NSG 548 Exam 4 V3 | NSG 548 FNP Role:
Children & Families | Actual Q&A with
Rationale (NSG548 Exam 4) | Wilkes
University
1. A 4-year-old child presents with a sudden onset of high fever, drooling, and a muffled
voice. The child is sitting in a ‘tripod position.’ Which of the following is the most appropriate
immediate action by the Family Nurse Practitioner?
A. Perform a thorough throat examination using a tongue depressor.
B. Obtain a lateral neck X-ray to confirm the diagnosis.
C. Administer a dose of intramuscular dexamethasone and observe for 30 minutes.
D. Arrange for immediate transport to the emergency department while keeping the child
calm.
Answer: D
Rationale: The clinical presentation is highly suggestive of acute epiglottitis, a medical
emergency that can lead to rapid airway obstruction. Any attempt to visualize the throat
with a tongue depressor can trigger a laryngospasm and complete airway closure. The
priority is to maintain a calm environment and arrange for immediate transport to a facility
where an artificial airway can be safely established if necessary.
,2. According to the CDC immunization schedule, at which age should a child receive the first
dose of the Measles, Mumps, and Rubella (MMR) vaccine?
A. 6 months
B. 4-6 years
C. 12-15 months
D. 2 years
Answer: C
Rationale: The first dose of the MMR vaccine is recommended for children between 12 and
15 months of age. Maternal antibodies typically provide protection against these diseases
during the first year of life, which may interfere with the vaccine’s effectiveness if given too
early. A second dose is then administered at 4 to 6 years of age to ensure long-term
immunity.
3. Which of the following physical examination findings is most characteristic of Kawasaki
disease in the acute phase?
A. Bilateral non-purulent conjunctival injection.
B. A discrete, sandpaper-like rash starting on the trunk.
C. General lymphadenopathy and splenomegaly.
D. Parotid gland swelling and tenderness.
Answer: A
,Rationale: Kawasaki disease is an acute systemic vasculitis, and bilateral non-purulent
conjunctival injection is one of the classic diagnostic criteria. Other criteria include changes
in oral mucosa such as a ‘strawberry tongue,’ edema or erythema of the hands and feet, and
a polymorphous rash. Early recognition is vital because untreated Kawasaki disease can
lead to coronary artery aneurysms.
4. A mother brings her 6-month-old infant to the clinic for a well-child visit. Which
developmental milestone should the FNP expect the infant to have achieved?
A. Sitting independently without support.
B. Transferring objects from one hand to the other.
C. Using a pincer grasp to pick up small objects.
D. Walking while holding onto furniture (cruising).
Answer: B
Rationale: By 6 months of age, infants typically demonstrate the ability to transfer objects
from one hand to the other. Sitting independently usually occurs around 6 to 8 months, but
many infants still require some support at exactly 6 months. Cruising and the pincer grasp
are developmental milestones that generally emerge between 9 and 12 months of age.
5. In the treatment of Acute Otitis Media (AOM) in a 3-year-old child with no known allergies,
what is the first-line antibiotic choice according to current guidelines?
A. Amoxicillin 80-90 mg/kg/day divided into two doses.
B. Azithromycin 10 mg/kg on day one, followed by 5 mg/kg for four days.
, C. Cephalexin 25-50 mg/kg/day divided into three doses.
D. Amoxicillin-Clavulanate 90 mg/kg/day (amoxicillin component).
Answer: A
Rationale: High-dose amoxicillin remains the first-line treatment for AOM in children
without a penicillin allergy due to its effectiveness against Streptococcus pneumoniae. The
recommended dosage is 80-90 mg/kg/day, which provides sufficient middle ear fluid
concentrations to overcome most resistant strains. If the child has received amoxicillin in
the past 30 days or has concurrent purulent conjunctivitis, amoxicillin-clavulanate should
be considered instead.
6. An 8-year-old boy presents with a ‘slapped-cheek’ appearance and a reticular, lacy rash on
his trunk and extremities. He is otherwise asymptomatic. What is the most likely diagnosis?
A. Roseola infantum
B. Scarlet fever
C. Hand-foot-and-mouth disease
D. Erythema infectiosum (Fifth disease)
Answer: D
Rationale: Erythema infectiosum, or Fifth disease, is caused by human parvovirus B19 and
typically presents with the classic ‘slapped-cheek’ rash followed by a lacy, maculopapular
rash on the body. The condition is usually self-limiting and mild in healthy children. It is
important to note that by the time the rash appears, the child is no longer contagious.
