NSG 548 Exam 3 V2 | NSG 548 FNP Role: Children &
Families | Actual Q&A with Rationale (NSG548
Exam 3) | Wilkes University
1. A 4-year-old child presents with a sudden onset of high fever, muffled voice, and a tripod
sitting position. What is the most likely diagnosis?
A. Viral Croup
B. Bacterial Tracheitis
C. Epiglottitis
D. Foreign Body Aspiration
Correct Answer: C
Explanation: Epiglottitis is a medical emergency often caused by Haemophilus influenzae
type b, though incidence has decreased due to vaccination. The tripod position, drooling,
and respiratory distress are classic clinical indicators of acute airway obstruction.
Immediate stabilization of the airway is the priority, and examination of the throat should
be avoided unless in a controlled surgical environment.
2. Which physical exam maneuver is used to assess for developmental dysplasia of the hip
(DDH) by attempting to relocate a dislocated hip?
A. Barlow maneuver
B. Galeazzi sign
,C. Ortolani maneuver
D. Trendelenburg test
Correct Answer: C
Explanation: The Ortolani maneuver involves abducting the hip while applying upward
pressure to the greater trochanter to reduce a dislocated femoral head back into the
acetabulum. This is distinct from the Barlow maneuver, which is a provocative test used to
identify an unstable hip by attempting to dislocate it. Consistent screening for DDH is
essential during well-child visits throughout the first year of life to prevent long-term gait
abnormalities.
3. An 8-month-old infant is brought to the clinic with episodes of inconsolable crying followed
by periods of lethargy, and the mother notes a ‘currant jelly’ appearance in the stool. What is
the priority diagnostic test?
A. Abdominal X-ray
B. Upper GI series
C. Air or contrast enema
D. Stool culture
Correct Answer: C
Explanation: Intussusception is the telescoping of one part of the intestine into another,
most commonly at the ileocecal valve, leading to bowel obstruction. An air or contrast
enema serves as both a diagnostic tool and the primary therapeutic intervention for
,reduction. Failure to reduce the intussusception non-surgically necessitates immediate
operative intervention to prevent bowel necrosis.
4. In the management of a child with acute otitis media (AOM), which of the following
represents the first-line antibiotic treatment according to current guidelines?
A. Azithromycin 10 mg/kg on day 1
B. Cephalexin 25-50 mg/kg/day
C. Amoxicillin 80-90 mg/kg/day
D. Trimethoprim-sulfamethoxazole
Correct Answer: C
Explanation: High-dose amoxicillin is the preferred first-line agent for AOM because it
effectively targets Streptococcus pneumoniae, the most common bacterial pathogen. The
high dosage is specifically designed to overcome potential penicillin resistance in the
community setting. If the patient has a history of non-type 1 penicillin allergy, second-
generation cephalosporins are typically recommended as alternatives.
5. A 6-week-old infant presents with projectile, non-bilious vomiting immediately after
feeding. A palpable ‘olive-shaped’ mass is noted in the right upper quadrant. What is the
most likely diagnosis?
A. Pyloric Stenosis
B. Gastroesophageal Reflux
C. Duodenal Atresia
, D. Hirschsprung Disease
Correct Answer: A
Explanation: Hypertrophic pyloric stenosis involves the thickening of the pyloric muscle,
which leads to gastric outlet obstruction in early infancy. The classic presentation includes
projectile vomiting and the presence of a palpable olive-like mass representing the
hypertrophied muscle. Diagnosis is usually confirmed via ultrasound, and management
requires surgical pyloromyotomy after correcting metabolic alkalosis and dehydration.
6. A 14-year-old female presents for a sports physical. During the exam, you note breast
budding and the appearance of sparse, long, pigmented pubic hair along the labia. What
Tanner stage best describes these findings?
A. Tanner Stage 1
B. Tanner Stage 4
C. Tanner Stage 3
D. Tanner Stage 2
Correct Answer: D
Explanation: Tanner Stage 2 in females is characterized by the onset of the pubertal
growth spurt and the development of breast buds (thelarche). Pubic hair at this stage is
typically sparse, straight, and lightly pigmented. This stage marks the clinical beginning of
puberty, and the Family Nurse Practitioner should provide guidance on expected
physiological changes over the next few years.
