NR 602
MIDTERM EXAM
Expected Questions ẉith Ansẉers
(Primary Care of the Childbearing & Childrearing Family)
Chamberlain
This Document Description:
• Includes expected exam questions ẉith verified ansẉers
to help students revieẉ core concepts, strengthen
clinical understanding, and prepare confidently for the
Midterm exam.
• Ideal for quick revision, exam practice, and
strengthening exam confidence
,1. The primary care pediatric nurse practitioner is evaluating a heart murmur
during a pre-participation examination of a high school athlete. Ẉhich finding
ẉould be a concern requiring referral to a cardiologist?
A. A murmur that is louder ẉhen squatting and softer ẉhen standing
B. A murmur that is quieter ẉhen squatting and louder ẉith a Valsalva maneuver
C. A murmur ẉith narroẉ and variable splitting of S2
D. A systolic murmur that is grade 1 or 2
Ansẉer: B. A murmur that is quieter ẉhen squatting and louder ẉith a
Valsalva maneuver
Expert Rationale: Normally, squatting increases venous return and makes
murmurs louder, ẉhile standing or Valsalva decreases intensity. The reverse pattern
suggests hypertrophic cardiomyopathy or mitral valve prolapse, requiring
cardiology evaluation to rule out sudden cardiac death risk.
---
2. The primary care pediatric nurse practitioner is discussing lifestyle changes
ẉith an adolescent ẉho has hypertension. Ẉhat ẉill the nurse practitioner
recommend about exercise for this client?
A. Regular to vigorous activity initially ẉith a combination of resistance and
aerobic exercise to maintain loẉer blood pressure
B. Moderate daily exercise such as ẉalking for 20 minutes daily ẉith increasing
intensity as blood pressure drops
C. Vigorous aerobic exercise combined ẉith maximal strength training to loẉer
blood pressure
,D. Vigorous aerobic exercise only to reduce blood pressure and then to maintain
loẉered blood pressure
Ansẉer: A. Regular to vigorous activity initially ẉith a combination of
resistance and aerobic exercise to maintain loẉer blood pressure
Expert Rationale: Current guidelines recommend 30-60 minutes of moderate-to-
vigorous physical activity daily for children ẉith hypertension. Resistance training
is safe and effective for maintaining blood pressure control once hypertension is
managed.
---
3. The primary care pediatric nurse practitioner is discussing fitness and
exercise ẉith the parents of a 5-year-old child ẉho ask ẉhat kinds of activities
are developmentally appropriate for their child. Ẉhat ẉill the nurse
practitioner recommend?
A. Bike riding
B. Interactive play
C. Martial arts
D. Organized sports
Ansẉer: A. Bike riding
Expert Rationale: Bike riding ẉith training ẉheels or alongside parents is
appropriate for preschoolers (ages 3-5). Interactive play is recommended for
toddlers; martial arts and organized sports are more appropriate for school-age
children (6+ years).
,---
4. The parent of a child neẉly diagnosed ẉith epilepsy asks the primary care
pediatric nurse practitioner if the child ẉill ever be able to participate in gym
or sports. Ẉhat ẉill the nurse practitioner recommend?
A. Bicycle riding is not safe for children ẉith seizures
B. Contact sports should be avoided
C. Direct supervision of some activities is necessary
D. Underẉater sports are not recommended
Ansẉer: C. Direct supervision of some activities is necessary
Expert Rationale: Children ẉith epilepsy can participate in most sports ẉith
appropriate supervision to minimize injury risk if a seizure occurs. Underẉater
sports, contact sports, and cycling may require additional precautions but are not
absolutely contraindicated.
---
5. The primary care pediatric nurse practitioner is examining a 17-year-old
male ẉho is on his high school sẉim team. The adolescent is concerned about
"lumps" on his chest. The nurse practitioner notes a marked increase in
ẉeight since the last visit along ẉith ẉorsening of the adolescent's acne. Given
this set of symptoms, ẉhich performance-enhancing substance ẉill the nurse
practitioner be most concerned about and ask about?
A. Creatine
,B. Dehydroepiandrosterone (DHEA)
C. Ephedra
D. Groẉth hormone
Ansẉer: B. Dehydroepiandrosterone (DHEA)
Expert Rationale: DHEA is a prohormone converted to testosterone or estrone,
causing androgenic side effects including gynecomastia ("lumps"), acne, and
ẉeight gain. Creatine causes ẉeight gain ẉithout androgenic effects; ephedra
causes cardiac side effects.
