NSG 548 Exam 4 V1 | NSG 548 FNP Role: Children &
Families | Actual Q&A with Rationale (NSG548
Exam 4) | Wilkes University
1. A 4-year-old child presents with a ‘barking’ cough, inspiratory stridor, and low-grade fever.
What is the most likely diagnosis and the primary treatment approach for moderate
symptoms?
A. Epiglottitis; immediate intubation and IV antibiotics
B. Croup (Laryngotracheobronchitis); single dose of Dexamethasone
C. Bacterial Tracheitis; humidified oxygen and suctioning
D. Pertussis; oral Azithromycin for 5 days
Correct Answer: B
Explanation: The classic presentation of a barking cough and stridor indicates Croup,
which is typically viral. Dexamethasone is the standard treatment for moderate cases to
reduce airway inflammation. This treatment helps prevent the need for hospitalization and
provides long-lasting corticosteroid effects.
2. When screening an adolescent for scoliosis using the Adams Forward Bend Test, the FNP
notes a rib hump and a scoliometer reading of 8 degrees. What is the appropriate next step?
A. Re-evaluate in 6 months during a routine check-up
B. Refer immediately to a physical therapist for core strengthening
,C. Prescribe a rigid back brace to be worn 23 hours a day
D. Order a standing PA and lateral spinal X-ray to measure the Cobb angle
Correct Answer: D
Explanation: A scoliometer reading of 7 degrees or greater warrants further investigation
with spinal radiographs. The Cobb angle measured via X-ray determines the severity of the
curvature and guides further management. This approach ensures that progressive spinal
deformities are captured early in the adolescent growth spurt.
3. A 15-month-old is brought in for a well-child visit. The mother is concerned because the
child is not yet walking independently. What is the most appropriate response by the FNP?
A. Assure the mother that independent walking is not expected until 18 months
B. Refer the child immediately to a pediatric neurologist for developmental delay
C. Perform a Denver II Developmental Screening to assess other milestones
D. Order a Vitamin D level and calcium panel to rule out rickets
Correct Answer: A
Explanation: While most children walk by 12 months, the normal range for independent
walking extends up to 18 months. The FNP should assess for other gross motor skills like
pulling to stand and cruising. Reassurance and continued monitoring are appropriate
unless other red flags are present during the assessment.
,4. An 8-year-old male presents with sudden onset of scrotal pain, nausea, and an absent
cremasteric reflex. What is the most critical action?
A. Order a scrotal ultrasound to rule out epididymitis
B. Immediate referral to the emergency department for surgical evaluation
C. Prescribe Ceftriaxone and Doxycycline for suspected infection
D. Apply ice packs and recommend bed rest for 24 hours
Correct Answer: B
Explanation: These symptoms are hallmark signs of testicular torsion, which is a surgical
emergency. The absence of the cremasteric reflex is a highly sensitive indicator for torsion
in pediatric patients. Delay in surgical intervention can lead to irreversible ischemic
damage and loss of the testicle.
5. During a sports physical, a 16-year-old female reports a history of frequent fainting during
exercise. Physical exam reveals a systolic murmur that increases in intensity with a Valsalva
maneuver. What condition is suspected?
A. Hypertrophic Cardiomyopathy
B. Mitral Valve Prolapse
C. Aortic Stenosis
D. Atrial Septal Defect
Correct Answer: A
, Explanation: Hypertrophic Cardiomyopathy (HCM) is characterized by a murmur that
intensifies during maneuvers that decrease preload, such as Valsalva. This condition is a
leading cause of sudden cardiac death in young athletes. The patient requires an immediate
referral to cardiology and cessation of competitive sports until cleared.
6. A 2-year-old child presents with a high fever (103°F) for 4 days, which suddenly drops,
followed by the appearance of a rose-pink maculopapular rash on the trunk. What is the
diagnosis?
A. Roseola Infantum (Exanthema Subitum)
B. Rubeola (Measles)
C. Rubella (German Measles)
D. Erythema Infectiosum (Fifth Disease)
Correct Answer: A
Explanation: Roseola is caused by Human Herpesvirus 6 and is classic for its high fever
that resolves abruptly just as the rash appears. The rash typically starts on the trunk and
spreads to the neck and extremities. Treatment is supportive, as the illness is self-limiting
and usually benign.
7. Which of the following findings is most diagnostic of Iron Deficiency Anemia in a 12-month-
old child?
