| Course | NRNP 6549 Advanced Primary Care of Adolescents and Children |
|---|---|
| Week | Week 6 |
| Paper type | Ranked differential paper |
| Length | About 870 words, 6 pages |
| Format | APA 7 student paper |
| School | Walden University |
| Program | Master of Science in Nursing (MSN) |
| Updated | October 2026 |
Free sample paper for NRNP 6549 Week 6
Ranked Differential: Fever, Sore Throat, and Posterior Neck Nodes in a 16-Year-Old, and the Same Throat at Four
Student Name
College of Nursing, Walden University
NRNP 6549: Advanced Primary Care of Adolescents and Children
Instructor Name
Month Day, Year
Ranked Differential: Fever, Sore Throat, and Posterior Neck Nodes in a 16-Year-Old, and the Same Throat at Four
Presentation
Composite case. A 16-year-old girl, a varsity soccer midfielder, reports five days of sore throat and fever to 38.6 C, with a week of fatigue that began before the sore throat: "I fell asleep in chemistry twice, which I never do." No cough, no runny nose. Swallowing hurts but she can drink. No rash. No recent travel. Seen alone for part of the visit: she has a boyfriend and they have been sexually active; condoms "most of the time." Exam: temperature 38.3 C; tonsils enlarged with gray-white exudate; several palatal petechiae; tender, enlarged posterior cervical nodes on both sides, anterior nodes small and nontender; spleen tip palpable 2 cm below the left costal margin on inspiration; no tonsillar asymmetry, no uvular deviation, no trismus.
Three Ranked Entries
1. Infectious mononucleosis. For: age, a week of fatigue that preceded the throat pain, exudative tonsillitis, posterior cervical adenopathy, palatal petechiae, and a palpable spleen. Against: none strong; exudate also occurs in strep. How common at this age: mononucleosis is concentrated between 5 and 25 years and is most frequent at 16 to 20, when about 1 in 13 people presenting with sore throat has it (Ebell et al., 2016). Why it ranks first: the features that raise its likelihood most are the ones she has; posterior cervical adenopathy, palatal petechiae, and splenomegaly each carry positive likelihood ratios of about 3 or more, while fatigue and sore throat are common but nonspecific (Ebell et al., 2016).
2. Group A streptococcal pharyngitis. For: fever, no cough, tonsillar exudate. Against: her tender nodes are posterior rather than anterior; the week of fatigue before the throat pain and the spleen are not typical of strep. How common at this age: strep causes a minority of sore throats in adolescents, fewer than in school-age children. The McIsaac modification of the Centor score adds a point for age 3 to 14, none for 15 to 44, and subtracts one at 45 or older, because age changes the prior probability of strep (McIsaac et al., 2004). Her score is 3: fever, no cough, exudate, no tender anterior nodes, no age point. At that score testing is indicated, not empirical treatment, and testing is needed anyway because mononucleosis and strep can coexist.
3. Other viral pharyngitis, such as adenovirus. For: fever and sore throat without cough. Against: palatal petechiae, a spleen, and prominent posterior nodes all point more specifically toward Epstein-Barr virus. How common at this age: viral causes account for most sore throats overall, but her specific features make a generic viral cause less likely than mononucleosis.
The One That Cannot Be Missed
Acute HIV infection. The early phase of HIV infection can present as a mononucleosis-like illness with fever, sore throat, fatigue, and lymphadenopathy. She reports inconsistent condom use. It is less likely than Epstein-Barr virus given her petechiae and spleen, but missing it would be costly: early diagnosis changes her care and her partner's. HIV screening is already recommended once for adolescents between 15 and 18 years at health supervision visits (Hagan et al., 2017), so testing now fits her routine care as well as this illness. A peritonsillar abscess was also considered and is not supported: no asymmetry, no uvular deviation, no trismus.
The Same Throat at Four
If the same fever, sore throat, and exudate appeared in a 4-year-old, the ranking would change. First would be other viral pharyngitis, adenovirus especially, which commonly causes exudative tonsillitis with fever in preschool children. Second, group A strep, which rises in likelihood: at age 4 the McIsaac score awards a point for age (McIsaac et al., 2004), and testing is recommended for children with sore throat and features suggesting strep (Shulman et al., 2012). Third, mononucleosis, which drops, because infection with Epstein-Barr virus at this age is often mild or unrecognized and most diagnosed cases occur from age 5 upward (Ebell et al., 2016). The can't-miss item changes too: a retropharyngeal abscess, which causes neck stiffness, drooling, or refusal to move the neck in young children, would replace acute HIV infection as the item to rule out.
Testing and the Soccer Question
For her: rapid antigen test for group A strep, with a backup throat culture if negative, as recommended for adolescents (Shulman et al., 2012); a heterophile antibody test; a complete blood count with differential, since atypical lymphocytes of 10% or more substantially raise the likelihood of mononucleosis (Ebell et al., 2016); and a fourth-generation HIV antigen and antibody test, discussed with her alone. If the heterophile test is negative this early in the illness, antibodies specific to Epstein-Barr virus can confirm it.
Her question, whether she can play Saturday: not this week. Splenic enlargement is common in mononucleosis, and although rupture is rare, it typically occurs within the first month after symptoms begin, which is why contact sport is restricted during that period (Putukian et al., 2023). Her spleen is palpable now. Return to soccer will be discussed at a follow-up visit, based on the time since symptom onset, how she feels, and whether her spleen is still enlarged, with a graded return rather than a single date.
