NURS6541 Exam 2 | NURS 6541 / NRNP 6541 Primary Care of Adolescents & Children |
Actual Q&A with Rationale | Walden University
1. A 4-year-old boy presents with 3 days of fever (Tmax 39.5°C), cough, and nasal
congestion. He has no history of wheezing. On exam, he has bilateral otitis media with
purulent effusion. He is up to date on vaccines. Which is the most appropriate antibiotic
choice?
A. Amoxicillin 90 mg/kg/day divided BID
B. Amoxicillin-clavulanate 45 mg/kg/day divided BID
C. Azithromycin 10 mg/kg on day 1, then 5 mg/kg for 4 days
D. Cefdinir 14 mg/kg/day divided BID
Correct Answer: A
Rationale: For uncomplicated acute otitis media in a child with no recent antibiotic
exposure and no severe symptoms, high-dose amoxicillin (80-90 mg/kg/day) is first-
line. Amoxicillin-clavulanate is reserved for treatment failure or severe illness.
Azithromycin is not first-line for AOM. Cefdinir is an alternative for penicillin allergy.
2. A 6-year-old girl with mild intermittent asthma presents with cough and wheezing
triggered by a viral URI. She has no respiratory distress, O2 sat 97%, and can speak in
full sentences. She has not used any medications in the past 3 months. What is the
most appropriate initial treatment?
A. Start low-dose inhaled corticosteroid (ICS) daily
B. Prescribe albuterol 2 puffs every 4-6 hours as needed
C. Start oral prednisolone 1 mg/kg/day for 5 days
D. Refer to pulmonology for spirometry
Correct Answer: B
Rationale: For mild intermittent asthma with an acute exacerbation triggered by URI,
short-acting beta-agonist (albuterol) as needed is appropriate. Daily ICS is not
indicated for intermittent asthma. Oral steroids are reserved for moderate-to-severe
exacerbations. Spirometry can be done later.
3. A 2-year-old boy presents with fever (39°C) for 2 days, drooling, and refusal to drink.
He has a hoarse cry and stridor when crying. He is sitting upright and leaning forward.
What is the most likely diagnosis?
A. Croup (laryngotracheobronchitis)
B. Epiglottitis
C. Bacterial tracheitis
,D. Retropharyngeal abscess
Correct Answer: B
Rationale: Epiglottitis presents with acute onset of fever, drooling, dysphagia, and
stridor, with the child sitting in the "tripod" position. Croup typically has a barking cough
and is less acute. Bacterial tracheitis has high fever and toxic appearance.
Retropharyngeal abscess presents with neck stiffness and refusal to move neck.
4. A 7-year-old boy with obesity (BMI >95th percentile) is noted to have acanthosis
nigricans on his neck and axillae. Fasting glucose is 110 mg/dL, HbA1c 6.0%. Which is the
most appropriate next step?
A. Start metformin 500 mg daily
B. Order a 2-hour oral glucose tolerance test (OGTT)
C. Recommend lifestyle modification and repeat HbA1c in 3 months
D. Refer to endocrinology for insulin therapy
Correct Answer: B
Rationale: Acanthosis nigricans suggests insulin resistance. With HbA1c 6.0%
(prediabetes range), an OGTT is recommended to confirm impaired glucose tolerance
or type 2 diabetes. Metformin may be indicated after diagnosis, but further testing is
needed first. Lifestyle modification is important but not the next diagnostic step.
5. A 3-year-old girl presents with acute onset of ear pain and fever. On exam, the left
tympanic membrane is bulging, erythematous, and has decreased mobility. She has no
known drug allergies. She has not had antibiotics in the past month. What is the most
appropriate first-line antibiotic?
A. Amoxicillin 80-90 mg/kg/day divided BID for 10 days
B. Amoxicillin-clavulanate 90 mg/kg/day divided BID for 10 days
C. Cefdinir 14 mg/kg/day divided BID for 5 days
D. Azithromycin 10 mg/kg on day 1, then 5 mg/kg for 4 days
Correct Answer: A
Rationale: High-dose amoxicillin is first-line for acute otitis media in children without
recent antibiotic use or severe illness. The 10-day course is recommended for children
under 6 years. Amoxicillin-clavulanate is reserved for treatment failure or severe
disease.
