NR 602 PEDIATRIC MIDTERM STUDY SET 2026 SPRING TEST QUESTIONS WITH
ACCURATE SOLUTIONS
The parent of a toddler is concerned that the child may have autism. The primary care
pediatric nurse practitioner completes a Modified Checklist for Autism in Toddlers (M-
CHAT) tool, which indicates several areas of concern. What will the nurse practitioner do?
Administer a Childhood Autism Rating Scale (CARS) in the clinic.
Consult a specialist to determine appropriate early intervention strategies.
Refer the child to a behavioral specialist for further evaluation.
Tell the parent that this result indicates that the child has autism.
ANS: C
The M-CHAT is a screening tool and is useful for detecting behaviors that may indicate
autism. This instrument has been found to have acceptable sensitivity, specificity, and
significant positive predictive value. If these behaviors are detected, the PNP should refer
the child to a specialist for further assessment, using more diagnostic tools. The CARS may
be used but requires specialty training and proper credentials. Until the diagnosis is
determined, strategies for intervention are not discussed. The M-CHAT is a screening tool
and is not diagnostic.
The mother of a newborn tells the primary care pediatric nurse practitioner that she is
worried that her child will develop allergies and asthma. Which tool will the nurse
practitioner use to evaluate this risk?
Three-generation pedigree
Review of systems
Genogram
Ecomap
ANS: A
The three-generation pedigree is used to map out risks for genetic diseases in families, as
well as conditions with modifiable risk factors. The review of systems is used to evaluate
,the history of the child's body systems. The genogram is an approach to developing a family
database to provide a graphic representation of family structure, roles, and problems of
recurring significance in a family. The ecomap is used to identify relationships in the family
and community that are supportive or harmful.
A 16-year-old female reports dull, achy cramping pain in her lower abdomen lasting 2 or 3
hours that occurs between her menstrual periods each month. The adolescent is not
sexually active. What is the treatment for this condition?
Abdominal ultrasound to rule out ovarian cyst
Oral contraceptives to suppress ovulation
Prostaglandin inhibitor analgesics and a heating pad
Referral to a pediatric gynecologist
ANS: C
The adolescent is experiencing mittelschmerz pain, which is thought to occur when the
follicle ruptures at the time of ovulation. Unless the pain is severe, the adolescent should
be reassured and offered strategies to relieve discomfort, such as a heating pad and
NSAIDs. The pain is intermittent and occurs between periods; if it were persistent and
severe, abdominal US would be indicated. Oral contraceptives are rarely used to suppress
ovulation when symptoms are severe. Referral to a pediatric gynecologist is not indicated.
An adolescent female tells the primary care pediatric nurse practitioner that she had
unprotected sexual intercourse 4 days prior and is worried she might become pregnant.
What will the nurse practitioner do?
Prescribe ulipristal acetate (Ella).
Recommend levonorgestrel (Plan B One Step).
Start a combination OCP at regular doses.
Suggest using the less expensive After Pill preparation.
ANS: A
,The prescription medication ulipristal can be used up to 5 days after unprotected
intercourse. Levonorgestrel, which is the active ingredient in Plan B and the After Pill,
should be taken within 72 hours of unprotected intercourse. The After Pill must be
purchased online. A combination OCP may be used, but it is an alternative approach.
A 17-year-old sexually active female who began having periods at age 14 reports having
moderate to severe dull lower abdominal pain associated predominantly with periods but
that occurs at other times as well. The history reveals a recent onset of these symptoms. A
pregnancy test is negative. Which course of action is most important?
Perform a full diagnostic workup to evaluate potential causes.
Prescribe a prostaglandin synthetase inhibitor.
Start a 3- to 6-month trial of oral contraceptive pills.
Suggest using transcutaneous electrical nerve stimulation.
ANS: A
This adolescent has symptoms consistent with secondary dysmenorrhea and should have
a full diagnostic workup to evaluate potential causes. Prostaglandin synthetase inhibitors,
OCPs, and TENS are useful to treat discomfort, but determining the cause is more
important.
A 16-year-old female reports breast tenderness and a "lump." The primary care pediatric
nurse practitioner palpates a small fluid-filled mass in her right breast. A pregnancy test is
negative. Which action is correct?
Obtain a CBC to rule out infection.
Order an ultrasound of the mass.
Prescribe NSAIDs to treat her discomfort.
Reassure her that the findings are normal.
ANS: B
, A cyst is usually a fluid-filled mass and should be evaluated by ultrasound to confirm this.
The mass is not warm or consistent with mastitis, so a CBC is not indicated. NSAIDs may
be offered once the diagnosis is confirmed. If the US reveals a cyst, reassurance can be
given.
The primary care pediatric nurse practitioner is prescribing contraception for an adolescent
who has not used birth control previously. The adolescent has a normal exam and has no
family history of cardiovascular and peripheral vascular disease or diabetes. Which
preparation is used initially?
A combination oral contraceptive pills (OCP) with 30 to 35 mcg of estrogen and low
progestin
A combination OCP with low androgenic potency, such as Ortho-Cyclen
A progestin-only mini-pill oral contraceptive
A subdermal implant contraception, such as Implanon or Nexplanon
ANS: A
The usual initial OCP is a combination with 30 to 35 mcg of estrogen and low progestin
potency. The combination OCP with low androgenic potency is used for adolescents with
hirsutism or PCOS. The progestin-only mini-pill is used in patients for whom progestin is
contraindicated, such as for lactating women, and is not generally used in adolescents
because of irregular bleeding and higher failure rates. The subdermal implants are used in
older adolescents who are committed to long-term contraception.
An adolescent female has periods every 30 days that are consistently heavy and last from 5
to 8 days. What is her diagnosis?
