Pediatric FNP Fitzgerald Study Guide
Exam Questions All Solved.
1. Which of the following is appropriate advice to give to a mother who is breastfeeding her 10-
day-old infant? A. "Your milk will come in today." B. "To minimize breast tenderness, the baby
should not be kept on either breast for more than 5 to 10 minutes."
C. "A clicking sound made by the baby during feedings signifies a good latch and suck." D. "The
baby's urine should be light or colorless." - Answer 1. Correct: D. "The baby's urine should be
light or colorless." Urine that is light and colorless is a good indication that the baby is well
hydrated and feeding sufficiently (D). Incorrect: The transition from colostrum to mature milk
typically occurs between days 2 to 5 after childbirth and not 10 days after birth (A). Proper
breastfeeding of the newborn should have a minimum of 10 minutes on each breast every 1.5
to 3 hours (B). A clicking sound made during nursing would indicate an improper latch (C).
2. Which of the following is appropriate advice to give to a mother who is breastfeeding her 12-
hour-old infant? A. "You will likely have enough milk to feed the baby within a few hours of
birth." B. "The baby might need to be awakened to be fed." C. "Supplemental feeding is needed
unless the baby has at least four wet diapers in the first day of life." D. "The baby will likely have
a seedy, yellow bowel movement today." - Answer 2. Correct: B. "The baby might need to be
awakened to be fed." A newborn who is breastfed should feed every 1.5 to 3 hours (about 8 to
12 times per day), which may require waking the baby to ensure adequate feeding (B).
Incorrect: The transition from colostrum to mature milk typically occurs between days 2 and 5
after childbirth (A). However, supplemental feeding with formula or dextrose and water should
be avoided as this will interfere with the baby's hunger drive to breastfeed and can delay or
reduce production of breast milk (C). The first bowel movements of the newborn consist of
meconium, which is a thick, black or dark green substance that eventually transitions to a
yellow-green stool (D).
3. Compared with the use of infant formula, advantages for the breastfed baby include all of the
following except: A. lower incidence of diarrheal illness. B. greater weight gain in the first few
weeks of life. C. reduced risk of allergic disorders. D. lower occurrence of constipation. - Answer
3. Correct: B. greater weight gain in the first few weeks of life. Newborns that are formula-fed
typically have greater weight gain during the first few weeks of life when compared to breastfed
babies (B). However, the overall benefits of breastfeeding far outweigh this small difference in
weight gain, and this likely represents excessive weight gain. Incorrect: Breastfeeding offers
several benefits to the newborn as it provides the ideal form of nutrition and transfers the
mother's antibodies to the infant to help prevent disease. Breastfed infants have been shown to
have a lower incidence of diarrheal illness (A), a lower risk of allergic disorders (C), and a lower
occurrence of constipation (D).
4. At 3 weeks of age, the average-weight, formula-fed infant should be expected to take: A. 2 to
,hours. Incorrect: A newborn infant that is formula-fed should be fed approximately every 2 to 3
hours (B, D) and would expect to take 2 to 3 oz at each feeding (C).
5. In infants, solid foods are best introduced no earlier than: A. 1 to 3 months. B. 3 to 5 months.
C. 4 to 6 months. D. 6 to 8 months. - Answer 5. Correct: C. 4 to 6 months. Solid foods should
not be introduced to infants earlier than 4 to 6 months of age (C). The infant should have at
least doubled the birth weight and consume at least 32 oz of formula per day or more than 8 to
10 feedings (breast or bottle) per day. Other signs would include being able to sit upright with
little support, having good head control, and opening the mouth and leaning forward when
food is offered. Incorrect: The introduction of solid foods should wait until at least 4 to 6 months
of age (A, B) as certain developmental milestones are needed to be reached. Waiting up to 6 to
8 months is not needed for most infants (D).
6. Nursing infants generally maximally receive about which percentage of the maternal dose of
a drug? A. 1% B. 3% C. 5% D. 10% - Answer 6. Correct: A. 1% When a nursing mother takes a
medication, the nursing infant typically receives 1% or less of the maternal dose of medication
from breast milk (A). Generally, if a medication is safe to give to a child, then it is safe to
prescribe to a nursing mother. Only a few drugs are contraindicated in nursing mothers.
