Pediatric Primary Care PNCB 1 Questions and Answers A+ Grade 2026/2027
| Complete Pediatric Nurse Practitioner Study Guide
The child at highest risk for having an elevated blood lead level is a:
3 month old exclusively breastfed infant
6 month old who lives in a home built after 1970
2 year old with iron deficiency anemia
2 year old who is a picky eater
D. - (ANSWER)2 year old with iron deficiency anemia
The amount of lead absorbed from the gut is increased in children with nutritional deficiencies such as
iron deficiency anemia (IDA). Iron deficiency anemia is often a comorbidity of lead poisoning. The hand-
to-mouth behavior of infants and young children increases their lead exposure. However, living in a
home built after 1970 reduces the risk since residential paint used in that era should not have been lead
based. Infants more than 4 months of age exclusively breast fed without supplemental iron are at
increased risk of IDA. A child who is a picky eater may or may not be at high risk for IDA, depending on
foods actually eaten.Which laboratory assessment is the BEST indicator of vitamin D deficiency?
Which laboratory assessment is the BEST indicator of vitamin D deficiency?
25(OH)-D (cholecalciferol)
1,25(OH)2-D (calcitriol)
PTH (parathyroid hormone)
,Pediatric Primary Care PNCB 1 Questions and Answers A+ Grade 2026/2027
| Complete Pediatric Nurse Practitioner Study Guide
25(OH)-D (cholecalciferol) - (ANSWER)25(OH)-D (cholecalciferol)
The best diagnostic study of vitamin D deficiency is the level of 25(OH)-D (cholecalciferol). 1,25(OH)2-D
(calcitriol) is the active metabolite of 25(OH)-D, but due to its short half-life it is not a good indicator of
vitamin D sufficiency. The parathyroid hormone releases calcium from bone. Rachitic changes can be
seen at growth plates and decreased calcification leads to thickening of the growth plate. Serum calcium
and phosphorous are initial screening tests but not the best indicator of vitamin D deficiency.
In a 2 month old with visible rib fractures on radiograph, the NEXT most critical evaluation to obtain is a:
CT scan of the head
long bone series
coagulation profile
retinal ophthalmologic exam - (ANSWER)CT scan of the head
Posterior rib fractures associated with accidental trauma are rare. Posterior fractures can be seen in
infants who have been shaken as the perpetrator hands are typically wrapped around the infant's thorax
during the shaking, with the vertebrae acting as a fulcrum. These findings should alert the provider to
consider shaken baby syndrome (SBS). Subdural and subarachnoid hemorrhages are the most common
acute intracranial injuries seen in SBS and are associated with high rates of morbidity and mortality.
Thus, the most important study to do next is a CT scan. Studies have shown that nearly one third of
,Pediatric Primary Care PNCB 1 Questions and Answers A+ Grade 2026/2027
| Complete Pediatric Nurse Practitioner Study Guide
confirmed abusive head trauma cases were missed on initial presentation, and many infants then sustain
additional brain injury along with poorer neurologic outcomes because of the delay in diagnosis. Long
bone studies will be needed as part of a thorough work-up of non-accidental trauma, but the skull would
be the most critical area to image first. Coagulation studies are done to rule out any coagulation problem
associated with injury to the brain and are important for medico-legal reasons, but again, brain studies
take precedence. A thorough ophthalmologic exam is needed in suspected cases of SBS—preferably
done by a pediatric ophthalmologist.
The MOST common barrier related to transitioning health care for an adolescent with special needs or
chronic illness is
finding an adult health care provider for transition.
resistance of the family and adolescent to transition of care.
lack of health care provider time to plan for transition of care.
difficulty in talking with patients about transitioning care. - (ANSWER)finding an adult health care
provider for transition.
Finding an adult health care provider, one who is qualified to care for young adults with special health
care needs, is the most commonly perceived barrier to the successful transition of health care as
identified by family and young adults, pediatric health care providers, and adult internists. Transitioning
of care requires time and communication with the parents and adolescents involved. Many families may
be hesitant to leave the nurturing environment of pediatric care, and may perceive differences in adult
practices as a difficult adjustment. Internists may lack the training and qualifications to address many of
the complicated health care needs of adolescents with chronic illnesses. Because of the delicate nature
of such conversations, some pediatric providers may not be comfortable in dealing with the complexities
of transitioning care.
, Pediatric Primary Care PNCB 1 Questions and Answers A+ Grade 2026/2027
| Complete Pediatric Nurse Practitioner Study Guide
A toddler is unable to use the right arm normally after the caregiver pulled her arm to prevent the child
from falling. Which finding would confirm the diagnosis of subluxation of the radial head?
severe swelling and bruising of the elbow
elbow flexed with pronated forearm
point tenderness at ulnar aspect of elbow
obvious deformity of the forearm - (ANSWER)elbow flexed with pronated forearm
Subluxation of the radial head, also called nursemaid's elbow, must be differentiated from a fracture
prior to reducing the annular ligament of the elbow. Radiographic examination is not necessary if the
child's physical findings and history are consistent with subluxation. The typical presentation of this
injury includes the following: age 2-5 years; history of a longitudinal traction injury, possible "pop" and
immediate pain, inability to use the arm normally, and arm splinted against the side. On examination the
elbow appears normal, is flexed with a pronated forearm against the body, is tender laterally over the
radial head, and has limited flexion with no supination. If the child fell on his/her elbow or there is no
history of a traction injury, suspect a fracture and order the appropriate radiograp
Education for caregivers whose child has sickle cell disease should include that the majority of pain crises
are triggered by which of the following?