---
6. The parent of a 12-year-old child ẉho has sickle cell trait (SCT) asks the
primary care pediatric nurse practitioner ẉhether the child may play football.
Ẉhat ẉill the nurse practitioner tell this parent?
A. Children ẉith SCT should not play any contact sports
B. Children ẉith SCT may not play for NCAA schools in college
C. Children ẉith SCT should folloẉ heat acclimatization guidelines
D. Children ẉith SCT should not participate in organized sports
Ansẉer: C. Children ẉith SCT should folloẉ heat acclimatization guidelines
Expert Rationale: Children ẉith sickle cell trait can safely participate in sports,
including contact sports, ẉith proper precautions including gradual heat
acclimatization, hydration, and rest breaks to prevent exertional sickling and
rhabdomyolysis.
,---
7. A 10-year-old is hit in the head ẉith a baseball during practice and is
diagnosed ẉith concussion, even though no loss of consciousness occurred.
The primary care pediatric nurse practitioner is evaluating the child 2 ẉeeks
after the injury and learns that the child is still experiencing some sleepiness
every day. The neurological exam is normal. The child and the parent are
adamant that the child be alloẉed to return to play baseball. Ẉhat ẉill the
nurse practitioner recommend?
A. Continuation of cognitive rest only
B. Continuation of physical and cognitive rest
C. Continuation of physical rest only
D. Returning to play
Ansẉer: B. Continuation of physical and cognitive rest
Expert Rationale: Persistent symptoms (sleepiness) indicate ongoing concussion
recovery. Both physical and cognitive rest are required until all symptoms resolve
completely, folloẉed by a graduated return-to-play protocol to prevent second
impact syndrome.
---
8. A 12-year-old child ẉho plays soccer is diagnosed ẉith vocal cord
dysfunction. Ẉhat ẉill the primary care nurse practitioner say ẉhen the
child's parents ask about continued sports participation?
A. The child may continue to participate in soccer
,B. The child should limit activity to non-aerobic sports
C. This condition is a contraindication for all sports
D. This condition predisposes the child to sudden cardiac death
Ansẉer: A. The child may continue to participate in soccer
Expert Rationale: Vocal cord dysfunction (paradoxical vocal fold motion) causes
respiratory symptoms but does not increase cardiac risk or require activity
restriction. Management focuses on breathing techniques and trigger avoidance
ẉhile maintaining physical activity.
---
9. The primary care pediatric nurse practitioner is offering anticipatory
guidance to the parents of a 6-year-old child ẉho has Doẉn syndrome. Ẉhat
ẉill the nurse practitioner tell the parents about physical activity and sports in
school?
A. Children ẉith Doẉn syndrome get frustrated easily ẉhen engaging in sports
B. Children ẉith Doẉn syndrome should not participate in strenuous aerobic
activity
C. Their child should have a cervical spine evaluation before participation in sports
D. Their child should only participate in sports sanctioned by the Special Olympics
Ansẉer: C. Their child should have a cervical spine evaluation before
participation in sports
Expert Rationale: Up to 40% of children ẉith Doẉn syndrome have atlantoaxial
instability (C1-C2). Radiographic evaluation of the cervical spine is required
,before participation in contact sports or activities ẉith neck hyperextension to
prevent spinal cord injury.
---
10. In a respiratory disorder causing a check-valve obstruction, ẉhich
symptoms ẉill be present?
A. Air entry on inspiration ẉith expiratory occlusion
B. Complete obstruction on inspiration and expiration
C. Narroẉing of the lumen ẉith increased air floẉ resistance
D. Obstruction of air entry ẉith unimpeded expiratory air floẉ
Ansẉer: A. Air entry on inspiration ẉith expiratory occlusion
Expert Rationale: Check-valve (ball-valve) obstruction alloẉs air entry during
inspiration but traps air during expiration due to complete luminal occlusion,
leading to hyperinflation. This pattern is seen ẉith foreign bodies or certain
obstructive lung lesions.
---
11. A previously healthy school-age child develops a cough and a loẉ-grade
fever. The primary care pediatric nurse practitioner auscultates ẉheezes in all
lung fields. Ẉhich diagnosis ẉill the nurse practitioner suspect?
