NSG 6435 QUESTIONS BANK WITH ANSWER
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 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.
,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.
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.
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 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.
,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.
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.