Families | Actual Q&A with Rationale (NSG548
Exam 3) | Wilkes University
1. A 4-year-old child presents with a sudden onset of high fever, muffled voice, and a tripod
sitting position. What is the most likely diagnosis?
A. Viral Croup
B. Bacterial Tracheitis
C. Epiglottitis
D. Foreign Body Aspiration
Correct Answer: C
Explanation: Epiglottitis is a medical emergency often caused by Haemophilus influenzae
type b, though incidence has decreased due to vaccination. The tripod position, drooling,
and respiratory distress are classic clinical indicators of acute airway obstruction.
Immediate stabilization of the airway is the priority, and examination of the throat should
be avoided unless in a controlled surgical environment.
2. Which physical exam maneuver is used to assess for developmental dysplasia of the hip
(DDH) by attempting to relocate a dislocated hip?
A. Barlow maneuver
B. Galeazzi sign
,C. Ortolani maneuver
D. Trendelenburg test
Correct Answer: C
Explanation: The Ortolani maneuver involves abducting the hip while applying upward
pressure to the greater trochanter to reduce a dislocated femoral head back into the
acetabulum. This is distinct from the Barlow maneuver, which is a provocative test used to
identify an unstable hip by attempting to dislocate it. Consistent screening for DDH is
essential during well-child visits throughout the first year of life to prevent long-term gait
abnormalities.
3. An 8-month-old infant is brought to the clinic with episodes of inconsolable crying followed
by periods of lethargy, and the mother notes a ‘currant jelly’ appearance in the stool. What is
the priority diagnostic test?
A. Abdominal X-ray
B. Upper GI series
C. Air or contrast enema
D. Stool culture
Correct Answer: C
Explanation: Intussusception is the telescoping of one part of the intestine into another,
most commonly at the ileocecal valve, leading to bowel obstruction. An air or contrast
enema serves as both a diagnostic tool and the primary therapeutic intervention for
,reduction. Failure to reduce the intussusception non-surgically necessitates immediate
operative intervention to prevent bowel necrosis.
4. In the management of a child with acute otitis media (AOM), which of the following
represents the first-line antibiotic treatment according to current guidelines?
A. Azithromycin 10 mg/kg on day 1
B. Cephalexin 25-50 mg/kg/day
C. Amoxicillin 80-90 mg/kg/day
D. Trimethoprim-sulfamethoxazole
Correct Answer: C
Explanation: High-dose amoxicillin is the preferred first-line agent for AOM because it
effectively targets Streptococcus pneumoniae, the most common bacterial pathogen. The
high dosage is specifically designed to overcome potential penicillin resistance in the
community setting. If the patient has a history of non-type 1 penicillin allergy, second-
generation cephalosporins are typically recommended as alternatives.
5. A 6-week-old infant presents with projectile, non-bilious vomiting immediately after
feeding. A palpable ‘olive-shaped’ mass is noted in the right upper quadrant. What is the
most likely diagnosis?
A. Pyloric Stenosis
B. Gastroesophageal Reflux
C. Duodenal Atresia
, D. Hirschsprung Disease
Correct Answer: A
Explanation: Hypertrophic pyloric stenosis involves the thickening of the pyloric muscle,
which leads to gastric outlet obstruction in early infancy. The classic presentation includes
projectile vomiting and the presence of a palpable olive-like mass representing the
hypertrophied muscle. Diagnosis is usually confirmed via ultrasound, and management
requires surgical pyloromyotomy after correcting metabolic alkalosis and dehydration.
6. A 14-year-old female presents for a sports physical. During the exam, you note breast
budding and the appearance of sparse, long, pigmented pubic hair along the labia. What
Tanner stage best describes these findings?
A. Tanner Stage 1
B. Tanner Stage 4
C. Tanner Stage 3
D. Tanner Stage 2
Correct Answer: D
Explanation: Tanner Stage 2 in females is characterized by the onset of the pubertal
growth spurt and the development of breast buds (thelarche). Pubic hair at this stage is
typically sparse, straight, and lightly pigmented. This stage marks the clinical beginning of
puberty, and the Family Nurse Practitioner should provide guidance on expected
physiological changes over the next few years.
