NSG 548/ NSG548 Exam 2 – FNP Role Children &
Families Guide| Wilkes EXAM with Questions and
Answers/Plus a Rationale Updated 2026 A+/Instant
Download PDF
EXAM COVERAGE - 1. Advanced Pediatric Health Assessment and
Diagnostic Reasoning - 2. Pediatric Growth, Development, and
Behavioral Health - 3. Common Acute and Chronic Pediatric
Pathologies and Management
1. An 8-month-old infant is brought to the clinic for a routine well-child check. During the physical
examination, the Family Nurse Practitioner (FNP) notes that the infant is unable to sit
unsupported and does not yet transfer objects from one hand to the other. Which of the following
is the most appropriate initial clinical action?
A. Reassure the parents and schedule a routine follow-up at the 12-month well-child visit.
B. Order an immediate comprehensive developmental evaluation and consider referral to
early intervention services.
C. Prescribe a pediatric physical therapy consultation and repeat the screening in 4 weeks.
D. Order serum lead levels and a complete metabolic panel to rule out organic failure to thrive.
CORRECT ANSWER : B
Rationale: The absence of independent sitting and object transfer by 8 months of age represents
significant developmental delays that exceed normal variance. According to developmental
screening guidelines and Bright Futures, failure to achieve these major motor milestones
warrants prompt comprehensive evaluation and referral to early intervention programs.
Reassuring the parents would dangerously delay crucial early therapeutic support, while
physical therapy alone or laboratory tests do not address the broader developmental spectrum
without a formal evaluation.
2. A 3-year-old child presents to the urgent care clinic with a 2-day history of high fever,
irritability, and refusal to drink fluids. On exam, the child is drooling, leaning forward in a tripod
position, and exhibiting inspiratory stridor. What is the most critical immediate intervention for
the FNP?
A. Perform a gentle direct visualization of the oropharynx using a tongue depressor to assess for
exudates.
, B. Immediately notify pediatric otolaryngology and anesthesia while keeping the child calm
and undisturbed.
C. Administer a high-dose nebulized albuterol treatment and oral dexamethasone for acute
bronchospasm.
D. Obtain a stat portable chest radiograph and complete blood count with differential in the
triage bay.
CORRECT ANSWER : B
Rationale: The presentation of high fever, drooling, tripod positioning, and stridor in a toddler is
classic for acute epiglottitis, a life-threatening pediatric airway emergency. Attempting to
visualize the oropharynx or moving the child unnecessarily can precipitate sudden, catastrophic
total airway obstruction. The provider must keep the child calm in a position of comfort and
immediately secure specialized airway management support.
3. A mother brings her 4-week-old male infant to the primary care clinic reporting persistent,
forceful, non-bilious vomiting immediately following every feeding over the past week. The
infant appears hungry immediately after vomiting. Palpation of the abdomen is most likely to
reveal which of the following findings?
A. A soft, non-tender abdomen with palpable, sausage-shaped masses in the left lower quadrant.
B. A small, mobile, firm, olive-shaped mass palpable in the right upper quadrant.
C. Generalized abdominal distension with visible peristaltic waves moving from left to right.
D. Tenderness and localized guarding in the right lower quadrant with an active stool hemoccult.
CORRECT ANSWER : B
Rationale: Hypertrophic pyloric stenosis typically manifests between 2 and 6 weeks of age with
progressive, non-bilious projectile vomiting after feeds. Pathognomonic physical examination
findings include a firm, mobile, olive-shaped mass palpable in the right upper quadrant,
representing the hypertrophied pylorus. Confirmation is achieved via targeted abdominal
ultrasound, followed by surgical correction.
4. A 2-year-old toddler is brought in by parents who are concerned about a noticeable inward
turning of the right eye when the child is tired. The corneal light reflex test reveals displacement
of the light reflection laterally on the right pupil, and the cover-uncover test demonstrates
movement of the right eye outward to fixate when the left eye is covered. What is the appropriate
management strategy?
A. Reassure the parents that intermittent strabismus spontaneously resolves by age 5 without
intervention.
, B. Refer the child immediately to a pediatric ophthalmologist for evaluation of potential
strabismus and amblyopia.
