NURP 532 EXAM 2 - COMPREHENSIVE PRACTICE EXAM
150+ Questions with Correct Answers and Rationales
1. A 6-month-old infant presents with a rectal temperature of 102.4°F. What is
the most appropriate initial action by the nurse practitioner?
A. Order immediate blood cultures and lumbar puncture
B. Perform a thorough history and physical examination
C. Prescribe empiric antibiotics immediately
D. Refer to the emergency department
Correct Answer: B
Rationale: For infants with fever, a thorough history and physical examination
should always be performed first to assess the overall clinical appearance and
identify potential sources of infection. The level of fever alone does not indicate
serious illness; the appearance and behavior of the child are more important
indicators. While infants under 3 months with fever require more aggressive
workup, a 6-month-old who appears well may be managed with careful
assessment first. Blood cultures, LP, or antibiotics would be indicated based on
findings from the history and physical, not as the first step.
2. What is the gold standard temperature measurement site for children under 3
years of age?
A. Oral
,B. Axillary
C. Rectal
D. Temporal artery
Correct Answer: C
Rationale: Rectal temperature is considered the gold standard for children under
3 years of age, especially those under 12 months, as it provides the most accurate
core body temperature reading. Oral temperatures are not reliable until around
age 5 when children can properly cooperate. Axillary temperatures are less
sensitive and may miss fevers. Temporal artery thermometers are convenient but
may be less accurate than rectal measurements in young children.
3. A 2-year-old presents with fever of 103°F for 2 days. The child is playful,
drinking fluids well, and has no focal findings on exam. The most appropriate
management is:
A. Immediate hospitalization
B. Reassurance and symptomatic treatment
C. Complete sepsis workup
D. Empiric antibiotic therapy
Correct Answer: B
Rationale: A well-appearing 2-year-old with fever but no focal findings and normal
behavior can be managed with reassurance and symptomatic treatment. The
child's appearance and behavior are more important indicators of serious illness
,than the height of the fever. Hospitalization, sepsis workup, and antibiotics are
reserved for children who appear toxic, have focal findings, or are at higher risk
(such as infants under 3 months).
4. Which statement about pediatric fever is TRUE?
A. The height of fever correlates with severity of illness
B. Children typically experience 4-6 febrile episodes in the first 2 years
C. Fever always indicates bacterial infection
D. Antipyretics prevent febrile seizures
Correct Answer: B
Rationale: Children typically experience 4-6 febrile episodes per year in the first 2
years of life, especially those in daycare settings. The height of fever does NOT
correlate with severity of illness - a child with 104°F may have a viral illness while
a child with 101°F may have serious bacterial infection. Fever can be caused by
viral, bacterial, or other causes. Antipyretics do NOT prevent febrile seizures,
though they may improve comfort.
5. A 4-week-old infant presents with a rectal temperature of 100.8°F. The infant
appears well. The most appropriate management is:
A. Discharge home with acetaminophen
B. Full sepsis workup including blood, urine, and CSF cultures
C. Urine culture only
D. Observe for 2 hours then discharge if afebrile
, Correct Answer: B
Rationale: Infants under 3 months (especially under 4-6 weeks) with fever
≥100.4°F require a full sepsis workup including blood cultures, urine cultures, and
CSF analysis/cultures, regardless of appearance. This age group has immature
immune systems and can deteriorate rapidly. They require hospitalization and
empiric antibiotics while awaiting culture results. Discharging without workup or
doing limited workup is inappropriate for this age group.
6. Fever is defined as a temperature greater than:
A. 100.0°F (37.8°C)
B. 100.4°F (38.0°C)
C. 101.0°F (38.3°C)
D. 99.5°F (37.5°C)
Correct Answer: B
Rationale: Fever is defined as a temperature ≥100.4°F (38.0°C) when measured
rectally. This is the standard definition used in clinical practice and research.
Lower temperatures may represent normal variation or low-grade elevation but
do not meet the criteria for fever.