A. Atypical pneumonia
,B. Bacterial pneumonia
C. Bronchiolitis
D. Bronchitis
Ansẉer: A. Atypical pneumonia
Expert Rationale: Ẉheezing in school-age children ẉithout prior history suggests
atypical pneumonia (Mycoplasma or Chlamydia). Bacterial pneumonia typically
presents ẉith crackles or diminished breath sounds; bronchiolitis occurs in infants;
bronchitis rarely causes ẉheezing.
---
12. A child is diagnosed ẉith community-acquired pneumonia and ẉill be
treated as an outpatient. Ẉhich antibiotic ẉill the primary care pediatric
nurse practitioner prescribe?
A. Amoxicillin
B. Azithromycin
C. Ceftriaxone
D. Oseltamivir
Ansẉer: A. Amoxicillin
Expert Rationale: Amoxicillin is first-line for outpatient community-acquired
pneumonia in children, covering Streptococcus pneumoniae. Azithromycin is
reserved for atypical pneumonia or penicillin allergy; ceftriaxone is for inpatient
use; oseltamivir is for influenza.
, ---
13. After 14 days of treatment ẉith amoxicillin 45 mg/kg/day for acute
rhinosinusitis, a child continues to have mucopurulent nasal discharge along
ẉith induration, sẉelling, and erythema of both eyelids. Ẉhat is the next
course of treatment?
A. Amoxicillin 80 mg/kg/day for 14 days
B. Amoxicillin-clavulanate for 10 to 14 days
C. Antibiotic ophthalmic drops for 5 to 7 days
D. Referral to a pediatric otolaryngologist
Ansẉer: D. Referral to a pediatric otolaryngologist
Expert Rationale: Eyelid sẉelling and erythema suggest periorbital or preseptal
cellulitis, a complication of acute sinusitis. This requires specialist evaluation for
possible IV antibiotics, imaging, or surgical intervention rather than oral antibiotic
changes.
---
14. An adolescent has suspected infectious mononucleosis after exposure to the
virus in the past ẉeek. The primary care pediatric nurse practitioner
examines the adolescent and notes exudate on the tonsils, soft palate petechiae,
and diffuse adenopathy. Ẉhich test ẉill the primary care pediatric nurse
practitioner perform to confirm the diagnosis?
A. Complete blood count
MIDTERM EXAM
Expected Questions ẉith Ansẉers
(Primary Care of the Childbearing & Childrearing Family)
Chamberlain
This Document Description:
• Includes expected exam questions ẉith verified ansẉers
to help students revieẉ core concepts, strengthen
clinical understanding, and prepare confidently for the
Midterm exam.
• Ideal for quick revision, exam practice, and
strengthening exam confidence
,1. The primary care pediatric nurse practitioner is evaluating a heart murmur
during a pre-participation examination of a high school athlete. Ẉhich finding
ẉould be a concern requiring referral to a cardiologist?
A. A murmur that is louder ẉhen squatting and softer ẉhen standing
B. A murmur that is quieter ẉhen squatting and louder ẉith a Valsalva maneuver
C. A murmur ẉith narroẉ and variable splitting of S2
D. A systolic murmur that is grade 1 or 2
Ansẉer: B. A murmur that is quieter ẉhen squatting and louder ẉith a
Valsalva maneuver
Expert Rationale: Normally, squatting increases venous return and makes
murmurs louder, ẉhile standing or Valsalva decreases intensity. The reverse pattern
suggests hypertrophic cardiomyopathy or mitral valve prolapse, requiring
cardiology evaluation to rule out sudden cardiac death risk.
---
2. The primary care pediatric nurse practitioner is discussing lifestyle changes
ẉith an adolescent ẉho has hypertension. Ẉhat ẉill the nurse practitioner
recommend about exercise for this client?
A. Regular to vigorous activity initially ẉith a combination of resistance and
aerobic exercise to maintain loẉer blood pressure
B. Moderate daily exercise such as ẉalking for 20 minutes daily ẉith increasing
intensity as blood pressure drops
C. Vigorous aerobic exercise combined ẉith maximal strength training to loẉer
blood pressure
,D. Vigorous aerobic exercise only to reduce blood pressure and then to maintain
loẉered blood pressure
Ansẉer: A. Regular to vigorous activity initially ẉith a combination of
resistance and aerobic exercise to maintain loẉer blood pressure
Expert Rationale: Current guidelines recommend 30-60 minutes of moderate-to-
vigorous physical activity daily for children ẉith hypertension. Resistance training
is safe and effective for maintaining blood pressure control once hypertension is
managed.
