NUR 682 ADVANCED PEDIATRIC
PRIMARY CARE
COMPREHENSIVE EXAM Q AND
A WITH DETAILED RATIONALES
ULTIMATE PEDIATRIC NURSE
PRACTITIONER
NUR 682: Advanced Pediatric Primary Care Exam
Questions
Question 1
A 14-month-old male is brought to the clinic for a well-child visit.
The nurse practitioner notes that the child is able to walk
independently, stack two blocks, and says "mama" and "dada"
specifically. However, he does not point to objects to show interest
or respond when his name is called unless there is a loud noise.
Which of the following is the most appropriate next step in
management?
A. Reassure the parents that this is a normal developmental
variation and re-evaluate at 18 months.
B. Administer the Modified Checklist for Autism in Toddlers (M-
CHAT-R/F) and refer for a formal audiologic evaluation.
C. Refer the child immediately to a pediatric neurologist for
suspected metabolic encephalopathy.
D. Order an urgent brain MRI to rule out a structural posterior
fossa lesion.
,CORRECT ANSWER: B
RATiONAlE: The child demonstrates red flags for both social-
communication deficits (not pointing to share interest, failing to
respond to name) and potential hearing impairment. In
advanced pediatric primary care, anytime a social-
communication delay is suspected, autism screening (such as the
M-CHAT-R/F, which is formally indicated at 18 and 24 months
but can be used if symptomatic earlier) should be performed
alongside a formal audiology referral to rule out sensorineural
or conductive hearing loss before assigning a developmental
diagnosis.
Question 2
A 4-week-old infant presents with a history of non-bilious,
projectile vomiting after every feeding for the past 4 days. The
infant appears hungry and eagerly accepts the bottle immediately
after vomiting. On physical examination, the infant appears
mildly dehydrated, and a small, olive-shaped mass is palpable in
the right upper quadrant. Which of the following metabolic
profiles is most characteristic of this condition?
A. Hypokalemic, hypochloratemic, metabolic alkalosis
B. Hyperkalemic, hyperchloratemic, metabolic acidosis
C. Normal electrolytes with a respiratory acidosis
D. Hyponatremic, hyperkalemic, metabolic acidosis
CORRECT ANSWER: A
RATiONAlE: The clinical presentation is classic for
hypertrophic pyloric stenosis (HPS). Persistent vomiting of
gastric contents results in the loss of hydrogen ions (hydrochloric
,acid) and potassium. The kidneys attempt to conserve hydrogen
ions at the expense of excreting potassium and retaining
bicarbonate, culminating in a classic contraction hypokalemic,
hypochloratemic metabolic alkalosis.
Question 3
A 6-year-old female presents with a 5-day history of high fever (up
to 104°F), bilateral non-purulent conjunctivitis, a polymorphous
rash over her trunk, and marked erythema and edema of her
hands and feet. The nurse practitioner notes prominent cervical
lymphadenopathy (1.8 cm) on the left side. What is the most
critical initial diagnostic or therapeutic intervention?
A. Initiate a 10-day course of high-dose oral Amoxicillin for
cervical lymphadenitis.
B. Order a broad viral PCR panel and obtain blood cultures while
withholding treatment.
C. Administer Intravenous Immunoglobulin (IVIG) and high-dose
Aspirin to prevent coronary artery aneurysms.
D. Perform an urgent lumbar puncture to rule out bacterial
meningitis.
CORRECT ANSWER: C
RATiONAlE: This child meets the diagnostic criteria for
classic Kawasaki Disease (fever for \(\ge \) 5 days plus at least 4
out of 5 principal clinical features: conjunctivitis, oral mucosal
changes, extremity changes, rash, and cervical
lymphadenopathy). The mainstay of therapy is IVIG and high-
dose aspirin, which must be initiated within the first 10 days of
fever onset to drastically reduce the risk of developing coronary
artery aneurysms.
, Question 4
A 3-year-old male is brought to the urgent care clinic during late
October presenting with a harsh, barking cough, inspiratory
stridor at rest, and mild intercostal retractions. He has had a mild
upper respiratory infection for the past 2 days. His oxygen
saturation is 94% on room air. According to the Westley Croup
Score, this represents moderate croup. What is the evidence-
based management strategy for this patient?
A. Administer nebulized albuterol and discharge home with oral
antibiotics.
B. Administer a single dose of oral or intramuscular
Dexamethasone and nebulized racemic epinephrine, followed by
an observation period.
C. Initiate home humidified mist therapy and schedule a follow-
up phone call in 48 hours.
D. Admit immediately to the pediatric intensive care unit for
endotracheal intubation.
CORRECT ANSWER: B
RATiONAlE: For moderate to severe croup characterized by
stridor at rest and respiratory distress, the standard of care
involves corticosteroids (Dexamethasone 0.6 mg/kg) to reduce
laryngeal mucosal edema and nebulized racemic epinephrine for
rapid, transient vasoconstriction of the subglottic airway.
Patients receiving epinephrine must be observed for at least 2 to
4 hours to ensure they do not experience a "rebound" worsening
of symptoms before safe discharge.
