NR602 Advanced Pediatric Nursing Care for Nurse
Practitioners Exam Prep Bundle | NR602 Study Guide,
Verified Practice Questions & Answers, Detailed Rationales,
Pediatric Primary Care Review, Midterm & Final Exam
Preparation for NR602 Success
Question 1: A 28-year-old pregnant patient at 32 weeks gestation presents with new-onset
hypertension (150/95 mmHg), proteinuria (300 mg/24hr), and persistent headache. Which
condition requires immediate intervention to prevent progression to eclampsia?
A. Gestational hypertension
B. Chronic hypertension
C. Preeclampsia
D. White-coat hypertension
CORRECT ANSWER: C. Preeclampsia
Rationale: Preeclampsia is defined by new-onset hypertension after 20 weeks gestation with
proteinuria or end-organ dysfunction. The presence of headache indicates possible cerebral
involvement, signaling severe features requiring urgent evaluation and magnesium sulfate
prophylaxis to prevent eclamptic seizures. Gestational hypertension lacks proteinuria/organ
dysfunction; chronic hypertension predates pregnancy; white-coat hypertension shows
elevated readings only in clinical settings.
Question 2: During a well-child visit for a 6-month-old infant, which developmental milestone
should the nurse practitioner expect the infant to demonstrate?
A. Walking with assistance
B. Pincer grasp of small objects
C. Rolling from back to front
D. Saying two-word phrases
CORRECT ANSWER: C. Rolling from back to front
Rationale: By 6 months, infants typically roll from back to front and front to back. Walking with
assistance emerges around 9-12 months; pincer grasp develops at 9-10 months; two-word
phrases appear around 18-24 months. Assessing age-appropriate milestones guides early
intervention referrals if delays are identified.
Question 3: A breastfeeding mother reports painful, cracked nipples and asks for
management strategies. Which recommendation is MOST appropriate as initial intervention?
A. Apply lanolin cream after each feeding and ensure proper latch technique
B. Switch to exclusive formula feeding for 48 hours to allow healing
C. Use warm compresses before feeding and cold compresses after
D. Prescribe topical antibiotic ointment for twice-daily application
CORRECT ANSWER: A. Apply lanolin cream after each feeding and ensure proper latch
technique
Rationale: Painful, cracked nipples most commonly result from improper latch. First-line
management includes lactation consultation to correct positioning/latch, followed by purified
lanolin application to promote healing. Formula supplementation is unnecessary unless
medically indicated; compresses may provide comfort but don't address etiology; antibiotics
are reserved for confirmed bacterial infection.
,Question 4: Which immunization is contraindicated for a 4-month-old infant with a history of
severe allergic reaction (anaphylaxis) to neomycin?
A. DTaP (Diphtheria, Tetanus, acellular Pertussis)
B. IPV (Inactivated Poliovirus)
C. MMR (Measles, Mumps, Rubella)
D. Hepatitis B
CORRECT ANSWER: C. MMR (Measles, Mumps, Rubella)
Rationale: MMR vaccine contains trace amounts of neomycin and is contraindicated in
individuals with anaphylactic allergy to neomycin. DTaP, IPV, and Hepatitis B vaccines do not
contain neomycin. Per CDC guidelines, anaphylaxis to a vaccine component is a true
contraindication to subsequent doses of that vaccine.
Question 5: A 34-year-old woman at 10 weeks gestation reports vaginal bleeding and
cramping. Ultrasound confirms an intrauterine pregnancy with fetal cardiac activity. What is
the MOST appropriate diagnosis?
A. Inevitable abortion
B. Threatened abortion
C. Missed abortion
D. Ectopic pregnancy
CORRECT ANSWER: B. Threatened abortion
Rationale: Threatened abortion is characterized by vaginal bleeding with or without cramping
before 20 weeks gestation, with a closed cervical os and confirmed viable intrauterine
pregnancy. Inevitable abortion involves cervical dilation; missed abortion shows nonviable
pregnancy without expulsion; ectopic pregnancy is excluded by ultrasound confirmation of
intrauterine location.
Question 6: When assessing a 2-year-old child for possible autism spectrum disorder (ASD),
which red flag warrants immediate referral for developmental evaluation?
A. Prefers solitary play over group activities
B. Does not respond to name by 12 months
C. Has occasional tantrums when frustrated
D. Uses 10-15 words at 18 months
CORRECT ANSWER: B. Does not respond to name by 12 months
Rationale: Failure to respond to name by 12 months is a validated early red flag for ASD per
CDC and AAP screening guidelines. While solitary play may be temperamental, tantrums are
developmentally typical, and language milestones vary, lack of response to name indicates
possible social communication deficits requiring prompt evaluation for early intervention
services.
Question 7: A postpartum patient at 2 weeks after vaginal delivery reports fever (38.5°C),
uterine tenderness, and foul-smelling lochia. Which condition is MOST likely?
