GNRS 590A Final EXAM QUESTIONS AND
VERIFIED CORRECT ANSWERS LATEST 2026-
2027 NEW VERSION
A child has an acute infection causing lower airway obstruction. Which initial
symptom is expected in this child?
A. atelectasis
B. wheezing
C. over-inflation
D. barrel chest - answer>>>B. wheezing
Wheezing is the principal sound patients make if the obstruction allows enough air
to pass through the narrowed lumen when lower airway obstruction occurs.
Eventually, over-inflation and atelectasis occur. Barrel chest is the result of chronic
over-inflation.
A 4-year-old child diagnosed with an upper respiratory tract infection has cloudy
nasal discharge and moderate nasal congestion interfering with sleep. The parent
asks what product to use to help with symptoms. What will the primary care nurse
practitioner recommend?
A. antihistamines
B. decongestant sprays
C. zinc supplements
D. saline rinses - answer>>>D. saline rinses
Normal saline nose drops, nasal rinses, or sprays are helpful for all ages of children
to clear nasal passages. The use of decongestants, antihistamines, and cough
medicine does not shorten the course of a disease. While their use may help with
relieving nasal symptoms, their use is not recommended for children younger than 6
, -
years old. Zinc is not recommended in children because of potential side effects and
questionable efficacy.
A 5-year-old child has enlarged tonsils and a history of six throat infections in the
previous year with fever, cervical lymphadenopathy, and positive Group A
Streptococcus pyogenes (GABHS) cultures. The parent reports that the child snores
at night and expresses concerns about the child's quality of sleep. What is the next
step in managing this child's condition?
a. continuing to observe the child for two or more GABHS infections
B. prescribing prophylactic antibiotics to prevent recurrent infection
C. referring to a pulmonologist for polysomnography evaluation
D. referring to an otolaryngologist for possible tonsillectomy - answer>>>C. referring
to a pulmonologist for polysomnography evaluation
The potential for sleep apnea should be evaluated since the parent reports snoring
and concerns with sleep in a child with frequent throat infections. This child has not
had a high enough number of GABHS throat infections to warrant tonsillectomy and
should be watched. Prophylactic antibiotics are not indicated.
A school-age child has an abrupt onset of sore throat, nausea, headache, and a
temperature of 102.3°F. An examination reveals petechiae on the soft palate, beefy-
red tonsils with yellow exudate, and a scarlatiniform rash. A Rapid Antigen Detection
Test (RADT) is negative. What is the next step in management for this child?
A. consider a sexual abuse diagnosis
B. perform a follow-up throat culture
C. prescribe amoxicillin for 10 days
D. obtain an anti-streptococcal antibody titer - answer>>>B. perform a follow-up
throat culture
,While an RADT has a high specificity, it has variable sensitivity, and a negative test
does not mean that streptococcal infection is not present. A culture should be
performed to confirm the diagnosis. If the throat culture is negative for GABHS,
other causes, such as gonococcal infection, may be considered but are less likely.
The RADT does not assess for sexual abuse. An ASO titer is not useful in the
diagnosis of acute pharyngitis, since the titers remain elevated for months after an
acute infection. Amoxicillin is not indicated unless infection is confirmed.
An adolescent has suspected infectious mononucleosis after exposure to the virus in
the past week. The primary care nurse practitioner examines the adolescent and
notes exudate on the tonsils, soft palate petechiae, and diffuse adenopathy. Which
test will the primary care pediatric nurse practitioner perform to confirm the
diagnosis?
A. heterophile antibody testing
B. CBC
C. EBV-specific antibody testing
D. throat culture - answer>>>C. EBV-specific antibody testing
EBV-specific IgG antibody testing is the specific serologic test for EBV infection.
Heterophile antibody testing can be helpful in school-age children and adolescents
after the first week of infection. A CBC can identify lymphocytosis with atypical
lymphocytes but is non-specific. A throat culture is performed to identify bacterial
causes; however, in this case of known exposure to Epstein-Barr virus (EBV) this
would not be the appropriate confirmatory test.
