Exam 1: NU664C/ NU 664C (Latest 2025/ 2026 Update) Family Psychiatric Mental Health I | Questions & Verified Answers| Graded A| 100% Correct (Verified Solutions)- Regis.

//Exam 1: NU664C/ NU 664C (Latest 2025/ 2026 Update) Family Psychiatric Mental Health I | Questions & Verified Answers| Graded A| 100% Correct (Verified Solutions)- Regis. Question: Gold standard for CAP diagnosis: Answer: Chest x-ray Question: If CAP symptoms present but no obvious signs of infection on CXR treatment is... Answer: Same as if CXR was positive Question: Immunizations for people over 65 or younger people with comorbidities such as asthma, CHF COPD: Answer: Pneumonia and flu vaccines Question: Who is at risk for CAP? Answer: Extremes of age, smokers, alcoholics, GERD, chronic disease, institutionalization Question: CAP presentation in adults: Answer: Cough (may be nonproductive), dyspnea, fever, hemoptysis, chest pain, fatigue, tachycardia Question: If lymphocytes are elevated? Answer: Indicative of viral process Question: If monocytes are elevated? Answer: Indicative of chronic process Question: If eosinophils are elevated? Answer: Indicative of asthma, allergic reaction Question: If basophils are elevated? Answer: Indicative of chronic process Question: If neutrophils are elevated? Answer: Indicative of acute bacterial process Question: 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? Answer: Streptococcus pneumonia: gram + Question: In the United States, the most common cause of myocarditis in children is: Answer: Viruses Question: 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? Answer: Your child is breathing slower than normal for his age. We need to send him to the ER for further intervention. Question: 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? Answer: Your child should continue his low-dose inhaled corticosteroid daily and add albuterol as needed for an exacerbation. Question: 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? Answer: Add an inhaled corticosteroid. Question: 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? 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. Question: 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. 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 Question: 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? Answer: Topical diphenhydramine and magnesium hydroxide. Question: 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? Answer: Order ototopical corticosteroid/antibiotic drops. Question: 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? Answer: A palpable lesion at the occipital region. Question: A toddler exhibits exotropia of the right eye during a cover-uncover screen. The PNP will refer to pediatric ophthalmologist to initiate which treatment? Answer: Patching the unaffected eye for 2 hrs./day Question: The most typical radiograph finding with a diagnosis of asthma Answer: Hyperinflation Question: Nasal mucosa pale, boggy and edematous with allergic shiners Answer: Allergic rhinitis Question: The category on your asthma action plan when you have had exposure to a known trigger, are coughing with wheezing, have a tight chest and are coughing at night. Answer: Yellow or cautious phase Question: Classification of asthma severity for a child who is 6 years old who has symptoms 3 days a week, uses his inhaler daily for exercise, but not otherwise, has minor limitation to activity and wakes 3 times a month with cough Answer: mild persistent asthma Question: Should not be used to treat asthma in children under the age of 4? Answer: dry powder inhalers Question: In addition to the routine PCV 13 vaccine series, sickle cell anemia patients older than 2 years of age should receive this once and then a booster in 5 years. Answer: PPSV23 Question: cradle cap or seborrheic dermatitis Answer: Often treated with Selsun blue shampoo. Question: Bilateral conjunctival injection, 5 days of fever, cervical lymphadenopathy, polymorphous exanthema, changes in peripheral extremities Answer: Kawasaki Disease Question: First line treatment for allergic rhinitis Answer: Oral H1 antihistamines and/or