Incorrect: Only 1% or less of a medication taken by a nursing mother will pass to the infant
while nursing (B, C, D).
7. Most drugs pass into breast milk through: A. active transport. B. facilitated transfer. C. simple
diffusion. D. creation of a pH gradient. - Answer 7. Correct: C. simple diffusion. Most drugs
pass into breast milk through simple diffusion, moving from areas of high concentration to low
concentration (C). For this reason, the pump-and-dump approach is not effective in removing a
medication from breast milk, as it creates an area of low concentration in the empty breast.
Incorrect: Active transport requires the expenditure of energy to move substances or
medications across membranes. Facilitated transfer utilizes transmembrane proteins to move
compounds across cell membranes. Neither of these mechanisms is generally used in the
movement of medication from mother's serum to breast milk (A, B). Similarly, a pH gradient is
not created to facilitate movement of medications to breast milk (D).
8. To remove a drug from breast milk through "pump and dump," the nursing mother should
refrain from taking the offending medication and the process must be continued for: A. two
infant feeding cycles. B. approximately 8 hours. C. three to five drug-free half-lives of the
medication. D. a period of time that is highly unpredictable. - Answer 8. Correct: C. three to
five drug-free half-lives of the medication. The pump-and-dump approach is not effective in
removing a medication from breast milk as it creates an area of low concentration in the empty
breast. The drug will then move from the area of high concentration (i.e., mother's serum) to
the breast. To ensure a minimal amount of offending medication is present in breast milk, the
mother should wait at least three to five drug-free half-lives of the medication before nursing
the baby (C). Incorrect: The time required to ensure a minimal amount of drug is present in
,9. When counseling a breastfeeding woman about alcohol use during lactation, you relate that:
A. drinking a glass of wine or beer will enhance the let-down reflex. B. because of its high
molecular weight, relatively little alcohol is passed into breast milk. C. maternal alcohol use
causes a reduction in the amount of milk ingested by the infant. D. infant intoxication can be
seen with the mother having as few as one to two alcoholic drinks. - Answer 9. Correct: C.
maternal alcohol use causes a reduction in the amount of milk ingested by the infant. Small
amounts of alcohol ingestion by a nursing mother can cause a reduction in the let-down reflex,
decreased milk production, and less rhythmic and frequent sucking by the infant, resulting in a
smaller volume of milk consumption (C). Incorrect: Alcohol has a low molecular weight that
easily passes to breast milk (B). Alcohol consumption can reduce the letdown reflex and result in
decreased milk production (A). One or two alcoholic drinks may not lead to infant intoxication
as less than 1% of the alcohol will pass to breast milk. However, even small amounts of alcohol
consumption can decrease the amount of milk consumption by the nursing infant (D).
10. The anticipated average daily weight gain during the first 3 months of life is approximately:
A. 15 g or 0.53 oz. B. 20 g or 0.7 oz. C. 25 g or 0.88 oz. D. 30 g or 1 oz. - Answer 10. Correct: D.
30 g or 1 oz. During the first 3 months of life, the average daily weight gain is approximately 26
to 31 g (D). The anticipated daily weight gain will then decrease to 17 to 18 g during months 3 to
6, and 12 to 13 g daily during months 6 to 9. Incorrect: In a newborn up to 3 months of age, the
average daily weight gain should exceed 25 g and range near 30 g (A, B, C).
11. The average required caloric intake in an infant from age 0 to 3 months is usually: A. 40 to 60
kcal/kg/day. B. 60 to 80 kcal/kg/day. C. 80 to 100 kcal/kg/day. D. 100 to 120 kcal/kg/day. -
Answer 11. Correct: D. 100 to 120 kcal/kg/day. The required caloric intake for an infant
between 0 and 3 months of age is approximately 100 to 120 kcal/kg/day (D). This amount does
not change substantially as the child grows, with a requirement of 105 to 115 kcal/kg/ day for
those 3 to 6 months of age and 100 to 105 kcal/ kg/day for those 6 to 9 months of age.
Incorrect: During the first 3 months of life, the average required caloric intake ranges from 100
to 120 kcal/kg/day (A, B, C).
