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PEDIATRICS ATI PROCTORED PRACTICE exam QUESTIONS, Exams of Pediatrics

PEDIATRICS ATI PROCTORED PRACTICE exam QUESTIONS

Typology: Exams

2024/2025

Available from 06/27/2025

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Parenting styles
PEDIATRICS ATI PROCTORED
PRACTICE exam QUESTIONS
Chapter 1: Family centered nursing
-Dictatorial or authoritarian:
-Parents try to control the child’s behaviors and attitudes through
unquestioned rules and expectations
-Ex: The child is never allowed to watch television on school nights
-Permissive:
-Parents exert little or no control over the child’s behaviors, and consult the
child when making decisions
-Ex: The child assists with deciding whether he will watch television
-Democratic or authoritative:
-Parents direct the child’s behavior by setting rules and explaining the reason
for each rule setting
-Ex: The child can watch television for 1 hr on school nights after
completing all of his homework and chores
-Parents negatively reinforce deviations form the rules
-Ex: The privilege is taken away but later reinstated based on new
guidelines
Chapter 2: Physical assessment findings
1.
Vital signs
-Usually vital signs are all high except for BP
-Temperature:
-3 6 months 99.5
-1 year 99.9
-3 year 99.0
-5 years 98.6
-7 years 98.2
-9 11 years 98.1
-13 years 97.9
-Pulse:
-Newborn 80 180/min
-1 weeks 3 months 80 220/min
-3 months 2 years 70 150/min
-2 10 years 60 110/min
-10 years and older 50 90/min
-Respirations:
-Newborn 1year 30 35/min
-1 2 years 25 30/min
-2 6 years 21 25/min
-6 12 years 19 21/min
-12 years and older 16 19/min
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Parenting styles

PEDIATRICS ATI PROCTORED

PRACTICE exam QUESTIONS Chapter 1: Family centered nursing

  • Dictatorial or authoritarian:
    • Parents try to control the child’s behaviors and attitudes through unquestioned rules and expectations
      • Ex: The child is never allowed to watch television on school nights
  • Permissive:
    • Parents exert little or no control over the child’s behaviors, and consult the child when making decisions
      • Ex: The child assists with deciding whether he will watch television
  • Democratic or authoritative:
    • Parents direct the child’s behavior by setting rules and explaining the reason for each rule setting
      • Ex: The child can watch television for 1 hr on school nights after completing all of his homework and chores
    • Parents negatively reinforce deviations form the rules
      • Ex: The privilege is taken away but later reinstated based on new guidelines **Chapter 2: Physical assessment findings
  1. Vital signs**
  • Usually vital signs are all high except for BP
  • Temperature:
    • 3 – 6 months 99.
    • 1 year 99.
    • 3 year 99.
    • 5 years 98.
    • 7 years 98.
    • 9 – 11 years 98.
    • 13 years 97.
  • Pulse:
    • Newborn 80 – 180/min
    • 1 weeks – 3 months 80 – 220/min
    • 3 months – 2 years 70 – 150/min
    • 2 – 10 years 60 – 110/min
    • 10 years and older 50 – 90/min
  • Respirations:
    • Newborn – 1year 30 – 35/min
    • 1 – 2 years 25 – 30/min
    • 2 – 6 years 21 – 25/min
    • 6 – 12 years 19 – 21/min
    • 12 years and older 16 – 19/min
  • Blood pressure:
    • Low as a baby but increases the older they get
    • Infants:
      • Systolic: 65 - 78
      • Diastolic: 41 - 52 2. Head
  • Fontanels should be flat
  • Posterior fontanel:
    • Closes by 6 - 8 weeks
  • Anterior fontanel:
    • Closes by 12 - 18 months 3. Teeth
  • Infants should have 6 - 8 teeth by 1 year old
  • Children and adolescents should have teeth that are white and smooth, and begin replacing the 20 deciduous teeth with 32 permanent teeth 4. Infant Reflexes Stepping Birth to 4 weeks Palmar Grasp Birth to 3 months Tonic Neck Reflex (Fencer Position) Birth to 3 – 4 months Sucking and Rooting Reflex Birth to 4 months Moro Reflex (Fall backward) Birth to 4 months Startle Reflex (Loud Noise) Birth to 4 months Plantar Reflex Birth to 8 months Babinski Reflex Birth to 1 year **Chapter 3: Health promotion of infants (2 days to 1 year)
  1. Physical Development**
  • Weight:
    • Doubled by 5 months
    • Tripled by 12 months
    • Quartered by 30 months
  • Height:
    • 2.5 cm (1 in) per month for the first 6 months
  • Length:
    • Increases by 50% by 12 months
  • Dentition:
    • First teeth erupt between 6 - 10 months 2. Motor skill development ▪ 1 Month o Head lag o Strong grasp reflex ▪ 2 Months o Lifts head when prone