intranasal steroids Question: Treatment for 3 year old with intermittent asthma Answer: SABA prn (Albuterol and levalbuterol) Question: Treatment for Kawasaki Answer: IVIG and High dose aspirin Question: A 9-year-old boy presents with a fever of 102 and leg pains. Mother reports he had an upper respiratory infection with a sore throat approximately 2 weeks ago which subsided without therapy. On physical exam, he has tender, swollen knees bilaterally. His heart rate is 120 beats per minute and a blowing systolic murmur is heard at the apex. No murmur previously noted. The most likely diagnosis is. Answer: Rheumatic Fever Question: labs for rheumatic fever Answer: ASO Titer Question: A 2 week old infant with complaint of rash near left upper eyelid several vesicular lesions on his left upper eyelid. What would you discuss with the mother as the PNP? Answer: It is important that you go to the children's hospital emergency department now because your child needs an immediate referral to a pediatric ophthalmologist. Question: A 3 year old w/ hx of blepharitis and his mother asks whether there is anything she can do to prevent this from occurring again. What would you suggest as the PNP? Answer: Good handwashing and daily eye lid and lash scrub with diluted baby shampoo should prevent this from reoccurring. Question: A 5 year old feeling like something might be in his eye. No visual changes had occurred, normal EOM, no known injury. You decide to complete fluorescein staining to the affected eye because you suspect Answer: Corneal abrasion Question: A 4-month-old w/1-week hx of nasal congestion and occasional cough. Prior evening Temp 102F refused to breastfeed and had coughing and noisy labored breathing. On exam ill-appearing infant who is lethargic w/ tachypnea, wheezing, and intercostal retractions. Does not attend daycare but has a 3-year-old sibling who is in daycare and who recently had a "cold". Considering the clinical presentation what is the most likely cause of the infant's illness? Answer: RSV bronchiolitis Question: A 6 year old hx of cough for 10 days, Fever 101.5 F in the past 24 hrs. Decrease appetite and complain of abdominal pain. Breathing faster than normal . Given the information, what is the most likely dx? Answer: Pneumonia Question: A 12 day old concerned about breathing. Feeding stops breathing for 10 seconds. Eats well never appeared pale/cyanotic, and has never become limp during any of these episodes. What would the PNP discuss w/ the parents? Answer: I know this can be concerning. This can be a normal variant for infants. Question: A child is diagnosed with community acquired pneumonia and will be treated as an outpatient. Which antibiotic will the PNP choose? Answer: Amoxicillin Question: A school-aged child has had nasal discharge and a daytime cough but no fever for 12 days without improvement in symptoms. The child has not had antibiotics recently and there is no significant antibiotic resistance in the local community. What is the appropriate treatment for this child? Answer: Amoxicillin 45mg/kg/day (treatment of acute rhinosinusitis (ARS) based on duration of symptoms without clinical improvement in symptoms) Question: The parent of a 3-month old reports that the infant arches and gags while feeding and spits up undigested formula frequently. The infant's weight gain has dropped to the 5th percentile from the 12th percentile. What is the best course of treatment for this infant? Answer: Begin a trial of extensively hydrolyzed protein formula for 2-4 weeks. Question: PNP performs the vision screen on a four month old and notes the presence of convergence and accommodation with esotropia of the 1eft eye. What will the NP do? Answer: Refer the infant to a pediatric ophthalmologist Question: What radiographic finding is diagnostic for croup? Answer: Steeple sign (Subglottic airway narrowing at the cricoid cartilage) Question: A school-age child who has an abrupt onset of sore throat, nausea, headache, and a temperature of 102.3 F. An examination reveals petechiae on the soft palate, beefy-red tonsils with yellow exudate, and scarlatiniform