12. Regarding physiological jaundice in the newborn, select all that are correct: A. It occurs
between the first 12 and 24 hours of life. B. It progresses from the abdomen toward the head of
the infant. C. Unconjugated bilirubin is elevated. D. Risk of development of hyperbilirubinemia
can be reduced in a breastfed infant with frequent breastfeeding every 2 to 3 hours per 24
hours. E. It can be avoided by supplemental water and dextrose feedings between breastfeeding
in the first 3 to 4 days of life to increase infant hydration while awaiting mother's milk to come
in. - Answer 12. Correct: C. Unconjugated bilirubin is elevated, and D. Risk of development of
hyperbilirubinemia can be reduced in a breastfed infant with frequent breastfeeding every 2 to
3 hours per 24 hours. Physiological jaundice occurs as a result of elevated levels of
unconjugated bilirubin (C). The condition can be prevented by keeping the newborn well
hydrated by breastfeeding at least 8 to 12 times per day, or every 2 to 3 hours (D). Incorrect:
Physiological jaundice typically occurs between days 3 to 5 (A) and usually starts at the head
and then spreads to the body (B). Supplemental water and dextrose should be avoided as this
, 13. The most likely consequence of inadequate feeding during the first few weeks of a newborn
is: A. hypercalcemia. B. hypernatremia. C. hypokalemia. D. hyperkalemia - Answer 13. Correct:
B. hypernatremia. Consequences of inadequate feeding during the first few weeks of life can
lead to dehydration, hypernatremia (B),
and hypoglycemia. Hypoglycemia is often characterized by a protracted high-pitched cry,
jitteriness, and potential seizures. Incorrect: Inadequate feeding of a newborn is not typically
associated with hypercalcemia (A), while hypernatremia is more likely than hypokalemia (C) or
hyperkalemia (D).
14. Which of the following would be a concern regarding weight change in a newborn? A.
weight loss of 2% by day 2 of life B. no weight gain after 3 days of life C. weight gain of less than
3% after 1 week of life D. weight loss of greater than 7% at any time after the first week of life -
Answer 14. Correct: D. weight loss of greater than 7% at any time after the first week of life A
key criterion to assess for adequate feeding is slow growth or weight loss during the first few
weeks of life. A weight loss of greater than 7% at any time, particularly after the first week of
life, is particularly concerning as it increases the likelihood of neonatal jaundice and
hypernatremia (D). Incorrect: Weight loss of greater than 7% at any time in a newborn is a
major concern. Some weight loss can be expected during the first few days of life (A, B) before
the newborn begins to gain weight (C).
15. A mother who has been breastfeeding her newborn is planning on returning to work and
asks about the use of breast pumps. The nurse practitioner (NP) counsels on all of the following
except: A. Some insurance companies will cover the costs of breast pumps. B. Breast pumps can
allow flexibility in allowing mothers to return to work or school. C. Double pumps are not
recommended as they express about half the amount of milk as single pumps. D. Federal law
requires the employer to provide adequate breaks and a location for breast pumping. - Answer
15. Correct: C. Double pumps are not recommended as they express about half the amount of
milk as single pumps. Breast pumps can provide breastfeeding mothers with flexibility with
feedings. Double pumps are particularly helpful as they reduce the time needed to pump by
one-half by expressing milk from both breasts at the same time. These pumps do not differ in
the amount of milk expressed compared to single pumps (C). Incorrect: Breast pumps can be
helpful in allowing nursing mothers to return to work or school (B). Some insurance companies
as well as state Medicaid will cover the costs of breast pumps (A). The FLSA requires employers
to provide a reasonable amount of break time to express milk as well as a functional space in
which to pump milk (D).
16 to 19. Indicate (yes or no) whether each of the following is expected with a good latch by a
newborn. 16. Areola easily visible 17. Dimpling of the baby's cheeks 18. Clicking noise made by
baby 19. Baby's mouth is widely open with lips flanged outward - Answer 16 to 19. Yes or No
16. Correct: No 17. Correct: No 18. Correct: No 19. Correct: Yes A correct latch is critical for
proper breastfeeding of the newborn. With adequate latch, the baby's chin and stomach should
be able to comfortably rest against the mother's body, the baby's mouth is widely open, with
Exam Questions All Solved.
