Question 1

The parents of an 18-month-old child bring the child to the clinic after observing a brief seizure of less than 2 minutes in their child. In the clinic, the child has a temperature of 103.1°F, and the primary care pediatric nurse practitioner notes a left otitis media. The child is alert and responding normally. What will the nurse practitioner do?

A) Order a lumbar puncture, complete blood count, and urinalysis.
B) Prescribe an antibiotic for the ear infection and reassure the parents.
C) Refer to a pediatric neurologist for anticonvulsant and antipyretic prophylaxis.
D) Send the child to the emergency department for EEG and possible MRI.

B

Accepted Answer

The child's seizure is likely febrile (related to the high fever) and the presence of an ear infection further supports this diagnosis. Febrile seizures are common in children and usually do not require extensive workup or neurologic consultation. Treatment of the underlying infection with antibiotics, along with antipyretics to control the fever, is usually sufficient. Close follow-up and education for the parents on how to manage future fever and seizure episodes is also appropriate. A lumbar puncture, complete blood count, urinalysis, EEG, and MRI are not needed for a simple febrile seizure in an otherwise healthy child with no other concerning symptoms or physical findings.

Question 2

Because of their inability to ambulate, children with cerebral palsy should be evaluated for which nutrients?&#10;A) Calcium and vitamin D&#10;B) Fat-soluble vitamins&#10;C) Iron and zinc&#10;D) Sodium and potassium

Accepted Answer

Children with cerebral palsy may have decreased bone density due to their inability to walk or bear weight, and may benefit from calcium and vitamin D supplementation to support bone health.

Question 3

A child with a recent history of URI reports tingling and pain in one ear followed by sagging of one side of the face. The primary care pediatric nurse practitioner observes that the child cannot close the eye or mouth on the affected side but does not elicit limb weakness on that side. What will the nurse practitioner do?

A) Initiate a short course of antibiotic therapy.
B) Perform diagnostic testing to rule out serious causes.
C) Prepare the parents for lifelong complications.
D) Prescribe oral prednisone 1 mg/kg/day initially.

D

Accepted Answer

The child's symptoms are indicative of Bell's palsy, which is characterized by sudden onset facial paralysis or weakness on one side of the face. This condition can occur after a viral infection, such as an upper respiratory infection (URI). The recommended treatment for Bell's palsy, especially in the acute phase, is oral prednisone to reduce inflammation and swelling of the facial nerve. Antibiotics are not indicated unless there is a specific bacterial infection. Diagnostic testing is not immediately necessary unless the diagnosis is uncertain or if the condition does not improve with treatment. Bell's palsy often resolves on its own, and most patients recover fully, so preparing the parents for lifelong complications is not appropriate at this stage.

Question 4

A child who has sustained a head injury after falling on the playground is brought to the clinic. The parents report that the child cried immediately and was able to walk around after falling. The primary care pediatric nurse practitioner notes slight slurring of the child's speech and the child has vomited twice in the exam room. Which course of action is warranted?

A) Admit the child to the hospital for a neurology consult.
B) Observe the child in the clinic for several hours.
C) Order a head CT and observe the child at home.
D) Send the child home with instructions for follow-up.

Accepted Answer

The child has exhibited symptoms of a concussion, including slurring of speech and vomiting. These symptoms indicate the need for further evaluation and monitoring in a hospital setting. A neurology consult would be appropriate to ensure there is no further damage to the brain.

Question 5

The pediatric nurse practitioner provides primary care for a 5-year-old child diagnosed with cerebral palsy who exhibits athetosis and poor weight gain in spite of receiving high-calorie formula to supplement intake. The child has had several episodes of pneumonia in the past year. Which specialty consultation is a priority for this child?

A) Feeding clinic to manage caloric intake
B) Neurology to assess medication needs
C) Pulmonology for possible tracheotomy
D) Surgery for possible fundoplication and gastrostomy

Accepted Answer

The child's poor weight gain in spite of high-calorie formula and history of pneumonia indicates a potential need for a gastrostomy tube for feeding and a fundoplication to prevent reflux. Therefore, a referral to a surgeon for a possible fundoplication and gastrostomy is the priority for this child.

Question 6

A child who has had a single non-febrile seizure has a normal neurologic exam. Which diagnostic test is indicated?&#10;A) Computerized tomography (CT)&#10;B) Electroencephalogram (EEG)&#10;C) Magnetic resonance imaging (MRI)&#10;D) Polysomnography

Accepted Answer

An EEG is the most appropriate diagnostic test in this scenario as it can help identify abnormal brain activity and diagnose epilepsy. CT and MRI scans may be used if there is suspicion of an underlying structural abnormality, but are not typically indicated after a single non-febrile seizure with a normal neurologic exam. Polysomnography is a sleep study and is not indicated in this scenario.