6. Social development

  • Separation Anxiety: protest when separated from parents
    • Begins around 4 - 8 months
  • Stranger Fear: ability to discriminate between familiar and unfamiliar people
    • Begins 6 - 8 months 7. Age appropriate activities
  • Rattles
  • Playing pat-a cake
  • Brightly colored toys
  • Playing with blocks 8. Nutrition
  • Breastfeeding provides a complete diet for infants during the first 6 months
  • Solids are introduced around 4 - 6 months
    • Iron-fortified cereal is the first to be introduced
    • New foods should be introduced one at a time, over a 5 - 7 day period to observe for allergy reactions
  • Juice and water usually not needed for 1 st^ year
  • Appropriate finger foods:
    • Ripe bananas
    • Toast strips
    • Graham crackers
    • Cheese cubes
    • Noodles
    • Firmly cooked vegetables
    • Raw pieces of fruit (except grapes) 9. Injury prevention
  • Avoid small objects (grapes, coins, and candy)
  • Handles of pots and pans should be kept turned to the back of the stove
  • Sunscreen should be used when infants are exposed to the sun
  • Infants and toddlers remain in a rear-facing car seat until age 2
  • Crib slats should be no farther apart than 6 months
  • Pillows should be kept out of the crib
  • Infants should be placed on their backs for sleep **Chapter 4: Health Promotion of Toddlers (1 to 3 years)
  1. Physical development**
  • Weight:
    • 30 months: 4 times the birth weight
  • Height:
    • Toddlers grow 7.5 cm (3 in) per year
  • Head circumference and chest circumference:
    • Usually equal by 1 to 2 years of age 2. Cognitive development
  • Piaget: sensorimotor stage transitions to preoperational stage 19 – 24 months
    • Object Permanence: fully developed

