NURS 629 Exam 2 V1 | NURS 629 Peds |
Actual Q&A with Rationale (NURS629
Exam 2) | Maryville University
1. A 6-year-old child presents with a ‘barking’ cough, inspiratory stridor, and hoarseness that
worsens at night. Which of the following is the most likely diagnosis?
A. Laryngotracheobronchitis (Croup)
B. Epiglottitis
C. Bacterial tracheitis
D. Foreign body aspiration
Correct Answer: A
Laryngotracheobronchitis, commonly known as Croup, is characterized by the classic
barking cough and inspiratory stridor due to subglottic narrowing. It is most frequently
caused by the parainfluenza virus and typically affects children between 6 months and 3
years of age. Management focuses on reducing airway edema, often using dexamethasone
and cool mist or racemic epinephrine in severe cases.
,2. A 10-month-old infant is brought to the clinic for a check-up. The mother reports the infant
has episodes of sudden, inconsolable crying followed by drawing the knees to the chest.
Between episodes, the infant appears normal. On examination, a sausage-shaped mass is felt
in the upper right quadrant. What is the priority intervention?
A. Immediate surgical consultation for appendectomy
B. Air or contrast enema for reduction
C. Abdominal ultrasound to rule out pyloric stenosis
D. Administration of oral rehydration salts
Correct Answer: B
The clinical presentation of paroxysmal pain, knee-to-chest positioning, and a sausage-
shaped mass is classic for intussusception. An air or hydrostatic (contrast) enema is both
the gold-standard diagnostic tool and the primary therapeutic intervention for reduction. If
the enema fails or if there is evidence of perforation or peritonitis, surgical intervention
becomes necessary.
3. A 5-year-old child with a history of asthma presents with increased wheezing and chest
tightness. According to the NAEPP EPR-3 guidelines, which medication is the first-line
treatment for an acute exacerbation?
A. Salmeterol
B. Fluticasone
C. Albuterol
,D. Montelukast
Correct Answer: C
Short-acting beta-agonists (SABA) like albuterol are the first-line treatment for acute
asthma exacerbations due to their rapid onset of action in dilating the bronchioles.
Salmeterol is a long-acting beta-agonist (LABA) and should not be used for rescue therapy.
Maintenance medications like fluticasone (ICS) or montelukast (LTRA) are used for long-
term control rather than acute relief.
4. A nurse practitioner is evaluating a pediatric patient for recurrent urinary tract infections
(UTIs). Which of the following factors increase the risk for UTIs in the pediatric population?
(Select all that apply)
A. Female gender
B. Vesicoureteral reflux (VUR)
C. Chronic constipation
D. Uncircumcised male infant under 1 year of age
E. Neurogenic bladder
F. Frequent complete bladder emptying
Correct Answer: A, B, C, D, E
Risk factors for pediatric UTIs include anatomical differences such as a shorter female
urethra and structural abnormalities like vesicoureteral reflux (VUR) which allows urine to
, backflow. Chronic constipation can cause fecal impaction that compresses the bladder
neck, leading to incomplete emptying and bacterial growth. Uncircumcised males are at a
ten-fold higher risk for UTIs in the first year of life compared to circumcised males.
5. Which of the following physical exam findings is most indicative of hypertrophic pyloric
stenosis in a 4-week-old infant?
A. Tympanic abdomen with absent bowel sounds
B. A small, firm, olive-shaped mass in the epigastrium
C. Currant jelly stools
D. Hepatomegaly and jaundice
Correct Answer: B
Hypertrophic pyloric stenosis typically presents between 3 to 6 weeks of age with non-
bilious projectile vomiting. The hallmark physical finding is a firm, mobile, olive-shaped
mass located in the right upper quadrant or epigastrium. Diagnosis is usually confirmed via
ultrasound showing a thickened and elongated pyloric muscle.
6. A 4-year-old child presents with a fever for 6 days, conjunctival injection without drainage,
cracked red lips, and a ‘strawberry tongue.’ Which complication is of greatest concern if this
condition is left untreated?