7. A parent calls about their 3-year-old who has a temperature of 102°F. The child
is sleeping but easily aroused and drinking fluids. Your advice should be:
A. Bring to the emergency department immediately
B. Give aspirin for fever reduction
150+ Questions with Correct Answers and Rationales
1. A 6-month-old infant presents with a rectal temperature of 102.4°F. What is
the most appropriate initial action by the nurse practitioner?
A. Order immediate blood cultures and lumbar puncture
B. Perform a thorough history and physical examination
C. Prescribe empiric antibiotics immediately
D. Refer to the emergency department
Correct Answer: B
Rationale: For infants with fever, a thorough history and physical examination
should always be performed first to assess the overall clinical appearance and
identify potential sources of infection. The level of fever alone does not indicate
serious illness; the appearance and behavior of the child are more important
indicators. While infants under 3 months with fever require more aggressive
workup, a 6-month-old who appears well may be managed with careful
assessment first. Blood cultures, LP, or antibiotics would be indicated based on
findings from the history and physical, not as the first step.
2. What is the gold standard temperature measurement site for children under 3
years of age?
A. Oral
,B. Axillary
C. Rectal
D. Temporal artery
Correct Answer: C
Rationale: Rectal temperature is considered the gold standard for children under
3 years of age, especially those under 12 months, as it provides the most accurate
core body temperature reading. Oral temperatures are not reliable until around
age 5 when children can properly cooperate. Axillary temperatures are less
sensitive and may miss fevers. Temporal artery thermometers are convenient but
may be less accurate than rectal measurements in young children.
3. A 2-year-old presents with fever of 103°F for 2 days. The child is playful,
drinking fluids well, and has no focal findings on exam. The most appropriate
management is:
A. Immediate hospitalization
B. Reassurance and symptomatic treatment
C. Complete sepsis workup
D. Empiric antibiotic therapy
Correct Answer: B
Rationale: A well-appearing 2-year-old with fever but no focal findings and normal
behavior can be managed with reassurance and symptomatic treatment. The
child's appearance and behavior are more important indicators of serious illness
,than the height of the fever. Hospitalization, sepsis workup, and antibiotics are
reserved for children who appear toxic, have focal findings, or are at higher risk
(such as infants under 3 months).
4. Which statement about pediatric fever is TRUE?
A. The height of fever correlates with severity of illness
B. Children typically experience 4-6 febrile episodes in the first 2 years
C. Fever always indicates bacterial infection
D. Antipyretics prevent febrile seizures
Correct Answer: B
Rationale: Children typically experience 4-6 febrile episodes per year in the first 2
years of life, especially those in daycare settings. The height of fever does NOT
correlate with severity of illness - a child with 104°F may have a viral illness while
a child with 101°F may have serious bacterial infection. Fever can be caused by
viral, bacterial, or other causes. Antipyretics do NOT prevent febrile seizures,
though they may improve comfort.
5. A 4-week-old infant presents with a rectal temperature of 100.8°F. The infant
appears well. The most appropriate management is:
A. Discharge home with acetaminophen
B. Full sepsis workup including blood, urine, and CSF cultures
C. Urine culture only
D. Observe for 2 hours then discharge if afebrile
, Correct Answer: B
Rationale: Infants under 3 months (especially under 4-6 weeks) with fever
≥100.4°F require a full sepsis workup including blood cultures, urine cultures, and
CSF analysis/cultures, regardless of appearance. This age group has immature
immune systems and can deteriorate rapidly. They require hospitalization and
empiric antibiotics while awaiting culture results. Discharging without workup or
doing limited workup is inappropriate for this age group.
6. Fever is defined as a temperature greater than:
A. 100.0°F (37.8°C)
B. 100.4°F (38.0°C)
C. 101.0°F (38.3°C)
D. 99.5°F (37.5°C)
Correct Answer: B
Rationale: Fever is defined as a temperature ≥100.4°F (38.0°C) when measured
rectally. This is the standard definition used in clinical practice and research.
Lower temperatures may represent normal variation or low-grade elevation but
do not meet the criteria for fever.
7. A parent calls about their 3-year-old who has a temperature of 102°F. The child
is sleeping but easily aroused and drinking fluids. Your advice should be:
A. Bring to the emergency department immediately
B. Give aspirin for fever reduction