C. Patch the right eye for two hours daily to strengthen the weaker extraocular muscles and
realign the visual axis.
D. Prescribe immediate bilateral corrective concave lenses with an urgent follow-up in 6 months.
CORRECT ANSWER : B
Rationale: Constant or intermittent strabismus confirmed by abnormal objective screening tests
(corneal light reflex and cover-uncover test) in a 2-year-old is abnormal and requires immediate
referral to a pediatric ophthalmologist. Timely intervention is essential to prevent permanent
visual loss from amblyopia. General reassurance is inappropriate given the documented
misalignment, and patching without an ophthalmologic diagnosis is contraindicated.
5. A 9-year-old boy presents with a 3-week history of a scaly, annular lesion on his scalp that has
resulted in localized hair loss. Examination under a Wood's lamp shows no fluorescence, and
scraping of the border reveals fungal elements on potassium hydroxide (KOH) preparation. What
is the most appropriate first-line systemic treatment?
A. Topical ketoconazole 2% cream applied twice daily for a minimum of four weeks.
B. Oral griseofulvin suspension taken consistently with a high-fat meal for 6 to 8 weeks.
C. Oral azithromycin pulse therapy administered once weekly for three consecutive weeks.
D. Topical selenium sulfide 1% shampoo combined with oral erythromycin base.
CORRECT ANSWER : B
Rationale: Tinea capitis is a dermatophyte infection of the scalp hair shafts that requires
systemic antifungal therapy because topical agents cannot penetrate the hair follicle effectively.
Oral griseofulvin is the traditional first-line treatment and absorption is significantly enhanced
when administered with fatty foods. Topical creams alone are ineffective for treating tinea
capitis.
6. An adolescent female presents for a routine sports participation physical examination. During the
screening, the FNP performs the Adams forward bend test and observes a pronounced right-sided
rib hump and asymmetrical spinal alignment. A scoliometer measurement indicates a truncal
rotation of 8 degrees. What is the mandatory next step in management?
A. Prescribe targeted physical therapy focusing on core spinal stabilization exercises three times
a week.
, B. Order a standing posteroanterior and lateral spinal radiograph to calculate the exact
Cobb angle.
C. Fit the patient for a rigid thoracolumbar sacral orthosis (TLSO) brace to be worn 18 hours
daily.
D. Re-evaluate the patient's spinal curvature and scoliometer reading in 6 months during a
routine visit.
CORRECT ANSWER : B
Rationale: An Adams forward bend test revealing a rib hump with a scoliometer measurement of
7 degrees or greater strongly suggests adolescent idiopathic scoliosis and requires diagnostic
imaging. A standing full-length spinal radiograph is necessary to measure the Cobb angle and
determine skeletal maturity and treatment trajectory. Deferring imaging or prescribing physical
therapy/bracing without radiographic verification is clinically improper.
7. A 6-year-old child presents with a 2-day history of sore throat, fever of 102.2°F, and a diffuse,
fine, erythematous papular rash that feels like sandpaper and is prominent in skin folds (Pastia
lines). The perioral area is pale, and the tongue exhibits prominent red papillae against a white
coating. Which pathogen is responsible for this clinical presentation?
A. Parvovirus B19
B. Group A Beta-Hemolytic Streptococcus
C. Epstein-Barr Virus
D. Human Herpesvirus 6
CORRECT ANSWER : B
Rationale: This clinical scenario describes scarlet fever, an exotoxin-mediated illness caused by
infection with Group A Beta-Hemolytic Streptococcus (Streptococcus pyogenes). Characteristic
clinical features include the sandpaper-like rash, Pastia lines, strawberry tongue, and
circumoral pallor. Prompt treatment with systemic antibiotics is required to prevent acute
rheumatic fever and glomerulonephritis.
8. An 18-month-old toddler is brought to the clinic for a routine supervision visit. The mother
expresses concern that the child only uses single words, does not combine words, and frequently
throws temper tantrums when frustrated. Physical examination and developmental milestones are
otherwise completely normal. What is the most appropriate guidance for the mother?
A. Refer the toddler immediately to a speech-language pathologist for comprehensive linguistic
therapy.
