NURS 6540 FINAL EXAM – PEDIATRIC PRIMARY CARE
ACTUAL EXAM Complete Exam with Answers – GRADED
A+ – Pass Guaranteed - A+ Graded
Part I: Growth, Development & Health Supervision
Q1: A mother brings her 6-month-old infant for a well-child visit. She asks when she
should switch from a rear-facing infant car seat to a forward-facing convertible seat.
What is the most accurate anticipatory guidance based on current AAP
recommendations?
A. At 12 months of age, regardless of weight, as long as the child can sit upright
unassisted
B. When the child reaches 20 pounds and is at least 1 year old, which is the minimum
legal requirement in most states
C. The child should remain rear-facing until reaching the maximum height or weight
limit allowed by the convertible car seat manufacturer, which is typically around 2 years
or older
D. Once the child demonstrates good head control and can sit without support, usually
by 9 months
Correct Answer: C
Rationale: The best answer is C. AAP guidelines now recommend keeping children
rear-facing as long as possible, up to the maximum height or weight limit of their
,convertible seat—often until age 2 or beyond. This positioning better protects the head,
neck, and spine in a crash. Many parents think 12 months and 20 pounds is still the rule,
but that changed years ago, and we want to make sure families understand the safest
practice. That aligns with the standard of care in pediatric primary care.
Q2: During a 12-month well-child visit, you perform developmental surveillance using the
CDC milestones. Which of the following developmental achievements would be most
concerning if NOT present at this age?
A. Walking independently without support
B. Saying "mama" or "dada" specifically to parents
C. Pointing to show interest in something
D. Playing simple pretend, such as feeding a doll
Correct Answer: C
Rationale: The best answer is C. By 12 months, pointing to show interest
(proto-declarative pointing) is a critical social-communication milestone. Its absence
raises concern for autism spectrum disorder and warrants referral for further evaluation,
such as an M-CHAT screening and possibly a developmental pediatric referral. Some
12-month-olds aren't walking yet, and simple pretend play typically emerges closer to 18
months, so those are less concerning. This matches what NURS 6540 teaches for
developmental surveillance.
Q3: A 2-year-old boy's growth chart shows his weight-for-age crossing from the 50th
percentile at 12 months down to the 5th percentile at 24 months, with length remaining
,at the 25th percentile. His diet consists mainly of whole milk (32 oz/day) and crackers.
What is the most appropriate next step in management?
A. Reassure the parents that some toddlers are naturally thin and recheck in 3 months
B. Order a complete metabolic panel, celiac panel, and thyroid studies immediately
C. Counsel on reducing milk intake to 16-20 oz/day, improving dietary variety, and
recheck weight in 6-8 weeks
D. Refer immediately to pediatric gastroenterology for failure to thrive workup
Correct Answer: C
Rationale: The best answer is C. This toddler has nutritional failure to thrive driven by
excessive milk consumption, which displaces iron-rich foods and contributes to iron
deficiency. Reducing milk to 16-20 oz daily, adding variety with proteins and vegetables,
and following up soon is the right first step. We don't jump to extensive labs or GI
referral before trying a nutritional intervention, especially when the cause is this clear
from the history. That aligns with the standard of care in pediatric primary care.
Q4: You are reviewing immunization records for a 4-month-old infant who received HepB
at birth and 2 months, DTaP, IPV, Hib, PCV13, and rotavirus at 2 months. Which vaccines
are due at the 4-month visit today?
A. DTaP, IPV, Hib, PCV13, and rotavirus only
B. DTaP, IPV, Hib, PCV13, rotavirus, and the second HepB dose
C. DTaP, IPV, Hib, PCV13, rotavirus, and influenza
D. DTaP, IPV, Hib, PCV13, and MMR
, Correct Answer: A
Rationale: The best answer is A. At 4 months, the infant receives the second doses of
DTaP, IPV, Hib, PCV13, and rotavirus. The third HepB dose isn't due until 6-18 months,
influenza starts at 6 months, and MMR is given at 12-15 months. Keeping the schedule
straight is one of those bread-and-butter skills for pediatric primary care. This matches
what NURS 6540 teaches for immunization scheduling.
Q5: During a 9-month well-child visit, the parents report their son is not yet sitting
without support. He can roll from prone to supine and reaches for toys, but he slumps
forward when placed in a sitting position. What is the most appropriate next step?
A. Reassure the parents that boys often sit later than girls and schedule routine
12-month visit
B. Refer immediately to early intervention for physical therapy evaluation
C. Perform the Ages & Stages Questionnaire (ASQ) and consider referral for
developmental evaluation if other delays are identified
D. Order an MRI of the brain to rule out cerebral palsy
Correct Answer: C
Rationale: The best answer is C. Independent sitting without support is expected by 9
months, so this is a valid developmental concern—but not an emergency. The best
approach is systematic screening with the ASQ to look at all developmental domains,
then deciding on referral based on the full picture. We don't reassure and ignore it, nor
do we jump to brain imaging before doing our developmental surveillance workup. That
aligns with the standard of care in pediatric primary care.
