Pediatric Primary Care PNCB Final
Exam Questions & Answers
You are seeing a 4-week old infant whose mother states that the child's right eye is
wet all the time and sometime there is thick mucus on the lashes. There has been no
fever and the baby is feeding well. Eye exam reveals a normal red reflex bilaterally
with no evidence of purulent drainage, conjunctival erythema, or cloudiness over
the cornea. You suspect:
a) adenovirus conjunctivits
b) nasolacrimal stenosis
c) chlamydial conjunctivitis
d) congenital cataract - b) nasolacrimal duct stenosis
A 9-month-old infant who was born at 32-weeks reaches for a block with only the left
hand. The right arm remains still at the side of her body. The PNP would:
a) record these findings as normal for a premature infant
b) refer the infant for further evaluation
c) refer the child for a muscle biopsy
d) record that the child will likely be left-handed - b) refer the infant for further
evaluation
During a 2-month-old well child visit you note that the red reflex in one eye seems
paler than in the other. What is the most appropriate follow-up step for this
observation?
a) assess and document a normal corneal light reflex in that eye
b) preform the cover/uncover test
c) re-evaluate the red re-screening test in 2 weeks
d) refer the infant to a pediatric ophthalmologist immediately - d) refer the infant to a
pediatric ophthalmologist immediately
Primary dentition erupts between:
a) 6-11 years
b) 6-30 months
c) 1-5 years
,d) 12-24 months - b) 6-30 months
The parent of a 4-year-old points to a picture and says "That's your sister!". The child
responds by saying "No! It's my baby!". This is an example of which type of thinking
in preschool-age children?
a) animism
b) artificialism
c) egocentrism
d) realism - d) realism
The primary care PNP performs a developmental assessment on a 32-month-old child.
The child's parent reports that about 70% of the child's speech is intelligible. The
pediatric nurse practitioner observes that the child has difficulty pronouncing "t" "d"
"k" and "g". Which action is correct?
a) evaluate the child's cognitive abilities
b) obtain a hearing evaluation
c) reassure the parent that this is normal
d) refer the child to a speech therapist - c) reassure the parent that this is normal
The primary care PNP is offering anticipatory guidance to the parents of a 12-month-
old child. The parents are bilingual in Spanish and English and have many Spanish -
speaking relatives nearby. They are resisting exposing the child to Spanish out of
concern that the child will not learn English well. What will the PNP tell the parents?
a) children who learn two languages simultaneously often confuse them in
conversation
b) children with multi-language proficiency do not understand that others cannot do
this
c) learning two languages at an early age prevents children from development
a dominant language
d) most bilingual children are able to shift from one language to another when
appropriate - d) most bilingual children are able to shift from one language to another
when appropriate
The parents of a 3-year-old child are concerns that the child has begun refusing usual
foods and wants to eat mashed potatoes and chicken strips at every meal and snack.
,The child's rate of weight has slowed, but the child remains at the same percentile
for weight on a growth chart. What will the PNP tell the parents to do>
a) allow the child to choose foods for meals to improve caloric intake
b) place a variety of nutritious foods on the child's plate at each meal
c) prepare masked potatoes and chicken strips for the child at mealtimes
d) suggest cutting out snacks to improve the child's appetite at mealtimes - b) place
a variety of nutritious foods on the child's plate at each meal
The PC-PNP is evaluating a 2-year-old with a documented speech delay. Screening
s to assess motor skills and cognition are normal, and the child passed a recent
hearing test. What will the PNP do next?
a) ask the child's parents whether they read to the child
b) give parents educational materials to encourage speech
c) refer the child to and early intervention program
d) suggest that they purchase age-appropriate music videos - a) ask the child's parents
whether they read to the child
The mother of a 3-year-old child takes the child to play group once a week. She
expressed concern that the child plays with toys but does not interact with the other
toddlers. What will the PNP counsel the mother?
