NUR 621 MODULE 4 EXAM STUDY GUIDE — UTICA COLLEGE
Health Promotion & Primary Care I | 2026 Update | Complete
Solutions
Welcome to your Module 4 comprehensive review. As your FNP educator, I expect you to not
only memorize these guidelines but to internalize the clinical reasoning behind them. The
NUR 621 exam will test your ability to prioritize, differentiate, and apply evidence-based
protocols at the point of care. Master this guide, and you will master the exam.
PART A: PECARN GUIDELINES & HEAD INJURY MANAGEMENT DRILL (Questions 1-10)
1. A 14-month-old presents after falling from a bed (2.5 feet) onto a carpeted floor. The child
cried immediately, is currently acting normally per the parents, has a GCS of 15, no vomiting,
and no palpable skull fracture. What is the most appropriate next step?
A) Observe in the clinic for 6 hours
B) Order a non-contrast head CT
C) Discharge home with return precautions
D) Refer to pediatric neurology
Correct Answer: C) Discharge home with return precautions
Rationale: This child meets PECARN criteria for "very low risk" (<0.02% risk of ciTBI) for
children <2 years: normal mental status, no LOC, no palpable skull fracture, no vomiting, and
a minor mechanism of injury (<3 feet).
High-Yield Pearl: PECARN is a decision rule designed to reduce unnecessary CTs. If a child <2
has a minor mechanism, normal exam, and no red flags, you discharge—do not observe or
scan.
2. Which of the following is considered a HIGH-risk factor for clinically important traumatic
brain injury (ciTBI) in a child UNDER 2 years old, necessitating a CT scan?
A) Loss of consciousness for 10 seconds
B) Not acting normally per parent
,C) Palpable skull fracture
D) One episode of vomiting
Correct Answer: C) Palpable skull fracture
Rationale: Palpable skull fracture is a high-risk factor indicating a need for CT. LOC >5 seconds
and "not acting normally" are medium-risk factors (warranting observation or CT based on
clinical judgment). Isolated vomiting is not independently high-risk in this age group without
other findings.
High-Yield Pearl: Memorize the "Big 3" high-risk factors for <2 years: Altered mental status,
Palpable skull fracture, Severe mechanism of injury.
3. A 3-year-old falls off a playground slide (4-foot fall onto concrete). They have a GCS of 14,
are sleepy but arousable, and have a suspected basilar skull fracture (Battle's sign). What is
the priority intervention?
A) Discharge with strict return precautions
B) Immediate non-contrast head CT
C) Observation for 4 hours and re-evaluate
D) Prescribe oral analgesics and follow up in 1 week
Correct Answer: B) Immediate non-contrast head CT
Rationale: For children ≥2 years, high-risk factors include altered mental status (GCS <15),
signs of basilar skull fracture, and severe mechanism. This patient has three high-risk factors.
High-Yield Pearl: For children ≥2 years, the "Big 3" high-risk factors are: Altered mental status,
Signs of basilar skull fracture, Severe mechanism. Any of these = CT.
4. A 20-month-old has a severe mechanism of injury (fall down 12 stairs) but has a normal
mental status, no LOC, no vomiting, and no palpable fracture. How should the FNP classify
this patient?
A) Very low risk
B) Low risk
C) Medium risk
, D) High risk
Correct Answer: C) Medium risk
Rationale: Severe mechanism of injury in a child <2 places them in the medium-risk category,
even without other symptoms. Medium-risk factors warrant either observation or CT,
depending on clinical gestalt, physician comfort, and parent preference.
High-Yield Pearl: Severe mechanism is a tricky variable—it is HIGH risk for ≥2 years, but
MEDIUM risk for <2 years unless accompanied by altered mental status or palpable fracture.
5. What constitutes a "severe mechanism of injury" according to PECARN guidelines for a 10-
month-old?
A) Fall from a standing height
B) Fall from >3 feet
C) Motor vehicle crash with ejection
D) Fall from a couch onto a padded rug
Correct Answer: C) Motor vehicle crash with ejection
Rationale: Severe mechanisms specifically include MVC with ejection, pedestrian or bicyclist
struck by motorized vehicle, or fall >3 feet (for those <2).
*High-Yield Pearl:* When you see "ejection," "pedestrian struck," or ">3 feet" in a stem, your
clinical radar must immediately shift to PECARN risk stratification.
6. A 2.5-year-old strikes their head on a table. They cried immediately, never lost
consciousness, and are playing normally in the exam room. The parent asks if the child needs
an X-ray of the skull. What is the FNP's best response?
A) "Skull X-rays are the gold standard for pediatric head trauma."
B) "Because there is no palpable fracture and normal mental status, imaging is not indicated."
C) "We must order a CT scan because any head trauma after age 2 requires imaging."
D) "We will observe for 24 hours in the hospital to be safe."
Correct Answer: B) "Because there is no palpable fracture and normal mental status, imaging
is not indicated."
