NURS 6541 MIDTERM EXAM
Question 1
What is the most common form of child abuse seen in pediatric primary care?
Answer: c. Shaken baby syndrome
Question 2
Which of the following conditions requires urgent inpatient admission?
Answer: b. Cervical adenitis
Question 3
An eye that deviates in when covered but that returns to midline when uncovered is an
Answer: b. esophoria
Question 4
All of the following are consistent with peritonsillar abscess except:
Answer: c. Trismus
Question 5
Which adolescent would be at greatest risk for developing anorexia nervosa?
Answer: d. 14-year-old female gymnast
Question 6
A mother states that her 4-year-old son constantly grinds his teeth at night. You document this as:
Answer: b. Bruxism
Question 7
FIRST-LINE therapy for preschoolers (4-5 years of age) diagnosed with attention-deficit
hyperactive disorder is:
Answer: c. Behavior therapy
Question 8
A 7-year-old has just been diagnosed with attention deficit hyperactivity disorder (ADHD). Her
parents report that she is doing poorly in school and is disruptive in the classroom. They ask you
what they can do. Your best response is:
Answer: c. "Use a consistent approach with behavioral cues both at home and at school."
Question 9
The most common substance used in middle school is
Answer: b. Alcohol
Question 10
The most likely weight of a 1-year-old whose birth weight was 6-1/2 pounds would be:
Answer: b. 19 to 20 pounds
Question 11
Which of the following characterizes middle adolescence (14 to 16 years old)?
Answer: c. Concrete thinking, present orientation, intense preoccupation with body image
Question 12
Mark, a 10-year-old, has a lot of ear pain. He does not want anyone to touch it and is crying in
pain. The ear canal is swollen and exudate is present. The TM is normal. Mark should be
instructed to do which of the following?
Answer: a. Keep ear dry until symptoms improve.
Question 13
A 2-year-old child weighs 34 lb. What type of car seat should the child use?
Answer: d. A forward-facing car seat in the back of the vehicle.
Question 14
An expected milestone of a 4-year-old is the ability to
Answer: b. Copy a cross
Question 15
A child's central visual acuity is 20/30 by age
Answer: b. 4 years
Question 16
Early reflexive responses that are not related to survival include all but:
Answer: c. Swimming
Question 17
Sam has an otitis media. He also presents with conjunctivitis. This is due to which organism?
Answer: d. Haemophilus influenza
Question 18
Which of the following children has abnormal language development?
Answer: b. Speech is 50% understandable at 36 months of age
Question 19
Appropriate advice for a mother of a 2-week-old child here for a “well child” visit includes
which of the following?
Answer: b. Sleep in the supine position is recommended
Question 20
A 14-year-old female comes into the office for an urgent visit after taking 10 valium tablets.
Following the initial emergent care and stabilization, the most important part of the management
is:
Answer: d. Obtaining a psychiatric consultation.
Question 21
Miguel, age 14, was hit in the eye with a baseball and developed eye pain, decreased visual
acuity, and injection of the globe. Upon exam you note blood in the anterior chamber and
confirm diagnosis of hyphema. What treatment do you recommend while Miguel is waiting to
see the ophthalmologist
Answer: b. Apply bilateral eye patches.
Question 22
A 4-month-old presents with both eyes turning inward. What is this called?
Answer: c. Esotropia
Question 23
Sarah, age 15, presents with pain and pressure over her cheeks and discolored nasal discharge.
You cannot transilluminate the sinuses. You suspect which common sinus to be affected?
Answer: d. Maxillary sinus
Question 24
You see a 30-month-old who speaks in mixed Spanish and English. The child’s vocabulary is
normal but at the low end of the normal language spectrum. The parent is worried the child’s
development will not be normal because she mixes up the two languages. You respond:
Answer: a. "Your child's speech is normal and bilingual children commonly intermix the words
from both languages until about 3 years of age."
Question 25
Sarah, 7 years old, is in the office today. All of the following are acceptable management options
for allergic rhinitis, except
Answer: d. Nasal neosynephrine
Question 26
The mother of a 4-year-old tells you he likes to "play with himself" while playing and watching
television. You advise the mother to
Answer: d. Explain to the child that masturbation is something that should be done in private.
Question 27
Which of the following would not suggest an eating disorder with a purging component?
Answer: d. Diarrhea
Question 28
I can roll over, grasp a rattle, and reach for things and have begun feeding myself finger foods,
but I can’t wave bye-bye yet. How old am I?
Answer: b. 6 months
Question 29
You see a 13-year-old who reports she is learning some basic geometry (areas, volume etc.). The
ability to successfully master these concepts occurs during which Piaget developmental stage?
Answer: d. Formal operational
Question 30
A 7-year-old boy with mental retardation was born at home at 26 weeks gestation to a 28year-old
mother who had received no prenatal care. An evaluation is likely to suggest his MR is related to
which of the following?
Answer: b. Congenital infection with cytomegalovirus
Question 31
You are doing a kindergarten physical on a 5-year-old girl. Which of the following scenarios
would suggest the child is not ready to start kindergarten in the fall?
