Examl 1:l NSG548/l NSGl 548l (NEWl 2025/l
2026l Update)l FNPl Rolel withl Childrenl
andl Familiesl Guide|l Questionsl &l
Answers|l Gradel A|l 100%l Correctl
(Verifiedl Solutions)-l Wilkes
QUESTION
Whatl isl tetheredl cord
Answer:
Tetheredl Cordl Syndromel isl al conditionl wherel thel spinall cordl isl abnormallyl attachedl
withinl thel bonyl spinel causingl stretchingl andl tuggingl thatl canl bel painfull andl leadl tol
disability.
Normally,l thel spinall cordl movesl freelyl throughl fluidl withinl thel spinel froml thel basel ofl
thel brainl downl tol thel lowerl back.l Soonl afterl conception,l speciall cellsl joinl tol createl al
tubel thatl willl forml thel baby'sl spinall cord.l Thel surfacel layerl ofl thel embryo,l calledl thel
ectoderm,l movesl belowl thel skinl andl isl surroundedl byl connectivel tissue,l calledl dura,l
thatl becomesl thel spinall coveringl andl bone.l Ifl thel ectoderml andl thel dural dol notl joinl
properlyl orl completely,l thel spinall cordl canl becomel "tethered."l Whenl al childl withl
tetheredl cordl bendsl orl stretches,l thel tensionl onl thel spinall cordl canl leadl tol permanentl
damagel tol musclesl andl nervesl thatl controll legs,l feet,l bowell andl bladder.
QUESTION
Tetheredl cordl findings
Answer:
Childrenl willl complainl ofl painl orl showl signsl ofl discomfort.l Therel arel threel typesl ofl
symptomsl thatl suggestl Tetheredl Cordl Syndrome:
Skinl onl lowerl partl ofl back
Fattyl mass
Hairyl patchl orl discoloration
,Skinl tags
Dimples
Bowell orl Bladderl problems
Changesl inl bowell control
Incompletel emptyingl ofl thel bladder
Frequentl urinaryl tractl infections
Changesl inl bladderl pressurel (seenl onl testsl calledl urodynamics)
Difficultyl toiletl trainingl youngerl children
Orthopedicl problems
Persistentl backl pain
Increasingl curvaturel ofl thel spinel (scoliosis)
Lossl ofl sensationl inl thel legsl orl feet
Unequall changesl inl thel sizel ofl thel legsl orl feet
Stumblingl orl changesl inl walking
Weaknessl inl thel legsl orl feet
QUESTION
Tetheredl cordl tx
Answer:
Treatmentl dependsl onl thel severityl ofl thel symptoms.l Inl morel severel cases,l thel spinall
cordl canl bel surgicallyl releasedl froml thel spine.l Operationl timel canl rangel froml fourl tol
sixl hoursl dependingl onl howl muchl tetheringl hasl occurred.l Ifl thel childl hasl reachedl
adultl heightl withl minimall symptoms,l doctorsl mayl suggestl onlyl carefull observation.l Itl isl
veryl importantl tol havel al sensel ofl whetherl thel symptomsl arel improving,l declining,l orl
stayingl thel same.l Thisl isl oftenl thel decidingl factorl inl decisionsl Tetheredl Cordl
Syndromel aboutl surgery.
QUESTION
Meningitis
Answer:
Meningitisl isl inflammationl ofl thel meningesl orl tissuel thatl surroundsl thel brainl andl
spinall cordl andl canl bel eitherl bacteriall orl virall inl origin.
