Question 1
A 3-year-old child presents to the pediatric clinic with a 2-day history of high fever, irritability, and reduced oral intake. The mother reports that the child has been crying more frequently and pulling at their ears. Upon examination, the child’s tympanic membrane appears red and bulging. Which of the following is the most appropriate initial management?
A) Prescribe oral decongestants.
B) Start broad-spectrum antibiotics.
C) Administer a dose of intramuscular corticosteroids.
D) Recommend acetaminophen for pain and fever.
E) Order a series of tympanometry and audiometry tests.
Rationale: The child’s symptoms and physical findings suggest acute otitis media, a common pediatric upper respiratory infection. Initial management focuses on pain and fever relief, for which acetaminophen is effective. Broad-spectrum antibiotics may be considered if symptoms do not improve in 48-72 hours or in severe cases, making option B a secondary consideration. Decongestants and corticosteroids are not first-line treatments for acute otitis media, and tympanometry and audiometry are diagnostic, not therapeutic, interventions.
Question 2
A 5-year-old boy is brought to the clinic with a 4-day history of cough, congestion, and a low-grade fever. His mother mentions that he has had several episodes of nocturnal coughing that interfere with his sleep. Physical examination reveals mild wheezing on auscultation. Which of the following would be the most appropriate treatment to alleviate his symptoms?
A) Administer a nebulized short-acting beta-agonist.
B) Prescribe a course of oral antibiotics.
C) Start treatment with an oral antihistamine.
D) Recommend over-the-counter cough suppressants.
E) Initiate oral corticosteroid therapy.
Rationale: The presence of wheezing and cough in a child with an upper respiratory infection may indicate bronchospasm, which can be effectively treated with a short-acting beta-agonist via nebulization to relieve symptoms. Antibiotics are not indicated unless there is evidence of bacterial infection. Antihistamines are primarily used for allergic reactions and may not be effective in this context. Cough suppressants are generally not recommended in children due to the risk of side effects and limited efficacy. Oral corticosteroids are not first-line for mild symptoms and are typically reserved for more severe respiratory distress.
Question 3
An 8-year-old girl is diagnosed with streptococcal pharyngitis after presenting with a sore throat, fever, and the absence of cough. Her pediatrician prescribes an antibiotic. Which of the following instructions should the nurse provide regarding antibiotic therapy?
A) “Stop the antibiotic as soon as her symptoms improve.”
B) “Complete the full course of antibiotics even if she feels better.”
C) “Double the dose if she misses a dose.”
D) “Mix the antibiotic with her favorite juice to improve its taste.”
E) “Only administer the antibiotic on an empty stomach to enhance absorption.”
Rationale: Completing the full course of antibiotics is crucial to ensure the complete eradication of the bacteria, prevent the development of resistance, and avoid recurrence of the infection. Stopping antibiotics early can lead to a resurgence of the infection and contribute to antibiotic resistance. Doubling doses can increase the risk of adverse effects and is not recommended. While some antibiotics can be taken with food or drinks to improve taste, this is not universally applicable and should be based on specific medication instructions. Absorption can vary, and some antibiotics indeed require an empty stomach, but this advice is not universally applicable and depends on the specific drug prescribed.
Question 4
A 2-year-old child is brought to the emergency department with a high fever, cough, and difficulty breathing. The child appears lethargic and has a bluish tint to their lips. The oxygen saturation on room air is 89%. Which of the following actions should the nurse take first?
A) Start an IV line for antibiotic administration.
B) Administer a dose of oral antipyretic.
C) Provide supplemental oxygen.
D) Prepare for a chest X-ray.
E) Give a nebulized bronchodilator.
Rationale: In a child presenting with signs of respiratory distress and hypoxia (evidenced by the bluish tint to lips and oxygen saturation below 90%), the immediate priority is to improve oxygenation. Providing supplemental oxygen is the most direct method to address hypoxia. While the other interventions may be part of the overall treatment plan, they are not the immediate priority. Starting an IV line for antibiotics, administering antipyretics, and preparing for diagnostic tests like a chest X-ray are important steps once the child’s oxygenation is stabilized. Nebulized bronchodilators may be beneficial if there is a component of bronchospasm, but this comes after addressing the urgent need for oxygen.
Question 5
A 6-month-old infant with a history of mild eczema is brought to the pediatrician by their parents, who report a 3-day history of nasal congestion and a mild cough. The infant is afebrile and breastfeeding well but appears irritable. On examination, the pediatrician notes clear nasal discharge and mild intercostal retractions. Which of the following recommendations is most appropriate for this infant?
A) Initiate broad-spectrum antibiotics.
B) Start oral corticosteroids.
C) Use a saline nasal spray and suction to clear nasal passages.
D) Prescribe a decongestant syrup.
E) Recommend an antihistamine.
Rationale: For an infant with nasal congestion and mild respiratory symptoms without fever, the most appropriate management is supportive care. Saline nasal spray and suctioning are effective methods to relieve nasal congestion, especially in infants who cannot blow their nose. This can help improve feeding and comfort. Broad-spectrum antibiotics are not indicated without evidence of a bacterial infection. Oral corticosteroids are not recommended for mild upper respiratory symptoms and can have significant side effects. Decongestant syrups are generally not recommended for infants due to potential side effects and lack of proven efficacy. Antihistamines are not effective for the common cold and can cause sedation and other side effects in infants.
