CPEN Neurological Emergencies 3

Question 1

A 2-year-old presents with fever, bulging fontanelle, and seizure. CSF gram stain shows gram-positive diplococci. The MOST appropriate antibiotic choice is:

Accepted Answer

Vancomycin and ceftriaxone

Answer

Vancomycin plus ceftriaxone is the empiric treatment for pneumococcal meningitis to cover possible penicillin-resistant strains.

Question 2

A 10-year-old with a GCS of 9 after blunt head trauma has a BP of 140/90 mmHg and HR of 52 bpm. This combination MOST likely indicates:

Accepted Answer

Cushing's triad with impending herniation

Answer

Hypertension with bradycardia (Cushing's triad) is a late, ominous sign of severely elevated ICP and impending brainstem herniation.

Question 3

Which position is MOST appropriate for a child with suspected increased ICP who is not in spinal precautions?

Accepted Answer

Head of bed elevated 30° with head midline

Answer

Head of bed at 30° with neutral head alignment promotes cerebral venous drainage and helps reduce ICP.

Question 4

A 4-year-old with new-onset focal seizures and a fever of 39.5°C has CSF showing 120 WBC (lymphocytic), elevated protein, and normal glucose. Which pathogen is MOST likely?

Accepted Answer

Herpes simplex virus

Answer

Lymphocytic pleocytosis, elevated protein, normal glucose, focal seizures, and fever together are classic for HSV encephalitis, requiring urgent acyclovir.

Question 5

What is the CORRECT pediatric dose of lorazepam for an actively seizing child?

Accepted Answer

0.05–0.1 mg/kg IV, max 4 mg per dose

Answer

Lorazepam 0.05–0.1 mg/kg IV (max 4 mg per dose) is the first-line benzodiazepine for acute pediatric seizure management.

CPEN - Certified Pediatric Emergency Nurse Practice Test

CPEN - Certified Pediatric Emergency Nurse Practice Test

CPEN Neurological Emergencies 3