1
NSG5140 WEEK 5 MIDTERM EXAM DUE 30TH SEPTEMBER
COMPLETE ACTUAL EXAM QUESTIONS 1- 50 SCREENSHOTS NSG
5140 ADVANCED PATHOPHYSIOLOGY NSG5140 ONLINE EXAM
ACTUAL QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS)
PLUS RATIONALES 2026 Q&A | INSTANT DOWNLOAD PDF.
**Section One: Questions 1–50**
Question 1
Which of the following statements is most concerning and would require
immediate action?
A. The patient has bilateral wheezing that is responsive to bronchodilators
B. The patient has a high-pitched inspiratory stridor at rest with drooling
C. The patient has mild expiratory wheezing that improves with positioning
D. The patient has an occasional non-productive cough without accessory muscle
use
B. The patient has a high-pitched inspiratory stridor at rest with drooling
RATIONALE: High-pitched inspiratory stridor at rest with drooling suggests
upper airway obstruction (e.g., epiglottitis or foreign body), which is a medical
emergency requiring immediate airway intervention. Epiglottitis is a life-
threatening condition characterized by inflammation and swelling of the epiglottis
and surrounding tissues, which can rapidly progress to complete airway
obstruction. The presence of drooling indicates the child is unable to manage
secretions due to pain and swelling. Bilateral wheezing responsive to
bronchodilators is consistent with reactive airway disease (asthma) and, while
requiring treatment, is not an immediate life-threatening emergency. Mild
expiratory wheezing that improves with positioning and occasional non-
productive cough without accessory muscle use are concerning but do not
indicate the same level of urgency as stridor with drooling. The priority in
pg. 1
,2
managing a child with suspected epiglottitis is to maintain a calm environment,
avoid any manipulation of the airway (including tongue depressor examination),
and arrange for immediate transport to a facility equipped for emergency airway
management.
Question 2
A mother brings her 6-month-old infant to the clinic with a 2-day history of clear
rhinorrhea and mild cough. Over the past 12 hours, the infant has developed
increased work of breathing with nasal flaring, intercostal retractions, and an
expiratory wheeze. The infant is afebrile and still taking fluids. What is the most
appropriate next step in management?
A. Prescribe an oral antibiotic for suspected bacterial pneumonia
B. Administer a nebulized albuterol treatment and discharge home
C. Provide supportive care including nasal suctioning and feeding guidance, with
return precautions
D. Immediately transfer to the emergency department for a chest x-ray
C. Provide supportive care including nasal suctioning and feeding guidance,
with return precautions
RATIONALE: This is classic bronchiolitis (most often RSV), a viral lower
respiratory tract infection that typically affects infants and young children.
Management is supportive in stable infants, focusing on maintaining hydration,
clearing nasal secretions, and monitoring respiratory status. The infant is afebrile,
still taking fluids, and has no signs of severe distress (e.g., lethargy, apnea, or
cyanosis), indicating that outpatient management is appropriate. Albuterol is not
routinely effective in bronchiolitis and is not recommended as a standard
treatment; studies have shown limited benefit in this population. Antibiotics are
not indicated for a viral illness, and unnecessary antibiotic use contributes to
antimicrobial resistance. Immediate transfer to the emergency department is not
necessary at this point, as the infant is stable. Parents should be educated on
signs of deterioration (increased work of breathing, lethargy, poor feeding, apnea)
and instructed to return for re-evaluation if these occur.
pg. 2
,3
Question 3
A mother reports that her 2-year-old has a "sore bottom." On exam, you note a
bright red, beefy-red rash in the perineal area, with several isolated "satellite"
lesions spreading onto the thighs. What is the most likely cause?
A. Irritant contact dermatitis from prolonged diaper wear
B. Candida albicans (yeast) diaper dermatitis
C. Bacterial impetigo
D. Atopic dermatitis (eczema) extending into the diaper area
B. Candida albicans (yeast) diaper dermatitis
RATIONALE: The beefy-red appearance with satellite lesions is characteristic
of candidal diaper dermatitis, a fungal infection caused by Candida albicans.
Candida overgrowth occurs in the warm, moist environment of the diaper area,
especially when the skin barrier is compromised by prolonged contact with urine
and feces. The satellite lesions are small papules or pustules that extend beyond
the main area of the rash, which is a distinguishing feature from irritant
dermatitis. Irritant contact dermatitis typically presents with diffuse erythema
that spares the skin folds, whereas candidal dermatitis often involves the folds.
