NURS 629 Ped Chapter Questions for all 4 Test Combined Questions With Verified Answers

1. The primary care pediatric nurse practitioner performs a vision screen on a 4 month old infant and notes the presence of convergence and accommodation with mild esotropia of the left eye. What will the nurse practitioner do? - Answer Refer the infant to a pediatric ophthalmologist. 2. During a well child exam on a 4yearold child, the primary care pediatric nurse practitioner notes that the clinic nurse recorded "20/50" for the child's vision and noted that the child had difficulty cooperating with the exam. What will the nurse practitioner recommend? - Answer Test the child's vision in 1 month. Correct 3. During a well child assessment of an African American infant, the primary care pediatric nurse practitioner notes a dark red brown light reflex in the left eye and a slightly brighter, red orange light reflex in the right eye. The nurse practitioner will - Answer . refer the infant to an ophthalmologist 4. The primary care pediatric nurse practitioner performs a Hirschberg test to evaluate - Answer ocular alignment. 5. The primary care pediatric nurse practitioner applies fluorescein stain to a child's eye. When examining the eye with a cobalt blue filter light, the entire cornea appears cloudy. What does this indicate? - Answer There is too much stain on the cornea 6. A toddler exhibits exotropia of the right eye during a coveruncover screen. The primary care pediatric nurse practitioner will refer to a pediatric ophthalmologist to initiate which treatment? - Answer Patching of the unaffected eye for 2 hours each day 7. The primary care pediatric nurse practitioner performs a well child examination on a 9monthold infant who has a history of prematurity at 28 weeks' gestation. The infant was treated for retinopathy of prematurity (ROP) and all symptoms have resolved. When will the infant need an ophthalmologic exam? - Answer At 12 months of age 8. During a wellbaby assessment on a 1weekold infant who had a normal examn when discharged from the newborn nursery 2 days prior, the primary care pediatric nurse practitioner notes moderate eyelid swelling, bulbar conjunctival injections, and moderate amounts of thick, purulent discharge. What is the likely diagnosis? - Answer Chlamydia trachomatis conjunctivitis 9. The primary care pediatric nurse practitioner performs a well baby assessment of a 5dayold infant and notes mild conjunctivitis, corneal opacity, and serosanguinous discharge in the right eye. Which course of action is correct? - Answer Admit the infant to the hospital immediately. 14. A schoolage child has a history of chronic otitis media and is seen in the clinicmwith vertigo. The primary care pediatric nurse practitioner notes profuse purulent otorrhea from both pressureequalizing tubes and a pearlywhite lesion on one tympanic membrane. Which condition is most likely? - Answer Cholesteatoma the parent of a 4monthold infant is concerned that the infant cannot hear. Which test will the primary care pediatric nurse practitioner order to evaluate potential hearing loss in this infant? - Answer Auditory brainstem response (ABR) 2. The primary care pediatric nurse practitioner obtains a tympanogram on a child that reveals a sharp peak of 180 mm H 2 O. What does this value indicate? - Answer Negative ear pressure 13. A child who was treated with amoxicillin and then amoxicillinclavulanate for acute otitis media is seen for followup. The primary care pediatric nurse practitioner notes dullgray tympanic membranes with a visible airfluid level. The child is afebrile and without pain. What is the next course of action? - Answer Monitoring ear fluid levels for 3 months Correct 12. The primary care pediatric nurse practitioner diagnoses acute otitis media in a 2 yearold child who has a history of three ear infections in the first 6 months of life. The child's tympanic membrane is intact and the child has a temperature of 101.5°F. What will the nurse practitioner prescribe for this child? - Answer An analgesic medication and watchful waiting an 18 month old child with no previous history of otitis media awoke during the night with right ear pain. The primary care pediatric nurse practitioner notes an axillary temperature of 100.5°F and an erythematous, bulging tympanic membrane. A tympanogram reveals of peak of +150 mm H 2 O. What is the recommended treatment for this child? - Answer An analgesic medication and watchful waiting 4. A 7monthold infant has had two prior acute ear infections and is currently on the 10th day of therapy with amoxicillinclavulanate after a failed course of amoxicillin. The primary care pediatric nurse practitioner notes marked middle ear effusion and erythema of the TM. The child is irritable and has a temperature of 99.8°F. What is the next step in management of this child's ear infection? - Answer Refer the child to an otolaryngologist. 