Health Promotion & Primary Care I | 2026 Update | Complete
Solutions
Welcome to your Module 4 comprehensive review. As your FNP educator, I expect you to not
only memorize these guidelines but to internalize the clinical reasoning behind them. The
NUR 621 exam will test your ability to prioritize, differentiate, and apply evidence-based
protocols at the point of care. Master this guide, and you will master the exam.
PART A: PECARN GUIDELINES & HEAD INJURY MANAGEMENT DRILL (Questions 1-10)
1. A 14-month-old presents after falling from a bed (2.5 feet) onto a carpeted floor. The child
cried immediately, is currently acting normally per the parents, has a GCS of 15, no vomiting,
and no palpable skull fracture. What is the most appropriate next step?
A) Observe in the clinic for 6 hours
B) Order a non-contrast head CT
C) Discharge home with return precautions
D) Refer to pediatric neurology
Correct Answer: C) Discharge home with return precautions
Rationale: This child meets PECARN criteria for "very low risk" (<0.02% risk of ciTBI) for
children <2 years: normal mental status, no LOC, no palpable skull fracture, no vomiting, and
a minor mechanism of injury (<3 feet).
High-Yield Pearl: PECARN is a decision rule designed to reduce unnecessary CTs. If a child <2
has a minor mechanism, normal exam, and no red flags, you discharge—do not observe or
scan.
2. Which of the following is considered a HIGH-risk factor for clinically important traumatic
brain injury (ciTBI) in a child UNDER 2 years old, necessitating a CT scan?
A) Loss of consciousness for 10 seconds
B) Not acting normally per parent
,C) Palpable skull fracture
D) One episode of vomiting
Correct Answer: C) Palpable skull fracture
Rationale: Palpable skull fracture is a high-risk factor indicating a need for CT. LOC >5 seconds
and "not acting normally" are medium-risk factors (warranting observation or CT based on
clinical judgment). Isolated vomiting is not independently high-risk in this age group without
other findings.
High-Yield Pearl: Memorize the "Big 3" high-risk factors for <2 years: Altered mental status,
Palpable skull fracture, Severe mechanism of injury.
3. A 3-year-old falls off a playground slide (4-foot fall onto concrete). They have a GCS of 14,
are sleepy but arousable, and have a suspected basilar skull fracture (Battle's sign). What is
the priority intervention?
A) Discharge with strict return precautions
B) Immediate non-contrast head CT
C) Observation for 4 hours and re-evaluate
D) Prescribe oral analgesics and follow up in 1 week
Correct Answer: B) Immediate non-contrast head CT
Rationale: For children ≥2 years, high-risk factors include altered mental status (GCS <15),
signs of basilar skull fracture, and severe mechanism. This patient has three high-risk factors.
High-Yield Pearl: For children ≥2 years, the "Big 3" high-risk factors are: Altered mental status,
Signs of basilar skull fracture, Severe mechanism. Any of these = CT.
4. A 20-month-old has a severe mechanism of injury (fall down 12 stairs) but has a normal
mental status, no LOC, no vomiting, and no palpable fracture. How should the FNP classify
this patient?
A) Very low risk
B) Low risk
C) Medium risk
, D) High risk
Correct Answer: C) Medium risk
Rationale: Severe mechanism of injury in a child <2 places them in the medium-risk category,
even without other symptoms. Medium-risk factors warrant either observation or CT,
depending on clinical gestalt, physician comfort, and parent preference.
High-Yield Pearl: Severe mechanism is a tricky variable—it is HIGH risk for ≥2 years, but
MEDIUM risk for <2 years unless accompanied by altered mental status or palpable fracture.
5. What constitutes a "severe mechanism of injury" according to PECARN guidelines for a 10-
month-old?
A) Fall from a standing height
B) Fall from >3 feet
C) Motor vehicle crash with ejection
D) Fall from a couch onto a padded rug
Correct Answer: C) Motor vehicle crash with ejection
Rationale: Severe mechanisms specifically include MVC with ejection, pedestrian or bicyclist
struck by motorized vehicle, or fall >3 feet (for those <2).
*High-Yield Pearl:* When you see "ejection," "pedestrian struck," or ">3 feet" in a stem, your
clinical radar must immediately shift to PECARN risk stratification.
6. A 2.5-year-old strikes their head on a table. They cried immediately, never lost
consciousness, and are playing normally in the exam room. The parent asks if the child needs
an X-ray of the skull. What is the FNP's best response?
A) "Skull X-rays are the gold standard for pediatric head trauma."
B) "Because there is no palpable fracture and normal mental status, imaging is not indicated."
C) "We must order a CT scan because any head trauma after age 2 requires imaging."
D) "We will observe for 24 hours in the hospital to be safe."
Correct Answer: B) "Because there is no palpable fracture and normal mental status, imaging
is not indicated."