3. Language development

  • 1 year: using one-word sentences
  • 2 years: 300 words, multiword sentences by combining 2 - 3 words 4. Psychosocial Development
  • Autonomy vs. Shame and Doubt
    • Independence is paramount for toddlers who are attempting to do everything for themselves
    • Use negativism or negative responses to express their independence
    • Ritualism, or maintaining routines and reliability, provides a sense of comfort for toddlers as they begin to explore the environment beyond those most familiar to them 5. Age appropriate activities
  • Parallel play: Toddlers observe other children and then might engage in activities nearby
  • Appropriate activities:
    • Playing with blocks
    • Push-pull toys
    • Large-piece puzzles
    • Thick crayons
  • Toilet training can begin when toddlers have the sensation of needing to urinate or defecate 6. Motor skill development ▪ 15 Months o Walks without help | Creeps up stairs o Uses a cup well | Builds 2 tower blocks ▪ 18 Months o Runs clumsily | Throws overhand | Jumps in place w/ both feet | Pulls/Pushes toys o Manages a spoon w/o rotation | Turns pages 2 - 3 pages /time | Builds 3 - 4 blocks | Uses crayon to scribble spontaneously | Feeds self ▪ 24 Months (2 years) o Walks backwards | Walks up/down stairs w/ 2 feet on each step o Builds 6- 7 blocks | Turns pages 1 @ a time ▪ 30 Months (2.5 years) o Balances on 1 leg | Jumps across floor / off chair w/ both feet | Walks tiptoe o Draws circles | has good hand-finger coordination 7. Nutrition
  • Whole milk at 1 year old
  • Can start drinking low-fat milk after 2 years of age
  • Juice consumption should be limited to 4 - 6 oz. per day
  • Foods that are potential choking hazards:
    • Nuts
    • Grapes
    • Hot dogs
    • Peanut butter
  • Playing ball
  • Putting puzzles together
  • Riding tricycles
  • Playing pretend dress up activities
  • Role-playing 6. Sleep and rest
  • On average, preschoolers need about 12 hours of sleep
  • Keep a consistent bedtime routine
  • Avoid allowing preschoolers to sleep with their parents **Chapter 6: Health promotion of School-Age children (6- 12 years)
  1. Physical development**
  • Weight:
  • Gain 2 - 3 kg (4.4-6.6 lb.) per year
  • Height:
  • Grows 5 cm (2 in.) per year 2. Cognitive development
  • Piaget: Concrete operations
  • Able to see the perspective of others 3. Psychosocial development
  • Erikson: Industry vs. Inferiority
  • A sense of industry is achieved through the development of skills and knowledge that allows the child to provide meaningful contributions to society
  • A sense of accomplishment is gained through the ability to cooperate and compete with others
  • Peer groups play an important part in social development 4. Age appropriate activities
  • Competitive and cooperative play is predominant
  • Play simple board and number games
  • Play hopscotch
  • Jump rope
  • Ride bicycles
  • Join organized sports (for skill building) 5. Sleep and rest
  • Need 9 hrs of sleep at age 11 6. Dental health
  • The first permanent teeth erupt around 6 years of age **Chapter 7: Health promotion of Adolescents (12 to 20 years)
  1. Physical development**
  • Girls stop growing at about 2 - 2.5 years after the onset of menarche
  • In girls, sexual maturation occurs in the following order:
  • Breast development
  • Pubic hair growth
  • Axillary hair growth
  • Menstruation
  • In boys, sexual maturation occurs in the following order:
  • Testicular enlargement
  • Pubic hair growth
  • Penile enlargement
  • Growth of axillary hair
  • Facial hair growth
  • Vocal changes 2. Cognitive development
  • Piaget: Formal operations
  • Increasingly capable of using formal logic to make decisions 3. Psychosocial development
  • Erikson: Identity vs. role confusion
  • Adolescents develop a sense of personal identity and to come to view themselves as unique individuals 4. Age-appropriate activities
  • Nonviolent videogames
  • Nonviolent music
  • Sports
  • Caring for a pet
  • Reading **Chapter 8: Safe Medication Administration
  1. Oral**
  • This route of medication administration is preferred for children
  • Avoid mixing medication with formula or putting it in a bottle of formula because the infant might not take the entire feeding, and the medication can alter the taste of the formula
  • Use the smallest measuring liquid medication for doses of liquid medication
  • Avoid measuring liquid medication in a tsp. or tbsp.
  • Administer the medication in the side of the mouth in small amounts
  • Stroke the infant under the chin to promote swallowing while holding the cheeks together 2. Otic
  • Children younger than years:
  • Pull the pinna downward and straight back
  • Children older than 3 years:
  • Pull the pinna upward and back 3. Intramuscular
  • Use a 22 - 25 gauge, 1/2- 1 inch needle
  • Vastus lateralis is the recommended site in infants and small children
  • Other sites:
  • Ventrogluteal and deltoid
  • Provide factual information
  • Encourage contact with peer group 5. Adolescent
  • Perceptions of illness severity are based on the degree of body images
  • Develops body image disturbance
  • Experiences feelings of isolation from peers
  • Provide factual information
  • Encourage contact with peer group **Chapter 11: Death and Dying
  1. Grief and mourning**
  • Anticipatory grief:
    • When death is expected or a possible outcome
  • Complicated grief:
    • Extends for more than 1 year following the loss 2. Current stages of development
  • Infants/toddlers (birth- 3 years):
    • Have little to no concept of death
    • Mirror parental emotions
    • Can regress to an earlier stage of behavior
  • Preschool (3-6):
    • Magical thinking allows for the belief that thoughts can cause an event such as death resulting in feeling guilt and shame
    • Interpret separation from parents as punishment for bad behavior
    • View dying as temporary
  • School-age (6-12):
    • Begin to have adult concept of death
    • Fear often displayed through uncooperative behavior
  • Adolescent (12-20):
  • Can have adult-like concept of death
  • Can have difficulty accepting death
  • Rely more on peers than the influence of parents
  • Can become increasingly stressed by changes in physical appearance 3. Physical manifestations of death
  • Sensation of heat when the body feels cool
  • Decreased sensation and movement in lower extremities
  • Swallowing difficulties
  • Bradycardia/hypotension
  • Cheyne-strokes respirations 4. After death
  • Allow family to stay with the body as long as they desire
  • Allow family to rock the infant/toddler
  • Remove tubes and equipment
  • Offer to allow family to assist with preparation of the body