6. A 14-year-old female presents with painful urination, urinary frequency, and
suprapubic discomfort for 2 days. She is sexually active. Urinalysis shows positive
nitrites and leukocyte esterase. What is the most appropriate antibiotic?
, A. Nitrofurantoin 100 mg BID for 5 days
B. Ciprofloxacin 500 mg BID for 3 days
C. Trimethoprim-sulfamethoxazole 1 DS tab BID for 3 days
D. Amoxicillin 500 mg TID for 7 days
Correct Answer: C
Rationale: For uncomplicated UTI in adolescents, TMP-SMX is first-line if local
resistance is <20%. Nitrofurantoin is also appropriate but less effective for
pyelonephritis. Ciprofloxacin is reserved for complicated cases due to side effects.
Amoxicillin has high resistance rates.
7. A 5-year-old boy presents with a 2-day history of fever, sore throat, and a
sandpaper-like rash on his trunk. He has a beefy red tongue and cervical
lymphadenopathy. Rapid strep test is positive. What is the most appropriate
treatment?
A. Amoxicillin 50 mg/kg/day divided BID for 10 days
B. Penicillin V 250 mg BID for 10 days
C. Azithromycin 10 mg/kg on day 1, then 5 mg/kg for 4 days
D. Cephalexin 40 mg/kg/day divided TID for 10 days
Correct Answer: B
Rationale: Penicillin V is first-line for group A streptococcal pharyngitis. Amoxicillin is
also acceptable but penicillin is preferred. Azithromycin is a second-line option for
penicillin allergy. Cephalexin is an alternative but not first-line.
8. A 9-month-old infant presents with fever (39°C) for 3 days, rhinorrhea, and cough.
On day 4, the fever resolves and a pink, maculopapular rash appears on the trunk and
spreads to extremities. The infant is playful and eating well. What is the most likely
diagnosis?
A. Measles
B. Roseola (exanthem subitum)
C. Rubella
D. Scarlet fever
Correct Answer: B
Rationale: Roseola (human herpesvirus 6) typically presents with high fever for 3-5
days followed by a rash that appears after defervescence. The child is well-appearing.
Measles has cough, coryza, conjunctivitis, and Koplik spots. Rubella has
lymphadenopathy. Scarlet fever has sandpaper rash and strep pharyngitis.
Actual Q&A with Rationale | Walden University
1. A 4-year-old boy presents with 3 days of fever (Tmax 39.5°C), cough, and nasal
congestion. He has no history of wheezing. On exam, he has bilateral otitis media with
purulent effusion. He is up to date on vaccines. Which is the most appropriate antibiotic
choice?
A. Amoxicillin 90 mg/kg/day divided BID
B. Amoxicillin-clavulanate 45 mg/kg/day divided BID
C. Azithromycin 10 mg/kg on day 1, then 5 mg/kg for 4 days
D. Cefdinir 14 mg/kg/day divided BID
Correct Answer: A
Rationale: For uncomplicated acute otitis media in a child with no recent antibiotic
exposure and no severe symptoms, high-dose amoxicillin (80-90 mg/kg/day) is first-
line. Amoxicillin-clavulanate is reserved for treatment failure or severe illness.
Azithromycin is not first-line for AOM. Cefdinir is an alternative for penicillin allergy.
2. A 6-year-old girl with mild intermittent asthma presents with cough and wheezing
triggered by a viral URI. She has no respiratory distress, O2 sat 97%, and can speak in
full sentences. She has not used any medications in the past 3 months. What is the
most appropriate initial treatment?
A. Start low-dose inhaled corticosteroid (ICS) daily
B. Prescribe albuterol 2 puffs every 4-6 hours as needed
C. Start oral prednisolone 1 mg/kg/day for 5 days
D. Refer to pulmonology for spirometry
Correct Answer: B
Rationale: For mild intermittent asthma with an acute exacerbation triggered by URI,
short-acting beta-agonist (albuterol) as needed is appropriate. Daily ICS is not
indicated for intermittent asthma. Oral steroids are reserved for moderate-to-severe
exacerbations. Spirometry can be done later.
3. A 2-year-old boy presents with fever (39°C) for 2 days, drooling, and refusal to drink.
He has a hoarse cry and stridor when crying. He is sitting upright and leaning forward.
What is the most likely diagnosis?
