NR 602 FINAL EXAM QUESTIONS AND
CORRECT ANSWERS
/. The parent of an infant experiencing colic asks about using a probiotic medication.
What will the primary care pediatric NP tell this parent?
A. Probiotic medications have demonstrated efficacy in treating colic.
B. Probiotics are not safe to use to treat infants who have colic.
C. There are no studies showing usefulness of probiotic to manage colic.
D. There is no conclusive evidence about using probiotics to treat colic. - Answer-✅D.
There is no conclusive evidence about using probiotics to treat colic.
/.A toddler who was born prematurely refuses most solid foods and has poor weight
gain. A barium swallow study reveals a normal esophagus. What will the primary care
pediatric NP consider the next to manage this child's nutritional needs?
A. consultation with dietician
B. Fiberoptic endoscopy evaluation.
C. MRI
D. Videofluroscopy swallowing study (VOSS) - Answer-✅D. Videofluroscopy swallowing
study (VOSS)
/.A toddler is seen in clinic after a 2-day hx of intermittent V/D. An assessment reveals
an irritable child with dry mucous membranes, 3-second cap refill. 2-second recoil of
skin, mild tachycardia and tachypnea, and cool hands and feet. The child has had 2 wet
diapers in the past 24 hours. What will the primary care pediatric NP recommend?
A. anti-diarrheal medication & clear fluids for 24H
B. Bolus of IV NS in the clinic until improvement
C. Hospital admission for IV rehydration & oral fluids
D. Oral rehydration solution with f/u in 24H - Answer-✅D. Oral rehydration solution with
f/u in 24H
/.A 9-year old girl has a hx of frequent vomiting and her mother has frequent migraine
ha. The child has recently begun having more frequent and prolonged episodes
accompanied by headaches. An exam reveals abnormal eye movement and mild
ataxia. What is the correct action?
A. begin using anti-migraine meds to prevent HA
B. Prescribe ondansetron and lorazepam to help manage sx
C. Reassure the parent that this is expected with cyclic vomiting syndrome
D. Refer to a pediatric gastroenterologist for further workup. - Answer-✅D. Refer to a
pediatric gastroenterologist for further workup.
/.The parent of a 3-month-old reports that the infant reports that the infant arches and
gags while feeding and spits up undigested formula frequently. The infant's weight gain
,has dropped to the 5th percentile from the 12th. What is the best course of tx for this
infant?
A. Begin a trial of extensively hydrolyzed protein formula for 2-4 wks.
B. Institute an emperic trial of acid suppression with a PPI
C. Perform esophageal pH monitoring to determine the degree of reflux.
D. Reassure the parent that these sx will likely resolved by 12-24 mo. - Answer-✅A.
Begin a trial of extensively hydrolyzed protein formula for 2-4 wks.
/.A school-age child has a 3-month hx of dull, aching epigastric pain that worsens with
eating and awakens from sleep. A CBC shows a Hgb of 8mg/dL. What is the next step
in management.
A. Administration of H RA or PPI meds
B. Empiric therapy for H. pylori
C. Ordering an upper GI series
D. Referral for EGD - Answer-✅D. Referral for EGD
/.A 2-mo old infant cries up to 4 hours each day and according to the parents, is
inconsolable during crying episodes with fits and legs notes to be tense and stiff. The
infant is breastfeeding frequently but is often fussy during feedings. The PE is normal
and the infant is gaining weight normally. What will the primary care pediatric NP
recommend?
A. A complete work-up, including lab and radiologic tests.
B. Eliminating certain foods from the mother's diet.
C. Empiric tx w/PPI
D. Stopping breastfeeding & beginning a hydrolyzed formula - Answer-✅B. Eliminating
certain foods from the mother's diet.
/.A child is in the clinic after swallowing a metal bead. A radiograph of the GI tract shows
a 6 mm cylindrical object in the child's stomach. The child is able to swallow without
difficulty and is not experiencing pain. What is the correct course of treatment?
a. Administer ipecac to induce vomiting.
b. Have the parents watch for the object in the child's stool.
c. Insert a nasogastric tube to flush out the object.
d. Refer the child for endoscopic removal of the object. - Answer-✅b. Have the parents
watch for the object in the child's stool.
/.A 10-year-old child has had abdominal pain for 2 days, which began in the
periumbilical area and then localized to the RLQ. The child vomited once today and
then experienced relief from pain followed by an increased fever. What is the likely
diagnosis?
A. Appendicitis w/perf
B. Gastroenteritis
C. Pelvic inflammatory disease (PID)
D. UTI - Answer-✅A. Appendicitis w/perf
, /.An 18-month-old child has a 1-day hx of intermittent, cramping abd pain w/non-bilious
vomiting. The child observed to scream and draw up his legs during pain episodes and
becomes lethargic in between. The primary care pediatric NP notes ta small amount of
bloody, mucous stool in the diaper. What is the most likely diagnosis?
