NSG 548 Exam 2 V2 | NSG 548 FNP Role: Children &
Families | Actual Q&A with Rationale (NSG548
Exam 2) | Wilkes University
1. A 4-year-old child is brought to the clinic for a well-child visit. Which developmental
milestone is most consistent with this age group?
A. Copying a square and hopping on one foot
B. Tying shoelaces independently
C. Using a spoon and fork correctly without spilling
D. Walking up stairs using alternating feet
Correct Answer: A
Explanation: At age 4, children typically demonstrate the fine motor skill of copying a
square and the gross motor skill of hopping on one foot. While walking up stairs with
alternating feet usually begins around age 3, hopping is a more advanced balance skill
expected by 4 years. The FNP must monitor these milestones to ensure appropriate
neurological and physical development during preschool years.
2. When evaluating a 6-month-old infant for developmental progress, which finding would
require further investigation?
A. Persistent Moro reflex
B. Inability to roll from tummy to back
,C. Failure to sit without support
D. Lack of pincer grasp
Correct Answer: A
Explanation: The Moro reflex, also known as the startle reflex, should typically disappear
by 3 to 4 months of age. A persistent Moro reflex at 6 months may indicate underlying
neurological dysfunction or a delay in central nervous system maturation. Sitting without
support and the pincer grasp are milestones expected slightly later, around 7-9 months,
thus their absence at 6 months is not necessarily pathological.
3. An FNP is assessing an 18-month-old child. Which finding during the physical examination
would be considered an ‘alarm’ sign for Autism Spectrum Disorder (ASD)?
A. Refusal to share toys
B. Inability to speak in two-word sentences
C. Parallel play alongside other children
D. Lack of pointing to show interest
Correct Answer: D
Explanation: Protodeclarative pointing, or pointing to indicate interest in an object, is a
critical social communication milestone that should be present by 14-16 months. The
absence of this joint attention behavior at 18 months is a significant ‘red flag’ for ASD and
requires immediate further screening using tools like the M-CHAT-R. Parallel play is
,developmentally appropriate for this age group, and two-word sentences are expected
closer to 24 months.
4. What is the gold standard for diagnosing a urinary tract infection (UTI) in a non-toilet-
trained infant?
A. Clean catch midstream collection
B. Urine bag collection
C. Leukocyte esterase on a dipstick
D. Suprapubic aspiration or transurethral catheterization
Correct Answer: D
Explanation: For infants who are not toilet trained, the most reliable method to obtain a
sterile specimen is via catheterization or suprapubic aspiration. Urine bags have a high rate
of contamination (up to 50%) and are not recommended for definitive culture-based
diagnosis. Accurate diagnosis is essential in this population to prevent renal scarring and
identify potential structural anomalies like vesicoureteral reflux.
5. A 12-month-old infant is found to have a lead level of 8 mcg/dL. What is the most
appropriate next step for the FNP?
A. Immediately start chelation therapy
B. Perform a confirmatory venous blood lead level
C. Recheck the level in one year
, D. Advise the parents to increase the child’s intake of Vitamin D
Correct Answer: B
Explanation: Current CDC guidelines suggest that any capillary lead screening result above
the reference value (currently 3.5-5 mcg/dL) must be confirmed with a venous blood
sample. Chelation therapy is typically reserved for much higher levels, usually above 45
mcg/dL. The FNP should also investigate potential environmental sources of lead and
ensure adequate iron and calcium intake, as these minerals can reduce lead absorption.
6. Which of the following physical exam findings is a classic sign of coarctation of the aorta in
a pediatric patient?
A. A continuous ‘machinery’ murmur
B. Bounding radial pulses and weak femoral pulses
C. Cyanosis that improves with crying
D. A loud, harsh holosystolic murmur at the left lower sternal border
Correct Answer: B
Explanation: Coarctation of the aorta typically results in a pressure gradient where blood
pressure and pulses are higher in the upper extremities compared to the lower extremities.
The FNP should always palpate femoral pulses simultaneously with brachial or radial
pulses during well-child exams. A machinery murmur is characteristic of Patent Ductus
Arteriosus (PDA), not coarctation.