Question 5
PRIMARY CARE
COMPREHENSIVE EXAM Q AND
A WITH DETAILED RATIONALES
ULTIMATE PEDIATRIC NURSE
PRACTITIONER
NUR 682: Advanced Pediatric Primary Care Exam
Questions
Question 1
A 14-month-old male is brought to the clinic for a well-child visit.
The nurse practitioner notes that the child is able to walk
independently, stack two blocks, and says "mama" and "dada"
specifically. However, he does not point to objects to show interest
or respond when his name is called unless there is a loud noise.
Which of the following is the most appropriate next step in
management?
A. Reassure the parents that this is a normal developmental
variation and re-evaluate at 18 months.
B. Administer the Modified Checklist for Autism in Toddlers (M-
CHAT-R/F) and refer for a formal audiologic evaluation.
C. Refer the child immediately to a pediatric neurologist for
suspected metabolic encephalopathy.
D. Order an urgent brain MRI to rule out a structural posterior
fossa lesion.
,CORRECT ANSWER: B
RATiONAlE: The child demonstrates red flags for both social-
communication deficits (not pointing to share interest, failing to
respond to name) and potential hearing impairment. In
advanced pediatric primary care, anytime a social-
communication delay is suspected, autism screening (such as the
M-CHAT-R/F, which is formally indicated at 18 and 24 months
but can be used if symptomatic earlier) should be performed
alongside a formal audiology referral to rule out sensorineural
or conductive hearing loss before assigning a developmental
diagnosis.
Question 2
A 4-week-old infant presents with a history of non-bilious,
projectile vomiting after every feeding for the past 4 days. The
infant appears hungry and eagerly accepts the bottle immediately
after vomiting. On physical examination, the infant appears
mildly dehydrated, and a small, olive-shaped mass is palpable in
the right upper quadrant. Which of the following metabolic
profiles is most characteristic of this condition?
A. Hypokalemic, hypochloratemic, metabolic alkalosis
B. Hyperkalemic, hyperchloratemic, metabolic acidosis
C. Normal electrolytes with a respiratory acidosis
D. Hyponatremic, hyperkalemic, metabolic acidosis
CORRECT ANSWER: A
RATiONAlE: The clinical presentation is classic for
hypertrophic pyloric stenosis (HPS). Persistent vomiting of
gastric contents results in the loss of hydrogen ions (hydrochloric
,acid) and potassium. The kidneys attempt to conserve hydrogen
ions at the expense of excreting potassium and retaining
bicarbonate, culminating in a classic contraction hypokalemic,
hypochloratemic metabolic alkalosis.
Question 3
A 6-year-old female presents with a 5-day history of high fever (up
to 104°F), bilateral non-purulent conjunctivitis, a polymorphous
rash over her trunk, and marked erythema and edema of her
hands and feet. The nurse practitioner notes prominent cervical
lymphadenopathy (1.8 cm) on the left side. What is the most
critical initial diagnostic or therapeutic intervention?
A. Initiate a 10-day course of high-dose oral Amoxicillin for
cervical lymphadenitis.
B. Order a broad viral PCR panel and obtain blood cultures while
withholding treatment.
C. Administer Intravenous Immunoglobulin (IVIG) and high-dose
Aspirin to prevent coronary artery aneurysms.
D. Perform an urgent lumbar puncture to rule out bacterial
meningitis.
CORRECT ANSWER: C
RATiONAlE: This child meets the diagnostic criteria for
classic Kawasaki Disease (fever for \(\ge \) 5 days plus at least 4
out of 5 principal clinical features: conjunctivitis, oral mucosal
changes, extremity changes, rash, and cervical
lymphadenopathy). The mainstay of therapy is IVIG and high-
dose aspirin, which must be initiated within the first 10 days of
fever onset to drastically reduce the risk of developing coronary
artery aneurysms.
, Question 4
A 3-year-old male is brought to the urgent care clinic during late
October presenting with a harsh, barking cough, inspiratory
stridor at rest, and mild intercostal retractions. He has had a mild
upper respiratory infection for the past 2 days. His oxygen
saturation is 94% on room air. According to the Westley Croup
Score, this represents moderate croup. What is the evidence-
based management strategy for this patient?
A. Administer nebulized albuterol and discharge home with oral
antibiotics.
B. Administer a single dose of oral or intramuscular
Dexamethasone and nebulized racemic epinephrine, followed by
an observation period.
C. Initiate home humidified mist therapy and schedule a follow-
up phone call in 48 hours.
D. Admit immediately to the pediatric intensive care unit for
endotracheal intubation.
CORRECT ANSWER: B
RATiONAlE: For moderate to severe croup characterized by
stridor at rest and respiratory distress, the standard of care
involves corticosteroids (Dexamethasone 0.6 mg/kg) to reduce
laryngeal mucosal edema and nebulized racemic epinephrine for
rapid, transient vasoconstriction of the subglottic airway.
Patients receiving epinephrine must be observed for at least 2 to
4 hours to ensure they do not experience a "rebound" worsening
of symptoms before safe discharge.
Question 5