Question 7

A 14-year-old child has a headache, unilateral weakness, and blurred vision preceded by fever and nausea. The child's parent reports a similar episode several months prior. The primary care pediatric nurse practitioner will consult with a pediatric neurologist to order what diagnostic test?

A) a lumbar puncture.
B) an electroencephalogram (EEG).
C) neuroimaging with magnetic resonance imaging (MRI).
D) positron emission tomography (PET) scan.

Accepted Answer

The symptoms described suggest possible neurological involvement, and neuroimaging with MRI is the best diagnostic test to evaluate for possible structural abnormalities, such as a brain lesion. A lumbar puncture may be considered if there is suspicion of infection or inflammation, but it is not the primary diagnostic test in this case. EEG and PET scans are not likely to be helpful in evaluating for structural abnormalities.

Question 8

A 4-year-old child who has previously met developmental milestones is not toiled trained. The primary care pediatric nurse practitioner notes decreased reflexes in the lower extremities and observe a dimple above the gluteal cleft. Which diagnosis may be considered for this child?

A) Arnold-Chiari malformation
B) Reye syndrome
C) Spina bifida cystica
D) Tethered cord

Accepted Answer

The decreased reflexes and dimple above the gluteal cleft suggest possible tethered cord syndrome, in which the spinal cord is attached or tethered to surrounding tissues, possibly causing motor and sensory deficits. Arnold-Chiari malformation can cause similar symptoms but typically presents with headache and neck pain. Reye syndrome is a rare but serious condition that affects the liver and brain, usually following a viral infection and use of aspirin-containing products. Spina bifida cystica is a type of neural tube defect that causes a visible protrusion of the spinal cord or meninges, typically in the lumbar or sacral region. While spina bifida can be associated with neurogenic bladder and bowel dysfunction, it would not directly explain the decreased reflexes and dimple in this case.

Question 9

When performing a neurologic exam to assess for meningeal signs in an infant, the primary care pediatric nurse practitioner will attempt to elicit the Kernig sign by implementing what action?&#10;A) bending the infant at the waist to touch fingers to toes.&#10;B) extending the leg at the knee with the infant supine.&#10;C) flexing the infant's neck to touch chin to chest.&#10;D) turning the infant's head from side to side.

Accepted Answer

Kernig sign is assessed by extending the leg at the knee while the infant is in a supine position. This action can elicit discomfort or resistance in the presence of meningeal irritation.

Question 10

The primary care pediatric nurse practitioner performs a well baby exam on a term 4-month-old infant and observes flattening of the left occiput, bossing of the right occiput, and anterior displacement of the left ear. The parents report performing various positioning maneuvers, but say that the baby's head shape has worsened. What will the nurse practitioner recommend to correct this finding?

A) Allow the infant to sleep on the tummy when the parents are in the room.
B) Lay the infant in the "back to sleep" position, alternating the left and right occiput.
C) Order a head CT to evaluate the infant for craniosynostosis.
D) Refer the infant for orthotic cranial molding helmet therapy.

Accepted Answer

The presentation in the question describes positional plagiocephaly, which is a common condition caused by prolonged positioning on one side of the head. The recommended treatment for severe cases is cranial orthotic molding therapy, which involves the use of a specialized helmet to direct head growth and correct head shape. Options A and B are helpful in preventing positional plagiocephaly but are not effective treatments for established cases. A head CT is not needed in this case since the etiology is already known, and CT is not a first-line diagnostic tool for positional plagiocephaly.

Question 11

To evaluate brain tissue disorders in infants, which test is useful?&#10;A) Computerized tomography&#10;B) Head radiographs&#10;C) Magnetic resonance imaging&#10;D) Ultrasonography

Accepted Answer

The answer of To evaluate brain tissue disorders in infants,...

Question 12

An adolescent female reports unilateral headache pain associated with abdominal pain and nausea occurring just prior to periods each month. The adolescent has been using naproxen sodium for 6 months but reports little relief from symptoms. What will the primary care pediatric nurse practitioner do?

A) Add acetaminophen and ondansetron to the naproxen regimen.
B) Consider prophylactic therapy with a beta-blocker or anticonvulsant drug.
C) Prescribe sumatriptan nasal spray at the onset of headache and every 2 hours.
D) Refer the adolescent to a pediatric neurologist for neuroimaging studies.

Accepted Answer

The answer of An adolescent female reports unilateral headache pain...

Question 13

A female infant who was developing normally stops meeting developmental milestones at age 12 months and then begins losing previously acquired skills. What will the primary care pediatric nurse practitioner expect to tell the parents about this child's prognosis?

A) Cognitive development will be normal but motor skills will be lost.
B) Physical and speech therapy will help the infant regain lost skills.
C) The child's intellectual development will not progress further.
D) This is a temporary condition with full recovery expected.

Accepted Answer

The answer of A female infant who was developing normally...

Deck 46: Neurologic Disorders