NURS 5432 Exam 4 V1 | NURS 5432 Family
I (FNP 1) | Actual Q&A with Rationale
(NURS5432 Exam 4) | The University of
Texas at Arlington
1. A 3-year-old boy presents with a sudden onset of high fever, drooling, and sitting in a
‘tripod’ position. Which of the following is the most appropriate next step in management?
A. Examine the throat with a tongue blade
B. Transfer to the emergency department for airway management
C. Perform an immediate physical exam in the office
D. Obtain a lateral neck X-ray
Answer: B
Rationale: This clinical presentation is highly suggestive of epiglottitis, a life-threatening
medical emergency. Attempting to visualize the throat or performing stressful exams can
trigger complete airway obstruction. The patient requires immediate stabilization in a
setting equipped for emergency intubation or tracheostomy.
2. Which cardiac defect is characterized by a harsh, holosystolic murmur heard best at the left
lower sternal border and is the most common congenital heart defect in children?
A. Ventricular Septal Defect (VSD)
B. Atrial Septal Defect (ASD)
,C. Patent Ductus Arteriosus (PDA)
D. Tetralogy of Fallot
Answer: A
Rationale: Ventricular Septal Defect (VSD) is the most frequent congenital heart lesion,
involving an opening in the septum between the ventricles. The murmur is typically loud,
harsh, and holosystolic due to the high-pressure gradient between the left and right
ventricles. Most small VSDs close spontaneously, but larger ones may require surgical
intervention to prevent pulmonary hypertension.
3. An 8-month-old infant is brought in for a well-child check. The mother reports the infant is
primarily drinking cow’s milk. Laboratory results show a low Hgb and a low MCV. What is the
most likely diagnosis?
A. Thalassemia
B. Sickle Cell Anemia
C. Lead Poisoning
D. Iron Deficiency Anemia
Answer: D
Rationale: Early introduction of cow’s milk before 12 months is a major risk factor for iron
deficiency anemia in infants. The laboratory findings of low hemoglobin and microcytosis
(low MCV) are hallmark indicators of this nutritional deficiency. Management includes
,switching to iron-fortified formula or breast milk and adding iron-rich complementary
foods.
4. A 5-year-old child presents with a 6-day history of high fever, bilateral conjunctival
injection without exudate, a ‘strawberry tongue,’ and edema of the hands. What is the
priority treatment for this patient?
A. Intravenous Immunoglobulin (IVIG) and Aspirin
B. High-dose Ibuprofen
C. Oral Amoxicillin
D. Oral Prednisone
Answer: A
Rationale: Kawasaki disease is diagnosed based on clinical criteria including prolonged
fever and mucocutaneous changes. The primary goal of treatment is to prevent coronary
artery aneurysms through the administration of IVIG. High-dose aspirin is also used
initially for its anti-inflammatory and anti-platelet properties despite the general
contraindication of aspirin in children.
5. A 4-month-old infant presents with projectile, non-bilious vomiting after feeding. On
examination, a small, olive-shaped mass is palpated in the right upper quadrant. What is the
gold standard diagnostic test?
A. Abdominal X-ray
B. Abdominal Ultrasound
, C. Endoscopy
D. Barium Enema
Answer: B
Rationale: Hypertrophic pyloric stenosis typically presents between 3 to 6 weeks of age
with progressive projectile vomiting. The ‘olive mass’ represents the hypertrophied pyloric
muscle and is pathognomonic for the condition. Ultrasound is the preferred diagnostic
modality because it accurately measures the thickness and length of the pylorus without
radiation exposure.
6. In a child with suspected Intussusception, which clinical finding is most characteristic of this
condition?
A. Ribbon-like stools
B. Pain relieved by defecation
C. ‘Currant jelly’ stools
D. Weight loss and steatorrhea
Answer: C
Rationale: Intussusception occurs when one segment of the bowel telescopes into another,
leading to obstruction and vascular compromise. The resulting ischemia causes the
intestinal mucosa to slough off, mixing with blood and mucus to create the classic ‘currant
jelly’ appearance. Immediate treatment usually involves an air or contrast enema to reduce
the telescoping.
