Burns: Pediatric Primary Care, 6th Edition
Burns: Pediatric Primary Care, 6th Edition
Chapter 25: Atopic, Rheumatic, and Immunodeficiency Disorders
Test Bank
Multiple Choice
1. 1. The parent of a school-age child reports that the child usually has
allergic rhinitis symptoms beginning each fall and that non-sedating
antihistamines are only marginally effective, especially for nasal
obstruction symptoms. What will the primary care pediatric nurse
practitioner do?
a. a. Order an intranasal corticosteroid to begin 1 to 2 weeks prior to
pollen season.
b. b. Prescribe a decongestant medication as adjunct therapy during
pollen season.
c. c. Recommend adding diphenhydramine to the child’s regimen for
additional relief.
d. d. Suggest using an over-the-counter intranasal decongestant.
ANS: A
Intranasal corticosteroids are a key component in long-term therapy to
manage symptoms associated with AR. These should be begun 1 to 2 weeks
prior to the beginning of pollen season. Decongestants are not
recommended for long-term use because of side effects. Diphenhydramine
causes daytime drowsiness.
1. 2. The primary care pediatric nurse practitioner sees a child for follow-up
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?
a. a. Aspirin is given for 2 weeks and then tapered to discontinue the
medication.
b. b. Prophylactic amoxicillin will need to be given for 5 years.
c. c. Steroids will be necessary to prevent development of heart
disease.
d. d. The child will need complete bedrest until all symptoms subside.
ANS: A
ASA is given for arthritis for 2 weeks and then will be tapered. Children with
ARF will need penicillin prophylaxis, not amoxicillin. Steroids are sometimes
,Burns: Pediatric Primary Care, 6th Edition
used for symptomatic relief but do not prevent chronic heart disease. Bed
rest is indicated only when cardiac symptoms occur.
1. 3. A school-age 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 FEV1 less than 70% of personal best. The primary
care pediatric nurse practitioner learns that the child’s parent administers
the daily medium-dose 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?
a. a. Have the parent administer all of the child’s medications.
b. b. Increase the ICS medication to a high-dose preparation.
c. c. Reinforce teaching about the importance of using the SABA.
d. d. Teach the child and parent how to use home PEF monitoring.
ANS: D
Home PEF monitoring is useful for children to identify when symptoms are
worsening. This child does not appear to notice the presence of airway
tightness or wheezing and so might benefit from PEF monitoring to know
when to use the SABA. School-age children should be learning how to
manage their chronic disease, so having the parent administer all
medications is not the best choice, especially since use of the SABA is still
dependent on the child’s report of symptoms. Since the child responded well
to administration of the SABA, increasing the dose of ICS should not be done
unless better management is not effective. Reinforcing the teaching is part of
the plan but, unless the child is aware of symptoms, may not occur.
1. 4. 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?
a. a. Anti-DNase B test
b. b. ASO titer
c. c. Rapid strep test
d. d. Throat culture
ANS: B
This child has symptoms and a history consistent with ARF. The ASO titer
peaks in 3 to 6 weeks and will confirm a recent strep infection. The anti-
DNase B test will also confirm a recent strep infection, but this doesn’t
peak until 6 to 8 weeks after the initial infection. A rapid strep test and
throat culture do not differentiate the carrier state from a true infection.
,Burns: Pediatric Primary Care, 6th Edition
1. 5. 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?
a. a. 200 mg
b. b. 250 mg
c. c. 400 mg
d. d. 450 mg
ANS: B
The maximum dose is 40 mg/kg/day divided into 3 to 4 doses. 25 kg ×
40 mg = 1000/4 = 250 mg.
1. 6. A school-age 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 short-acting 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?
a. a. Administer an oral corticosteroid and repeat the three treatments
of the inhaled SABA.
b. b. Admit the child to the hospital for every 2 hour inhaled SABA
and intravenous steroids.
c. c. Give the child 2 mg/kg of an oral corticosteroid and have the
child taken to the emergency department.
d. d. Order an oral corticosteroid, continue the SABA every 3 to 4
hours, and follow closely.
ANS: D
Children with an incomplete response (FEV1 between 40% and 69% of
personal best) should be given oral steroids and instructed to continue the
SABA every 3 to 4 hours with close follow-up. Hospitalization is not
necessary unless severe distress occurs. An FEV1 less than 40% after
treatment indicates a need to be seen in the ED.