A. Urinary tract infection
B. Endometritis
C. Mastitis
D. Wound infection
, CORRECT ANSWER: B. Endometritis
Rationale: Endometritis typically presents 24 hours to 2 weeks postpartum with fever, uterine
tenderness, and foul-smelling lochia due to ascending bacterial infection of the decidua. UTI
would present with dysuria/urgency; mastitis involves breast erythema/pain; wound infection
would show localized redness/drainage at episiotomy or cesarean site.
Question 8: Which screening tool is validated for detecting postpartum depression during the
6-week postpartum visit?
A. PHQ-9 (Patient Health Questionnaire-9)
B. Edinburgh Postnatal Depression Scale (EPDS)
C. GAD-7 (Generalized Anxiety Disorder-7)
D. AUDIT-C (Alcohol Use Disorders Identification Test)
CORRECT ANSWER: B. Edinburgh Postnatal Depression Scale (EPDS)
Rationale: The EPDS is specifically validated for perinatal populations, with items addressing
postpartum-specific symptoms like guilt, anxiety, and sleep disturbance unrelated to infant
care. While PHQ-9 is a general depression screen, EPDS has higher sensitivity/specificity in
postpartum women and is recommended by ACOG for routine screening.
Question 9: A 5-year-old child presents with fever, sore throat, and sandpaper-like rash.
Rapid strep test is positive. Which complication is this child at increased risk for if untreated?
A. Rheumatic fever
B. Glomerulonephritis
C. Scarlet fever
D. Peritonsillar abscess
CORRECT ANSWER: A. Rheumatic fever
Rationale: Untreated group A streptococcal pharyngitis can lead to acute rheumatic fever, an
autoimmune sequela affecting heart, joints, skin, and brain. While scarlet fever describes the
rash presentation (already present), rheumatic fever is the serious preventable complication.
Glomerulonephritis is another post-strep complication but less directly linked to pharyngitis
treatment timing.
Question 10: During preconception counseling, which supplement should a woman planning
pregnancy begin taking at least 1 month before conception to reduce neural tube defect risk?
A. Iron 30 mg daily
B. Calcium 1000 mg daily
C. Folic acid 400-800 mcg daily
D. Vitamin D 600 IU daily
CORRECT ANSWER: C. Folic acid 400-800 mcg daily
Rationale: Per CDC and ACOG guidelines, folic acid supplementation starting ≥1 month pre-
conception reduces neural tube defect risk by 50-70%. Neural tube closure occurs by day 28
post-conception, often before pregnancy recognition. Iron, calcium, and vitamin D support
overall health but do not specifically prevent neural tube defects.
Question 11: A 3-year-old child is brought for evaluation of speech delay. The child uses 5-10
words, follows simple commands, but does not combine words. Which action is MOST
appropriate?
Practitioners Exam Prep Bundle | NR602 Study Guide,
Verified Practice Questions & Answers, Detailed Rationales,
Pediatric Primary Care Review, Midterm & Final Exam
Preparation for NR602 Success
Question 1: A 28-year-old pregnant patient at 32 weeks gestation presents with new-onset
hypertension (150/95 mmHg), proteinuria (300 mg/24hr), and persistent headache. Which
condition requires immediate intervention to prevent progression to eclampsia?
A. Gestational hypertension
B. Chronic hypertension
C. Preeclampsia
D. White-coat hypertension
CORRECT ANSWER: C. Preeclampsia
Rationale: Preeclampsia is defined by new-onset hypertension after 20 weeks gestation with
proteinuria or end-organ dysfunction. The presence of headache indicates possible cerebral
involvement, signaling severe features requiring urgent evaluation and magnesium sulfate
prophylaxis to prevent eclamptic seizures. Gestational hypertension lacks proteinuria/organ
dysfunction; chronic hypertension predates pregnancy; white-coat hypertension shows
elevated readings only in clinical settings.
Question 2: During a well-child visit for a 6-month-old infant, which developmental milestone
should the nurse practitioner expect the infant to demonstrate?
A. Walking with assistance
B. Pincer grasp of small objects
C. Rolling from back to front
D. Saying two-word phrases
CORRECT ANSWER: C. Rolling from back to front
Rationale: By 6 months, infants typically roll from back to front and front to back. Walking with
assistance emerges around 9-12 months; pincer grasp develops at 9-10 months; two-word
phrases appear around 18-24 months. Assessing age-appropriate milestones guides early
intervention referrals if delays are identified.
Question 3: A breastfeeding mother reports painful, cracked nipples and asks for
management strategies. Which recommendation is MOST appropriate as initial intervention?
A. Apply lanolin cream after each feeding and ensure proper latch technique
B. Switch to exclusive formula feeding for 48 hours to allow healing
C. Use warm compresses before feeding and cold compresses after
D. Prescribe topical antibiotic ointment for twice-daily application
CORRECT ANSWER: A. Apply lanolin cream after each feeding and ensure proper latch
technique
Rationale: Painful, cracked nipples most commonly result from improper latch. First-line
management includes lactation consultation to correct positioning/latch, followed by purified
lanolin application to promote healing. Formula supplementation is unnecessary unless
medically indicated; compresses may provide comfort but don't address etiology; antibiotics
are reserved for confirmed bacterial infection.