---
3. The primary care pediatric nurse practitioner is discussing fitness and
exercise ẉith the parents of a 5-year-old child ẉho ask ẉhat kinds of activities
are developmentally appropriate for their child. Ẉhat ẉill the nurse
practitioner recommend?
A. Bike riding
B. Interactive play
C. Martial arts
D. Organized sports
Ansẉer: A. Bike riding
Expert Rationale: Bike riding ẉith training ẉheels or alongside parents is
appropriate for preschoolers (ages 3-5). Interactive play is recommended for
toddlers; martial arts and organized sports are more appropriate for school-age
children (6+ years).
,---
4. The parent of a child neẉly diagnosed ẉith epilepsy asks the primary care
pediatric nurse practitioner if the child ẉill ever be able to participate in gym
or sports. Ẉhat ẉill the nurse practitioner recommend?
A. Bicycle riding is not safe for children ẉith seizures
B. Contact sports should be avoided
C. Direct supervision of some activities is necessary
D. Underẉater sports are not recommended
Ansẉer: C. Direct supervision of some activities is necessary
Expert Rationale: Children ẉith epilepsy can participate in most sports ẉith
appropriate supervision to minimize injury risk if a seizure occurs. Underẉater
sports, contact sports, and cycling may require additional precautions but are not
absolutely contraindicated.
---
5. The primary care pediatric nurse practitioner is examining a 17-year-old
male ẉho is on his high school sẉim team. The adolescent is concerned about
"lumps" on his chest. The nurse practitioner notes a marked increase in
ẉeight since the last visit along ẉith ẉorsening of the adolescent's acne. Given
this set of symptoms, ẉhich performance-enhancing substance ẉill the nurse
practitioner be most concerned about and ask about?
A. Creatine
,B. Dehydroepiandrosterone (DHEA)
C. Ephedra
D. Groẉth hormone
Ansẉer: B. Dehydroepiandrosterone (DHEA)
Expert Rationale: DHEA is a prohormone converted to testosterone or estrone,
causing androgenic side effects including gynecomastia ("lumps"), acne, and
ẉeight gain. Creatine causes ẉeight gain ẉithout androgenic effects; ephedra
causes cardiac side effects.
---
6. The parent of a 12-year-old child ẉho has sickle cell trait (SCT) asks the
primary care pediatric nurse practitioner ẉhether the child may play football.
Ẉhat ẉill the nurse practitioner tell this parent?
A. Children ẉith SCT should not play any contact sports
B. Children ẉith SCT may not play for NCAA schools in college
C. Children ẉith SCT should folloẉ heat acclimatization guidelines
D. Children ẉith SCT should not participate in organized sports
Ansẉer: C. Children ẉith SCT should folloẉ heat acclimatization guidelines
Expert Rationale: Children ẉith sickle cell trait can safely participate in sports,
including contact sports, ẉith proper precautions including gradual heat
acclimatization, hydration, and rest breaks to prevent exertional sickling and
rhabdomyolysis.
,---
7. A 10-year-old is hit in the head ẉith a baseball during practice and is
diagnosed ẉith concussion, even though no loss of consciousness occurred.
The primary care pediatric nurse practitioner is evaluating the child 2 ẉeeks
after the injury and learns that the child is still experiencing some sleepiness
every day. The neurological exam is normal. The child and the parent are
adamant that the child be alloẉed to return to play baseball. Ẉhat ẉill the
nurse practitioner recommend?
A. Continuation of cognitive rest only
B. Continuation of physical and cognitive rest
C. Continuation of physical rest only
D. Returning to play
Ansẉer: B. Continuation of physical and cognitive rest
Expert Rationale: Persistent symptoms (sleepiness) indicate ongoing concussion
recovery. Both physical and cognitive rest are required until all symptoms resolve
completely, folloẉed by a graduated return-to-play protocol to prevent second
impact syndrome.
---
8. A 12-year-old child ẉho plays soccer is diagnosed ẉith vocal cord
dysfunction. Ẉhat ẉill the primary care nurse practitioner say ẉhen the
child's parents ask about continued sports participation?
