NUR 6111 Advanced Practice Nursing I Final Exam
2026| Actual Exam Questions and Correct Answers
Question 1: A 8 year old, 60 lb child diagnosed with left otits externa can be managed with
a. Ciprodex otic, 4 drops to the affected ear bid X 7 days
b. Children's Ibuprofen liquid 10 mls q 6-8h prn for discomfort
C. Avoidance of swimming/underwater baths until resolved
d. All of the above
**Correct Answer:
d. All of the above
Explanation:
Management of otitis externa (swimmer’s ear) in an 8-year-old child includes:
1. Topical antibiotic drops:
o Ciprodex (Ciprofloxacin-Dexamethasone) otic drops
o Dosage: 4 drops in the affected ear twice daily for 7 days
o Ciprodex provides antibiotic coverage (ciprofloxacin) and reduces inflammation
(dexamethasone).
2. Pain management:
o Ibuprofen (Children’s liquid) is appropriate for pain relief.
o Dosage: Ibuprofen 10 mg/kg/dose every 6-8 hours as needed.
o The child weighs 60 lbs (~27 kg), so 10 mL of Children's Ibuprofen (100 mg/5 mL
concentration) provides adequate pain relief.
3. Avoidance of water exposure:
o Swimming and underwater baths should be avoided to prevent further irritation
and promote healing.
Question 2: A 1 month old female is brought to the office for a follow-up visit due to feeding
issues. She was a NSVD at 39 weeks gestation, no complications. Was discharged to home on
day 2 after delivery. The mother states she had a hepatits B vaccine in the hospital prior to being
discharged. In reviewing the chart the NP would anticipate ordering which immunization at this
visit?
a. DTaP, IPV, and Hepatitis B
b. DTaP, IPV, HIB, and Prevnar
c. Hepatitis B
d. DTaP, IPV, HIB, Prevnar, Hepatitis B, Rototeq
**Correct Answer:
c. Hepatitis B
Explanation:
At birth: Hepatitis B vaccine (1st dose)
1- month visit: Hepatitis B vaccine (2nd dose)
2- month visit: DTaP, IPV, Hib, PCV13 (Prevnar), Rotavirus, and possibly Hepatitis B (if
not given at 1 month).
,Question 3: A 5 year old comes to the office with right ear pain X 3 days. Today mom states that
she is feeling a little better. She has had a fever of 100 to 101 X2 days. On otoscopic exam of her
ear you note a perforation in the TM. What treatment would you recommend?
a. Amoxicillin 90 mg/kg/day X 10 days
b. Cefdinir 14 mg/kg/day X 10 days
c. Ciprodex otic drops 4 drops to affected are bid X 7 days
d. Treat with both oral and topical antibiotics
Correct Answer:
d. Treat with both oral and topical antibiotics
Explanation:
A 5-year-old child with acute otitis media (AOM) with TM perforation should be treated
with
both oral and topical antibiotics to cover for common pathogens (Streptococcus pneumoniae,
Haemophilus influenzae, Moraxella catarrhalis).
Oral Antibiotic:
First-line: Amoxicillin 90 mg/kg/day divided BID for 10 days
If the child has a penicillin allergy (non-severe reaction): Cefdinir 14 mg/kg/day is a
good alternative.
If severe beta-lactam allergy: Clindamycin or macrolides (like azithromycin) may be
used, though they have less coverage.
Topical Antibiotic:
Ciprodex otic (Ciprofloxacin-Dexamethasone) drops
o Dosage: 4 drops to the affected ear twice daily for 7 days
o Helps treat the infection locally and reduces inflammation.
Why Both Oral and Topical?
Oral antibiotics are necessary because middle ear infections often have a bacterial
etiology and require systemic treatment.
Topical fluoroquinolone ear drops (like Ciprodex) are safe with TM perforation and help
prevent otorrhea and secondary infection
Question 4: All are findings consistent with peritonsillar abscess EXCEPT:
a. muffled voice
b. unilateral enlargement of tonsil
C. trismus
d. exudate on tonsils
Correct Answer:
d. Exudate on tonsils
Explanation:
A peritonsillar abscess (PTA) is a deep neck space infection that typically presents with:
✅ Common findings:
, Muffled "hot potato" voice (a) due to oropharyngeal swelling.
