Walden University NRNP 6541 Final
Exam (pdf) | 2026/2027 | Q&A | Primary
Care
1. A small for gestational
gestational age,
age,dysmorphic
dysmorphicnewborn
newborninfant
infanthas
hasmicrocephaly,
microcephaly,sloping
sloping
forehead, cutis
cutis aplasia
aplasia(missing
(missingportion
portionofofthe
theskin
skinand
andhair)
hair)of
ofthe
thescalp,
scalp,polydactyly,
polydactyly,
microphthalmia, and omphalocele.
microphthalmia, and omphalocele. Which
Which is thethe most
mostlikely
likely diagnosis?
diagnosis?
A) Down syndrome (trisomy 21)
B) Edwards syndrome (trisomy 18)
C) Patau syndrome (trisomy 13)
D) Turner syndrome
Correct Answer: C
Rationale: Patau syndrome (trisomy 13) is characterized by severe microcephaly, sloping
forehead, cutis aplasia of the scalp, polydactyly, microphthalmia, and omphalocele. These
findings are classic for trisomy 13, which has a very poor prognosis with most infants not
surviving beyond the first year of life.
2. A 16-year-old
16-year-old girl
girl has
has enuresis,
enuresis, frequent
frequent urination,
urination, a white vaginal discharge,
discharge,and
andaa
dark rash around
dark rash around her
her neck.
neck. Her
Herserum
serum glucose
glucose level
levelisis250
250mg/dL,
mg/dL,and
andherher urinalysis
urinalysisisis
positive
positive for
for 2+ glucose
glucosebutbutisisotherwise
otherwisenegative.
negative.Which
Whichisisthe most
the likely
most diagnosis?
likely diagnosis?
A) Type I diabetes mellitus
B) Urinary tract infection
C) Type II diabetes mellitus
D) Polycystic ovary syndrome
Correct Answer: C
Rationale: This adolescent has classic findings of type 2 diabetes mellitus: hyperglycemia
(glucose 250 mg/dL), glucosuria, enuresis, and acanthosis nigricans (the dark rash around the
neck). The white vaginal discharge likely represents a yeast infection, which is common with
hyperglycemia. Type 2 diabetes is increasingly common in obese adolescents.
3. Mark, age 15,
Mark, age 15, is
is 5 feet tall and weighs
weighs 85
85 pounds.
pounds.You
You suspect
suspectanorexia
anorexianervosa.
nervosa.
What is
What is the best
best initial
initial approach?
A) Admit to the hospital immediately
B) Refer to a nutritionist only
,C) Discuss the diagnosis with the parents first
D) Confront Mark with the fact that you suspect an eating disorder
Correct Answer: D
Rationale: A direct, non-judgmental confrontation about the suspected eating disorder is the
best initial approach. This allows the healthcare provider to open a dialogue, assess the
patient's readiness for treatment, and gather more information. Hospitalization may be needed
if there are severe electrolyte abnormalities or vital sign instability.
4. Which of the following is NOT
Which of NOT aa sign
sign or symptom of congenital
congenitalhypothyroidism?
hypothyroidism?
A) Prolonged jaundice
B) Macroglossia
C) Hoarse cry
D) Frequent stooling
Correct Answer: D
Rationale: Congenital hypothyroidism typically presents with constipation, not frequent
stooling. Other signs include prolonged jaundice, macroglossia (large tongue), hoarse cry,
umbilical hernia, poor feeding, lethargy, and hypotonia. Frequent stooling is not a feature of
hypothyroidism.
5. While doing a 5-year-old well child exam, you notice
While doing notice two
two small
small patches
patchesofofhair
hairloss.
loss.
hair is
Broken hair is present, as
as is
iserythema
erythemaand
andscaling.
scaling.What
Whatisisthe
thelikely
likelydiagnosis?
diagnosis?
A) Trichotillomania
B) Alopecia areata
C) Tinea capitis
D) Traction alopecia
Correct Answer: C
Rationale: Tinea capitis (fungal infection of the scalp) presents with patches of hair loss,
broken hairs, erythema, and scaling. It is a common pediatric condition caused by
dermatophytes. Treatment requires oral antifungal therapy because topical agents do not
penetrate the hair shaft effectively.
6. Hope is a 7-month-old
7-month-old who
who presents
presentsin inJanuary
Januarywith
with aa 1-day
1-day history
history of
of cough,
cough,yellow
yellow
nasal discharge,
nasal discharge,andandlow-grade
low-gradefever
fever(T(T max
max 100°F).