rash. A rapid antigen detection test (RADT) is negative, what is the next step in the management for this child? Answer: Perform a follow-up throat culture Question: Fluorescein staining could be used to detect this. Answer: Corneal abrasion Question: Confirming the diagnosis that newborn chlamydia conjunctivitis would be best done by obtaining this. Answer: Culture of conjunctival scrapings Question: Acute sudden onset high fever, severe sore throat, muffled voice drooling, choking sensation restless with hyper extension of neck. Answer: Epiglottitis Question: Helps with the prevention of epiglottitis Answer: Hib Vaccine Question: What is the drug of choice for treating pertussis? Answer: Azithromycin 10mg/kg x 5days Question: Sneezing, discomfort and unilateral purulent it malodorous or bloody nasal discharge is a sign of. nasal foreign body Answer: Question: This can occur in patients with an untreated streptococcal infection of the upper respiratory tract. Answer: acute rheumatic fever Question: This has a decreasing incidence from H influenza with the use of the HIV vaccine by 99% in children younger than I thought, but can still a current even with a complete set of vaccines. Answer: Epiglottitis Question: Concurrent otitis media and conjunctivitis is likely due to which organism. Answer: Haemophilus Influenza Question: Examination of TM Answer: Pull auricle down and back in children <3 Pull auricle up and back for children >3 Question: Conductive hearing loss Answer: hearing impairment caused by interference with sound or vibratory energy in the external canal, middle ear, or ossicles Question: Sensorineural hearing loss Answer: hearing loss caused by damage to the cochlea's receptor cells or to the auditory nerves; also called nerve deafness Question: Treatment of otitis externa Answer: Withdraw any foreign bodies or debri by gentle irrigation Topical abx drops (ofloxacin) Insert cotton wick if significant swelling Analgesics Avoid getting ear wet Question: Etiology of AOM Answer: After viral URI Highest incidence 6-36 months Winter/spring males Question: First line therapy for AOM Answer: Amoxicillin (cefdinir if allergy) Question: Second line therapy for AOM Answer: Augmentin (no improvement 48-72 hrs, recurrence within 1 month, concomitant conjunctivitis) Question: Third line therapy for AOM Answer: Ceftriaxone Question: If allergic to penicillin what do you treat the AOM with Answer: Cephalosporin Question: If a child is being treated for an AOM and is vomiting or unable to tolerate oral medication what do you prescribe Answer: Rocephin IV or IM Question: Otitis media with effusion what is the most common organism Answer: H. influenzae Question: What is the most common cause of hearing loss in children Answer: otitis media with effusion Question: Refer to ENT for AOM Answer: Persistent, resistant to treatment over 1-2 months; 3 infections in 6 months or 4 infections in 1 year Question: Management/treatment of OME Answer: Most cases resolve w/o abx Limit use of abx prophylaxis due to marginal benefit Limit passive smoking exposure, control allergies Referral to ENT if persists >3 months f/u every 3-4 weeks Question: Treatment for chlamydia conjunctiva Answer: Systemic Erythromycin 50mg/kg/day in four divided doses for 14 days or Azithromycin 20mg/kg for 3 days (not topical) Question: Chlamydia conjunctiva symptoms Answer: Begins 5-14 days of life up to 6 weeks; moderate eyelid swelling and palpebral or bulbar conjunctival injection and moderate, thick, purulent discharge, assess for systemic infection (pharyngitis, ear infection, pneumonia) Question: At 12 months of age the head and chest circumference should be Answer: Equal Question: Mastoiditis Answer: suppurative infection of the mastoid cells that may occur with AOM or follow an AOM, mucoperiosteal lining of the mastoid air cells becomes inflamed with subsequent progressive swelling and obstruction caused by drainage from the mastoid Question: What vaccines decrease the incidence of mastoiditis and what are the two most common causes? Answer: Hib and S. pneumoniae are the 2 common causes Pneumococcal