NSG 548 Exam 4 V2 | NSG 548 FNP Role: Children &
Families | Actual Q&A with Rationale (NSG548
Exam 4) | Wilkes University
1. A 3-year-old child presents with a sudden onset of high fever, drooling, and an ‘anxious’
appearance while sitting in a tripod position. Which action is most critical for the Family
Nurse Practitioner to take?
A. Immediately refer the child to the Emergency Department for airway stabilization.
B. Obtain a STAT lateral neck X-ray to confirm the ‘thumb sign’.
C. Inspect the throat using a tongue blade to rule out strep throat.
D. Administer a dose of nebulized epinephrine to reduce swelling.
Correct Answer: A
Explanation: The clinical presentation is highly suggestive of acute epiglottitis, which is a
life-threatening medical emergency. Attempting to visualize the throat or performing
procedures that cause distress can trigger a complete laryngospasm. The FNP must ensure
the child is transported to a facility capable of emergency intubation or tracheostomy
without delay.
2. An infant presents with forceful, non-bilious, projectile vomiting immediately after feeding.
Upon palpation, the FNP notes a small, firm, olive-shaped mass in the epigastrium. What is
the most likely diagnosis?
A. Gastroesophageal Reflux Disease (GERD)
,B. Intussusception
C. Hirschsprung Disease
D. Hypertrophic Pyloric Stenosis
Correct Answer: D
Explanation: Hypertrophic pyloric stenosis typically occurs between 3 to 6 weeks of age
and is characterized by projectile vomiting. The ‘olive mass’ is pathognomonic for this
condition and represents the thickened pyloric muscle. Diagnostic confirmation is usually
achieved through abdominal ultrasound showing increased pyloric length and thickness.
3. According to the NAEPP guidelines, a 10-year-old child who experiences asthma symptoms
3 days per week and nighttime awakenings 3 times per month should be classified as having:
A. Intermittent Asthma
B. Moderate Persistent Asthma
C. Mild Persistent Asthma
D. Severe Persistent Asthma
Correct Answer: C
Explanation: Mild persistent asthma is characterized by symptoms occurring more than 2
days per week but not daily. Nighttime awakenings for children aged 5-11 in this category
occur 3 to 4 times per month. This classification requires the initiation of a daily long-term
controller medication, typically a low-dose inhaled corticosteroid.
, 4. A mother brings her 4-month-old infant to the clinic concerned about ‘spitting up.’ The
infant is gaining weight well, has no respiratory symptoms, and is otherwise happy. What is
the appropriate management?
A. Start a trial of an H2 receptor antagonist like Ranitidine.
B. Recommend switching to a soy-based formula immediately.
C. Order an upper GI series to rule out anatomical abnormalities.
D. Reassure the mother that this is physiologic GER and will likely resolve by 12 months.
Correct Answer: D
Explanation: Physiologic gastroesophageal reflux (GER) is common in infants and is often
referred to as ‘happy spitting.’ As long as the infant is gaining weight and has no ‘red flag’
symptoms like hematemesis or apnea, no medical intervention is required. Most cases
resolve spontaneously as the lower esophageal sphincter matures and the child spends
more time upright.
5. During a well-child visit, a mother reports that her 2-year-old child has had several ‘temper
tantrums’ and says ‘no’ frequently. The FNP should explain that this behavior:
A. Is a normal developmental stage related to the quest for autonomy.
B. Is a sign of Autistic Spectrum Disorder (ASD).
C. Indicates a need for a formal behavioral health evaluation.
D. Suggests an insecure attachment style with the primary caregiver.
Families | Actual Q&A with Rationale (NSG548
Exam 4) | Wilkes University
1. A 3-year-old child presents with a sudden onset of high fever, drooling, and an ‘anxious’
appearance while sitting in a tripod position. Which action is most critical for the Family
Nurse Practitioner to take?
A. Immediately refer the child to the Emergency Department for airway stabilization.
B. Obtain a STAT lateral neck X-ray to confirm the ‘thumb sign’.
C. Inspect the throat using a tongue blade to rule out strep throat.
D. Administer a dose of nebulized epinephrine to reduce swelling.
Correct Answer: A
Explanation: The clinical presentation is highly suggestive of acute epiglottitis, which is a
life-threatening medical emergency. Attempting to visualize the throat or performing
procedures that cause distress can trigger a complete laryngospasm. The FNP must ensure
the child is transported to a facility capable of emergency intubation or tracheostomy
without delay.
2. An infant presents with forceful, non-bilious, projectile vomiting immediately after feeding.
Upon palpation, the FNP notes a small, firm, olive-shaped mass in the epigastrium. What is
the most likely diagnosis?
A. Gastroesophageal Reflux Disease (GERD)
,B. Intussusception
C. Hirschsprung Disease
D. Hypertrophic Pyloric Stenosis
Correct Answer: D
Explanation: Hypertrophic pyloric stenosis typically occurs between 3 to 6 weeks of age
and is characterized by projectile vomiting. The ‘olive mass’ is pathognomonic for this
condition and represents the thickened pyloric muscle. Diagnostic confirmation is usually
achieved through abdominal ultrasound showing increased pyloric length and thickness.
3. According to the NAEPP guidelines, a 10-year-old child who experiences asthma symptoms
3 days per week and nighttime awakenings 3 times per month should be classified as having:
A. Intermittent Asthma
B. Moderate Persistent Asthma
C. Mild Persistent Asthma
D. Severe Persistent Asthma
Correct Answer: C
Explanation: Mild persistent asthma is characterized by symptoms occurring more than 2
days per week but not daily. Nighttime awakenings for children aged 5-11 in this category
occur 3 to 4 times per month. This classification requires the initiation of a daily long-term
controller medication, typically a low-dose inhaled corticosteroid.
, 4. A mother brings her 4-month-old infant to the clinic concerned about ‘spitting up.’ The
infant is gaining weight well, has no respiratory symptoms, and is otherwise happy. What is
the appropriate management?
A. Start a trial of an H2 receptor antagonist like Ranitidine.
B. Recommend switching to a soy-based formula immediately.
C. Order an upper GI series to rule out anatomical abnormalities.
D. Reassure the mother that this is physiologic GER and will likely resolve by 12 months.
Correct Answer: D
Explanation: Physiologic gastroesophageal reflux (GER) is common in infants and is often
referred to as ‘happy spitting.’ As long as the infant is gaining weight and has no ‘red flag’
symptoms like hematemesis or apnea, no medical intervention is required. Most cases
resolve spontaneously as the lower esophageal sphincter matures and the child spends
more time upright.
5. During a well-child visit, a mother reports that her 2-year-old child has had several ‘temper
tantrums’ and says ‘no’ frequently. The FNP should explain that this behavior:
A. Is a normal developmental stage related to the quest for autonomy.
B. Is a sign of Autistic Spectrum Disorder (ASD).
C. Indicates a need for a formal behavioral health evaluation.
D. Suggests an insecure attachment style with the primary caregiver.