Families Guide| Wilkes EXAM with Questions and
Answers/Plus a Rationale Updated 2026 A+/Instant
Download PDF
EXAM COVERAGE - 1. Advanced Pediatric Health Assessment and
Diagnostic Reasoning - 2. Pediatric Growth, Development, and
Behavioral Health - 3. Common Acute and Chronic Pediatric
Pathologies and Management
1. An 8-month-old infant is brought to the clinic for a routine well-child check. During the physical
examination, the Family Nurse Practitioner (FNP) notes that the infant is unable to sit
unsupported and does not yet transfer objects from one hand to the other. Which of the following
is the most appropriate initial clinical action?
A. Reassure the parents and schedule a routine follow-up at the 12-month well-child visit.
B. Order an immediate comprehensive developmental evaluation and consider referral to
early intervention services.
C. Prescribe a pediatric physical therapy consultation and repeat the screening in 4 weeks.
D. Order serum lead levels and a complete metabolic panel to rule out organic failure to thrive.
CORRECT ANSWER : B
Rationale: The absence of independent sitting and object transfer by 8 months of age represents
significant developmental delays that exceed normal variance. According to developmental
screening guidelines and Bright Futures, failure to achieve these major motor milestones
warrants prompt comprehensive evaluation and referral to early intervention programs.
Reassuring the parents would dangerously delay crucial early therapeutic support, while
physical therapy alone or laboratory tests do not address the broader developmental spectrum
without a formal evaluation.
2. A 3-year-old child presents to the urgent care clinic with a 2-day history of high fever,
irritability, and refusal to drink fluids. On exam, the child is drooling, leaning forward in a tripod
position, and exhibiting inspiratory stridor. What is the most critical immediate intervention for
the FNP?
A. Perform a gentle direct visualization of the oropharynx using a tongue depressor to assess for
exudates.
, B. Immediately notify pediatric otolaryngology and anesthesia while keeping the child calm
and undisturbed.
C. Administer a high-dose nebulized albuterol treatment and oral dexamethasone for acute
bronchospasm.
D. Obtain a stat portable chest radiograph and complete blood count with differential in the
triage bay.
CORRECT ANSWER : B
Rationale: The presentation of high fever, drooling, tripod positioning, and stridor in a toddler is
classic for acute epiglottitis, a life-threatening pediatric airway emergency. Attempting to
visualize the oropharynx or moving the child unnecessarily can precipitate sudden, catastrophic
total airway obstruction. The provider must keep the child calm in a position of comfort and
immediately secure specialized airway management support.
3. A mother brings her 4-week-old male infant to the primary care clinic reporting persistent,
forceful, non-bilious vomiting immediately following every feeding over the past week. The
infant appears hungry immediately after vomiting. Palpation of the abdomen is most likely to
reveal which of the following findings?
A. A soft, non-tender abdomen with palpable, sausage-shaped masses in the left lower quadrant.
B. A small, mobile, firm, olive-shaped mass palpable in the right upper quadrant.
C. Generalized abdominal distension with visible peristaltic waves moving from left to right.
D. Tenderness and localized guarding in the right lower quadrant with an active stool hemoccult.
CORRECT ANSWER : B
Rationale: Hypertrophic pyloric stenosis typically manifests between 2 and 6 weeks of age with
progressive, non-bilious projectile vomiting after feeds. Pathognomonic physical examination
findings include a firm, mobile, olive-shaped mass palpable in the right upper quadrant,
representing the hypertrophied pylorus. Confirmation is achieved via targeted abdominal
ultrasound, followed by surgical correction.
4. A 2-year-old toddler is brought in by parents who are concerned about a noticeable inward
turning of the right eye when the child is tired. The corneal light reflex test reveals displacement
of the light reflection laterally on the right pupil, and the cover-uncover test demonstrates
movement of the right eye outward to fixate when the left eye is covered. What is the appropriate
management strategy?
A. Reassure the parents that intermittent strabismus spontaneously resolves by age 5 without
intervention.
, B. Refer the child immediately to a pediatric ophthalmologist for evaluation of potential
strabismus and amblyopia.