100°F). She
She was
waspreviously
previouslyhealthy.
healthy.She
She
has 2+ edema of the nasal turbinates and cloudy rhinorrhea. She is afebrile in the
has 2+ edema of the nasal turbinates and cloudy rhinorrhea. She is afebrile in the office.office.
Her chest,
Her chest, mouth, and ears
ears are
are clear.
clear. What should you
What should you prescribe?
prescribe?
,A) Antibiotics
B) Decongestants
C) Antihistamines
D) Saline drops, bulb suction, humidified air, and increased PO fluids
Correct Answer: D
Rationale: This infant has viral upper respiratory infection symptoms. Supportive care is the
mainstay of treatment: saline drops, bulb suction to clear nasal passages, humidified air, and
increased oral fluids. Antibiotics are not indicated for viral infections, and decongestants and
antihistamines are not recommended in infants.
Absolutely. Below are original practice questions, not copied or represented as actual exam
questions, numbered 7–50, and modeled on the same NRNP 6541 Primary Care style and
format. Rationales are in plain text.
7. A 4-year-old
4-year-old child
childpresents
presentswith fever,
with sore
fever, throat,
sore tonsillar
throat, exudates,
tonsillar tendertender
exudates, anterior
anterior
cervical
cervicallymph
lymphnodes,
nodes,and nono
and cough. Which
cough. Whichdiagnostic test should
diagnostic the nurse
test should the practitioner
nurse practitioner
obtain
obtainfirst?
first?
A) Monospot test
B) Rapid antigen detection test for group A Streptococcus
C) Chest radiograph
D) Serum Epstein-Barr virus antibody panel
Correct Answer: B
Rationale: The patient's findings are highly suggestive of streptococcal pharyngitis. A rapid
antigen detection test is an appropriate initial diagnostic test in children with suspected group
A Streptococcus infection. A throat culture may be performed if the rapid test is negative.
8. A 7-year-old
7-year-old child
childhas
hasrecurrent
recurrent episodes of wheezing,
episodes coughing
of wheezing, at night,
coughing and shortness
at night, of
and shortness of
breath during
breath duringexercise.
exercise.Which
Whichfinding would
finding most
would strongly
most support
strongly a diagnosis
support of asthma?
a diagnosis of asthma?
A) Persistent crackles on auscultation
B) Reversible airflow obstruction
C) Fixed restrictive lung disease
D) Decreased tactile fremitus
Correct Answer: B
, Rationale: Asthma is characterized by variable and usually reversible airflow obstruction.
Symptoms commonly include episodic wheezing, cough, chest tightness, and dyspnea that
may worsen with exercise or at night.
9. A 3-year-old
3-year-old child
childpresents
presents with
witha barking cough,
a barking hoarseness,
cough, and inspiratory
hoarseness, stridorstridor
and inspiratory that that
worsens at night. Which is the most likely diagnosis?
worsens at night. Which is the most likely diagnosis?
A) Epiglottitis
B) Croup
C) Bronchiolitis
D) Bacterial pneumonia
Correct Answer: B
Rationale: Croup typically presents with a characteristic barking cough, hoarseness, and
inspiratory stridor caused by upper-airway inflammation. Symptoms frequently worsen at
night.
10. A 2-month-old
2-month-old infant
infanthas
haspersistent
persistentprojectile vomiting
projectile afterafter
vomiting feeding and appears
feeding hungryhungry
and appears
immediately
immediatelyafterward.
afterward.Which
Whichcondition
conditionshould thethe
should nurse practitioner
nurse suspect?
practitioner suspect?
A) Gastroesophageal reflux
B) Pyloric stenosis
C) Intussusception
D) Hirschsprung disease
Correct Answer: B
Rationale: Hypertrophic pyloric stenosis commonly presents in young infants with
progressive projectile, nonbilious vomiting followed by hunger. A palpable olive-shaped
mass may be present in the upper abdomen.
11. A 6-month-old
6-month-old infant
infanthas
hasrhinorrhea
rhinorrheafollowed
followedby by
cough, wheezing,
cough, tachypnea,
wheezing, and and
tachypnea,
increased work of breathing. Which diagnosis is most likely?
increased work of breathing. Which diagnosis is most likely?