Chapter 12: Acute Neurological disorders

1. Meningitis

  • Viral (aseptic) Meningitis: supportive care for recovery
  • Bacterial (septic) Meningitis: contagious infection - Hib and PCV vaccines decrease the incidence
  • Newborns:
    • Poor Muscle Tone
    • Weak Cry
    • Poor Suck | Refuses Feedings
    • Vomiting/Diarrhea
    • Bulging Fontanels (late sign)
  • 3 Months – 2 Years:
    • Seizures with a High-Pitched Cry
    • Bulging Fontanels
    • Poor Feedings | Vomiting
    • Possible nuchal rigidity
    • Brudzinki’s sign and Kernig’s sign not reliable for diagnosis
  • 2 Years – Adolescence:
    • Seizures (often initial sign)
    • Nuchal rigidity
    • Fever/chills
    • Headache/vomiting
    • Irritability/restlessness that can progress to drowsiness/stupor
    • Petechiae or purpuric type rash (with meningococcal infection)
    • + Brudzinski Sign : flexion of extremities with deliberate flexion of the neck
    • + Kernig’s Sign : resistance to extension of the leg from a flexed position
  • Laboratory Tests
    • Blood Cultures | CBC | CSF Analysis
    • Viral CSF
      • Clear Color | Slightly Elevated WBC & Protein | Normal Glucose | - Gram
    • Bacterial CSF
      • Cloudy Color | Elevated WBC | Elevated Protein | Decreased Glucose | +Gram
  • Diagnostic Procedures
    • Lumbar Puncture (Definitive Diagnostic Test)
      • Empty Bladder
      • EMLA Cream 45min – 1 - hour prior
      • Side-lying Position, Head Flexed, Knees Drawn up to Chest
      • Remain in Flat Position to prevent Leakage and Spinal HA
  • Nursing care:
    • Droplet precautions
    • Maintain NPO status if the client has decreased LOC
  • Violent jerking movements of the body
  • Postictal State (30 minutes)
  • Remains semiconscious but arouses with difficulty and confused
  • No recollection of the seizure
  • Absence seizure: petit mal or lapses
  • Onset between ages 5 – 8 years and ceases by the teenage years
  • Loss of Consciousness lasting 5 – 10 seconds
  • Minimal or no change in behavior
  • Resembles daydreaming or Inattentiveness
  • Can drop items being held, but the child seldom falls
  • Lip Smacking | Twitching of Eyelids or Face | Slight Hand Movements
  • Myoclonic seizure:
  • Brief contraction of muscle or groups of muscle
  • No postictal state
  • Atonic or akinetic seizure:
  • Muscle tone is lost for a few seconds 3. Diagnostic procedures
  • EEG:
  • Abstain from caffeine for several hours prior to the procedure
  • Wash hair (no oils or sprays) before and after the procedure to remove electrode gel 4. Nursing care
  • Initiate Seizure Precautions:
  • Pad side rails of Bed | Crib | Wheelchair
  • Keep bed free of objects that could cause Injury
  • Have Suction and Oxygen Equipment available
  • During a Seizure:
  • Protect from Injury (move furniture away, hold head in lap)
  • Maintain a position to provide a patent airway
  • Suction Oral Secretions
  • Side-lying Position (decreases risk of aspiration)
  • Loosen restrictive clothing
  • Do NOT restrain the child
  • Do NOT put anything in the child’s mouth
  • Do NOT open the jaw or insert an airway during seizure
  • This can damage teeth, lips, or tongue
  • Remain with the child
  • Note onset, time, and characteristics of seizure
  • Allow seizure to end spontaneously
  • Post-Seizure:
  • Side-lying position to prevent aspiration and facilitate drainage of secretions
  • Check for breathing, V/S and position of head
  • NPO until swallowing reflex has returned 5. Medications
  • Antiepileptic Drugs (AEDs):
  • Diazepam (Valium) | Phenytoin | Carbamazepine | Valporic Acid | 6. Therapeutic procedures
  • Focal Resection: of an area of the brain to remove epileptogenic zone
  • Corpus Callostomy: separation of two hemispheres in the brain
  • Vagal Nerve Stimulator 7. Complications
  • Status Epilepticus:
  • Prolonged Seizure Activity that Lasts >30 minutes or Continuous seizure activity in which the client does not enter a Postictal Phase
  • Maintain Airway, Administer oxygen, IV access **Chapter 14: Head injury
  1. Physical assessment findings**
  • Minor injury:
  • Vomiting
  • Pallor
