NUR 6130 Exam 3 – Advanced Practice Nursing III
William Paterson University (2026) Practice Exam
Instructions: This 200-question practice exam is designed
to assess your knowledge in key areas of Advanced
Practice Nursing III. Select the best answer for each
question.
Section 1: Neonatology & Pediatrics
1. A term newborn develops jaundice with a total
bilirubin of 12 mg/dL at 20 hours of life. The infant is
A+ and the mother is O+. Which underlying
mechanism best explains this clinical picture?
• A) Reduced hepatic production of conjugated bilirubin
• B) Transplacental passage of maternal IgG antibodies
causing hemolysis
• C) Inherited deficiency of glucuronyl transferase
• D) Biliary atresia with impaired bile excretion
Answer: B
Rationale: In ABO incompatibility, maternal IgG anti-A or
anti-B antibodies cross the placenta and hemolyze fetal
RBCs, causing anemia and indirect hyperbilirubinemia.
, 2. A neonate with suspected ABO incompatibility has a
positive direct Coombs test and elevated indirect
bilirubin. Which baseline management strategy is most
appropriate for all affected neonates?
• A) Immediate exchange transfusion at birth
• B) Serial monitoring of bilirubin and hemoglobin levels
• C) Routine prophylactic phototherapy
• D) Empiric IVIG therapy
Answer: B
Rationale: Baseline management includes close
surveillance of bilirubin and Hgb to gauge severity. Only a
minority require acute interventions such as phototherapy
or exchange transfusion.
3. A 2-year-old child presents with pallor, fatigue, and
pica. Labs show microcytic anemia with a low ferritin.
What is the most likely diagnosis?
• A) Iron deficiency anemia
• B) Thalassemia trait
• C) Lead poisoning
• D) Anemia of chronic disease
Answer: A
Rationale: Iron deficiency anemia is the most common
cause of microcytic anemia in young children, often
presenting with pica. A low ferritin confirms iron depletion.
, 4. A child is brought in with developmental delay,
abdominal pain, and a history ofeating paint chips. A
blood lead level is 45 mcg/dL. What is the most
appropriate next step?
• A) Oralsuccimer (DMSA) chelation therapy
• B) Hospitalization for IV EDTA chelation
• C) Iron supplementation
• D) Removalfrom theenvironment only
Answer: A
Rationale: Forlead levels between 45-69 mcg/dL, oral
chelation with succimer is indicated. Levels ≥70 mcg/dL
typically require hospitalization and IV chelation.
5. A 4-year-old presents with sudden onset ofbruising
and petechiae following a viral illness. Platelet count is
15,000/µL, but WBC and RBC counts are normal. What is
the most likely diagnosis?
• A) Hemophilia A
• B) Idiopathic Thrombocytopenic Purpura (ITP)
• C) Acute lymphoblasticleukemia
• D) Disseminated intravascular coagulation (DIC)
Answer: B
Rationale: ITP typically presents as an acute, self-limited
condition in children following a viral infection, characterized
by isolatedthrombocytopenia with normal red and white
blood cell lines.
, 6. A neonate with jaundice has a total bilirubin of 18
mg/dL at 48 hours of life, with a direct fraction of 1.5
mg/dL. What is the most important next step?
• A) Begin phototherapy immediately
• B) Check the direct Coombs test
• C) Evaluate for biliary atresia or other causes of cholestasis
• D) Increase feeding frequency
Answer: C
Rationale: A direct bilirubin >1.0 mg/dL or >20% of the total
in a jaundiced infant indicates cholestasis, which requires
prompt evaluation for biliary atresia, metabolic disorders, or
othercauses of liver dysfunction.
7. Apregnant woman at 28 weeks gestation presents with
new-onset hypertension and proteinuria. What is the
priority assessment?
• A) Fetal heart rate tracing
• B) Maternal blood glucose
• C) Serum creatinine
• D) Symptoms of severe features (headache, visual changes,
epigastric pain)
Answer: D
Rationale: The assessment of severe features (e.g., severe
headache, visual disturbances, epigastric pain,
thrombocytopenia, elevated liver enzymes) is crucial to
William Paterson University (2026) Practice Exam
Instructions: This 200-question practice exam is designed
to assess your knowledge in key areas of Advanced
Practice Nursing III. Select the best answer for each
question.
