NR 602 Midterm Exam: 200 Practice
Questions with Detailed Rationales
NR 602 midterm with 200 pediatric primary care practice questions covering SIDS, growth
and development, immunizations, and common pediatric disorders—each with detailed
answers and rationales.
Section 1: Pediatric Foundations & Roles (Questions 1–50)
1. A nurse practitioner is counseling new parents on infant sleep practices. Which statement by the
parents indicates a correct understanding of SIDS prevention?
A. "We will place the baby on her side to sleep so she doesn't choke."
B. "We will use a soft crib bumper to keep her from hitting the sides."
C. "We will place her on her back for every sleep and keep the crib free of soft objects."
D. "We will let her sleep in our bed so we can monitor her breathing."
Correct: C
Rationale: The American Academy of Pediatrics recommends supine (back) positioning for every sleep
as the single most effective SIDS risk reduction strategy. Side sleeping is unstable and infants may roll
into prone position, which increases SIDS risk. Soft crib bumpers, blankets, and toys increase suffocation
risk. Bed-sharing is associated with a significantly increased risk of SIDS and accidental suffocation;
room-sharing without bed-sharing is recommended for at least the first 6 months of life.
2. Which action by the nurse practitioner represents primary prevention in pediatric practice?
A. Administering a newborn metabolic screening test
B. Providing immunizations to a healthy 2-month-old infant
C. Prescribing an inhaled corticosteroid for a child with asthma
D. Referring a child with scoliosis for physical therapy
Correct: B
Rationale: Primary prevention prevents disease before it occurs. Immunizations administered to a
healthy infant prevent future infectious diseases. Newborn metabolic screening and scoliosis detection
are secondary prevention (early detection of disease). Inhaled corticosteroid therapy for existing asthma
and physical therapy for existing scoliosis are tertiary prevention (limiting complications from
established disease).
,3. A 3-month-old infant is brought to the clinic by his mother, who reports he "sleeps through the
night on his stomach." What is the nurse practitioner's priority action?
A. Reassure the mother that this is normal and no intervention is needed.
B. Educate the mother on the importance of placing the infant supine for all sleep and document the
counseling.
C. Recommend a home apnea monitor to prevent SIDS.
D. Prescribe a sleep sack to replace blankets in the crib.
Correct: B
Rationale: Prone sleeping is the strongest modifiable risk factor for SIDS. The NP must provide
immediate education on supine positioning for all sleep episodes and document the counseling. Home
monitors have not been shown to prevent SIDS. While sleep sacks are safer than loose blankets, the
priority intervention is correcting the sleep position.
4. Which statement about SIDS epidemiology is correct?
A. SIDS is most common in infants younger than 1 month of age.
B. SIDS rates are highest among infants of mothers who smoked during pregnancy.
C. SIDS occurs more frequently in the summer months.
D. SIDS is equally distributed across all racial and ethnic groups.
Correct: B
Rationale: Maternal smoking during pregnancy is a major modifiable risk factor for SIDS. SIDS peaks
between 2 and 4 months of age, not before 1 month. SIDS occurs more frequently in colder months.
Significant disparities exist, with higher rates among African American and Native American infants.
5. The nurse practitioner is teaching a group of new parents about SIDS prevention. Which statement
should be included?
A. "You should place a pacifier in your baby's mouth immediately after birth."
B. "A firm mattress with a fitted sheet is the safest sleep surface."
C. "You should stop using a pacifier once breastfeeding is established."
D. "Sleeping with your baby in the same bed reduces the risk of SIDS."
Correct: B
Rationale: A firm mattress with a fitted sheet is the recommended sleep surface for infants. Pacifier use
should be offered at sleep onset after breastfeeding is well established (usually around 3–4 weeks), not
immediately after birth. Bed-sharing increases SIDS risk.
6. Which of the following is an example of tertiary prevention?
A. Administering the HPV vaccine to an 11-year-old
B. Performing a hearing screening on a newborn
C. Teaching a child with diabetes how to monitor blood glucose levels
D. Educating parents about car seat safety
Correct: C
Rationale: Tertiary prevention focuses on managing existing disease to prevent complications and
,optimize function. Teaching a child with diabetes to monitor glucose is tertiary prevention. HPV
vaccination and car seat education are primary prevention. Hearing screening is secondary prevention.
