Walden University NRNP 6541 Midterm Exam (pdf) | 2026/2027 |
Q&A | Primary Care
**1. Sheila is pregnant and fearful of getting cervical cancer as her sister
recently did. She asks about receiving the HPV vaccine. How do you
respond?**
A) "As long as you're in your first trimester, the HPV vaccine is safe and
effective."
B) "Research has not shown this vaccine to be effective against preventing
cervical cancer."
C) "After the age of 20, the HPV vaccine is not recommended."
D) "You should not receive the vaccination when you are pregnant."
**Correct Answer: D**
**Rationale:** The HPV vaccine is not recommended during pregnancy. If a
woman is found to be pregnant, she should delay vaccination until after
delivery. There is no evidence of harm to the fetus from inadvertent
administration, but it is contraindicated intentionally during pregnancy.
---
**2. Jack and Jill present for a preconception health counseling session. Jack
is 34, Jill is 33, and they have a 5-year-old son, Jake. Jake has spina bifida
with a loss of function of his lower extremities. Jack and Jill want another
child and ask if there is anything they can do to prevent the recurrence of a
neural tube defect in future pregnancies. What is your best response?**
A) "Jill should take 60 mg/day of an iron supplement to enhance stores to
support fetal development."
B) "It is a matter of genetics, and there is nothing you can do."
,C) "Have a CVS performed at 12 to 14 weeks gestation to determine the
health of the fetus."
D) "Jill should take 4 mg/day of folic acid, beginning before conception."
**Correct Answer: D**
**Rationale:** Women with a previous pregnancy affected by a neural tube
defect should take a high-dose folic acid supplement (4 mg/day) beginning at
least one month before conception and continuing through the first trimester.
This dose is significantly higher than the standard 0.4 mg/day
recommendation for the general population.
---
**3. You are invited to speak to a group of public school administrators about
recent outbreaks of head lice. As an advocate for children and families you
share:**
A) "No nit" policies that exclude children until all nits are removed are
essential to eradicate this problem.
B) The American Academy of Pediatrics and the National Association of
School Nurses discourage "no nit" policies that exclude children from school.
C) Occlusive agents, such as petroleum shampoo and herbal oils, applied to
suffocate the lice are showing promising results in randomized controlled
trials.
D) Lindane is recommended by the American Academy of Pediatrics as a
treatment choice.
**Correct Answer: B**
,**Rationale:** The American Academy of Pediatrics (AAP) and the National
Association of School Nurses (NASN) discourage "no nit" policies that exclude
children from school. These policies are not effective at controlling head lice
and can lead to unnecessary school absences. Treatment with pediculicides
and proper combing is recommended.
---
**4. A 15-year-old female has a 1-month history of urinary frequency without
dysuria and recent onset of an itchy rash beneath both breasts. She has
been gaining weight over the past year and regularly complains of fatigue.
She is febrile with a weight greater than the 99th percentile and has an
erythematous, macular rash beneath both breasts characterized by satellite
lesions. UA is significant for 2+ glucosuria, but no pyuria. Which of the
following is the most likely diagnosis?**
A) Diabetes mellitus
B) Fanconi syndrome
C) Human immunodeficiency virus
D) Occult malignancy
E) Severe combined immunodeficiency (SCID)
**Correct Answer: A**
**Rationale:** This obese adolescent has findings consistent with diabetes
mellitus. The cutaneous candidiasis (satellite lesions beneath the breasts) is
likely an indication of secondary immunosuppression related to
hyperglycemia. In diabetes, hyperglycemia promotes neutrophil dysfunction
and circulatory insufficiency contributes to ineffective neutrophil chemotaxis
during infection.
---
, **5. A mother notes her 6-week-old son's umbilical cord is still attached. His
activity and intake are normal; there has been no illness or fever. Delivery
was at term without problems. His examination is notable for a cord without
evidence of separation and a shallow, 0.5 cm ulceration at the occiput
without discharge or surrounding erythema. Mother declares that the "sore,"
caused by a scalp probe, has been slowly healing since birth and was
deemed unremarkable at his 2-week checkup. Which of the following is
consistent with this child's likely diagnosis?**
A) Defective humoral response
B) Functional leukocyte adherence glycoproteins
C) Marked neutrophilia
D) Normal wound healing
E) Purulent abscess formation
**Correct Answer: C**
**Rationale:** This presentation suggests leukocyte adhesion deficiency
(LAD), an inheritable disorder of leukocyte chemotaxis and adherence
characterized by delayed wound healing. Marked neutrophilia is common
with WBC counts typically exceeding 50,000 cells/mm³. Good skin and oral
hygiene are important; broad-spectrum antimicrobials and surgical
debridement are early considerations with infection.
---
**6. Which of the following statements regarding adolescent substance use is
true?**
A) Most teen alcohol abusers are "functional" alcoholics.