Bacterial impetigo presents with honey-colored crusted lesions, and atopic
dermatitis in the diaper area is less common and typically presents with dry, scaly
patches. Treatment involves topical antifungal agents (e.g., nystatin, clotrimazole)
and frequent diaper changes to keep the area clean and dry. Parents should be
advised to allow the area to air dry and to apply barrier creams to protect the
skin.
Question 4
A 4-year-old presents with a fever and ear pain. On otoscopic exam, you note a
distinctly red, bulging, and opaque tympanic membrane with decreased mobility
on pneumatic otoscopy. The child has no known drug allergies. What is the first-
line antibiotic of choice?
pg. 3
, 4
A. Azithromycin
B. Amoxicillin
C. Trimethoprim-sulfamethoxazole (TMP-SMX)
D. Cefdinir
B. Amoxicillin
RATIONALE: High-dose amoxicillin (80-90 mg/kg/day) remains first-line for
acute otitis media (AOM) in children without penicillin allergy due to its efficacy
against the most common pathogens, particularly Streptococcus pneumoniae.
AOM is characterized by acute onset of middle ear inflammation with effusion
and signs of infection (erythema, bulging, opacity, and decreased mobility of the
tympanic membrane). Amoxicillin has excellent penetration into the middle ear
space, is well-tolerated, and has a narrow spectrum of activity, which helps
reduce the development of antimicrobial resistance. Azithromycin is not first-line
for AOM; it is typically reserved for patients with penicillin allergy or treatment
failure after 48-72 hours. Trimethoprim-sulfamethoxazole (TMP-SMX) is not
recommended as first-line therapy due to increasing resistance among S.
pneumoniae and Haemophilus influenzae. Cefdinir, a third-generation
cephalosporin, may be used in penicillin-allergic patients but is not the first-line
choice. If the child does not improve after 48-72 hours of amoxicillin, treatment
failure should be considered, and alternative antibiotics may be prescribed.
Question 5
A 5-year-old child is brought to the clinic with a painful limp for one day. The
parents report a fever of 102°F at home. The child refuses to bear weight on the
right leg and holds the hip in a flexed, externally rotated position. What is the
priority diagnosis to rule out?
A. Transient synovitis of the hip
B. Legg-Calvé-Perthes disease
C. Septic arthritis of the hip
D. Slipped capital femoral epiphysis (SCFE)
C. Septic arthritis of the hip
pg. 4
NSG5140 WEEK 5 MIDTERM EXAM DUE 30TH SEPTEMBER
COMPLETE ACTUAL EXAM QUESTIONS 1- 50 SCREENSHOTS NSG
5140 ADVANCED PATHOPHYSIOLOGY NSG5140 ONLINE EXAM
ACTUAL QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS)
PLUS RATIONALES 2026 Q&A | INSTANT DOWNLOAD PDF.
**Section One: Questions 1–50**
Question 1
Which of the following statements is most concerning and would require
immediate action?
A. The patient has bilateral wheezing that is responsive to bronchodilators
B. The patient has a high-pitched inspiratory stridor at rest with drooling
C. The patient has mild expiratory wheezing that improves with positioning
D. The patient has an occasional non-productive cough without accessory muscle
use
B. The patient has a high-pitched inspiratory stridor at rest with drooling
RATIONALE: High-pitched inspiratory stridor at rest with drooling suggests
upper airway obstruction (e.g., epiglottitis or foreign body), which is a medical
emergency requiring immediate airway intervention. Epiglottitis is a life-
threatening condition characterized by inflammation and swelling of the epiglottis
and surrounding tissues, which can rapidly progress to complete airway
obstruction. The presence of drooling indicates the child is unable to manage
secretions due to pain and swelling. Bilateral wheezing responsive to
bronchodilators is consistent with reactive airway disease (asthma) and, while
requiring treatment, is not an immediate life-threatening emergency. Mild
expiratory wheezing that improves with positioning and occasional non-
productive cough without accessory muscle use are concerning but do not
indicate the same level of urgency as stridor with drooling. The priority in
pg. 1
,2
managing a child with suspected epiglottitis is to maintain a calm environment,
avoid any manipulation of the airway (including tongue depressor examination),
and arrange for immediate transport to a facility equipped for emergency airway
management.
Question 2
A mother brings her 6-month-old infant to the clinic with a 2-day history of clear
rhinorrhea and mild cough. Over the past 12 hours, the infant has developed
increased work of breathing with nasal flaring, intercostal retractions, and an
expiratory wheeze. The infant is afebrile and still taking fluids. What is the most
appropriate next step in management?
