NR 603 Week 7 Edition Exam Questions and Answers Advanced Practice Clinical Review: Essential Competencies for Primary Care Management of the Childbearing and Childrearing Family

NR 603 Week 7 Edition Exam Questions and Answers Advanced Practice
Clinical Review: Essential Competencies for Primary Care Management of
the Childbearing and Childrearing Family

Block 1: Maternal & Newborn Care
1. A 38-year-old pregnant patient at 28 weeks' gestation is at increased risk for
which complication due to her age?
 A. Placenta accreta.

 B. Inability to adjust uterine blood flow to meet fetal demands.

 C. Rapid cervical dilation.

 D. Excessive amniotic fluid.

Rationale: Women over 35 (Mature Gravidas) often have less flexible uterine
vasculature, which can lead to placental insufficiency or pregnancy-induced
hypertension.
2. Which finding during a physical exam of a 12-hour-old newborn is considered a
normal physiological transition?
 B. Bluish tint to the hands and feet with a pink trunk.

 B. Persistent nasal flaring and grunting.

 C. Jaundice of the face and sclera.

 D. A heart rate of 80 beats per minute while awake.

Rationale: Acrocyanosis is normal in the first 24–48 hours; however, jaundice in the
first 24 hours is always pathologic.
3. When assessing a 4-month-old infant, the NP notes a full, tense anterior
fontanel while the infant is upright and quiet. This most likely indicates:
 A. Dehydration.

 B. Normal growth spurt.

 C. Increased intracranial pressure (Hydrocephalus).

 D. Premature closure of the sutures.

, Rationale: A depressed fontanel indicates dehydration; a full/tense fontanel in a non-
crying infant suggests fluid buildup or pressure.
4. A patient who is 6 hours post-Cesarean section is requesting a meal. What is
the most critical assessment before ordering a diet?
 A. Pain level on a scale of 1–10.

 B. Auscultation of bowel sounds in all four quadrants.

 C. Ability to ambulate to the bathroom.

 D. Firmness of the uterine fundus.

Rationale: Post-abdominal surgery, the return of peristalsis must be confirmed to
prevent a paralytic ileus.


Block 2: Inflammatory Disorders (RA, SLE, Gout)
5. A patient with Systemic Lupus Erythematosus (SLE) presents with new-onset
edema and hypertension. Which lab result would most likely confirm renal
involvement?
 A. Elevated Rheumatoid Factor.

 B. Proteinuria on a 24-hour urine collection.

 C. Positive Anti-Smith antibody.

 D. Decreased C-Reactive Protein.

Rationale: Lupus Nephritis is a major complication of SLE, characterized by protein
leaking into the urine due to glomerular damage.
6. Which medication is the "gold standard" for slowing joint destruction in
Rheumatoid Arthritis but requires strict folic acid supplementation?
 A. Prednisone.

 B. Hydroxychloroquine.

 C. Methotrexate.

 D. Etanercept.

Rationale: Methotrexate is a folate antagonist; without folic acid supplements, patients
develop stomatitis, GI distress, and bone marrow suppression.

, 7. A patient presents with sudden, excruciating pain in the first
metatarsophalangeal joint. The NP suspects Gout. What is the definitive
diagnostic test?
 A. Serum Uric Acid level > 8.0 mg/dL.

 B. Joint aspiration for synovial fluid crystal analysis.

 C. X-ray of the foot showing "punched-out" erosions.

 D. Response to a trial of Naproxen.

Rationale: Many people have high uric acid without gout; only the presence of
negatively birefringent crystals in joint fluid confirms the diagnosis.
8. When initiating Allopurinol for a patient with chronic gout, why must the NP
also prescribe low-dose Colchicine for the first 3–6 months?
 A. To treat the underlying infection.

 B. To prevent kidney stone formation.

 C. To prevent a "mobilization flare" as urate levels drop.

 D. To increase the absorption of the Allopurinol.

Rationale: Rapidly lowering serum urate can cause crystals to shift, paradoxically
triggering an acute flare.


Block 3: Substance Use & Mental Health
9. Using the Clinical Opioid Withdrawal Scale (COWS), a patient scores a 15. The
NP should document this as:
 A. Mild withdrawal.

 B. Moderate withdrawal.

 C. Severe withdrawal.

 D. Life-threatening withdrawal.

Rationale: COWS scores 5–12 are mild, 13–24 are moderate, and 25–36 are
moderately severe.
10. A primary care NP uses the SBIRT tool during a routine physical. What does
the "BI" in SBIRT stand for?

,  B. Brief Intervention.

 B. Behavioral Integration.

 C. Biological Indices.

 D. Basic Intake.

Rationale: SBIRT stands for Screening, Brief Intervention, and Referral to Treatment.
11. A patient is being switched from Alprazolam (Xanax) to a longer-acting
benzodiazepine for tapering. How long should a safe taper typically last?
 A. 3 to 5 days.

 B. 2 weeks.

 C. 8 weeks to several months.

 D. Tapering is not required for Xanax.

Rationale: Rapid benzo withdrawal can cause seizures and death; a very slow taper is
required for neuro-stability.


Block 4: Pediatrics & Development
12. A mother is concerned her 18-month-old is not talking. Which behavior is a
"red flag" for Autism Spectrum Disorder at this age?
 A. Inability to stack 4 blocks.

 B. Lack of pointing to share interest (joint attention).

 C. Refusing to eat vegetables.

 D. Crying when the mother leaves the room.

Rationale: "Pointing to show" is a milestone of social communication; its absence is a
high-priority screening indicator.
13. At what age should an NP expect a child to be able to jump in place and use 2-
word phrases?
 A. 12 months.

 B. 18 months.

 C. 24 months (2 years).