NU 664 Exam 1 with precise detailed
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solutions
Gold standard for CAP diagnosis: - Correct answer ✔Chest x-ray
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If CAP symptoms present but no obvious signs of infection on CXR treatment is... -
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Correct answer ✔Same as if CXR was positive
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Immunizations for people over 65 or younger people with comorbidities such as asthma,
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CHF COPD: - Correct answer ✔Pneumonia and flu vaccines
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Who is at risk for CAP? - Correct answer ✔Extremes of age, smokers, alcoholics, GERD,
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chronic disease, institutionalization
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CAP presentation in adults: - Correct answer ✔Cough (may be nonproductive), dyspnea,
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fever, hemoptysis, chest pain, fatigue, tachycardia
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If lymphocytes are elevated? - Correct answer ✔Indicative of viral process
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If monocytes are elevated? - Correct answer ✔Indicative of chronic process
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If eosinophils are elevated? - Correct answer ✔Indicative of asthma, allergic reaction
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If basophils are elevated? - Correct answer ✔Indicative of chronic process
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If neutrophils are elevated? - Correct answer ✔Indicative of acute bacterial process
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,CAP: patient present with symptoms of chills, fever, chest pain, productive cough with
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purulent sputum, positive chest x-ray, and patient had URI last week? - Correct answer
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✔Streptococcus pneumonia: gram + |! |! |!
In the United States, the most common cause of myocarditis in children is: - Correct
|! |! |! |! |! |! |! |! |! |! |! |! |! |! |!
answer ✔Viruses |!
Your next patient is a 5-year-old child with a history of moderate persistent asthma. He
|! |! |! |! |! |! |! |! |! |! |! |! |! |! |!
has been wheezing and coughing for the past two days, and his mother brings him in
|! |! |! |! |! |! |! |! |! |! |! |! |! |! |! |!
today for evaluation. He has been using albuterol every four hours. His respiratory rate is
|! |! |! |! |! |! |! |! |! |! |! |! |! |! |!
13 breaths per minute; his lungs are clear to auscultation; and no retractions are noted.
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What may be your assessment and intervention based on this information? - Correct
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answer ✔Your child is breathing slower than normal for his age. We need to send him to
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the ER for further intervention.
|! |! |! |! |!
Your next patient is a 6-year-old male here for his annual influenza vaccine. He has a
|! |! |! |! |! |! |! |! |! |! |! |! |! |! |! |!
history of mild persistent asthma. What would you discuss for medications when
|! |! |! |! |! |! |! |! |! |! |! |!
reviewing his asthma action plan? - Correct answer ✔Your child should continue his low-
|! |! |! |! |! |! |! |! |! |! |! |! |!
dose inhaled corticosteroid daily and add albuterol as needed for an exacerbation.
|! |! |! |! |! |! |! |! |! |! |!
A child who has been diagnosed with asthma for several years has been using a short-
|! |! |! |! |! |! |! |! |! |! |! |! |! |! |!
acting Beta-agonist (SABA) to control symptoms. The PNP learns that the child has
|! |! |! |! |! |! |! |! |! |! |! |! |!
recently begun using the SABA 2-3 times each week to prevent wheezing and shortness
|! |! |! |! |! |! |! |! |! |! |! |! |! |!
of breath. The child currently has clear breath sounds and an FEV1 of 75% of personal
|! |! |! |! |! |! |! |! |! |! |! |! |! |! |! |!
best. What will the NP do? - Correct answer ✔Add an inhaled corticosteroid.
|! |! |! |! |! |! |! |! |! |! |! |!
Your next patient is a six-month-old infant who just completed amoxicillin for otitis media.
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The mother states her child is better except for a diaper rash. Upon examination, you
|! |! |! |! |! |! |! |! |! |! |! |! |! |! |! |!
note red scaly plaques in the diaper area with satellite lesions to his upper thighs. What
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would you do next as the PNP? - Correct answer ✔Your child has a rash that is likely due
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to a fungus, Candida, and commonly occurs after taking antibiotics. I will prescribe
|! |! |! |! |! |! |! |! |! |! |! |! |! |!
nystatin to be applied to the diaper area. |! |! |! |! |! |! |!
