NURS6541 Exam 3 | NURS 6541 / NRNP 6541 Primary Care of Adolescents & Children |
Actual Q&A with Rationale | Walden University
1. A 15-year-old female presents for a well-child visit. Her mother remains in the room
during the interview. The adolescent avoids eye contact and gives short answers. What
is the most appropriate next step?
A. Ask the mother to step out for a portion of the visit to interview the adolescent alone
B. Conduct the entire visit with the mother present to maintain trust
C. Refer the adolescent to a mental health specialist immediately
D. Reschedule the visit when the adolescent can come alone
Correct Answer: A
Rationale: Confidentiality is essential in adolescent care. Interviewing the adolescent
alone allows disclosure of sensitive information. The parent should be invited back for
discussion. This approach builds trust and respects autonomy.
2. A 16-year-old male reports feeling sad for the past three weeks, loss of interest in
video games, and trouble sleeping. He denies suicidal thoughts. PHQ-9 score is 12. What
is the most appropriate initial management?
A. Start fluoxetine 10 mg daily and schedule follow-up in 4 weeks
B. Refer for cognitive behavioral therapy and monitor symptoms
C. Prescribe sertraline 50 mg daily and refer to psychiatry
D. Recommend exercise and sleep hygiene, reevaluate in 2 months
Correct Answer: B
Rationale: For mild to moderate depression (PHQ-9 10-14), first-line treatment is
psychotherapy (CBT). Antidepressants are indicated for moderate to severe
depression or if therapy is unavailable. Close monitoring is essential.
3. A 14-year-old girl is brought in by her mother for concerns about weight loss. The
adolescent states she feels "fat" and has been restricting calories. BMI is at the 15th
percentile. Which physical finding would most suggest anorexia nervosa?
A. Acanthosis nigricans
B. Lanugo hair on arms and back
C. Acne vulgaris on the face
D. Palpable thyroid gland
Correct Answer: B
Rationale: Lanugo (fine, downy hair) is a compensatory mechanism for poor insulation
,in anorexia. Acanthosis nigricans suggests insulin resistance. Acne and thyroid
enlargement are not specific to eating disorders.
4. A 17-year-old female requests birth control without her parents' knowledge. She is
sexually active with a male partner and uses condoms inconsistently. Which action is
legally and ethically appropriate?
A. Refuse to prescribe because she is a minor
B. Prescribe oral contraceptives and encourage parental disclosure
C. Inform her parents because she is under 18
D. Refer her to a school nurse for counseling only
Correct Answer: B
Rationale: Minors can consent to contraceptive services in all 50 states. Encouraging
parental disclosure is appropriate but not mandatory. Confidentiality should be
maintained to ensure access to care.
5. A 13-year-old boy is brought to the clinic by his grandmother, who reports he has
been "stealing things from the store" and "starting fights" at school. He has been
suspended twice. Which factor is most important to assess?
A. History of head trauma or seizures
B. Presence of depressive symptoms
C. Exposure to violence or abuse at home
D. Dietary intake and sleep patterns
Correct Answer: C
Rationale: Conduct disorder and oppositional behaviors in children often stem from
trauma, abuse, or household dysfunction. Assessing for adverse childhood experiences
(ACEs) is critical before diagnosing a behavioral disorder.
6. A 16-year-old male presents with a two-week history of sore throat, fever, and
fatigue. Exam shows pharyngeal erythema, exudates, and cervical lymphadenopathy.
Rapid strep test is negative. What is the most appropriate next step?
A. Start amoxicillin empirically
B. Obtain a throat culture
C. Diagnose viral pharyngitis and provide supportive care
D. Order a monospot test
Correct Answer: D
Rationale: In an adolescent with exudative pharyngitis and negative strep test,
, infectious mononucleosis (EBV) is likely. Monospot test is indicated. Antibiotics are not
indicated for viral infections and amoxicillin can cause a rash in EBV.
7. A 14-year-old female reports heavy menstrual bleeding for the past six months. She
has missed school due to flooding and fatigue. Hb is 9.2 g/dL. Which is the most
appropriate initial treatment?
A. Oral contraceptive pills to regulate cycles
B. Nonsteroidal anti-inflammatory drugs (NSAIDs) for dysmenorrhea
C. Iron supplementation and observation
D. Referral to gynecology for endometrial biopsy
Correct Answer: A
Rationale: Heavy menstrual bleeding in adolescents is often due to anovulation.
Combined oral contraceptives are first-line to regulate cycles and reduce bleeding. Iron
is also indicated, but hormonal management is key to preventing anemia.
8. A 17-year-old male is brought to the ED after his parents found a bottle of
acetaminophen empty in his room. He admits to taking "a handful" of pills because his
girlfriend broke up with him. He states he regrets it. What is the most urgent next step?
A. Administer N-acetylcysteine
B. Start fluoxetine
C. Obtain a psychiatry consult after medical clearance
D. Call child protective services
Correct Answer: A
Rationale: Acetaminophen overdose is potentially hepatotoxic. N-acetylcysteine is
most effective within 8 hours. After medical stabilization, a psychiatric evaluation is
needed. Suicide risk assessment is critical.
9. A 12-year-old boy with ADHD (on methylphenidate) is brought in by his mother, who
reports he has lost weight and has trouble sleeping. His grades have improved. What is
the best management for his side effects?
A. Discontinue methylphenidate immediately
B. Switch to a non-stimulant like atomoxetine
C. Administer medication after school and give a high-calorie breakfast
D. Add a sleep aid and appetite stimulant
Correct Answer: C
Rationale: Stimulant side effects (appetite suppression, insomnia) can be managed by
timing (medication after breakfast, avoiding evening doses) and nutritional strategies.