Section 1: Neonatology & Pediatrics
1. A term newborn develops jaundice with a total
bilirubin of 12 mg/dL at 20 hours of life. The infant is
A+ and the mother is O+. Which underlying
mechanism best explains this clinical picture?
• A) Reduced hepatic production of conjugated bilirubin
• B) Transplacental passage of maternal IgG antibodies
causing hemolysis
• C) Inherited deficiency of glucuronyl transferase
• D) Biliary atresia with impaired bile excretion
Answer: B
Rationale: In ABO incompatibility, maternal IgG anti-A or
anti-B antibodies cross the placenta and hemolyze fetal
RBCs, causing anemia and indirect hyperbilirubinemia.
, 2. A neonate with suspected ABO incompatibility has a
positive direct Coombs test and elevated indirect
bilirubin. Which baseline management strategy is most
appropriate for all affected neonates?
• A) Immediate exchange transfusion at birth
• B) Serial monitoring of bilirubin and hemoglobin levels
• C) Routine prophylactic phototherapy
• D) Empiric IVIG therapy
Answer: B
Rationale: Baseline management includes close
surveillance of bilirubin and Hgb to gauge severity. Only a
minority require acute interventions such as phototherapy
or exchange transfusion.
3. A 2-year-old child presents with pallor, fatigue, and
pica. Labs show microcytic anemia with a low ferritin.
What is the most likely diagnosis?
• A) Iron deficiency anemia
• B) Thalassemia trait
• C) Lead poisoning
• D) Anemia of chronic disease
Answer: A
Rationale: Iron deficiency anemia is the most common
cause of microcytic anemia in young children, often
presenting with pica. A low ferritin confirms iron depletion.
, 4. A child is brought in with developmental delay,
abdominal pain, and a history ofeating paint chips. A
blood lead level is 45 mcg/dL. What is the most
appropriate next step?
• A) Oralsuccimer (DMSA) chelation therapy
• B) Hospitalization for IV EDTA chelation
• C) Iron supplementation
• D) Removalfrom theenvironment only
Answer: A
Rationale: Forlead levels between 45-69 mcg/dL, oral
chelation with succimer is indicated. Levels ≥70 mcg/dL
typically require hospitalization and IV chelation.
5. A 4-year-old presents with sudden onset ofbruising
and petechiae following a viral illness. Platelet count is
15,000/µL, but WBC and RBC counts are normal. What is
the most likely diagnosis?
• A) Hemophilia A
• B) Idiopathic Thrombocytopenic Purpura (ITP)
• C) Acute lymphoblasticleukemia
• D) Disseminated intravascular coagulation (DIC)
Answer: B
Rationale: ITP typically presents as an acute, self-limited
condition in children following a viral infection, characterized
by isolatedthrombocytopenia with normal red and white
blood cell lines.
, 6. A neonate with jaundice has a total bilirubin of 18
mg/dL at 48 hours of life, with a direct fraction of 1.5
mg/dL. What is the most important next step?
• A) Begin phototherapy immediately
• B) Check the direct Coombs test
• C) Evaluate for biliary atresia or other causes of cholestasis
• D) Increase feeding frequency
Answer: C
Rationale: A direct bilirubin >1.0 mg/dL or >20% of the total
in a jaundiced infant indicates cholestasis, which requires
prompt evaluation for biliary atresia, metabolic disorders, or
othercauses of liver dysfunction.
7. Apregnant woman at 28 weeks gestation presents with
new-onset hypertension and proteinuria. What is the
priority assessment?
• A) Fetal heart rate tracing
• B) Maternal blood glucose
• C) Serum creatinine
• D) Symptoms of severe features (headache, visual changes,
epigastric pain)
Answer: D
Rationale: The assessment of severe features (e.g., severe
headache, visual disturbances, epigastric pain,
thrombocytopenia, elevated liver enzymes) is crucial to
