QUESTIONS AND RATIONALE ANSWERS FOR Burns: Pediatric Primary Care, 6th Edition Test Bank

The parent of a school-age child reports that the child usually has allergic rhinitis symptoms beginning each fall and that non-sedating antihistamines are only marginally effective, especially for nasal obstruction symptoms. What will the primary care pediatric nurse practitioner do? a. Order an intranasal corticosteroid to begin 1 to 2 weeks prior to pollen season. b. Prescribe a decongestant medication as adjunct therapy during pollen season. c. Recommend adding diphenhydramine to the child’s regimen for additional relief. d. Suggest using an over-the-counter intranasal decongestant.

Respuesta: ANS: A Intranasal corticosteroids are a key component in long-term therapy to manage symptoms associated with AR. These should be begun 1 to 2 weeks prior to the beginning of pollen season. Decongestants are not recommended for long-term use because of side effects. Diphenhydramine causes daytime drowsiness.

The primary care pediatric nurse practitioner sees a child for follow-up care after hospitalization for ARF. The child has polyarthritis but no cardiac involvement. What will the nurse practitioner teach the family about ongoing care for this child? a. Aspirin is given for 2 weeks and then tapered to discontinue the medication. b. Prophylactic amoxicillin will need to be given for 5 years. c. Steroids will be necessary to prevent development of heart disease. d. The child will need complete bedrest until all symptoms subside.

Respuesta: ANS: A ASA is given for arthritis for 2 weeks and then will be tapered. Children with ARF will need penicillin prophylaxis, not amoxicillin. Steroids are sometimes used for symptomatic relief but do not prevent chronic heart disease. Bed rest is indicated only when cardiac symptoms occur.

A school-age child with asthma is seen for a well child checkup and, in spite of “feeling fine,” has pronounced expiratory wheezes, decreased breath sounds, and an FEV1 less than 70% of personal best. The primary care pediatric nurse practitioner learns that the child’s parent administers the daily medium-dose ICS but that the child is responsible for using the SABA. A treatment of 4 puffs of a SABA in clinic results in marked improvement in the child’s status. What will the nurse practitioner do? a. Have the parent administer all of the child’s medications. b. Increase the ICS medication to a high-dose preparation. c. Reinforce teaching about the importance of using the SABA. d. Teach the child and parent how to use home PEF monitoring.

Respuesta: ANS: D Home PEF monitoring is useful for children to identify when symptoms are worsening. This child does not appear to notice the presence of airway tightness or wheezing and so might benefit from PEF monitoring to know when to use the SABA. School-age children should be learning how to manage their chronic disease, so having the parent administer all medications is not the best choice, especially since use of the SABA is still dependent on the child’s report of symptoms. Since the child responded well to administration of the SABA, increasing the dose of ICS should not be done unless better management is not effective. Reinforcing the teaching is part of the plan but, unless the child is aware of symptoms, may not occur.

A child has a fever and arthralgia. The primary care pediatric nurse practitioner learns that the child had a sore throat 3 weeks prior and auscultates a murmur in the clinic. Which test will the nurse practitioner order? a. Anti-DNase B test b. ASO titer c. Rapid strep test d. Throat culture

Respuesta: ANS: B This child has symptoms and a history consistent with ARF. The ASO titer peaks in 3 to 6 weeks and will confirm a recent strep infection. The antiDNase B test will also confirm a recent strep infection, but this doesn’t peak until 6 to 8 weeks after the initial infection. A rapid strep test and throat culture do not differentiate the carrier state from a true infection.

The primary care pediatric nurse practitioner is prescribing ibuprofen for a 25 kg child with JIA who has oligoarthitis. If the child will take 4 doses per day, what is the maximum amount the child will receive per dose? a. 200 mg b. 250 mg c. 400 mg d. 450 mg

Respuesta: ANS: B The maximum dose is 40 mg/kg/day divided into 3 to 4 doses. 25 kg × 40 mg = 1000/4 = 250 mg.