ACTUAL EXAM Complete Exam with Answers – GRADED
A+ – Pass Guaranteed - A+ Graded
Part I: Growth, Development & Health Supervision
Q1: A mother brings her 6-month-old infant for a well-child visit. She asks when she
should switch from a rear-facing infant car seat to a forward-facing convertible seat.
What is the most accurate anticipatory guidance based on current AAP
recommendations?
A. At 12 months of age, regardless of weight, as long as the child can sit upright
unassisted
B. When the child reaches 20 pounds and is at least 1 year old, which is the minimum
legal requirement in most states
C. The child should remain rear-facing until reaching the maximum height or weight
limit allowed by the convertible car seat manufacturer, which is typically around 2 years
or older
D. Once the child demonstrates good head control and can sit without support, usually
by 9 months
Correct Answer: C
Rationale: The best answer is C. AAP guidelines now recommend keeping children
rear-facing as long as possible, up to the maximum height or weight limit of their
,convertible seat—often until age 2 or beyond. This positioning better protects the head,
neck, and spine in a crash. Many parents think 12 months and 20 pounds is still the rule,
but that changed years ago, and we want to make sure families understand the safest
practice. That aligns with the standard of care in pediatric primary care.
Q2: During a 12-month well-child visit, you perform developmental surveillance using the
CDC milestones. Which of the following developmental achievements would be most
concerning if NOT present at this age?
A. Walking independently without support
B. Saying "mama" or "dada" specifically to parents
C. Pointing to show interest in something
D. Playing simple pretend, such as feeding a doll
Correct Answer: C
Rationale: The best answer is C. By 12 months, pointing to show interest
(proto-declarative pointing) is a critical social-communication milestone. Its absence
raises concern for autism spectrum disorder and warrants referral for further evaluation,
such as an M-CHAT screening and possibly a developmental pediatric referral. Some
12-month-olds aren't walking yet, and simple pretend play typically emerges closer to 18
months, so those are less concerning. This matches what NURS 6540 teaches for
developmental surveillance.
Q3: A 2-year-old boy's growth chart shows his weight-for-age crossing from the 50th
percentile at 12 months down to the 5th percentile at 24 months, with length remaining
,at the 25th percentile. His diet consists mainly of whole milk (32 oz/day) and crackers.
What is the most appropriate next step in management?
A. Reassure the parents that some toddlers are naturally thin and recheck in 3 months
B. Order a complete metabolic panel, celiac panel, and thyroid studies immediately
C. Counsel on reducing milk intake to 16-20 oz/day, improving dietary variety, and
recheck weight in 6-8 weeks
D. Refer immediately to pediatric gastroenterology for failure to thrive workup
Correct Answer: C
Rationale: The best answer is C. This toddler has nutritional failure to thrive driven by
excessive milk consumption, which displaces iron-rich foods and contributes to iron
deficiency. Reducing milk to 16-20 oz daily, adding variety with proteins and vegetables,
and following up soon is the right first step. We don't jump to extensive labs or GI
referral before trying a nutritional intervention, especially when the cause is this clear
from the history. That aligns with the standard of care in pediatric primary care.
Q4: You are reviewing immunization records for a 4-month-old infant who received HepB
at birth and 2 months, DTaP, IPV, Hib, PCV13, and rotavirus at 2 months. Which vaccines
are due at the 4-month visit today?
A. DTaP, IPV, Hib, PCV13, and rotavirus only
B. DTaP, IPV, Hib, PCV13, rotavirus, and the second HepB dose
C. DTaP, IPV, Hib, PCV13, rotavirus, and influenza
D. DTaP, IPV, Hib, PCV13, and MMR
, Correct Answer: A
Rationale: The best answer is A. At 4 months, the infant receives the second doses of
DTaP, IPV, Hib, PCV13, and rotavirus. The third HepB dose isn't due until 6-18 months,
influenza starts at 6 months, and MMR is given at 12-15 months. Keeping the schedule
straight is one of those bread-and-butter skills for pediatric primary care. This matches
what NURS 6540 teaches for immunization scheduling.
Q5: During a 9-month well-child visit, the parents report their son is not yet sitting
without support. He can roll from prone to supine and reaches for toys, but he slumps
forward when placed in a sitting position. What is the most appropriate next step?
A. Reassure the parents that boys often sit later than girls and schedule routine
12-month visit
B. Refer immediately to early intervention for physical therapy evaluation
C. Perform the Ages & Stages Questionnaire (ASQ) and consider referral for
developmental evaluation if other delays are identified
D. Order an MRI of the brain to rule out cerebral palsy
Correct Answer: C
Rationale: The best answer is C. Independent sitting without support is expected by 9
months, so this is a valid developmental concern—but not an emergency. The best
approach is systematic screening with the ASQ to look at all developmental domains,
then deciding on referral based on the full picture. We don't reassure and ignore it, nor
do we jump to brain imaging before doing our developmental surveillance workup. That
aligns with the standard of care in pediatric primary care.
