NURS6541 Final Exam | NURS 6541 / NRNP 6541
Primary Care of Adolescents & Children | Actual Q&A
with Rationale | Walden University
1. A 5-day-old full-term newborn is jaundiced to the chest. Total bilirubin is 16 mg/dL. The
infant is feeding well, has adequate wet diapers, and is otherwise healthy. The blood type is O+,
mother is A+. Direct Coombs test is negative. Which is the most appropriate management?
A. Reassure and repeat bilirubin in 48 hours
B. Start intensive phototherapy
C. Perform exchange transfusion
D. Order a head ultrasound
[Answer] B
Rationale: A total bilirubin of 16 mg/dL at day 5 in a term infant without hemolysis is above the
phototherapy threshold (approximately 13–15 mg/dL depending on risk factors). Jaundice to
the chest indicates a level likely >12 mg/dL. Phototherapy is indicated. Exchange transfusion is
reserved for levels >25 mg/dL or failure of phototherapy.
2. A 14-year-old male is brought to the clinic by his mother for a "checkup." When the mother
leaves the room, the patient reports he has been feeling sad for the past month, has lost
interest in video games, and has trouble sleeping. He denies suicidal ideation. Which screening
tool is most appropriate?
A. CRAFFT questionnaire
B. PHQ-9 modified for adolescents
C. SCOFF questionnaire
D. Vanderbilt Assessment Scale
[Answer] B
Rationale: The PHQ-9 modified for adolescents (PHQ-A) is a validated screening tool for
depression in adolescents ages 12–18. The CRAFFT screens for substance use. SCOFF screens
for eating disorders. Vanderbilt screens for ADHD.
3. A 2-year-old child is brought to the clinic with a 3-day history of high fever (max 40°C),
bilateral conjunctival injection without discharge, cracked lips, and a red tongue. The child is
irritable. Which is the most urgent diagnostic test to perform?
A. Throat culture
B. Echocardiogram
C. Complete blood count
D. Electrocardiogram
[Answer] B
, Rationale: The presentation is classic for Kawasaki disease. An echocardiogram is urgently
needed to evaluate for coronary artery aneurysms, the most serious complication. CBC may
show elevated inflammatory markers but does not diagnose cardiac involvement. Treatment
with IVIG and aspirin should be initiated promptly.
4. A 6-month-old infant is seen for a well-child visit. The parent reports the infant was born at
32 weeks gestation. Which immunization schedule should be followed?
A. Chronological age, regardless of prematurity
B. Corrected gestational age until 12 months
C. Weight-based schedule
D. Delay all vaccines until 12 months
[Answer] A
Rationale: Immunizations for preterm infants should be given at the same chronological age as
full-term infants, regardless of birth weight or gestational age. Preterm infants are at higher risk
for vaccine-preventable diseases and benefit from timely immunization.
5. A 9-year-old child presents with a 2-day history of periumbilical pain that has migrated to the
right lower quadrant. The child has a temperature of 38.5°C, tenderness at McBurney's point,
and guarding. Which is the most appropriate next step?
A. Obtain a complete blood count and abdominal ultrasound
B. Start broad-spectrum antibiotics
C. Refer to a pediatric surgeon immediately
D. Prescribe acetaminophen and recheck in 24 hours
[Answer] A
Rationale: Classic presentation of appendicitis requires confirmation with labwork (CBC) and
imaging (ultrasound or CT) before surgical referral. Immediate surgical referral without imaging
is appropriate only if the diagnosis is highly certain and imaging is unavailable.
6. A 15-year-old female reports heavy menstrual bleeding lasting 9 days each cycle for the past
6 months. She is not sexually active. Hemoglobin is 9.8 g/dL. Which is the most appropriate
initial management?
A. Oral contraceptive pills
B. Tranexamic acid
C. Iron supplementation alone
D. Refer to gynecology
[Answer] A
Rationale: Heavy menstrual bleeding in adolescents is often due to anovulation. Combined oral
contraceptives are first-line for cycle regulation and reducing menstrual flow. Iron
supplementation is adjunctive. Tranexamic acid is used for acute heavy bleeding. Referral is
indicated if medical management fails.