1. 7. An adolescent who has asthma and severe perennial allergies has poor
asthma control in spite of appropriate use of a SABA and a daily high-dose
inhaled corticosteroid. What will the primary care pediatric nurse
practitioner do next to manage this child’s asthma?
a. a. Consider daily oral corticosteroid administration.
b. b. Order an anticholinergic medication in conjunction with the
current regimen.
c. c. Prescribe a LABA/inhaled corticosteroid combination medication.
d. d. Refer to a pulmonologist for omalizumab therapy.
, Burns: Pediatric Primary Care, 6th Edition
ANS: D
Children older than 12 years who have moderate to severe allergy-related
asthma and who react to perennial allergens may benefit from omalizumab
as a second-line treatment when symptoms are not controlled by ICSs. The
PNP should refer children to a pulmonologist for such treatment. Daily oral
corticosteroid medications are not recommended because of the adverse
effects caused by prolonged use of this route. Anticholinergic medications
are generally used for acute exacerbations during in-patient stays or in the
ED. A LABA/ICS combination will not produce different results.
1. 8. A 4-month-old infant has a history of reddened, dry, itchy skin. The
primary care pediatric nurse practitioner notes fine papules on the
extensor aspect of the infant’s arms, anterior thighs, and lateral aspects
of the cheeks. What is the initial treatment?
a. a. Moisturizers
b. b. Oral antihistamines
c. c. Topical corticosteroids
d. d. Wet wrap therapy
ANS: A
Moisturization is the first-line therapy to interrupt the itch-scratch-itch cycle.
Oral antihistamines are used mostly to allow sleep during nighttime pruritus.
Topical corticosteroids are used if moisturization is not effective. Wet wrap
therapy is used to treat flares with recalcitrant disease.
1. 9. An 8-year-old 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?
a. a. Complete remission occurs in some children at the age of
puberty.
b. b. Periods of remission may occur but there is no permanent cure.
c. c. SLE can be cured with effective medication and treatment.
d. d. The disease is always progressive with no cure and no
remissions.
ANS: B
Periods of remission do occur in some children with SLE for unknown reasons,
but there is no permanent remission or cure. For some children with Juvenile
Idiopathic Arthritis (JIA), complete remission occurs at puberty.
1. 10. The primary care pediatric nurse practitioner is examining a school-
age child who has had several hospitalizations for bronchitis and wheezing.
The parent reports that the child has several coughing episodes
Burns: Pediatric Primary Care, 6th Edition
Chapter 25: Atopic, Rheumatic, and Immunodeficiency Disorders
Test Bank
Multiple Choice
1. 1. The parent of a school-age child reports that the child usually has
allergic rhinitis symptoms beginning each fall and that non-sedating
antihistamines are only marginally effective, especially for nasal
obstruction symptoms. What will the primary care pediatric nurse
practitioner do?
a. a. Order an intranasal corticosteroid to begin 1 to 2 weeks prior to
pollen season.
b. b. Prescribe a decongestant medication as adjunct therapy during
pollen season.
c. c. Recommend adding diphenhydramine to the child’s regimen for
additional relief.
d. d. Suggest using an over-the-counter intranasal decongestant.
ANS: A
Intranasal corticosteroids are a key component in long-term therapy to
manage symptoms associated with AR. These should be begun 1 to 2 weeks
prior to the beginning of pollen season. Decongestants are not
recommended for long-term use because of side effects. Diphenhydramine
causes daytime drowsiness.
1. 2. The primary care pediatric nurse practitioner sees a child for follow-up
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?
a. a. Aspirin is given for 2 weeks and then tapered to discontinue the
medication.
b. b. Prophylactic amoxicillin will need to be given for 5 years.
c. c. Steroids will be necessary to prevent development of heart
disease.
d. d. The child will need complete bedrest until all symptoms subside.
ANS: A
ASA is given for arthritis for 2 weeks and then will be tapered. Children with
ARF will need penicillin prophylaxis, not amoxicillin. Steroids are sometimes
,Burns: Pediatric Primary Care, 6th Edition
used for symptomatic relief but do not prevent chronic heart disease. Bed
rest is indicated only when cardiac symptoms occur.
1. 3. A school-age 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 FEV1 less than 70% of personal best. The primary
care pediatric nurse practitioner learns that the child’s parent administers
the daily medium-dose 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?
a. a. Have the parent administer all of the child’s medications.
b. b. Increase the ICS medication to a high-dose preparation.
c. c. Reinforce teaching about the importance of using the SABA.
d. d. Teach the child and parent how to use home PEF monitoring.
