RNSG 6435: ATOPIC, RHEUMATIC, AND
IMMUNODEFICIENCY DISORDERS EXAM
WITH EXPLAINED ANSWERS
1. A toddler is receiving long-term antibiotics to treat osteomyelitis. Which
laboratory test will the primary care pediatric nurse practitioner order to
monitor response to therapy in this child?
a. Blood cultures
b. Erythrocyte sedimentation rate (ESR)
c. Serum procalcitonin (Pro-CT)
d. White blood count (WBC)
ANS: B
ESR is a late measure of inflammation and is useful in helping monitor
response to therapy, especially when long-term antibiotics are used. Blood
cultures will most likely be negative during antibiotic treatment. Pro-CT is
used to differentiate viral from bacterial infections. The WBC will most likely
decrease over time with a treated infection and is not useful for monitoring
response to therapy.
2. A 3-year-old child whose immunizations are up-to-date 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. Administer the MMR vaccine to help prevent disease.
b. Give antiviral medications at the first sign of symptoms.
c. Give the child a dose of immune globulin to mitigate the response.
d. Reassure the parent that most exposed children will not get measles.
,ANS: A
The measles vaccine can be given to those exposed if given within 72 hours
of exposure. IG may be given in those without prior measles vaccine.
Antiviral medications are not effective. Nine of 10 children who are
unimmunized or under-immunized will contract the disease if exposed.
3. An 18-month-old 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?
a. Consider therapy with rimantadine.
b. Hospitalize for supportive treatment.
c. Prescribe oseltamivir and follow closely
d. Wait for cultures to determine treatment.
,ANS: C
A negative rapid viral culture should not be the determining factor when
deciding on a clinical course of treatment when influenza is suspected.
Children under age 2 years should be treated with antiviral medications.
Rimantadine is not recommended unless susceptibility is reliable; cultures
will not be confirmed for several days. It is not necessary to hospitalize
unless the child has signs of respiratory distress or cardiac involvement.
Antivirals should be initiated within 72 hours of onset of symptoms.
4. When reviewing a white blood cell (WBC) count, the primary care pediatric
nurse practitioner suspects a viral infection when which WBC element is
elevated?
a. Bands
b. Leukocytes
c. Lymphocytes
d. Neutrophils
ANS: C
Lymphocytes are usually elevated during viral infections. Bands and
neutrophils are generally elevated with bacterial infections. Leukocytes
comprise all WBCs and are usually, although not always, elevated during
bacterial infections.
5. A 5-year-old child who received VariZIG after exposure to varicella
while immunocompromised during chemotherapy is in the clinic 5
months after stopping chemotherapy for kindergarten vaccines. What
will the primary care pediatric nurse practitioner order for this child?
a. MMR and Tdap
b. MMR, Varivax, Tdap
c. Tdap only
d. Varivax and Tdap
, ANS: B
This child is eligible for all three vaccines. Varivax should be given 5 months
after VariZIG, unless varicella disease occurred despite VariZIG
administration.
6. A 7-year-old child whose immunizations are up-to-date has a fever,
headache, stiff neck, and photophobia. What course of treatment is
indicated?
a. Empiric treatment with oral antibiotics or intramuscular ceftriaxone
b. Hospitalization for diagnosis and treatment with antibiotics
c. Immediate vaccination with meningococcal vaccine
d. Outpatient lab work, including a CBC and blood and CSF cultures
ANS: B
Any child suspected of having meningococcal meningitis should be
hospitalized immediately with IV antibiotics started pending cultures. Empiric
treatment is not indicated. Vaccination is not helpful once the disease has
started. Outpatient lab
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
IMMUNODEFICIENCY DISORDERS EXAM
WITH EXPLAINED ANSWERS
1. A toddler is receiving long-term antibiotics to treat osteomyelitis. Which
laboratory test will the primary care pediatric nurse practitioner order to
monitor response to therapy in this child?
a. Blood cultures
b. Erythrocyte sedimentation rate (ESR)
c. Serum procalcitonin (Pro-CT)
d. White blood count (WBC)
ANS: B
ESR is a late measure of inflammation and is useful in helping monitor
response to therapy, especially when long-term antibiotics are used. Blood
cultures will most likely be negative during antibiotic treatment. Pro-CT is
used to differentiate viral from bacterial infections. The WBC will most likely
decrease over time with a treated infection and is not useful for monitoring
response to therapy.
2. A 3-year-old child whose immunizations are up-to-date 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. Administer the MMR vaccine to help prevent disease.
b. Give antiviral medications at the first sign of symptoms.
c. Give the child a dose of immune globulin to mitigate the response.
d. Reassure the parent that most exposed children will not get measles.
,ANS: A
The measles vaccine can be given to those exposed if given within 72 hours
of exposure. IG may be given in those without prior measles vaccine.
Antiviral medications are not effective. Nine of 10 children who are
unimmunized or under-immunized will contract the disease if exposed.
3. An 18-month-old 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?
a. Consider therapy with rimantadine.
b. Hospitalize for supportive treatment.
c. Prescribe oseltamivir and follow closely
d. Wait for cultures to determine treatment.
,ANS: C
A negative rapid viral culture should not be the determining factor when
deciding on a clinical course of treatment when influenza is suspected.
Children under age 2 years should be treated with antiviral medications.
Rimantadine is not recommended unless susceptibility is reliable; cultures
will not be confirmed for several days. It is not necessary to hospitalize
unless the child has signs of respiratory distress or cardiac involvement.
Antivirals should be initiated within 72 hours of onset of symptoms.
4. When reviewing a white blood cell (WBC) count, the primary care pediatric
nurse practitioner suspects a viral infection when which WBC element is
elevated?
a. Bands
b. Leukocytes
c. Lymphocytes
d. Neutrophils
ANS: C
Lymphocytes are usually elevated during viral infections. Bands and
neutrophils are generally elevated with bacterial infections. Leukocytes
comprise all WBCs and are usually, although not always, elevated during
bacterial infections.
5. A 5-year-old child who received VariZIG after exposure to varicella
while immunocompromised during chemotherapy is in the clinic 5
months after stopping chemotherapy for kindergarten vaccines. What
will the primary care pediatric nurse practitioner order for this child?
a. MMR and Tdap
b. MMR, Varivax, Tdap
c. Tdap only
d. Varivax and Tdap
, ANS: B
This child is eligible for all three vaccines. Varivax should be given 5 months
after VariZIG, unless varicella disease occurred despite VariZIG
administration.
6. A 7-year-old child whose immunizations are up-to-date has a fever,
headache, stiff neck, and photophobia. What course of treatment is
indicated?
a. Empiric treatment with oral antibiotics or intramuscular ceftriaxone
b. Hospitalization for diagnosis and treatment with antibiotics
c. Immediate vaccination with meningococcal vaccine
d. Outpatient lab work, including a CBC and blood and CSF cultures
ANS: B
Any child suspected of having meningococcal meningitis should be
hospitalized immediately with IV antibiotics started pending cultures. Empiric
treatment is not indicated. Vaccination is not helpful once the disease has
started. Outpatient lab
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