Primary Care of Adolescents & Children | Actual Q&A
with Rationale | Walden University
1. A 5-day-old full-term newborn is jaundiced to the chest. Total bilirubin is 16 mg/dL. The
infant is feeding well, has adequate wet diapers, and is otherwise healthy. The blood type is O+,
mother is A+. Direct Coombs test is negative. Which is the most appropriate management?
A. Reassure and repeat bilirubin in 48 hours
B. Start intensive phototherapy
C. Perform exchange transfusion
D. Order a head ultrasound
[Answer] B
Rationale: A total bilirubin of 16 mg/dL at day 5 in a term infant without hemolysis is above the
phototherapy threshold (approximately 13–15 mg/dL depending on risk factors). Jaundice to
the chest indicates a level likely >12 mg/dL. Phototherapy is indicated. Exchange transfusion is
reserved for levels >25 mg/dL or failure of phototherapy.
2. A 14-year-old male is brought to the clinic by his mother for a "checkup." When the mother
leaves the room, the patient reports he has been feeling sad for the past month, has lost
interest in video games, and has trouble sleeping. He denies suicidal ideation. Which screening
tool is most appropriate?
A. CRAFFT questionnaire
B. PHQ-9 modified for adolescents
C. SCOFF questionnaire
D. Vanderbilt Assessment Scale
[Answer] B
Rationale: The PHQ-9 modified for adolescents (PHQ-A) is a validated screening tool for
depression in adolescents ages 12–18. The CRAFFT screens for substance use. SCOFF screens
for eating disorders. Vanderbilt screens for ADHD.
3. A 2-year-old child is brought to the clinic with a 3-day history of high fever (max 40°C),
bilateral conjunctival injection without discharge, cracked lips, and a red tongue. The child is
irritable. Which is the most urgent diagnostic test to perform?
A. Throat culture
B. Echocardiogram
C. Complete blood count
D. Electrocardiogram
[Answer] B
, Rationale: The presentation is classic for Kawasaki disease. An echocardiogram is urgently
needed to evaluate for coronary artery aneurysms, the most serious complication. CBC may
show elevated inflammatory markers but does not diagnose cardiac involvement. Treatment
with IVIG and aspirin should be initiated promptly.
4. A 6-month-old infant is seen for a well-child visit. The parent reports the infant was born at
32 weeks gestation. Which immunization schedule should be followed?
A. Chronological age, regardless of prematurity
B. Corrected gestational age until 12 months
C. Weight-based schedule
D. Delay all vaccines until 12 months
[Answer] A
Rationale: Immunizations for preterm infants should be given at the same chronological age as
full-term infants, regardless of birth weight or gestational age. Preterm infants are at higher risk
for vaccine-preventable diseases and benefit from timely immunization.
5. A 9-year-old child presents with a 2-day history of periumbilical pain that has migrated to the
right lower quadrant. The child has a temperature of 38.5°C, tenderness at McBurney's point,
and guarding. Which is the most appropriate next step?
A. Obtain a complete blood count and abdominal ultrasound
B. Start broad-spectrum antibiotics
C. Refer to a pediatric surgeon immediately
D. Prescribe acetaminophen and recheck in 24 hours
[Answer] A
Rationale: Classic presentation of appendicitis requires confirmation with labwork (CBC) and
imaging (ultrasound or CT) before surgical referral. Immediate surgical referral without imaging
is appropriate only if the diagnosis is highly certain and imaging is unavailable.
6. A 15-year-old female reports heavy menstrual bleeding lasting 9 days each cycle for the past
6 months. She is not sexually active. Hemoglobin is 9.8 g/dL. Which is the most appropriate
initial management?
A. Oral contraceptive pills
B. Tranexamic acid
C. Iron supplementation alone
D. Refer to gynecology
[Answer] A
Rationale: Heavy menstrual bleeding in adolescents is often due to anovulation. Combined oral
contraceptives are first-line for cycle regulation and reducing menstrual flow. Iron
supplementation is adjunctive. Tranexamic acid is used for acute heavy bleeding. Referral is
indicated if medical management fails.