7. A 4-month-old infant is exclusively breastfed. The mother asks when she should introduce a pacifier
for SIDS prevention. What is the nurse practitioner's best response?
A. "You should introduce the pacifier now, as breastfeeding is established."
B. "Wait until the baby is 6 months old to introduce a pacifier."
C. "Pacifiers should be avoided in breastfed infants."
D. "Offer the pacifier only during the day, not at night."
Correct: A
Rationale: The AAP recommends offering a pacifier at sleep onset once breastfeeding is firmly
established, which typically occurs around 3–4 weeks of age. By 4 months, breastfeeding is established,
so the mother can introduce a pacifier. Pacifier use at sleep has been associated with reduced SIDS risk.
8. Which of the following describes the correct scope of practice for a pediatric nurse practitioner?
A. Performing surgical repair of inguinal hernias
B. Providing well-child care, diagnosing common illnesses, and prescribing medications
C. Independently interpreting all pediatric imaging studies
D. Managing complex congenital heart disease in the ICU setting
Correct: B
Rationale: Pediatric nurse practitioners provide primary care including well-child assessments, diagnosis
and management of common acute and chronic conditions, prescribing medications, and anticipatory
guidance. Surgical procedures, complex ICU management, and independent interpretation of all imaging
studies fall outside the typical PNP scope.
9. A parent asks the nurse practitioner whether using a fan in the infant's room reduces SIDS risk.
What is the most accurate response?
A. "Fans have been proven to eliminate SIDS risk."
B. "Some studies suggest fan use may reduce SIDS risk, but it should not replace other safe sleep
practices."
C. "Fans increase the risk of SIDS by circulating cold air."
D. "Fans should only be used if the infant has a respiratory infection."
Correct: B
Rationale: Some research suggests that fan use in the infant's sleep environment may be associated
with reduced SIDS risk, possibly by improving air circulation and preventing CO₂ pooling. However, fan
use does not replace the core safe sleep recommendations (supine positioning, firm surface, no soft
bedding, room-sharing without bed-sharing).
10. The nurse practitioner is assessing a family's understanding of primary prevention. Which
statement by the parent indicates correct understanding?
A. "We bring our child for annual checkups to catch problems early."
B. "We make sure our child gets all recommended vaccines on time."
, C. "We manage our child's asthma with daily controller medication."
D. "We take our child to physical therapy after his sports injury."
Correct: B
Rationale: Primary prevention prevents disease before it occurs. Vaccinations are a classic example.
Annual checkups for early detection are secondary prevention. Managing existing asthma with
controller medications and physical therapy after injury are tertiary prevention.
11. Which of the following is the strongest risk factor for SIDS?
A. Male sex
B. Prone sleeping
C. Pacifier use
D. Breastfeeding
Correct: B
Rationale: Prone (stomach) sleeping is the strongest modifiable risk factor for SIDS. While male sex is a
non-modifiable risk factor, prone sleeping is the most significant modifiable factor. Pacifier use and
breastfeeding are associated with reduced SIDS risk.
12. A mother of a 2-month-old asks the nurse practitioner about using a blanket in the crib. What is
the best response?
A. "You can use a light blanket as long as you tuck it tightly under the mattress."
B. "Blankets are safe once the baby can roll over."
C. "Use a sleep sack instead of a blanket to keep the baby warm safely."
D. "You should avoid all bedding, including sleep sacks."
Correct: C
Rationale: Sleep sacks are a safe alternative to blankets because they keep the infant warm without the
risk of loose bedding covering the face. Blankets, even when tucked, can become loose and pose a
suffocation risk. Sleep sacks are recommended.
13. The nurse practitioner is evaluating a 6-month-old infant who was born prematurely at 28 weeks'
gestation. Adjusted age should be used for developmental assessment until what age?
A. 6 months corrected age
B. 12 months corrected age
C. 18 months corrected age
D. 24 months corrected age
Correct: D
Rationale: For preterm infants, adjusted age (chronological age minus weeks of prematurity) should be
used for developmental assessment until 24 months of age to avoid over-identifying developmental
delays.