  • Irritability
  • Lethargy/drowsiness
  • Severe injury: Increased ICP
  • Infants:
  • Bulging fontanel
  • Irritability (usually 1 st^ sign)
  • High-pitched cry
  • Poor feeding
  • Children:
  • Nausea/headache
  • Forceful vomiting
  • Blurred vision
  • Seizures
  • Late signs:
  • Alterations in pupillary response
  • Posturing (flexion and extension)
  • Decreased motor response
  • Decreased response to painful stimuli
  • Cheyne-stokes respirations
  • Seizures
  • Flexion: severe dysfunction of the cerebral cortex
  • Extension: Severe dysfunction at the level of the midbrain 2. Nursing care
  • Ensure the spine is stabilized until a spinal cord injury is ruled out
  • Implement actions to decrease ICP:
  • Keep the head midline with the bed elevated 30 degrees, which will also promote venous draining
  • Avoid extreme flexion, extension, or rotation of the head and maintain in midline neutral position
  • Tilt the head back slightly, and press the inhaler
  • While pressing the inhaler, begin a slow, deep breath that lasts for 3 - 5 seconds
  • Hold the breath for 5 - 10 seconds 2. Dry powder inhaler
  • DO NOT shake 3. Chest physiotherapy
  • Is a set of techniques that includes manual or mechanical percussion, vibration, cough, forceful expiration (or huffing), and breathing exercises
  • Helps loosen respiratory secretions
  • Schedule treatments before meals or at least 1 hr after meals and at bedtime
  • Administer bronchodilator medication or nebulizer treatment prior 4 4. Hypoxemia
  • Early signs:
    • Tachypnea
    • Tachycardia
    • Restlessness
    • Use of accessory muscles
    • Nasal flaring 5. Oxygen toxicity
  • Can result from high concentrations of oxygen, long duration of oxygen therapy, and the child’s degree of lung disease
  • Hypoventilation and increased PaCO 2 levels allow for rapid progression into unconscious state **Chapter 17: Acute and infectious respiratory illnesses
  1. Tonsillitis**
  • Physical assessment findings:
    • Report of sore throat with difficulty swallowing
    • Mouth odor/mouth breathing
    • Fever
    • Tonsil inflammation with redness and edema
  • Laboratory tests:
    • Throat culture:
      • For GABHS
  • Medications:
    • Antipyretics/analgesics: acetaminophen
    • Antibiotics: for Tx of GABHS
  • Tonsillectomy: for recurring tonsillitis
    • Side-lying position after then elevate HOB when child is awake
      • Assess for evidence of bleeding:
        • Frequent swallowing/clearing the throat
    • Avoid red-colored liquids, citrus juice, and milk-based foods
    • Discourage coughing, throat clearing, and nose blowing in order to protect the surgical site
    • Avoid straws: can damage surgical site
  • Alert parents that there can be clots or blood-tinged mucus in vomitus
  • Limit activity to decrease the potential for bleeding
  • Fully recovery usually occurs in 14 days 2. Croup syndromes
  • Bacterial epiglottis (acute supraglottis):
  • Expected findings:
  • Drooling
  • Dysphonia: thick, muffled voice and froglike croaking sound
  • Dysphagia
  • High fever
  • Nursing care:
  • Avoid throat culture/putting tongue blade in the mouth
  • Prepare for intubation
  • Administer ABX therapy starting with IV, then transition to oral to complete a 10 - day course
  • Droplet isolation precautions for first 24 hr after IV ABX initiated 3. Influenza A and B
  • Expected findings:
  • Sudden onset of chills and fever
  • Body aches
  • Antivirals can be given but must be within 48 hrs of onset
  • Amantadine, Zanamivir, Oseltamivir **Chapter 18: Asthma
  1. Triggers to asthma**
  • Allergens
  • Smoke
  • Exercise
  • Cold air or changes in the weather or temperature 2. Expected findings
  • Dyspnea
  • Cough
  • Audible wheezing
  • Use of accessory muscles 3. Medications
  • Bronchodilators: albuterol
  • SE: tremors/tachycardia
  • Anticholinergics: atropine/ipratropium
  • Dries you up
  • Corticosteroids: prednisone
  • Rinse mouth afterwards 4. How to use a peak flow meter
  • Ensure the marker is zeroed
  • Close lips tightly around the mouthpiece
  • Blow out as hard and as quickly as possible