C. Patch the right eye for two hours daily to strengthen the weaker extraocular muscles and
realign the visual axis.
D. Prescribe immediate bilateral corrective concave lenses with an urgent follow-up in 6 months.
CORRECT ANSWER : B
Rationale: Constant or intermittent strabismus confirmed by abnormal objective screening tests
(corneal light reflex and cover-uncover test) in a 2-year-old is abnormal and requires immediate
referral to a pediatric ophthalmologist. Timely intervention is essential to prevent permanent
visual loss from amblyopia. General reassurance is inappropriate given the documented
misalignment, and patching without an ophthalmologic diagnosis is contraindicated.
5. A 9-year-old boy presents with a 3-week history of a scaly, annular lesion on his scalp that has
resulted in localized hair loss. Examination under a Wood's lamp shows no fluorescence, and
scraping of the border reveals fungal elements on potassium hydroxide (KOH) preparation. What
is the most appropriate first-line systemic treatment?
A. Topical ketoconazole 2% cream applied twice daily for a minimum of four weeks.
B. Oral griseofulvin suspension taken consistently with a high-fat meal for 6 to 8 weeks.
C. Oral azithromycin pulse therapy administered once weekly for three consecutive weeks.
D. Topical selenium sulfide 1% shampoo combined with oral erythromycin base.
CORRECT ANSWER : B
Rationale: Tinea capitis is a dermatophyte infection of the scalp hair shafts that requires
systemic antifungal therapy because topical agents cannot penetrate the hair follicle effectively.
Oral griseofulvin is the traditional first-line treatment and absorption is significantly enhanced
when administered with fatty foods. Topical creams alone are ineffective for treating tinea
capitis.
6. An adolescent female presents for a routine sports participation physical examination. During the
screening, the FNP performs the Adams forward bend test and observes a pronounced right-sided
rib hump and asymmetrical spinal alignment. A scoliometer measurement indicates a truncal
rotation of 8 degrees. What is the mandatory next step in management?
A. Prescribe targeted physical therapy focusing on core spinal stabilization exercises three times
a week.
, B. Order a standing posteroanterior and lateral spinal radiograph to calculate the exact
Cobb angle.
C. Fit the patient for a rigid thoracolumbar sacral orthosis (TLSO) brace to be worn 18 hours
daily.
D. Re-evaluate the patient's spinal curvature and scoliometer reading in 6 months during a
routine visit.
CORRECT ANSWER : B
Rationale: An Adams forward bend test revealing a rib hump with a scoliometer measurement of
7 degrees or greater strongly suggests adolescent idiopathic scoliosis and requires diagnostic
imaging. A standing full-length spinal radiograph is necessary to measure the Cobb angle and
determine skeletal maturity and treatment trajectory. Deferring imaging or prescribing physical
therapy/bracing without radiographic verification is clinically improper.
7. A 6-year-old child presents with a 2-day history of sore throat, fever of 102.2°F, and a diffuse,
fine, erythematous papular rash that feels like sandpaper and is prominent in skin folds (Pastia
lines). The perioral area is pale, and the tongue exhibits prominent red papillae against a white
coating. Which pathogen is responsible for this clinical presentation?
A. Parvovirus B19
B. Group A Beta-Hemolytic Streptococcus
C. Epstein-Barr Virus
D. Human Herpesvirus 6
CORRECT ANSWER : B
Rationale: This clinical scenario describes scarlet fever, an exotoxin-mediated illness caused by
infection with Group A Beta-Hemolytic Streptococcus (Streptococcus pyogenes). Characteristic
clinical features include the sandpaper-like rash, Pastia lines, strawberry tongue, and
circumoral pallor. Prompt treatment with systemic antibiotics is required to prevent acute
rheumatic fever and glomerulonephritis.
8. An 18-month-old toddler is brought to the clinic for a routine supervision visit. The mother
expresses concern that the child only uses single words, does not combine words, and frequently
throws temper tantrums when frustrated. Physical examination and developmental milestones are
otherwise completely normal. What is the most appropriate guidance for the mother?
A. Refer the toddler immediately to a speech-language pathologist for comprehensive linguistic
therapy.