Answer: c. Counts to 4 and draws a person with three parts.
Question 32
A healthy, well-developed 6-year-old child arrives as a new patient to your clinic. His
immunization card reveals that he received an immunization at birth and some when he was 2
months old, but none sense. Which of the following statements about him is correct?
Answer: a. He is too old to receive the Haemophilus influenzae Type B vaccine.
Question 33
Conductive hearing loss can be caused by
Answer: a. Serous otitis
Question 34
A fifteen-year-old female makes a statement to you during a well visit. Which of the following
statements should not be kept confidential?
Answer: d. "Sometimes I feel like ending my life."
Question 35
Which of the following eye findings would be considered an ophthalmic emergency?
Answer: a. Unilateral vesicular lesions on the upper eyelid in a 3-week old.
Question 36
You see a 7-year-old with complaints of "having accidents at night." Physical exam and history
are unremarkable. Urinalysis, urine culture, and specific gravity are normal. His parents ask
about the best treatment for this problem. The best response is
Answer: c. Fluid restriction and voiding prior to the night may be effective.
Question 37
During a domestic health assessment, the CDC recommends screening every refugee child for
which of the following diseases?
Answer: b. tuberculosis
Question 38
The diagnostic criteria for autism spectrum disorder include all of the following except
Answer: c. Tolerance of flexibility with routines
Question 39
A 19-month-old says “mama” and “dada,” points and gestures if he wants things, and follows
simple one-step commands. Your best response is which of the following?
Answer: c. Encourage early intervention services for speech.
Question 40
While assessing the skin of an infant, you note cafe-au-lait spots. Which disease should be ruled
out?
Answer: a. Neurofibromatosis
Question 41
A differential diagnosis for child abuse would include all of the following except.
Answer: c. Prader-Willi syndrome
Question 42
Which of the following screenings should adolescents have done annually?
Answer: d. Psychosocial screening, blood pressure, body mass index
Question 43
The nurse practitioner role was initially established to
Answer: c. Improve access to care and partially solve physician shortage.
Question 44
An 8-year-old female is brought into the office by her mother. She has complaints of fever and
sore throat for the past 2 days. She denies difficulty swallowing but has loss of appetite and mild
diarrhea. A few classmates have similar symptoms. A review of systems reveals clear nasal
drainage, dry cough, and hoarseness. On exam she has a 101.5 temperature, 3+ erythematous
tonsils, and anterior cervical lymphadenopathy. What is the likely diagnosis?
Answer: b. Strep pharyngitis
Question 45
Josh, age 13, has some enlargement of the scrotum and testes, a reddened scrotal sac, and some
hair texture alteration. His penis is not enlarged. He is in Tanner stage
Answer: d. II
Question 46
Mark is in the exam room. You are concerned he may have epiglottitis. In what position do these
patients prefer to sit?
Answer: c. Sitting up and leaning forward
Question 47
Hannah, age 4, is brought into the office by her father. She complains of a sore throat, difficulty
swallowing, copious oral secretions, stridor, and a temperature of 102F. She does not have
pharyngeal erythema or cough. What do you suspect?
Answer: c. Epiglottitis
Question 48
John is diagnosed with allergic conjunctivitis. What type of discharge do you expect to see upon
exam?
Answer: a. Stringy and white
Question 49
The first sign of the onset of female puberty is usually:
Answer: c. Breast buds
Question 50
A 6-month-old infant has been growing poorly. His parents have changed his formula three times
without success. His examination is remarkable for a pale, emaciated child with little
subcutaneous fat and anterior fontanelle fullness. His laboratory test results are notable for a
hemolytic anemia and prolonged bleeding times. Which of the following is the most appropriate
next step?
Answer: d. Obtain a sweat chloride concentration
Question 51
Which of the following statements about "routine" screening tests is true?
Answer: d. Lead testing is obtained on all 12- and 14-monthold children.
Question 52
A mother of a 6-month-old asks you about normal sleep patterns for an infant this age. The best
response is:
Answer: a. 10 hours at night and 3-4 hours during the day
Question 53
A Mantoux test in a child with no risk factors is considered positive with a reaction of:
Answer: a. at least 15 mm induration
Question 54
Which is the correct order for introduction of solid foods to an infant?
Answer: c. Cereal, vegetables, fruits, and meats
Question 55
Initial screening tests for an 11-year-old with a family history of hyperlipidemia and weight at
the 97th percentile include:
Answer: a. fasting glucose, postprandial glucose, fasting lipid profile
Question 56
Luke, a 17-month-old, failed treatment with amoxicillin for otitis media. At the two-week
recheck, his TM was still erythematous and you cannot see the landmarks. He has persistent
nasal congestion, he is not sleeping at night, and he has a 101°F fever. What is the next best step
for Luke?
