube defects are not associated with deficiencies of protein, iron, or vitamin D.

Question 7

18-7. What term is used to document a herniation of brain and meninges through a defect in the
occipital area of the skull?

a. Encephalocele
b. Meningocele
c. Myelomeningocele
d. Craniosynostosis

Answer 7

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 sac-like structure. A meningocele is a
sac-like 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 sac-like 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, and metopic) during the first 18–20 months of the
infant’s life.

Question 8

18-8. Which term is used to document a hernial protrusion of a sac-like cyst through a defect in the
posterior arch of a vertebra?

a. Craniosynostosis
b. Meningocele
c. Encephalocele
d. Myelomeningocele

Answer 8

ANS: D

A myelomeningocele is a hernial protrusion of a sac-like 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 18–20 months of the
infant’s life. A meningocele, a sac-like 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 sac-like structure.

Question 9

18-9. What term is used to describe a premature closure of one or more of the cranial sutures during
the first 18 months of life?

a. Craniosynostosis
b. Congential hydrocephalus
c. Microcephaly
d. Acrania

Answer 9

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 is often present.

Question 10

18-10. 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

Answer 10

ANS: C

The Dandy-Walker malformation is a congenital defect of the cerebellum characterized by a
large posterior fossa cyst, which communicates with the fourth 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.

Question 11

18-11. What is the cause of true (primary) microcephaly?

a. Viral infection
b. An autosomal recessive gene
c. Fetal trauma
d. Hydrocephalus

Answer 11

ANS: B

True (primary) microcephaly is usually caused by an autosomal recessive genetic or
chromosomal defect. Viral infections and fetal trauma can lead to microcephaly but are not
the true cause. Hydrocephalus does not lead to microcephaly.

Question 12

18-12. 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

Answer 12

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.

Question 13

18-13. What is the most common type of cerebral palsy?

a. Ataxic
b. Dystonic
c. Spastic
d. Mixed

Answer 13

ANS: C

Spastic cerebral palsy accounts for approximately 70%–80% of cerebral palsy cases. Ataxic
cerebral palsy accounts for 5%–10% of cerebral palsy cases. Dystonic cerebral palsy accounts
for 10%–20% of cerebral palsy cases. Mixed cases account for 13% of cerebral palsy cases.

Question 14

18-14. 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

Answer 14

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.

Question 15

18-15. Which of the following diseases does the nurse screen for in all newborns?

a. Epilepsy
b. Tay-Sachs disease
c. Pica
d. Phenylketonuria (PKU)

Answer 15

ANS: D

All newborns are screened for PKU. Not all newborns are screened for epilepsy, Tay-Sachs,
or pica.

Question 16

18-16. Parents of a 3 month old bring the infant to the emergency room (ER) after a seizure has
caused muscle rigidity. Both parents 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

Answer 16

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. Jewish ancestry is not
necessarily associated with epilepsy, encephalopathy, or PKU.

Question 17

18-17. A 3 year old has been diagnosed with 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

Answer 17

ANS: B

The most common cause of bacterial meningitis in children under 4 is N. meningitidis.
Haemophilus influenzae formerly was the most common cause of bacterial meningitis, but
vaccines have decreased this. Streptococcus pneumonia can cause meningitis and is the most
common cause of bacterial meningitis in children under 23 months while E. coli is the most
common cause of meningitis in the newborn.

Question 18

18-18. It is true that 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 cerebral spinal fluid (CSF).

Answer 18

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.

Question 19

18-19. A 3-year-old Black child with a history of sickle cell disease and is now diagnosed with
meningitis. Which is the most likely microorganism the nurse will find on the lab report?

a. Virus
b. H. influenzae type B
c. S. pneumonia
d. N. meningitidis

Answer 19

ANS: C

Children with sickle cell disease are at risk for developing bacterial meningitis. These children
do not experience an increased risk for the development of a viral infection, H. influenzae, or
N. meningitidis.

Question 20

18-20. When should the nurse assess for the vomiting and headache that are the classic symptoms of
childhood brain tumors?

a. Morning
b. Early afternoon
c. As the sun goes down and darkness begins
d. During the middle of the night

Answer 20

ANS: A

Headache and vomiting occur more commonly in the morning.

Question 21

18-21. 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. germ cell.

Answer 21

ANS: B

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

Question 22

18-22. What is the most common location of brain tumors in children?

a. Above the cerebellum
b. In the posterior fossa
c. In the anterior cerebrum
d. In the ventricular lining

Answer 22

ANS: B

Two thirds of all pediatric brain tumors are found in the posterior fossa, not above the
cerebellum, in the cerebrum, or in the ventricular lining.

Question 23

18-23. A nurse recalls that the most frequent location of a neuroblastoma is the:

a. retroperitoneal region.
b. mediastinum.
c. cervical ganglion.
d. lung.

Answer 23

ANS: A

Sixty-five percent of neuroblastomas occur in the retroperitoneal region. Fifteen percent of
neuroblastomas occur in the mediastinum. Four percent of neuroblastomas occur in the
cervical ganglion. Neuroblastomas do not occur in the lung.

Question 24

18-24. A 10 year old presents with headache and seizures. CT scan reveals a tumor that is located
near the pituitary gland. Which of the following is the most likely tumor type?

a. Astrocytoma
b. Craniopharyngioma
c. Ependymoma
d. Medulloblastoma

Answer 24

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