A) Bronchiolitis
B) Croup
C) Bacterial sinusitis
D) Epiglottitis
Correct Answer: A
Exam (pdf) | 2026/2027 | Q&A | Primary
Care
1. A small for gestational
gestational age,
age,dysmorphic
dysmorphicnewborn
newborninfant
infanthas
hasmicrocephaly,
microcephaly,sloping
sloping
forehead, cutis
cutis aplasia
aplasia(missing
(missingportion
portionofofthe
theskin
skinand
andhair)
hair)of
ofthe
thescalp,
scalp,polydactyly,
polydactyly,
microphthalmia, and omphalocele.
microphthalmia, and omphalocele. Which
Which is thethe most
mostlikely
likely diagnosis?
diagnosis?
A) Down syndrome (trisomy 21)
B) Edwards syndrome (trisomy 18)
C) Patau syndrome (trisomy 13)
D) Turner syndrome
Correct Answer: C
Rationale: Patau syndrome (trisomy 13) is characterized by severe microcephaly, sloping
forehead, cutis aplasia of the scalp, polydactyly, microphthalmia, and omphalocele. These
findings are classic for trisomy 13, which has a very poor prognosis with most infants not
surviving beyond the first year of life.
2. A 16-year-old
16-year-old girl
girl has
has enuresis,
enuresis, frequent
frequent urination,
urination, a white vaginal discharge,
discharge,and
andaa
dark rash around
dark rash around her
her neck.
neck. Her
Herserum
serum glucose
glucose level
levelisis250
250mg/dL,
mg/dL,and
andherher urinalysis
urinalysisisis
positive
positive for
for 2+ glucose
glucosebutbutisisotherwise
otherwisenegative.
negative.Which
Whichisisthe most
the likely
most diagnosis?
likely diagnosis?
A) Type I diabetes mellitus
B) Urinary tract infection
C) Type II diabetes mellitus
D) Polycystic ovary syndrome
Correct Answer: C
Rationale: This adolescent has classic findings of type 2 diabetes mellitus: hyperglycemia
(glucose 250 mg/dL), glucosuria, enuresis, and acanthosis nigricans (the dark rash around the
neck). The white vaginal discharge likely represents a yeast infection, which is common with
hyperglycemia. Type 2 diabetes is increasingly common in obese adolescents.
3. Mark, age 15,
Mark, age 15, is
is 5 feet tall and weighs
weighs 85
85 pounds.
pounds.You
You suspect
suspectanorexia
anorexianervosa.
nervosa.
What is
What is the best
best initial
initial approach?
A) Admit to the hospital immediately
B) Refer to a nutritionist only
,C) Discuss the diagnosis with the parents first
D) Confront Mark with the fact that you suspect an eating disorder
Correct Answer: D
Rationale: A direct, non-judgmental confrontation about the suspected eating disorder is the
best initial approach. This allows the healthcare provider to open a dialogue, assess the
patient's readiness for treatment, and gather more information. Hospitalization may be needed
if there are severe electrolyte abnormalities or vital sign instability.
4. Which of the following is NOT
Which of NOT aa sign
sign or symptom of congenital
congenitalhypothyroidism?
hypothyroidism?
A) Prolonged jaundice
B) Macroglossia
C) Hoarse cry
D) Frequent stooling
Correct Answer: D
Rationale: Congenital hypothyroidism typically presents with constipation, not frequent
stooling. Other signs include prolonged jaundice, macroglossia (large tongue), hoarse cry,
umbilical hernia, poor feeding, lethargy, and hypotonia. Frequent stooling is not a feature of
hypothyroidism.
5. While doing a 5-year-old well child exam, you notice
While doing notice two
two small
small patches
patchesofofhair
hairloss.
loss.
hair is
Broken hair is present, as
as is
iserythema
erythemaand
andscaling.
scaling.What
Whatisisthe
thelikely
likelydiagnosis?
diagnosis?
A) Trichotillomania
B) Alopecia areata
C) Tinea capitis
D) Traction alopecia
Correct Answer: C
Rationale: Tinea capitis (fungal infection of the scalp) presents with patches of hair loss,
broken hairs, erythema, and scaling. It is a common pediatric condition caused by
dermatophytes. Treatment requires oral antifungal therapy because topical agents do not
penetrate the hair shaft effectively.
6. Hope is a 7-month-old
7-month-old who
who presents
presentsin inJanuary
Januarywith
with aa 1-day
1-day history
history of
of cough,
cough,yellow
yellow
nasal discharge,
nasal discharge,andandlow-grade
low-gradefever
fever(T(T max
max 100°F).
