NURS 651 Bundled Module
Comprehensive Exam with verified
answers and rationale graded A+
Section 1: Pediatric Growth, Development, and
Health Promotion (Questions 1-20)
1. The primary care pediatric nurse practitioner is offering anticipatory
guidance to the parents of a 12-month-old child. The parents are bilingual in
Spanish and English and have many Spanish-speaking relatives nearby. They are
resisting exposing the child to Spanish out of concern that the child will not
learn English well. What will the nurse practitioner tell the parents?
A. Children with multi-language proficiency do not understand that others cannot do
this
B. Most bilingual children are able to shift from one language to another when
appropriate
C. Children who learn two languages simultaneously often confuse them in
conversation
D. Learning two languages at an early age prevents children from developing a
dominant language
Answer: B
Rationale: Most bilingual children are able to shift from one language to another
when appropriate. Research demonstrates that children can successfully learn two
languages simultaneously without long-term confusion or language delays.
Bilingualism is a cognitive advantage and should be encouraged rather than
discouraged -16 .
2. Anticipatory guidance regarding safe sleeping practice includes:
A. Apply bumper pads and comforter
B. Elevating the head of bed 30 degrees
C. Covering the mattress with one fitted sheet
D. Encourage co-sleeping in the parents' bed
,Answer: C
Rationale: Safe sleep practices to prevent SIDS include using a firm sleep surface
covered by a fitted sheet, with no soft objects, bumper pads, or loose bedding in the
crib. Bed sharing is not recommended due to increased risk of suffocation -16 .
3. The parent of a 24-month-old child asks the primary care pediatric nurse
practitioner when toilet training should begin. How will the pediatric nurse
practitioner respond?
A. "Early toilet training is often linked with intelligence"
B. "Begin when the child shows signs of readiness such as staying dry for two hours"
C. "Start at 18 months regardless of readiness signs"
D. "Wait until the child is 3 years old"
Answer: B
Rationale: Toilet training readiness signs include staying dry for at least 2 hours,
showing interest in the toilet, being able to communicate needs, and demonstrating
physical readiness. Training should begin when these signs are present, typically
between 18-30 months -16 .
4. Which of the following best describes growth and nutrition in the 12-month-
old?
A. Most infants have transitioned to 3 meals with two snacks
B. Height growth accelerates during this period
C. Usual weight gain is 4 pounds per month starting at 12 months
D. Breast milk should be the sole source of nutrition
Answer: A
Rationale: By 12 months, most infants have transitioned to a pattern of three meals
with two snacks daily. Growth velocity normally decelerates after the first year, and
solid foods should be the primary source of nutrition with breast milk or formula as a
supplement -16 .
5. The mother of a 3-month-old male infant tells the primary care pediatric
nurse practitioner that she occasionally notices he has a penile erection just
after nursing. What will the nurse practitioner tell the mother?
A. The infant is conscious of the pleasure associated with nursing
B. This is a normal, reflexive behavior at this age
C. Infants should be prevented from masturbating
D. This is a form of infantile priapism
Answer: B
Rationale: Penile erections in infants are a normal reflexive behavior that can occur
spontaneously or in response to stimulation such as a full bladder or feeding. This is
not sexual in nature and requires no intervention -16 .
, 6. A 10-year-old is hit in the head with a baseball during practice and is
diagnosed with concussion, even though no loss of consciousness occurred. The
primary care pediatric nurse practitioner is evaluating the child 2 weeks after
the injury and learns that the child is still experiencing some sleepiness every
day. The neurological exam is normal. The child and parent are adamant that
the child be allowed to return to sports. What is the appropriate response?
A. Allow full return to sports immediately
B. Continue to restrict activity until symptoms completely resolve
C. Refer for neuropsychological testing and gradual return-to-play protocol
D. Clear the child for non-contact sports only
Answer: C
Rationale: Persistent symptoms beyond the expected recovery period (typically 7-10
days for children) warrant further evaluation. A gradual return-to-play protocol with
neuropsychological testing ensures safe reintegration and prevents second-impact
syndrome -16 .
7. The parent of a 14-year-old child asks the primary care pediatric nurse
practitioner how to help the child prevent injuries when basketball tryouts
begin later in the school year. Which recommendation will be of most benefit?
A. Consume energy drinks before games
B. Protective knee braces
C. Preseason conditioning
D. Reduce carbohydrate intake
Answer: C
Rationale: Preseason conditioning is the most effective injury prevention strategy as
it prepares the body for the physical demands of the sport, improves strength and
flexibility, and reduces injury risk. Protective equipment and nutrition also play roles
but conditioning is foundational -16 .
8. The primary care pediatric nurse practitioner is performing a well child exam
on an 8-year-old girl and notes the presence of breast buds. What will the nurse
practitioner include when initiating anticipatory guidance for this patient?
A. Sexual orientation and the nature of sexual relationships
B. Material about the human papillomavirus vaccine
C. Information about sexual maturity and menstrual periods
D. A discussion about the risks of pregnancy and sexually transmitted diseases
Answer: C
Rationale: Breast budding (thelarche) is typically the first sign of puberty in females,
occurring around age 8-10. Anticipatory guidance should include age-appropriate
information about the physical changes of puberty and preparation for menarche -
16 .
