Question 1

A child is brought to the clinic with a fever, headache, malaise, and a red, annular
macule surrounded by an area of clearing and a larger, erythematous annular ring. The child complains of itching at the site. What will the primary care pediatric nurse practitioner do to determine the diagnosis?

Accepted Answer

The presentation of fever, headache, malaise, and a red, annular macule with itching in a child suggest the possibility of Lyme disease, which is commonly transmitted by tick bites. Asking about recent tick bites will help in determining the diagnosis. Obtaining a skin culture, blood cultures, or serologic testing are not typically used to diagnose Lyme disease.

Question 2

A school­age child has fever of 104°F, sore throat, vomiting and malaise. The
primary care pediatric nurse practitioner observes that the tonsils, oropharynx, and palate are
erythematous and covered with exudate; the tongue is coated and red; and there is a red, sandpaper­like rash on the child's neck, trunk, and extremities. A rapid strep test is positive. What will the nurse practitioner do to manage this child's illness?

Accepted Answer

The child's symptoms are consistent with a diagnosis of streptococcal pharyngitis with accompanying scarlet fever rash. The first-line treatment for strep is oral penicillin or amoxicillin. Intramuscular ceftriaxone or hospitalization for further diagnostic tests are not necessary in this case. Referral to a specialist may be considered only if the child has recurrent or chronic strep infections.

Question 3

An adolescent has a TB skin test prior to working as a volunteer in a hospital. The
adolescent is healthy and has not travelled to or from a TB­endemic area or had close contact with anyone who has TB. The Mantoux skin test shows 10 mm of induration after 48 hours. What will the primary care pediatric nurse practitioner do?

Accepted Answer

The answer of An adolescent has a TB skin test...

Question 4

A 10­month­old infant has an erythematous, fluctuant, non­draining abscess on
the right buttock after 10 days of treatment with amoxicillin for impetigo. What is the next step in managing this infant's care?

Accepted Answer

The presentation of an erythematous, fluctuant, non-draining abscess on the right buttock suggests a bacterial skin infection that has not responded to the previous treatment with amoxicillin. The next step would be to perform incision and drainage of the abscess with culture to identify the causative organism and guide antibiotic therapy. This is the standard of care for the management of skin abscesses. Consultation with a pediatric infectious disease specialist may be considered if there are complications or if the culture results are concerning. Empiric treatment with clindamycin may be considered if there is a high suspicion for methicillin-resistant Staphylococcus aureus (MRSA) infection, but should not be the initial step without confirming the diagnosis. Culture of any superficial open surface wounds may also be helpful in identifying the causative organism, but incision and drainage of the abscess is the priority in this case.

Question 5

An 18­month­old child who developed upper respiratory symptoms 1 day prior is
brought to the clinic with a high fever, chills, muscle pains, and a dry, hacking cough. A rapid influenza test is negative and a viral culture is pending. What will the primary care pediatric nurse practitioner do?

Accepted Answer

The child's presentation is consistent with influenza despite the negative rapid test, and treatment with oseltamivir should be started empirically while awaiting viral culture results. Hospitalization is not necessary unless the child's condition deteriorates. Rimantadine is not recommended for use in children under 10 years old. Waiting for cultures to determine treatment would delay potentially effective treatment for the child.

Question 6

An unimmunized school­age child whose mother is in her first trimester of
pregnancy is diagnosed with rubella after a local outbreak. What will the primary care pediatric nurse practitioner recommend?

Accepted Answer

The primary care pediatric nurse practitioner should recommend assessment of maternal rubella titers to determine if the mother is already immune to rubella or if she needs to receive the MMR vaccine. This is important for the safety of the fetus, as rubella infection during pregnancy can lead to serious complications such as congenital rubella syndrome. Intravenous immunoglobulin is not recommended for rubella treatment, and terminating the pregnancy is not necessary unless serious complications arise. MMR vaccine for the child may be considered after the acute phase of the illness has passed.

Question 7

The primary care pediatric nurse practitioner is examining a 2­month­old infant
with fever and cough. A WBC is 14,000/mm3 and a chest radiograph is normal. The infant is nursing well and having normal stools. What would be an appropriate next step?

Accepted Answer

A catheterized urinalysis is appropriate to screen for a urinary tract infection, which is a common cause of fever in infants.

Question 8

A child with a history of a pustular rash at the site of a cat scratch on one arm now
has warm, tender, swollen axillary lymph nodes on the affected side. The primary care pediatric nurse practitioner notes induration and erythema of these nodes. What will the nurse practitioner do?

Accepted Answer

The answer of A child with a history of a...

Question 9

A child whose parents have refused vaccines has been exposed to chickenpox,
and the parents ask whether the child may attend day care. What will the primary care pediatric nurse practitioner tell them?

Accepted Answer

The answer of A child whose parents have refused vaccines...

Question 10

The primary care pediatric nurse practitioner is reviewing medical records for a
newborn that is new to the clinic. The toddler's mother was found to be HIV positive during her pregnancy with this child and received antiretroviral therapy during pregnancy. The child was born by cesarean section, begun on anti­retroviral prophylaxis, and did not breastfeed. What is the correct management for this child?

Accepted Answer

The answer of The primary care pediatric nurse practitioner is...