11. A 3yearold child has had one episode of acute otitis media 3 weeks prior with a normal tympanogram just after treatment with amoxicillin. In the clinic today, the child has a type B tympanogram, a temperature of 102.5°F, and a bulging tympanic membrane. What will the primary care pediatric nurse practitioner order? - Answer Amoxicillinclavulanate twice daily 10. The primary care pediatric nurse practitioner notes a small, round object in a child's external auditory canal, near the tympanic membrane. The child's parent thinks it is probably a dried pea. What will the nurse practitioner do to remove this object? - Answer Refer the child to an otolaryngologist for removal. 5. A 3yearold child with pressureequalizing tubes (PET) in both ears has otalgia in one ear. The primary care pediatric nurse practitioner is able to visualize the tube and does not see exudate in the ear canal and obtains a type A tympanogram. What will the nurse practitioner do? - Answer Order ototopical antibiotic/corticosteroid drops. 6. What will the primary care pediatric nurse practitioner teach the parents of a child who has new pressureequalizing tubes (PET) in both ears? - Answer Parents should notice improved hearing in their child. 7. A child with a history of otitis externa asks about ways to prevent this condition. What will the primary care pediatric nurse practitioner recommend? - Answer Drying the ear canal with a hair dryer 9. A child who has otitis externa has severe swelling of the external auditory canal that persists after 2 days of therapy with ototopical antibiotic/corticosteroid drops. What is the next step in treatment for this child? - Answer Insert a wick into the external auditory canal. 8. A child complains of itching in both ears and is having trouble hearing. The primary care pediatric nurse practitioner notes periauricular edema and marked swelling of the external auditory canal and elicits severe pain when manipulating the external ear structures. Which is an appropriate intervention? - Answer Order ototopical antibiotic/corticosteroid drops. The primary care pediatric nurse practitioner is examining a 2weekold infant and auscultates a wide splitting of S 2 during expiration. What condition may this finding represent? - Answer Atrial septal defect 2. The primary care pediatric nurse practitioner auscultates a new grade II vibratory, midsystolic murmur at the mid sternal border in a 4yearold child that is louder when the child is supine. What type of murmur is most likely? - Answer Still's murmur 3. During a well child assessment, the primary care pediatric nurse practitioner auscultates a harsh, blowing grade IV/VI murmur in a 6monthold infant. What will the nurse practitioner do next? - Answer Refer to a pediatric cardiologist for further evaluation 4. The primary care pediatric nurse practitioner provides primary care for a 4month old infant who has a ventricular septal defect. The infant has been breastfeeding well but in the past month has dropped from the 20th percentile to the 5th for weight. What will the nurse practitioner recommend? - Answer Fortifying breast milk to increase the number of calories per ounce 5. A 12monthold infant who had cardiopulmonary bypass with RBC and plasma infusions during surgery at 8 months is seen for a well child examination. Which vaccine may be administered at this visit? - Answer PCV13 The primary care pediatric nurse practitioner performs a well child examination on a 12monthold child who had repair of a congenital heart defect at 8 months of age. The child has a normal exam. The parent reports that the child is not taking any medications. The nurse practitioner will contact the child's cardiologist to discuss whether the child needs which medication? - Answer Amoxicillin 20. A 7yearold child who has a history of a repaired congenital heart defect has many dental caries along with gingival erythema and irritation and a temperature of 102.5°F. What will the primary care pediatric nurse practitioner do next? - Answer Admit to the hospital with a pediatric cardiology consult. 21. A 15yearold female reports fainting at school in class on two occasions. The adolescent's orthostatic blood pressures are normal. The primary care pediatric nurse practitioner suspects a cardiac cause for these episodes and will order which tests before referring her to a pediatric cardiologist? - Answer 12lead electrocardiogram 7. During a well baby examination of a 6weekold infant, the primary care pediatric nurse practitioner notes poor weight gain, acrocyanosis of the hands and feet, and a respiratory rate of 60 breaths per minute. Oxygen saturation on room air is 93%. The remainder of the exam is unremarkable. Which action is correct? - Answer Refer the infant to a pediatric cardiologist 8. A 3monthold infant who was previously healthy now has a persistent cough, bilateral lung crackles, and poor appetite. The primary care pediatric nurse practitioner auscultates a grade III/VI, lowpitched, holosystolic murmur over the left lower sternal border and palpates the liver at one centimeter below the ribs. What diagnosis is likely? - Answer Ventricular septal defect 9. An infant with trisomy 21 has a complete AV canal defect. Which finding, associated with having both of these conditions, will the primary