, A 12 y.o. female presents to the clinic after being bit by a dog on the face. Abrasion with
|! |! |! |! |! |! |! |! |! |! |! |! |! |! |! |! |! |!
2 puncture wounds on the upper right cheek, approximately 1 inch below the eye. The
|! |! |! |! |! |! |! |! |! |! |! |! |! |! |! |!
area is slightly erythematous, with a small amount of bruising and raised area along the
|! |! |! |! |! |! |! |! |! |! |! |! |! |! |!
cheekbone. - Correct answer ✔Using normal saline, irrigate the wounds using high
|! |! |! |! |! |! |! |! |! |! |! |!
pressure (greater than 4 pounds per square inch) and high volume (greater than 1 L).
|! |! |! |! |! |! |! |! |! |! |! |! |! |! |!
Isolated puncture wounds should not be irrigated, instead soak the wound in a diluted
|! |! |! |! |! |! |! |! |! |! |! |! |! |!
solution of tap water and povidone-iodine for 15 .minutes • Prescribe a 3- to 5-day
|! |! |! |! |! |! |! |! |! |! |! |! |! |! |!
course of prophylactic antibiotics
|! |! |!
A 4 yo child has clusters of small, clear, tense vesicles with an erythematous base on one
|! |! |! |! |! |! |! |! |! |! |! |! |! |! |! |!
side of the mouth along the vermillion border, which are causing discomfort and
|! |! |! |! |! |! |! |! |! |! |! |! |! |!
difficulty eating. What will the PNP recommend as treatment? - Correct answer ✔Topical
|! |! |! |! |! |! |! |! |! |! |! |! |!
diphenhydramine and magnesium hydroxide. |! |! |!
A 4 year old child with PE tubes in both ears has otalgia in one ear. The PNP is able to
|! |! |! |! |! |! |! |! |! |! |! |! |! |! |! |! |! |! |! |! |!
visualize the tube and does not see exudate in the ear canal and obtains a type A
|! |! |! |! |! |! |! |! |! |! |! |! |! |! |! |! |!
tympanogram. What will the NP do? - Correct answer ✔Order ototopical |! |! |! |! |! |! |! |! |! |! |!
corticosteroid/antibiotic drops. |!
The parent of a 1-week old is concerned about the unusual shape of their child's head.
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In the physical exam, which of the following signs would not support the diagnosis of
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craniosynostosis? - Correct answer ✔A palpable lesion at the occipital region. |! |! |! |! |! |! |! |! |! |!
A toddler exhibits exotropia of the right eye during a cover-uncover screen. The PNP will
|! |! |! |! |! |! |! |! |! |! |! |! |! |! |!
refer to pediatric ophthalmologist to initiate which treatment? - Correct answer ✔Patching
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the unaffected eye for 2 hrs./day
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The most typical radiograph finding with a diagnosis of asthma - Correct answer
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✔Hyperinflation
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solutions
Gold standard for CAP diagnosis: - Correct answer ✔Chest x-ray
|! |! |! |! |! |! |! |! |!
If CAP symptoms present but no obvious signs of infection on CXR treatment is... -
|! |! |! |! |! |! |! |! |! |! |! |! |! |! |!
Correct answer ✔Same as if CXR was positive
|! |! |! |! |! |! |!
Immunizations for people over 65 or younger people with comorbidities such as asthma,
|! |! |! |! |! |! |! |! |! |! |! |! |!
CHF COPD: - Correct answer ✔Pneumonia and flu vaccines
|! |! |! |! |! |! |! |!
Who is at risk for CAP? - Correct answer ✔Extremes of age, smokers, alcoholics, GERD,
|! |! |! |! |! |! |! |! |! |! |! |! |! |! |!
chronic disease, institutionalization
|! |!