Chapter 20: Cardiovascular disorders

1. Defects that INCREASE pulmonary blood flow

  • Ventricular septal defect (VSD):
    • A hole in the septum between the right and left ventricle that results in increased pulmonary blood flow (left-to-right shunt)
    • Expected finding:
      • Loud, harsh murmur at the left sternal border
  • Atrial septal defect (ASD):
    • A hole in the septum between the right and left atria that results in increased pulmonary blood flow (left-to-right shunt)
    • Expected findings:
      • Loud, harsh murmur with a fixed split second heart sound
  • Patent ductus arteriosus (PDA):
    • Connection between pulmonary artery and aorta stays open after birth causing mixing of blood
    • Expected findings:
      • Murmur (machine hum)
      • Bounding pulses 2. Defects that DECREASE pulmonary blood flow
  • Tricuspid atresia:
    • A complete closure of the tricuspid valve that results in mixed blood flow
  • Tetralogy of Fallot:
    • Pulmonary stenosis, right ventricular hypertrophy, overriding aorta, and ventricular septal defect (PROV) 3. Obstructive defects
  • Pulmonary stenosis:
    • A narrowing of the pulmonary valve or pulmonary artery that results in obstruction of blood flow from the ventricles
    • Expected findings:
      • Systolic ejection murmur
  • Aortic stenosis:
    • A narrowing of the aortic valve
  • Coarctation of the aorta:
    • A narrowing of the lumen of the aorta
    • Expected findings: (BP/pulse elevated on top, but not on the bottom)
      • Elevated blood pressure in the arms
      • Bounding pulses in the upper extremities
      • Decreased blood pressure in the lower extremities
      • Cool skin of lower extremities
      • Weak or absent femoral pulses 4. Mixed defects
  • Transportation of the great arteries:
  • A condition in which the aorta is connected to the right ventricle instead of the left, and the pulmonary artery is connected to the left ventricle instead of the right
  • Expected findings:
    • Severe to less cyanosis depending on the size of the associated defect
  • Truncus arteriosus:
  • Failure of septum formation, resulting in a single vessel that comes off of the ventricles
  • Hypoplastic left heart syndrome:
  • Left side of the heart is underdeveloped
  • Expected findings:
  • Lethargy/cyanosis 5. Cardiac catherization
  • Check for allergies to iodine or shellfish
  • Provide for NPO status 4 - 6 hr prior
  • Locate and mark the Dorsalis pedis and posterior tibial pulses on both extremities
  • Prevent bleeding by maintaining the affected extremity in a straight position for 4 - 8 hr 6. Heart medications
  • Digoxin: Improves myocardial contractility
  • Infant: hold if pulse<
  • Children: hold if pulse <
  • Monitor for toxicity:
  • Bradycardia
  • Dysrhytmias
  • Nausea/vomiting
  • Anorexia
  • Ace inhibitors: captopril
  • Beta-blockers: metroprolol
  • Potassium-wasting diuretics: furosemide
  • Watch for hypokalemia (nausea/vomiting/dizziness)
  • Foods high in potassium:
  • Bran cereal, potatoes, tomatoes, dark green leafy veggies, bananas, orange juice, oranges, and melons 7. Hypoxemia
  • Immediately place the child in the knee-chest position, attempt to calm the child, and call for help 8. Infective (bacterial) endocarditis
  • Counsel the family of high-risk children about the need for prophylactic antibiotics prior to dental and surgical procedures 9. Rheumatic fever
  • Usually occurs within 2 - 6 weeks following an untreated or partially treated upper respiratory infection (strep throat) with GABHS
  • Laboratory tests:
  • Throat culture for GABHS
  • Serum antistreptolysin-O titer: