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NSG6435 QUESTION BANK FOR FINAL EXAM,
MIDTERM EXAM, WEEK 1 TO WEEK 9 QUIZ
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 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.
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 associated with chest tightness each week and gets relief with an
albuterol metered-dose inhaler. What will the nurse practitioner order?
a. a. Allergy testing
b. b. Chest radiography
c. c. Spirometry testing
d. d. Sweat chloride test
ANS: C
Spirometry testing is the gold standard for diagnosing asthma and is then used on a regular basis
to monitor, evaluate, and manage asthma. Allergy testing should be considered but is not
diagnostic of asthma. Chest radiography should not be routine. A sweat chloride test is used
based on history.
1. 11. 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
a. a. enthesitis-related JIA.
b. b. oligoarticular JIA.
c. c. polyarticular JIA.
d. d. systemic JIA.
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