Answer: c. Ceftriaxone and an antihistamine
Question 57
A 2-year-old boy has been slightly less than the 50th percentile for weight, height and head
circumference, but in the last 6 months he has fallen to slightly less than the 25th percentile for
weight. The pregnancy was normal, his development is as expected, and the family reports no
psychosocial problems. The mother says that he is now a finicky eater (wants only macaroni and
cheese at all meals), but she insists that he eat a variety of foods. The meals are marked by much
frustration for everyone. His examination is normal. Which of the following is the best next step
in his care?
Answer: a. Sweat chloride testing
Question 58
The parent of a 2-year-old tells you her daughter recently started having breath-holding spells.
She tells you the older sibling “did the same thing” and asks you for help. You advise her that
after a breath-holding event:
Answer: c. Act as if nothing abnormal happened.
Question 59
Which of the following represents normal sequencing of development in a toddler?
Answer: d. Feeds self, can undress self with help, washes hands, imitates housework.
Question 60
You diagnose a 16-year-old with acute otitis media and need to prescribe an antibiotic with betalactamase coverage. What do you choose?
Answer: d. amoxicillin and potassium clavulanate (Augmentin)
Question 61
A 14-year old has ataxia. He is brought to the local emergency department, where he appears
euphoric, emotionally labile, and a bit disoriented. He has nystagmus and hypersalivation. Many
notice his abusive language. Which of the following agents is most likely responsible for his
condition?
Answer: d. Phencyclidine (PCP)
Question 62
Medicaid provides health insurance coverage to
Answer: d. Anyone whose personal income falls below federal poverty level.
Question 63
Which of the following vaccines is routinely recommended at 4 months of age?
Answer: b. Diphtheria, tetanus, acellular pertussis (DTaP)
Question 64
A 13-month-old child is noted to be at the 25th percentile for weight, the 10th percentile for
height, and less than the 5th percentile for head circumference. She was born at term. She was
noted to have a small head at birth, to be developmentally delayed throughout her life, and to
have required cataract surgery shortly after birth. She currently takes phenobarbital for seizures.
Which of the following would most likely explain this child’s small size?
Answer: a. Congenital cytomegalovirus infection
Question 65
A 3-year-old (37 months) refuses to have bowel movements on the toilet. He is bladder trained.
He goes and hides and squats when having bowel movements. Positive encouragement and
praise is not working. You advise:
Answer: a. Toilet refusal in 3-year-olds is largely due to caregivers overemphasizing toilet
training.
Question 66
Which of the following children should be referred for a comprehensive developmental
evaluation?
Answer: d. A 3-year-old who consistently tracks at the 5th percentile for height and weight since
birth.
Question 67
Which of the following injuries is most likely to be caused by abuse of a toddler?
Answer: b. Spiral fracture of the tibia.
Question 68
You would be concerned about the language development of a child who:
Answer: b. Pronounces words that are not understandable at 2 years of age
Question 69
A 7-month-old male is found to have a spiral fracture of the femur that his father says he got by
climbing onto a chair and then jumping off. Which of the following statements is true regarding
this situation?
Answer: c. You can be held legally liable for failing to report child abuse.
Question 70
A new mom calls the NP on postpartum day 5. She reports her newborn wants to nurse for 30
minutes every 1-1/2 to 2 hours. Which of these is the best response?
Answer: c. "This is a very healthy breastfeeding pattern. Be sure to rest when you can. You are
doing a great job."
Question 71
Upon eye examination of a newborn, you note inner canthal folds and Brushfield spots. What do
you suspect?
Answer: d. Down syndrome
Question 72
Acute otitis media can be diagnosed when there is
Answer: c. Fluid in the middle ear without signs or symptoms of an ear infection.
Question 73
Which of the following are important considerations when screening child refugees for
tuberculosis? SELECT TWO (2)
Answer: b. Mantoux TST should not be used in a child who has received a Bacille CalmetteGuerin vaccination.
c. IGRA may be falsely positive in children who have autoimmune disorders.
Question 74
Which of the following statements is true regarding lying and stealing by the school-age child?
Answer: c. They represent a common, transient problem.
Question 75
Which of the following foreign body in the nose requires immediate removal?
Answer: c. battery
Question 76
During a “well-child” visit, the parents of a healthy 5-month-old offer a great amount of
information. Which of the following bits of information is of most concern?
Answer: d. Limited eye contact with parents.
Question 77
You assess a 15-year-old's visual acuity and note her vision to be 20/50 in the right eye. She asks
you what that means and you respond
Answer: b. "You can see at 20 feet with your right eye what most people can see at 50 feet."
Question 78
An 11-year-old girl has dizziness, pupillary dilation, nausea, fever, tachycardia, and facial
flushing. She says she can "see" sound and "hear" colors. The agent likely to be responsible is
which of the following?
Answer: e. Lysergic acid diethylamide (LSD)
Question 79
Which of the following signs may indicate a baby is not receiving sufficient breastmilk?
Answer: b. Sleepiness and excitability
Question 80
Which of the following strategies would not be appropriate to include as part of your treatment
plan of an 8-year-old boy who is obese?
Answer: b. Referral to nutritionist for weight reduction plan.