ANS: D
Home PEF monitoring is useful for children to identify when symptoms are
worsening. This child does not appear to notice the presence of airway
tightness or wheezing and so might benefit from PEF monitoring to know
when to use the SABA. School-age children should be learning how to
manage their chronic disease, so having the parent administer all
medications is not the best choice, especially since use of the SABA is still
dependent on the child’s report of symptoms. Since the child responded well
to administration of the SABA, increasing the dose of ICS should not be done
unless better management is not effective. Reinforcing the teaching is part of
the plan but, unless the child is aware of symptoms, may not occur.
1. 4. 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?
a. a. Anti-DNase B test
b. b. ASO titer
c. c. Rapid strep test
d. d. Throat culture
ANS: B
This child has symptoms and a history consistent with ARF. The ASO titer
peaks in 3 to 6 weeks and will confirm a recent strep infection. The anti-
DNase B test will also confirm a recent strep infection, but this doesn’t
peak until 6 to 8 weeks after the initial infection. A rapid strep test and
throat culture do not differentiate the carrier state from a true infection.
,Burns: Pediatric Primary Care, 6th Edition
1. 5. 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?
a. a. 200 mg
b. b. 250 mg
c. c. 400 mg
d. d. 450 mg
ANS: B
The maximum dose is 40 mg/kg/day divided into 3 to 4 doses. 25 kg ×
40 mg = 1000/4 = 250 mg.
1. 6. A school-age 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 short-acting 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?
a. a. Administer an oral corticosteroid and repeat the three treatments
of the inhaled SABA.
b. b. Admit the child to the hospital for every 2 hour inhaled SABA
and intravenous steroids.
c. c. Give the child 2 mg/kg of an oral corticosteroid and have the
child taken to the emergency department.
d. d. Order an oral corticosteroid, continue the SABA every 3 to 4
hours, and follow closely.
ANS: D
Children with an incomplete response (FEV1 between 40% and 69% of
personal best) should be given oral steroids and instructed to continue the
SABA every 3 to 4 hours with close follow-up. Hospitalization is not
necessary unless severe distress occurs. An FEV1 less than 40% after
treatment indicates a need to be seen in the ED.
1. 7. An adolescent who has asthma and severe perennial allergies has poor
asthma control in spite of appropriate use of a SABA and a daily high-dose
inhaled corticosteroid. What will the primary care pediatric nurse
practitioner do next to manage this child’s asthma?
a. a. Consider daily oral corticosteroid administration.
b. b. Order an anticholinergic medication in conjunction with the
current regimen.
c. c. Prescribe a LABA/inhaled corticosteroid combination medication.
d. d. Refer to a pulmonologist for omalizumab therapy.
, Burns: Pediatric Primary Care, 6th Edition
ANS: D
Children older than 12 years who have moderate to severe allergy-related
asthma and who react to perennial allergens may benefit from omalizumab
as a second-line treatment when symptoms are not controlled by ICSs. The
PNP should refer children to a pulmonologist for such treatment. Daily oral
corticosteroid medications are not recommended because of the adverse
effects caused by prolonged use of this route. Anticholinergic medications
are generally used for acute exacerbations during in-patient stays or in the
ED. A LABA/ICS combination will not produce different results.
1. 8. A 4-month-old infant has a history of reddened, dry, itchy skin. The
primary care pediatric nurse practitioner notes fine papules on the
extensor aspect of the infant’s arms, anterior thighs, and lateral aspects
of the cheeks. What is the initial treatment?
a. a. Moisturizers
b. b. Oral antihistamines
c. c. Topical corticosteroids
d. d. Wet wrap therapy
ANS: A
Moisturization is the first-line therapy to interrupt the itch-scratch-itch cycle.
Oral antihistamines are used mostly to allow sleep during nighttime pruritus.
Topical corticosteroids are used if moisturization is not effective. Wet wrap
therapy is used to treat flares with recalcitrant disease.
1. 9. An 8-year-old 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?
a. a. Complete remission occurs in some children at the age of
puberty.
b. b. Periods of remission may occur but there is no permanent cure.
c. c. SLE can be cured with effective medication and treatment.
d. d. The disease is always progressive with no cure and no
remissions.
ANS: B
Periods of remission do occur in some children with SLE for unknown reasons,
but there is no permanent remission or cure. For some children with Juvenile
Idiopathic Arthritis (JIA), complete remission occurs at puberty.
1. 10. The primary care pediatric nurse practitioner is examining a school-
age child who has had several hospitalizations for bronchitis and wheezing.
The parent reports that the child has several coughing episodes
