NR 602 Midterm Exam: 200 Additional
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 explaining the three-tier structure of the 2026 CDC childhood immunization
schedule to a group of parents. Which category includes vaccines recommended for all children
regardless of risk factors?
A. Shared clinical decision-making
B. Recommended for certain high-risk groups
C. Recommended for all children
D. Not recommended
Correct: C
Rationale: The 2026 CDC schedule restructured vaccines into three categories. The "Recommended for
All Children" category includes DTaP, Hib, pneumococcal conjugate, polio, MMR, HPV (now 1 dose), and
varicella.
2. Which vaccine was moved to the shared clinical decision-making category in the 2026 CDC
schedule?
A. DTaP
B. Rotavirus
C. MMR
D. Varicella
Correct: B
Rationale: Rotavirus vaccine, along with COVID-19, influenza, hepatitis A, hepatitis B, and
meningococcal vaccines, was moved to the shared clinical decision-making category.
,3. A parent asks the NP about the AAP's position on the 2026 CDC schedule changes. What is the most
accurate response?
A. "The AAP fully endorses all changes without exception."
B. "The AAP and AAFP continue to recommend the full, evidence-based vaccination schedule."
C. "The AAP has not commented on the changes."
D. "The AAP recommends against all vaccines now."
Correct: B
Rationale: The AAP and AAFP continue to recommend the full, evidence-based vaccination schedule,
despite the CDC's restructuring. All vaccines remain covered without out-of-pocket cost by ACA-
regulated private insurance, Medicaid, and the VFC program.
4. Which of the following is an example of primary prevention in pediatric practice?
A. Newborn hearing screening
B. Developmental screening at 18 months
C. Fluoride varnish application
D. Physical therapy for cerebral palsy
Correct: C
Rationale: Fluoride varnish prevents dental caries before they occur, making it primary prevention.
Hearing and developmental screenings are secondary prevention. Physical therapy for cerebral palsy is
tertiary prevention.
5. A 2-month-old infant is brought to the clinic. The parent reports the infant sleeps on the stomach
because "she seems more comfortable." What is the NP's priority action?
A. Reassure the parent that stomach sleeping is acceptable.
B. Educate the parent on supine sleeping for every sleep and document the counseling.
C. Recommend a home apnea monitor.
D. Prescribe a sleep aid.
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.
6. A parent asks whether a fan in the infant's room can prevent SIDS. What is the NP's best response?
A. "Fans have been proven to eliminate SIDS risk."
B. "Some studies suggest fan use may be associated with reduced SIDS risk, but it should not replace
other safe sleep practices."
C. "Fans increase the risk of SIDS."
D. "Fans should only be used if the infant has a respiratory infection."
Correct: B
Rationale: Fan use may improve air circulation and reduce CO₂ pooling, but it is not a substitute for
supine sleeping, a firm surface, and removing soft bedding.
7. Which of the following is a non-modifiable risk factor for SIDS?
,A. Prone sleeping
B. Maternal smoking
C. Male sex
D. Soft bedding
Correct: C
Rationale: Male sex is a non-modifiable risk factor. Prone sleeping, maternal smoking, and soft bedding
are modifiable.
8. A nurse practitioner is counseling a family about safe sleep. Which statement by the parent
indicates correct understanding?
A. "I will put my baby on her side to sleep so she doesn't spit up."
B. "I will use a soft bumper pad to prevent her from hitting the crib sides."
C. "I will place her on her back for every sleep and keep the crib free of soft objects."
D. "I will let her sleep in my bed so I can check on her breathing."
Correct: C
Rationale: Supine positioning for every sleep is the most effective SIDS risk reduction strategy. Soft
bedding and bed-sharing increase risk.
9. Which of the following describes the correct approach when a parent declines a recommended
vaccine?
A. Document the refusal and dismiss the family from the practice
B. Explore the parent's concerns, provide evidence-based information, and document the discussion
C. Administer the vaccine anyway
D. Refer the family to child protective services
Correct: B
Rationale: The NP should use a non-judgmental, empathetic approach to address vaccine hesitancy,
providing evidence-based information while respecting parental autonomy.
10. A 4-month-old infant is brought to the clinic. Which preventive service is indicated at this visit?
A. MMR vaccine
B. DTaP, Hib, IPV, pneumococcal conjugate, and rotavirus vaccines
C. Vision screening
D. Lead level screening
Correct: B
Rationale: At 2, 4, and 6 months, infants receive DTaP, Hib, IPV, pneumococcal conjugate, and rotavirus
vaccines. MMR is given at 12–15 months. Vision and lead screening are not routine at 4 months.