Unilateral tonsillar enlargement with uvular deviation (b).
Trismus (difficulty opening the mouth) (c) due to inflammation and spasm of the
pterygoid muscles.
🚫 Not a specific finding for PTA:
Exudate on tonsils (d) is more commonly seen in bacterial pharyngitis (e.g.,
streptococcal pharyngitis) or infectious mononucleosis.
While there may be some tonsillar exudate in PTA, it is not a defining feature like the
other choices.
Question 5: Which of the following does not represent a risk factor for recurrent AOM in
younger children?
a. pacifier use after age 10 months
b. craniofacial abnormalities
c. exposure to second hand smoke
d. birth at 34 weeks gestation
Correct Answer:
d. Birth at 34 weeks gestation
Explanation:
Recurrent acute otitis media (AOM) is defined as ≥3 episodes in 6 months or ≥4 episodes in
12 months. Several risk factors increase susceptibility to middle ear infections in young
children.
✅ Risk factors for recurrent AOM include:
Pacifier use after 10 months (a): Prolonged pacifier use can lead to Eustachian tube
dysfunction, increasing AOM risk.
Craniofacial abnormalities (b): Conditions like cleft palate or Down syndrome impair
Eustachian tube function, predisposing children to infections.
Exposure to secondhand smoke (c): Tobacco smoke causes mucosal inflammation and
impaired ciliary function, increasing the risk of recurrent infections.
🚫 Birth at 34 weeks gestation (d) is not a direct risk factor for recurrent AOM.
While preterm birth may be associated with general immune immaturity, it is not
strongly linked to recurrent AOM unless accompanied by other risk factors (e.g., NICU
stay, prolonged intubation).
Question 6: Which of the following is a common cause of acquired coronary artery disease
during childhood?
a. Rheumatic fever
b. Hypertension
c. Systemic lupus erythematosus
d. Kawasaki disease
Correct Answer:
, d. Kawasaki disease
Explanation:
Kawasaki disease (KD) is the most common cause of acquired coronary artery disease
(CAD) in children. It is a vasculitis that primarily affects medium-sized arteries, including the
coronary arteries, leading to potential aneurysm formation and long-term cardiac
complications.
✅ Why Kawasaki disease?
It can cause coronary artery aneurysms, myocardial infarction, and ischemia if
untreated.
Early treatment with IVIG (intravenous immunoglobulin) and aspirin reduces the risk of
coronary complications.
🚫 Other options are less common causes of CAD in children:
Rheumatic fever (a) → Causes valvular heart disease (especially mitral stenosis), but
not coronary artery disease.
Hypertension (b) → Can lead to left ventricular hypertrophy, but does not typically
cause CAD in young children.
Systemic lupus erythematosus (SLE) (c) → Can cause vasculitis and pericarditis, but
coronary involvement is rare in childhood.
Question 7: A 8 year old is seen in a Urgent Care by the NP. The mother reports that her
child has had a fever X 2 days and is not eating well due to a sore throat and painful sores
inside her mouth. The child's temperature is 101F. During the exam the NP notices several
small blisters and shallow ulcers on the child's pharynx and the oral mucosa. The child has
round, red, rashes on both palms of hands and soles of her feet. Which of the following
conditions is most likely?
a. herpes simplex infection
b. hand, foot, and mouth disease
C. varicella infection
d. strep throat
Correct Answer:
b. Hand, foot, and mouth disease (HFMD)
Explanation:
The child's symptoms are most consistent with HFMD, a viral illness caused primarily by
Coxsackievirus A16 or Enterovirus 71. It is highly contagious, affecting children under 10
years old, and is characterized by:
✅ Key Features of HFMD:
Fever (101°F in this case) for 2-3 days.
Painful oral lesions (small blisters and shallow ulcers on the pharynx and oral mucosa).
Red maculopapular rash with vesicles on the palms and soles (a hallmark of HFMD).