Question 81
Which of the following complication of strep pharyngitis cannot be prevented with antibiotics?
Answer: d. Glomerulonephritis
Question 82
You see a 4-year-old for a well-child visit. He has received four diphtheria, tetanus, and acellular
pertussis vaccines (DTaP); three injected polio vaccines (IPV); one measles, mumps, and rubella
vaccine (MMR); one varicella vaccine; and two hepatitis B (Hep B) vaccines. What do you order
today?
Answer: b. PVC 13, DTaP, IPV, MMR, and Varivax
Question 83
You see a 6-month-old for a well-child visit and the mother tells you the child’s grandmother
recommends that she give the infant whole milk and eggs when he starts solids. What should you
tell the mother?
Answer: b. The baby should remain on infant formula and stage 2 and 3 baby foods for now.
Question 84
Which of the following substances is associated with pupillary constriction?
Answer: c. Heroin
Question 85
A breastfed infant is expected to have a lower incidence of which of the following?
Answer: b. Asthma
Question 86
The results of the hemoglobin A1c test are LESS reliable in children with which of the following
conditions? (Hint: select two)
Answer: d. Sickle Cell Disease
e. Cystic Fibrosis
Question 87
Which of the following statements about bullying is true?
Answer: b. It occurs most commonly during unstructured times (lunch, recess, etc.).
Question 88
An 8-year-old female has an edematous, mildly erythematous right upper eyelid for 2 days with a
fever of 102.9 (F). Which important eye assessment do you need to consider?
Answer: a. Ocular mobility
Question 89
What method can be safely used to remove cerumen in a 15-month-old child's ear?
Answer: d. Irrigation using warm water from a soft bulb syringe
Question 90
You see a 5-month-old who is fussy, has interrupted sleep, and is drooling. You note large lower
lateral incisor bulges. You recommend:
Answer: e. A and D
Question 91
Sandy, age 18 months, crosses her legs when lifted from behind rather than pulling them up. Her
legs are also hard to separate, making diaper changing difficult. She persistently uses only one
hand. What condition do you suspect?
Answer: a. Cerebral palsy
Question 92
By what age should most children be able to sit well without support?
Answer: c. 9 months
Question 93
Chelsea, age 8, complains that she feels as if something is stuck in her ear. What action is
contraindicated?
Answer: a. Using a small suction device to try and remove the object.
Question 94
A teenage female who is overweight has moderate acne on the face and chest, and irregular
menses. Elevation of which laboratory test provides the test evidence of polycystic ovarian
syndrome?
Answer: b. free testosterone
Question 95
Please interpret the following labs for an adolescent. The adolescent has a history of obesity and
acanthosis nigricans.
Answer: b. Impaired fasting glucose, impaired glucose tolerance
Question 96
You see a 3-year-old for a well-child visit. His mother informs you that potty training has been
very easy because he “has an amazing internal clock. He falls asleep, gets hungry, and has bowel
movements at the same time every day.” This describes which aspect of temperament?
Answer: d. Rhythmicity
Question 97
A 4-month-old child has poor weight gain. Her current weight is less than the 5th percentile,
height about the 10th percentile, and head circumference at the 50th percentile. The planned
pregnancy resulted in a normal, spontaneous, vaginal delivery; mother and child were discharged
after a 48-hour hospitalization. Feeding is via breast and bottle; the quantity seems sufficient.
The child has had no illness. The examination is unremarkable except for the child’s small size.
Screening laboratory shows the hemoglobin and hematocrit are 11 mg/dL and 33% respectively,
with a platelet count of 198,000/mm3. Serum electrolyte levels are sodium 140, chloride 105,
potassium 3.5, bicarbonate 17, blood urea nitrogen 15, and creatinine 0.3. Liver function tests are
normal. Urinalysis reveals a pH of 8 with occasional epithelial cells but no white blood cells,
bacteria, protein, ketones, or reducing substances. Which of the following is the most appropriate
therapy for this child?
Answer: a. Sweat chloride analysis
Question 98
Mark, a 10-year-old, has a lot of ear pain. He does not want anyone to touch it and is crying in
pain. The ear canal is swollen and exudate is present. The TM is normal. What is the proper
management for his patient?
Answer: a. Oral Amoxicillin and topical anesthetic
Question 99
A mother brings her 4-week-old infant into the office because she noticed small yellow-white
glistening bumps on her infant's gums. She says they look like teeth but is concerned that they
may be cancer. You diagnose these bumps as
Answer: a. Epstein's pearls
Question 100
A 2-day-old newborn with conjunctivitis is likely due to
Answer: c. Gonorrhea
NURS 6541 Midterm Exam (Latest): Walden University (FOR 100% CORRECT
ANSWER CHECK THE LAST PAGE)
Question 1
Medicaid provides health insurance coverage to
Answer: b. Certain categories of people whose personal income falls below a certain percentage
of the federal poverty level.
Question 2
A differential diagnosis for child abuse would include all of the following except.