CAP presentation in adults: - Correct answer ✔Cough (may be nonproductive), dyspnea,
|! |! |! |! |! |! |! |! |! |! |! |!
fever, hemoptysis, chest pain, fatigue, tachycardia
|! |! |! |! |!
If lymphocytes are elevated? - Correct answer ✔Indicative of viral process
|! |! |! |! |! |! |! |! |! |!
If monocytes are elevated? - Correct answer ✔Indicative of chronic process
|! |! |! |! |! |! |! |! |! |!
If eosinophils are elevated? - Correct answer ✔Indicative of asthma, allergic reaction
|! |! |! |! |! |! |! |! |! |! |!
If basophils are elevated? - Correct answer ✔Indicative of chronic process
|! |! |! |! |! |! |! |! |! |!
If neutrophils are elevated? - Correct answer ✔Indicative of acute bacterial process
|! |! |! |! |! |! |! |! |! |! |!
,CAP: patient present with symptoms of chills, fever, chest pain, productive cough with
|! |! |! |! |! |! |! |! |! |! |! |! |!
purulent sputum, positive chest x-ray, and patient had URI last week? - Correct answer
|! |! |! |! |! |! |! |! |! |! |! |! |! |!
✔Streptococcus pneumonia: gram + |! |! |!
In the United States, the most common cause of myocarditis in children is: - Correct
|! |! |! |! |! |! |! |! |! |! |! |! |! |! |!
answer ✔Viruses |!
Your next patient is a 5-year-old child with a history of moderate persistent asthma. He
|! |! |! |! |! |! |! |! |! |! |! |! |! |! |!
has been wheezing and coughing for the past two days, and his mother brings him in
|! |! |! |! |! |! |! |! |! |! |! |! |! |! |! |!
today for evaluation. He has been using albuterol every four hours. His respiratory rate is
|! |! |! |! |! |! |! |! |! |! |! |! |! |! |!
13 breaths per minute; his lungs are clear to auscultation; and no retractions are noted.
|! |! |! |! |! |! |! |! |! |! |! |! |! |! |!
What may be your assessment and intervention based on this information? - Correct
|! |! |! |! |! |! |! |! |! |! |! |! |!
answer ✔Your child is breathing slower than normal for his age. We need to send him to
|! |! |! |! |! |! |! |! |! |! |! |! |! |! |! |!
the ER for further intervention.
|! |! |! |! |!
Your next patient is a 6-year-old male here for his annual influenza vaccine. He has a
|! |! |! |! |! |! |! |! |! |! |! |! |! |! |! |!
history of mild persistent asthma. What would you discuss for medications when
|! |! |! |! |! |! |! |! |! |! |! |!
reviewing his asthma action plan? - Correct answer ✔Your child should continue his low-
|! |! |! |! |! |! |! |! |! |! |! |! |!
dose inhaled corticosteroid daily and add albuterol as needed for an exacerbation.
|! |! |! |! |! |! |! |! |! |! |!
A child who has been diagnosed with asthma for several years has been using a short-
|! |! |! |! |! |! |! |! |! |! |! |! |! |! |!
acting Beta-agonist (SABA) to control symptoms. The PNP learns that the child has
|! |! |! |! |! |! |! |! |! |! |! |! |!
recently begun using the SABA 2-3 times each week to prevent wheezing and shortness
|! |! |! |! |! |! |! |! |! |! |! |! |! |!
of breath. The child currently has clear breath sounds and an FEV1 of 75% of personal
|! |! |! |! |! |! |! |! |! |! |! |! |! |! |! |!
best. What will the NP do? - Correct answer ✔Add an inhaled corticosteroid.
|! |! |! |! |! |! |! |! |! |! |! |!
Your next patient is a six-month-old infant who just completed amoxicillin for otitis media.
|! |! |! |! |! |! |! |! |! |! |! |! |!
