NURS 5433 Family II Final Exam 2025 – 150 Detailed
Questions, Answers, and Rationales
1. A 3-year-old presents with a barking cough, inspiratory stridor, and low-grade
fever, worse at night. Most likely diagnosis?
A. Epiglottitis
B. Croup
C. Asthma exacerbation
D. Bronchiolitis
Answer: B. Croup
Rationale: Classic viral laryngotracheobronchitis presents with a “barking”
cough, stridor, and symptoms that are worse at night. Epiglottitis is more acute
with drooling and tripod positioning, while bronchiolitis affects younger infants
and asthma exacerbation typically has a history of recurrent wheezing.
---
2. A 16-year-old sexually active female presents with dysuria and urinary
frequency. No fever. Best initial treatment?
A. Ciprofloxacin
B. Nitrofurantoin
C. Metronidazole
,D. Azithromycin
Answer: B. Nitrofurantoin
Rationale: First-line therapy for uncomplicated urinary tract infections in
adolescents and adults is nitrofurantoin or TMP-SMX, as recommended by the
IDSA. Ciprofloxacin is reserved for resistant infections.
---
3. A 58-year-old male with hypertension presents with bilateral lower extremity
edema, orthopnea, and exertional dyspnea. Which finding is most indicative of
congestive heart failure?
A. Wheezes
B. +1 edema
C. S3 heart sound
D. Dry mucous membranes
Answer: C. S3 heart sound
Rationale: An S3 gallop is strongly associated with systolic heart failure. While
edema may suggest fluid overload, S3 is more specific for CHF.
---
,4. A 3-month-old presents with fever, irritability, poor feeding, and bulging
anterior fontanelle. What is the priority intervention?
A. Complete blood count
B. Immediate lumbar puncture
C. Urinalysis
D. Chest X-ray
Answer: B. Immediate lumbar puncture
Rationale: In infants under 12 months, fever with bulging fontanelle may indicate
bacterial meningitis, which requires urgent LP and empiric antibiotics.
---
5. A patient presents with a unilateral red eye, tearing, photophobia, and
dendritic lesions on fluorescein staining. Diagnosis?
A. Bacterial conjunctivitis
B. HSV keratitis
C. Uveitis
D. Allergic conjunctivitis
Answer: B. HSV keratitis
, Rationale: Dendritic corneal lesions are pathognomonic for herpes simplex virus
infection and require antiviral treatment to prevent corneal scarring.
---
6. A child with asthma uses a short-acting beta-agonist 3–4 days per week and
wakes at night twice per month with symptoms. What is the asthma
classification?
A. Intermittent
B. Mild persistent
C. Moderate persistent
D. Severe persistent
Answer: B. Mild persistent
Rationale: According to the NHLBI, mild persistent asthma is defined by
symptoms more than 2 days/week but not daily and nighttime symptoms 3–4
times per month.
---
7. First-line controller therapy for mild persistent asthma?
A. SABA only
Questions, Answers, and Rationales
1. A 3-year-old presents with a barking cough, inspiratory stridor, and low-grade
fever, worse at night. Most likely diagnosis?
A. Epiglottitis
B. Croup
C. Asthma exacerbation
D. Bronchiolitis
Answer: B. Croup
Rationale: Classic viral laryngotracheobronchitis presents with a “barking”
cough, stridor, and symptoms that are worse at night. Epiglottitis is more acute
with drooling and tripod positioning, while bronchiolitis affects younger infants
and asthma exacerbation typically has a history of recurrent wheezing.
---
2. A 16-year-old sexually active female presents with dysuria and urinary
frequency. No fever. Best initial treatment?
A. Ciprofloxacin
B. Nitrofurantoin
C. Metronidazole
,D. Azithromycin
Answer: B. Nitrofurantoin
Rationale: First-line therapy for uncomplicated urinary tract infections in
adolescents and adults is nitrofurantoin or TMP-SMX, as recommended by the
IDSA. Ciprofloxacin is reserved for resistant infections.
---
3. A 58-year-old male with hypertension presents with bilateral lower extremity
edema, orthopnea, and exertional dyspnea. Which finding is most indicative of
congestive heart failure?
A. Wheezes
B. +1 edema
C. S3 heart sound
D. Dry mucous membranes
Answer: C. S3 heart sound
Rationale: An S3 gallop is strongly associated with systolic heart failure. While
edema may suggest fluid overload, S3 is more specific for CHF.
---
,4. A 3-month-old presents with fever, irritability, poor feeding, and bulging
anterior fontanelle. What is the priority intervention?
A. Complete blood count
B. Immediate lumbar puncture
C. Urinalysis
D. Chest X-ray
Answer: B. Immediate lumbar puncture
Rationale: In infants under 12 months, fever with bulging fontanelle may indicate
bacterial meningitis, which requires urgent LP and empiric antibiotics.
---
5. A patient presents with a unilateral red eye, tearing, photophobia, and
dendritic lesions on fluorescein staining. Diagnosis?
A. Bacterial conjunctivitis
B. HSV keratitis
C. Uveitis
D. Allergic conjunctivitis
Answer: B. HSV keratitis
, Rationale: Dendritic corneal lesions are pathognomonic for herpes simplex virus
infection and require antiviral treatment to prevent corneal scarring.
---
6. A child with asthma uses a short-acting beta-agonist 3–4 days per week and
wakes at night twice per month with symptoms. What is the asthma
classification?
A. Intermittent
B. Mild persistent
C. Moderate persistent
D. Severe persistent
Answer: B. Mild persistent
Rationale: According to the NHLBI, mild persistent asthma is defined by
symptoms more than 2 days/week but not daily and nighttime symptoms 3–4
times per month.
---
7. First-line controller therapy for mild persistent asthma?
A. SABA only
