NRNP BOARD EVALUATION 2026
GUARANTEED PASS ANSWERS GRADED A+
● (4) A mother notes her 6-week-old son's umbilical cord is still
attached. His activity and intake are normal; there has been no illness or
fever. Delivery was at term without problems. His examination is
notable for a cord without evidence of separation and a shallow, 0.5cm
ulceration at the occiput without discharge or surrounding erythema.
Mother declares that the "sore," caused by a scalp probe, has been
slowly healing since birth and was deemed unremarkable at his 2-week
checkup. Which of the following is consistent with this child's likely
diagnosis?
A. Defective humoral response
B. Functional leukocyte adherence glycoproteins
C. Marked neutrophilia
D. Normal wound healing
E. Purulent abscess formation Answer: C. You suspect leukocyte
adhesion deficiency (LAD) as the etiology of this child's problem. LAD
is an inheritable disorder of leukocyte chemotaxis and adherence
characterized by recurring sinopulmonary, oropharyngeal, and cutaneous
infections with delayed wound healing. Neutrophila is common with
WBC counts of typically more than 50,000 cells/mm. Severe, life-
threatening infection is possible with Staphylococcus species,
Enterobacteriaceae, and Candida species. Good skin and oral hygiene
are important; broad-spectrum antimicrobials and surgical debridement
are early consideration with infection.
,● (4) A 6-month-old girl is seen after an emergency room visit for
decreased intake, emesis, and watery diarrhea for the past 3 days. She
was diagnosed yesterday with "stomach flu" and given IV fluids. She is
doing better today with improved intake and resolution of her emesis
and diarrhea. The father is concerned about her thrush since birth
(despite multiple courses of an oral antifungal) and that she has been
hospitalized twice for pneumonia over the past 4 months. Her weight has
dropped from the 50th percentile on her 4-month visit to the 5th
percentile today. She has no findings consistent with dehydration, but
she does appear to have some extremity muscle wasting. Her
examination is remarkable for buccal mucosal exudates and hyperactive
bowel sounds. Vital signs and the remainder of her examination are
normal. You suspect severe combined immunodeficiency (SCID). Which
of the following is consistent with the diagn Answer: C. SCID is an
autosomal recessive or X-linked disorder of both humoral and cellular
immunity. Serum immunoglobulins and T cells are often markedly
diminished or absent. Thymic dysgenesis is also seen. Recurring
cutaneous, gastrointestinal, or pulmonary infections occur with
opportunistic organisms such as cytomegalovirus (CMV) and PCP.
Death typically occurs in the first 12 to 24 months of life unless bone
marrow transplantation is performed.
● (4) You are called urgently to examine a term, 2-hour-old newborn
who has had temperature instability, difficulty with feeding, and a
suspected seizure. He has atypical facies (wide-set eyes, a prominent
nose, and a small mandible), a cleft palate, and a holosystolic murmur.
Stat laboratory tests and chest radiograph reveal marked hypocalcemia, a
, boot-shaped heart, and no apparent thymus. Which of the following is
the most likely diagnosis?
A. Ataxia-telangiectasia
B. DiGeorge syndrome
C. Hyper-IgE syndrome
D. SCID
E. Wiskott-Aldrich syndrome Answer: B. DiGeorge syndrome is caused
by a 22q11 microdeletion. This syndromic immunodeficiency is
characterized by decreased T-cell production and recurring infection.
Findings include characteristic facies and velocardiofacial defects such
as ventricular septal defect and tetralogy of Fallot. Thymic or
parathyroid dysgenesis can occur, accompanied by hypocalcemia and
seizures. Developmental and speech delay are common in older patients.
● (6) A 2-day-old infant has significant nasal and rectal bleeding. He
was delivered by a midwife at home; the pregnancy was without
complications. His Apgar scores were 9 at 1 minute and 9 at 5 minutes.
He has breast-fed well and has not required a health-care professional
visit since birth. Which of the following vitamin deficiencies might
explain his condition?
