CMN568 FINAL EXAM /CMN568 INTRO TO FAMILY NP FINAL NEWEST 2025 ACTUAL EXAM
Incidence of Fever - (answer) One of most common reasons for parents to seek medical care.
Preschoolers have an average 6-8 febrile illnesses a year.
Definition of fever - (answer) Rectal temperature ≥ 100.4°F
Tympanic temperature - (answer) Not accurate in infants under 3 months
Fever Causes - (answer) Most common Benign viral illness, can also caused by bacterial or fungal
infections, drug reactions including immunizations, malignancies, autoimmune or metabolic disorders,
CNS disorders, excessive environmental temperatures.
Factors that increase likelihood of serious bacterial illness - (answer) Age under 3 months, history of
prematurity, chronic medical conditions such as immunosupression or aspenia, previous hospitalizations,
daycare. Toxic appearance
Non-Toxic appearance - (answer) Strong cry
Consolable
Alert and easy to arouse
Pink skin tones
Good hydration; good turgor, tears, moist mucous membranes
Smiles, responsive to environment
Toxic appearance - (answer) Weak or high pitched cry
Inconsolable
Difficult to arouse
Pale, ashen, cyanotic, or mottled skin tones
Poor hydration; poor turgor, dry mucous membranes, no tears
No smile, listless, dull, infant won't alert to environment
Signs of serious illness - (answer) Fever greater than 40 (105)
,CMN568 FINAL EXAM /CMN568 INTRO TO FAMILY NP FINAL NEWEST 2025 ACTUAL EXAM
Nuchal rigidity
Petechial skin rash
Seizure activity
Stridor or increased WOB
Physical exam signs of serious infection: Skin - (answer) Petechiae, rashes
Physical exam signs of serious infection: head/neck - (answer) Sunken or bulging fontanelles, nuchal
rigidity
Physical exam signs of serious infection: ears - (answer) Bulging TM, AOM, mastoiditis
Physical exam signs of serious infection: Chest - (answer) Tachypnea, wheezing, rales, rhonchi
Physical exam signs of serious infection: Heart - (answer) Murmurs
Physical exam signs of serious infection: Abdomen - (answer) Tenderness, distension
Physical exam signs of serious infection: Musculoskeletal - (answer) Refusal to bear weight or use an
extremity, erythema/warmth over joint
Diagnostic tests for fever in infant and young child - (answer) CBC w/ Diff (WBC > 15,000 may indicate
SBI. Child with overwhelming sepsis my have WBC <5,000)
UA/ C&S: R/O UTI
CXR: R/O Pneumonia
Lumbar Puncture: R/O meningitis
Blood cultures: R/O Bacteremia
Stools for C&S: R/O Infectious diarrhea
Management of fever in infant < 4 weeks - (answer) Refer to pediatrician
,CMN568 FINAL EXAM /CMN568 INTRO TO FAMILY NP FINAL NEWEST 2025 ACTUAL EXAM
Hospitalization
Full septic workup
IV antibiotics pending culture results
Management of fever in infant 4 weeks - 3Mo - (answer) Toxic appearance:
Refer to pediatrician
Hospitalization
Full septic workup
IV antibiotics pending culture results
Non-Toxic appearance/No risk factors for SBI:
Full septic workup
Specific treatment for any diagnosed conditions
Empiric antibiotics after cultures: Rocephin 50mg/kg/day (up to 1 gm max)
Must have reliable caregiver with phone and transportation
Close followup in 24 hours
Management of fever in 3Mo to Preschool - (answer) Toxic appearance:
Septic work up
Consider hospitalization and IV antibiotics, especially if no focal source of fever can be identified
Non-Toxic appearance:
Lab work up guided by H&P
CBC with Diff
CXR if cough or dyspnea
Stool C&S if diarrhea
UA: all girls under 2yo, all males under 6Mo, uncircumcised males under 12Mo
Non-Toxic appearance:
Fever <39 (102) no obvious source: Antipyretics, close followup by visit or phone
Fever >39 (102) antipyretics, consider empiric antibiotics, close followup by visit or phone
, CMN568 FINAL EXAM /CMN568 INTRO TO FAMILY NP FINAL NEWEST 2025 ACTUAL EXAM
Antipyretic - (answer) Acetaminophen: 10-15mg/kg Q 4-6 Hrs (Max 5 doses in 24 hours)
Ibuprofen: 5-10mg/kg Q 6-8hrs (max 40mg/kg/day)
Never use aspirin
Educate parents on risk of overdosing and review concentration information.
Fever-Home Care - (answer) Increased fluids to maintain hydration
Light clothing/blankets to help reduce fever
Tepid sponge baths if fever unresponsive to antipyretics
No alcohol or cold water baths
Parents should check every 4 hours for: Temp, activity level, fluid intake and report any change in
condition to medical provider
Fever - Follow up - (answer) Close follow up is essential for safe out-patient management of fever in
infants and young children
Follow up by office visit or phone in 24 hours
Follow up on all labs and cultures and focus treatment on any positive findings
Proper otoscope technique - (answer) Always brace finger against patients cheek
Adult: Pinna up and back
Peds: Pinna down and back
Normal Otoscope View - (answer) Malleus, Umbo, Cone of light
Cone of light at 7 o'clock in left and 5 o'clock on right
Cone of light disappears when there is fluid
Otitis Externa - (answer) Cellulitis of the soft tissues of the external auditory canal
Hallmark - tragus pain (doesn't hurt with middle ear infection)
Pathogens: Otitis Externa - (answer) Pseudomonas aeruginosa
Incidence of Fever - (answer) One of most common reasons for parents to seek medical care.
