CPEN Neurological Emergencies 5

Question 1

A 1-month-old presents with seizures, lethargy, and a sodium of 118 mEq/L after breastfeeding with excessive water supplementation. The SAFEST correction rate for hyponatremia is:

Accepted Answer

Correct sodium by no more than 1–2 mEq/L per hour, max 10–12 mEq/L per day

Answer

Overly rapid correction of hyponatremia risks osmotic demyelination; the safe rate is ≤1–2 mEq/L/hr, not exceeding 10–12 mEq/L in 24 hours (except for acute symptomatic seizures).

Question 2

Which antiepileptic drug is FIRST-LINE for infantile spasms (West syndrome)?

Accepted Answer

ACTH (adrenocorticotropic hormone)

Answer

ACTH is the first-line treatment for infantile spasms and has shown superior efficacy in reducing spasms and improving EEG in West syndrome.

Question 3

A 7-year-old presents 4 hours after last seizure with persistent confusion and no return to baseline. The MOST appropriate diagnosis to rule out immediately is:

Accepted Answer

Nonconvulsive status epilepticus (NCSE)

Answer

Persistent altered consciousness beyond the expected post-ictal period requires EEG to exclude nonconvulsive status epilepticus, which is treatable but easily missed.

Question 4

In a pediatric patient with suspected spinal cord injury without radiographic abnormality (SCIWORA), which imaging modality is MOST sensitive for diagnosis?

Accepted Answer

MRI of the spine

Answer

MRI is the gold standard for SCIWORA, as it visualizes cord edema, hemorrhage, and ligamentous injury not seen on CT or X-ray.

Question 5

A 10-year-old post-cardiac arrest is receiving targeted temperature management. The target core temperature range is:

Accepted Answer

36–37.5°C (normothermia) for 72 hours

Answer

Current pediatric post-arrest guidelines support targeted temperature management at 36–37.5°C (normothermia prevention of fever) for at least 72 hours.

CPEN - Certified Pediatric Emergency Nurse Practice Test

CPEN - Certified Pediatric Emergency Nurse Practice Test

CPEN Neurological Emergencies 5