NSG 548 Exam 4 V2 | NSG 548 FNP Role:
Children & Families | Actual Q&A with
Rationale (NSG548 Exam 4) | Wilkes
University
1. A 4-week-old male infant presents with a history of non-bilious projectile vomiting after
every feeding. On physical examination, a small, firm, olive-shaped mass is palpable in the
right upper quadrant. Which of the following is the most likely diagnosis?
A. Gastroesophageal Reflux Disease (GERD)
B. Hypertrophic Pyloric Stenosis
C. Intussusception
D. Hirschsprung Disease
Answer: B
Rationale: Hypertrophic pyloric stenosis typically presents in infants between 3 to 6
weeks of age with worsening non-bilious projectile vomiting. The presence of a palpable
‘olive’ mass is a pathognomonic finding during physical examination. Diagnosis is usually
confirmed via abdominal ultrasound, and the definitive treatment is a surgical
pyloromyotomy.
2. An 18-month-old child is brought to the clinic for a routine well-child visit. According to
developmental milestones, which of the following tasks should this child be able to perform?
A. Build a tower of 3 to 4 blocks
,B. Walk up and down stairs alone
C. State their first and last name
D. Ride a tricycle
Answer: A
Rationale: By 18 months of age, a child is expected to have the fine motor skills necessary
to stack a tower of 2 to 4 blocks. Walking up stairs alone and knowing their full name are
milestones typically achieved closer to 2 or 3 years of age. Riding a tricycle is a gross motor
skill usually mastered at age 3.
3. A 6-year-old child presents with a sudden onset of high fever, sore throat, and a
‘sandpaper’ texture rash that is most prominent in the skin folds. The tongue appears bright
red with prominent papillae. What is the most appropriate management?
A. Prescribe a 10-day course of Oral Penicillin V
B. Supportive care for a viral exanthem
C. Administer a single dose of Acyclovir
D. Apply topical Permethrin cream
Answer: A
Rationale: The clinical presentation of a sandpaper rash and strawberry tongue is
characteristic of Scarlet Fever, caused by Group A Streptococcus. Antibiotic therapy is
required to prevent complications such as acute rheumatic fever or post-streptococcal
, glomerulonephritis. Penicillin or Amoxicillin remains the first-line treatment for this
condition.
4. A 12-year-old female presents for a sports physical. During the Adams Forward Bend Test,
the clinician notes a lateral curvature of the spine and rib hump. What is the most
appropriate next step?
A. Measure the Scoliometer angle and obtain a spinal radiograph if >7 degrees
B. Refer to physical therapy for core strengthening
C. Instruct the patient to use a back brace for 12 hours a day
D. Reassess in 12 months for progression
Answer: A
Rationale: The Adams Forward Bend Test is the standard screening tool for adolescent
idiopathic scoliosis. A scoliometer reading of 7 degrees or more warrants further
evaluation with a standing spinal radiograph (Cobb angle). Treatment decisions are based
on the degree of curvature and the skeletal maturity of the patient.
5. A 2-year-old child presents with a ‘barking’ cough and inspiratory stridor that worsens at
night. The child is afebrile and does not appear toxic. What is the most likely diagnosis?
A. Epiglottitis
B. Bacterial Tracheitis
C. Foreign Body Aspiration
Children & Families | Actual Q&A with
Rationale (NSG548 Exam 4) | Wilkes
University
1. A 4-week-old male infant presents with a history of non-bilious projectile vomiting after
every feeding. On physical examination, a small, firm, olive-shaped mass is palpable in the
right upper quadrant. Which of the following is the most likely diagnosis?
A. Gastroesophageal Reflux Disease (GERD)
B. Hypertrophic Pyloric Stenosis
C. Intussusception
D. Hirschsprung Disease
Answer: B
Rationale: Hypertrophic pyloric stenosis typically presents in infants between 3 to 6
weeks of age with worsening non-bilious projectile vomiting. The presence of a palpable
‘olive’ mass is a pathognomonic finding during physical examination. Diagnosis is usually
confirmed via abdominal ultrasound, and the definitive treatment is a surgical
pyloromyotomy.
2. An 18-month-old child is brought to the clinic for a routine well-child visit. According to
developmental milestones, which of the following tasks should this child be able to perform?
A. Build a tower of 3 to 4 blocks
,B. Walk up and down stairs alone
C. State their first and last name
D. Ride a tricycle
Answer: A
Rationale: By 18 months of age, a child is expected to have the fine motor skills necessary
to stack a tower of 2 to 4 blocks. Walking up stairs alone and knowing their full name are
milestones typically achieved closer to 2 or 3 years of age. Riding a tricycle is a gross motor
skill usually mastered at age 3.
3. A 6-year-old child presents with a sudden onset of high fever, sore throat, and a
‘sandpaper’ texture rash that is most prominent in the skin folds. The tongue appears bright
red with prominent papillae. What is the most appropriate management?
A. Prescribe a 10-day course of Oral Penicillin V
B. Supportive care for a viral exanthem
C. Administer a single dose of Acyclovir
D. Apply topical Permethrin cream
Answer: A
Rationale: The clinical presentation of a sandpaper rash and strawberry tongue is
characteristic of Scarlet Fever, caused by Group A Streptococcus. Antibiotic therapy is
required to prevent complications such as acute rheumatic fever or post-streptococcal
, glomerulonephritis. Penicillin or Amoxicillin remains the first-line treatment for this
condition.
4. A 12-year-old female presents for a sports physical. During the Adams Forward Bend Test,
the clinician notes a lateral curvature of the spine and rib hump. What is the most
appropriate next step?
A. Measure the Scoliometer angle and obtain a spinal radiograph if >7 degrees
B. Refer to physical therapy for core strengthening
C. Instruct the patient to use a back brace for 12 hours a day
D. Reassess in 12 months for progression
Answer: A
Rationale: The Adams Forward Bend Test is the standard screening tool for adolescent
idiopathic scoliosis. A scoliometer reading of 7 degrees or more warrants further
evaluation with a standing spinal radiograph (Cobb angle). Treatment decisions are based
on the degree of curvature and the skeletal maturity of the patient.
5. A 2-year-old child presents with a ‘barking’ cough and inspiratory stridor that worsens at
night. The child is afebrile and does not appear toxic. What is the most likely diagnosis?
A. Epiglottitis
B. Bacterial Tracheitis
C. Foreign Body Aspiration