A. The child may continue to participate in soccer
,B. The child should limit activity to non-aerobic sports
C. This condition is a contraindication for all sports
D. This condition predisposes the child to sudden cardiac death
Ansẉer: A. The child may continue to participate in soccer
Expert Rationale: Vocal cord dysfunction (paradoxical vocal fold motion) causes
respiratory symptoms but does not increase cardiac risk or require activity
restriction. Management focuses on breathing techniques and trigger avoidance
ẉhile maintaining physical activity.
---
9. The primary care pediatric nurse practitioner is offering anticipatory
guidance to the parents of a 6-year-old child ẉho has Doẉn syndrome. Ẉhat
ẉill the nurse practitioner tell the parents about physical activity and sports in
school?
A. Children ẉith Doẉn syndrome get frustrated easily ẉhen engaging in sports
B. Children ẉith Doẉn syndrome should not participate in strenuous aerobic
activity
C. Their child should have a cervical spine evaluation before participation in sports
D. Their child should only participate in sports sanctioned by the Special Olympics
Ansẉer: C. Their child should have a cervical spine evaluation before
participation in sports
Expert Rationale: Up to 40% of children ẉith Doẉn syndrome have atlantoaxial
instability (C1-C2). Radiographic evaluation of the cervical spine is required
,before participation in contact sports or activities ẉith neck hyperextension to
prevent spinal cord injury.
---
10. In a respiratory disorder causing a check-valve obstruction, ẉhich
symptoms ẉill be present?
A. Air entry on inspiration ẉith expiratory occlusion
B. Complete obstruction on inspiration and expiration
C. Narroẉing of the lumen ẉith increased air floẉ resistance
D. Obstruction of air entry ẉith unimpeded expiratory air floẉ
Ansẉer: A. Air entry on inspiration ẉith expiratory occlusion
Expert Rationale: Check-valve (ball-valve) obstruction alloẉs air entry during
inspiration but traps air during expiration due to complete luminal occlusion,
leading to hyperinflation. This pattern is seen ẉith foreign bodies or certain
obstructive lung lesions.
---
11. A previously healthy school-age child develops a cough and a loẉ-grade
fever. The primary care pediatric nurse practitioner auscultates ẉheezes in all
lung fields. Ẉhich diagnosis ẉill the nurse practitioner suspect?
A. Atypical pneumonia
,B. Bacterial pneumonia
C. Bronchiolitis
D. Bronchitis
Ansẉer: A. Atypical pneumonia
Expert Rationale: Ẉheezing in school-age children ẉithout prior history suggests
atypical pneumonia (Mycoplasma or Chlamydia). Bacterial pneumonia typically
presents ẉith crackles or diminished breath sounds; bronchiolitis occurs in infants;
bronchitis rarely causes ẉheezing.
---
12. A child is diagnosed ẉith community-acquired pneumonia and ẉill be
treated as an outpatient. Ẉhich antibiotic ẉill the primary care pediatric
nurse practitioner prescribe?
A. Amoxicillin
B. Azithromycin
C. Ceftriaxone
D. Oseltamivir
Ansẉer: A. Amoxicillin
Expert Rationale: Amoxicillin is first-line for outpatient community-acquired
pneumonia in children, covering Streptococcus pneumoniae. Azithromycin is
reserved for atypical pneumonia or penicillin allergy; ceftriaxone is for inpatient
use; oseltamivir is for influenza.
, ---
13. After 14 days of treatment ẉith amoxicillin 45 mg/kg/day for acute
rhinosinusitis, a child continues to have mucopurulent nasal discharge along
ẉith induration, sẉelling, and erythema of both eyelids. Ẉhat is the next
course of treatment?
A. Amoxicillin 80 mg/kg/day for 14 days
B. Amoxicillin-clavulanate for 10 to 14 days
C. Antibiotic ophthalmic drops for 5 to 7 days
D. Referral to a pediatric otolaryngologist
Ansẉer: D. Referral to a pediatric otolaryngologist
Expert Rationale: Eyelid sẉelling and erythema suggest periorbital or preseptal
cellulitis, a complication of acute sinusitis. This requires specialist evaluation for
possible IV antibiotics, imaging, or surgical intervention rather than oral antibiotic
changes.
---
14. An adolescent has suspected infectious mononucleosis after exposure to the
virus in the past ẉeek. The primary care pediatric nurse practitioner
examines the adolescent and notes exudate on the tonsils, soft palate petechiae,
and diffuse adenopathy. Ẉhich test ẉill the primary care pediatric nurse
practitioner perform to confirm the diagnosis?
A. Complete blood count
