AANP Family Nurse Practitioner (FNP) Certification ExamAssessmentMedium
A 4-year-old child is brought to the clinic by her mother, who reports a 3-day history of fever (up to 102°F), poor appetite, and irritability. On examination, the nurse practitioner observes multiple small, painful vesicles and ulcers on the buccal mucosa and tongue, along with a maculopapular rash on the palms and soles. The child's immunizations are up-to-date. What is the most appropriate management plan?
- ARefer to pediatric infectious disease for IV immunoglobulin
- BOrder a rapid strep test and prescribe antibiotics if positive
- CPrescribe oral acyclovir for 7 days
- DAdvise supportive care with hydration and pain management
Show answer & explanationAnswer & explanation
Correct answer: D. Advise supportive care with hydration and pain management
The symptoms (fever, oral vesicles/ulcers, rash on palms/soles) are classic for Hand-Foot-and-Mouth Disease (HFMD), which is caused by coxsackievirus. HFMD is a viral illness that is typically self-limiting and requires only supportive care, focusing on hydration and pain relief.
Why the other options are wrong
- A. IV immunoglobulin is reserved for severe, life-threatening viral infections, not routine HFMD.
- B. The rash and oral lesions are not consistent with streptococcal pharyngitis, and antibiotics are ineffective against viral infections.
- C. Acyclovir is an antiviral for herpes simplex, not typically used for coxsackievirus.
Hand-Foot-Mouth Disease (HFMD)
A common viral illness, usually caused by coxsackievirus, characterized by fever, oral lesions (vesicles/ulcers), and a rash on the hands and feet.
- Caused by coxsackievirus.
- Classic triad: fever, oral enanthem, exanthem on palms/soles.
- Self-limiting, managed with supportive care.
Memory trick: Rash with Fever: Think Viral, Treat Supportively