Pediatric Primary Care PNCB 2 questions and answers
2026\2027 A+ Grade
A female athlete experiences anaphylaxis during a soccer game. The only significant history is that she
had lunch about 1 hour before the incident. Food-dependent exercise-induced anaphylaxis is diagnosed.
Of the following, the MOST likely cause is:
chocolate milkshake
pineapple
tomatoes
whole wheat bread
- correct answer whole wheat bread
Exercise is a known co-factor in some children who experience anaphylaxis. Food-dependent exercise-
induced anaphylaxis (FDEIA) is defined as a food induced allergic reaction that occurs during or soon
after exercise. Children should not exercise within 2-3 hours of ingesting the triggering food. Nuts,
wheat, apples, bananas, kiwi, peaches and eggs frequently are the cause for anaphylaxis.
A healthy 24 month old can be expected to have achieved which of the following language milestones?
counts three objects correctly
speaks using 30 - 50 words
states full name
,tells a story
- correct answer speaks using 30 - 50 words
Utilizing the Early Language Milestone Scale, beginning at the age of 11 months and continuing to 24
months of age, the child should have a vocabulary of 50 words. This child should be able to put words
together in short, 2 - 3 word sentences and name at least one object in a picture. The child at age 3 - 4
years will be able to tell a short story and begin to count. A 2 year old may know his first name, but
usually cannot state full name until he/she is older.
Which is the MOST important safety question to ask a 17 year old?
"Are you aware of ways to avoid accidents?"
"Do you play violent video games more than 2 hours a day?"
"Do you always wear a seat belt when driving or riding in a car?"
"Is there a gun anywhere in your house?"
- correct answer "Do you always wear a seat belt when driving or riding in a car?"
Motor vehicle accidents are the leading cause of death among children in the United States, with 78% of
all unintentional injury deaths related to MVA among adolescents. When correctly used, restraint
systems can prevent fatalities and reduce the number and severity of injuries to children and
adolescents. As adolescents begin to drive and carry peer passengers, it is especially important to
remind them of basic safety issues, including the use of seat belts, emphasizing the danger of driving,
drinking and drug use as well as appropriate behavior while in the car. Reinforcing pedestrian safety is
another important issue with adolescents. Firearm injuries have decreased over recent years, especially
among older children, and there is no link between violent video games and increased accidents.
The parent of an 8 month old, reports switching the baby's formula to cow's milk due to the continued
expense of formula. Which is the BEST response?
Cow's milk does not contain adequate nutrition, and poses a higher risk for allergy.
,Cow's milk has a lower protein and fat content, which will impede growth of the baby.
Switching to cow's milk sooner than 1 year will not cause any harm.
There is no need to continue formula as long as the child is receiving other baby foods.
- correct answer Cow's milk does not contain adequate nutrition, and poses a higher risk for allergy.
During the first year of life, infants should receive only formula or breast milk. The use of cow's milk is
contraindicated because of its high protein content, inappropriate nutrition composition, especially lack
of iron sources, and the risk of gastrointestinal bleeding and allergic reactions. If an infant is switched
sooner than one year, the practitioner should encourage the family to resume use of formula or breast
milk until the one year birthday. Despite the addition of table foods or baby solid foods, formula and
breast milk are still the dietary mainstay.
A 10 month old has had apparent abdominal pain for the past 4 hours. During episodes of pain, the
infant screams inconsolably and draws his legs towards the abdomen, has vomited twice, but has had no
diarrhea. Between episodes the infant is calm and quiet. The MOST likely diagnosis is:
Meckel's diverticulum
intussusception
acute appendicitis
acute gastroenteritis
- correct answer intussusception
Acute onset of abdominal pain requires immediate investigation. The nurse practitioner must be able to
distinguish between conditions that can safely be managed at home and those requiring immediate
referral. Meckel's diverticulum usually involves painless rectal bleeding. Acute appendicitis can occur in
infants and must be considered in the differential diagnosis. The pain history of acute appendicitis is
usually more continuous, and there is no palpable mass. Acute gastroenteritis may involve intermittent
pain and cramping, but more typically the child appears ill, and vomiting and diarrhea play a more
, prominent role. The pain of intussusception is very severe, with periods of well-being in between. There
is frequently vomiting, however stools initially are normal. Later stools can be like red jelly in
appearance. A sausage shaped mass is frequently palpable in the right upper quadrant and aids in
diagnosis.
For the parents of an 8 month old, the MOST appropriate age-related anticipatory guidance regarding
safety includes which of the following?
cover electrical outlets, keep small objects out of reach, turn car seat to forward-facing position
keep medications out of reach, continue to use car seat in rear-facing position, cover electrical outlets
avoid finger foods that can be easily aspirated, teach stranger safety, place Mr. Yuk stickers on toxic
materials
keep matches out of reach, place Mr. Yuk stickers on toxic materials, teach stranger safety
- correct answer keep medications out of reach, continue to use car seat in rear-facing position, cover
electrical outlets
An 8 month old is beginning to cruise, crawl and develop a fine pincer grasp. Keeping medications and
small objects out of reach in this age group assists in avoiding choking or toxic ingestions. Covering
electrical outlets helps to prevent accidental electrocution while the infant is exploring his surroundings.
An infant should maintain the rear-facing position of the car seat until the age of one year. An 8 month
old is not at a developmental level to understand stranger caution nor Mr. Yuk stickers. Keeping
matches out of reach is important, although it is not as likely that an 8 month old would have the
dexterity to strike a match.
The INITIAL treatment for a school-age female with well-demarcated erythema and mucoid discharge in
the vulva area includes:
discontinuation of bubble baths.
instruction on front to back cleansing.
