CPN Exam Neurologic Conditions

Question 1

Cerebral Palsy

Answer 1

A non-progressive neuromuscular disorder that affects movement and posture
Most common in preemies

Question 2

Disability with CP

Answer 2

Abnormal muscle coordination and tone
Vision, hearing, speech disturbances
Seizures
Intellectual disability

Question 3

CP Management

Answer 3

Speech, occupational, and physical therapy
Adaptive equipment (bracing, splinting, crutches, walkers)
Age-appropriate cognitive activities and incentives for motor development

Question 4

Down Syndrome (Trisomy 21)

Answer 4

Congenital condition characterized by intellectual disability, dysmorphic facial features, and other defects (e.g. congenital heart defects)

Question 5

CP Assessment

Answer 5

Intellectual Disability
Flat, broad forehead
Low-set ears
Hypotonia
Protruding tongue
Short stature
Simian Crease

Question 6

CP Management

Answer 6

Developmentally appropriate play and activities
Small, straight handled spoon to push food back toward side and back of mouth

Question 7

Seizures

Answer 7

A sudden, episodic involuntary alteration in consciousness, motor activity, behavior, sensation, or autonomic function

Question 8

Seizure disorder/Epilepsy

Answer 8

A condition characterized by two or more unprovoked seizures

Question 9

Seizure Disorder Treatment

Answer 9

Antiepileptic Drugs
Ketogenic Diet
Vagal nerve stimulation

Question 10

Febrile Seizures

Answer 10

Seizure in association with a febrile illness in the absence of a central nervous system infection or acute electrolyte imbalance in children older than 1 month of age without prior afebrile seizures

Question 11

Febrile Seizure Age

Answer 11

6 mo - 3 years
uncommon > 5 years

Question 12

Febrile Seizure Management

Answer 12

Age susceptibility to seizure induced by fever (usually > 38.8oC
No anti-epileptic therapy
Emotional support and reinforce the benign nature of the febrile seizure

Question 13

Concussion

Answer 13

Transient state of neurologic dysfunction caused by jarring of the brain
May or may not be accompanied by loss of consciousness
Classified as a mild traumatic brain injury (TBI)
Most common TBI

Question 14

Second Impact Syndrome

Answer 14

Rapid brain swelling which can occur with resuming physical activities before healed

Question 15

Concussion Symptoms

Answer 15

Headache
Dizziness
Vision problems
Changes in emotions or behaviors
Sleep disturbances
Difficulty remembering
Vomiting

Question 16

Concussion Discharge Teaching

Answer 16

Brain Rest
Gradually return to learn, then play

Question 17

Increased Intracranial Pressure (ICP)

Answer 17

Occurs when compensation is not possible
A persistent increase destroys healthy brain tissue and alters mental function

Question 18

ICP Infant Assessment

Answer 18

High-pitched cry
Extreme Irritability
Bulging fontanel

Question 19

ICP Children Assessment

Answer 19

Headache
Vomiting
Seizure
Decreased LOC

Question 20

ICP Management

Answer 20

Monitor neuro status
Limit fluids
Administer osmotic diuretic/corticosteroid
Elevate head of bed 30 degrees

Question 21

Hydrocephalus

Answer 21

A syndrome resulting from a disturbance in the dynamics of cerebral spinal fluid (CSF)

Question 22

Hydrocephalus Assessment

Answer 22

Measure head circumstances
Observe full, tense fontanel
Note signs of increased ICP

Question 23

Hydrocephalus Management

Answer 23

Surgical placement of a VP shunt – Drains CSF from the ventricles to the peritoneum

Question 24

Hydrocephalus Post Op

Answer 24

Position on non-affected side or back
Measurement of head circumference
Strict I & O with fluid restrictions
Skin care of incision site
Monitor for signs of infection and increased ICP

Question 25

Neural Tube Defects

Answer 25

Group of related CNS birth defects caused by the incomplete closure of the embryonic neural tube including: anencephaly, encephalocele, meningocele, myelomeningocele

Question 26

Meningocele

Answer 26

Hernial protrusion of saclike cyst containing meninges but no spinal cord

Question 27

Myelomeningocele

Answer 27

Protruding sac containing CSF, meninges, and a portion of the spinal cord

Question 28

Spina Bifida Pre-Op Assessment

Answer 28

Leakage from sac
infection around sac
Motor activity below sac
Head circumference

Question 29

Spina Bifida Post-Op Assessment

Answer 29

Position child on abdomen
Avoid contamination of sac
Cover sac with saline soaked dressing
Not leg movement
Assess for paralysis
Assess for neurogenic bladder

Question 30

Neurogenic Bladder

Answer 30

Intermittent urinary catheterization prevents infection and kidney damage due to increased bladder pressure

Question 31

Spina Bifida - Avoid

Answer 31

Pacifiers
Feeding nipples
Elastic
Chewing gum
Banana, Avocado, Chestnut, Kiwi
Condoms (Trojan or ya know… the other brands I guess)

Question 32

Meningitis

Answer 32

An inflammation of the meninges of the brain and spinal cord
Sudden onset– Serious illness within 24 hours

Question 33

Meningitis Assessment

Answer 33

Infant: High pitched cry
Bulging fontanel
Irritability

Children: Headache
Stiff Neck
Vomiting
Nuchal rigidity

Question 34

Meningitis Diagnosis

Answer 34

Lumbar Puncture: cloudy color, Increased WBC, Increased protein, decreased glucose level

Question 35

Meningitis Interventions

Answer 35

Antibiotics
Corticosteroids
Droplet Precautions
Neuro assessment
Monitor fluid status

Question 36

Lead Poisoning (plumbism)

Answer 36

Questionnaire - beginning at 6 months for all primary care visits
Does the child live in a home built before 1978?
Is there evidence of PICA?
Serum screen - 12 months and 24 months in high-risk groups