1. Which of the following is appropriate advice to give to a mother who is breastfeeding her 10-
day-old infant? A. "Your milk will come in today." B. "To minimize breast tenderness, the baby
should not be kept on either breast for more than 5 to 10 minutes."
C. "A clicking sound made by the baby during feedings signifies a good latch and suck." D. "The
baby's urine should be light or colorless." - Answer 1. Correct: D. "The baby's urine should be
light or colorless." Urine that is light and colorless is a good indication that the baby is well
hydrated and feeding sufficiently (D). Incorrect: The transition from colostrum to mature milk
typically occurs between days 2 to 5 after childbirth and not 10 days after birth (A). Proper
breastfeeding of the newborn should have a minimum of 10 minutes on each breast every 1.5
to 3 hours (B). A clicking sound made during nursing would indicate an improper latch (C).
2. Which of the following is appropriate advice to give to a mother who is breastfeeding her 12-
hour-old infant? A. "You will likely have enough milk to feed the baby within a few hours of
birth." B. "The baby might need to be awakened to be fed." C. "Supplemental feeding is needed
unless the baby has at least four wet diapers in the first day of life." D. "The baby will likely have
a seedy, yellow bowel movement today." - Answer 2. Correct: B. "The baby might need to be
awakened to be fed." A newborn who is breastfed should feed every 1.5 to 3 hours (about 8 to
12 times per day), which may require waking the baby to ensure adequate feeding (B).
Incorrect: The transition from colostrum to mature milk typically occurs between days 2 and 5
after childbirth (A). However, supplemental feeding with formula or dextrose and water should
be avoided as this will interfere with the baby's hunger drive to breastfeed and can delay or
reduce production of breast milk (C). The first bowel movements of the newborn consist of
meconium, which is a thick, black or dark green substance that eventually transitions to a
yellow-green stool (D).
3. Compared with the use of infant formula, advantages for the breastfed baby include all of the
following except: A. lower incidence of diarrheal illness. B. greater weight gain in the first few
weeks of life. C. reduced risk of allergic disorders. D. lower occurrence of constipation. - Answer
3. Correct: B. greater weight gain in the first few weeks of life. Newborns that are formula-fed
typically have greater weight gain during the first few weeks of life when compared to breastfed
babies (B). However, the overall benefits of breastfeeding far outweigh this small difference in
weight gain, and this likely represents excessive weight gain. Incorrect: Breastfeeding offers
several benefits to the newborn as it provides the ideal form of nutrition and transfers the
mother's antibodies to the infant to help prevent disease. Breastfed infants have been shown to
have a lower incidence of diarrheal illness (A), a lower risk of allergic disorders (C), and a lower
occurrence of constipation (D).
4. At 3 weeks of age, the average-weight, formula-fed infant should be expected to take: A. 2 to
,hours. Incorrect: A newborn infant that is formula-fed should be fed approximately every 2 to 3
hours (B, D) and would expect to take 2 to 3 oz at each feeding (C).
5. In infants, solid foods are best introduced no earlier than: A. 1 to 3 months. B. 3 to 5 months.
C. 4 to 6 months. D. 6 to 8 months. - Answer 5. Correct: C. 4 to 6 months. Solid foods should
not be introduced to infants earlier than 4 to 6 months of age (C). The infant should have at
least doubled the birth weight and consume at least 32 oz of formula per day or more than 8 to
10 feedings (breast or bottle) per day. Other signs would include being able to sit upright with
little support, having good head control, and opening the mouth and leaning forward when
food is offered. Incorrect: The introduction of solid foods should wait until at least 4 to 6 months
of age (A, B) as certain developmental milestones are needed to be reached. Waiting up to 6 to
8 months is not needed for most infants (D).
6. Nursing infants generally maximally receive about which percentage of the maternal dose of
a drug? A. 1% B. 3% C. 5% D. 10% - Answer 6. Correct: A. 1% When a nursing mother takes a
medication, the nursing infant typically receives 1% or less of the maternal dose of medication
from breast milk (A). Generally, if a medication is safe to give to a child, then it is safe to
prescribe to a nursing mother. Only a few drugs are contraindicated in nursing mothers.