A school-age child has had nasal discharge and daytime cough but no fever for 12
days without improvement in symptoms. The child has not had antibiotics recently
and there is no significant antibiotic resistance in the local community. What is the
appropriate treatment for this child?
A. amoxicillin 45 mg/kg/day
B. amoxicillin-clavulanate 80-90 mg/kg/day
, -
C. saline irrigation for symptomatic relief
D. amoxicillin 80-90 mg/kg/day - answer>>>A. amoxicillin 45 mg/kg/day
This child meets criteria for treatment of acute rhinosinusitis (ARS) based on
duration of symptoms without clinical improvement. The initial treatment is
amoxicillin 45 mg/kg/day. The higher dose is used to treat ARS in communities with
resistant S. pneumonia. If antibiotics have been used previously, amoxicillin-
clavulanate is used. The use of buffered isotonic saline into the nasal cavity by
squeeze bottle or neti pot (in late childhood and adolescence) may be helpful, but
the clinical guidelines do not support or negate the use of saline.
A school-age child has frequent nosebleeds. Nasal visualization reveals fresh clots
and excoriated nasal mucosa but no visible site of bleeding. Coagulation studies are
normal. In spite of symptomatic measures, the child continues to have nosebleeds.
What is the next course of action?
A. order a topical vasoconstrictor medication
B. cauterize the mucosa with silver nitrate sticks
C. prescribe a barrier agent such as petrolatum jelly
D. refer to an otolaryngologist for further evaluation - answer>>>D. refer to an
otolaryngologist for further evaluation
Children with persistent epistaxis should be referred for evaluation and treatment
after usual symptomatic measures are ineffective. Cautery works well for exposed
vessels, but the site must be easily accessible, visible, and not bleeding briskly.
Topical vasoconstrictors are occasionally used. Petrolatum jelly has not been shown
to be effective.
VERIFIED CORRECT ANSWERS LATEST 2026-
2027 NEW VERSION
A child has an acute infection causing lower airway obstruction. Which initial
symptom is expected in this child?
A. atelectasis
B. wheezing
C. over-inflation
D. barrel chest - answer>>>B. wheezing
Wheezing is the principal sound patients make if the obstruction allows enough air
to pass through the narrowed lumen when lower airway obstruction occurs.
Eventually, over-inflation and atelectasis occur. Barrel chest is the result of chronic
over-inflation.
A 4-year-old child diagnosed with an upper respiratory tract infection has cloudy
nasal discharge and moderate nasal congestion interfering with sleep. The parent
asks what product to use to help with symptoms. What will the primary care nurse
practitioner recommend?
A. antihistamines
B. decongestant sprays
C. zinc supplements
D. saline rinses - answer>>>D. saline rinses
Normal saline nose drops, nasal rinses, or sprays are helpful for all ages of children
to clear nasal passages. The use of decongestants, antihistamines, and cough
medicine does not shorten the course of a disease. While their use may help with
relieving nasal symptoms, their use is not recommended for children younger than 6
, -
years old. Zinc is not recommended in children because of potential side effects and
questionable efficacy.
A 5-year-old child has enlarged tonsils and a history of six throat infections in the
previous year with fever, cervical lymphadenopathy, and positive Group A
Streptococcus pyogenes (GABHS) cultures. The parent reports that the child snores
at night and expresses concerns about the child's quality of sleep. What is the next
step in managing this child's condition?
a. continuing to observe the child for two or more GABHS infections
B. prescribing prophylactic antibiotics to prevent recurrent infection
C. referring to a pulmonologist for polysomnography evaluation
D. referring to an otolaryngologist for possible tonsillectomy - answer>>>C. referring
to a pulmonologist for polysomnography evaluation
The potential for sleep apnea should be evaluated since the parent reports snoring
and concerns with sleep in a child with frequent throat infections. This child has not
had a high enough number of GABHS throat infections to warrant tonsillectomy and
should be watched. Prophylactic antibiotics are not indicated.