care pediatric nurse practitioner expect? - Answer Oxygen desaturation 10. A 9monthold infant has a grade III/VI, harsh, rumbling, continuous murmur in the left infraclavicular fossa and pulmonic area. A chest radiograph reveals cardiac enlargement. The primary care pediatric nurse practitioner will refer the infant to a pediatric cardiologist and prepare the parents for which intervention to repair this defect? - Answer Coil insertion in the catheterization laboratory A 5yearold child who had a repair for transposition of the great arteries shortly after birth is growing normally and has been asymptomatic since the surgery. The primary care nurse practitioner notes mild shortness of breath with exertion and, upon questioning, learns that the child has recently complained of dizziness. What will the nurse practitioner do? - Answer Refer the child to the cardiologist immediately 7. A 6yearold child has a systolic blood pressure between the 95th and 99th percentile for age, sex, and height and a diastolic blood pressure between the 90th and the 95th percentile on three separate clinic visits. This child's blood pressure is classified as - Answer stage 1 hypertensive 12. The primary care pediatric nurse practitioner is performing a well child examination on a schoolage child who had complete repair of a tetralogy of Fallot defect in infancy. What is important in this child's health maintenance regime? - Answer Cardiology clearance for sports participation 19. A 12yearold child whose BMI is greater than the 95th percentile has a blood pressure at the 98th percentile for age, sex, and height. After lifestyle changes that include diet and exercise, the child's BMI drops to the 90th percentile, but the blood pressure remains the same. What is the primary care pediatric nurse practitioner's next step in treating this child? - Answer Referral to a nephrologist or cardiologist 13. The primary care pediatric nurse practitioner is performing a sports physical on an adolescent whose history reveals mild aortic stenosis. What will the nurse practitioner recommend? - Answer Evaluation by a cardiologist prior to participation 18. A 12yearold child whose weight and BMI are in the 75th percentile has a diastolic blood pressure that is between the 95th and 99th percentiles for age, sex, and height on three separate occasions. Initial tests for this child will include - Answer renal function and plasma renin tests 16. An adolescent female has a history of repaired tetralogy of Fallot. Which long term complication is a concern for this patient? - Answer Mitral valve prolapse 15. A 5yearold child has an elevated blood pressure during a well child exam. The primary care pediatric nurse practitioner notes mottling and pallor of the child's feet and lower legs and auscultates a systolic ejection murmur in the left infraclavicular region radiating to the child's back. The nurse practitioner will suspect which condition? - Answer Coarctation of the aorta 14. During a routine well child exam on a 5yearold child, the primary care pediatric nurse practitioner auscultates a grade II/VI, harsh, late systolic ejection murmur at the upper left sternal border that transmits to both lung fields. The child has normal growth and development. What will the nurse practitioner suspect? - Answer Pulmonic stenosis In a respiratory disorder causing a checkvalve obstruction, which symptoms will be present? - Answer Air entry on inspiration with expiratory occlusion 5. A schoolage 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, beefyred 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? - Answer Perform a followup throat culture 2. A child has an acute infection causing lower airway obstruction. Which initial symptom is expected in this child? - Answer Wheezing 3. A 4yearold child with an upper respiratory tract infection has cloudy nasaldischarge and moderate nasal congestion interfering with sleep. The parent asks what product to use to help with symptoms. What will the primary care pediatric nurse practitioner recommend? - Answer Saline rinses 4. A 5yearold child has enlarged tonsils and a history of four throat infections in the previous year with fever, cervical lymphadenopathy, and positive Group AStreptococcus pyogenes (GABHS) cultures. The parent reports that the child snores at night and expresses concerns about the child's quality of sleep. The next step in managing this child's condition is to - Answer refer to a pulmonologist for polysomnography evaluation An adolescent has suspected infectious mononucleosis after exposure to the virus in the past week. The primary care pediatric 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? - Answer EBVspecific antibody testing 7. A schoolage 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? - Answer Amoxicillin 45 mg/kg/day 8. After 14 days of treatment with amoxicillin 45 mg/kg/day for acute rhinosinusitis, a child continues to have mucopurulent nasal discharge along with induration, swelling, and erythema of both eyelids. What is the next course of treatment? - Answer Referral to a pediatric otolaryngologist 