NR602 FINAL STUDY GUIDE
CERTIFICATION STUDY GUIDE 2026
COMPREHENSIVE QUESTIONS AND
VERIFIED ANSWERS
◉ 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
CERTIFICATION STUDY GUIDE 2026
COMPREHENSIVE QUESTIONS AND
VERIFIED ANSWERS
◉ 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
