NP Pediatric Nurse Practitioner 5 — Questions and Answers
Question 1: A 5-year-old with asthma requires a second controller medication. Which add-on therapy is preferred in children aged 5-11 years according to NAEPP guidelines?
- Long-acting beta-agonist (LABA) alone
- Low-dose ICS plus LABA (Correct answer)
- Montelukast as monotherapy
- Theophylline
Correct answer: Low-dose ICS plus LABA
NAEPP guidelines recommend adding a LABA to low-dose inhaled corticosteroids as step-up therapy for children 5-11 years with uncontrolled moderate persistent asthma.
Question 2: A 3-year-old presents with sudden onset of wheezing and decreased breath sounds on the right. He was playing with small toys before symptom onset. What is the priority intervention?
- Nebulized albuterol
- Chest X-ray and rigid bronchoscopy (Correct answer)
- Oral prednisolone
- Intranasal corticosteroid spray
Correct answer: Chest X-ray and rigid bronchoscopy
Unilateral decreased breath sounds with sudden wheezing in a toddler strongly suggests foreign body aspiration, which requires urgent bronchoscopy for diagnosis and removal.
Question 3: Which lab finding is most diagnostic of iron deficiency anemia in a 12-month-old?
- Elevated serum ferritin
- Low MCV with elevated RDW and low serum ferritin (Correct answer)
- Normal MCV with low reticulocyte count
- Elevated total bilirubin with low haptoglobin
Correct answer: Low MCV with elevated RDW and low serum ferritin
Iron deficiency anemia is characterized by microcytosis (low MCV), elevated red cell distribution width (RDW) indicating anisocytosis, and low ferritin reflecting depleted iron stores.
Question 4: A 10-year-old with known sickle cell disease presents with severe headache and right-sided weakness. What is the immediate priority?
- Morphine for pain crisis management
- Exchange transfusion and neuroimaging (Correct answer)
- High-dose hydroxyurea
- IV fluids and supplemental oxygen only
Correct answer: Exchange transfusion and neuroimaging
Acute stroke in sickle cell disease requires emergent exchange transfusion to rapidly reduce HbS percentage and neuroimaging to confirm the diagnosis and guide care.
Question 5: A 2-year-old has a serum lead level of 8 mcg/dL found on routine screening. What is the appropriate next step?
- Chelation therapy with succimer
- Environmental investigation and dietary counseling (Correct answer)
- Repeat level in 1 week
- Hospitalization for IV chelation
Correct answer: Environmental investigation and dietary counseling
Lead levels 3.5-14 mcg/dL require environmental investigation to identify and remove lead sources, plus nutritional counseling (iron, calcium, vitamin C) without chelation therapy.
Question 6: An 8-year-old presents with a painless, freely mobile anterior neck mass that moves upward when the patient swallows or sticks out the tongue. What is the most likely diagnosis?
- Branchial cleft cyst
- Thyroglossal duct cyst (Correct answer)
- Reactive lymphadenopathy
- Cystic hygroma
Correct answer: Thyroglossal duct cyst
Thyroglossal duct cysts are midline neck masses that move with tongue protrusion because they are attached to the hyoid bone and thyroglossal tract remnant.
Question 7: A 13-year-old female with anorexia nervosa has bradycardia (HR 42 bpm) and QTc of 490 ms. What is the most appropriate setting for treatment?
- Outpatient nutrition therapy only
- Intensive outpatient program
- Medical inpatient hospitalization (Correct answer)
- Residential eating disorder facility
Correct answer: Medical inpatient hospitalization
Bradycardia below 50 bpm and prolonged QTc in anorexia nervosa indicate medical instability requiring inpatient hospitalization for cardiac monitoring and refeeding.
NP Pediatric Nurse Practitioner 5
A 5-year-old with asthma requires a second controller medication.
Which add-on therapy is preferred in children aged 5-11 years according to NAEPP guidelines?