A. Vitamin A
B. Vitamin B1
C. Vitamin C
D. Vitamin D
GUARANTEED PASS ANSWERS GRADED A+
● (4) A mother notes her 6-week-old son's umbilical cord is still
attached. His activity and intake are normal; there has been no illness or
fever. Delivery was at term without problems. His examination is
notable for a cord without evidence of separation and a shallow, 0.5cm
ulceration at the occiput without discharge or surrounding erythema.
Mother declares that the "sore," caused by a scalp probe, has been
slowly healing since birth and was deemed unremarkable at his 2-week
checkup. Which of the following is consistent with this child's likely
diagnosis?
A. Defective humoral response
B. Functional leukocyte adherence glycoproteins
C. Marked neutrophilia
D. Normal wound healing
E. Purulent abscess formation Answer: C. You suspect leukocyte
adhesion deficiency (LAD) as the etiology of this child's problem. LAD
is an inheritable disorder of leukocyte chemotaxis and adherence
characterized by recurring sinopulmonary, oropharyngeal, and cutaneous
infections with delayed wound healing. Neutrophila is common with
WBC counts of typically more than 50,000 cells/mm. Severe, life-
threatening infection is possible with Staphylococcus species,
Enterobacteriaceae, and Candida species. Good skin and oral hygiene
are important; broad-spectrum antimicrobials and surgical debridement
are early consideration with infection.
,● (4) A 6-month-old girl is seen after an emergency room visit for
decreased intake, emesis, and watery diarrhea for the past 3 days. She
was diagnosed yesterday with "stomach flu" and given IV fluids. She is
doing better today with improved intake and resolution of her emesis
and diarrhea. The father is concerned about her thrush since birth
(despite multiple courses of an oral antifungal) and that she has been
hospitalized twice for pneumonia over the past 4 months. Her weight has
dropped from the 50th percentile on her 4-month visit to the 5th
percentile today. She has no findings consistent with dehydration, but
she does appear to have some extremity muscle wasting. Her
examination is remarkable for buccal mucosal exudates and hyperactive
bowel sounds. Vital signs and the remainder of her examination are
normal. You suspect severe combined immunodeficiency (SCID). Which
of the following is consistent with the diagn Answer: C. SCID is an
autosomal recessive or X-linked disorder of both humoral and cellular
immunity. Serum immunoglobulins and T cells are often markedly
diminished or absent. Thymic dysgenesis is also seen. Recurring
cutaneous, gastrointestinal, or pulmonary infections occur with
opportunistic organisms such as cytomegalovirus (CMV) and PCP.
Death typically occurs in the first 12 to 24 months of life unless bone
marrow transplantation is performed.
● (4) You are called urgently to examine a term, 2-hour-old newborn
who has had temperature instability, difficulty with feeding, and a
suspected seizure. He has atypical facies (wide-set eyes, a prominent
nose, and a small mandible), a cleft palate, and a holosystolic murmur.
Stat laboratory tests and chest radiograph reveal marked hypocalcemia, a
, boot-shaped heart, and no apparent thymus. Which of the following is
the most likely diagnosis?
A. Ataxia-telangiectasia
B. DiGeorge syndrome
C. Hyper-IgE syndrome
D. SCID
E. Wiskott-Aldrich syndrome Answer: B. DiGeorge syndrome is caused
by a 22q11 microdeletion. This syndromic immunodeficiency is
characterized by decreased T-cell production and recurring infection.
Findings include characteristic facies and velocardiofacial defects such
as ventricular septal defect and tetralogy of Fallot. Thymic or
parathyroid dysgenesis can occur, accompanied by hypocalcemia and
seizures. Developmental and speech delay are common in older patients.
● (6) A 2-day-old infant has significant nasal and rectal bleeding. He
was delivered by a midwife at home; the pregnancy was without
complications. His Apgar scores were 9 at 1 minute and 9 at 5 minutes.
He has breast-fed well and has not required a health-care professional
visit since birth. Which of the following vitamin deficiencies might
explain his condition?
A. Vitamin A
B. Vitamin B1
C. Vitamin C
D. Vitamin D