A. Appendicitis
B. Gastroenteritis
C. Intussusception
D. Testicular torsion - Answer-✅C. Intussusception
/.A school-age child has had abd pain for 3 mo htat occurs once to twice weekly and is
associated with a h/a and occ diff sleeping, often causing the child to stay home from
school. The child does not have V/D & is gaining weight normally. The PE is normal.
According to Bishop, what is included in the initial diagnostic work-up for this child?
A. CBC, ESR, amylase, lipase, UA, & abd US
B. CBC, ESR, CRP, and fecal calprotectin
C. CBC, ESR, CRP, UA, stool for ova, parasites, and culture
D. Stool for H.pylori antigen and serum IgA, IgG, tTg - Answer-✅A. CBC, ESR,
amylase, lipase, UA, & abd US
/.An adolescent is dx with functional abdominal pain (FAP). The child's sx worsen during
stressful events, esp w/school anxiety. What will be an important part of tx for this child?
A. informing the parents that the pain is most likely not real
B. instituting a lactose-free diet along w/lactobacillus supplements
C. teaching about the brain-gut interaction causing sx
D. using histamine2-blockers to help alleviate sx - Answer-✅C. teaching about the
brain-gut interaction causing sx
/.A school-age child has recurrent diarrhea w/foul-smelling stools, excessive flatus, abd
distention, and FTT. A 2-week lactose-free trial failed to reduce sx. What is the next
step in diagnosing this condition?
A. lactose hydrogen breath test
B. serologic testing for celiac disease
C. stool for ova and parasites
D. Sweat chloride test for cystic fiborisis - Answer-✅B. serologic testing for celiac
disease
/.A child is diagnosed w/Chron disease. What are the likely complications for this child?
A. cancer of the colon and possible colectomy
B. intestinal obstruction w/scarring and strictures
C. intestinal perforation and hemorrhage
D. liver disease and sepsis - Answer-✅B. intestinal obstruction w/scarring and strictures
/.A 12-month old infant exhibits poor wt. gain after previously normal growth patterns.
There is no hx of V/D, or irregular BM, and the PE is normal. What is the next step in
evaluating these findings?
A. CBC and electrolytes
CORRECT ANSWERS
/. The parent of an infant experiencing colic asks about using a probiotic medication.
What will the primary care pediatric NP tell this parent?
A. Probiotic medications have demonstrated efficacy in treating colic.
B. Probiotics are not safe to use to treat infants who have colic.
C. There are no studies showing usefulness of probiotic to manage colic.
D. There is no conclusive evidence about using probiotics to treat colic. - Answer-✅D.
There is no conclusive evidence about using probiotics to treat colic.
/.A toddler who was born prematurely refuses most solid foods and has poor weight
gain. A barium swallow study reveals a normal esophagus. What will the primary care
pediatric NP consider the next to manage this child's nutritional needs?
A. consultation with dietician
B. Fiberoptic endoscopy evaluation.
C. MRI
D. Videofluroscopy swallowing study (VOSS) - Answer-✅D. Videofluroscopy swallowing
study (VOSS)
/.A toddler is seen in clinic after a 2-day hx of intermittent V/D. An assessment reveals
an irritable child with dry mucous membranes, 3-second cap refill. 2-second recoil of
skin, mild tachycardia and tachypnea, and cool hands and feet. The child has had 2 wet
diapers in the past 24 hours. What will the primary care pediatric NP recommend?
A. anti-diarrheal medication & clear fluids for 24H
B. Bolus of IV NS in the clinic until improvement
C. Hospital admission for IV rehydration & oral fluids
D. Oral rehydration solution with f/u in 24H - Answer-✅D. Oral rehydration solution with
f/u in 24H
/.A 9-year old girl has a hx of frequent vomiting and her mother has frequent migraine
ha. The child has recently begun having more frequent and prolonged episodes
accompanied by headaches. An exam reveals abnormal eye movement and mild
ataxia. What is the correct action?
A. begin using anti-migraine meds to prevent HA
B. Prescribe ondansetron and lorazepam to help manage sx
C. Reassure the parent that this is expected with cyclic vomiting syndrome
D. Refer to a pediatric gastroenterologist for further workup. - Answer-✅D. Refer to a
pediatric gastroenterologist for further workup.
/.The parent of a 3-month-old reports that the infant reports that the infant arches and
gags while feeding and spits up undigested formula frequently. The infant's weight gain
,has dropped to the 5th percentile from the 12th. What is the best course of tx for this
infant?
