,
,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. 200 mg
b. 250 mg
c. 400 mg
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. Administer an oral corticosteroid and repeat the three treatments
of the inhaled SABA.
b. Admit the child to the hospital for every 2 hour inhaled SABA and
intravenous steroids.
c. Give the child 2 mg/kg of an oral corticosteroid and have the
child taken to the emergency department.
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. Consider daily oral corticosteroid administration.
b. Order an anticholinergic medication in conjunction with the
current regimen.
c. Prescribe a LABA/inhaled corticosteroid combination medication.
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. Complete remission occurs in some children at the age of
puberty.
b. Periods of remission may occur but there is no permanent cure.
c. SLE can be cured with effective medication and treatment.
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
,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. 200 mg
b. 250 mg
c. 400 mg
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. Administer an oral corticosteroid and repeat the three treatments
of the inhaled SABA.
b. Admit the child to the hospital for every 2 hour inhaled SABA and
intravenous steroids.
c. Give the child 2 mg/kg of an oral corticosteroid and have the
child taken to the emergency department.
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. Consider daily oral corticosteroid administration.
b. Order an anticholinergic medication in conjunction with the
current regimen.
c. Prescribe a LABA/inhaled corticosteroid combination medication.
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. Complete remission occurs in some children at the age of
puberty.
b. Periods of remission may occur but there is no permanent cure.
c. SLE can be cured with effective medication and treatment.
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
