PEDIATRIC PRIMARY CARE NP BARKLEY PRACTICE EXAM EXAM
with Questions and Answers/Plus a Rationale Updated 2026 A+/Instant
Download PDF
EXAM COVERAGE
1. Advanced Pediatric Growth, Development, and Behavioral Assessment
2. Pediatric Pathophysiology and Advanced Pharmacotherapeutics
3. Management of Acute and Chronic Pediatric Illnesses Across Settings
4. Pediatric Preventive Care, Immunizations, and Anticipatory Guidance
5. Professional Role, Ethical Standards, and Evidence-Based Practice in Pediatrics
1. A 3-week-old term male infant is brought to the clinic by his parents due to non-bilious projectile
vomiting immediately after feeding over the past 48 hours. The infant is eager to feed again right
after vomiting. Physical examination reveals a small, mobile, olive-shaped mass in the right
upper quadrant. Which acid-base imbalance is most likely to develop if this condition remains
uncorrected?
A. Metabolic acidosis with an elevated anion gap
B. Metabolic alkalosis with hypokalemia and hypochloremia
C. Respiratory alkalosis secondary to compensatory hyperventilation
D. Normal anion gap metabolic acidosis with hyperkalemia
CORRECT ANSWER : B
Rationale: Pyloric stenosis causes persistent vomiting of gastric secretions rich in hydrochloric
acid, resulting in loss of hydrogen and chloride ions, leading to hypochloremic, hypokalemic
metabolic alkalosis. Option A is incorrect because acid loss from the stomach drives alkalosis,
not acidosis. Option C describes a primary respiratory abnormality, whereas this is metabolic.
Option D is incorrect because potassium and chloride are lost through gastric secretions and
renal conservation of hydrogen ions.
,2. A 4-year-old female is brought in by her mother with a 3-day history of high fever, barking
cough, and hoarseness that worsens at night. On examination, the child is afebrile at the moment,
alert, but exhibits mild inspiratory stridor and sternal retractions when agitated. A soft-tissue
neck radiograph reveals a classic subglottic narrowing known as the "steeple sign." What is the
most appropriate initial pharmacological management?
A. Intravenous broad-spectrum cephalosporins
B. A single dose of oral dexamethasone
C. Inhaled racemic epinephrine nebulization as first-line outpatient monotherapy
D. High-dose systemic albuterol nebulization
CORRECT ANSWER : B
Rationale: Mild-to-moderate croup is effectively managed with a single dose of oral
corticosteroid such as dexamethasone to reduce laryngeal mucosal edema. Option A is indicated
for bacterial tracheitis or epiglottitis rather than viral croup. Option C is reserved for moderate-
to-severe stridor at rest with retractions, usually administered in a monitored setting. Option D
is ineffective since bronchospasm is not the primary pathology of croup.
3. A 6-month-old infant presents for a routine health maintenance evaluation. The mother notes that
the child was born at 32 weeks of gestation. According to pediatric primary care immunization
standards, how should the provider calculate and administer vaccines for this infant?
A. Delay all immunizations until the child reaches 12 months of chronological age
B. Administer all routine childhood immunizations based on chronological age rather than
adjusted gestational age
C. Adjust the immunization schedule based strictly on the infant's corrected gestational age
D. Withhold live viral vaccines indefinitely due to prematurity
CORRECT ANSWER : B
Rationale: Premature infants should receive routine vaccinations according to their
chronological age and using standard doses, as immune responses are generally safe and
effective. Options A and C incorrectly delay protection by using adjusted age. Option D is false,
as routine live vaccines can be given once age and weight criteria are met, provided the infant is
clinically stable.
4. A 9-year-old male is brought to the clinic by his father with complaints of recurrent, episodic
wheezing, chest tightness, and a chronic dry cough that is worse at night and during physical
education class. Spirometry demonstrates a baseline FEV1 of 78% of predicted with a 15%
, improvement following short-acting beta-agonist inhalation. According to current pediatric
asthma guidelines, what is the preferred initial daily controller medication?
A. Long-acting muscarinic antagonist monotherapy
B. Low-dose inhaled corticosteroid (ICS)
C. Oral leukotriene receptor antagonist monotherapy as a last resort only
D. Daily systemic oral prednisone
CORRECT ANSWER : B
Rationale: Low-dose inhaled corticosteroids are the gold standard and preferred initial daily
controller therapy for persistent asthma in children to reduce airway inflammation. Option A is
not standard first-line maintenance for pediatric asthma. Option C is an alternative, but ICS is
more efficacious. Option D is restricted to acute, severe exacerbations.
5. A 15-month-old toddler is brought to the clinic for a routine well-child visit. Screening via the
Modified Checklist for Autism in Toddlers (M-CHAT-R/F) is performed. Which developmental
milestone failure at this age is most strongly suggestive of an underlying Autism Spectrum
Disorder?
A. Inability to jump with both feet off the ground
B. Lack of social smiling, absence of joint attention, and failure to respond to name
C. Inability to ride a tricycle
D. Absence of complex multi-word sentences
CORRECT ANSWER : B
Rationale: Red flags for autism spectrum disorder in toddlers include absent joint attention, lack
of response to name, and poor social reciprocity. Option A and C represent gross motor
milestones achieved much later (around 2 to 3 years). Option D is expected at 15 months, as
multi-word sentences emerge around 2 years of age.