Families | Actual Q&A with Rationale (NSG548
Exam 2) | Wilkes University
1. A 4-year-old child is brought to the clinic for a well-child visit. Which developmental
milestone is most consistent with this age group?
A. Copying a square and hopping on one foot
B. Tying shoelaces independently
C. Using a spoon and fork correctly without spilling
D. Walking up stairs using alternating feet
Correct Answer: A
Explanation: At age 4, children typically demonstrate the fine motor skill of copying a
square and the gross motor skill of hopping on one foot. While walking up stairs with
alternating feet usually begins around age 3, hopping is a more advanced balance skill
expected by 4 years. The FNP must monitor these milestones to ensure appropriate
neurological and physical development during preschool years.
2. When evaluating a 6-month-old infant for developmental progress, which finding would
require further investigation?
A. Persistent Moro reflex
B. Inability to roll from tummy to back
,C. Failure to sit without support
D. Lack of pincer grasp
Correct Answer: A
Explanation: The Moro reflex, also known as the startle reflex, should typically disappear
by 3 to 4 months of age. A persistent Moro reflex at 6 months may indicate underlying
neurological dysfunction or a delay in central nervous system maturation. Sitting without
support and the pincer grasp are milestones expected slightly later, around 7-9 months,
thus their absence at 6 months is not necessarily pathological.
3. An FNP is assessing an 18-month-old child. Which finding during the physical examination
would be considered an ‘alarm’ sign for Autism Spectrum Disorder (ASD)?
A. Refusal to share toys
B. Inability to speak in two-word sentences
C. Parallel play alongside other children
D. Lack of pointing to show interest
Correct Answer: D
Explanation: Protodeclarative pointing, or pointing to indicate interest in an object, is a
critical social communication milestone that should be present by 14-16 months. The
absence of this joint attention behavior at 18 months is a significant ‘red flag’ for ASD and
requires immediate further screening using tools like the M-CHAT-R. Parallel play is
,developmentally appropriate for this age group, and two-word sentences are expected
closer to 24 months.
4. What is the gold standard for diagnosing a urinary tract infection (UTI) in a non-toilet-
trained infant?
A. Clean catch midstream collection
B. Urine bag collection
C. Leukocyte esterase on a dipstick
D. Suprapubic aspiration or transurethral catheterization
Correct Answer: D
Explanation: For infants who are not toilet trained, the most reliable method to obtain a
sterile specimen is via catheterization or suprapubic aspiration. Urine bags have a high rate
of contamination (up to 50%) and are not recommended for definitive culture-based
diagnosis. Accurate diagnosis is essential in this population to prevent renal scarring and
identify potential structural anomalies like vesicoureteral reflux.
5. A 12-month-old infant is found to have a lead level of 8 mcg/dL. What is the most
appropriate next step for the FNP?
A. Immediately start chelation therapy
B. Perform a confirmatory venous blood lead level
C. Recheck the level in one year
, D. Advise the parents to increase the child’s intake of Vitamin D
Correct Answer: B
Explanation: Current CDC guidelines suggest that any capillary lead screening result above
the reference value (currently 3.5-5 mcg/dL) must be confirmed with a venous blood
sample. Chelation therapy is typically reserved for much higher levels, usually above 45
mcg/dL. The FNP should also investigate potential environmental sources of lead and
ensure adequate iron and calcium intake, as these minerals can reduce lead absorption.
6. Which of the following physical exam findings is a classic sign of coarctation of the aorta in
a pediatric patient?
A. A continuous ‘machinery’ murmur
B. Bounding radial pulses and weak femoral pulses
C. Cyanosis that improves with crying
D. A loud, harsh holosystolic murmur at the left lower sternal border
Correct Answer: B
Explanation: Coarctation of the aorta typically results in a pressure gradient where blood
pressure and pulses are higher in the upper extremities compared to the lower extremities.
The FNP should always palpate femoral pulses simultaneously with brachial or radial
pulses during well-child exams. A machinery murmur is characteristic of Patent Ductus
Arteriosus (PDA), not coarctation.