I (FNP 1) | Actual Q&A with Rationale
(NURS5432 Exam 4) | The University of
Texas at Arlington
1. A 3-year-old boy presents with a sudden onset of high fever, drooling, and sitting in a
‘tripod’ position. Which of the following is the most appropriate next step in management?
A. Examine the throat with a tongue blade
B. Transfer to the emergency department for airway management
C. Perform an immediate physical exam in the office
D. Obtain a lateral neck X-ray
Answer: B
Rationale: This clinical presentation is highly suggestive of epiglottitis, a life-threatening
medical emergency. Attempting to visualize the throat or performing stressful exams can
trigger complete airway obstruction. The patient requires immediate stabilization in a
setting equipped for emergency intubation or tracheostomy.
2. Which cardiac defect is characterized by a harsh, holosystolic murmur heard best at the left
lower sternal border and is the most common congenital heart defect in children?
A. Ventricular Septal Defect (VSD)
B. Atrial Septal Defect (ASD)
,C. Patent Ductus Arteriosus (PDA)
D. Tetralogy of Fallot
Answer: A
Rationale: Ventricular Septal Defect (VSD) is the most frequent congenital heart lesion,
involving an opening in the septum between the ventricles. The murmur is typically loud,
harsh, and holosystolic due to the high-pressure gradient between the left and right
ventricles. Most small VSDs close spontaneously, but larger ones may require surgical
intervention to prevent pulmonary hypertension.
3. An 8-month-old infant is brought in for a well-child check. The mother reports the infant is
primarily drinking cow’s milk. Laboratory results show a low Hgb and a low MCV. What is the
most likely diagnosis?
A. Thalassemia
B. Sickle Cell Anemia
C. Lead Poisoning
D. Iron Deficiency Anemia
Answer: D
Rationale: Early introduction of cow’s milk before 12 months is a major risk factor for iron
deficiency anemia in infants. The laboratory findings of low hemoglobin and microcytosis
(low MCV) are hallmark indicators of this nutritional deficiency. Management includes
,switching to iron-fortified formula or breast milk and adding iron-rich complementary
foods.
4. A 5-year-old child presents with a 6-day history of high fever, bilateral conjunctival
injection without exudate, a ‘strawberry tongue,’ and edema of the hands. What is the
priority treatment for this patient?
A. Intravenous Immunoglobulin (IVIG) and Aspirin
B. High-dose Ibuprofen
C. Oral Amoxicillin
D. Oral Prednisone
Answer: A
Rationale: Kawasaki disease is diagnosed based on clinical criteria including prolonged
fever and mucocutaneous changes. The primary goal of treatment is to prevent coronary
artery aneurysms through the administration of IVIG. High-dose aspirin is also used
initially for its anti-inflammatory and anti-platelet properties despite the general
contraindication of aspirin in children.
5. A 4-month-old infant presents with projectile, non-bilious vomiting after feeding. On
examination, a small, olive-shaped mass is palpated in the right upper quadrant. What is the
gold standard diagnostic test?
A. Abdominal X-ray
B. Abdominal Ultrasound
, C. Endoscopy
D. Barium Enema
Answer: B
Rationale: Hypertrophic pyloric stenosis typically presents between 3 to 6 weeks of age
with progressive projectile vomiting. The ‘olive mass’ represents the hypertrophied pyloric
muscle and is pathognomonic for the condition. Ultrasound is the preferred diagnostic
modality because it accurately measures the thickness and length of the pylorus without
radiation exposure.
6. In a child with suspected Intussusception, which clinical finding is most characteristic of this
condition?
A. Ribbon-like stools
B. Pain relieved by defecation
C. ‘Currant jelly’ stools
D. Weight loss and steatorrhea
Answer: C
Rationale: Intussusception occurs when one segment of the bowel telescopes into another,
leading to obstruction and vascular compromise. The resulting ischemia causes the
intestinal mucosa to slough off, mixing with blood and mucus to create the classic ‘currant
jelly’ appearance. Immediate treatment usually involves an air or contrast enema to reduce
the telescoping.
