Deck 32: Respiratory Disorders

Question 1

A child has an acute infection causing lower airway obstruction. Which initial symptom is expected in this child?
A. Atelectasis
B. Barrel chest
C. Over­inflation
D. Wheezing

Answer 1

Wheezing

Question 2

A 5­year­old child has enlarged tonsils and a history of four throat infections in the
previous year with fever, cervical lymphadenopathy, and positive Group AStreptococcus pyogenes (GABHS) cultures. The parent reports that the child snores at night and expresses concerns about the child's quality of sleep. The next step in managing this child's condition is to
A. continue to observe the child for two or more GABHS infections.
B. prescribe prophylactic antibiotics to prevent recurrent infection.
C. refer to a pulmonologist for polysomnography evaluation.
D. refer to an otolaryngologist for possible tonsillectomy.

Answer 2

refer to a pulmonologist for polysomnography evaluation.

Question 3

The primary care pediatric nurse practitioner manages care in conjunction with a
pediatric pulmonologist for a child with cystic fibrosis. Which medication regimen is used to facilitate airway clearance for this child?
A. Ibuprofen and azithromycin
B. Inhaled dornase alfa
C. Ivacaftor
D. Prophylactic clindamycin

Answer 3

Inhaled dornase alfa

Question 4

A school­age child has an abrupt onset of sore throat, nausea, headache, and a
temperature of 102.3°F. An examination reveals petechiae on the soft palate, beefy­red tonsils with yellow exudate, and a scarlatiniform rash. A Rapid Antigen Detection Test (RADT) is negative.
What is the next step in management for this child?
A. Consider a sexual abuse diagnosis.
B. Obtain an anti­streptococcal antibody titer.
C. Perform a follow­up throat culture.
D. Prescribe amoxicillin for 10 days.

Question 5

A previously healthy school­age child develops a cough and a low­grade fever.
The primary care pediatric nurse practitioner auscultates wheezes in all lung fields. Which diagnosis will the nurse practitioner suspect?
A. Atypical pneumonia
B. Bacterial pneumonia
C. Bronchiolitis
D. Bronchitis

Question 6

A 4­year­old child with an upper respiratory tract infection has cloudy nasal
discharge and moderate nasal congestion interfering with sleep. The parent asks what product to use to help with symptoms. What will the primary care pediatric nurse practitioner recommend?
A. Antihistamines
B. Decongestant sprays
C. Saline rinses
D. Zinc supplements

Question 7

A child is in the clinic because of symptoms of purulent, foul­smelling nasal
discharge from the right nostril. Nasal visualization reveals something shiny in a mass of mucous in the nasal cavity. What will the primary care pediatric nurse practitioner do?
A. Attempt to remove the mass gently using alligator forceps.
B. Perform a saline nasal rinse using a water jet device.
C. Refer the child to a pediatric otolaryngologist.
D. Suction the mucoid mass using a bulb syringe.

Question 8

A 5­month­old infant who has a 3­day history of cough and rhinorrhea has
developed symptoms of respiratory distress with audible expiratory wheezes and increased coughing. The infant's immunizations are up­to­date. The physical exam reveals a respiratory rate of 50 breaths per minute, coarse expiratory wheezing, and prolonged expiration. An oxygen saturation is 96% on room air. What is the recommended treatment for this infant?
A. Administer a trial of bronchodilators.
B. Obtain a viral culture of nasal washings.
C. Order an oral corticosteroid medication.
D. Recommend increased fluids and close follow­up.

Question 9

The parent of a toddler and a 4­week­old infant tells the primary care pediatric
nurse practitioner that the toddler has just been diagnosed with pertussis. What will the nurse practitioner do to prevent disease transmission to the infant?
A. Administer the initial diphtheria, pertussis, and tetanus vaccine.
B. Instruct the parent to limit contact between the toddler and the infant.
C. Order azithromycin 10 mg/kg/day in a single dose daily for 5 days.
D. Prescribe erythromycin 10 mg/kg/dose four times daily for 14 days.

Question 10

The primary care pediatric nurse practitioner evaluates a child who awoke with a
sore throat and high fever after a nap. The child appears anxious and is sitting on the parent's lap with the neck hyperextended. The physical exam reveals stridor, drooling, nasal flaring, and retractions. What will the nurse practitioner do next?
A. Administer a broad­spectrum intravenous antibiotic.
B. Obtain blood and throat cultures and start antibiotic therapy.
C. Send the child to radiology for a lateral neck radiograph.
D. Transport the child to the hospital via emergency medical services.

Question 11

A 2­year­old child is brought to the clinic after developing a hoarse, bark­like
cough during the night with "trouble catching his breath" according to the parent. The history reveals a 2 day history of low­grade fever and upper respiratory symptoms. On exam, the child has a respiratory rate of 40 breaths per minute, occasional stridor when crying, and a temperature of 101.3°F. What is the next step in treatment for this child?
A. Administer intramuscular dexamethasone.
B. Admit the child for inpatient hospitalization.
C. Give the child a racemic epinephrine treatment in the office.
D. Prescribe oral dexamethasone for 2 days.

Question 12

A school­age child has frequent nosebleeds. Nasal visualization reveals fresh
clots and excoriated nasal mucosa but no visible site of bleeding. Coagulation studies are normal. In spite of symptomatic measures, the child continues to have nosebleeds. What is the next course of action?
A. Cauterize the mucosa with silver nitrate sticks.
B. Order a topical vasoconstrictor medication.
C. Prescribe a barrier agent such as petrolatum jelly.
D. Refer to an otolaryngologist for further evaluation.

Question 13

After 14 days of treatment with amoxicillin 45 mg/kg/day for acute rhinosinusitis, a
child continues to have mucopurulent nasal discharge along with induration, swelling, and erythema of both eyelids. What is the next course of treatment?
A. Amoxicillin 80 mg/kg/day for 14 days
B. Amoxicillin­clavulanate for 10 to 14 days
C. Antibiotic ophthalmic drops for 5 to 7 days
D. Referral to a pediatric otolaryngologist

Question 14

A school­age child has had nasal discharge and daytime cough but no fever for
12 days without improvement in symptoms. The child has not had antibiotics recently and there is no significant antibiotic resistance in the local community. What is the appropriate treatment for this child?
A. Amoxicillin 45 mg/kg/day
B. Amoxicillin 80­90 mg/kg/day
C. Amoxicillin­clavulanate 80­90 mg/kg/day
D. Saline irrigation for symptomatic relief

Question 15

In a respiratory disorder causing a check­valve obstruction, which symptoms will be present?
A. Air entry on inspiration with expiratory occlusion
B. Complete obstruction on inspiration and expiration
C. Narrowing of the lumen with increased air flow resistance
D. Obstruction of air entry with unimpeded expiratory air flow

Question 16

A child is diagnosed with community­acquired pneumonia and will be treated as
an outpatient. Which antibiotic will the primary care pediatric nurse practitioner prescribe?
A. Amoxicillin
B. Azithromycin
C. Ceftriaxone
D. Oseltamivir

Question 17

An adolescent has suspected infectious mononucleosis after exposure to the
virus in the past week. The primary care pediatric nurse practitioner examines the adolescent and notes exudate on the tonsils, soft palate petechiae, and diffuse adenopathy. Which test will the primary care pediatric nurse practitioner perform to confirm the diagnosis?
A. Complete blood count
B. EBV­specific antibody testing
C. Heterophile antibody testing
D. Throat culture