NRNP 6665-01 WEEK 11 FINAL PAPER 2026
ACTUAL EXAM
◉ Epiglottitis s/s Answer: Acute and rapid onset of high fever, chills,
and toxicity. Severe sore throat and drooling saliva. Will not eat or
drink, muffled (hot potato) voice, and anxiety. Sitting posture with
hyperextended neck with open-mouth breathing. Stridor,
tachycardia, and tachypnea
◉ Epiglottitis prevention Answer: Haemophilus influenzae type B
(Hib) vaccine
◉ Steeple sign Answer: a radiologic sign found on radiograph where
the subglottic tracheal narrowing produces a shape of a church
steeple which supports a diagnosis of croup
◉ Foreign body aspiration antibiotic? Answer: Depends on the
nature of the material aspirated, plus the location and degree of
obstruction. Bronchial or laryngeal foreign body aspiration, a
bronchoscopy must be performed for removal of the foreign body
◉ Antibiotics for bronchiolitis? Answer: Use of saline drops and
suctioning of the nares. There is no evidence to support the routine
use of antibiotics
,◉ Antibiotics for croup? Answer: Nebulized epinephrine,
corticosteroids (dexamethasone oral or IM), blow by oxygen or
heliox in severe croup. Racemic epinephrine with the use of
corticosteroids to limit rebound swelling
◉ Antibiotics for epiglottitis? Answer: Establish an airway
preferably by nasotracheal intubation. Administer IV antibiotics
such as rocephin to cover H.influenzae. Administer oxygen and
respiratory support. Antibiotics should be continued for 10 days.
Rifampin prophylaxis 20 mg/kg in a single dose (maximum of 600
mg) for 4 days for infants and children, 600 mg once a day for adults
for 4 days. Should be provided for household contacts who are at
risk (Younger than 4 years old who is non-immunized or
incompletely immunized, children less than 12 months who have
not received primary series of Hib, and immunocompromised
children.
◉ Asthma treatment Answer: The pharmacological management of
asthma in children is based on the severity of asthma and the child's
age. After initial control, decrease treatment to the least amount of
medication needed to maintain control. Systemic corticosteroids
may be needed at any time and stepped up if there is a major flare-
up of symptoms.
◉ Step 1 Asthma management for children 0-4 years old Answer:
Step 1: SABA (Short acting beta2-agonist) PRN: With viral
,respiratory symptoms short acting beta 2-agonist should be used
every 4-6 hours up to 24 hours (longer with a physician consult).
Consider short course of oral systemic corticosteroids if severe
exacerbation. Frequent use of SABA may indicate the need to step up
treatment
◉ Step 2 Asthma management for children 0-4 years old Answer:
Step 2: Consider consultation with asthma specialist. Low dose of
inhaled corticosteroids.
◉ Step 3 asthma mgmt for children 0-4 yrs Answer: Step 3: Medium-
dose of inhaled corticosteroids
◉ Steps 4-6 asthma mgmt for children 0-4 yrs Answer: Step 4:
Medium-dose ICS and Long acting beta2-agonist or montelukast.
Step 5: High dose ICS and Long acting beta 2-agonist or montelukast.
Step 6: High dose of ICS and LABA or montelukast and oral
corticosteroids
◉ Steps 1-3 asthma mgmt for children 5-11 yrs Answer: Step 1:
SABA (Short acting beta 2-agonist) PRN: Increasing the use of short-
acting beta 2-agonist or use greater than 2 days a week for symptom
, relief generally indicates inadequate control and the need to step up
treatment.
Step 2: Consider consultation with asthma specialist. Low dose of
inhaled corticosteroids.
Step 3: Low dose of inhaled corticosteroid and LABA. Or medium
dose of inhaled corticosteroids.
◉ Steps 4-6 asthma mgmt for children 5-11 yrs Answer: Step 4:
Medium-dose ICS and LABA or medium dose of inhaled
corticosteroid and leukotriene receptor antagonist or theophylline. .
Step 5: High dose ICS and LABA or high dose of inhaled
corticosteroid and leukotriene receptor antagonist or theophylline. .
Step 6: High dose of ICS and LABA and oral corticosteroids or high
dose of inhaled corticosteroids and leukotriene receptor antagonist
or theophylline and oral corticosteroids.