A school-age child who uses a SABA and an inhaled corticosteroid medication is seen in the clinic for an acute asthma exacerbation. After 4 puffs of an inhaled short-acting B2-agonist (SABA) every 20 minutes for three treatments, spirometry testing shows an FEV1 of 60% of the child’s personal best. What will the primary care pediatric nurse practitioner do next? a. Administer an oral corticosteroid and repeat the three treatments of the inhaled SABA. b. Admit the child to the hospital for every 2 hour inhaled SABA and intravenous steroids. c. Give the child 2 mg/kg of an oral corticosteroid and have the child taken to the emergency department. d. Order an oral corticosteroid, continue the SABA every 3 to 4 hours, and follow closely.

Respuesta: ANS: D Children with an incomplete response (FEV1 between 40% and 69% of personal best) should be given oral steroids and instructed to continue the SABA every 3 to 4 hours with close follow-up. Hospitalization is not necessary unless severe distress occurs. An FEV1 less than 40% after treatment indicates a need to be seen in the ED.

An adolescent who has asthma and severe perennial allergies has poor asthma control in spite of appropriate use of a SABA and a daily high-dose inhaled corticosteroid. What will the primary care pediatric nurse practitioner do next to manage this child’s asthma? a. Consider daily oral corticosteroid administration. b. Order an anticholinergic medication in conjunction with the current regimen. c. Prescribe a LABA/inhaled corticosteroid combination medication. d. Refer to a pulmonologist for omalizumab therapy.

Respuesta: ANS: D Children older than 12 years who have moderate to severe allergy-related asthma and who react to perennial allergens may benefit from omalizumab as a second-line treatment when symptoms are not controlled by ICSs. The PNP should refer children to a pulmonologist for such treatment. Daily oral corticosteroid medications are not recommended because of the adverse effects caused by prolonged use of this route. Anticholinergic medications are generally used for acute exacerbations during in-patient stays or in the ED. A LABA/ICS combination will not produce different results.

A 4-month-old infant has a history of reddened, dry, itchy skin. The primary care pediatric nurse practitioner notes fine papules on the extensor aspect of the infant’s arms, anterior thighs, and lateral aspects of the cheeks. What is the initial treatment? a. a. Moisturizers b. b. Oral antihistamines c. c. Topical corticosteroids d. d. Wet wrap therapy

Respuesta: ANS: A Moisturization is the first-line therapy to interrupt the itch-scratch-itch cycle. Oral antihistamines are used mostly to allow sleep during nighttime pruritus. Topical corticosteroids are used if moisturization is not effective. Wet wrap therapy is used to treat flares with recalcitrant disease.

An 8-year-old child is diagnosed with systemic lupus erythematosus ( SLE), and the child’s parent asks if there is a cure. What will the primary care pediatric nurse practitioner tell the parent? a. Complete remission occurs in some children at the age of puberty. b. Periods of remission may occur but there is no permanent cure. c. SLE can be cured with effective medication and treatment. d. The disease is always progressive with no cure and no remissions.

Respuesta: ANS: B Periods of remission do occur in some children with SLE for unknown reasons, but there is no permanent remission or cure. For some children with Juvenile Idiopathic Arthritis (JIA), complete remission occurs at puberty.

The primary care pediatric nurse practitioner is examining a school-age child who has had several hospitalizations for bronchitis and wheezing. The parent reports that the child has several coughing episodes associated with chest tightness each week and gets relief with an albuterol metered-dose inhaler. What will the nurse practitioner order? a. Allergy testing b. Chest radiography c. Spirometry testing d. Sweat chloride test

Respuesta: ANS: C Spirometry testing is the gold standard for diagnosing asthma and is then used on a regular basis to monitor, evaluate, and manage asthma. Allergy testing should be considered but is not diagnostic of asthma. Chest radiography should not be routine. A sweat chloride test is used based on history.