A. Prescribe an oral antibiotic for suspected bacterial pneumonia
B. Administer a nebulized albuterol treatment and discharge home
C. Provide supportive care including nasal suctioning and feeding guidance, with
return precautions
D. Immediately transfer to the emergency department for a chest x-ray
C. Provide supportive care including nasal suctioning and feeding guidance,
with return precautions
RATIONALE: This is classic bronchiolitis (most often RSV), a viral lower
respiratory tract infection that typically affects infants and young children.
Management is supportive in stable infants, focusing on maintaining hydration,
clearing nasal secretions, and monitoring respiratory status. The infant is afebrile,
still taking fluids, and has no signs of severe distress (e.g., lethargy, apnea, or
cyanosis), indicating that outpatient management is appropriate. Albuterol is not
routinely effective in bronchiolitis and is not recommended as a standard
treatment; studies have shown limited benefit in this population. Antibiotics are
not indicated for a viral illness, and unnecessary antibiotic use contributes to
antimicrobial resistance. Immediate transfer to the emergency department is not
necessary at this point, as the infant is stable. Parents should be educated on
signs of deterioration (increased work of breathing, lethargy, poor feeding, apnea)
and instructed to return for re-evaluation if these occur.
pg. 2
,3
Question 3
A mother reports that her 2-year-old has a "sore bottom." On exam, you note a
bright red, beefy-red rash in the perineal area, with several isolated "satellite"
lesions spreading onto the thighs. What is the most likely cause?
A. Irritant contact dermatitis from prolonged diaper wear
B. Candida albicans (yeast) diaper dermatitis
C. Bacterial impetigo
D. Atopic dermatitis (eczema) extending into the diaper area
B. Candida albicans (yeast) diaper dermatitis
RATIONALE: The beefy-red appearance with satellite lesions is characteristic
of candidal diaper dermatitis, a fungal infection caused by Candida albicans.
Candida overgrowth occurs in the warm, moist environment of the diaper area,
especially when the skin barrier is compromised by prolonged contact with urine
and feces. The satellite lesions are small papules or pustules that extend beyond
the main area of the rash, which is a distinguishing feature from irritant
dermatitis. Irritant contact dermatitis typically presents with diffuse erythema
that spares the skin folds, whereas candidal dermatitis often involves the folds.
Bacterial impetigo presents with honey-colored crusted lesions, and atopic
dermatitis in the diaper area is less common and typically presents with dry, scaly
patches. Treatment involves topical antifungal agents (e.g., nystatin, clotrimazole)
and frequent diaper changes to keep the area clean and dry. Parents should be
advised to allow the area to air dry and to apply barrier creams to protect the
skin.
Question 4
A 4-year-old presents with a fever and ear pain. On otoscopic exam, you note a
distinctly red, bulging, and opaque tympanic membrane with decreased mobility
on pneumatic otoscopy. The child has no known drug allergies. What is the first-
line antibiotic of choice?
pg. 3
, 4
A. Azithromycin
B. Amoxicillin
C. Trimethoprim-sulfamethoxazole (TMP-SMX)
D. Cefdinir
B. Amoxicillin
RATIONALE: High-dose amoxicillin (80-90 mg/kg/day) remains first-line for
acute otitis media (AOM) in children without penicillin allergy due to its efficacy
against the most common pathogens, particularly Streptococcus pneumoniae.
AOM is characterized by acute onset of middle ear inflammation with effusion
and signs of infection (erythema, bulging, opacity, and decreased mobility of the
tympanic membrane). Amoxicillin has excellent penetration into the middle ear
space, is well-tolerated, and has a narrow spectrum of activity, which helps
reduce the development of antimicrobial resistance. Azithromycin is not first-line
for AOM; it is typically reserved for patients with penicillin allergy or treatment
failure after 48-72 hours. Trimethoprim-sulfamethoxazole (TMP-SMX) is not
recommended as first-line therapy due to increasing resistance among S.
pneumoniae and Haemophilus influenzae. Cefdinir, a third-generation
cephalosporin, may be used in penicillin-allergic patients but is not the first-line
choice. If the child does not improve after 48-72 hours of amoxicillin, treatment
failure should be considered, and alternative antibiotics may be prescribed.
Question 5
A 5-year-old child is brought to the clinic with a painful limp for one day. The
parents report a fever of 102°F at home. The child refuses to bear weight on the
right leg and holds the hip in a flexed, externally rotated position. What is the
priority diagnosis to rule out?
A. Transient synovitis of the hip
B. Legg-Calvé-Perthes disease
C. Septic arthritis of the hip
D. Slipped capital femoral epiphysis (SCFE)
C. Septic arthritis of the hip
pg. 4