Answer: c. Prader-Willi syndrome
Question 3
Which of the following injuries is most likely to be caused by abuse of a toddler?
Answer: d. A displaced posterior rib fracture.
Question 4
You are doing a kindergarten physical on a 5-year-old girl. Which of the following scenarios
would suggest the child is not ready to start kindergarten in the fall?
Answer: a. Counts to 4 and draws a person with three parts.
Question 5
The first sign of the onset of female puberty is usually:
Answer: b. Breast buds
Question 1
When completing this quiz, did you comply with Walden University’s Code of Conduct
including the expectations for academic integrity?
Answer: Yes
Question 2
Miguel, age 14, was hit in the eye with a baseball and developed eye pain, decreased visual
acuity, and injection of the globe. Upon exam you note blood in the anterior chamber and
confirm diagnosis of hyphema. What treatment do you recommend while Miguel is waiting to
see the ophthalmologist
Answer: a. Apply bilateral eye patches.
Question 3
The father of a 3-year-old is concerned because the child stutters. What should your approach
be?
Answer: a. Explain that this can be normal until 4 years of age.
Question 4
A 2-day-old newborn with conjunctivitis is likely due to
Answer: b. Gonorrhea
Question 5
You see a 13-year-old who reports she is learning some basic geometry (areas, volume etc.). The
ability to successfully master these concepts occurs during which Piaget developmental stage?
Answer: b. Sensorimotor
Question 6
For adolescent girls, peak height velocity should occur by Tanner Stage (SMR):
Answer: a. 3
Question 7
Which is the correct order for introduction of solid foods to an infant?
Answer: a. Fruits, cereal, vegetables, and meats
Question 8
I can walk well on tiptoes, my speech is 50% understandable, I know six body parts, but I cannot
balance on one foot for 1 second. I am:
Answer: b. 2-1/2 years old (30 months)
Question 9
You receive a phone call from the mother of a 2-year-old. She states her child has sleep refusal.
You suggest the child should be able to:
Answer: c. Set his own bedtime based on his internal clock.
Question 10
A 15-month-old boy says “mama” and “dada,” points and gestures if he wants things, and
follows simple one-step commands. Your best response is which of the following?
Answer: c. Reevaluate the child at the 24-month visit.
Question 11
At what age would a child be expected to remember a string of numbers and repeat them
backwards?
Answer: b. 12 years
Question 12
A 13-month-old child is noted to be at the 25th percentile for weight, the 10th percentile for
height, and less than the 5th percentile for head circumference. She was born at term. She was
noted to have a small head at birth, to be developmentally delayed throughout her life, and to
have required cataract surgery shortly after birth. She currently takes phenobarbital for seizures.
Which of the following would most likely explain this child’s small size?
Answer: e. Congenital cytomegalovirus infection
Question 13
A child's head circumference is routinely measured on each well visit until what age?
Answer: a. 2 years
Question 14
A 14-year-old female comes into the office for an urgent visit after taking 10 valium tablets.
Following the initial emergent care and stabilization, the most important part of the management
is:
Answer: a. Assessing the family supports available to the child.
Question 15
All of the following are consistent with peritonsillar abscess except:
Answer: b. Exudate on tonsils
Question 16
Which of the following complication of strep pharyngitis cannot be prevented with antibiotics?
Answer: b. Glomerulonephritis
Question 17
A 4-year-old believes there is more juice in a tall, thin glass than a shorter, wider one. The child
has not yet achieved which of the principles of Piaget?
Answer: b. Conservation
Question 18
Josh, age 13, has some enlargement of the scrotum and testes, a reddened scrotal sac, and some
hair texture alteration. His penis is not enlarged. He is in Tanner stage
Answer: d. II
Question 19
A breastfed infant is expected to have a lower incidence of which of the following?
Answer: e. Diarrhea
Question 20
A 12-year-old male states he noticed an enlargement of his testes and scrotum. When counseling
him about the next step in pubertal development, you state:
Answer: d. The penis will grow in length and width.
Question 21
You see a 7-year-old with complaints of "having accidents at night." Physical exam and history
are unremarkable. Urinalysis, urine culture, and specific gravity are normal. His parents ask
about the best treatment for this problem. The best response is
Answer: a. Fluid restriction and voiding prior to the night may be effective.
Question 22
Chelsea, age 8, complains that she feels as if something is stuck in her ear. What action is
contraindicated?
Answer: c. Flushing the ear with water.
Question 23
By what age should most children be able to sit well without support?
Answer: a. 9 months
Question 24
A typically developing 8-year-old girl will have which of the following genital development?
Answer: a. No pubic hair at all
Question 25
John is diagnosed with allergic conjunctivitis. What type of discharge do you expect to see upon
exam?
Answer: c. Serous and clear
Question 26
Which of the following vaccines is routinely recommended at 4 months of age?
Answer: a. Diphtheria, tetanus, acellular pertussis (DTaP)
Question 27
An 8-year-old female has an edematous, mildly erythematous right upper eyelid for 2 days with a
fever of 102.9 (F). Which important eye assessment do you need to consider?