a) the child probably is very shy but will outgrow this tendency with repeated
exposure to other children
b) the toddler may have a language delay that interferes with socialization with other
children
c) toddlers may be interested in other children but usually do not engage in interactive
play
d) toddlers need more structured play to encourage interaction and socialization with
others - c) toddlers may be interested in other children but usually do not engage in
interactive play
Which of the following set of symptoms would be most consistent GABHS infection?
a) cough, nasal congestion, cervical lymphadenopathy
b) fever, HA, tender cervical lymphadenopathy
c) cough, fever, macular papular rash to trunk
, d) sneezing, rhinorrhea, exudative tonsils - b) fever, HA, tender
cervical lymphadenopathy
What of the following is the most appropriate treatment for strep throat?
a) penicillin V 250mg BID x5days and tylenol for pain or fever
b) azithromycin for 5 days and ibuprofen
c) penicillin V 500mg bid for 10 days with tylenol for pain and fever
d) cephalexin 500mg BID for 10 days - c) penicillin V 500mg bid for 10 days
with tylenol for pain and fever
The red reflex is done in the newborn to rule out:
a) retinoblastoma
b) decreased visual acuity
c) strabismus
d) corneal abrasions - a) retinoblastoma
A child presents with acute onset of 104 temperature and difficult swallowing.
She appears anxious and is drooling. You suspect epiglotitis. Your immediate
management plan would be:
a) medical transportation to an ER with anesthesiology notified
b) given an injection of ceftriaxone in the clinic and have the parents transport
the child to the ER
c) obtain a CBC and blood culture and transport the child to the ER/hospital
for admission
d) obtain a rapid strep and culture to rule out GABHS - a) medical transportation to
an ER with anesthesiology notified
Laboratory analysis of neonatal ocular discharge would be positive for gram
negative intracellular diplococci for which of the following organisms?
a) chlamydia
b) influenza
c) adenovirus
d) gonococcus - d) gonococcus
All bacterial conjunctivitis:
Exam Questions & Answers
You are seeing a 4-week old infant whose mother states that the child's right eye is
wet all the time and sometime there is thick mucus on the lashes. There has been no
fever and the baby is feeding well. Eye exam reveals a normal red reflex bilaterally
with no evidence of purulent drainage, conjunctival erythema, or cloudiness over
the cornea. You suspect:
a) adenovirus conjunctivits
b) nasolacrimal stenosis
c) chlamydial conjunctivitis
d) congenital cataract - b) nasolacrimal duct stenosis
A 9-month-old infant who was born at 32-weeks reaches for a block with only the left
hand. The right arm remains still at the side of her body. The PNP would:
a) record these findings as normal for a premature infant
b) refer the infant for further evaluation
c) refer the child for a muscle biopsy
d) record that the child will likely be left-handed - b) refer the infant for further
evaluation
During a 2-month-old well child visit you note that the red reflex in one eye seems
paler than in the other. What is the most appropriate follow-up step for this
observation?
a) assess and document a normal corneal light reflex in that eye
b) preform the cover/uncover test
c) re-evaluate the red re-screening test in 2 weeks
d) refer the infant to a pediatric ophthalmologist immediately - d) refer the infant to a
pediatric ophthalmologist immediately
Primary dentition erupts between:
a) 6-11 years
b) 6-30 months
c) 1-5 years
,d) 12-24 months - b) 6-30 months
The parent of a 4-year-old points to a picture and says "That's your sister!". The child
responds by saying "No! It's my baby!". This is an example of which type of thinking
in preschool-age children?
a) animism
b) artificialism
c) egocentrism
d) realism - d) realism
The primary care PNP performs a developmental assessment on a 32-month-old child.