References
Ebell, M. H., Call, M., Shinholser, J., & Gardner, J. (2016). Does this patient have infectious mononucleosis? The rational clinical examination systematic review. JAMA, 315(14), 1502-1509. https://doi.org/10.1001/jama.2016.2111
Hagan, J. F., Jr., Shaw, J. S., & Duncan, P. M. (Eds.). (2017). Bright Futures: Guidelines for health supervision of infants, children, and adolescents (4th ed.). American Academy of Pediatrics.
McIsaac, W. J., Kellner, J. D., Aufricht, P., Vanjaka, A., & Low, D. E. (2004). Empirical validation of guidelines for the management of pharyngitis in children and adults. JAMA, 291(13), 1587-1595. https://doi.org/10.1001/jama.291.13.1587
Putukian, M., McGrew, C. A., Benjamin, H. J., Hammell, M. K., Hwang, C. E., Ray, J. W., Statuta, S. M., Sylvester, J., & Wilson, K. (2023). American Medical Society for Sports Medicine position statement: Mononucleosis and athletic participation. Clinical Journal of Sport Medicine, 33(4), 359-367. https://doi.org/10.1097/JSM.0000000000001161
Shulman, S. T., Bisno, A. L., Clegg, H. W., Gerber, M. A., Kaplan, E. L., Lee, G., Martin, J. M., & Van Beneden, C. (2012). Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 update by the Infectious Diseases Society of America. Clinical Infectious Diseases, 55(10), e86-e102. https://doi.org/10.1093/cid/cis629
The Walden NRNP 6549 Week 6 instructions
Week 6 of NRNP 6549 typically sets a common pediatric respiratory complaint for a differential, with attention to how age changes the list. You present the case, rank the leading diagnoses with reasons, name the serious condition that must not be missed, compare with another age group, and choose tests that follow the ranking. Faculty assess ranking, so an unordered list costs the most. Cite infectious disease guidelines and pediatric sources in APA 7. Return to sport or school is often part of the plan. Testing should be justified by pretest probability. Sexual history may be relevant for adolescents and should be taken confidentially. Consider how the same symptoms would rank in a younger child, as the prompt often asks.
How this NRNP 6549 Week 6 example is built
A brief presentation opens the document: fever, sore throat, a week of fatigue, and tender nodes at the back of the neck, reported mostly by the adolescent herself. The differential follows as a numbered list of three with one can't-miss item set apart below it. Each entry lists what points toward it, what points away, and a sentence on how common it is at this age. Mononucleosis ranks first, and the note says exactly which features put it there. The McIsaac modification of the Centor criteria is cited for the point that age belongs inside the clinical score. A separate paragraph then reorders the same list for a four-year-old and explains each move. Testing choices close the document, with a line on the soccer season she is asking about.
Reading the NRNP 6549 Week 6 rubric
Ranking is the skill being assessed, which makes an unordered list the costliest error available. The example earns the reasoning criterion by giving every entry the same for, against and prevalence lines, so its order can be audited. Age-appropriateness is often scored separately; the preschool paragraph exists to satisfy it and to prove the ranking was not copied from an adult template. Common losses: citing a clinical score without saying what it adds, ordering strep first by reflex for a presentation that points elsewhere, and leaving the can't-miss diagnosis unnamed. Some sections deduct for testing plans that do not follow from the ranking. A sports answer given without its basis, or skipped when the adolescent raised it, costs the patient-education line that many rubrics include.
NRNP 6549 Week 6 help: mistakes that cost marks
Differentials lose the most credit when entries appear without an order or a reason for that order. Rank them and give each a supporting and an opposing finding. Another common gap is forgetting acute HIV in a sexually active adolescent with a mononucleosis-like illness. Keep it on the list and test where history supports it. Writers also apply adult strep scores to a preschooler without adjustment. Explain the age difference. Avoid ordering a monospot in a young child, where it is often falsely negative. Address return to soccer, since contact sport risks splenic rupture after mononucleosis. Keep the timeline of fatigue and sore throat consistent. Close with what results would change the plan.
Get a NRNP 6549 Week 6 example written to your instructions
Tell the desk which respiratory or ENT presentation your Week 6 prompt uses and include the rubric; the differential is ranked for that age, with a contrast band if your section wants one. A first request is free and comes back within 24-48 hours for comparison with your own ordering.
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NRNP 6549 Week 6 questions, answered
Why include a preschooler in a note about a teenager?
Because this week's criteria reward a differential ordered for the patient's age group, and the clearest proof that age shaped an ordering is to show it changing when age changes. The contrast paragraph is short and sits after the main differential, so the adolescent case stays the subject. Some prompts do not ask for it, and the sample drops it then.
Does the note say when she can return to soccer?
It records her question and answers it with the reasoning and a cited source, because a return-to-sport decision after mononucleosis turns on the risk to an enlarged spleen. It does not state a timeline as advice on this page. Your own note would cite the guidance your program uses, and the plan in the example leaves a clear place for that citation.
Is Week 6 always about sore throats?
Not specifically. Respiratory and ear, nose and throat infections usually fill this stretch of the course, and the prompt may hand you a cough, an ear, or a wheeze instead of a throat. The ranking discipline is identical whichever complaint appears. The adolescent here is invented for teaching, and a request built on your prompt invents its own patient to match.
Where can I find a free NRNP 6549 Week 6 sample paper?
The 16-year-old's sore throat differential is printed here with three ranked entries, the cannot-miss diagnosis, the comparison at age four and the soccer decision.
When can a teen return to sports after mono in NRNP 6549 Week 6?
Usually not before about three to four weeks from symptom onset and only when well, because the spleen can rupture with contact. The example explains the timing to her.