🚫 Why Not the Other Options?
2026| Actual Exam Questions and Correct Answers
Question 1: A 8 year old, 60 lb child diagnosed with left otits externa can be managed with
a. Ciprodex otic, 4 drops to the affected ear bid X 7 days
b. Children's Ibuprofen liquid 10 mls q 6-8h prn for discomfort
C. Avoidance of swimming/underwater baths until resolved
d. All of the above
**Correct Answer:
d. All of the above
Explanation:
Management of otitis externa (swimmer’s ear) in an 8-year-old child includes:
1. Topical antibiotic drops:
o Ciprodex (Ciprofloxacin-Dexamethasone) otic drops
o Dosage: 4 drops in the affected ear twice daily for 7 days
o Ciprodex provides antibiotic coverage (ciprofloxacin) and reduces inflammation
(dexamethasone).
2. Pain management:
o Ibuprofen (Children’s liquid) is appropriate for pain relief.
o Dosage: Ibuprofen 10 mg/kg/dose every 6-8 hours as needed.
o The child weighs 60 lbs (~27 kg), so 10 mL of Children's Ibuprofen (100 mg/5 mL
concentration) provides adequate pain relief.
3. Avoidance of water exposure:
o Swimming and underwater baths should be avoided to prevent further irritation
and promote healing.
Question 2: A 1 month old female is brought to the office for a follow-up visit due to feeding
issues. She was a NSVD at 39 weeks gestation, no complications. Was discharged to home on
day 2 after delivery. The mother states she had a hepatits B vaccine in the hospital prior to being
discharged. In reviewing the chart the NP would anticipate ordering which immunization at this
visit?
a. DTaP, IPV, and Hepatitis B
b. DTaP, IPV, HIB, and Prevnar
c. Hepatitis B
d. DTaP, IPV, HIB, Prevnar, Hepatitis B, Rototeq
**Correct Answer:
c. Hepatitis B
Explanation:
At birth: Hepatitis B vaccine (1st dose)
1- month visit: Hepatitis B vaccine (2nd dose)
2- month visit: DTaP, IPV, Hib, PCV13 (Prevnar), Rotavirus, and possibly Hepatitis B (if
not given at 1 month).
,Question 3: A 5 year old comes to the office with right ear pain X 3 days. Today mom states that
she is feeling a little better. She has had a fever of 100 to 101 X2 days. On otoscopic exam of her
ear you note a perforation in the TM. What treatment would you recommend?
a. Amoxicillin 90 mg/kg/day X 10 days
b. Cefdinir 14 mg/kg/day X 10 days
c. Ciprodex otic drops 4 drops to affected are bid X 7 days
d. Treat with both oral and topical antibiotics
Correct Answer:
d. Treat with both oral and topical antibiotics
Explanation:
A 5-year-old child with acute otitis media (AOM) with TM perforation should be treated
with
both oral and topical antibiotics to cover for common pathogens (Streptococcus pneumoniae,
Haemophilus influenzae, Moraxella catarrhalis).
Oral Antibiotic:
First-line: Amoxicillin 90 mg/kg/day divided BID for 10 days
If the child has a penicillin allergy (non-severe reaction): Cefdinir 14 mg/kg/day is a
good alternative.
If severe beta-lactam allergy: Clindamycin or macrolides (like azithromycin) may be
used, though they have less coverage.
Topical Antibiotic:
Ciprodex otic (Ciprofloxacin-Dexamethasone) drops
o Dosage: 4 drops to the affected ear twice daily for 7 days
o Helps treat the infection locally and reduces inflammation.
Why Both Oral and Topical?
Oral antibiotics are necessary because middle ear infections often have a bacterial
etiology and require systemic treatment.
Topical fluoroquinolone ear drops (like Ciprodex) are safe with TM perforation and help
prevent otorrhea and secondary infection
Question 4: All are findings consistent with peritonsillar abscess EXCEPT:
a. muffled voice
b. unilateral enlargement of tonsil
C. trismus
d. exudate on tonsils
Correct Answer:
d. Exudate on tonsils
Explanation:
A peritonsillar abscess (PTA) is a deep neck space infection that typically presents with:
✅ Common findings:
, Muffled "hot potato" voice (a) due to oropharyngeal swelling.