,QUESTION
Riskl factorsl forl Meningitis
Answer:
Thel mostl commonl riskl factorsl forl bacteriall meningitisl inl thel neonatel are:
■Positivel maternall groupl Bl streptococcil (GBS)l statusl duringl delivery
■Prematurity
■Lowl birthl weight
■Prematurel rupturel ofl membranes
■Traumaticl delivery
■Maternall prenatall infection
■Abnormalitiesl ofl thel urinaryl tractl (Edwardsl &l Baker,l 2018)
Thel mostl commonl riskl factorsl forl bacteriall meningitisl inl thel childl olderl thanl 1l monthl
are:
■Beingl underimmunizedl (Hib,l pneumococcus)
■Recentl travell tol endemicl area
■Recentl bacteriall infection
■Recentl headl traumal orl surgery
■Cochlearl implants
■Otherl congenitall anatomicl defectsl (i.e.,l urinaryl tractl anomaly;l Kaplan,l 2018)
Thel mostl commonl riskl factorsl forl virall meningitisl are:
■Recentl virall infectionl (e.g.,l influenza,l enterovirus,l arbovirus,l orl mumps
QUESTION
Meningitsl subjectivel andl Objectivel findings
Answer:
Thel mostl commonl manifestationsl revealedl duringl thel reviewl ofl systemsl include:
■Constitutional:l feverl orl difficultyl regulatingl temperature,l decreasedl orall intake,l
difficultyl nursingl inl thel infant
■HEENT:l headache,l recentl earl orl upperl respiratoryl infection;l inl thel olderl child,l
photophobia
■Gastrointestinal:l vomiting/diarrhea
■Neurologic:l Increasedl fussinessl orl irritabilityl ofl newborn;l olderl child:l confusion,l seizure
■Musculoskeletal:l nuchall rigidity
, ■Dermatologic:l skinl rash,l recentl insectl orl tickl bitel forl possiblel virall originl (Kaplan,l
2018)
Objectivel Findings
Thel physicall examinationl ofl thel childl withl meningitisl mayl reveal:
■Illl appearance
■Vitall signl abnormalities:l Positivel fever,l tachycardia,l tachypnea,l possiblel enlargementl ofl
headl circumference
■Bulgingl fontanel
■Positivel Kernigl andl Brudzinskil signs
■Changel inl mentall status
■Papilledema
■Seizures
■Petechiael orl purpural onl extremitiesl followingl maculopapularl rashl (commonl withl N.l
meningitidis)
■Mayl seel mouthl ulcersl (herpangina),l hand-foot-mouthl disease,l conjunctivitis,l
lymphadenopathyl withl virall meningitis
PROl TIPl Suspectl possiblel meningitisl inl al newbornl orl infantl thatl presentsl withl fever,l
seizure-likel events,l poorl feeding,l andl lethargy.l Dol notl delayl diagnosisl orl treatment,l asl
bacteriall meningitisl isl al medicall emergency.l Sendl infantl tol thel emergencyl departmentl
immediatelyl ifl youl suspectl meningitis.
QUESTION
Meningitsl DX
Answer:
Thel diagnosisl ofl meningitisl isl basedl uponl thel clinicall findings,l laboratoryl results,l andl
thel specimenl resultsl froml al lumbarl puncturel (LP)
QUESTION
Meningitsl TX
Answer:
Empiricl antibioticl therapyl knownl tol achievel significantl levelsl inl thel CSFl shouldl beginl
immediatelyl afterl LP.l Third-generationl cephalosporinsl andl vancomycinl arel commonlyl
usedl (Kaplan,l 2018).l Oncel culturesl identifyl thel causativel organism,l antibioticsl canl bel
2026l Update)l FNPl Rolel withl Childrenl
andl Familiesl Guide|l Questionsl &l
Answers|l Gradel A|l 100%l Correctl
(Verifiedl Solutions)-l Wilkes
QUESTION
Whatl isl tetheredl cord
Answer:
Tetheredl Cordl Syndromel isl al conditionl wherel thel spinall cordl isl abnormallyl attachedl
withinl thel bonyl spinel causingl stretchingl andl tuggingl thatl canl bel painfull andl leadl tol
disability.
Normally,l thel spinall cordl movesl freelyl throughl fluidl withinl thel spinel froml thel basel ofl
thel brainl downl tol thel lowerl back.l Soonl afterl conception,l speciall cellsl joinl tol createl al
tubel thatl willl forml thel baby'sl spinall cord.l Thel surfacel layerl ofl thel embryo,l calledl thel
ectoderm,l movesl belowl thel skinl andl isl surroundedl byl connectivel tissue,l calledl dura,l
thatl becomesl thel spinall coveringl andl bone.l Ifl thel ectoderml andl thel dural dol notl joinl
properlyl orl completely,l thel spinall cordl canl becomel "tethered."l Whenl al childl withl
tetheredl cordl bendsl orl stretches,l thel tensionl onl thel spinall cordl canl leadl tol permanentl
damagel tol musclesl andl nervesl thatl controll legs,l feet,l bowell andl bladder.
QUESTION
Tetheredl cordl findings
Answer:
Childrenl willl complainl ofl painl orl showl signsl ofl discomfort.l Therel arel threel typesl ofl
symptomsl thatl suggestl Tetheredl Cordl Syndrome:
Skinl onl lowerl partl ofl back
Fattyl mass
Hairyl patchl orl discoloration
,Skinl tags
Dimples
Bowell orl Bladderl problems
Changesl inl bowell control
Incompletel emptyingl ofl thel bladder
Frequentl urinaryl tractl infections
Changesl inl bladderl pressurel (seenl onl testsl calledl urodynamics)
Difficultyl toiletl trainingl youngerl children
Orthopedicl problems
Persistentl backl pain
Increasingl curvaturel ofl thel spinel (scoliosis)
Lossl ofl sensationl inl thel legsl orl feet
Unequall changesl inl thel sizel ofl thel legsl orl feet
Stumblingl orl changesl inl walking
Weaknessl inl thel legsl orl feet
QUESTION
Tetheredl cordl tx
Answer:
Treatmentl dependsl onl thel severityl ofl thel symptoms.l Inl morel severel cases,l thel spinall
cordl canl bel surgicallyl releasedl froml thel spine.l Operationl timel canl rangel froml fourl tol
sixl hoursl dependingl onl howl muchl tetheringl hasl occurred.l Ifl thel childl hasl reachedl
adultl heightl withl minimall symptoms,l doctorsl mayl suggestl onlyl carefull observation.l Itl isl
veryl importantl tol havel al sensel ofl whetherl thel symptomsl arel improving,l declining,l orl
stayingl thel same.l Thisl isl oftenl thel decidingl factorl inl decisionsl Tetheredl Cordl
Syndromel aboutl surgery.