Question 11

A 3­year­old child whose immunizations are up­to­date has been exposed to
measles because of a localized outbreak among unvaccinated children. The parent reports that contact with infected children occurred within the last 2 days at a birthday party. What is the best course of action?

Accepted Answer

The best course of action is to administer the MMR vaccine to help prevent disease. While the child's immunizations are up-to-date, the vaccine is not 100% effective and may not have provided full immunity. Administering the vaccine after exposure can also potentially reduce the severity of the illness if the child does develop measles. Antiviral medications and immune globulin are not effective treatments for measles. Reassuring the parent is not appropriate as measles is a serious and potentially life-threatening illness.

Question 12

A 7­year­old child whose immunizations are up­to­date has a fever, headache, stiff neck, and photophobia. What course of treatment is indicated?

Accepted Answer

The symptoms presented in the scenario indicate a possible case of meningitis, which requires urgent treatment with antibiotics. Hospitalization is necessary for appropriate diagnosis and treatment.

Question 13

A preschool­age child is brought to clinic for evaluation of a rash. The primary
care pediatric nurse practitioner notes an intense red eruption on the child's cheeks and circumoral pallor. What will the nurse practitioner tell the parents about this rash?

Accepted Answer

The answer of A preschool­age child is brought to clinic...

Question 14

A child whose family has been camping in a region with endemic Lyme disease
suffered several tick bites. The parents report removing the ticks but are not able to verify the type or the length of time the ticks were attached. The child is asymptomatic. What is the best course of action?

Accepted Answer

The child is asymptomatic and there is no evidence to suggest that the ticks transmitted Lyme disease. Therefore, administration of prophylactic antibiotics or serologic testing is not recommended. The best course of action is to teach the parents to monitor the child for the signs and symptoms of Lyme disease and to seek medical attention if any symptoms develop.

Quiz 24: Infectious Diseases and Immunizations

A child is brought to the clinic with a fever, headache, malaise, and a red, annular macule surrounded by an area of clearing and a larger, erythematous annular ring. The child complains of itching at the site. What will the primary care pediatric nurse practitioner do to determine the diagnosis?

A 10monthold infant has an erythematous, fluctuant, nondraining abscess on the right buttock after 10 days of treatment with amoxicillin for impetigo. What is the next step in managing this infant's care?

An 18monthold child who developed upper respiratory symptoms 1 day prior is brought to the clinic with a high fever, chills, muscle pains, and a dry, hacking cough. A rapid influenza test is negative and a viral culture is pending. What will the primary care pediatric nurse practitioner do?

An unimmunized schoolage child whose mother is in her first trimester of pregnancy is diagnosed with rubella after a local outbreak. What will the primary care pediatric nurse practitioner recommend?

The primary care pediatric nurse practitioner is examining a 2monthold infant with fever and cough. A WBC is 14,000/mm3 and a chest radiograph is normal. The infant is nursing well and having normal stools. What would be an appropriate next step?

A child with a history of a pustular rash at the site of a cat scratch on one arm now has warm, tender, swollen axillary lymph nodes on the affected side. The primary care pediatric nurse practitioner notes induration and erythema of these nodes. What will the nurse practitioner do?

A child whose parents have refused vaccines has been exposed to chickenpox, and the parents ask whether the child may attend day care. What will the primary care pediatric nurse practitioner tell them?

A 3yearold child whose immunizations are uptodate has been exposed to measles because of a localized outbreak among unvaccinated children. The parent reports that contact with infected children occurred within the last 2 days at a birthday party. What is the best course of action?

A 7yearold child whose immunizations are uptodate has a fever, headache, stiff neck, and photophobia. What course of treatment is indicated?

A preschoolage child is brought to clinic for evaluation of a rash. The primary care pediatric nurse practitioner notes an intense red eruption on the child's cheeks and circumoral pallor. What will the nurse practitioner tell the parents about this rash?

A child whose family has been camping in a region with endemic Lyme disease suffered several tick bites. The parents report removing the ticks but are not able to verify the type or the length of time the ticks were attached. The child is asymptomatic. What is the best course of action?

Quiz 24: Infectious Diseases and Immunizations

A child is brought to the clinic with a fever, headache, malaise, and a red, annular macule surrounded by an area of clearing and a larger, erythematous annular ring. The child complains of itching at the site. What will the primary care pediatric nurse practitioner do to determine the diagnosis?

A 10­month­old infant has an erythematous, fluctuant, non­draining abscess on the right buttock after 10 days of treatment with amoxicillin for impetigo. What is the next step in managing this infant's care?

An 18­month­old child who developed upper respiratory symptoms 1 day prior is brought to the clinic with a high fever, chills, muscle pains, and a dry, hacking cough. A rapid influenza test is negative and a viral culture is pending. What will the primary care pediatric nurse practitioner do?

An unimmunized school­age child whose mother is in her first trimester of pregnancy is diagnosed with rubella after a local outbreak. What will the primary care pediatric nurse practitioner recommend?

The primary care pediatric nurse practitioner is examining a 2­month­old infant with fever and cough. A WBC is 14,000/mm3 and a chest radiograph is normal. The infant is nursing well and having normal stools. What would be an appropriate next step?