Question 1

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.

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 2

A 14&#173;year&#173;old child has a headache, unilateral weakness, and blurred vision&#10;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&#10;A. a lumbar puncture.&#10;B. an electroencephalogram (EEG).&#10;C. neuroimaging with magnetic resonance imaging (MRI).&#10;D. positron emission tomography (PET) scan.

Accepted Answer

The symptoms described are indicative of a possible neurological issue and may warrant neuroimaging with MRI to assess for potential causes such as a brain tumor or demyelinating disease. The other options may also be considered in certain situations, but neuroimaging with MRI is the best choice in this scenario.

Question 3

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 betablocker 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

Prescribe sumatriptan nasal spray at the onset of headache and every 2 hours.

Question 4

A child who has had a single non&#173;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 electroencephalogram (EEG) is indicated in a child who has had a single non-febrile seizure with a normal neurologic exam. It can help diagnose any underlying electrical activity in the brain that may have led to the seizure. CT or MRI scans may be considered if there are additional symptoms or concerns, but they are not typically the first-line diagnostic tests for a single non-febrile seizure with a normal exam. Polysomnography is not indicated for this particular scenario.

Question 5

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 followup.

Accepted Answer

The child's symptoms suggest a possible head injury with potential for intracranial bleeding or swelling. The slurred speech and vomiting are concerning and warrant further evaluation with a neurology consult, which would be most appropriately done in the hospital setting. Observation in the clinic or at home and ordering a head CT alone without admission to the hospital are not sufficient for management of a potentially serious brain injury. Sending the child home without further evaluation and monitoring could lead to potentially life-threatening complications.

Question 6

The primary care pediatric nurse practitioner performs a well baby exam on a
term 4monthold 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 findings suggest positional plagiocephaly, which can be corrected with orthotic cranial molding helmet therapy. The other options, such as allowing the infant to sleep on the tummy or ordering a head CT, are not appropriate interventions for this condition. Alternating the position of the infant's head in the "back to sleep" position may help prevent positional plagiocephaly, but it will not correct existing flattening and deformity.

Question 7

The parents of an 18&#173;month&#173;old child bring the child to the clinic after observing a&#10;brief seizure of less than 2 minutes in their child. In the clinic, the child has a temperature of 103.1&#176;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?&#10;A. Order a lumbar puncture, complete blood count, and urinalysis.&#10;B. Prescribe an antibiotic for the ear infection and reassure the parents.&#10;C. Refer to a pediatric neurologist for anticonvulsant and antipyretic prophylaxis.&#10;D. Send the child to the emergency department for EEG and possible MRI.

Accepted Answer

The child's seizure was likely caused by the high fever associated with the ear infection (febrile seizure). The management of febrile seizures involves treating the underlying cause (the infection) and providing supportive care. Antibiotics are indicated for otitis media, and the parents should be reassured that febrile seizures are relatively common in young children and typically do not cause long-term harm. Diagnostic testing such as a lumbar puncture, complete blood count, urinalysis, EEG or MRI are not indicated unless there are other concerning symptoms or risk factors present. Referral to a neurologist for prophylaxis is also not necessary in this scenario.

Question 8

Because of their inability to ambulate, children with cerebral palsy should be evaluated for which nutrients?
A. Calcium and vitamin D
B. Fatsoluble vitamins
C. Iron and zinc
D. Sodium and potassium

Accepted Answer

Children with cerebral palsy often have limited mobility, putting them at a higher risk for bone density issues and fractures. Calcium and vitamin D are essential for bone health and should be evaluated to ensure they are getting enough through diet and supplementation if needed.

Question 9

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 10

During a well baby exam on a 9&#173;month&#173;old infant, the parent reports that the baby&#10;always uses the left hand to pick up objects and asks if the baby will be left&#173;handed. What will the primary care pediatric nurse practitioner do?&#10;A. Explain that it is too soon to tell which hand the infant will prefer later.&#10;B. Perform a careful assessment of fine and gross motor skills.&#10;C. Teach the parent to encourage the infant to use both hands.&#10;D. Tell the parent that a hand preference usually develops between 6 and 12 months.

Accepted Answer

A consistent hand preference before 12 months may indicate a motor deficit, so an assessment of motor skills is necessary.

Question 11

The pediatric nurse practitioner provides primary care for a 5yearold child who
has cerebral palsy who exhibits athetosis and poor weight gain in spite of receiving highcalorie 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 answer of The pediatric nurse practitioner provides primary care...

Question 12

A 4&#173;year&#173;old child who has previously met developmental milestones is not toiled&#10;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?&#10;A. Arnold&#173;Chiari malformation&#10;B. Reye syndrome&#10;C. Spina bifida cystica&#10;D. Tethered cord

Accepted Answer

The answer of A 4&#173;year&#173;old child who has previously met...

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...

Question 14

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
A. bending the infant at the waist to touch fingers to toes.
B. extending the leg at the knee with the infant supine.
C. flexing the infant's neck to touch chin to chest.
D. turning the infant's head from side to side.

Accepted Answer

The answer of When performing a neurologic exam to assess...

Deck 28: Neurologic Disorders