A. Rheumatic heart disease
B. Coronary artery aneurysms
C. Acute glomerulonephritis
Actual Q&A with Rationale (NURS629
Exam 2) | Maryville University
1. A 6-year-old child presents with a ‘barking’ cough, inspiratory stridor, and hoarseness that
worsens at night. Which of the following is the most likely diagnosis?
A. Laryngotracheobronchitis (Croup)
B. Epiglottitis
C. Bacterial tracheitis
D. Foreign body aspiration
Correct Answer: A
Laryngotracheobronchitis, commonly known as Croup, is characterized by the classic
barking cough and inspiratory stridor due to subglottic narrowing. It is most frequently
caused by the parainfluenza virus and typically affects children between 6 months and 3
years of age. Management focuses on reducing airway edema, often using dexamethasone
and cool mist or racemic epinephrine in severe cases.
,2. A 10-month-old infant is brought to the clinic for a check-up. The mother reports the infant
has episodes of sudden, inconsolable crying followed by drawing the knees to the chest.
Between episodes, the infant appears normal. On examination, a sausage-shaped mass is felt
in the upper right quadrant. What is the priority intervention?
A. Immediate surgical consultation for appendectomy
B. Air or contrast enema for reduction
C. Abdominal ultrasound to rule out pyloric stenosis
D. Administration of oral rehydration salts
Correct Answer: B
The clinical presentation of paroxysmal pain, knee-to-chest positioning, and a sausage-
shaped mass is classic for intussusception. An air or hydrostatic (contrast) enema is both
the gold-standard diagnostic tool and the primary therapeutic intervention for reduction. If
the enema fails or if there is evidence of perforation or peritonitis, surgical intervention
becomes necessary.
3. A 5-year-old child with a history of asthma presents with increased wheezing and chest
tightness. According to the NAEPP EPR-3 guidelines, which medication is the first-line
treatment for an acute exacerbation?
A. Salmeterol
B. Fluticasone
C. Albuterol
,D. Montelukast
Correct Answer: C
Short-acting beta-agonists (SABA) like albuterol are the first-line treatment for acute
asthma exacerbations due to their rapid onset of action in dilating the bronchioles.
Salmeterol is a long-acting beta-agonist (LABA) and should not be used for rescue therapy.
Maintenance medications like fluticasone (ICS) or montelukast (LTRA) are used for long-
term control rather than acute relief.
4. A nurse practitioner is evaluating a pediatric patient for recurrent urinary tract infections
(UTIs). Which of the following factors increase the risk for UTIs in the pediatric population?
(Select all that apply)
A. Female gender
B. Vesicoureteral reflux (VUR)
C. Chronic constipation
D. Uncircumcised male infant under 1 year of age
E. Neurogenic bladder
F. Frequent complete bladder emptying
Correct Answer: A, B, C, D, E
Risk factors for pediatric UTIs include anatomical differences such as a shorter female
urethra and structural abnormalities like vesicoureteral reflux (VUR) which allows urine to
, backflow. Chronic constipation can cause fecal impaction that compresses the bladder
neck, leading to incomplete emptying and bacterial growth. Uncircumcised males are at a
ten-fold higher risk for UTIs in the first year of life compared to circumcised males.
5. Which of the following physical exam findings is most indicative of hypertrophic pyloric
stenosis in a 4-week-old infant?
A. Tympanic abdomen with absent bowel sounds
B. A small, firm, olive-shaped mass in the epigastrium
C. Currant jelly stools
D. Hepatomegaly and jaundice
Correct Answer: B
Hypertrophic pyloric stenosis typically presents between 3 to 6 weeks of age with non-
bilious projectile vomiting. The hallmark physical finding is a firm, mobile, olive-shaped
mass located in the right upper quadrant or epigastrium. Diagnosis is usually confirmed via
ultrasound showing a thickened and elongated pyloric muscle.
6. A 4-year-old child presents with a fever for 6 days, conjunctival injection without drainage,
cracked red lips, and a ‘strawberry tongue.’ Which complication is of greatest concern if this
condition is left untreated?
A. Rheumatic heart disease
B. Coronary artery aneurysms
C. Acute glomerulonephritis