vaccine decreases incidence Question: Mastoiditis management and treatment Answer: Urgent ENT referral, hospitalization, abx, myringotomy, tube placement, mastoidectomy Question: What is the most common cause of otitis media Answer: Streptococcus pneumoniae Question: What groups are at risk for AOM Answer: children younger than 24 months, recent beta-lactam drugs, exposed to large number of other children, immune deficiency, smoke exposure in household, bottle fed Question: With otitis media with effusion when should a myringotomy or tympanostomy tubes be considered Answer: children 6 month to 12 years who have had bilateral effusion for a total of 3 months or longer with documented hearing deficiency or for children with recurrent AOM who have evidence of middle ear effusion at the time of assessment for tubes Question: Otitis Externa most common organism Answer: pseudomonas aeruginosa Question: Acute otitis externa discharge color Answer: scant white mucous Question: Chronic otitis externa discharge Answer: bloody Question: Fungal otitis externa discharge Answer: fluffy, and white to off-white discharge but may be black, gray, bluish-green, or yellow Question: Retinoblastoma Answer: Tumor arising from a developing retinal cell Question: Leukocoria abnormal appearance of a white film in the pupil Answer: Question: Management/treatment of retinoblastoma Answer: Curable if diagnosed early Urgent referral to pediatric ophthalmologist; eval within 72 hours Chemo, radiation, laser therapy and/or surgical removal Genetic counseling Question: Hordeolum Answer: Infection of meibomian glands (internal) or glands of Zeis or Moll (external or stye) of eyelid Question: Treatment of hordeolum Answer: Warm compress May use topical anti-infective ointment (erythromycin or bacitracin/polymyxin B) Refer if mass fails to disappear after several weeks Question: Retinopathy of Prematurity (ROP) Answer: Involves abnormal growth of retinal vessels in incompletely vascularized retinas of premature infant Question: Ocular misalignment after age 4 months Answer: Considered suspicious Child should be referred Question: Periorbital cellulitis Answer: Inflammation and infection of eyelids and periorbital tissue Treatment: If concerned for MRSA use monotherapy of clindamycin or combo with oral trimethoprim-sulfamethoxazole and amoxicillin or amoxicillin-clavulanate, cefpodoxime, of cefdinir Question: Hyphema Answer: blood in the anterior chamber of the eye, refer to ophthalmologist Question: Nasolacrimal duct obstruction (dacryostenosis) Answer: defect of lacrimal drainage system resulting in blockage Treatment: Massage lacrimal sac several times a day If secondarily infected treat with anti-infective Refer to ophthalmologist if not resolved by 12 months of age Question: Corneal abrasion Answer: Scratched, abraded, or denuded cornea, May see uneven light reflection or cloudiness of cornea May see foreign body After staining with fluorescein and using cobalt-blue light or Wood's lamp will see area of green staining (persists with blinking) Decreased visual acuity Instill topical ophthalmic anti infective ointment Patching not recommended Question: Allergic conjunctivitis clinical pearls Answer: • Cold compresses • Lubricants • Topical antihistamines/decongestants/NSAIDs/mast cell stabilizers • Systemic antihistamines Avoid rubbing eyes Handwashing Will last about 10-14 days Question: Bacterial conjunctivitis medications Answer: Erythromycin ophthalmic ointment Trimethoprim-polymyxin B ophthalmic ointment or drops (Polytrim) >2 months old Moxifloxacin or Moxeza (>4 months old) Levofloxacin (>1 year old) Treat conjunctivitis-otitis syndrome for otitis only, concurrent use of topical abx not needed Question: Pneumonia treatment 3 months-5 years: Answer: amoxicillin 90mg/kg/d w or w/o azithromycin for 7-10 days Question: Pneumonia treatment 5 or older: Answer: azithromycin or amoxicillin 90mg/kg/d for 7-10 days or penicillin G Question: Penicillin Allergy: Answer: 3rd generation cephalosporin (non type 1 reaction) Macrolides, levofloxacin, clindamycin Question: Physical findings of cystic fibrosis