Incorrect: Only 1% or less of a medication taken by a nursing mother will pass to the infant
while nursing (B, C, D).
7. Most drugs pass into breast milk through: A. active transport. B. facilitated transfer. C. simple
diffusion. D. creation of a pH gradient. - Answer 7. Correct: C. simple diffusion. Most drugs
pass into breast milk through simple diffusion, moving from areas of high concentration to low
concentration (C). For this reason, the pump-and-dump approach is not effective in removing a
medication from breast milk, as it creates an area of low concentration in the empty breast.
Incorrect: Active transport requires the expenditure of energy to move substances or
medications across membranes. Facilitated transfer utilizes transmembrane proteins to move
compounds across cell membranes. Neither of these mechanisms is generally used in the
movement of medication from mother's serum to breast milk (A, B). Similarly, a pH gradient is
not created to facilitate movement of medications to breast milk (D).
8. To remove a drug from breast milk through "pump and dump," the nursing mother should
refrain from taking the offending medication and the process must be continued for: A. two
infant feeding cycles. B. approximately 8 hours. C. three to five drug-free half-lives of the
medication. D. a period of time that is highly unpredictable. - Answer 8. Correct: C. three to
five drug-free half-lives of the medication. The pump-and-dump approach is not effective in
removing a medication from breast milk as it creates an area of low concentration in the empty
breast. The drug will then move from the area of high concentration (i.e., mother's serum) to
the breast. To ensure a minimal amount of offending medication is present in breast milk, the
mother should wait at least three to five drug-free half-lives of the medication before nursing
the baby (C). Incorrect: The time required to ensure a minimal amount of drug is present in
,9. When counseling a breastfeeding woman about alcohol use during lactation, you relate that:
A. drinking a glass of wine or beer will enhance the let-down reflex. B. because of its high
molecular weight, relatively little alcohol is passed into breast milk. C. maternal alcohol use
causes a reduction in the amount of milk ingested by the infant. D. infant intoxication can be
seen with the mother having as few as one to two alcoholic drinks. - Answer 9. Correct: C.
maternal alcohol use causes a reduction in the amount of milk ingested by the infant. Small
amounts of alcohol ingestion by a nursing mother can cause a reduction in the let-down reflex,
decreased milk production, and less rhythmic and frequent sucking by the infant, resulting in a
smaller volume of milk consumption (C). Incorrect: Alcohol has a low molecular weight that
easily passes to breast milk (B). Alcohol consumption can reduce the letdown reflex and result in
decreased milk production (A). One or two alcoholic drinks may not lead to infant intoxication
as less than 1% of the alcohol will pass to breast milk. However, even small amounts of alcohol
consumption can decrease the amount of milk consumption by the nursing infant (D).
10. The anticipated average daily weight gain during the first 3 months of life is approximately:
A. 15 g or 0.53 oz. B. 20 g or 0.7 oz. C. 25 g or 0.88 oz. D. 30 g or 1 oz. - Answer 10. Correct: D.
30 g or 1 oz. During the first 3 months of life, the average daily weight gain is approximately 26
to 31 g (D). The anticipated daily weight gain will then decrease to 17 to 18 g during months 3 to
6, and 12 to 13 g daily during months 6 to 9. Incorrect: In a newborn up to 3 months of age, the
average daily weight gain should exceed 25 g and range near 30 g (A, B, C).
11. The average required caloric intake in an infant from age 0 to 3 months is usually: A. 40 to 60
kcal/kg/day. B. 60 to 80 kcal/kg/day. C. 80 to 100 kcal/kg/day. D. 100 to 120 kcal/kg/day. -
Answer 11. Correct: D. 100 to 120 kcal/kg/day. The required caloric intake for an infant
between 0 and 3 months of age is approximately 100 to 120 kcal/kg/day (D). This amount does
not change substantially as the child grows, with a requirement of 105 to 115 kcal/kg/ day for
those 3 to 6 months of age and 100 to 105 kcal/ kg/day for those 6 to 9 months of age.
Incorrect: During the first 3 months of life, the average required caloric intake ranges from 100
to 120 kcal/kg/day (A, B, C).
