NR 602 FINAL EXAM COMPREHENSIVE STUDY
GUIDE 2026 ADVANCED PRIMARY CARE AND
FAMILY NURSE PRACTITIONER PRINCIPLES
◉ A toddler who was born prematurely refuses most solid foods and
has poor weight gain. A barium swallow study reveals a normal
esophagus. What will the primary care pediatric NP consider the
next to manage this child's nutritional needs?
A. consultation with dietician
B. Fiberoptic endoscopy evaluation.
C. MRI
D. Videofluroscopy swallowing study (VOSS)
Answer: D. Videofluroscopy swallowing study (VOSS)
◉ A toddler is seen in clinic after a 2-day hx of intermittent V/D. An
assessment reveals an irritable child with dry mucous membranes,
3-second cap refill. 2-second recoil of skin, mild tachycardia and
tachypnea, and cool hands and feet. The child has had 2 wet diapers
in the past 24 hours. What will the primary care pediatric NP
recommend?
A. anti-diarrheal medication & clear fluids for 24H
B. Bolus of IV NS in the clinic until improvement
C. Hospital admission for IV rehydration & oral fluids
,D. Oral rehydration solution with f/u in 24H
Answer: D. Oral rehydration solution with f/u in 24H
◉ A 9-year old girl has a hx of frequent vomiting and her mother has
frequent migraine ha. The child has recently begun having more
frequent and prolonged episodes accompanied by headaches. An
exam reveals abnormal eye movement and mild ataxia. What is the
correct action?
A. begin using anti-migraine meds to prevent HA
B. Prescribe ondansetron and lorazepam to help manage sx
C. Reassure the parent that this is expected with cyclic vomiting
syndrome
D. Refer to a pediatric gastroenterologist for further workup.
Answer: D. Refer to a pediatric gastroenterologist for further
workup.
◉ The parent of a 3-month-old reports that the infant reports that
the infant arches and gags while feeding and spits up undigested
formula frequently. The infant's weight gain has dropped to the 5th
percentile from the 12th. What is the best course of tx for this
infant?
A. Begin a trial of extensively hydrolyzed protein formula for 2-4
wks.
B. Institute an emperic trial of acid suppression with a PPI
,C. Perform esophageal pH monitoring to determine the degree of
reflux.
D. Reassure the parent that these sx will likely resolved by 12-24 mo.
Answer: A. Begin a trial of extensively hydrolyzed protein formula
for 2-4 wks.
◉ A school-age child has a 3-month hx of dull, aching epigastric pain
that worsens with eating and awakens from sleep. A CBC shows a
Hgb of 8mg/dL. What is the next step in management.
A. Administration of H RA or PPI meds
B. Empiric therapy for H. pylori
C. Ordering an upper GI series
D. Referral for EGD
Answer: D. Referral for EGD
◉ A 2-mo old infant cries up to 4 hours each day and according to
the parents, is inconsolable during crying episodes with fits and legs
notes to be tense and stiff. The infant is breastfeeding frequently but
is often fussy during feedings. The PE is normal and the infant is
gaining weight normally. What will the primary care pediatric NP
recommend?
A. A complete work-up, including lab and radiologic tests.
B. Eliminating certain foods from the mother's diet.
C. Empiric tx w/PPI
, D. Stopping breastfeeding & beginning a hydrolyzed formula
Answer: B. Eliminating certain foods from the mother's diet.
◉ A child is in the clinic after swallowing a metal bead. A radiograph
of the GI tract shows a 6 mm cylindrical object in the child's
stomach. The child is able to swallow without difficulty and is not
experiencing pain. What is the correct course of treatment?
a. Administer ipecac to induce vomiting.
b. Have the parents watch for the object in the child's stool.
c. Insert a nasogastric tube to flush out the object.
d. Refer the child for endoscopic removal of the object.
Answer: b. Have the parents watch for the object in the child's stool.
◉ A 10-year-old child has had abdominal pain for 2 days, which
began in the periumbilical area and then localized to the RLQ. The
child vomited once today and then experienced relief from pain
followed by an increased fever. What is the likely diagnosis?
A. Appendicitis w/perf
B. Gastroenteritis
C. Pelvic inflammatory disease (PID)
D. UTI
Answer: A. Appendicitis w/perf
GUIDE 2026 ADVANCED PRIMARY CARE AND
FAMILY NURSE PRACTITIONER PRINCIPLES
◉ A toddler who was born prematurely refuses most solid foods and
has poor weight gain. A barium swallow study reveals a normal
esophagus. What will the primary care pediatric NP consider the
next to manage this child's nutritional needs?
A. consultation with dietician
B. Fiberoptic endoscopy evaluation.
C. MRI
D. Videofluroscopy swallowing study (VOSS)
Answer: D. Videofluroscopy swallowing study (VOSS)
◉ A toddler is seen in clinic after a 2-day hx of intermittent V/D. An
assessment reveals an irritable child with dry mucous membranes,
3-second cap refill. 2-second recoil of skin, mild tachycardia and
tachypnea, and cool hands and feet. The child has had 2 wet diapers
in the past 24 hours. What will the primary care pediatric NP
recommend?
A. anti-diarrheal medication & clear fluids for 24H
B. Bolus of IV NS in the clinic until improvement
C. Hospital admission for IV rehydration & oral fluids
,D. Oral rehydration solution with f/u in 24H
Answer: D. Oral rehydration solution with f/u in 24H
◉ A 9-year old girl has a hx of frequent vomiting and her mother has
frequent migraine ha. The child has recently begun having more
frequent and prolonged episodes accompanied by headaches. An
exam reveals abnormal eye movement and mild ataxia. What is the
correct action?
A. begin using anti-migraine meds to prevent HA
B. Prescribe ondansetron and lorazepam to help manage sx
C. Reassure the parent that this is expected with cyclic vomiting
syndrome
D. Refer to a pediatric gastroenterologist for further workup.
Answer: D. Refer to a pediatric gastroenterologist for further
workup.
◉ The parent of a 3-month-old reports that the infant reports that
the infant arches and gags while feeding and spits up undigested
formula frequently. The infant's weight gain has dropped to the 5th
percentile from the 12th. What is the best course of tx for this
infant?
A. Begin a trial of extensively hydrolyzed protein formula for 2-4
wks.
B. Institute an emperic trial of acid suppression with a PPI
,C. Perform esophageal pH monitoring to determine the degree of
reflux.
D. Reassure the parent that these sx will likely resolved by 12-24 mo.
Answer: A. Begin a trial of extensively hydrolyzed protein formula
for 2-4 wks.
◉ A school-age child has a 3-month hx of dull, aching epigastric pain
that worsens with eating and awakens from sleep. A CBC shows a
Hgb of 8mg/dL. What is the next step in management.
A. Administration of H RA or PPI meds
B. Empiric therapy for H. pylori
C. Ordering an upper GI series
D. Referral for EGD
Answer: D. Referral for EGD
◉ A 2-mo old infant cries up to 4 hours each day and according to
the parents, is inconsolable during crying episodes with fits and legs
notes to be tense and stiff. The infant is breastfeeding frequently but
is often fussy during feedings. The PE is normal and the infant is
gaining weight normally. What will the primary care pediatric NP
recommend?
A. A complete work-up, including lab and radiologic tests.
B. Eliminating certain foods from the mother's diet.
C. Empiric tx w/PPI
, D. Stopping breastfeeding & beginning a hydrolyzed formula
Answer: B. Eliminating certain foods from the mother's diet.
◉ A child is in the clinic after swallowing a metal bead. A radiograph
of the GI tract shows a 6 mm cylindrical object in the child's
stomach. The child is able to swallow without difficulty and is not
experiencing pain. What is the correct course of treatment?
a. Administer ipecac to induce vomiting.
b. Have the parents watch for the object in the child's stool.
c. Insert a nasogastric tube to flush out the object.
d. Refer the child for endoscopic removal of the object.
Answer: b. Have the parents watch for the object in the child's stool.
◉ A 10-year-old child has had abdominal pain for 2 days, which
began in the periumbilical area and then localized to the RLQ. The
child vomited once today and then experienced relief from pain
followed by an increased fever. What is the likely diagnosis?
A. Appendicitis w/perf
B. Gastroenteritis
C. Pelvic inflammatory disease (PID)
D. UTI
Answer: A. Appendicitis w/perf