6. An 8-year-old male presents with a 2-week history of gross, painless hematuria occurring shortly
after recovering from a mild upper respiratory tract infection. Laboratory results show normal
serum complement levels (C3), normal renal function, and isolated persistent microscopic
hematuria with mild proteinuria. What is the most likely renal diagnosis?
A. Post-streptococcal glomerulonephritis
B. IgA nephropathy (Berger's disease)
, C. Hemolytic uremic syndrome
D. Minimal change disease
CORRECT ANSWER : B
Rationale: IgA nephropathy typically presents with gross hematuria shortly after a mucosal
infection (synpharyngitic), with normal serum complement levels. Option A presents weeks after
infection and shows depressed serum C3 levels. Option C features microangiopathic hemolytic
anemia and thrombocytopenia. Option D presents with nephrotic-range proteinuria, not
hematuria.
7. A 2-month-old infant is brought to the clinic for a routine checkup. During the physical
examination, the clinician notes asymmetrical gluteal folds and a positive Ortolani maneuver,
where a distinct "clunk" is felt as the femoral head is reduced back into the acetabulum. What is
the most appropriate next step in clinical management?
A. Reassure the parents and recheck at the 6-month visit
B. Order an urgent pediatric hip ultrasound and refer to a pediatric orthopedist
C. Apply a rigid Pavlik harness immediately without imaging
D. Order a standing pelvic radiograph
CORRECT ANSWER : B
Rationale: Developmental dysplasia of the hip in infants under 4 to 6 months of age is evaluated
with a targeted hip ultrasound, coupled with prompt orthopedic referral. Option A delays
necessary early intervention. Option C is premature without diagnostic confirmation. Option D
is uninformative because infant femoral heads are largely cartilaginous and not well visualized
on plain X-rays at 2 months.
8. A 10-year-old female presents with a 3-day history of fever, sore throat, and fatigue. Physical
examination reveals marked tonsillar hypertrophy with thick white exudates, tender anterior
cervical lymphadenopathy, and palatal petechiae. Rapid antigen detection test for Group A
Streptococcus is negative. What is the most appropriate next clinical action?
A. Prescribe empiric amoxicillin immediately without further testing
B. Perform a throat culture or follow-up molecular test to confirm Group A Strep before
treating, or evaluate for infectious mononucleosis
C. Initiate systemic oral corticosteroids and discharge
D. Prescribe broad-spectrum fluoroquinolones
with Questions and Answers/Plus a Rationale Updated 2026 A+/Instant
Download PDF
EXAM COVERAGE
1. Advanced Pediatric Growth, Development, and Behavioral Assessment
2. Pediatric Pathophysiology and Advanced Pharmacotherapeutics
3. Management of Acute and Chronic Pediatric Illnesses Across Settings
4. Pediatric Preventive Care, Immunizations, and Anticipatory Guidance
5. Professional Role, Ethical Standards, and Evidence-Based Practice in Pediatrics
1. A 3-week-old term male infant is brought to the clinic by his parents due to non-bilious projectile
vomiting immediately after feeding over the past 48 hours. The infant is eager to feed again right
after vomiting. Physical examination reveals a small, mobile, olive-shaped mass in the right
upper quadrant. Which acid-base imbalance is most likely to develop if this condition remains
uncorrected?
A. Metabolic acidosis with an elevated anion gap
B. Metabolic alkalosis with hypokalemia and hypochloremia
C. Respiratory alkalosis secondary to compensatory hyperventilation
D. Normal anion gap metabolic acidosis with hyperkalemia
CORRECT ANSWER : B
Rationale: Pyloric stenosis causes persistent vomiting of gastric secretions rich in hydrochloric
acid, resulting in loss of hydrogen and chloride ions, leading to hypochloremic, hypokalemic
metabolic alkalosis. Option A is incorrect because acid loss from the stomach drives alkalosis,
not acidosis. Option C describes a primary respiratory abnormality, whereas this is metabolic.
Option D is incorrect because potassium and chloride are lost through gastric secretions and
renal conservation of hydrogen ions.
,2. A 4-year-old female is brought in by her mother with a 3-day history of high fever, barking
cough, and hoarseness that worsens at night. On examination, the child is afebrile at the moment,
alert, but exhibits mild inspiratory stridor and sternal retractions when agitated. A soft-tissue
neck radiograph reveals a classic subglottic narrowing known as the "steeple sign." What is the
most appropriate initial pharmacological management?
A. Intravenous broad-spectrum cephalosporins
B. A single dose of oral dexamethasone
C. Inhaled racemic epinephrine nebulization as first-line outpatient monotherapy
D. High-dose systemic albuterol nebulization
CORRECT ANSWER : B
Rationale: Mild-to-moderate croup is effectively managed with a single dose of oral
corticosteroid such as dexamethasone to reduce laryngeal mucosal edema. Option A is indicated
for bacterial tracheitis or epiglottitis rather than viral croup. Option C is reserved for moderate-
to-severe stridor at rest with retractions, usually administered in a monitored setting. Option D
is ineffective since bronchospasm is not the primary pathology of croup.