14. Which of the following is an example of secondary prevention?
A. Teaching parents to use a car seat
B. Administering the MMR vaccine
Questions with Detailed Rationales
NR 602 midterm with 200 pediatric primary care practice questions covering SIDS, growth
and development, immunizations, and common pediatric disorders—each with detailed
answers and rationales.
Section 1: Pediatric Foundations & Roles (Questions 1–50)
1. A nurse practitioner is counseling new parents on infant sleep practices. Which statement by the
parents indicates a correct understanding of SIDS prevention?
A. "We will place the baby on her side to sleep so she doesn't choke."
B. "We will use a soft crib bumper to keep her from hitting the sides."
C. "We will place her on her back for every sleep and keep the crib free of soft objects."
D. "We will let her sleep in our bed so we can monitor her breathing."
Correct: C
Rationale: The American Academy of Pediatrics recommends supine (back) positioning for every sleep
as the single most effective SIDS risk reduction strategy. Side sleeping is unstable and infants may roll
into prone position, which increases SIDS risk. Soft crib bumpers, blankets, and toys increase suffocation
risk. Bed-sharing is associated with a significantly increased risk of SIDS and accidental suffocation;
room-sharing without bed-sharing is recommended for at least the first 6 months of life.
2. Which action by the nurse practitioner represents primary prevention in pediatric practice?
A. Administering a newborn metabolic screening test
B. Providing immunizations to a healthy 2-month-old infant
C. Prescribing an inhaled corticosteroid for a child with asthma
D. Referring a child with scoliosis for physical therapy
Correct: B
Rationale: Primary prevention prevents disease before it occurs. Immunizations administered to a
healthy infant prevent future infectious diseases. Newborn metabolic screening and scoliosis detection
are secondary prevention (early detection of disease). Inhaled corticosteroid therapy for existing asthma
and physical therapy for existing scoliosis are tertiary prevention (limiting complications from
established disease).
,3. A 3-month-old infant is brought to the clinic by his mother, who reports he "sleeps through the
night on his stomach." What is the nurse practitioner's priority action?
A. Reassure the mother that this is normal and no intervention is needed.
B. Educate the mother on the importance of placing the infant supine for all sleep and document the
counseling.
C. Recommend a home apnea monitor to prevent SIDS.
D. Prescribe a sleep sack to replace blankets in the crib.
Correct: B
Rationale: Prone sleeping is the strongest modifiable risk factor for SIDS. The NP must provide
immediate education on supine positioning for all sleep episodes and document the counseling. Home
monitors have not been shown to prevent SIDS. While sleep sacks are safer than loose blankets, the
priority intervention is correcting the sleep position.
4. Which statement about SIDS epidemiology is correct?
A. SIDS is most common in infants younger than 1 month of age.
B. SIDS rates are highest among infants of mothers who smoked during pregnancy.
C. SIDS occurs more frequently in the summer months.
D. SIDS is equally distributed across all racial and ethnic groups.
Correct: B
Rationale: Maternal smoking during pregnancy is a major modifiable risk factor for SIDS. SIDS peaks
between 2 and 4 months of age, not before 1 month. SIDS occurs more frequently in colder months.
Significant disparities exist, with higher rates among African American and Native American infants.
5. The nurse practitioner is teaching a group of new parents about SIDS prevention. Which statement
should be included?
A. "You should place a pacifier in your baby's mouth immediately after birth."
B. "A firm mattress with a fitted sheet is the safest sleep surface."
C. "You should stop using a pacifier once breastfeeding is established."
D. "Sleeping with your baby in the same bed reduces the risk of SIDS."
Correct: B
Rationale: A firm mattress with a fitted sheet is the recommended sleep surface for infants. Pacifier use
should be offered at sleep onset after breastfeeding is well established (usually around 3–4 weeks), not
immediately after birth. Bed-sharing increases SIDS risk.
6. Which of the following is an example of tertiary prevention?
A. Administering the HPV vaccine to an 11-year-old
B. Performing a hearing screening on a newborn
C. Teaching a child with diabetes how to monitor blood glucose levels
D. Educating parents about car seat safety
Correct: C
Rationale: Tertiary prevention focuses on managing existing disease to prevent complications and
,optimize function. Teaching a child with diabetes to monitor glucose is tertiary prevention. HPV
vaccination and car seat education are primary prevention. Hearing screening is secondary prevention.