Preschoolers have an average 6-8 febrile illnesses a year.
Definition of fever - (answer) Rectal temperature ≥ 100.4°F
Tympanic temperature - (answer) Not accurate in infants under 3 months
Fever Causes - (answer) Most common Benign viral illness, can also caused by bacterial or fungal
infections, drug reactions including immunizations, malignancies, autoimmune or metabolic disorders,
CNS disorders, excessive environmental temperatures.
Factors that increase likelihood of serious bacterial illness - (answer) Age under 3 months, history of
prematurity, chronic medical conditions such as immunosupression or aspenia, previous hospitalizations,
daycare. Toxic appearance
Non-Toxic appearance - (answer) Strong cry
Consolable
Alert and easy to arouse
Pink skin tones
Good hydration; good turgor, tears, moist mucous membranes
Smiles, responsive to environment
Toxic appearance - (answer) Weak or high pitched cry
Inconsolable
Difficult to arouse
Pale, ashen, cyanotic, or mottled skin tones
Poor hydration; poor turgor, dry mucous membranes, no tears
No smile, listless, dull, infant won't alert to environment
Signs of serious illness - (answer) Fever greater than 40 (105)
,CMN568 FINAL EXAM /CMN568 INTRO TO FAMILY NP FINAL NEWEST 2025 ACTUAL EXAM
Nuchal rigidity
Petechial skin rash
Seizure activity
Stridor or increased WOB
Physical exam signs of serious infection: Skin - (answer) Petechiae, rashes
Physical exam signs of serious infection: head/neck - (answer) Sunken or bulging fontanelles, nuchal
rigidity
Physical exam signs of serious infection: ears - (answer) Bulging TM, AOM, mastoiditis
Physical exam signs of serious infection: Chest - (answer) Tachypnea, wheezing, rales, rhonchi
Physical exam signs of serious infection: Heart - (answer) Murmurs
Physical exam signs of serious infection: Abdomen - (answer) Tenderness, distension
Physical exam signs of serious infection: Musculoskeletal - (answer) Refusal to bear weight or use an
extremity, erythema/warmth over joint
Diagnostic tests for fever in infant and young child - (answer) CBC w/ Diff (WBC > 15,000 may indicate
SBI. Child with overwhelming sepsis my have WBC <5,000)
UA/ C&S: R/O UTI
CXR: R/O Pneumonia
Lumbar Puncture: R/O meningitis
Blood cultures: R/O Bacteremia
Stools for C&S: R/O Infectious diarrhea
Management of fever in infant < 4 weeks - (answer) Refer to pediatrician
,CMN568 FINAL EXAM /CMN568 INTRO TO FAMILY NP FINAL NEWEST 2025 ACTUAL EXAM
Hospitalization
Full septic workup
IV antibiotics pending culture results
Management of fever in infant 4 weeks - 3Mo - (answer) Toxic appearance:
Refer to pediatrician
Hospitalization
Full septic workup
IV antibiotics pending culture results
Non-Toxic appearance/No risk factors for SBI:
Full septic workup
Specific treatment for any diagnosed conditions
Empiric antibiotics after cultures: Rocephin 50mg/kg/day (up to 1 gm max)
Must have reliable caregiver with phone and transportation
Close followup in 24 hours
Management of fever in 3Mo to Preschool - (answer) Toxic appearance:
Septic work up
Consider hospitalization and IV antibiotics, especially if no focal source of fever can be identified
Non-Toxic appearance:
Lab work up guided by H&P
CBC with Diff
CXR if cough or dyspnea
Stool C&S if diarrhea
UA: all girls under 2yo, all males under 6Mo, uncircumcised males under 12Mo
Non-Toxic appearance:
Fever <39 (102) no obvious source: Antipyretics, close followup by visit or phone
Fever >39 (102) antipyretics, consider empiric antibiotics, close followup by visit or phone
, CMN568 FINAL EXAM /CMN568 INTRO TO FAMILY NP FINAL NEWEST 2025 ACTUAL EXAM
Antipyretic - (answer) Acetaminophen: 10-15mg/kg Q 4-6 Hrs (Max 5 doses in 24 hours)
Ibuprofen: 5-10mg/kg Q 6-8hrs (max 40mg/kg/day)
Never use aspirin
Educate parents on risk of overdosing and review concentration information.
Fever-Home Care - (answer) Increased fluids to maintain hydration
Light clothing/blankets to help reduce fever
Tepid sponge baths if fever unresponsive to antipyretics
No alcohol or cold water baths
Parents should check every 4 hours for: Temp, activity level, fluid intake and report any change in
condition to medical provider
Fever - Follow up - (answer) Close follow up is essential for safe out-patient management of fever in
infants and young children
Follow up by office visit or phone in 24 hours
Follow up on all labs and cultures and focus treatment on any positive findings
Proper otoscope technique - (answer) Always brace finger against patients cheek
Adult: Pinna up and back
Peds: Pinna down and back
Normal Otoscope View - (answer) Malleus, Umbo, Cone of light
Cone of light at 7 o'clock in left and 5 o'clock on right
Cone of light disappears when there is fluid
Otitis Externa - (answer) Cellulitis of the soft tissues of the external auditory canal
Hallmark - tragus pain (doesn't hurt with middle ear infection)
Pathogens: Otitis Externa - (answer) Pseudomonas aeruginosa
