GRADUATE NURSING • ADVANCED PRACTICE
NUR 6130 Exam 2 A+
2026/2027 Official Exam
Advanced Practice Nursing III — Pediatric & Childbearing Primary Care Management
A+ QUESTIONS 5 SECTIONS 100%
VERIFIED COMPLETE RATIONALES
CATEGORIES
■ 1. Endocrine & Pubertal Disorders
■ 2. Genitourinary Conditions
■ 3. Behavioral, Developmental & Neurological Conditions
■ 4. Musculoskeletal & Orthopedic Conditions
■ 5. Dermatologic, Gastrointestinal, Infectious & Immunizations
STUVIAACTUALEXAM
Passing Score: 80% • 1 Mark per Question • Application / Analysis Level
, SECTION 1: Endocrine & Pubertal Disorders
Q1. A mother brings her 6-year-old daughter to the primary care clinic because she has noticed breast budding and
sparse axillary hair over the past four months. The child has grown 3.5 cm in the last six months and has no history of
neurological symptoms or exogenous hormone exposure. The nurse practitioner’s most appropriate next step is to:
A. Reassure the parent that this is normal early puberty and recheck in one year
B. Order a bone-age radiograph and baseline LH, FSH, and estradiol levels
C. Prescribe a GnRH agonist immediately to halt further progression
D. Refer immediately to endocrinology without laboratory evaluation
Correct Answer: B
Rationale: Breast development before age 8 years in girls constitutes precocious puberty and warrants evaluation. Bone-age
radiograph and gonadotropin/estradiol levels help differentiate central from peripheral precocious puberty and guide urgency of
referral. Immediate treatment or simple reassurance is not appropriate before diagnostic data are obtained.
Q2. An 8-year-old boy is brought in because his parents notice that he has developed pubic hair and a deepening
voice. His height is at the 95th percentile and his testicular volume is 4 mL bilaterally. The nurse practitioner explains
that true precocious puberty in boys is defined as the appearance of secondary sexual characteristics before age:
A. 9 years
B. 7 years
C. 8 years
D. 10 years
Correct Answer: A
Rationale: In boys, secondary sexual characteristics appearing before age 9 years are considered precocious. Testicular
enlargement is the earliest reliable sign of central (gonadotropin-dependent) puberty. Accurate age cut-offs guide the decision for
laboratory and imaging work-up.
Q3. A 7-year-old girl presents with isolated breast development without pubic or axillary hair and a normal linear growth
velocity. Bone age is consistent with chronological age. The most likely diagnosis is:
A. Central precocious puberty
B. Premature adrenarche
C. Premature thelarche
D. McCune-Albright syndrome
Correct Answer: C
Rationale: Premature thelarche is isolated breast development without other secondary sexual characteristics or accelerated
growth. It is usually benign and self-limited. Central precocious puberty involves progressive changes and advanced bone age;
premature adrenarche involves pubic/axillary hair without breast development.
Q4. During a well-child visit, a 9-year-old girl is noted to have Tanner stage 2 breast development and Tanner stage 1
pubic hair. Her mother asks when menarche is typically expected after thelarche begins. The nurse practitioner
correctly replies:
A. Within 6 months of breast budding
B. Immediately after pubic hair appears
C. Only after peak height velocity is completed
D. Approximately 2 to 2.5 years after thelarche
Correct Answer: D
Rationale: Menarche usually occurs 2 to 2.5 years after the onset of breast development (thelarche). Understanding the normal
tempo of puberty allows accurate counseling and recognition of disordered progression.
NUR 6130 Exam 2 | Page 2
NUR 6130 Exam 2 A+
2026/2027 Official Exam
Advanced Practice Nursing III — Pediatric & Childbearing Primary Care Management
A+ QUESTIONS 5 SECTIONS 100%
VERIFIED COMPLETE RATIONALES
CATEGORIES
■ 1. Endocrine & Pubertal Disorders
■ 2. Genitourinary Conditions
■ 3. Behavioral, Developmental & Neurological Conditions
■ 4. Musculoskeletal & Orthopedic Conditions
■ 5. Dermatologic, Gastrointestinal, Infectious & Immunizations
STUVIAACTUALEXAM
Passing Score: 80% • 1 Mark per Question • Application / Analysis Level
, SECTION 1: Endocrine & Pubertal Disorders
Q1. A mother brings her 6-year-old daughter to the primary care clinic because she has noticed breast budding and
sparse axillary hair over the past four months. The child has grown 3.5 cm in the last six months and has no history of
neurological symptoms or exogenous hormone exposure. The nurse practitioner’s most appropriate next step is to:
A. Reassure the parent that this is normal early puberty and recheck in one year
B. Order a bone-age radiograph and baseline LH, FSH, and estradiol levels
C. Prescribe a GnRH agonist immediately to halt further progression
D. Refer immediately to endocrinology without laboratory evaluation
Correct Answer: B
Rationale: Breast development before age 8 years in girls constitutes precocious puberty and warrants evaluation. Bone-age
radiograph and gonadotropin/estradiol levels help differentiate central from peripheral precocious puberty and guide urgency of
referral. Immediate treatment or simple reassurance is not appropriate before diagnostic data are obtained.
Q2. An 8-year-old boy is brought in because his parents notice that he has developed pubic hair and a deepening
voice. His height is at the 95th percentile and his testicular volume is 4 mL bilaterally. The nurse practitioner explains
that true precocious puberty in boys is defined as the appearance of secondary sexual characteristics before age:
A. 9 years
B. 7 years
C. 8 years
D. 10 years
Correct Answer: A
Rationale: In boys, secondary sexual characteristics appearing before age 9 years are considered precocious. Testicular
enlargement is the earliest reliable sign of central (gonadotropin-dependent) puberty. Accurate age cut-offs guide the decision for
laboratory and imaging work-up.
Q3. A 7-year-old girl presents with isolated breast development without pubic or axillary hair and a normal linear growth
velocity. Bone age is consistent with chronological age. The most likely diagnosis is:
A. Central precocious puberty
B. Premature adrenarche
C. Premature thelarche
D. McCune-Albright syndrome
Correct Answer: C
Rationale: Premature thelarche is isolated breast development without other secondary sexual characteristics or accelerated
growth. It is usually benign and self-limited. Central precocious puberty involves progressive changes and advanced bone age;
premature adrenarche involves pubic/axillary hair without breast development.
Q4. During a well-child visit, a 9-year-old girl is noted to have Tanner stage 2 breast development and Tanner stage 1
pubic hair. Her mother asks when menarche is typically expected after thelarche begins. The nurse practitioner
correctly replies:
A. Within 6 months of breast budding
B. Immediately after pubic hair appears
C. Only after peak height velocity is completed
D. Approximately 2 to 2.5 years after thelarche
Correct Answer: D
Rationale: Menarche usually occurs 2 to 2.5 years after the onset of breast development (thelarche). Understanding the normal
tempo of puberty allows accurate counseling and recognition of disordered progression.
NUR 6130 Exam 2 | Page 2