,Question 4: Which immunization is contraindicated for a 4-month-old infant with a history of
severe allergic reaction (anaphylaxis) to neomycin?
A. DTaP (Diphtheria, Tetanus, acellular Pertussis)
B. IPV (Inactivated Poliovirus)
C. MMR (Measles, Mumps, Rubella)
D. Hepatitis B
CORRECT ANSWER: C. MMR (Measles, Mumps, Rubella)
Rationale: MMR vaccine contains trace amounts of neomycin and is contraindicated in
individuals with anaphylactic allergy to neomycin. DTaP, IPV, and Hepatitis B vaccines do not
contain neomycin. Per CDC guidelines, anaphylaxis to a vaccine component is a true
contraindication to subsequent doses of that vaccine.
Question 5: A 34-year-old woman at 10 weeks gestation reports vaginal bleeding and
cramping. Ultrasound confirms an intrauterine pregnancy with fetal cardiac activity. What is
the MOST appropriate diagnosis?
A. Inevitable abortion
B. Threatened abortion
C. Missed abortion
D. Ectopic pregnancy
CORRECT ANSWER: B. Threatened abortion
Rationale: Threatened abortion is characterized by vaginal bleeding with or without cramping
before 20 weeks gestation, with a closed cervical os and confirmed viable intrauterine
pregnancy. Inevitable abortion involves cervical dilation; missed abortion shows nonviable
pregnancy without expulsion; ectopic pregnancy is excluded by ultrasound confirmation of
intrauterine location.
Question 6: When assessing a 2-year-old child for possible autism spectrum disorder (ASD),
which red flag warrants immediate referral for developmental evaluation?
A. Prefers solitary play over group activities
B. Does not respond to name by 12 months
C. Has occasional tantrums when frustrated
D. Uses 10-15 words at 18 months
CORRECT ANSWER: B. Does not respond to name by 12 months
Rationale: Failure to respond to name by 12 months is a validated early red flag for ASD per
CDC and AAP screening guidelines. While solitary play may be temperamental, tantrums are
developmentally typical, and language milestones vary, lack of response to name indicates
possible social communication deficits requiring prompt evaluation for early intervention
services.
Question 7: A postpartum patient at 2 weeks after vaginal delivery reports fever (38.5°C),
uterine tenderness, and foul-smelling lochia. Which condition is MOST likely?
A. Urinary tract infection
B. Endometritis
C. Mastitis
D. Wound infection
, CORRECT ANSWER: B. Endometritis
Rationale: Endometritis typically presents 24 hours to 2 weeks postpartum with fever, uterine
tenderness, and foul-smelling lochia due to ascending bacterial infection of the decidua. UTI
would present with dysuria/urgency; mastitis involves breast erythema/pain; wound infection
would show localized redness/drainage at episiotomy or cesarean site.
Question 8: Which screening tool is validated for detecting postpartum depression during the
6-week postpartum visit?
A. PHQ-9 (Patient Health Questionnaire-9)
B. Edinburgh Postnatal Depression Scale (EPDS)
C. GAD-7 (Generalized Anxiety Disorder-7)
D. AUDIT-C (Alcohol Use Disorders Identification Test)
CORRECT ANSWER: B. Edinburgh Postnatal Depression Scale (EPDS)
Rationale: The EPDS is specifically validated for perinatal populations, with items addressing
postpartum-specific symptoms like guilt, anxiety, and sleep disturbance unrelated to infant
care. While PHQ-9 is a general depression screen, EPDS has higher sensitivity/specificity in
postpartum women and is recommended by ACOG for routine screening.
Question 9: A 5-year-old child presents with fever, sore throat, and sandpaper-like rash.
Rapid strep test is positive. Which complication is this child at increased risk for if untreated?
A. Rheumatic fever
B. Glomerulonephritis
C. Scarlet fever
D. Peritonsillar abscess
CORRECT ANSWER: A. Rheumatic fever
Rationale: Untreated group A streptococcal pharyngitis can lead to acute rheumatic fever, an
autoimmune sequela affecting heart, joints, skin, and brain. While scarlet fever describes the
rash presentation (already present), rheumatic fever is the serious preventable complication.
Glomerulonephritis is another post-strep complication but less directly linked to pharyngitis
treatment timing.
Question 10: During preconception counseling, which supplement should a woman planning
pregnancy begin taking at least 1 month before conception to reduce neural tube defect risk?
A. Iron 30 mg daily
B. Calcium 1000 mg daily
C. Folic acid 400-800 mcg daily
D. Vitamin D 600 IU daily
CORRECT ANSWER: C. Folic acid 400-800 mcg daily
Rationale: Per CDC and ACOG guidelines, folic acid supplementation starting ≥1 month pre-
conception reduces neural tube defect risk by 50-70%. Neural tube closure occurs by day 28
post-conception, often before pregnancy recognition. Iron, calcium, and vitamin D support
overall health but do not specifically prevent neural tube defects.
Question 11: A 3-year-old child is brought for evaluation of speech delay. The child uses 5-10
words, follows simple commands, but does not combine words. Which action is MOST
appropriate?
