NUR 6130 EXAM 1 COMPLETE QUESTIONS
AND 100% VERIFIED ANSWERS
Question 1
A 6-year-old presents with fever for 5 days, bilateral conjunctival injection, cracked
red lips, a strawberry tongue, and a polymorphous truncal rash. Which of the
following is the most likely diagnosis?
a. Measles
b. Kawasaki disease
c. Scarlet fever
d. Stevens-Johnson syndrome
Correct Answer: b. Kawasaki disease
Rationale: Kawasaki disease is diagnosed clinically by prolonged fever (≥5 days)
plus at least 4 of 5 classic criteria: bilateral conjunctival injection, oral mucous
membrane changes (cracked lips, strawberry tongue), rash, extremity changes,
and cervical lymphadenopathy. Measles presents with cough, coryza, and
conjunctivitis with Koplik spots. Scarlet fever causes sandpaper rash and
pharyngitis. Stevens-Johnson syndrome involves mucosal ulceration and target
lesions.
Question 2
A 4-year-old is diagnosed with Kawasaki disease. An echocardiogram is ordered.
What is the primary cardiac complication the NP is monitoring for?
,a. Myocarditis
b. Coronary artery aneurysms
c. Aortic stenosis
d. Pericardial effusion
Correct Answer: b. Coronary artery aneurysms
Rationale: The most significant long-term complication of Kawasaki disease is the
development of coronary artery aneurysms due to vasculitis of the medium-sized
arteries. Myocarditis and pericardial effusion can occur acutely but are not the
primary concern. Aortic stenosis is not associated with Kawasaki disease.
Question 3
A 2-year-old presents with fever for 4 days, irritability, bilateral conjunctivitis
without discharge, and a rash. The NP suspects incomplete Kawasaki disease.
What is the most appropriate next step?
a. Prescribe oral amoxicillin and follow up in 48 hours
b. Order an ESR and CRP, and obtain an echocardiogram
c. Refer to dermatology for skin biopsy
d. Reassure the parents and send home with antipyretics
Correct Answer: b. Order an ESR and CRP, and obtain an echocardiogram
Rationale: In incomplete Kawasaki disease, laboratory markers of inflammation
(ESR, CRP) and echocardiography to assess for coronary artery changes are
essential for diagnosis. Treatment should not be delayed if criteria are met.
Antibiotics are not indicated. Reassurance alone risks missing coronary
complications.
Question 4
A 5-year-old with Kawasaki disease is started on IVIG and high-dose aspirin. What
is the purpose of the aspirin in this setting?
,a. Antipyretic effect only
b. Anti-inflammatory and antiplatelet effects to prevent thrombosis
c. Pain relief for arthralgias
d. To reduce the risk of Reye's syndrome
Correct Answer: b. Anti-inflammatory and antiplatelet effects to prevent
thrombosis
Rationale: In Kawasaki disease, high-dose aspirin is used for its anti-inflammatory
effect during the acute phase, followed by low-dose aspirin for its antiplatelet
effect to prevent coronary artery thrombosis. Antipyretic and analgesic effects are
secondary. Reye's syndrome is a concern with aspirin use in viral illnesses, but in
Kawasaki disease, the benefits outweigh risks.
Question 5
A 7-year-old has a history of Kawasaki disease treated 6 weeks ago. The mother
asks about exercise restrictions. What should the NP advise?
a. No restrictions; the child can return to full activity
b. Avoid contact sports for 6 months
c. Activity restrictions depend on echocardiogram findings and coronary artery
status
d. Lifetime restriction from all competitive sports
Correct Answer: c. Activity restrictions depend on echocardiogram findings and
coronary artery status
Rationale: After Kawasaki disease, activity recommendations are based on the
presence or absence of coronary artery abnormalities. Patients with normal
echocardiograms have no restrictions. Those with aneurysms may need activity
modifications to reduce risk of thrombosis or rupture. Lifelong restrictions are not
indicated for all patients.
, Question 6
Which of the following is a common cause of acquired coronary artery disease
during childhood?
a. Rheumatic fever
b. Hypertension
c. Systemic lupus erythematosus
d. Kawasaki disease
Correct Answer: d. Kawasaki disease
Rationale: Kawasaki disease is the leading cause of acquired coronary artery
disease in children in developed countries. It causes vasculitis leading to coronary
artery aneurysms, stenosis, and potential myocardial infarction. Rheumatic fever
causes valvular damage, not coronary artery disease. Hypertension and SLE are
rare causes in childhood.