9. The parent of a toddler and a 4weekold infant tells the primary care pediatric nurse practitioner that the toddler has just been diagnosed with pertussis. What will the nurse practitioner do to prevent disease transmission to the infant? - Answer Order azithromycin 10 mg/kg/day in a single dose daily for 5 days 10. A schoolage 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? - Answer Refer to an otolaryngologist for further evaluation 13. The primary care pediatric nurse practitioner evaluates a child who awoke with a sore throat and high fever after a nap. The child appears anxious and is sitting on the parent's lap with the neck hyperextended. The physical exam reveals stridor, drooling, nasal flaring, and retractions. What will the nurse practitioner do next? - Answer Transport the child to the hospital via emergency medical services. A child is in the clinic because of symptoms of purulent, foulsmelling nasal discharge from the right nostril. Nasal visualization reveals something shiny in a mass of mucous in the nasal cavity. What will the primary care pediatric nurse practitioner do? - Answer Attempt to remove the mass gently using alligator forceps. 12. A 2yearold child is brought to the clinic after developing a hoarse, barklike cough during the night with "trouble catching his breath" according to the parent. The history reveals a 2 day history of lowgrade fever and upper respiratory symptoms. On exam, the child has a respiratory rate of 40 breaths per minute, occasional stridor when crying, and a temperature of 101.3°F. What is the next step in treatment for this child? - Answer Prescribe oral dexamethasone for 2 days The parent of an infant asks about using a probiotic medication. What will the primary care pediatric nurse practitioner tell this parent? - Answer there is no conclusive evidence about using probiotics to treat colic. 2. A toddler who was born prematurely refuses most solid foods and has poor weight gain. A barium swallow study reveals a normal esophagus. What will the primary care pediatric nurse practitioner consider next to manage this child's nutritional needs? - Answer Video fluoroscopy swallowing study 3. A toddler is seen in the clinic after a 2day history of intermittent vomiting and diarrhea. An assessment reveals an irritable child with dry mucous membranes, 3second capillary refill, 2 second recoil of skin, mild tachycardia and tachypnea, and cool hands and feet. The child has had two wet diapers in the past 24 hours. What will the primary care pediatric nurse practitioner recommend? - Answer Oral rehydration solution with followup in 24 hours 4. A 9yearold girl has a history of frequent vomiting and her mother has frequent migraine headaches. The child has recently begun having more frequent and prolonged episodes accompanied by headaches. An exam reveals abnormal eye movements and mild ataxia. What is the correct action? - Answer Refer to a pediatric gastroenterologist for further workup. 5. The parent of a 3monthold reports that the infant arches and gags while feeding - Answer Begin a trial of extensively hydrolyzed protein formula for 2 to 4 weeks. A schoolage child has a 3month history of dull, aching epigastric pain that worsens with eating and awakens the child from sleep. A complete blood count shows a hemoglobin of 8 mg/dL. What is the next step in management? - Answer Referral for esophagogastroduodenoscopy (EGD) 7. A 2monthold infant cries up to 4 hours each day and, according to the parents, is inconsolable during crying episodes with fists and legs noted to be tense and stiff. The infant is breastfeeding frequently but is often fussy during feedings. The physical exam is normal and the infant is gaining weight normally. What will the primary care pediatric nurse practitioner recommend? - Answer Eliminating certain foods from the mother's diet 8. A child is in the clinic after swallowing a metal bead. A radiograph of the GI tract shows a 6 mm cylindrical object in the child's stomach. The child is able to swallow without difficulty and is not experiencing pain. What is the correct course of treatment? - Answer Have the parents watch for the object in the child's stool 9. A 10yearold child has had abdominal pain for 2 days, which began in the periumbilical area and then localized to the right lower quadrant. The child vomited once today and then experienced relief from pain followed by an increased fever. What is the likely diagnosis? - Answer Appendicitis with perforation An 18monthold child has a 1day history of intermittent, cramping abdominal pain with nonbilious vomiting. The child is observed to scream and draw up his legs during pain episodes and becomes lethargic in between. The primary care pediatric nurse practitioner notes a small amount of bloody, mucous stool in the diaper. What is the most likely diagnosis? - Answer Intussusception 13. A schoolage child has recurrent diarrhea with foulsmelling stools, excessive flatus, abdominal distension, and failuretothrive. A 2week lactosefree trial failed to reduce symptoms. What is the next step in diagnosing this