Menometrorrhagia
Menorrhagia
Metrorrhagia
Polymenorrhea
ACCURATE SOLUTIONS
The parent of a toddler is concerned that the child may have autism. The primary care
pediatric nurse practitioner completes a Modified Checklist for Autism in Toddlers (M-
CHAT) tool, which indicates several areas of concern. What will the nurse practitioner do?
Administer a Childhood Autism Rating Scale (CARS) in the clinic.
Consult a specialist to determine appropriate early intervention strategies.
Refer the child to a behavioral specialist for further evaluation.
Tell the parent that this result indicates that the child has autism.
ANS: C
The M-CHAT is a screening tool and is useful for detecting behaviors that may indicate
autism. This instrument has been found to have acceptable sensitivity, specificity, and
significant positive predictive value. If these behaviors are detected, the PNP should refer
the child to a specialist for further assessment, using more diagnostic tools. The CARS may
be used but requires specialty training and proper credentials. Until the diagnosis is
determined, strategies for intervention are not discussed. The M-CHAT is a screening tool
and is not diagnostic.
The mother of a newborn tells the primary care pediatric nurse practitioner that she is
worried that her child will develop allergies and asthma. Which tool will the nurse
practitioner use to evaluate this risk?
Three-generation pedigree
Review of systems
Genogram
Ecomap
ANS: A
The three-generation pedigree is used to map out risks for genetic diseases in families, as
well as conditions with modifiable risk factors. The review of systems is used to evaluate
,the history of the child's body systems. The genogram is an approach to developing a family
database to provide a graphic representation of family structure, roles, and problems of
recurring significance in a family. The ecomap is used to identify relationships in the family
and community that are supportive or harmful.
A 16-year-old female reports dull, achy cramping pain in her lower abdomen lasting 2 or 3
hours that occurs between her menstrual periods each month. The adolescent is not
sexually active. What is the treatment for this condition?
Abdominal ultrasound to rule out ovarian cyst
Oral contraceptives to suppress ovulation
Prostaglandin inhibitor analgesics and a heating pad
Referral to a pediatric gynecologist
ANS: C
The adolescent is experiencing mittelschmerz pain, which is thought to occur when the
follicle ruptures at the time of ovulation. Unless the pain is severe, the adolescent should
be reassured and offered strategies to relieve discomfort, such as a heating pad and
NSAIDs. The pain is intermittent and occurs between periods; if it were persistent and
severe, abdominal US would be indicated. Oral contraceptives are rarely used to suppress
ovulation when symptoms are severe. Referral to a pediatric gynecologist is not indicated.
An adolescent female tells the primary care pediatric nurse practitioner that she had
unprotected sexual intercourse 4 days prior and is worried she might become pregnant.
What will the nurse practitioner do?
Prescribe ulipristal acetate (Ella).
Recommend levonorgestrel (Plan B One Step).
Start a combination OCP at regular doses.
Suggest using the less expensive After Pill preparation.
ANS: A
,The prescription medication ulipristal can be used up to 5 days after unprotected
intercourse. Levonorgestrel, which is the active ingredient in Plan B and the After Pill,
should be taken within 72 hours of unprotected intercourse. The After Pill must be
purchased online. A combination OCP may be used, but it is an alternative approach.
A 17-year-old sexually active female who began having periods at age 14 reports having
moderate to severe dull lower abdominal pain associated predominantly with periods but
that occurs at other times as well. The history reveals a recent onset of these symptoms. A
pregnancy test is negative. Which course of action is most important?
Perform a full diagnostic workup to evaluate potential causes.
Prescribe a prostaglandin synthetase inhibitor.
Start a 3- to 6-month trial of oral contraceptive pills.
Suggest using transcutaneous electrical nerve stimulation.
ANS: A
This adolescent has symptoms consistent with secondary dysmenorrhea and should have
a full diagnostic workup to evaluate potential causes. Prostaglandin synthetase inhibitors,
OCPs, and TENS are useful to treat discomfort, but determining the cause is more
important.
A 16-year-old female reports breast tenderness and a "lump." The primary care pediatric
nurse practitioner palpates a small fluid-filled mass in her right breast. A pregnancy test is
negative. Which action is correct?
Obtain a CBC to rule out infection.
Order an ultrasound of the mass.
Prescribe NSAIDs to treat her discomfort.
Reassure her that the findings are normal.
ANS: B
, A cyst is usually a fluid-filled mass and should be evaluated by ultrasound to confirm this.
The mass is not warm or consistent with mastitis, so a CBC is not indicated. NSAIDs may
be offered once the diagnosis is confirmed. If the US reveals a cyst, reassurance can be
given.
The primary care pediatric nurse practitioner is prescribing contraception for an adolescent
who has not used birth control previously. The adolescent has a normal exam and has no
family history of cardiovascular and peripheral vascular disease or diabetes. Which
preparation is used initially?
A combination oral contraceptive pills (OCP) with 30 to 35 mcg of estrogen and low
progestin
A combination OCP with low androgenic potency, such as Ortho-Cyclen
A progestin-only mini-pill oral contraceptive
A subdermal implant contraception, such as Implanon or Nexplanon
ANS: A
The usual initial OCP is a combination with 30 to 35 mcg of estrogen and low progestin
potency. The combination OCP with low androgenic potency is used for adolescents with
hirsutism or PCOS. The progestin-only mini-pill is used in patients for whom progestin is
contraindicated, such as for lactating women, and is not generally used in adolescents
because of irregular bleeding and higher failure rates. The subdermal implants are used in
older adolescents who are committed to long-term contraception.
An adolescent female has periods every 30 days that are consistently heavy and last from 5
to 8 days. What is her diagnosis?
Menometrorrhagia
Menorrhagia
Metrorrhagia
Polymenorrhea