The child's parent reports that about 70% of the child's speech is intelligible. The
pediatric nurse practitioner observes that the child has difficulty pronouncing "t" "d"
"k" and "g". Which action is correct?
a) evaluate the child's cognitive abilities
b) obtain a hearing evaluation
c) reassure the parent that this is normal
d) refer the child to a speech therapist - c) reassure the parent that this is normal
The primary care PNP is offering anticipatory guidance to the parents of a 12-month-
old child. The parents are bilingual in Spanish and English and have many Spanish -
speaking relatives nearby. They are resisting exposing the child to Spanish out of
concern that the child will not learn English well. What will the PNP tell the parents?
a) children who learn two languages simultaneously often confuse them in
conversation
b) children with multi-language proficiency do not understand that others cannot do
this
c) learning two languages at an early age prevents children from development
a dominant language
d) most bilingual children are able to shift from one language to another when
appropriate - d) most bilingual children are able to shift from one language to another
when appropriate
The parents of a 3-year-old child are concerns that the child has begun refusing usual
foods and wants to eat mashed potatoes and chicken strips at every meal and snack.
,The child's rate of weight has slowed, but the child remains at the same percentile
for weight on a growth chart. What will the PNP tell the parents to do>
a) allow the child to choose foods for meals to improve caloric intake
b) place a variety of nutritious foods on the child's plate at each meal
c) prepare masked potatoes and chicken strips for the child at mealtimes
d) suggest cutting out snacks to improve the child's appetite at mealtimes - b) place
a variety of nutritious foods on the child's plate at each meal
The PC-PNP is evaluating a 2-year-old with a documented speech delay. Screening
s to assess motor skills and cognition are normal, and the child passed a recent
hearing test. What will the PNP do next?
a) ask the child's parents whether they read to the child
b) give parents educational materials to encourage speech
c) refer the child to and early intervention program
d) suggest that they purchase age-appropriate music videos - a) ask the child's parents
whether they read to the child
The mother of a 3-year-old child takes the child to play group once a week. She
expressed concern that the child plays with toys but does not interact with the other
toddlers. What will the PNP counsel the mother?
a) the child probably is very shy but will outgrow this tendency with repeated
exposure to other children
b) the toddler may have a language delay that interferes with socialization with other
children
c) toddlers may be interested in other children but usually do not engage in interactive
play
d) toddlers need more structured play to encourage interaction and socialization with
others - c) toddlers may be interested in other children but usually do not engage in
interactive play
Which of the following set of symptoms would be most consistent GABHS infection?
a) cough, nasal congestion, cervical lymphadenopathy
b) fever, HA, tender cervical lymphadenopathy
c) cough, fever, macular papular rash to trunk
, d) sneezing, rhinorrhea, exudative tonsils - b) fever, HA, tender
cervical lymphadenopathy
What of the following is the most appropriate treatment for strep throat?
a) penicillin V 250mg BID x5days and tylenol for pain or fever
b) azithromycin for 5 days and ibuprofen
c) penicillin V 500mg bid for 10 days with tylenol for pain and fever
d) cephalexin 500mg BID for 10 days - c) penicillin V 500mg bid for 10 days
with tylenol for pain and fever
The red reflex is done in the newborn to rule out:
a) retinoblastoma
b) decreased visual acuity
c) strabismus
d) corneal abrasions - a) retinoblastoma
A child presents with acute onset of 104 temperature and difficult swallowing.
She appears anxious and is drooling. You suspect epiglotitis. Your immediate
management plan would be:
a) medical transportation to an ER with anesthesiology notified
b) given an injection of ceftriaxone in the clinic and have the parents transport
the child to the ER
c) obtain a CBC and blood culture and transport the child to the ER/hospital
for admission
d) obtain a rapid strep and culture to rule out GABHS - a) medical transportation to
an ER with anesthesiology notified
Laboratory analysis of neonatal ocular discharge would be positive for gram
negative intracellular diplococci for which of the following organisms?
a) chlamydia
b) influenza
c) adenovirus
d) gonococcus - d) gonococcus
All bacterial conjunctivitis:
