Question 1

A child has an acute infection causing lower airway obstruction. Which initial symptom is expected in this child?

Accepted Answer

Wheezing is a common symptom of lower airway obstruction in children, caused by narrowing of the air passages due to inflammation and mucus buildup. Atelectasis, barrel chest, and over-inflation are not initial symptoms of lower airway obstruction.

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

Accepted Answer

C

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?

Accepted Answer

Inhaled dornase alfa is a medication commonly used for airway clearance in patients with cystic fibrosis. Ibuprofen and azithromycin may have some benefits in cystic fibrosis management but are not specifically used for airway clearance. Ivacaftor is a medication used for patients with specific cystic fibrosis mutations but is not primarily used for airway clearance. Prophylactic clindamycin is not typically used for airway clearance in cystic fibrosis management.

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?

Accepted Answer

The child's symptoms and physical findings are suggestive of streptococcal pharyngitis (strep throat), however, the negative RADT does not rule it out completely as it has a high false-negative rate. The next step in management would be to perform a follow-up throat culture to confirm the diagnosis before starting antibiotic treatment.

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?

Accepted Answer

Atypical pneumonia can present with a cough, low-grade fever, and wheezes in all lung fields, especially in school-age children, differentiating it from the more localized symptoms of bacterial pneumonia and the age group typically affected by bronchiolitis (younger children).

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?

Accepted Answer

Saline rinses are a safe and effective option for children with nasal congestion and discharge. They help to clear the nasal passages and improve symptoms without the potential side effects of antihistamines or decongestant sprays. Zinc supplements have not been shown to have significant benefits in treating upper respiratory infections.

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?

Accepted Answer

The symptoms and visualization suggest a foreign body in the nasal cavity. The primary care pediatric nurse practitioner should attempt to remove the foreign body gently using alligator forceps, as it is a common practice to remove visible foreign bodies in the clinic setting.

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?

Accepted Answer

The answer of A 5­month­old infant who has a 3­day...

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?

Accepted Answer

Azithromycin is recommended for prophylaxis against pertussis in infants and close contacts, including family members, to prevent disease transmission. It is preferred due to its shorter course and better tolerability compared to erythromycin.

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?

Accepted Answer

The child's presentation and physical exam findings suggest acute epiglottitis, a potentially life-threatening condition. Immediate transfer to the hospital via emergency medical services is recommended for evaluation and possible intubation. Antibiotic therapy should also be initiated as soon as possible. Radiography is contraindicated as it may trigger laryngospasm and worsen the condition.

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?

Accepted Answer

The answer of A 2­year­old child is brought to the...

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?

Accepted Answer

The recurrent nosebleeds in a school-age child with fresh clots and excoriated nasal mucosa but no visible site of bleeding and normal coagulation studies should prompt referral to an otolaryngologist for further evaluation. This may include endoscopic visualization of the nasal cavity or imaging studies to identify the source of bleeding and determine the best course of treatment. Cauterization or topical vasoconstrictor medications may offer temporary relief but do not address the underlying cause and can potentially cause further harm to the nasal mucosa. A barrier agent may be used for symptomatic relief but does not address the recurrent nature of the nosebleeds.

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?

Accepted Answer

The answer of After 14 days of treatment with amoxicillin...

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?

Accepted Answer

The answer of A school­age child has had nasal discharge...

Question 15

In a respiratory disorder causing a check­valve obstruction, which symptoms will be present?

Accepted Answer

A check-valve obstruction in the respiratory system allows air to enter the lungs during inspiration but prevents or significantly hinders its exit during expiration, leading to air trapping and potentially hyperinflation of the affected lung areas.

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?

Accepted Answer

Amoxicillin is the first-line antibiotic treatment for community-acquired pneumonia in children when outpatient treatment is appropriate. It is recommended due to its effectiveness against the most common causative agent, Streptococcus pneumoniae.

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?

Accepted Answer

The answer of An adolescent has suspected infectious mononucleosis after...

Quiz 32: Respiratory Disorders

A child has an acute infection causing lower airway obstruction. Which initial symptom is expected in this child?

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 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 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 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?

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 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?

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 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?

In a respiratory disorder causing a checkvalve obstruction, which symptoms will be present?

A child is diagnosed with communityacquired pneumonia and will be treated as an outpatient. Which antibiotic will the primary care pediatric nurse practitioner prescribe?

Quiz 32: Respiratory Disorders

A child has an acute infection causing lower airway obstruction. Which initial symptom is expected in this child?

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 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 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 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?

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 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?

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 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?

In a respiratory disorder causing a check­valve obstruction, which symptoms will be present?

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 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 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 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?

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 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 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?

In a respiratory disorder causing a checkvalve obstruction, which symptoms will be present?

A child is diagnosed with communityacquired pneumonia and will be treated as an outpatient. Which antibiotic will the primary care pediatric nurse practitioner prescribe?