2026\2027 A+ Grade
A female athlete experiences anaphylaxis during a soccer game. The only significant history is that she
had lunch about 1 hour before the incident. Food-dependent exercise-induced anaphylaxis is diagnosed.
Of the following, the MOST likely cause is:
chocolate milkshake
pineapple
tomatoes
whole wheat bread
- correct answer whole wheat bread
Exercise is a known co-factor in some children who experience anaphylaxis. Food-dependent exercise-
induced anaphylaxis (FDEIA) is defined as a food induced allergic reaction that occurs during or soon
after exercise. Children should not exercise within 2-3 hours of ingesting the triggering food. Nuts,
wheat, apples, bananas, kiwi, peaches and eggs frequently are the cause for anaphylaxis.
A healthy 24 month old can be expected to have achieved which of the following language milestones?
counts three objects correctly
speaks using 30 - 50 words
states full name
,tells a story
- correct answer speaks using 30 - 50 words
Utilizing the Early Language Milestone Scale, beginning at the age of 11 months and continuing to 24
months of age, the child should have a vocabulary of 50 words. This child should be able to put words
together in short, 2 - 3 word sentences and name at least one object in a picture. The child at age 3 - 4
years will be able to tell a short story and begin to count. A 2 year old may know his first name, but
usually cannot state full name until he/she is older.
Which is the MOST important safety question to ask a 17 year old?
"Are you aware of ways to avoid accidents?"
"Do you play violent video games more than 2 hours a day?"
"Do you always wear a seat belt when driving or riding in a car?"
"Is there a gun anywhere in your house?"
- correct answer "Do you always wear a seat belt when driving or riding in a car?"
Motor vehicle accidents are the leading cause of death among children in the United States, with 78% of
all unintentional injury deaths related to MVA among adolescents. When correctly used, restraint
systems can prevent fatalities and reduce the number and severity of injuries to children and
adolescents. As adolescents begin to drive and carry peer passengers, it is especially important to
remind them of basic safety issues, including the use of seat belts, emphasizing the danger of driving,
drinking and drug use as well as appropriate behavior while in the car. Reinforcing pedestrian safety is
another important issue with adolescents. Firearm injuries have decreased over recent years, especially
among older children, and there is no link between violent video games and increased accidents.
The parent of an 8 month old, reports switching the baby's formula to cow's milk due to the continued
expense of formula. Which is the BEST response?
Cow's milk does not contain adequate nutrition, and poses a higher risk for allergy.
,Cow's milk has a lower protein and fat content, which will impede growth of the baby.
Switching to cow's milk sooner than 1 year will not cause any harm.
There is no need to continue formula as long as the child is receiving other baby foods.
- correct answer Cow's milk does not contain adequate nutrition, and poses a higher risk for allergy.
During the first year of life, infants should receive only formula or breast milk. The use of cow's milk is
contraindicated because of its high protein content, inappropriate nutrition composition, especially lack
of iron sources, and the risk of gastrointestinal bleeding and allergic reactions. If an infant is switched
sooner than one year, the practitioner should encourage the family to resume use of formula or breast
milk until the one year birthday. Despite the addition of table foods or baby solid foods, formula and
breast milk are still the dietary mainstay.
A 10 month old has had apparent abdominal pain for the past 4 hours. During episodes of pain, the
infant screams inconsolably and draws his legs towards the abdomen, has vomited twice, but has had no
diarrhea. Between episodes the infant is calm and quiet. The MOST likely diagnosis is:
Meckel's diverticulum
intussusception
acute appendicitis
acute gastroenteritis
- correct answer intussusception
Acute onset of abdominal pain requires immediate investigation. The nurse practitioner must be able to
distinguish between conditions that can safely be managed at home and those requiring immediate
referral. Meckel's diverticulum usually involves painless rectal bleeding. Acute appendicitis can occur in
infants and must be considered in the differential diagnosis. The pain history of acute appendicitis is
usually more continuous, and there is no palpable mass. Acute gastroenteritis may involve intermittent
pain and cramping, but more typically the child appears ill, and vomiting and diarrhea play a more
, prominent role. The pain of intussusception is very severe, with periods of well-being in between. There
is frequently vomiting, however stools initially are normal. Later stools can be like red jelly in
appearance. A sausage shaped mass is frequently palpable in the right upper quadrant and aids in
diagnosis.
For the parents of an 8 month old, the MOST appropriate age-related anticipatory guidance regarding
safety includes which of the following?
cover electrical outlets, keep small objects out of reach, turn car seat to forward-facing position
keep medications out of reach, continue to use car seat in rear-facing position, cover electrical outlets
avoid finger foods that can be easily aspirated, teach stranger safety, place Mr. Yuk stickers on toxic
materials
keep matches out of reach, place Mr. Yuk stickers on toxic materials, teach stranger safety
- correct answer keep medications out of reach, continue to use car seat in rear-facing position, cover
electrical outlets
An 8 month old is beginning to cruise, crawl and develop a fine pincer grasp. Keeping medications and
small objects out of reach in this age group assists in avoiding choking or toxic ingestions. Covering
electrical outlets helps to prevent accidental electrocution while the infant is exploring his surroundings.
An infant should maintain the rear-facing position of the car seat until the age of one year. An 8 month
old is not at a developmental level to understand stranger caution nor Mr. Yuk stickers. Keeping
matches out of reach is important, although it is not as likely that an 8 month old would have the
dexterity to strike a match.
The INITIAL treatment for a school-age female with well-demarcated erythema and mucoid discharge in
the vulva area includes:
discontinuation of bubble baths.
instruction on front to back cleansing.