A school-age child has an abrupt onset of sore throat, nausea, headache, and a
temperature of 102.3°F. An examination reveals petechiae on the soft palate, beefy-
red tonsils with yellow exudate, and a scarlatiniform rash. A Rapid Antigen Detection
Test (RADT) is negative. What is the next step in management for this child?
A. consider a sexual abuse diagnosis
B. perform a follow-up throat culture
C. prescribe amoxicillin for 10 days
D. obtain an anti-streptococcal antibody titer - answer>>>B. perform a follow-up
throat culture
,While an RADT has a high specificity, it has variable sensitivity, and a negative test
does not mean that streptococcal infection is not present. A culture should be
performed to confirm the diagnosis. If the throat culture is negative for GABHS,
other causes, such as gonococcal infection, may be considered but are less likely.
The RADT does not assess for sexual abuse. An ASO titer is not useful in the
diagnosis of acute pharyngitis, since the titers remain elevated for months after an
acute infection. Amoxicillin is not indicated unless infection is confirmed.
An adolescent has suspected infectious mononucleosis after exposure to the virus in
the past week. The primary care nurse practitioner examines the adolescent and
notes exudate on the tonsils, soft palate petechiae, and diffuse adenopathy. Which
test will the primary care pediatric nurse practitioner perform to confirm the
diagnosis?
A. heterophile antibody testing
B. CBC
C. EBV-specific antibody testing
D. throat culture - answer>>>C. EBV-specific antibody testing
EBV-specific IgG antibody testing is the specific serologic test for EBV infection.
Heterophile antibody testing can be helpful in school-age children and adolescents
after the first week of infection. A CBC can identify lymphocytosis with atypical
lymphocytes but is non-specific. A throat culture is performed to identify bacterial
causes; however, in this case of known exposure to Epstein-Barr virus (EBV) this
would not be the appropriate confirmatory test.
A school-age child has had nasal discharge and daytime cough but no fever for 12
days without improvement in symptoms. The child has not had antibiotics recently
and there is no significant antibiotic resistance in the local community. What is the
appropriate treatment for this child?
A. amoxicillin 45 mg/kg/day
B. amoxicillin-clavulanate 80-90 mg/kg/day
, -
C. saline irrigation for symptomatic relief
D. amoxicillin 80-90 mg/kg/day - answer>>>A. amoxicillin 45 mg/kg/day
This child meets criteria for treatment of acute rhinosinusitis (ARS) based on
duration of symptoms without clinical improvement. The initial treatment is
amoxicillin 45 mg/kg/day. The higher dose is used to treat ARS in communities with
resistant S. pneumonia. If antibiotics have been used previously, amoxicillin-
clavulanate is used. The use of buffered isotonic saline into the nasal cavity by
squeeze bottle or neti pot (in late childhood and adolescence) may be helpful, but
the clinical guidelines do not support or negate the use of saline.
A school-age child has frequent nosebleeds. Nasal visualization reveals fresh clots
and excoriated nasal mucosa but no visible site of bleeding. Coagulation studies are
normal. In spite of symptomatic measures, the child continues to have nosebleeds.
What is the next course of action?
A. order a topical vasoconstrictor medication
B. cauterize the mucosa with silver nitrate sticks
C. prescribe a barrier agent such as petrolatum jelly
D. refer to an otolaryngologist for further evaluation - answer>>>D. refer to an
otolaryngologist for further evaluation
Children with persistent epistaxis should be referred for evaluation and treatment
after usual symptomatic measures are ineffective. Cautery works well for exposed
vessels, but the site must be easily accessible, visible, and not bleeding briskly.
Topical vasoconstrictors are occasionally used. Petrolatum jelly has not been shown
to be effective.