Answer: d. Ocular mobility
Question 28
Role-play with equipment during the course of the physical exam would be the most beneficial
with which age group?
Answer: b. Preschoolers
Question 29
Conductive hearing loss can be caused by
Answer: c. Serous otitis
Question 30
You see a 30-month-old who speaks in mixed Spanish and English. The child’s vocabulary is
normal but at the low end of the normal language spectrum. The parent is worried the child’s
development will not be normal because she mixes up the two languages. You respond:
Answer: d. "Your child's speech is normal and bilingual children commonly intermix the words
from both languages until about 3 years of age."
Question 31
Mark is in the exam room. You are concerned he may have epiglottitis. In what position do these
patients prefer to sit?
Answer: d. Sitting up and leaning forward
Question 32
The mother of a 4-year-old tells you he likes to "play with himself" while playing and watching
television. You advise the mother to
Answer: a. Explain to the child that masturbation is something that should be done in private.
Question 33
Parents bring their 6-month-old son to see you. He is symmetrically less than the 5th percentile
for height, weight and head circumference. He was born at 30 weeks’ gestation and weighed
1000g. He was a planned pregnancy, and his mother’s prenatal course was uneventful until an
automobile accident initiated the labor. He was ventilated for 3 days in the intensive care unit but
otherwise did well without ongoing problems. He was discharged at 8 weeks of life. Which of
the following is the most likely explanation for his small size?
Answer: e. Normal ex-preemie infant growth
Question 34
You assess a 15-year-old's visual acuity and note her vision to be 20/50 in the right eye. She asks
you what that means and you respond
Answer: d. "You can see at 20 feet with your right eye what most people can see at 50 feet."
Question 35
During a “well-child” visit, the parents of a healthy 5-month-old offer a great amount of
information. Which of the following bits of information is of most concern?
Answer: a. Limited eye contact with parents.
Question 36
You are performing an examination of a 3-year-old who is new to your office. Which finding
requires immediate further evaluation?
Answer: d. Weight plots in the 50th percentile, while height plots at the 75th percentile.
Question 37
A 9-year-old who weighs 70 pounds asks why she can't sit in the front passenger seat of the
family car. Your best response is
Answer: c. The safest place for children under 12 years old and 100 pounds is in the backseat of
the car.
Question 38
Which of the following would not suggest an eating disorder with a purging component?
Answer: d. Sore throat
Question 39
A fifteen-year-old female makes a statement to you during a well visit. Which of the following
statements should not be kept confidential?
Answer: b. "Sometimes I feel like ending my life."
Question 40
Sarah, age 15, presents with pain and pressure over her cheeks and discolored nasal discharge.
You cannot transilluminate the sinuses. You suspect which common sinus to be affected?
Answer: d. Maxillary sinus
Question 41
A 6-month-old infant has been growing poorly. His parents have changed his formula three times
without success. His examination is remarkable for a pale, emaciated child with little
subcutaneous fat and anterior fontanelle fullness. His laboratory test results are notable for a
hemolytic anemia and prolonged bleeding times. Which of the following is the most appropriate
next step?
Answer: d. Obtain a sweat chloride concentration
Question 42
Medicaid provides health insurance coverage to
Answer: a. Certain categories of people whose personal income falls below a certain percentage
of the federal poverty level.
Question 43
The mother of a 5-year-old informs you that her daughter cheats when playing board games.
What is the best response?
Answer: b. Tell the mother to spend time clarifying board game rules before starting games.
Question 44
Which of the following substances is associated with pupillary constriction?
Answer: b. Heroin
Question 45
A 7-year-old has just been diagnosed with attention deficit hyperactivity disorder (ADHD). Her
parents report that she is doing poorly in school and is disruptive in the classroom. They ask you
what they can do. Your best response is:
Answer: a. "Use a consistent approach with behavioral cues both at home and at school."
Question 46
Flourescein staining of the eye is used to detect a
Answer: c. Foreign body
Question 47
Luke, a 17-month-old, failed treatment with amoxicillin for otitis media. At the two-week
recheck, his TM was still erythematous and you cannot see the landmarks. He has persistent
nasal congestion, he is not sleeping at night, and he has a 101°F fever. What is the next best step
for Luke?
Answer: a. Ceftriaxone and an antihistamine
Question 48
All of the following may predispose a patient to thrush except:
Answer: c. Poor oral hygiene
Question 49
Head and chest circumferences should be equal at:
Answer: c. 1 year of age
Question 50
The diagnostic criteria for autism spectrum disorder include all of the following except
Answer: c. Tolerance of flexibility with routines
Question 51
Which of the following statements about bullying is true?
Answer: b. It occurs most commonly during unstructured times (lunch, recess, etc.).
Question 52
The most likely weight of a 1-year-old whose birth weight was 6-1/2 pounds would be:
Answer: a. 19 to 20 pounds
Question 53
An eye that deviates in when covered but that returns to midline when uncovered is an
Answer: c. esophoria
Question 54
A 7-year-old boy with mental retardation was born at home at 26 weeks gestation to a 28-yearold mother who had received no prenatal care. An evaluation is likely to suggest his MR is
related to which of the following?