A. Low Mean Corpuscular Volume (MCV) and high RDW
B. Elevated Hemoglobin and Hematocrit
Families | Actual Q&A with Rationale (NSG548
Exam 4) | Wilkes University
1. A 4-year-old child presents with a ‘barking’ cough, inspiratory stridor, and low-grade fever.
What is the most likely diagnosis and the primary treatment approach for moderate
symptoms?
A. Epiglottitis; immediate intubation and IV antibiotics
B. Croup (Laryngotracheobronchitis); single dose of Dexamethasone
C. Bacterial Tracheitis; humidified oxygen and suctioning
D. Pertussis; oral Azithromycin for 5 days
Correct Answer: B
Explanation: The classic presentation of a barking cough and stridor indicates Croup,
which is typically viral. Dexamethasone is the standard treatment for moderate cases to
reduce airway inflammation. This treatment helps prevent the need for hospitalization and
provides long-lasting corticosteroid effects.
2. When screening an adolescent for scoliosis using the Adams Forward Bend Test, the FNP
notes a rib hump and a scoliometer reading of 8 degrees. What is the appropriate next step?
A. Re-evaluate in 6 months during a routine check-up
B. Refer immediately to a physical therapist for core strengthening
,C. Prescribe a rigid back brace to be worn 23 hours a day
D. Order a standing PA and lateral spinal X-ray to measure the Cobb angle
Correct Answer: D
Explanation: A scoliometer reading of 7 degrees or greater warrants further investigation
with spinal radiographs. The Cobb angle measured via X-ray determines the severity of the
curvature and guides further management. This approach ensures that progressive spinal
deformities are captured early in the adolescent growth spurt.
3. A 15-month-old is brought in for a well-child visit. The mother is concerned because the
child is not yet walking independently. What is the most appropriate response by the FNP?
A. Assure the mother that independent walking is not expected until 18 months
B. Refer the child immediately to a pediatric neurologist for developmental delay
C. Perform a Denver II Developmental Screening to assess other milestones
D. Order a Vitamin D level and calcium panel to rule out rickets
Correct Answer: A
Explanation: While most children walk by 12 months, the normal range for independent
walking extends up to 18 months. The FNP should assess for other gross motor skills like
pulling to stand and cruising. Reassurance and continued monitoring are appropriate
unless other red flags are present during the assessment.
,4. An 8-year-old male presents with sudden onset of scrotal pain, nausea, and an absent
cremasteric reflex. What is the most critical action?
A. Order a scrotal ultrasound to rule out epididymitis
B. Immediate referral to the emergency department for surgical evaluation
C. Prescribe Ceftriaxone and Doxycycline for suspected infection
D. Apply ice packs and recommend bed rest for 24 hours
Correct Answer: B
Explanation: These symptoms are hallmark signs of testicular torsion, which is a surgical
emergency. The absence of the cremasteric reflex is a highly sensitive indicator for torsion
in pediatric patients. Delay in surgical intervention can lead to irreversible ischemic
damage and loss of the testicle.
5. During a sports physical, a 16-year-old female reports a history of frequent fainting during
exercise. Physical exam reveals a systolic murmur that increases in intensity with a Valsalva
maneuver. What condition is suspected?
A. Hypertrophic Cardiomyopathy
B. Mitral Valve Prolapse
C. Aortic Stenosis
D. Atrial Septal Defect
Correct Answer: A
, Explanation: Hypertrophic Cardiomyopathy (HCM) is characterized by a murmur that
intensifies during maneuvers that decrease preload, such as Valsalva. This condition is a
leading cause of sudden cardiac death in young athletes. The patient requires an immediate
referral to cardiology and cessation of competitive sports until cleared.
6. A 2-year-old child presents with a high fever (103°F) for 4 days, which suddenly drops,
followed by the appearance of a rose-pink maculopapular rash on the trunk. What is the
diagnosis?
A. Roseola Infantum (Exanthema Subitum)
B. Rubeola (Measles)
C. Rubella (German Measles)
D. Erythema Infectiosum (Fifth Disease)
Correct Answer: A
Explanation: Roseola is caused by Human Herpesvirus 6 and is classic for its high fever
that resolves abruptly just as the rash appears. The rash typically starts on the trunk and
spreads to the neck and extremities. Treatment is supportive, as the illness is self-limiting
and usually benign.
7. Which of the following findings is most diagnostic of Iron Deficiency Anemia in a 12-month-
old child?
A. Low Mean Corpuscular Volume (MCV) and high RDW
B. Elevated Hemoglobin and Hematocrit