Q&A | Primary Care
**1. Sheila is pregnant and fearful of getting cervical cancer as her sister
recently did. She asks about receiving the HPV vaccine. How do you
respond?**
A) "As long as you're in your first trimester, the HPV vaccine is safe and
effective."
B) "Research has not shown this vaccine to be effective against preventing
cervical cancer."
C) "After the age of 20, the HPV vaccine is not recommended."
D) "You should not receive the vaccination when you are pregnant."
**Correct Answer: D**
**Rationale:** The HPV vaccine is not recommended during pregnancy. If a
woman is found to be pregnant, she should delay vaccination until after
delivery. There is no evidence of harm to the fetus from inadvertent
administration, but it is contraindicated intentionally during pregnancy.
---
**2. Jack and Jill present for a preconception health counseling session. Jack
is 34, Jill is 33, and they have a 5-year-old son, Jake. Jake has spina bifida
with a loss of function of his lower extremities. Jack and Jill want another
child and ask if there is anything they can do to prevent the recurrence of a
neural tube defect in future pregnancies. What is your best response?**
A) "Jill should take 60 mg/day of an iron supplement to enhance stores to
support fetal development."
B) "It is a matter of genetics, and there is nothing you can do."
,C) "Have a CVS performed at 12 to 14 weeks gestation to determine the
health of the fetus."
D) "Jill should take 4 mg/day of folic acid, beginning before conception."
**Correct Answer: D**
**Rationale:** Women with a previous pregnancy affected by a neural tube
defect should take a high-dose folic acid supplement (4 mg/day) beginning at
least one month before conception and continuing through the first trimester.
This dose is significantly higher than the standard 0.4 mg/day
recommendation for the general population.
---
**3. You are invited to speak to a group of public school administrators about
recent outbreaks of head lice. As an advocate for children and families you
share:**
A) "No nit" policies that exclude children until all nits are removed are
essential to eradicate this problem.
B) The American Academy of Pediatrics and the National Association of
School Nurses discourage "no nit" policies that exclude children from school.
C) Occlusive agents, such as petroleum shampoo and herbal oils, applied to
suffocate the lice are showing promising results in randomized controlled
trials.
D) Lindane is recommended by the American Academy of Pediatrics as a
treatment choice.
**Correct Answer: B**
,**Rationale:** The American Academy of Pediatrics (AAP) and the National
Association of School Nurses (NASN) discourage "no nit" policies that exclude
children from school. These policies are not effective at controlling head lice
and can lead to unnecessary school absences. Treatment with pediculicides
and proper combing is recommended.
---
**4. A 15-year-old female has a 1-month history of urinary frequency without
dysuria and recent onset of an itchy rash beneath both breasts. She has
been gaining weight over the past year and regularly complains of fatigue.
She is febrile with a weight greater than the 99th percentile and has an
erythematous, macular rash beneath both breasts characterized by satellite
lesions. UA is significant for 2+ glucosuria, but no pyuria. Which of the
following is the most likely diagnosis?**
A) Diabetes mellitus
B) Fanconi syndrome
C) Human immunodeficiency virus
D) Occult malignancy
E) Severe combined immunodeficiency (SCID)
**Correct Answer: A**
**Rationale:** This obese adolescent has findings consistent with diabetes
mellitus. The cutaneous candidiasis (satellite lesions beneath the breasts) is
likely an indication of secondary immunosuppression related to
hyperglycemia. In diabetes, hyperglycemia promotes neutrophil dysfunction
and circulatory insufficiency contributes to ineffective neutrophil chemotaxis
during infection.
---
, **5. A mother notes her 6-week-old son's umbilical cord is still attached. His
activity and intake are normal; there has been no illness or fever. Delivery
was at term without problems. His examination is notable for a cord without
evidence of separation and a shallow, 0.5 cm ulceration at the occiput
without discharge or surrounding erythema. Mother declares that the "sore,"
caused by a scalp probe, has been slowly healing since birth and was
deemed unremarkable at his 2-week checkup. Which of the following is
consistent with this child's likely diagnosis?**
A) Defective humoral response
B) Functional leukocyte adherence glycoproteins
C) Marked neutrophilia
D) Normal wound healing
E) Purulent abscess formation
**Correct Answer: C**
**Rationale:** This presentation suggests leukocyte adhesion deficiency
(LAD), an inheritable disorder of leukocyte chemotaxis and adherence
characterized by delayed wound healing. Marked neutrophilia is common
with WBC counts typically exceeding 50,000 cells/mm³. Good skin and oral
hygiene are important; broad-spectrum antimicrobials and surgical
debridement are early considerations with infection.
---
**6. Which of the following statements regarding adolescent substance use is
true?**
A) Most teen alcohol abusers are "functional" alcoholics.