Answer: e. Complications of prematurity
Question 55
The most common substance used in middle school is
Answer: a. Alcohol
Question 56
A 2-day-old infant has significant nasal and rectal bleeding. He was delivered by a midwife at
home; the pregnancy was without complications. His Apgar scores were 9 at 1 minute and 9 at 5
minutes. He has breastfed well and has not required a health care professional visit since birth.
Which of the following vitamin deficiencies might explain his condition?
Answer: a. Vitamin K
Question 57
Tammy, age 3, is at the office for her well-child visit. She has trouble removing her own shirt as
requested. Her mother yanks off her shirt after smacking her wrist and saying, "you must do as
you're told quickly." Which action is indicated?
Answer: d. Observe Tammy for signs of child abuse.
Question 58
A 4-month-old child has poor weight gain. Her current weight is less than the 5th percentile,
height about the 10th percentile, and head circumference at the 50th percentile. The planned
pregnancy resulted in a normal, spontaneous, vaginal delivery; mother and child were
discharged after a 48-hour hospitalization. Feeding is via breast and bottle; the quantity seems
sufficient. The child has had no illness. The examination is unremarkable except for the child’s
small size. Screening laboratory shows the hemoglobin and hematocrit are 11 mg/dL and 33%
respectively, with a platelet count of 198,000/mm3. Serum electrolyte levels are sodium 140,
chloride 105, potassium 3.5, bicarbonate 17, blood urea nitrogen 15, and creatinine 0.3. Liver
function tests are normal. Urinalysis reveals a pH of 8 with occasional epithelial cells but no
white blood cells, bacteria, protein, ketones, or reducing substances. Which of the following is
the most appropriate therapy for this child?
Answer: d. Oral supplementation with bicarbonate
Question 59
A teenage female who is overweight has moderate acne on the face and chest, and irregular
menses. Elevation of which laboratory test provides the test evidence of polycystic ovarian
syndrome?
Answer: a. free testosterone
Question 60
A 2-year-old boy has been slightly less than the 50th percentile for weight, height and head
circumference, but in the last 6 months he has fallen to slightly less than the 25th percentile for
weight. The pregnancy was normal, his development is as expected, and the family reports no
psychosocial problems. The mother says that he is now a finicky eater (wants only macaroni and
cheese at all meals), but she insists that he eat a variety of foods. The meals are marked by much
frustration for everyone. His examination is normal. Which of the following is the best next step
in his care?
Answer: c. Reassurance and counseling for family about childhood normal developmental stage
Question 61
I like to use my pincer grasp that involves the ability to pick up a small object such as a raisin or
piece of cereal with the thumb and forefinger, and that is mastered around what age?
Answer: b. 9 months
Question 62
An 11-year-old girl has dizziness, pupillary dilation, nausea, fever, tachycardia, and facial
flushing. She says she can "see" sound and "hear" colors. The agent likely to be responsible is
which of the following?
Answer: d. Lysergic acid diethylamide (LSD)
Question 63
An 8-year-old female is brought into the office by her mother. She has complaints of fever and
sore throat for the past 2 days. She denies difficulty swallowing but has loss of appetite and mild
diarrhea. A few classmates have similar symptoms. A review of systems reveals clear nasal
drainage, dry cough, and hoarseness. On exam she has a 101.5 temperature, 3+ erythematous
tonsils, and anterior cervical lymphadenopathy. What is the likely diagnosis?
Answer: c. Viral pharyngitis
Question 64
Appropriate advice for a mother of a 2-week-old child here for a “well child” visit includes
which of the following?
Answer: c. Sleep in the supine position is recommended
Question 65
What is the most traumatic, yet common form and of child abuse seen in pediatric primary care?
Answer: d. Soft tissue injuries
Question 66
Which of the following is a priority nurse practitioner role to help children and adolescents to
have healthy sexual development?
Answer: a. Begin anticipatory guidance related to sexuality and normal pubertal development in
the early school-age visits.
Question 67
Appropriate anticipatory guidance for the parents of an 8-year-old girl includes
Answer: c. Information that the child will start to value personal idols and role models.
Question 68
Max, a 9-year-old boy, is a very active child with limited self-control. He is easily distracted and
has difficulty staying on task. You determine that he should have a neurodevelopmental
evaluation because he is showing signs of
Answer: d. ADHD
Question 69
Which of the following injuries is most likely to be caused by abuse of a toddler?
Answer: c. A displaced posterior rib fracture.
Question 70
Which of the following issues or concepts is relevant to the school-age child?
Answer: a. Erikson's initiative versus guilt
Question 71
While assessing the skin of an infant, you note cafe-au-lait spots. Which disease should be ruled
out?
Answer: c. Neurofibromatosis
Question 72
The first sign of the onset of female puberty is usually:
Answer: d. Breast buds
Question 73
A mother states that her 4-year-old son constantly grinds his teeth at night. You document this as:
Answer: d. Bruxism
Question 74
Which of the following characterizes middle adolescence (14 to 16 years old)?