Unilateral tonsillar enlargement with uvular deviation (b).
Trismus (difficulty opening the mouth) (c) due to inflammation and spasm of the
pterygoid muscles.
🚫 Not a specific finding for PTA:
Exudate on tonsils (d) is more commonly seen in bacterial pharyngitis (e.g.,
streptococcal pharyngitis) or infectious mononucleosis.
While there may be some tonsillar exudate in PTA, it is not a defining feature like the
other choices.
Question 5: Which of the following does not represent a risk factor for recurrent AOM in
younger children?
a. pacifier use after age 10 months
b. craniofacial abnormalities
c. exposure to second hand smoke
d. birth at 34 weeks gestation
Correct Answer:
d. Birth at 34 weeks gestation
Explanation:
Recurrent acute otitis media (AOM) is defined as ≥3 episodes in 6 months or ≥4 episodes in
12 months. Several risk factors increase susceptibility to middle ear infections in young
children.
✅ Risk factors for recurrent AOM include:
Pacifier use after 10 months (a): Prolonged pacifier use can lead to Eustachian tube
dysfunction, increasing AOM risk.
Craniofacial abnormalities (b): Conditions like cleft palate or Down syndrome impair
Eustachian tube function, predisposing children to infections.
Exposure to secondhand smoke (c): Tobacco smoke causes mucosal inflammation and
impaired ciliary function, increasing the risk of recurrent infections.
🚫 Birth at 34 weeks gestation (d) is not a direct risk factor for recurrent AOM.
While preterm birth may be associated with general immune immaturity, it is not
strongly linked to recurrent AOM unless accompanied by other risk factors (e.g., NICU
stay, prolonged intubation).
Question 6: Which of the following is a common cause of acquired coronary artery disease
during childhood?
a. Rheumatic fever
b. Hypertension
c. Systemic lupus erythematosus
d. Kawasaki disease
Correct Answer:
, d. Kawasaki disease
Explanation:
Kawasaki disease (KD) is the most common cause of acquired coronary artery disease
(CAD) in children. It is a vasculitis that primarily affects medium-sized arteries, including the
coronary arteries, leading to potential aneurysm formation and long-term cardiac
complications.
✅ Why Kawasaki disease?
It can cause coronary artery aneurysms, myocardial infarction, and ischemia if
untreated.
Early treatment with IVIG (intravenous immunoglobulin) and aspirin reduces the risk of
coronary complications.
🚫 Other options are less common causes of CAD in children:
Rheumatic fever (a) → Causes valvular heart disease (especially mitral stenosis), but
not coronary artery disease.
Hypertension (b) → Can lead to left ventricular hypertrophy, but does not typically
cause CAD in young children.
Systemic lupus erythematosus (SLE) (c) → Can cause vasculitis and pericarditis, but
coronary involvement is rare in childhood.
Question 7: A 8 year old is seen in a Urgent Care by the NP. The mother reports that her
child has had a fever X 2 days and is not eating well due to a sore throat and painful sores
inside her mouth. The child's temperature is 101F. During the exam the NP notices several
small blisters and shallow ulcers on the child's pharynx and the oral mucosa. The child has
round, red, rashes on both palms of hands and soles of her feet. Which of the following
conditions is most likely?
a. herpes simplex infection
b. hand, foot, and mouth disease
C. varicella infection
d. strep throat
Correct Answer:
b. Hand, foot, and mouth disease (HFMD)
Explanation:
The child's symptoms are most consistent with HFMD, a viral illness caused primarily by
Coxsackievirus A16 or Enterovirus 71. It is highly contagious, affecting children under 10
years old, and is characterized by:
✅ Key Features of HFMD:
Fever (101°F in this case) for 2-3 days.
Painful oral lesions (small blisters and shallow ulcers on the pharynx and oral mucosa).
Red maculopapular rash with vesicles on the palms and soles (a hallmark of HFMD).
🚫 Why Not the Other Options?