condition? - Answer Serologic testing for celiac disease 12. An adolescent is diagnosed with functional abdominal pain (FAP). The child's symptoms worsen during stressful events, especially with school anxiety. What will be an important part of treatment for this child? - Answer Teaching about the braingut interaction causing symptoms 11. A schoolage child has had abdominal pain for 3 months that occurs once or twice weekly and is associated with a headache and occasional difficulty sleeping, often causing the child to stay home from school. The child does not have vomiting or diarrhea and is gaining weight normally. The physical exam is normal. According to Bishop, what is included in the initial diagnostic workup for this child? - Answer CBC, ESR, amylase, lipase, UA, and abdominal ultrasound A 30monthold girl who has been toilet trained for 6 months has daytime enuresis and dysuria and a lowgrade fever. A dipstick urinalysis is negative for leukocyte esterase and nitrites. What is the next step? - Answer Send the urine to the lab for culture. 2. The clean catch urine specimen of a child with dysuria, frequency, and fever has a colony count between 50,000 and 100,000 of E. coli. What is the treatment for this child? - Answer Treat with antibiotics for urinary tract infection 3. A dipstick urinalysis is positive for leukocyte esterase and nitrites in a schoolage child with dysuria and foulsmelling urine but no fever who has not had previous urinary tract infections. A culture is pending. What will the pediatric nurse practitioner do to treat this child? - Answer Prescribe trimethoprimsulfamethoxazole (TMP) twice daily for 3 to 5 days 4. A preschoolage child with no previous history has mild flank pain and fever but no abdominal pain or vomiting. A urinalysis is positive for leukocyte esterase and nitrites. A culture is pending. Which is the correct course of treatment for this child? - Answer Order amoxicillin clavulanate 5. A 3yearold child has just completed a 7day course of amoxicillin for a secondfebrile urinary tract infection and currently has a negative urine culture. What is the next course of action? - Answer Obtain a renal and bladder ultrasound. A 9monthold infant with a history of three urinary tract infections is diagnosed with grade II vesicoureteral reflux. Which medication will be prescribed? - Answer TMPSMX; TMP 2 mg/kg as a single daily dose 12. A child who has nephrotic syndrome is on a steroids and a saltrestricted diet for a relapse of symptoms. A dipstick urinalysis shows 1+ protein, down from 3+ at the beginning of the episode. In consultation with the child's nephrologist, what is the correct course of treatment considering this finding? - Answer Continue with steroids and salt restrictions until the urine is negative for protein 13. A child who had GABHS 2 weeks prior is in the clinic with periorbital edema, dyspnea, and elevated blood pressure. A urinalysis reveals teacolored urine with hematuria and mild proteinuria. What will the primary care pediatric nurse practitioner do to manage this condition? - Answer Refer the child to a pediatric nephrologist for hospitalization. 16. A 6monthold infant has a retractile testis that was noted at the 2month well baby exam. What will the primary care pediatric nurse practitioner do to manage this condition? - Answer Refer the infant to a pediatric urologist or surgeon for possible orchiopexy 14. An adolescent has rightsided flank pain without fever. A dipstick urinalysis reveals gross hematuria without signs of infection or bacteriuria, and the primary care pediatric nurse practitioner diagnoses possible nephrolithiasis. What is the initial treatment for this condition? - Answer Increasing fluid intake up to 2 L daily 15. During a well child examination of a 2yearold child, the primary care pediatric nurse practitioner palpates a unilateral, smooth, firm abdominal mass which does not cross the midline. What is the next course of action that? - Answer Refer the child to an oncologist immediately. 17. A 9monthold infant is brought to the clinic with scrotal swelling and fussiness. The primary care pediatric nurse practitioner notes a tender mass in the affected scrotum that is difficult to reduce. What is the correct action? - Answer Refer immediately to a pediatric surgeon 18. The mother of a 12monthold uncircumcised male infant reports that the child seems to have pain associated with voiding. A physical examination reveals a tight, pinpoint opening of the foreskin, which thickened and inflamed. What will the primary care pediatric nurse practitioner do? - Answer Refer the child to a pediatric urologist. 19. An adolescent male comes to the clinic reporting unilateral scrotal pain, nausea, and vomiting that began that morning. The primary care pediatric nurse practitioner palpates a painful, swollen testis and elicits increased pain with slight elevation of the testis (a negative Phren's sign). What will the nurse practitioner do? - Answer Refer the adolescent immediately to a pediatric urologist or surgeon 11. A child is diagnosed with nephrotic syndrome, and the pediatric nurse practitioner provides primary care in consultation with a pediatric nephrologist. The child was treated with steroids and responded well to this treatment. What will the nurse practitioner tell the child's parents about this disease? - Answer "Steroids will be used when relapses occur." 