QUESTION
Meningitis
Answer:
Meningitisl isl inflammationl ofl thel meningesl orl tissuel thatl surroundsl thel brainl andl
spinall cordl andl canl bel eitherl bacteriall orl virall inl origin.
,QUESTION
Riskl factorsl forl Meningitis
Answer:
Thel mostl commonl riskl factorsl forl bacteriall meningitisl inl thel neonatel are:
■Positivel maternall groupl Bl streptococcil (GBS)l statusl duringl delivery
■Prematurity
■Lowl birthl weight
■Prematurel rupturel ofl membranes
■Traumaticl delivery
■Maternall prenatall infection
■Abnormalitiesl ofl thel urinaryl tractl (Edwardsl &l Baker,l 2018)
Thel mostl commonl riskl factorsl forl bacteriall meningitisl inl thel childl olderl thanl 1l monthl
are:
■Beingl underimmunizedl (Hib,l pneumococcus)
■Recentl travell tol endemicl area
■Recentl bacteriall infection
■Recentl headl traumal orl surgery
■Cochlearl implants
■Otherl congenitall anatomicl defectsl (i.e.,l urinaryl tractl anomaly;l Kaplan,l 2018)
Thel mostl commonl riskl factorsl forl virall meningitisl are:
■Recentl virall infectionl (e.g.,l influenza,l enterovirus,l arbovirus,l orl mumps
QUESTION
Meningitsl subjectivel andl Objectivel findings
Answer:
Thel mostl commonl manifestationsl revealedl duringl thel reviewl ofl systemsl include:
■Constitutional:l feverl orl difficultyl regulatingl temperature,l decreasedl orall intake,l
difficultyl nursingl inl thel infant
■HEENT:l headache,l recentl earl orl upperl respiratoryl infection;l inl thel olderl child,l
photophobia
■Gastrointestinal:l vomiting/diarrhea
■Neurologic:l Increasedl fussinessl orl irritabilityl ofl newborn;l olderl child:l confusion,l seizure
■Musculoskeletal:l nuchall rigidity
, ■Dermatologic:l skinl rash,l recentl insectl orl tickl bitel forl possiblel virall originl (Kaplan,l
2018)
Objectivel Findings
Thel physicall examinationl ofl thel childl withl meningitisl mayl reveal:
■Illl appearance
■Vitall signl abnormalities:l Positivel fever,l tachycardia,l tachypnea,l possiblel enlargementl ofl
headl circumference
■Bulgingl fontanel
■Positivel Kernigl andl Brudzinskil signs
■Changel inl mentall status
■Papilledema
■Seizures
■Petechiael orl purpural onl extremitiesl followingl maculopapularl rashl (commonl withl N.l
meningitidis)
■Mayl seel mouthl ulcersl (herpangina),l hand-foot-mouthl disease,l conjunctivitis,l
lymphadenopathyl withl virall meningitis
PROl TIPl Suspectl possiblel meningitisl inl al newbornl orl infantl thatl presentsl withl fever,l
seizure-likel events,l poorl feeding,l andl lethargy.l Dol notl delayl diagnosisl orl treatment,l asl
bacteriall meningitisl isl al medicall emergency.l Sendl infantl tol thel emergencyl departmentl
immediatelyl ifl youl suspectl meningitis.
QUESTION
Meningitsl DX
Answer:
Thel diagnosisl ofl meningitisl isl basedl uponl thel clinicall findings,l laboratoryl results,l andl
thel specimenl resultsl froml al lumbarl puncturel (LP)
QUESTION
Meningitsl TX
Answer:
Empiricl antibioticl therapyl knownl tol achievel significantl levelsl inl thel CSFl shouldl beginl
immediatelyl afterl LP.l Third-generationl cephalosporinsl andl vancomycinl arel commonlyl
usedl (Kaplan,l 2018).l Oncel culturesl identifyl thel causativel organism,l antibioticsl canl bel