3. A 6-month-old infant presents for a routine health maintenance evaluation. The mother notes that
the child was born at 32 weeks of gestation. According to pediatric primary care immunization
standards, how should the provider calculate and administer vaccines for this infant?
A. Delay all immunizations until the child reaches 12 months of chronological age
B. Administer all routine childhood immunizations based on chronological age rather than
adjusted gestational age
C. Adjust the immunization schedule based strictly on the infant's corrected gestational age
D. Withhold live viral vaccines indefinitely due to prematurity
CORRECT ANSWER : B
Rationale: Premature infants should receive routine vaccinations according to their
chronological age and using standard doses, as immune responses are generally safe and
effective. Options A and C incorrectly delay protection by using adjusted age. Option D is false,
as routine live vaccines can be given once age and weight criteria are met, provided the infant is
clinically stable.
4. A 9-year-old male is brought to the clinic by his father with complaints of recurrent, episodic
wheezing, chest tightness, and a chronic dry cough that is worse at night and during physical
education class. Spirometry demonstrates a baseline FEV1 of 78% of predicted with a 15%
, improvement following short-acting beta-agonist inhalation. According to current pediatric
asthma guidelines, what is the preferred initial daily controller medication?
A. Long-acting muscarinic antagonist monotherapy
B. Low-dose inhaled corticosteroid (ICS)
C. Oral leukotriene receptor antagonist monotherapy as a last resort only
D. Daily systemic oral prednisone
CORRECT ANSWER : B
Rationale: Low-dose inhaled corticosteroids are the gold standard and preferred initial daily
controller therapy for persistent asthma in children to reduce airway inflammation. Option A is
not standard first-line maintenance for pediatric asthma. Option C is an alternative, but ICS is
more efficacious. Option D is restricted to acute, severe exacerbations.
5. A 15-month-old toddler is brought to the clinic for a routine well-child visit. Screening via the
Modified Checklist for Autism in Toddlers (M-CHAT-R/F) is performed. Which developmental
milestone failure at this age is most strongly suggestive of an underlying Autism Spectrum
Disorder?
A. Inability to jump with both feet off the ground
B. Lack of social smiling, absence of joint attention, and failure to respond to name
C. Inability to ride a tricycle
D. Absence of complex multi-word sentences
CORRECT ANSWER : B
Rationale: Red flags for autism spectrum disorder in toddlers include absent joint attention, lack
of response to name, and poor social reciprocity. Option A and C represent gross motor
milestones achieved much later (around 2 to 3 years). Option D is expected at 15 months, as
multi-word sentences emerge around 2 years of age.
6. An 8-year-old male presents with a 2-week history of gross, painless hematuria occurring shortly
after recovering from a mild upper respiratory tract infection. Laboratory results show normal
serum complement levels (C3), normal renal function, and isolated persistent microscopic
hematuria with mild proteinuria. What is the most likely renal diagnosis?
A. Post-streptococcal glomerulonephritis
B. IgA nephropathy (Berger's disease)
, C. Hemolytic uremic syndrome
D. Minimal change disease
CORRECT ANSWER : B
Rationale: IgA nephropathy typically presents with gross hematuria shortly after a mucosal
infection (synpharyngitic), with normal serum complement levels. Option A presents weeks after
infection and shows depressed serum C3 levels. Option C features microangiopathic hemolytic
anemia and thrombocytopenia. Option D presents with nephrotic-range proteinuria, not
hematuria.
7. A 2-month-old infant is brought to the clinic for a routine checkup. During the physical
examination, the clinician notes asymmetrical gluteal folds and a positive Ortolani maneuver,
where a distinct "clunk" is felt as the femoral head is reduced back into the acetabulum. What is
the most appropriate next step in clinical management?
A. Reassure the parents and recheck at the 6-month visit
B. Order an urgent pediatric hip ultrasound and refer to a pediatric orthopedist
C. Apply a rigid Pavlik harness immediately without imaging
D. Order a standing pelvic radiograph
CORRECT ANSWER : B
Rationale: Developmental dysplasia of the hip in infants under 4 to 6 months of age is evaluated
with a targeted hip ultrasound, coupled with prompt orthopedic referral. Option A delays
necessary early intervention. Option C is premature without diagnostic confirmation. Option D
is uninformative because infant femoral heads are largely cartilaginous and not well visualized
on plain X-rays at 2 months.
8. A 10-year-old female presents with a 3-day history of fever, sore throat, and fatigue. Physical
examination reveals marked tonsillar hypertrophy with thick white exudates, tender anterior
cervical lymphadenopathy, and palatal petechiae. Rapid antigen detection test for Group A
Streptococcus is negative. What is the most appropriate next clinical action?
A. Prescribe empiric amoxicillin immediately without further testing
B. Perform a throat culture or follow-up molecular test to confirm Group A Strep before
treating, or evaluate for infectious mononucleosis
C. Initiate systemic oral corticosteroids and discharge
D. Prescribe broad-spectrum fluoroquinolones