** Theophylline levels must be monitored.
◉ Differentials for patient with sore throat Answer: Strep
pharyngitis
ACTUAL EXAM
◉ Epiglottitis s/s Answer: Acute and rapid onset of high fever, chills,
and toxicity. Severe sore throat and drooling saliva. Will not eat or
drink, muffled (hot potato) voice, and anxiety. Sitting posture with
hyperextended neck with open-mouth breathing. Stridor,
tachycardia, and tachypnea
◉ Epiglottitis prevention Answer: Haemophilus influenzae type B
(Hib) vaccine
◉ Steeple sign Answer: a radiologic sign found on radiograph where
the subglottic tracheal narrowing produces a shape of a church
steeple which supports a diagnosis of croup
◉ Foreign body aspiration antibiotic? Answer: Depends on the
nature of the material aspirated, plus the location and degree of
obstruction. Bronchial or laryngeal foreign body aspiration, a
bronchoscopy must be performed for removal of the foreign body
◉ Antibiotics for bronchiolitis? Answer: Use of saline drops and
suctioning of the nares. There is no evidence to support the routine
use of antibiotics
,◉ Antibiotics for croup? Answer: Nebulized epinephrine,
corticosteroids (dexamethasone oral or IM), blow by oxygen or
heliox in severe croup. Racemic epinephrine with the use of
corticosteroids to limit rebound swelling
◉ Antibiotics for epiglottitis? Answer: Establish an airway
preferably by nasotracheal intubation. Administer IV antibiotics
such as rocephin to cover H.influenzae. Administer oxygen and
respiratory support. Antibiotics should be continued for 10 days.
Rifampin prophylaxis 20 mg/kg in a single dose (maximum of 600
mg) for 4 days for infants and children, 600 mg once a day for adults
for 4 days. Should be provided for household contacts who are at
risk (Younger than 4 years old who is non-immunized or
incompletely immunized, children less than 12 months who have
not received primary series of Hib, and immunocompromised
children.
◉ Asthma treatment Answer: The pharmacological management of
asthma in children is based on the severity of asthma and the child's
age. After initial control, decrease treatment to the least amount of
medication needed to maintain control. Systemic corticosteroids
may be needed at any time and stepped up if there is a major flare-
up of symptoms.
◉ Step 1 Asthma management for children 0-4 years old Answer:
Step 1: SABA (Short acting beta2-agonist) PRN: With viral
,respiratory symptoms short acting beta 2-agonist should be used
every 4-6 hours up to 24 hours (longer with a physician consult).
Consider short course of oral systemic corticosteroids if severe
exacerbation. Frequent use of SABA may indicate the need to step up
treatment
◉ Step 2 Asthma management for children 0-4 years old Answer:
Step 2: Consider consultation with asthma specialist. Low dose of
inhaled corticosteroids.
◉ Step 3 asthma mgmt for children 0-4 yrs Answer: Step 3: Medium-
dose of inhaled corticosteroids
◉ Steps 4-6 asthma mgmt for children 0-4 yrs Answer: Step 4:
Medium-dose ICS and Long acting beta2-agonist or montelukast.
Step 5: High dose ICS and Long acting beta 2-agonist or montelukast.
Step 6: High dose of ICS and LABA or montelukast and oral
corticosteroids
◉ Steps 1-3 asthma mgmt for children 5-11 yrs Answer: Step 1:
SABA (Short acting beta 2-agonist) PRN: Increasing the use of short-
acting beta 2-agonist or use greater than 2 days a week for symptom
, relief generally indicates inadequate control and the need to step up
treatment.
Step 2: Consider consultation with asthma specialist. Low dose of
inhaled corticosteroids.
Step 3: Low dose of inhaled corticosteroid and LABA. Or medium
dose of inhaled corticosteroids.
◉ Steps 4-6 asthma mgmt for children 5-11 yrs Answer: Step 4:
Medium-dose ICS and LABA or medium dose of inhaled
corticosteroid and leukotriene receptor antagonist or theophylline. .
Step 5: High dose ICS and LABA or high dose of inhaled
corticosteroid and leukotriene receptor antagonist or theophylline. .
Step 6: High dose of ICS and LABA and oral corticosteroids or high
dose of inhaled corticosteroids and leukotriene receptor antagonist
or theophylline and oral corticosteroids.
** Theophylline levels must be monitored.
◉ Differentials for patient with sore throat Answer: Strep
pharyngitis