Question 7
An 8-year-old is seen in Urgent Care. Mother reports fever x 2 days, poor eating
due to sore throat and painful mouth sores. Temp 101°F. Exam shows small
blisters and shallow ulcers on pharynx and oral mucosa, plus round red rashes
on palms and soles. Which condition is most likely?
a. Herpes simplex infection
b. Hand, foot, and mouth disease
c. Varicella infection
d. Strep throat
Correct Answer: b. Hand, foot, and mouth disease
Rationale: Hand, foot, and mouth disease (typically caused by Coxsackievirus A16)
presents with fever, oral enanthem (vesicles/ulcers on pharynx and oral mucosa),
and exanthem on palms and soles. Herpes simplex causes gingivostomatitis with
vesicles on lips and anterior mouth, not palms/soles. Varicella (chickenpox) is
AND 100% VERIFIED ANSWERS
Question 1
A 6-year-old presents with fever for 5 days, bilateral conjunctival injection, cracked
red lips, a strawberry tongue, and a polymorphous truncal rash. Which of the
following is the most likely diagnosis?
a. Measles
b. Kawasaki disease
c. Scarlet fever
d. Stevens-Johnson syndrome
Correct Answer: b. Kawasaki disease
Rationale: Kawasaki disease is diagnosed clinically by prolonged fever (≥5 days)
plus at least 4 of 5 classic criteria: bilateral conjunctival injection, oral mucous
membrane changes (cracked lips, strawberry tongue), rash, extremity changes,
and cervical lymphadenopathy. Measles presents with cough, coryza, and
conjunctivitis with Koplik spots. Scarlet fever causes sandpaper rash and
pharyngitis. Stevens-Johnson syndrome involves mucosal ulceration and target
lesions.
Question 2
A 4-year-old is diagnosed with Kawasaki disease. An echocardiogram is ordered.
What is the primary cardiac complication the NP is monitoring for?
,a. Myocarditis
b. Coronary artery aneurysms
c. Aortic stenosis
d. Pericardial effusion
Correct Answer: b. Coronary artery aneurysms
Rationale: The most significant long-term complication of Kawasaki disease is the
development of coronary artery aneurysms due to vasculitis of the medium-sized
arteries. Myocarditis and pericardial effusion can occur acutely but are not the
primary concern. Aortic stenosis is not associated with Kawasaki disease.
Question 3
A 2-year-old presents with fever for 4 days, irritability, bilateral conjunctivitis
without discharge, and a rash. The NP suspects incomplete Kawasaki disease.
What is the most appropriate next step?
a. Prescribe oral amoxicillin and follow up in 48 hours
b. Order an ESR and CRP, and obtain an echocardiogram
c. Refer to dermatology for skin biopsy
d. Reassure the parents and send home with antipyretics
Correct Answer: b. Order an ESR and CRP, and obtain an echocardiogram
Rationale: In incomplete Kawasaki disease, laboratory markers of inflammation
(ESR, CRP) and echocardiography to assess for coronary artery changes are
essential for diagnosis. Treatment should not be delayed if criteria are met.
Antibiotics are not indicated. Reassurance alone risks missing coronary
complications.
Question 4
A 5-year-old with Kawasaki disease is started on IVIG and high-dose aspirin. What
is the purpose of the aspirin in this setting?
,a. Antipyretic effect only
b. Anti-inflammatory and antiplatelet effects to prevent thrombosis
c. Pain relief for arthralgias
d. To reduce the risk of Reye's syndrome
Correct Answer: b. Anti-inflammatory and antiplatelet effects to prevent
thrombosis
Rationale: In Kawasaki disease, high-dose aspirin is used for its anti-inflammatory
effect during the acute phase, followed by low-dose aspirin for its antiplatelet
effect to prevent coronary artery thrombosis. Antipyretic and analgesic effects are
secondary. Reye's syndrome is a concern with aspirin use in viral illnesses, but in
Kawasaki disease, the benefits outweigh risks.
Question 5
A 7-year-old has a history of Kawasaki disease treated 6 weeks ago. The mother
asks about exercise restrictions. What should the NP advise?
a. No restrictions; the child can return to full activity
b. Avoid contact sports for 6 months
c. Activity restrictions depend on echocardiogram findings and coronary artery
status
d. Lifetime restriction from all competitive sports
Correct Answer: c. Activity restrictions depend on echocardiogram findings and
coronary artery status
Rationale: After Kawasaki disease, activity recommendations are based on the
presence or absence of coronary artery abnormalities. Patients with normal
echocardiograms have no restrictions. Those with aneurysms may need activity
modifications to reduce risk of thrombosis or rupture. Lifelong restrictions are not
indicated for all patients.
, Question 6
Which of the following is a common cause of acquired coronary artery disease
during childhood?
a. Rheumatic fever
b. Hypertension
c. Systemic lupus erythematosus
d. Kawasaki disease
Correct Answer: d. Kawasaki disease
Rationale: Kawasaki disease is the leading cause of acquired coronary artery
disease in children in developed countries. It causes vasculitis leading to coronary
artery aneurysms, stenosis, and potential myocardial infarction. Rheumatic fever
causes valvular damage, not coronary artery disease. Hypertension and SLE are
rare causes in childhood.
Question 7
An 8-year-old is seen in Urgent Care. Mother reports fever x 2 days, poor eating
due to sore throat and painful mouth sores. Temp 101°F. Exam shows small
blisters and shallow ulcers on pharynx and oral mucosa, plus round red rashes
on palms and soles. Which condition is most likely?
a. Herpes simplex infection
b. Hand, foot, and mouth disease
c. Varicella infection
d. Strep throat
Correct Answer: b. Hand, foot, and mouth disease
Rationale: Hand, foot, and mouth disease (typically caused by Coxsackievirus A16)
presents with fever, oral enanthem (vesicles/ulcers on pharynx and oral mucosa),
and exanthem on palms and soles. Herpes simplex causes gingivostomatitis with
vesicles on lips and anterior mouth, not palms/soles. Varicella (chickenpox) is