no identifying cause
temperature changes
| Complete Pediatric Nurse Practitioner Study Guide
The child at highest risk for having an elevated blood lead level is a:
3 month old exclusively breastfed infant
6 month old who lives in a home built after 1970
2 year old with iron deficiency anemia
2 year old who is a picky eater
D. - (ANSWER)2 year old with iron deficiency anemia
The amount of lead absorbed from the gut is increased in children with nutritional deficiencies such as
iron deficiency anemia (IDA). Iron deficiency anemia is often a comorbidity of lead poisoning. The hand-
to-mouth behavior of infants and young children increases their lead exposure. However, living in a
home built after 1970 reduces the risk since residential paint used in that era should not have been lead
based. Infants more than 4 months of age exclusively breast fed without supplemental iron are at
increased risk of IDA. A child who is a picky eater may or may not be at high risk for IDA, depending on
foods actually eaten.Which laboratory assessment is the BEST indicator of vitamin D deficiency?
Which laboratory assessment is the BEST indicator of vitamin D deficiency?
25(OH)-D (cholecalciferol)
1,25(OH)2-D (calcitriol)
PTH (parathyroid hormone)
,Pediatric Primary Care PNCB 1 Questions and Answers A+ Grade 2026/2027
| Complete Pediatric Nurse Practitioner Study Guide
25(OH)-D (cholecalciferol) - (ANSWER)25(OH)-D (cholecalciferol)
The best diagnostic study of vitamin D deficiency is the level of 25(OH)-D (cholecalciferol). 1,25(OH)2-D
(calcitriol) is the active metabolite of 25(OH)-D, but due to its short half-life it is not a good indicator of
vitamin D sufficiency. The parathyroid hormone releases calcium from bone. Rachitic changes can be
seen at growth plates and decreased calcification leads to thickening of the growth plate. Serum calcium
and phosphorous are initial screening tests but not the best indicator of vitamin D deficiency.
In a 2 month old with visible rib fractures on radiograph, the NEXT most critical evaluation to obtain is a:
CT scan of the head
long bone series
coagulation profile
retinal ophthalmologic exam - (ANSWER)CT scan of the head
Posterior rib fractures associated with accidental trauma are rare. Posterior fractures can be seen in
infants who have been shaken as the perpetrator hands are typically wrapped around the infant's thorax
during the shaking, with the vertebrae acting as a fulcrum. These findings should alert the provider to
consider shaken baby syndrome (SBS). Subdural and subarachnoid hemorrhages are the most common
acute intracranial injuries seen in SBS and are associated with high rates of morbidity and mortality.
Thus, the most important study to do next is a CT scan. Studies have shown that nearly one third of
,Pediatric Primary Care PNCB 1 Questions and Answers A+ Grade 2026/2027
| Complete Pediatric Nurse Practitioner Study Guide
confirmed abusive head trauma cases were missed on initial presentation, and many infants then sustain
additional brain injury along with poorer neurologic outcomes because of the delay in diagnosis. Long
bone studies will be needed as part of a thorough work-up of non-accidental trauma, but the skull would
be the most critical area to image first. Coagulation studies are done to rule out any coagulation problem
associated with injury to the brain and are important for medico-legal reasons, but again, brain studies
take precedence. A thorough ophthalmologic exam is needed in suspected cases of SBS—preferably
done by a pediatric ophthalmologist.
The MOST common barrier related to transitioning health care for an adolescent with special needs or
chronic illness is
finding an adult health care provider for transition.
resistance of the family and adolescent to transition of care.
lack of health care provider time to plan for transition of care.
difficulty in talking with patients about transitioning care. - (ANSWER)finding an adult health care
provider for transition.
Finding an adult health care provider, one who is qualified to care for young adults with special health
care needs, is the most commonly perceived barrier to the successful transition of health care as
identified by family and young adults, pediatric health care providers, and adult internists. Transitioning
of care requires time and communication with the parents and adolescents involved. Many families may
be hesitant to leave the nurturing environment of pediatric care, and may perceive differences in adult
practices as a difficult adjustment. Internists may lack the training and qualifications to address many of
the complicated health care needs of adolescents with chronic illnesses. Because of the delicate nature
of such conversations, some pediatric providers may not be comfortable in dealing with the complexities
of transitioning care.
, Pediatric Primary Care PNCB 1 Questions and Answers A+ Grade 2026/2027
| Complete Pediatric Nurse Practitioner Study Guide
A toddler is unable to use the right arm normally after the caregiver pulled her arm to prevent the child
from falling. Which finding would confirm the diagnosis of subluxation of the radial head?
severe swelling and bruising of the elbow
elbow flexed with pronated forearm
point tenderness at ulnar aspect of elbow
obvious deformity of the forearm - (ANSWER)elbow flexed with pronated forearm
Subluxation of the radial head, also called nursemaid's elbow, must be differentiated from a fracture
prior to reducing the annular ligament of the elbow. Radiographic examination is not necessary if the
child's physical findings and history are consistent with subluxation. The typical presentation of this
injury includes the following: age 2-5 years; history of a longitudinal traction injury, possible "pop" and
immediate pain, inability to use the arm normally, and arm splinted against the side. On examination the
elbow appears normal, is flexed with a pronated forearm against the body, is tender laterally over the
radial head, and has limited flexion with no supination. If the child fell on his/her elbow or there is no
history of a traction injury, suspect a fracture and order the appropriate radiograp
Education for caregivers whose child has sickle cell disease should include that the majority of pain crises
are triggered by which of the following?
no identifying cause
temperature changes