12. Regarding physiological jaundice in the newborn, select all that are correct: A. It occurs
between the first 12 and 24 hours of life. B. It progresses from the abdomen toward the head of
the infant. C. Unconjugated bilirubin is elevated. D. Risk of development of hyperbilirubinemia
can be reduced in a breastfed infant with frequent breastfeeding every 2 to 3 hours per 24
hours. E. It can be avoided by supplemental water and dextrose feedings between breastfeeding
in the first 3 to 4 days of life to increase infant hydration while awaiting mother's milk to come
in. - Answer 12. Correct: C. Unconjugated bilirubin is elevated, and D. Risk of development of
hyperbilirubinemia can be reduced in a breastfed infant with frequent breastfeeding every 2 to
3 hours per 24 hours. Physiological jaundice occurs as a result of elevated levels of
unconjugated bilirubin (C). The condition can be prevented by keeping the newborn well
hydrated by breastfeeding at least 8 to 12 times per day, or every 2 to 3 hours (D). Incorrect:
Physiological jaundice typically occurs between days 3 to 5 (A) and usually starts at the head
and then spreads to the body (B). Supplemental water and dextrose should be avoided as this
, 13. The most likely consequence of inadequate feeding during the first few weeks of a newborn
is: A. hypercalcemia. B. hypernatremia. C. hypokalemia. D. hyperkalemia - Answer 13. Correct:
B. hypernatremia. Consequences of inadequate feeding during the first few weeks of life can
lead to dehydration, hypernatremia (B),
and hypoglycemia. Hypoglycemia is often characterized by a protracted high-pitched cry,
jitteriness, and potential seizures. Incorrect: Inadequate feeding of a newborn is not typically
associated with hypercalcemia (A), while hypernatremia is more likely than hypokalemia (C) or
hyperkalemia (D).
14. Which of the following would be a concern regarding weight change in a newborn? A.
weight loss of 2% by day 2 of life B. no weight gain after 3 days of life C. weight gain of less than
3% after 1 week of life D. weight loss of greater than 7% at any time after the first week of life -
Answer 14. Correct: D. weight loss of greater than 7% at any time after the first week of life A
key criterion to assess for adequate feeding is slow growth or weight loss during the first few
weeks of life. A weight loss of greater than 7% at any time, particularly after the first week of
life, is particularly concerning as it increases the likelihood of neonatal jaundice and
hypernatremia (D). Incorrect: Weight loss of greater than 7% at any time in a newborn is a
major concern. Some weight loss can be expected during the first few days of life (A, B) before
the newborn begins to gain weight (C).
15. A mother who has been breastfeeding her newborn is planning on returning to work and
asks about the use of breast pumps. The nurse practitioner (NP) counsels on all of the following
except: A. Some insurance companies will cover the costs of breast pumps. B. Breast pumps can
allow flexibility in allowing mothers to return to work or school. C. Double pumps are not
recommended as they express about half the amount of milk as single pumps. D. Federal law
requires the employer to provide adequate breaks and a location for breast pumping. - Answer
15. Correct: C. Double pumps are not recommended as they express about half the amount of
milk as single pumps. Breast pumps can provide breastfeeding mothers with flexibility with
feedings. Double pumps are particularly helpful as they reduce the time needed to pump by
one-half by expressing milk from both breasts at the same time. These pumps do not differ in
the amount of milk expressed compared to single pumps (C). Incorrect: Breast pumps can be
helpful in allowing nursing mothers to return to work or school (B). Some insurance companies
as well as state Medicaid will cover the costs of breast pumps (A). The FLSA requires employers
to provide a reasonable amount of break time to express milk as well as a functional space in
which to pump milk (D).
16 to 19. Indicate (yes or no) whether each of the following is expected with a good latch by a
newborn. 16. Areola easily visible 17. Dimpling of the baby's cheeks 18. Clicking noise made by
baby 19. Baby's mouth is widely open with lips flanged outward - Answer 16 to 19. Yes or No
16. Correct: No 17. Correct: No 18. Correct: No 19. Correct: Yes A correct latch is critical for
proper breastfeeding of the newborn. With adequate latch, the baby's chin and stomach should
be able to comfortably rest against the mother's body, the baby's mouth is widely open, with