A. Begin a trial of extensively hydrolyzed protein formula for 2-4 wks.
B. Institute an emperic trial of acid suppression with a PPI
C. Perform esophageal pH monitoring to determine the degree of reflux.
D. Reassure the parent that these sx will likely resolved by 12-24 mo. - Answer-✅A.
Begin a trial of extensively hydrolyzed protein formula for 2-4 wks.
/.A school-age child has a 3-month hx of dull, aching epigastric pain that worsens with
eating and awakens from sleep. A CBC shows a Hgb of 8mg/dL. What is the next step
in management.
A. Administration of H RA or PPI meds
B. Empiric therapy for H. pylori
C. Ordering an upper GI series
D. Referral for EGD - Answer-✅D. Referral for EGD
/.A 2-mo old infant cries up to 4 hours each day and according to the parents, is
inconsolable during crying episodes with fits and legs notes to be tense and stiff. The
infant is breastfeeding frequently but is often fussy during feedings. The PE is normal
and the infant is gaining weight normally. What will the primary care pediatric NP
recommend?
A. A complete work-up, including lab and radiologic tests.
B. Eliminating certain foods from the mother's diet.
C. Empiric tx w/PPI
D. Stopping breastfeeding & beginning a hydrolyzed formula - Answer-✅B. Eliminating
certain foods from the mother's diet.
/.A child is in the clinic after swallowing a metal bead. A radiograph of the GI tract shows
a 6 mm cylindrical object in the child's stomach. The child is able to swallow without
difficulty and is not experiencing pain. What is the correct course of treatment?
a. Administer ipecac to induce vomiting.
b. Have the parents watch for the object in the child's stool.
c. Insert a nasogastric tube to flush out the object.
d. Refer the child for endoscopic removal of the object. - Answer-✅b. Have the parents
watch for the object in the child's stool.
/.A 10-year-old child has had abdominal pain for 2 days, which began in the
periumbilical area and then localized to the RLQ. The child vomited once today and
then experienced relief from pain followed by an increased fever. What is the likely
diagnosis?
A. Appendicitis w/perf
B. Gastroenteritis
C. Pelvic inflammatory disease (PID)
D. UTI - Answer-✅A. Appendicitis w/perf
, /.An 18-month-old child has a 1-day hx of intermittent, cramping abd pain w/non-bilious
vomiting. The child observed to scream and draw up his legs during pain episodes and
becomes lethargic in between. The primary care pediatric NP notes ta small amount of
bloody, mucous stool in the diaper. What is the most likely diagnosis?
A. Appendicitis
B. Gastroenteritis
C. Intussusception
D. Testicular torsion - Answer-✅C. Intussusception
/.A school-age child has had abd pain for 3 mo htat occurs once to twice weekly and is
associated with a h/a and occ diff sleeping, often causing the child to stay home from
school. The child does not have V/D & is gaining weight normally. The PE is normal.
According to Bishop, what is included in the initial diagnostic work-up for this child?
A. CBC, ESR, amylase, lipase, UA, & abd US
B. CBC, ESR, CRP, and fecal calprotectin
C. CBC, ESR, CRP, UA, stool for ova, parasites, and culture
D. Stool for H.pylori antigen and serum IgA, IgG, tTg - Answer-✅A. CBC, ESR,
amylase, lipase, UA, & abd US
/.An adolescent is dx with functional abdominal pain (FAP). The child's sx worsen during
stressful events, esp w/school anxiety. What will be an important part of tx for this child?
A. informing the parents that the pain is most likely not real
B. instituting a lactose-free diet along w/lactobacillus supplements
C. teaching about the brain-gut interaction causing sx
D. using histamine2-blockers to help alleviate sx - Answer-✅C. teaching about the
brain-gut interaction causing sx
/.A school-age child has recurrent diarrhea w/foul-smelling stools, excessive flatus, abd
distention, and FTT. A 2-week lactose-free trial failed to reduce sx. What is the next
step in diagnosing this condition?
A. lactose hydrogen breath test
B. serologic testing for celiac disease
C. stool for ova and parasites
D. Sweat chloride test for cystic fiborisis - Answer-✅B. serologic testing for celiac
disease
/.A child is diagnosed w/Chron disease. What are the likely complications for this child?
A. cancer of the colon and possible colectomy
B. intestinal obstruction w/scarring and strictures
C. intestinal perforation and hemorrhage
D. liver disease and sepsis - Answer-✅B. intestinal obstruction w/scarring and strictures
/.A 12-month old infant exhibits poor wt. gain after previously normal growth patterns.
There is no hx of V/D, or irregular BM, and the PE is normal. What is the next step in
evaluating these findings?
A. CBC and electrolytes