Question 6
A 4-year-old child presents to the clinic with a barking cough, stridor at rest, and a hoarse voice. The mother reports that the symptoms started suddenly last night. The child has no known allergies and is up-to-date with vaccinations. Which of the following is the most likely diagnosis?
A) Asthma
B) Acute bronchitis
C) Croup (laryngotracheobronchitis)
D) Bacterial tracheitis
E) Epiglottitis
Rationale: The child’s presentation with a barking cough, stridor, and hoarseness is characteristic of croup, a common viral infection in children that affects the larynx, trachea, and bronchi. Asthma typically presents with wheezing and difficulty breathing but not with a barking cough or stridor. Acute bronchitis involves inflammation of the bronchi and primarily presents with coughing, not stridor or a barking cough. Bacterial tracheitis and epiglottitis are serious bacterial infections that can cause similar symptoms but are less common and often present with more severe respiratory distress and fever.
Question 7
A 7-year-old child is brought to the pediatric clinic with complaints of a sore throat, difficulty swallowing, and fever for 2 days. Physical examination reveals tonsillar exudates and tender cervical lymphadenopathy. The child’s parents are concerned about the use of antibiotics and ask if they are really necessary. Which of the following is the best response?
A) “Antibiotics are not needed since most sore throats are viral.”
B) “We should wait a few more days to see if the symptoms resolve on their own.”
C) “Antibiotics are necessary to prevent complications like rheumatic fever.”
D) “It’s best to start with antiviral medications first.”
E) “A throat culture should be performed to confirm the diagnosis before deciding on antibiotics.”
Rationale: The presentation suggests possible streptococcal pharyngitis, which can be confirmed with a throat culture or rapid strep test. Antibiotics are recommended for confirmed cases to prevent complications like rheumatic fever. However, not all sore throats are caused by streptococcal infections; many are viral and do not require antibiotics. Waiting without a definitive diagnosis risks complications. Antiviral medications are not effective against bacterial infections like streptococcal pharyngitis.
Question 8
A 6-year-old girl presents with a 3-day history of barking cough, stridor at rest, and hoarseness. She has a history of mild asthma but no recent asthma exacerbations. Her parents report that she has had difficulty swallowing and seems to be breathing faster than usual. Which of the following is the most likely diagnosis?
A) Bacterial tracheitis
B) Asthma exacerbation
C) Croup (Laryngotracheobronchitis)
D) Acute epiglottitis
E) Bronchiolitis
Rationale: The clinical presentation of a barking cough, stridor, and hoarseness is characteristic of croup, an upper respiratory infection commonly caused by the parainfluenza virus. Croup primarily affects the larynx and trachea, leading to these distinctive symptoms. Bacterial tracheitis and acute epiglottitis are serious bacterial infections that also present with respiratory distress but typically with a higher fever and more severe symptoms. Asthma exacerbation could be considered due to her history, but the presence of stridor and a barking cough is more indicative of croup. Bronchiolitis is common in younger children and primarily affects the bronchioles, presenting with wheezing and difficulty breathing but not typically with a barking cough or stridor.
Question 9
A 4-year-old boy with no significant medical history presents to the pediatric clinic with fever, nasal congestion, and a harsh, dry cough. He is alert and active but appears uncomfortable. His mother is concerned because he has been refusing to eat and has been crying due to discomfort from swallowing. Examination reveals red and swollen nasal passages and pharynx. Which of the following home care instructions is most appropriate for this child?
A) “Give him over-the-counter cold medications to ease his symptoms.”
B) “Ensure he stays well hydrated and offer soft, soothing foods.”
C) “Start him on an antibiotic to prevent secondary bacterial infections.”
D) “Use a humidifier in his room only during nighttime.”
E) “Restrict his fluid intake to avoid worsening the nasal congestion.”
Rationale: For a child presenting with upper respiratory infection symptoms, such as fever, nasal congestion, and cough, ensuring adequate hydration is crucial. It helps thin the mucus, making it easier to expel, and soft, soothing foods can alleviate throat discomfort. Over-the-counter cold medications are generally not recommended for children under six years of age due to potential side effects and lack of proven efficacy. Antibiotics are not indicated unless there’s evidence of a secondary bacterial infection. A humidifier can be beneficial both day and night to help relieve congestion, and restricting fluid intake could exacerbate symptoms by thickening mucus.
Question 10
A 7-year-old girl is diagnosed with sinusitis after presenting with persistent nasal discharge, cough, especially at night, and low-grade fever lasting over 10 days. Which of the following is the most appropriate antibiotic choice if the decision is made to treat with antibiotics?
A) Amoxicillin
B) Vancomycin
C) Metronidazole
D) Ciprofloxacin
E) Azithromycin
Rationale: Amoxicillin is the first-line antibiotic treatment for uncomplicated acute bacterial sinusitis in children due to its effectiveness against the common pathogens causing sinusitis and its safety profile in the pediatric population. Vancomycin is used for resistant infections and not first-line for sinusitis. Metronidazole is primarily effective against anaerobic bacteria and not typically used for sinus infections. Ciprofloxacin, a fluoroquinolone, is not recommended in children when possible due to concerns over joint and tendon complications. Azithromycin could be considered, especially in cases of allergy to penicillin, but it is not the first choice.