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?

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 14­year­old 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

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?

Accepted Answer

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Question 4

A child who has had a single non­febrile seizure has a normal neurologic exam. Which diagnostic test is indicated?

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?

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?

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 18­month­old 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?

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?

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?

Accepted Answer

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

Question 10

During a well baby exam on a 9­month­old infant, the parent reports that the baby
always uses the left hand to pick up objects and asks if the baby will be left­handed. What will the primary care pediatric nurse practitioner do?

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?

Accepted Answer

The child's poor weight gain in spite of high-calorie formula suggests that they may need a more long-term solution for nutrition intake, such as a gastrostomy. Additionally, the child's history of pneumonia and athetosis may put them at risk for aspiration, making a fundoplication procedure to prevent reflux important. While feeding clinic and neurology consultations may be helpful, addressing the child's potential need for surgical interventions is a priority. Pulmonology may be consulted if the child's respiratory status worsens, but it is not the priority in this case.

Question 12

A 4­year­old 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?

Accepted Answer

The presence of a dimple above the gluteal cleft and decreased reflexes in the lower extremities suggests a possible tethered cord. Tethered cord occurs when the spinal cord is attached or “tethered” to the surrounding tissues, preventing the normal growth and movement of the spinal cord. This can lead to a variety of symptoms, including difficulty with toileting and decreased reflexes. Additional diagnostic testing, such as an MRI, may be needed to confirm the diagnosis.

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?

Accepted Answer

The loss of previously acquired skills is a red flag for the diagnosis of a degenerative disorder such as Rett syndrome or a metabolic disorder. In general, these disorders are associated with permanent loss of skills and intellectual disability.

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

Accepted Answer

The Kernig sign is elicited by extending the leg at the knee with the infant supine. Resistance or pain during this maneuver may indicate meningeal irritation.

Quiz 28: Neurologic Disorders

A 14yearold 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

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 child who has had a single nonfebrile seizure has a normal neurologic exam. Which diagnostic test is indicated?

Because of their inability to ambulate, children with cerebral palsy should be evaluated for which nutrients?

To evaluate brain tissue disorders in infants, which test is useful?

During a well baby exam on a 9monthold infant, the parent reports that the baby always uses the left hand to pick up objects and asks if the baby will be lefthanded. What will the primary care pediatric nurse practitioner do?

A 4yearold 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 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?

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

Quiz 28: Neurologic Disorders

A 14­year­old 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

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 child who has had a single non­febrile seizure has a normal neurologic exam. Which diagnostic test is indicated?

Because of their inability to ambulate, children with cerebral palsy should be evaluated for which nutrients?

To evaluate brain tissue disorders in infants, which test is useful?

During a well baby exam on a 9­month­old infant, the parent reports that the baby always uses the left hand to pick up objects and asks if the baby will be left­handed. What will the primary care pediatric nurse practitioner do?

A 4­year­old 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 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?

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 14yearold 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

A child who has had a single nonfebrile seizure has a normal neurologic exam. Which diagnostic test is indicated?

During a well baby exam on a 9monthold infant, the parent reports that the baby always uses the left hand to pick up objects and asks if the baby will be lefthanded. What will the primary care pediatric nurse practitioner do?

A 4yearold 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?