CPEN Neurological Emergencies 4

Question 1

A 9-year-old with ALL presents with altered mental status and bilateral papilledema. Lumbar puncture is deferred. Which intervention is MOST immediately indicated?

Accepted Answer

Start dexamethasone and obtain urgent head CT

Answer

Papilledema contraindicates LP before imaging; dexamethasone reduces cerebral edema while CT defines the cause in this immunocompromised patient.

Question 2

Hypertonic saline (3% NaCl) is ordered for a pediatric patient with severe TBI. The GOAL serum sodium target is:

Accepted Answer

150–160 mEq/L

Answer

For ICP management with hypertonic saline, the goal serum sodium is typically 150–160 mEq/L to create an osmotic gradient that reduces cerebral edema.

Question 3

An infant presents with opisthotonus, high-pitched cry, and a bulging fontanelle. Bacterial meningitis is confirmed. When should dexamethasone be given?

Accepted Answer

15–20 minutes before or with the first antibiotic dose

Answer

Dexamethasone is most effective when given 15–20 minutes before or concurrently with the first antibiotic dose to blunt the inflammatory response.

Question 4

Which EEG pattern is pathognomonic for absence seizures in children?

Accepted Answer

3 Hz spike-and-wave discharges

Answer

Absence seizures (petit mal) are characterized by 3 Hz generalized spike-and-wave discharges on EEG, often provoked by hyperventilation.

Question 5

A 15-year-old presents with thunderclap headache — worst of life, sudden onset. After a negative CT, the NEXT step is:

Accepted Answer

Lumbar puncture to detect xanthochromia

Answer

CT misses ~2% of subarachnoid hemorrhages; LP detecting xanthochromia or blood in CSF is essential when CT is negative after thunderclap headache.

CPEN - Certified Pediatric Emergency Nurse Practice Test

CPEN - Certified Pediatric Emergency Nurse Practice Test

CPEN Neurological Emergencies 4