The mother states her child is better except for a diaper rash. Upon examination, you
|! |! |! |! |! |! |! |! |! |! |! |! |! |! |! |!
note red scaly plaques in the diaper area with satellite lesions to his upper thighs. What
|! |! |! |! |! |! |! |! |! |! |! |! |! |! |! |!
would you do next as the PNP? - Correct answer ✔Your child has a rash that is likely due
|! |! |! |! |! |! |! |! |! |! |! |! |! |! |! |! |! |!
to a fungus, Candida, and commonly occurs after taking antibiotics. I will prescribe
|! |! |! |! |! |! |! |! |! |! |! |! |! |!
nystatin to be applied to the diaper area. |! |! |! |! |! |! |!
, A 12 y.o. female presents to the clinic after being bit by a dog on the face. Abrasion with
|! |! |! |! |! |! |! |! |! |! |! |! |! |! |! |! |! |!
2 puncture wounds on the upper right cheek, approximately 1 inch below the eye. The
|! |! |! |! |! |! |! |! |! |! |! |! |! |! |! |!
area is slightly erythematous, with a small amount of bruising and raised area along the
|! |! |! |! |! |! |! |! |! |! |! |! |! |! |!
cheekbone. - Correct answer ✔Using normal saline, irrigate the wounds using high
|! |! |! |! |! |! |! |! |! |! |! |!
pressure (greater than 4 pounds per square inch) and high volume (greater than 1 L).
|! |! |! |! |! |! |! |! |! |! |! |! |! |! |!
Isolated puncture wounds should not be irrigated, instead soak the wound in a diluted
|! |! |! |! |! |! |! |! |! |! |! |! |! |!
solution of tap water and povidone-iodine for 15 .minutes • Prescribe a 3- to 5-day
|! |! |! |! |! |! |! |! |! |! |! |! |! |! |!
course of prophylactic antibiotics
|! |! |!
A 4 yo child has clusters of small, clear, tense vesicles with an erythematous base on one
|! |! |! |! |! |! |! |! |! |! |! |! |! |! |! |!
side of the mouth along the vermillion border, which are causing discomfort and
|! |! |! |! |! |! |! |! |! |! |! |! |! |!
difficulty eating. What will the PNP recommend as treatment? - Correct answer ✔Topical
|! |! |! |! |! |! |! |! |! |! |! |! |!
diphenhydramine and magnesium hydroxide. |! |! |!
A 4 year old child with PE tubes in both ears has otalgia in one ear. The PNP is able to
|! |! |! |! |! |! |! |! |! |! |! |! |! |! |! |! |! |! |! |! |!
visualize the tube and does not see exudate in the ear canal and obtains a type A
|! |! |! |! |! |! |! |! |! |! |! |! |! |! |! |! |!
tympanogram. What will the NP do? - Correct answer ✔Order ototopical |! |! |! |! |! |! |! |! |! |! |!
corticosteroid/antibiotic drops. |!
The parent of a 1-week old is concerned about the unusual shape of their child's head.
|! |! |! |! |! |! |! |! |! |! |! |! |! |! |! |!
In the physical exam, which of the following signs would not support the diagnosis of
|! |! |! |! |! |! |! |! |! |! |! |! |! |! |!
craniosynostosis? - Correct answer ✔A palpable lesion at the occipital region. |! |! |! |! |! |! |! |! |! |!
A toddler exhibits exotropia of the right eye during a cover-uncover screen. The PNP will
|! |! |! |! |! |! |! |! |! |! |! |! |! |! |!
refer to pediatric ophthalmologist to initiate which treatment? - Correct answer ✔Patching
|! |! |! |! |! |! |! |! |! |! |!
the unaffected eye for 2 hrs./day
|! |! |! |! |! |!
The most typical radiograph finding with a diagnosis of asthma - Correct answer
|! |! |! |! |! |! |! |! |! |! |! |! |!
✔Hyperinflation
