Deck 25: Atopic and Rheumatic Disorders

Question 1

The parent of a school­age child who is diagnosed with oligoarticular JIA asks the
primary care pediatric nurse practitioner what exercises the child may do to help reduce symptoms. What will the nurse practitioner recommend?
A. Running
B. Swimming
C. Weights
D. Yoga

Answer 1

Swimming

Question 2

An 8­year­old boy has a recent history of an upper respiratory infection and
comes to the clinic with a maculopapular rash on his lower extremities and swelling and tenderness in both ankles. The pediatric nurse practitioner performs a UA, which shows proteinuria and hematuria and diagnoses HSP. What ongoing evaluation will the nurse practitioner perform during the course of this disease?
A. ANA titers
B. Blood pressure measurement
C. Chest radiographs
D. Liver function studies

Answer 2

Blood pressure measurement

Question 3

A child who has been diagnosed with asthma for several years has been using a
short­acting B2­agonist (SABA) to control symptoms. The primary care pediatric nurse practitioner learns that the child has recently begun using the SABA two or three times each week to treat wheezing and shortness of breath. The child currently has clear breath sounds and an FEV1 of 75% of personal best. What will the nurse practitioner do next?
A. Add a daily inhaled corticosteroid.
B. Administer 3 SABA treatments.
C. Continue the current treatment.
D. Order an oral corticosteroid.

Answer 3

Add a daily inhaled corticosteroid.

Question 4

A 10­year­old child has a 1­week history of fever of 104°C that is unresponsive to
antipyretics. The primary care pediatric nurse practitioner examines the child and notes bilateral conjunctival injection and a polymorphous exanthema, with no other symptoms. Lab tests show elevated ESR, CRP, and platelets. Cultures are all negative. What will the nurse practitioner do?
A. Begin treatment with intravenous methyl prednisone.
B. Consider IVIG therapy if symptoms persist one more week.
C. Order a baseline echocardiogram today and another in 2 weeks.
D. Reassure the child's parents that this is a self­limiting disorder.

Question 5

An adolescent female reports poor sleep, fatigue, muscle and joint paint, and
anxiety lasting for several months. The primary care pediatric nurse practitioner notes point tenderness at several sites. What will the nurse practitioner do next?
A. Evaluate the adolescent's pain using a numeric pain scale.
B. Obtain ANA, CBC, liver function, and muscle enzymes tests.
C. Reassure the adolescent that this condition is not life­threatening.
D. Refer the adolescent to a rheumatologist for further evaluation.

Question 6

The primary care pediatric nurse practitioner is examining a school­age child who
has had several hospitalizations for bronchitis and wheezing. The parent reports that the child has
several coughing episodes associated with chest tightness each week and gets relief with an albuterol metered­dose inhaler. What will the nurse practitioner order?
A. Allergy testing
B. Chest radiography
C. Spirometry testing
D. Sweat chloride test

Question 7

The primary care pediatric nurse practitioner is managing care for a child who has JIA who has a positive ANA. Which specialty referral is critical for this child?
A. Cardiology
B. Ophthalmology
C. Orthopedics
D. Pain management

Question 8

A child has a fever and arthralgia. The primary care pediatric nurse practitioner
learns that the child had a sore throat 3 weeks prior and auscultates a murmur in the clinic. Which test will the nurse practitioner order?
A. Anti­DNase B test
B. ASO titer
C. Rapid strep test
D. Throat culture

Question 9

The primary care pediatric nurse practitioner examines a child who has had
stiffness and warmth in the right knee and left ankle for 7 or 8 months but no back pain. The nurse practitioner will refer the child to a rheumatology specialist to evaluate for
A. enthesitis­related JIA.
B. oligoarticular JIA.
C. polyarticular JIA.
D. systemic JIA.

Question 10

The primary care pediatric nurse practitioner sees a child for follow­up care after
hospitalization for ARF. The child has polyarthritis but no cardiac involvement. What will the nurse practitioner teach the family about ongoing care for this child?
A. Aspirin is given for 2 weeks and then tapered to discontinue the medication.
B. Prophylactic amoxicillin will need to be given for 5 years.
C. Steroids will be necessary to prevent development of heart disease.
D. The child will need complete bedrest until all symptoms subside.

Question 11

An 8­year­old child is diagnosed with systemic lupus erythematosus (SLE), and
the child's parent asks if there is a cure. What will the primary care pediatric nurse practitioner tell the parent?
A. Complete remission occurs in some children at the age of puberty.
B. Periods of remission may occur but there is no permanent cure.
C. SLE can be cured with effective medication and treatment.
D. The disease is always progressive with no cure and no remissions.

Question 12

An adolescent who has asthma and severe perennial allergies has poor asthma
control in spite of appropriate use of a SABA and a daily high­dose inhaled corticosteroid. What will the primary care pediatric nurse practitioner do next to manage this child's asthma?
A. Consider daily oral corticosteroid administration.
B. Order an anticholinergic medication in conjunction with the current regimen.
C. Prescribe a LABA/inhaled corticosteroid combination medication.
D. Refer to a pulmonologist for omalizumab therapy.