7. A 4-month-old infant is exclusively breastfed. The mother asks when she should introduce a pacifier
for SIDS prevention. What is the nurse practitioner's best response?
A. "You should introduce the pacifier now, as breastfeeding is established."
B. "Wait until the baby is 6 months old to introduce a pacifier."
C. "Pacifiers should be avoided in breastfed infants."
D. "Offer the pacifier only during the day, not at night."
Correct: A
Rationale: The AAP recommends offering a pacifier at sleep onset once breastfeeding is firmly
established, which typically occurs around 3–4 weeks of age. By 4 months, breastfeeding is established,
so the mother can introduce a pacifier. Pacifier use at sleep has been associated with reduced SIDS risk.
8. Which of the following describes the correct scope of practice for a pediatric nurse practitioner?
A. Performing surgical repair of inguinal hernias
B. Providing well-child care, diagnosing common illnesses, and prescribing medications
C. Independently interpreting all pediatric imaging studies
D. Managing complex congenital heart disease in the ICU setting
Correct: B
Rationale: Pediatric nurse practitioners provide primary care including well-child assessments, diagnosis
and management of common acute and chronic conditions, prescribing medications, and anticipatory
guidance. Surgical procedures, complex ICU management, and independent interpretation of all imaging
studies fall outside the typical PNP scope.
9. A parent asks the nurse practitioner whether using a fan in the infant's room reduces SIDS risk.
What is the most accurate response?
A. "Fans have been proven to eliminate SIDS risk."
B. "Some studies suggest fan use may reduce SIDS risk, but it should not replace other safe sleep
practices."
C. "Fans increase the risk of SIDS by circulating cold air."
D. "Fans should only be used if the infant has a respiratory infection."
Correct: B
Rationale: Some research suggests that fan use in the infant's sleep environment may be associated
with reduced SIDS risk, possibly by improving air circulation and preventing CO₂ pooling. However, fan
use does not replace the core safe sleep recommendations (supine positioning, firm surface, no soft
bedding, room-sharing without bed-sharing).
10. The nurse practitioner is assessing a family's understanding of primary prevention. Which
statement by the parent indicates correct understanding?
A. "We bring our child for annual checkups to catch problems early."
B. "We make sure our child gets all recommended vaccines on time."
, C. "We manage our child's asthma with daily controller medication."
D. "We take our child to physical therapy after his sports injury."
Correct: B
Rationale: Primary prevention prevents disease before it occurs. Vaccinations are a classic example.
Annual checkups for early detection are secondary prevention. Managing existing asthma with
controller medications and physical therapy after injury are tertiary prevention.
11. Which of the following is the strongest risk factor for SIDS?
A. Male sex
B. Prone sleeping
C. Pacifier use
D. Breastfeeding
Correct: B
Rationale: Prone (stomach) sleeping is the strongest modifiable risk factor for SIDS. While male sex is a
non-modifiable risk factor, prone sleeping is the most significant modifiable factor. Pacifier use and
breastfeeding are associated with reduced SIDS risk.
12. A mother of a 2-month-old asks the nurse practitioner about using a blanket in the crib. What is
the best response?
A. "You can use a light blanket as long as you tuck it tightly under the mattress."
B. "Blankets are safe once the baby can roll over."
C. "Use a sleep sack instead of a blanket to keep the baby warm safely."
D. "You should avoid all bedding, including sleep sacks."
Correct: C
Rationale: Sleep sacks are a safe alternative to blankets because they keep the infant warm without the
risk of loose bedding covering the face. Blankets, even when tucked, can become loose and pose a
suffocation risk. Sleep sacks are recommended.
13. The nurse practitioner is evaluating a 6-month-old infant who was born prematurely at 28 weeks'
gestation. Adjusted age should be used for developmental assessment until what age?
A. 6 months corrected age
B. 12 months corrected age
C. 18 months corrected age
D. 24 months corrected age
Correct: D
Rationale: For preterm infants, adjusted age (chronological age minus weeks of prematurity) should be
used for developmental assessment until 24 months of age to avoid over-identifying developmental
delays.
14. Which of the following is an example of secondary prevention?
A. Teaching parents to use a car seat
B. Administering the MMR vaccine