Children & Families | Actual Q&A with
Rationale (NSG548 Exam 4) | Wilkes
University
1. A 4-year-old child presents with a sudden onset of high fever, drooling, and a muffled
voice. The child is sitting in a ‘tripod position.’ Which of the following is the most appropriate
immediate action by the Family Nurse Practitioner?
A. Perform a thorough throat examination using a tongue depressor.
B. Obtain a lateral neck X-ray to confirm the diagnosis.
C. Administer a dose of intramuscular dexamethasone and observe for 30 minutes.
D. Arrange for immediate transport to the emergency department while keeping the child
calm.
Answer: D
Rationale: The clinical presentation is highly suggestive of acute epiglottitis, a medical
emergency that can lead to rapid airway obstruction. Any attempt to visualize the throat
with a tongue depressor can trigger a laryngospasm and complete airway closure. The
priority is to maintain a calm environment and arrange for immediate transport to a facility
where an artificial airway can be safely established if necessary.
,2. According to the CDC immunization schedule, at which age should a child receive the first
dose of the Measles, Mumps, and Rubella (MMR) vaccine?
A. 6 months
B. 4-6 years
C. 12-15 months
D. 2 years
Answer: C
Rationale: The first dose of the MMR vaccine is recommended for children between 12 and
15 months of age. Maternal antibodies typically provide protection against these diseases
during the first year of life, which may interfere with the vaccine’s effectiveness if given too
early. A second dose is then administered at 4 to 6 years of age to ensure long-term
immunity.
3. Which of the following physical examination findings is most characteristic of Kawasaki
disease in the acute phase?
A. Bilateral non-purulent conjunctival injection.
B. A discrete, sandpaper-like rash starting on the trunk.
C. General lymphadenopathy and splenomegaly.
D. Parotid gland swelling and tenderness.
Answer: A
,Rationale: Kawasaki disease is an acute systemic vasculitis, and bilateral non-purulent
conjunctival injection is one of the classic diagnostic criteria. Other criteria include changes
in oral mucosa such as a ‘strawberry tongue,’ edema or erythema of the hands and feet, and
a polymorphous rash. Early recognition is vital because untreated Kawasaki disease can
lead to coronary artery aneurysms.
4. A mother brings her 6-month-old infant to the clinic for a well-child visit. Which
developmental milestone should the FNP expect the infant to have achieved?
A. Sitting independently without support.
B. Transferring objects from one hand to the other.
C. Using a pincer grasp to pick up small objects.
D. Walking while holding onto furniture (cruising).
Answer: B
Rationale: By 6 months of age, infants typically demonstrate the ability to transfer objects
from one hand to the other. Sitting independently usually occurs around 6 to 8 months, but
many infants still require some support at exactly 6 months. Cruising and the pincer grasp
are developmental milestones that generally emerge between 9 and 12 months of age.
5. In the treatment of Acute Otitis Media (AOM) in a 3-year-old child with no known allergies,
what is the first-line antibiotic choice according to current guidelines?
A. Amoxicillin 80-90 mg/kg/day divided into two doses.
B. Azithromycin 10 mg/kg on day one, followed by 5 mg/kg for four days.
, C. Cephalexin 25-50 mg/kg/day divided into three doses.
D. Amoxicillin-Clavulanate 90 mg/kg/day (amoxicillin component).
Answer: A
Rationale: High-dose amoxicillin remains the first-line treatment for AOM in children
without a penicillin allergy due to its effectiveness against Streptococcus pneumoniae. The
recommended dosage is 80-90 mg/kg/day, which provides sufficient middle ear fluid
concentrations to overcome most resistant strains. If the child has received amoxicillin in
the past 30 days or has concurrent purulent conjunctivitis, amoxicillin-clavulanate should
be considered instead.
6. An 8-year-old boy presents with a ‘slapped-cheek’ appearance and a reticular, lacy rash on
his trunk and extremities. He is otherwise asymptomatic. What is the most likely diagnosis?
A. Roseola infantum
B. Scarlet fever
C. Hand-foot-and-mouth disease
D. Erythema infectiosum (Fifth disease)
Answer: D
Rationale: Erythema infectiosum, or Fifth disease, is caused by human parvovirus B19 and
typically presents with the classic ‘slapped-cheek’ rash followed by a lacy, maculopapular
rash on the body. The condition is usually self-limiting and mild in healthy children. It is
important to note that by the time the rash appears, the child is no longer contagious.
