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?

Accepted Answer

Swimming is a low-impact exercise that can help improve strength and mobility while reducing joint pain and inflammation. Running and weights may aggravate joint symptoms in a child with JIA. While yoga has potential benefits, it should be approached with caution as certain poses may not be appropriate for a child with JIA. It is best to consult with a physical therapist or rheumatologist for specific exercise recommendations.

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?

Accepted Answer

HSP (Henoch-Schönlein purpura) is characterized by inflammation of small blood vessels in the skin, joints, gastrointestinal tract, and kidneys. Blood pressure measurement is important as hypertension can occur due to renal involvement. ANA titers, chest radiographs, and liver function studies are not routinely indicated in the evaluation and management of HSP.

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?

Accepted Answer

The child's increased use of the short-acting B2-agonist indicates poor asthma control, which puts them at risk for exacerbations and potential long-term lung damage. Adding a daily inhaled corticosteroid is recommended as first-line therapy for persistent asthma in children over 5 years old. Administering more SABA treatments may provide temporary relief, but it does not address the underlying issue of poor control. Continuing the current treatment is not appropriate given the child's increased use of the SABA. Ordering an oral corticosteroid is reserved for moderate to severe exacerbations and should not be used as a long-term solution for poor asthma control.

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?

Accepted Answer

The child's symptoms and lab results are consistent with Kawasaki disease, a systemic vasculitis. The American Heart Association recommends that all patients with suspected Kawasaki disease receive an echocardiogram prior to treatment and then again at 6-8 weeks after onset of symptoms to assess for coronary artery aneurysms which can occur as a complication of the disease. Treatment typically involves high-dose aspirin and intravenous immunoglobulin (IVIG). High-dose steroids may be considered for refractory cases, but they are not typically used as first-line treatment. While Kawasaki disease is usually self-limiting, it requires prompt and aggressive treatment to prevent long-term complications.

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?

Accepted Answer

The symptoms described by the adolescent are consistent with fibromyalgia, a chronic condition that is typically managed by a rheumatologist. The presence of point tenderness at several sites further supports this diagnosis. While pain scale evaluation may provide some information, it is not necessary in this case as the diagnosis is suspected based on the presenting symptoms. Ordering laboratory tests may also be helpful to rule out other conditions, but the diagnosis and management of fibromyalgia is primarily clinical. Reassuring the adolescent is important, but a referral to a specialist is necessary for further evaluation and management.

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?

Accepted Answer

The child's history of wheezing and coughing with chest tightness suggests asthma. Spirometry testing assesses lung function and can help diagnose asthma. Allergy testing may be helpful if the child has allergies, but it is not the primary diagnostic test for asthma. Chest radiography and sweat chloride testing are not appropriate for the diagnosis of asthma.

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?

Accepted Answer

Ophthalmology referral is critical for this child because a positive ANA can be indicative of uveitis, which is a potential complication of JIA that can cause permanent vision loss if left untreated. Cardiology referral is not necessary for JIA with a positive ANA, and while orthopedics and pain management may be involved in the child's care, they are not critical referrals based solely on the positive ANA.

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?

Accepted Answer

The presentation of fever, arthralgia, and a murmur following a sore throat suggests a possible rheumatic fever. The ASO titer is a blood test used to detect antibodies produced in response to a streptococcal infection, which can help confirm a diagnosis of rheumatic fever. The anti-DNase B test is another blood test that can detect antibodies produced in response to a streptococcal infection, but it may not be as specific to rheumatic fever as the ASO titer. The rapid strep test and throat culture are used to diagnose current streptococcal infections and may not be as helpful in diagnosing a past infection that has led to complications such as rheumatic fever.

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

Accepted Answer

Oligoarticular JIA typically involves four or fewer joints, often affecting large joints like knees and ankles, and is consistent with the symptoms described.

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?

Accepted Answer

Aspirin is used to manage inflammation and pain associated with polyarthritis in acute rheumatic fever (ARF). It is typically given for a period and then tapered off as symptoms improve.

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?

Accepted Answer

There is no permanent cure for systemic lupus erythematosus, but periods of remission may occur with effective medication and treatment. Complete remission may occur in some children at the age of puberty, but this is not guaranteed. The disease is not always progressive, and managing symptoms through medication and lifestyle changes can help to improve quality of life.

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?

Accepted Answer

The answer of An adolescent who has asthma and severe...

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?

Accepted Answer

Anti-double-strand DNA antibodies are highly specific for SLE and are considered a diagnostic criterion for the disease. The other antibody tests listed are commonly found in patients with SLE, but are not specific enough to confirm a diagnosis on their own.

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?

Accepted Answer

The child's FEV1 indicates that the asthma exacerbation is moderate, not severe. Therefore, hospital admission is not necessary. The best course of action in this case is to administer an oral corticosteroid to reduce inflammation and continue the SABA every 3 to 4 hours while closely monitoring the child's symptoms. Repeat spirometry testing should also be considered to assess the effectiveness of the treatment. Referral to emergency department is not necessary in this case.

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?

Accepted Answer

The answer of A school­age child with asthma is seen...

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?

Accepted Answer

Ordering an intranasal corticosteroid 1 to 2 weeks prior to the pollen season will provide effective relief for nasal obstruction symptoms in allergic rhinitis patients. Decongestants and diphenhydramine have limited effectiveness and may cause side effects. Intranasal decongestants should be avoided due to the risk of rebound congestion.

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?

Accepted Answer

While family history may increase the likelihood of asthma, it is too soon to make a definitive diagnosis in an 11-month-old infant who has had only viral respiratory illnesses causing bronchiolitis. Further evaluation and monitoring will be necessary to determine if the infant has 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?

Accepted Answer

Since the adolescent is experiencing decreased effectiveness of albuterol, it is appropriate to add a daily inhaled corticosteroid medication to control EIA symptoms over the long term. Reducing the number of practices or increasing the dose of albuterol may not address the underlying issue and is not a sustainable solution. Cromolyn sodium is an alternative prophylactic medication, but it is less effective and often requires frequent dosing throughout the day, so it may not be the best choice.

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?

Accepted Answer

Using UVA and UVB sunscreen daily is important for children with SLE to minimize flares, as sun exposure can trigger or worsen symptoms.

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?

Accepted Answer

The typical dosing for ibuprofen in children is 10 mg/kg per dose. For a 25 kg child, this would be 250 mg per dose.

Quiz 25: Atopic and Rheumatic Disorders

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?

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?

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 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?

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

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?

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?

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?

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?

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?

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?

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?

Quiz 25: Atopic and Rheumatic Disorders

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?

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?

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 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?

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

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?

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?

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?

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?

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?

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?

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?

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?

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?

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?

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?

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?

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?