Question 13

A 12­year­old child is brought to the clinic with joint pain, a 3­week history of low­
grade fever, and a facial rash. The primary care pediatric nurse practitioner palpates an enlarged liver 2 cm below the subcostal margin along with diffuse lymphadenopathy. An ANA test is positive. Which test may be ordered to confirm a diagnosis of SLE?
A. Anti­double­strand DNA antibodies
B. Anti­La antibodies
C. Anti­Ro antibodies
D. Anti­Sm antibodies

Question 14

A school­age child who uses a SABA and an inhaled corticosteroid medication is
seen in the clinic for an acute asthma exacerbation. After 4 puffs of an inhaled short­acting B2­ agonist (SABA) every 20 minutes for three treatments, spirometry testing shows an FEV1 of 60% of the child's personal best. What will the primary care pediatric nurse practitioner do next?
A. Administer an oral corticosteroid and repeat the three treatments of the inhaled SABA.
B. Admit the child to the hospital for every 2 hour inhaled SABA and intravenous steroids.
C. Give the child 2 mg/kg of an oral corticosteroid and have the child taken to the emergency department.
D. Order an oral corticosteroid, continue the SABA every 3 to 4 hours, and follow closely.

Question 15

A school­age child with asthma is seen for a well child checkup and, in spite of
"feeling fine," has pronounced expiratory wheezes, decreased breath sounds, and an FEV1less than 70% of personal best. The primary care pediatric nurse practitioner learns that the child's parent administers the daily medium­dose ICS but that the child is responsible for using the SABA. A treatment of 4 puffs of a SABA in clinic results in marked improvement in the child's status. What will the nurse practitioner do?
A. Have the parent administer all of the child's medications.
B. Increase the ICS medication to a high­dose preparation.
C. Reinforce teaching about the importance of using the SABA.
D. Teach the child and parent how to use home PEF monitoring.

Question 16

The parent of a school­age child reports that the child usually has allergic rhinitis
symptoms beginning each fall and that non­sedating antihistamines are only marginally effective, especially for nasal obstruction symptoms. What will the primary care pediatric nurse practitioner do?
A. Order an intranasal corticosteroid to begin 1 to 2 weeks prior to pollen season.
B. Prescribe a decongestant medication as adjunct therapy during pollen season.
C. Recommend adding diphenhydramine to the child's regimen for additional relief.
D. Suggest using an over­the­counter intranasal decongestant.

Question 17

The primary care pediatric nurse practitioner is evaluating an 11­month­old infant
who has had three viral respiratory illnesses causing bronchiolitis. The child's parents both have seasonal allergies and ask whether the infant may have asthma. What will the nurse practitioner tell the parents?
A. "Although it is likely, based on family history, it is too soon to tell."
B. "There is little reason to suspect that your infant has asthma."
C. "With your infant's history of bronchiolitis, asthma is very likely."
D. "Your infant has definitive symptoms consistent with a diagnosis of asthma."

Question 18

An adolescent who has exercise­induced asthma (EIA) is on the high school track
team and has recently begun to practice daily during the school week. The adolescent uses 2 puffs
of albuterol via a metered­dose inhaler 20 minutes before exercise but reports decreased effectiveness since beginning daily practice. What will the primary care pediatric nurse practitioner do?
A. Counsel the adolescent to decrease the number of practices each week.
B. Increase the albuterol to 4 puffs 20 minutes prior to exercise.
C. Order a daily inhaled corticosteroid medication.
D. Prescribe cromolyn sodium in addition to the albuterol.

Question 19

The primary care pediatric nurse practitioner is reviewing the rheumatology plan
of care for a child who is diagnosed with SLE. Besides reinforcing information about prescribed medications, what will the nurse practitioner teach the family to help minimize flaring of episodes?
A. Have the child rest between activities.
B. Obtain regular ophthalmology exams.
C. Participate in low­impact exercises.
D. Use UVA and UVB sunscreen daily.

Question 20

The primary care pediatric nurse practitioner is prescribing ibuprofen for a 25 kg
child with JIA who has oligoarthitis. If the child will take 4 doses per day, what is the maximum amount the child will receive per dose?
A. 200 mg
B. 250 mg
C. 400 mg
D. 450 mg

Question 21

The primary care pediatric nurse practitioner is performing a well­baby checkup
on a 6­month­old infant and notes a candida diaper rash and oral thrush. The infant has had two
ear infections in the past 2 months and is in the 3rd percentile for weight. What will the nurse practitioner do?
A. Order a CBC with differential and platelets and quantitative immunoglobulins.
B. Order candida and pneumococcal skin tests and lymphocyte surface markers.
C. Refer the infant to an immunologist for evaluation of immunodeficiency.
D. Refer the infant to an otolaryngologist to evaluate recurrent otitis media.

Question 22

A 4­month­old infant has a history of reddened, dry, itchy skin. The primary care
pediatric nurse practitioner notes fine papules on the extensor aspect of the infant's arms, anterior thighs, and lateral aspects of the cheeks. What is the initial treatment?
A. Moisturizers
B. Oral antihistamines
C. Topical corticosteroids
D. Wet wrap therapy