Comprehensive Exam with verified
answers and rationale graded A+
Section 1: Pediatric Growth, Development, and
Health Promotion (Questions 1-20)
1. The primary care pediatric nurse practitioner is offering anticipatory
guidance to the parents of a 12-month-old child. The parents are bilingual in
Spanish and English and have many Spanish-speaking relatives nearby. They are
resisting exposing the child to Spanish out of concern that the child will not
learn English well. What will the nurse practitioner tell the parents?
A. Children with multi-language proficiency do not understand that others cannot do
this
B. Most bilingual children are able to shift from one language to another when
appropriate
C. Children who learn two languages simultaneously often confuse them in
conversation
D. Learning two languages at an early age prevents children from developing a
dominant language
Answer: B
Rationale: Most bilingual children are able to shift from one language to another
when appropriate. Research demonstrates that children can successfully learn two
languages simultaneously without long-term confusion or language delays.
Bilingualism is a cognitive advantage and should be encouraged rather than
discouraged -16 .
2. Anticipatory guidance regarding safe sleeping practice includes:
A. Apply bumper pads and comforter
B. Elevating the head of bed 30 degrees
C. Covering the mattress with one fitted sheet
D. Encourage co-sleeping in the parents' bed
,Answer: C
Rationale: Safe sleep practices to prevent SIDS include using a firm sleep surface
covered by a fitted sheet, with no soft objects, bumper pads, or loose bedding in the
crib. Bed sharing is not recommended due to increased risk of suffocation -16 .
3. The parent of a 24-month-old child asks the primary care pediatric nurse
practitioner when toilet training should begin. How will the pediatric nurse
practitioner respond?
A. "Early toilet training is often linked with intelligence"
B. "Begin when the child shows signs of readiness such as staying dry for two hours"
C. "Start at 18 months regardless of readiness signs"
D. "Wait until the child is 3 years old"
Answer: B
Rationale: Toilet training readiness signs include staying dry for at least 2 hours,
showing interest in the toilet, being able to communicate needs, and demonstrating
physical readiness. Training should begin when these signs are present, typically
between 18-30 months -16 .
4. Which of the following best describes growth and nutrition in the 12-month-
old?
A. Most infants have transitioned to 3 meals with two snacks
B. Height growth accelerates during this period
C. Usual weight gain is 4 pounds per month starting at 12 months
D. Breast milk should be the sole source of nutrition
Answer: A
Rationale: By 12 months, most infants have transitioned to a pattern of three meals
with two snacks daily. Growth velocity normally decelerates after the first year, and
solid foods should be the primary source of nutrition with breast milk or formula as a
supplement -16 .
5. The mother of a 3-month-old male infant tells the primary care pediatric
nurse practitioner that she occasionally notices he has a penile erection just
after nursing. What will the nurse practitioner tell the mother?
A. The infant is conscious of the pleasure associated with nursing
B. This is a normal, reflexive behavior at this age
C. Infants should be prevented from masturbating
D. This is a form of infantile priapism
Answer: B
Rationale: Penile erections in infants are a normal reflexive behavior that can occur
spontaneously or in response to stimulation such as a full bladder or feeding. This is
not sexual in nature and requires no intervention -16 .
, 6. A 10-year-old is hit in the head with a baseball during practice and is
diagnosed with concussion, even though no loss of consciousness occurred. The
primary care pediatric nurse practitioner is evaluating the child 2 weeks after
the injury and learns that the child is still experiencing some sleepiness every
day. The neurological exam is normal. The child and parent are adamant that
the child be allowed to return to sports. What is the appropriate response?
A. Allow full return to sports immediately
B. Continue to restrict activity until symptoms completely resolve
C. Refer for neuropsychological testing and gradual return-to-play protocol
D. Clear the child for non-contact sports only
Answer: C
Rationale: Persistent symptoms beyond the expected recovery period (typically 7-10
days for children) warrant further evaluation. A gradual return-to-play protocol with
neuropsychological testing ensures safe reintegration and prevents second-impact
syndrome -16 .
7. The parent of a 14-year-old child asks the primary care pediatric nurse
practitioner how to help the child prevent injuries when basketball tryouts
begin later in the school year. Which recommendation will be of most benefit?
A. Consume energy drinks before games
B. Protective knee braces
C. Preseason conditioning
D. Reduce carbohydrate intake
Answer: C
Rationale: Preseason conditioning is the most effective injury prevention strategy as
it prepares the body for the physical demands of the sport, improves strength and
flexibility, and reduces injury risk. Protective equipment and nutrition also play roles
but conditioning is foundational -16 .
8. The primary care pediatric nurse practitioner is performing a well child exam
on an 8-year-old girl and notes the presence of breast buds. What will the nurse
practitioner include when initiating anticipatory guidance for this patient?
A. Sexual orientation and the nature of sexual relationships
B. Material about the human papillomavirus vaccine
C. Information about sexual maturity and menstrual periods
D. A discussion about the risks of pregnancy and sexually transmitted diseases
Answer: C
Rationale: Breast budding (thelarche) is typically the first sign of puberty in females,
occurring around age 8-10. Anticipatory guidance should include age-appropriate
information about the physical changes of puberty and preparation for menarche -
16 .