Actual Q&A with Rationale | Walden University
1. A 15-year-old female presents for a well-child visit. Her mother remains in the room
during the interview. The adolescent avoids eye contact and gives short answers. What
is the most appropriate next step?
A. Ask the mother to step out for a portion of the visit to interview the adolescent alone
B. Conduct the entire visit with the mother present to maintain trust
C. Refer the adolescent to a mental health specialist immediately
D. Reschedule the visit when the adolescent can come alone
Correct Answer: A
Rationale: Confidentiality is essential in adolescent care. Interviewing the adolescent
alone allows disclosure of sensitive information. The parent should be invited back for
discussion. This approach builds trust and respects autonomy.
2. A 16-year-old male reports feeling sad for the past three weeks, loss of interest in
video games, and trouble sleeping. He denies suicidal thoughts. PHQ-9 score is 12. What
is the most appropriate initial management?
A. Start fluoxetine 10 mg daily and schedule follow-up in 4 weeks
B. Refer for cognitive behavioral therapy and monitor symptoms
C. Prescribe sertraline 50 mg daily and refer to psychiatry
D. Recommend exercise and sleep hygiene, reevaluate in 2 months
Correct Answer: B
Rationale: For mild to moderate depression (PHQ-9 10-14), first-line treatment is
psychotherapy (CBT). Antidepressants are indicated for moderate to severe
depression or if therapy is unavailable. Close monitoring is essential.
3. A 14-year-old girl is brought in by her mother for concerns about weight loss. The
adolescent states she feels "fat" and has been restricting calories. BMI is at the 15th
percentile. Which physical finding would most suggest anorexia nervosa?
A. Acanthosis nigricans
B. Lanugo hair on arms and back
C. Acne vulgaris on the face
D. Palpable thyroid gland
Correct Answer: B
Rationale: Lanugo (fine, downy hair) is a compensatory mechanism for poor insulation
,in anorexia. Acanthosis nigricans suggests insulin resistance. Acne and thyroid
enlargement are not specific to eating disorders.
4. A 17-year-old female requests birth control without her parents' knowledge. She is
sexually active with a male partner and uses condoms inconsistently. Which action is
legally and ethically appropriate?
A. Refuse to prescribe because she is a minor
B. Prescribe oral contraceptives and encourage parental disclosure
C. Inform her parents because she is under 18
D. Refer her to a school nurse for counseling only
Correct Answer: B
Rationale: Minors can consent to contraceptive services in all 50 states. Encouraging
parental disclosure is appropriate but not mandatory. Confidentiality should be
maintained to ensure access to care.
5. A 13-year-old boy is brought to the clinic by his grandmother, who reports he has
been "stealing things from the store" and "starting fights" at school. He has been
suspended twice. Which factor is most important to assess?
A. History of head trauma or seizures
B. Presence of depressive symptoms
C. Exposure to violence or abuse at home
D. Dietary intake and sleep patterns
Correct Answer: C
Rationale: Conduct disorder and oppositional behaviors in children often stem from
trauma, abuse, or household dysfunction. Assessing for adverse childhood experiences
(ACEs) is critical before diagnosing a behavioral disorder.
6. A 16-year-old male presents with a two-week history of sore throat, fever, and
fatigue. Exam shows pharyngeal erythema, exudates, and cervical lymphadenopathy.
Rapid strep test is negative. What is the most appropriate next step?
A. Start amoxicillin empirically
B. Obtain a throat culture
C. Diagnose viral pharyngitis and provide supportive care
D. Order a monospot test
Correct Answer: D
Rationale: In an adolescent with exudative pharyngitis and negative strep test,
, infectious mononucleosis (EBV) is likely. Monospot test is indicated. Antibiotics are not
indicated for viral infections and amoxicillin can cause a rash in EBV.
7. A 14-year-old female reports heavy menstrual bleeding for the past six months. She
has missed school due to flooding and fatigue. Hb is 9.2 g/dL. Which is the most
appropriate initial treatment?
A. Oral contraceptive pills to regulate cycles
B. Nonsteroidal anti-inflammatory drugs (NSAIDs) for dysmenorrhea
C. Iron supplementation and observation
D. Referral to gynecology for endometrial biopsy
Correct Answer: A
Rationale: Heavy menstrual bleeding in adolescents is often due to anovulation.
Combined oral contraceptives are first-line to regulate cycles and reduce bleeding. Iron
is also indicated, but hormonal management is key to preventing anemia.
8. A 17-year-old male is brought to the ED after his parents found a bottle of
acetaminophen empty in his room. He admits to taking "a handful" of pills because his
girlfriend broke up with him. He states he regrets it. What is the most urgent next step?
A. Administer N-acetylcysteine
B. Start fluoxetine
C. Obtain a psychiatry consult after medical clearance
D. Call child protective services
Correct Answer: A
Rationale: Acetaminophen overdose is potentially hepatotoxic. N-acetylcysteine is
most effective within 8 hours. After medical stabilization, a psychiatric evaluation is
needed. Suicide risk assessment is critical.
9. A 12-year-old boy with ADHD (on methylphenidate) is brought in by his mother, who
reports he has lost weight and has trouble sleeping. His grades have improved. What is
the best management for his side effects?
A. Discontinue methylphenidate immediately
B. Switch to a non-stimulant like atomoxetine
C. Administer medication after school and give a high-calorie breakfast
D. Add a sleep aid and appetite stimulant
Correct Answer: C
Rationale: Stimulant side effects (appetite suppression, insomnia) can be managed by
timing (medication after breakfast, avoiding evening doses) and nutritional strategies.