11. Which of the following is included in the scope of practice for a pediatric nurse practitioner?
A. Performing surgery
B. Diagnosing and managing common pediatric conditions
C. Independently interpreting all imaging studies
D. Managing complex congenital heart disease in the ICU
, Correct: B
Rationale: PNPs diagnose and manage common pediatric conditions, provide well-child care, and
prescribe medications. Surgery, complex ICU management, and independent interpretation of all
imaging are outside the primary care PNP scope.
12. A 6-month-old infant is brought to the clinic. The parent reports the infant has been having
episodes of cyanosis and difficulty breathing during feeding. What is the NP's priority action?
A. Reassure the parent that this is normal.
B. Refer the infant immediately for cardiology evaluation.
C. Prescribe an antibiotic.
D. Recommend switching to formula feeding.
Correct: B
Rationale: Cyanosis and feeding difficulty may indicate congenital heart disease and require urgent
cardiology evaluation.
13. Which of the following is an example of secondary prevention?
A. Administering the HPV vaccine
B. Performing a developmental screening at 18 months
C. Teaching a child with asthma how to use an inhaler
D. Providing car seat education
Correct: B
Rationale: Developmental screening detects delays early, before symptoms become severe. Vaccination
and car seat education are primary prevention. Inhaler teaching is tertiary prevention.
14. A 3-year-old child is brought to the clinic. The parent reports the child has been having frequent
tantrums. What is the NP's best response?
A. "This is abnormal and requires psychiatric evaluation."
B. "Tantrums are a normal part of development at this age as the child seeks autonomy."
C. "You should discipline the child more strictly."
D. "This indicates the child has oppositional defiant disorder."
Correct: B
Rationale: Tantrums are developmentally normal in toddlers and preschoolers as they assert
independence (Erikson's autonomy vs. shame and doubt, initiative vs. guilt).
15. Which statement about SIDS is correct?
A. SIDS is most common in infants older than 12 months.
B. SIDS rates have increased significantly in recent years.
C. SIDS is the leading cause of death in infants aged 1 month to 1 year.
D. SIDS is entirely preventable.
Correct: C
Rationale: SIDS is the leading cause of death in infants aged 1 month to 1 year. It peaks at 2–4 months.
Rates have declined since the Back to Sleep campaign, but racial disparities persist.
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 explaining the three-tier structure of the 2026 CDC childhood immunization
schedule to a group of parents. Which category includes vaccines recommended for all children
regardless of risk factors?
A. Shared clinical decision-making
B. Recommended for certain high-risk groups
C. Recommended for all children
D. Not recommended
Correct: C
Rationale: The 2026 CDC schedule restructured vaccines into three categories. The "Recommended for
All Children" category includes DTaP, Hib, pneumococcal conjugate, polio, MMR, HPV (now 1 dose), and
varicella.
2. Which vaccine was moved to the shared clinical decision-making category in the 2026 CDC
schedule?
A. DTaP
B. Rotavirus
C. MMR
D. Varicella
Correct: B
Rationale: Rotavirus vaccine, along with COVID-19, influenza, hepatitis A, hepatitis B, and
meningococcal vaccines, was moved to the shared clinical decision-making category.
,3. A parent asks the NP about the AAP's position on the 2026 CDC schedule changes. What is the most
accurate response?
A. "The AAP fully endorses all changes without exception."
B. "The AAP and AAFP continue to recommend the full, evidence-based vaccination schedule."
C. "The AAP has not commented on the changes."
D. "The AAP recommends against all vaccines now."
Correct: B
Rationale: The AAP and AAFP continue to recommend the full, evidence-based vaccination schedule,
despite the CDC's restructuring. All vaccines remain covered without out-of-pocket cost by ACA-
regulated private insurance, Medicaid, and the VFC program.
4. Which of the following is an example of primary prevention in pediatric practice?
A. Newborn hearing screening
B. Developmental screening at 18 months
C. Fluoride varnish application
D. Physical therapy for cerebral palsy
Correct: C
Rationale: Fluoride varnish prevents dental caries before they occur, making it primary prevention.
Hearing and developmental screenings are secondary prevention. Physical therapy for cerebral palsy is
tertiary prevention.
5. A 2-month-old infant is brought to the clinic. The parent reports the infant sleeps on the stomach
because "she seems more comfortable." What is the NP's priority action?
A. Reassure the parent that stomach sleeping is acceptable.
B. Educate the parent on supine sleeping for every sleep and document the counseling.
C. Recommend a home apnea monitor.
D. Prescribe a sleep aid.
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.
