NUNP 6541 Pediatric Final Exam-Walden
University
Recommended treatment for RSV in a 7 month old (outpatient) - correct answer
Use of saline drops and suctioning of the nares. Indications of when to use
antipyretics. Signs of respiratory distress or dehydration. Guidelines for feeding an
infant with signs of mild respiratory distress which includes smaller more frequent
feedings; monitoring of the respiratory rate; and guarding against vomiting. The
parents should be educated that the child may have the symptoms over the
course of 2-3 weeks
Epiglottitis s/s - correct 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 - correct answer Haemophilus influenzae type B (Hib)
vaccine
Steeple sign - correct 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? - correct 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? - correct answer Use of saline drops and suctioning
of the nares. There is no evidence to support the routine use of antibiotics
Antibiotics for croup? - correct 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? - correct 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
,NUNP 6541 Pediatric Final Exam-Walden
University
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 - correct 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 - correct 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 - correct answer Step 2:
Consider consultation with asthma specialist. Low dose of inhaled corticosteroids.
Step 3 asthma mgmt for children 0-4 yrs - correct answer Step 3: Medium-dose
of inhaled corticosteroids
Steps 4-6 asthma mgmt for children 0-4 yrs - correct 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 - correct 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.
,NUNP 6541 Pediatric Final Exam-Walden
University
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 - correct 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 - correct answer Strep pharyngitis
Peritonsillar abscess
Viral pharyngitis
Infectious mononucleosis
Epiglottitis
small-for-gestational-age infants: which type of chromosomal analysis should be
included? - correct answer Trisomy 18
Holt-Olram
, NUNP 6541 Pediatric Final Exam-Walden
University
Trisomy 13
Turner Syndrome
Trisomy 21
Prader-Willi Syndrome
heart defects associated with Down syndrome - correct answer Atrioventricular
Septal Defect
Ventricular Septal Defect
Persistant Ductus Arteriosus
Tetrology of Fallot
Contact sports with Down's Syndrome - correct answer Do not recommend due
to atlantoaxial instability
Diagnosing Down Syndrome - correct answer Usually identified at birth by the
presence of certain physical traits: low muscle tone, a single deep crease across
the palm of the hand, a slightly flattened facial profile and an upward slant to the
eyes. Because these features may be present in other babies, a chromosomal
analysis called a karyotype is done to confirm the diagnosis. To obtain a
karyotype, doctors draw a blood sample to examine the baby's cells. They
photograph the chromosomes and then group them by size, number, and shape.
By examining the karyotype, doctors can diagnose. Another genetic test called
FISH can apply similar principles and confirm a diagnosis in a shorter amount of
time
Diagnosing Trisomy 18 (Edwards Syndrome) - correct answer A sample of the
baby's dna is extracted from a blood sample or other bodily cells or tissue and is
cultured to examine a picture of the chromosomes called a karyotype. In order to
get this picture, the chromosomes are isolated, stained, and examined under the
microscope. Most often, this is done using the chromosomes in the white blood
cells. A picture of the chromosomes is taken through the microscope. A visible
extra 18th chromosome confirms a Trisomy 18 diagnosis
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