Answer: Wheezing and air trapping with barrel chest Productive cough Crackles Increased WOB Nasal polyps, chronic sinusitis Failure to thrive Hepatosplenomegaly Delayed puberty Question: Diagnostic tests/findings of CF Answer: Pilocarpine iontophoresis sweat test (sweat chloride test) Genotyping Question: Pertussis treatment Answer: Macrolides Azithromycin, erythromycin, or clarithromycin Question: Rhinosinusitis Answer: inflammation of the nares and paranasal sinuses, including frontal, ethmoid, maxillary, and sphenoid sinuses; replaces the term sinusitis Question: Treatment of rhinosinusitis Answer: Augmentin (when indicated) Topical nasal steroids NS nasal irrigation Mucolytics Question: Treatment of mono Answer: Supportive Recheck weekly Question: Diagnostic tests for mono Answer: Monospot Commercial diagnostic kits about 98% sensitive CBC with diff Liver enzymes EBV serology indicated in acutely ill pt with negative monospot and strong suspicion Throat culture Question: Treatment of mono Answer: Supportive Recheck weekly Question: Underlying lung diseases in older patients (COPD) Abrupt onset Fever, cough, chills, purulent sputum Pleuritic chest pain (+/-) Physician exam and chest xray consistent with consolidation Answer: Hemophilus influenza: Gram - Question: Extremely ill patients (inpatient ICU) Often follows post influenza pneumonia Complications can include: empyema, lung abscess, pneumothorax Answer: Staphylococcus aureus: Gram + Question: ETOH Abuse/Debilitated Patients Dense consolidation usually in upper lobe "Current jelly" sputum Increased mortality rate (25-50%) Answer: Klebsiella pneumonia: Gram - Question: Common in structural lung disease- CF patient Steroid Therapy Malnutrition Antibiotic therapy within the past month Answer: Pseudomonas aeruginosa: Gram - Question: Nonbacterial and bacterial organisms that do not share the expected characteristics of most bacteria. Younger population generally Answer: ATYPICAL ORGANISMS Question: Insidious onset: headache, sore throat, malaise Usually in persons <35 years old Nonproductive, dry cough Usually milder, but may take up to 6 weeks to resolve 10-20% develop maculopapular rash Normal CBC, unimpressive exam, negative sputum Answer: MYCOPLASMA PNUEMONIA Question: Begins with severe sore throat Similar in presentation to mycoplasma Cough, fever, usually milder Occurs in those in close living facilities Answer: CHLAMYDOPHILA PNA Question: Water/contaminated aerosols/plumbing Mild self limited to severe with respiratory failure Risk factors: COPD, smoking, DM, immunocompromised Answer: LEOGINELLA PNA *** Question: Outbreaks seen in communities/facilities Starts with URI but progresses to paroxysms of coughing (nonproductive "whoop"), convalescent phase can last 1-3 months Answer: Nasal swab or serology if patient presenting later in course BORDATELLA PERTUSIS Question: NEW GUIDELINES FOR THE U.S. DUE INCREASED TO S. PNEUMONIAE >25% CAP (WITHOUT) COMORBIDITY OR RECENT ABX USE(within 3 mos) Answer: Doxycycline 100mg bid Question: TREATING CAP IN PREGNANCY Answer: Consider combination BETA LACTAM therapy with: ceftriaxone, cefuroxime, or ampi-sulbactum + Azithromycin Question: Mild COPD PFT Answer: >80% Question: Moderate COPD PFT Answer: 50-79% Question: Severe COPD PFT Answer: 30-49% Question: Very severe COPD PFT Answer: <29% Question: Asthma severe persistent Answer: Continuous symptoms, frequent nocturnal symptoms, <60% FEV Question: Moderate persistent asthma Answer: Daily symptoms, >1 time a week nocturnal symptoms, 60-80% FEV Question: Mild persistent asthma Answer: >1 time a week but not daily symptoms, >2 times a month nocturnal symptoms, >80% FEV Question: Intermittent asthma Answer: <1 time a week symptoms, <2 times a month nocturnal symptoms, >80% FEV Question: Step 1 asthma treatment Answer: SABA prn Question: Step 2 asthma treatment Answer: SABA prn + Low dose inhaled corticosteroid Question: Step 3 asthma treatment Answer: Combination low dose inhaled corticosteroid and LABA + SABA prn Question: Step 4 asthma treatment Answer: Combination high dose inhaled corticosteroid and LABA + SABA prn