6. A parent asks whether a fan in the infant's room can prevent SIDS. What is the NP's best response?
A. "Fans have been proven to eliminate SIDS risk."
B. "Some studies suggest fan use may be associated with reduced SIDS risk, but it should not replace
other safe sleep practices."
C. "Fans increase the risk of SIDS."
D. "Fans should only be used if the infant has a respiratory infection."
Correct: B
Rationale: Fan use may improve air circulation and reduce CO₂ pooling, but it is not a substitute for
supine sleeping, a firm surface, and removing soft bedding.
7. Which of the following is a non-modifiable risk factor for SIDS?
,A. Prone sleeping
B. Maternal smoking
C. Male sex
D. Soft bedding
Correct: C
Rationale: Male sex is a non-modifiable risk factor. Prone sleeping, maternal smoking, and soft bedding
are modifiable.
8. A nurse practitioner is counseling a family about safe sleep. Which statement by the parent
indicates correct understanding?
A. "I will put my baby on her side to sleep so she doesn't spit up."
B. "I will use a soft bumper pad to prevent her from hitting the crib sides."
C. "I will place her on her back for every sleep and keep the crib free of soft objects."
D. "I will let her sleep in my bed so I can check on her breathing."
Correct: C
Rationale: Supine positioning for every sleep is the most effective SIDS risk reduction strategy. Soft
bedding and bed-sharing increase risk.
9. Which of the following describes the correct approach when a parent declines a recommended
vaccine?
A. Document the refusal and dismiss the family from the practice
B. Explore the parent's concerns, provide evidence-based information, and document the discussion
C. Administer the vaccine anyway
D. Refer the family to child protective services
Correct: B
Rationale: The NP should use a non-judgmental, empathetic approach to address vaccine hesitancy,
providing evidence-based information while respecting parental autonomy.
10. A 4-month-old infant is brought to the clinic. Which preventive service is indicated at this visit?
A. MMR vaccine
B. DTaP, Hib, IPV, pneumococcal conjugate, and rotavirus vaccines
C. Vision screening
D. Lead level screening
Correct: B
Rationale: At 2, 4, and 6 months, infants receive DTaP, Hib, IPV, pneumococcal conjugate, and rotavirus
vaccines. MMR is given at 12–15 months. Vision and lead screening are not routine at 4 months.
11. Which of the following is included in the scope of practice for a pediatric nurse practitioner?
A. Performing surgery
B. Diagnosing and managing common pediatric conditions
C. Independently interpreting all imaging studies
D. Managing complex congenital heart disease in the ICU
, Correct: B
Rationale: PNPs diagnose and manage common pediatric conditions, provide well-child care, and
prescribe medications. Surgery, complex ICU management, and independent interpretation of all
imaging are outside the primary care PNP scope.
12. A 6-month-old infant is brought to the clinic. The parent reports the infant has been having
episodes of cyanosis and difficulty breathing during feeding. What is the NP's priority action?
A. Reassure the parent that this is normal.
B. Refer the infant immediately for cardiology evaluation.
C. Prescribe an antibiotic.
D. Recommend switching to formula feeding.
Correct: B
Rationale: Cyanosis and feeding difficulty may indicate congenital heart disease and require urgent
cardiology evaluation.
13. Which of the following is an example of secondary prevention?
A. Administering the HPV vaccine
B. Performing a developmental screening at 18 months
C. Teaching a child with asthma how to use an inhaler
D. Providing car seat education
Correct: B
Rationale: Developmental screening detects delays early, before symptoms become severe. Vaccination
and car seat education are primary prevention. Inhaler teaching is tertiary prevention.
14. A 3-year-old child is brought to the clinic. The parent reports the child has been having frequent
tantrums. What is the NP's best response?
A. "This is abnormal and requires psychiatric evaluation."
B. "Tantrums are a normal part of development at this age as the child seeks autonomy."
C. "You should discipline the child more strictly."
D. "This indicates the child has oppositional defiant disorder."
Correct: B
Rationale: Tantrums are developmentally normal in toddlers and preschoolers as they assert
independence (Erikson's autonomy vs. shame and doubt, initiative vs. guilt).
15. Which statement about SIDS is correct?
A. SIDS is most common in infants older than 12 months.
B. SIDS rates have increased significantly in recent years.
C. SIDS is the leading cause of death in infants aged 1 month to 1 year.
D. SIDS is entirely preventable.
Correct: C
Rationale: SIDS is the leading cause of death in infants aged 1 month to 1 year. It peaks at 2–4 months.
Rates have declined since the Back to Sleep campaign, but racial disparities persist.