100°F). She
She was
waspreviously
previouslyhealthy.
healthy.She
She
has 2+ edema of the nasal turbinates and cloudy rhinorrhea. She is afebrile in the
has 2+ edema of the nasal turbinates and cloudy rhinorrhea. She is afebrile in the office.office.
Her chest,
Her chest, mouth, and ears
ears are
are clear.
clear. What should you
What should you prescribe?
prescribe?
,A) Antibiotics
B) Decongestants
C) Antihistamines
D) Saline drops, bulb suction, humidified air, and increased PO fluids
Correct Answer: D
Rationale: This infant has viral upper respiratory infection symptoms. Supportive care is the
mainstay of treatment: saline drops, bulb suction to clear nasal passages, humidified air, and
increased oral fluids. Antibiotics are not indicated for viral infections, and decongestants and
antihistamines are not recommended in infants.
Absolutely. Below are original practice questions, not copied or represented as actual exam
questions, numbered 7–50, and modeled on the same NRNP 6541 Primary Care style and
format. Rationales are in plain text.
7. A 4-year-old
4-year-old child
childpresents
presentswith fever,
with sore
fever, throat,
sore tonsillar
throat, exudates,
tonsillar tendertender
exudates, anterior
anterior
cervical
cervicallymph
lymphnodes,
nodes,and nono
and cough. Which
cough. Whichdiagnostic test should
diagnostic the nurse
test should the practitioner
nurse practitioner
obtain
obtainfirst?
first?
A) Monospot test
B) Rapid antigen detection test for group A Streptococcus
C) Chest radiograph
D) Serum Epstein-Barr virus antibody panel
Correct Answer: B
Rationale: The patient's findings are highly suggestive of streptococcal pharyngitis. A rapid
antigen detection test is an appropriate initial diagnostic test in children with suspected group
A Streptococcus infection. A throat culture may be performed if the rapid test is negative.
8. A 7-year-old
7-year-old child
childhas
hasrecurrent
recurrent episodes of wheezing,
episodes coughing
of wheezing, at night,
coughing and shortness
at night, of
and shortness of
breath during
breath duringexercise.
exercise.Which
Whichfinding would
finding most
would strongly
most support
strongly a diagnosis
support of asthma?
a diagnosis of asthma?
A) Persistent crackles on auscultation
B) Reversible airflow obstruction
C) Fixed restrictive lung disease
D) Decreased tactile fremitus
Correct Answer: B
, Rationale: Asthma is characterized by variable and usually reversible airflow obstruction.
Symptoms commonly include episodic wheezing, cough, chest tightness, and dyspnea that
may worsen with exercise or at night.
9. A 3-year-old
3-year-old child
childpresents
presents with
witha barking cough,
a barking hoarseness,
cough, and inspiratory
hoarseness, stridorstridor
and inspiratory that that
worsens at night. Which is the most likely diagnosis?
worsens at night. Which is the most likely diagnosis?
A) Epiglottitis
B) Croup
C) Bronchiolitis
D) Bacterial pneumonia
Correct Answer: B
Rationale: Croup typically presents with a characteristic barking cough, hoarseness, and
inspiratory stridor caused by upper-airway inflammation. Symptoms frequently worsen at
night.
10. A 2-month-old
2-month-old infant
infanthas
haspersistent
persistentprojectile vomiting
projectile afterafter
vomiting feeding and appears
feeding hungryhungry
and appears
immediately
immediatelyafterward.
afterward.Which
Whichcondition
conditionshould thethe
should nurse practitioner
nurse suspect?
practitioner suspect?
A) Gastroesophageal reflux
B) Pyloric stenosis
C) Intussusception
D) Hirschsprung disease
Correct Answer: B
Rationale: Hypertrophic pyloric stenosis commonly presents in young infants with
progressive projectile, nonbilious vomiting followed by hunger. A palpable olive-shaped
mass may be present in the upper abdomen.
11. A 6-month-old
6-month-old infant
infanthas
hasrhinorrhea
rhinorrheafollowed
followedby by
cough, wheezing,
cough, tachypnea,
wheezing, and and
tachypnea,
increased work of breathing. Which diagnosis is most likely?
increased work of breathing. Which diagnosis is most likely?
A) Bronchiolitis
B) Croup
C) Bacterial sinusitis
D) Epiglottitis
Correct Answer: A