A. Croup (laryngotracheobronchitis)
B. Epiglottitis
C. Bacterial tracheitis
,D. Retropharyngeal abscess
Correct Answer: B
Rationale: Epiglottitis presents with acute onset of fever, drooling, dysphagia, and
stridor, with the child sitting in the "tripod" position. Croup typically has a barking cough
and is less acute. Bacterial tracheitis has high fever and toxic appearance.
Retropharyngeal abscess presents with neck stiffness and refusal to move neck.
4. A 7-year-old boy with obesity (BMI >95th percentile) is noted to have acanthosis
nigricans on his neck and axillae. Fasting glucose is 110 mg/dL, HbA1c 6.0%. Which is the
most appropriate next step?
A. Start metformin 500 mg daily
B. Order a 2-hour oral glucose tolerance test (OGTT)
C. Recommend lifestyle modification and repeat HbA1c in 3 months
D. Refer to endocrinology for insulin therapy
Correct Answer: B
Rationale: Acanthosis nigricans suggests insulin resistance. With HbA1c 6.0%
(prediabetes range), an OGTT is recommended to confirm impaired glucose tolerance
or type 2 diabetes. Metformin may be indicated after diagnosis, but further testing is
needed first. Lifestyle modification is important but not the next diagnostic step.
5. A 3-year-old girl presents with acute onset of ear pain and fever. On exam, the left
tympanic membrane is bulging, erythematous, and has decreased mobility. She has no
known drug allergies. She has not had antibiotics in the past month. What is the most
appropriate first-line antibiotic?
A. Amoxicillin 80-90 mg/kg/day divided BID for 10 days
B. Amoxicillin-clavulanate 90 mg/kg/day divided BID for 10 days
C. Cefdinir 14 mg/kg/day divided BID for 5 days
D. Azithromycin 10 mg/kg on day 1, then 5 mg/kg for 4 days
Correct Answer: A
Rationale: High-dose amoxicillin is first-line for acute otitis media in children without
recent antibiotic use or severe illness. The 10-day course is recommended for children
under 6 years. Amoxicillin-clavulanate is reserved for treatment failure or severe
disease.
6. A 14-year-old female presents with painful urination, urinary frequency, and
suprapubic discomfort for 2 days. She is sexually active. Urinalysis shows positive
nitrites and leukocyte esterase. What is the most appropriate antibiotic?
, A. Nitrofurantoin 100 mg BID for 5 days
B. Ciprofloxacin 500 mg BID for 3 days
C. Trimethoprim-sulfamethoxazole 1 DS tab BID for 3 days
D. Amoxicillin 500 mg TID for 7 days
Correct Answer: C
Rationale: For uncomplicated UTI in adolescents, TMP-SMX is first-line if local
resistance is <20%. Nitrofurantoin is also appropriate but less effective for
pyelonephritis. Ciprofloxacin is reserved for complicated cases due to side effects.
Amoxicillin has high resistance rates.
7. A 5-year-old boy presents with a 2-day history of fever, sore throat, and a
sandpaper-like rash on his trunk. He has a beefy red tongue and cervical
lymphadenopathy. Rapid strep test is positive. What is the most appropriate
treatment?
A. Amoxicillin 50 mg/kg/day divided BID for 10 days
B. Penicillin V 250 mg BID for 10 days
C. Azithromycin 10 mg/kg on day 1, then 5 mg/kg for 4 days
D. Cephalexin 40 mg/kg/day divided TID for 10 days
Correct Answer: B
Rationale: Penicillin V is first-line for group A streptococcal pharyngitis. Amoxicillin is
also acceptable but penicillin is preferred. Azithromycin is a second-line option for
penicillin allergy. Cephalexin is an alternative but not first-line.
8. A 9-month-old infant presents with fever (39°C) for 3 days, rhinorrhea, and cough.
On day 4, the fever resolves and a pink, maculopapular rash appears on the trunk and
spreads to extremities. The infant is playful and eating well. What is the most likely
diagnosis?
A. Measles
B. Roseola (exanthem subitum)
C. Rubella
D. Scarlet fever
Correct Answer: B
Rationale: Roseola (human herpesvirus 6) typically presents with high fever for 3-5
days followed by a rash that appears after defervescence. The child is well-appearing.
Measles has cough, coryza, conjunctivitis, and Koplik spots. Rubella has
lymphadenopathy. Scarlet fever has sandpaper rash and strep pharyngitis.