7. The parent of a toddler diagnosed with grade V vesicoureteral reflux asks the primary care pediatric nurse practitioner how the disease will be treated. What will the nurse practitioner tell this parent? - Answer That surgery to correct the condition is possible 9. A child has gross hematuria, abdominal pain, and arthralgia as well as a rash. What diagnosis is most likely? - Answer HenochSchönlein purpura 10. An adolescent has 2+ proteinuria in a random dipstick urinalysis. A subsequent first morning voided specimen is negative. What will the primary care pediatric nurse practitioner do to manage this condition? - Answer Monitor for proteinuria at each annual well child examination. 8. A healthy 14yearold female has a dipstick urinalysis that is positive for 56 RBCs per hpf but otherwise normal. What is the first question the primary care pediatric nurse practitioner will ask this patient? - Answer "When was your last menstrual period (LMP)?" The primary care pediatric nurse practitioner is teaching a parent of a child with dry skin about hydrating the skin with bathing. What will the nurse practitioner include in teaching? - Answer Have the child soak in a lukewarm water bath. 15. A schoolage child is brought to clinic after a pediculosis capitis infestation is reported at the child's school. If this child is positive, what will the primary care pediatric nurse practitioner expect to find on physical examination, along with live lice near the scalp? - Answer Itching of the scalp, with skin excoriation on the back of the head 16. A 3yearold child has head lice. What will the initial treatment recommendation be to treat this child? - Answer Permethrin 17. A 9monthold infant has vesiculopustular lesions on the palms and soles, on the face and neck, and in skin folds of the extremities. The primary care pediatric nurse practitioner notes linear and Sshaped burrow lesions on the parent's hands and wrists. What is the treatment for this rash for this infant? - Answer Permethrin 5% cream applied to face, neck, and body and rinsed off in 8 to 14 hours 18. An adolescent has acne with lesions on the cheeks and under the chin.Which distribution is this? - Answer Hormonal 19. An adolescent has acne characterized by papules and pustules mostly on the forehead and chin. What will the primary care pediatric nurse practitioner prescribe? - Answer Topical erythromycin with benzoyl peroxide 20. A child has an area of inflammation on the neck that began after wearing a handknot woolen sweater. On examination, the skin appears chafed with mild erythematous patches. The lesions are not pruritic. What is an appropriate initial treatment? - Answer Topical corticosteroids applied 2 to 3 times daily 21. An adolescent who had cradle cap as an infant is in the clinic with thick crusts of yellow, greasy scales on the forehead and behind the ears. What will the primary care pediatric nurse practitioner recommend? - Answer Daily application of ketoconazole 2% topical cream 22. A child is brought to the clinic with a generalized, annular rash characterized by raised wheals with pale centers. On physical examination, the child's lungs are clear and there is no peripheral edema. A history reveals ingestion of strawberries earlier in the day. What is the initial treatment? - Answer Diphenhydramine 0.5 to 1 mg/kg/dose every 4 to 6 hours 23. A child who has been taking antibiotics is brought to the clinic with a rash. The parent reports that the child had a fever associated with what looked like sunburn and now has "blisters" all over. A physical examination shows coalescent target lesions and widespread bullae and areas of peeled skin revealing moist, red surfaces. What will the primary care pediatric nurse practitioner do? - Answer Consult with a pediatric intensivist for admission to a pediatric intensive care unit. 24. A schoolage child has a rash without fever or preceding symptoms. Physical examination reveals a 3cm ovoid, erythematous lesion on the trunk with a finely scaled elevated border, along with generalized macular, ovoid lesions appearing in a "Christmas tree" pattern on the child's back. What is the initial action? - Answer Reassure the child's parents that the rash is benign and self limited. 25. A child who has psoriasis, who has been using a moderate potency topical steroid on thick plaques on the extremities and a highpotency topical steroid on more severe plaques on the elbows and knees, continues to have worsening of plaques. In consultation with a dermatologist, which treatment will be added? - Answer A. Anthralin ointment in high strength applied for 10 to 30 minutes daily B. Calcipotriol cream applied liberally each day to the entire body C. Oral steroids and methotrexate therapy until plaques resolve D. Wideband ultraviolet therapy for 15 minutes twice daily