Answer: c. Need for privacy, increased conflicts with parents, financial independence
Question 75
I can roll over, grasp a rattle, and reach for things and have begun feeding myself finger foods,
but I can’t wave bye-bye yet. How old am I?
Answer: a. 6 months
Question 76
You would be concerned about the language development of a child who:
Answer: b. Stutters when excited or tired at the age of 7
Question 77
Most children can independently get dressed by themselves by age:
Answer: d. 5 years
Question 78
A differential diagnosis for child abuse would include all of the following except.
Answer: b. Prader-Willi syndrome
Question 79
Which of the following eye findings would be considered an ophthalmic emergency?
Answer: b. Unilateral vesicular lesions on the upper eyelid in a 3-week old.
Question 80
A 2-year-old child weighs 34 lb. What type of car seat should the child use?
Answer: b. A forward-facing car seat in the back of the vehicle.
Question 81
An expected milestone of a 4-year-old is the ability to
Answer: c. Copy a cross
Question 82
Sam has an otitis media. He also presents with conjunctivitis. This is due to which organism?
Answer: a. Haemophilus influenza
Question 83
A 14-year old has ataxia. He is brought to the local emergency department, where he appears
euphoric, emotionally labile, and disoriented. Many notice his abusive language. Which of the
following agents is most likely responsible for his condition?
Answer: a. Phencyclidine (PCP)
Question 84
What method can be safely used to remove cerumen in a 15-month-old child's ear?
Answer: d. Irrigation using warm water from a soft bulb syringe
Question 85
The appropriate lab tests in assessment of cervical adenitis include all of the following except:
Answer: a. Blood culture
Question 86
Which of the following represents normal sequencing of development in a toddler?
Answer: b. Feeds self, can undress self with help, washes hands, imitates housework.
Question 87
You see a young child who has tripled her birth weight and looks for hidden objects. When given
blocks, she places one in each hand. She has a fine pincer grasp. On the floor, she walks around
holding objects and is trying to take independent steps. This child is most likely how old?
Answer: c. 12 months
Question 88
During a domestic health assessment, the CDC recommends screening every refugee child for
which of the following diseases?
Answer: d. tuberculosis
Question 89
A 4-month-old presents with both eyes turning inward. What is this called?
Answer: b. Esotropia
Question 90
A mother brings her 4-week-old infant into the office because she noticed small yellow-white
glistening bumps on her infant's gums. She says they look like teeth but is concerned that they
may be cancer. You diagnose these bumps as
Answer: d. Epstein's pearls
Question 91
The parents of a 7-year-old are concerned their son does not want to attend school. Which of the
historical findings are not usually associated with the diagnosis of school phobia?
Answer: d. Chronic medical illness
Question 92
You are doing a kindergarten physical on a 5-year-old girl. Which of the following scenarios
would suggest the child is not ready to start kindergarten in the fall?
Answer: d. Counts to 4 and draws a person with three parts.
Question 93
Which of the following children should be referred for a comprehensive developmental
evaluation?
Answer: a. A 3-year-old who consistently tracks at the 5th percentile for height and weight since
birth.
Question 94
Sarah, 7 years old, is in the office today. All of the following are acceptable management options
for allergic rhinitis, except
Answer: b. Nasal neosynephrine
Question 95
You see a 3-year-old for a well-child visit. His mother informs you that potty training has been
very easy because he “has an amazing internal clock. He falls asleep, gets hungry, and has bowel
movements at the same time every day.” This describes which aspect of temperament?
Answer: a. Rhythmicity
Question 96
You see a healthy 18-month-old for a well-child visit. At the 12-month visit he received the
diphtheria, tetanus, and acellular pertussis (DTaP) third dose; hepatitis B second dose; measles,
mumps, and rubella (MMR) first dose; injected poliovirus (IPV) second dose; pneumococcal
conjugate (PCV13) fourth dose; and Haemophilus influenzae type B (Hib) fourth dose. Which of
the following do you order today?
Answer: c. DTaP, varicella, hepatitis A, and hepatitis B
Question 97
The results of the hemoglobin A1c test are LESS reliable in children with which of the following
conditions? (Hint: select two)
Answer: a. Cystic Fibrosis
b. Sickle Cell Disease
Question 98
You see a 5-month-old who is fussy, has interrupted sleep, and is drooling. You note large lower
lateral incisor bulges. You recommend:
Answer: e. A and D
Question 99
A 7-month-old male is found to have a spiral fracture of the femur that his father says he got by
climbing onto a chair and then jumping off. Which of the following statements is true regarding
this situation?
Answer: d. You should anonymously report the abuse to the authorities.
Question 100
The nurse practitioner role was initially established to
Answer: b. Improve access to care and partially solve physician shortage.
Question 101
Which of the following is a true contraindication of vaccinating a child?
Answer: d. Previous vaccination reaction that consisted of wheezing and hypotension
