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A five-year-old child's physical examination is normal and the child has no known allergies to
foods or medications. To date, the child has not been immunized and has had
varicelladisease. The pediatric primary care nurse practitioner now administers a poliovirus
vaccine, a diphtheria, tetanus, and acellular pertussis vaccine; a measles, mumps, and rubella
virus vaccine, and a:
a. Haemophilus influenza Type b vaccine
b. Hepatitis B vaccine
c. Meningococcal vaccined.
d. Varicella vaccine (Varivax)
, b. Hepatitis B vaccine
Rationale: Since the child has not been previously immunized, Hepatitis B should
be given. The Haemophilus influenza Type B vaccine should not be given to
children over 5 years of age if they are otherwise healthy. The meninogococcal
vaccine is not indicated in healthy children until 11 years of age. Because the child
has had the varicella disease, the varicella vaccine is not a priority at this visit.
(CDC, Immunizations, 2019)
An otherwise healthy 2-year old boy is brought to the emergency room with a four-week
history of wheezing and persistent cough. Prior to the start of these symptoms, the parent
recalls a coughing event which resolved spontaneously. Of the following the most likely
diagnosis is:
a. Viral pneumonia
b. Acute laryngotracheobronchitis
c. Bronchiolitis
d. Foreign body aspiration
, d. Foreign body aspiration
Rationale: An initial choking, gagging, or coughing episode following by
spontaneous resolution is often present in history finding of a child with foreign
body aspiration. The episode is typically followed by respiratory symptoms such
as stridor, wheezing, and prolonged cough in the absence of illness. Acute
layngotracheobronchitis, bronchitis, and viral pneumonia are also associated with
coughing and wheezing but also involve other symptoms such as fever,
rhinorrhea, fatigue and usually resolve within 10-14 days. (Nelson Textbook of
Pediatrics 20th edition, Chapter 327)
Evidence-based practice in clinical management is grounded in:
a. Clinical practice guidelines
b. Cohort studies
c. Expert opinions
d. Systematic reviews
d. Systematic reviews
Rationale: Systematic reviews are the highest level of evidence to support
evidence base management. Clinical practice guidelines are often based on
systematic reviews and provide grading of recommendations. Expert opinions and
cohort studies do not provide a high enough level of evidence. (Research levels
of evidence; Stewart & Denisco, Chapter 7)
10. During a well-child visit, a mother expresses concern that her three-year-old has recently
started to stutter when excited. The pediatric primary care nurse practitioner informs the
mother that stuttering in a preschool-aged child:
A five-year-old child's physical examination is normal and the child has no known allergies to
foods or medications. To date, the child has not been immunized and has had
varicelladisease. The pediatric primary care nurse practitioner now administers a poliovirus
vaccine, a diphtheria, tetanus, and acellular pertussis vaccine; a measles, mumps, and rubella
virus vaccine, and a:
a. Haemophilus influenza Type b vaccine
b. Hepatitis B vaccine
c. Meningococcal vaccined.
d. Varicella vaccine (Varivax)
, b. Hepatitis B vaccine
Rationale: Since the child has not been previously immunized, Hepatitis B should
be given. The Haemophilus influenza Type B vaccine should not be given to
children over 5 years of age if they are otherwise healthy. The meninogococcal
vaccine is not indicated in healthy children until 11 years of age. Because the child
has had the varicella disease, the varicella vaccine is not a priority at this visit.
(CDC, Immunizations, 2019)
An otherwise healthy 2-year old boy is brought to the emergency room with a four-week
history of wheezing and persistent cough. Prior to the start of these symptoms, the parent
recalls a coughing event which resolved spontaneously. Of the following the most likely
diagnosis is:
a. Viral pneumonia
b. Acute laryngotracheobronchitis
c. Bronchiolitis
d. Foreign body aspiration
, d. Foreign body aspiration
Rationale: An initial choking, gagging, or coughing episode following by
spontaneous resolution is often present in history finding of a child with foreign
body aspiration. The episode is typically followed by respiratory symptoms such
as stridor, wheezing, and prolonged cough in the absence of illness. Acute
layngotracheobronchitis, bronchitis, and viral pneumonia are also associated with
coughing and wheezing but also involve other symptoms such as fever,
rhinorrhea, fatigue and usually resolve within 10-14 days. (Nelson Textbook of
Pediatrics 20th edition, Chapter 327)
Evidence-based practice in clinical management is grounded in:
a. Clinical practice guidelines
b. Cohort studies
c. Expert opinions
d. Systematic reviews
d. Systematic reviews
Rationale: Systematic reviews are the highest level of evidence to support
evidence base management. Clinical practice guidelines are often based on
systematic reviews and provide grading of recommendations. Expert opinions and
cohort studies do not provide a high enough level of evidence. (Research levels
of evidence; Stewart & Denisco, Chapter 7)
10. During a well-child visit, a mother expresses concern that her three-year-old has recently
started to stutter when excited. The pediatric primary care nurse practitioner informs the
mother that stuttering in a preschool-aged child:
