FLORIDA BOARD OF NURSING PEDIATRIC
PRIMARY CARE CERTIFICATION EXAM
WITH ACTUAL QUESTIONS AND VERIFIED
ANSWERS, PLUS EXPLAINED
RATIONALES/EXPERT VERIFIED FOR
GUARANTEED 100% PASS 2026/LATEST
UPDATE/INSTANT DOWNLOAD PDF
1. Neonatal assessment — Harlequin sign
A pediatric primary care nurse practitioner examines a healthy 3-day-old
newborn. When the newborn is placed in a lateral position, the
dependent side of the body becomes distinctly erythematous while the
upper side remains pale. The infant is afebrile, feeding well, has normal
oxygen saturation, and has no respiratory distress or neurologic
abnormalities. Which explanation is most appropriate?
A. Polycythemia causing dependent vascular congestion
B. Immaturity of autonomic vasomotor regulation producing a harlequin
color change
C. Unilateral arterial obstruction caused by congenital heart disease
D. Neonatal sepsis causing asymmetric peripheral vasoconstriction
Answer: B. Immaturity of autonomic vasomotor regulation
producing a harlequin color change
Rationale: The harlequin sign is a benign transient phenomenon
caused by immature autonomic regulation of cutaneous vascular tone.
The dependent side becomes flushed while the upper side remains
pale. It usually resolves spontaneously and does not require treatment
in an otherwise well newborn. Polycythemia can cause generalized
ruddy coloration but does not typically produce this sharply
1
,demarcated positional pattern. Sepsis would generally produce
systemic illness rather than an isolated positional color change.
2. Developmental surveillance
A 9-month-old infant is evaluated during a well-child visit. The parents
report that the infant sits independently, transfers objects between hands,
uses repetitive consonant sounds, smiles responsively, and searches for
an object that has been hidden. Which finding would be most concerning
and warrant additional developmental evaluation?
A. Inability to walk independently
B. Inability to use two-word phrases
C. Inability to sit without support
D. Inability to draw a circle
Answer: C. Inability to sit without support
Rationale: Independent sitting is an important gross-motor milestone
expected well before 9 months. Failure to sit independently at this age
warrants developmental assessment and consideration of neurologic,
neuromuscular, or developmental disorders. Independent walking,
two-word phrases, and drawing circles occur substantially later and
are not expected milestones at 9 months.
3. Acute otitis media
A 2-year-old child presents with fever, irritability, and ear pulling.
Otoscopic examination reveals a moderately bulging, erythematous
tympanic membrane with decreased mobility and purulent middle-ear
effusion. The child has no penicillin allergy and has not received
amoxicillin during the previous month. Which treatment is most
appropriate?
2
,A. Oral amoxicillin
B. Oral azithromycin
C. Topical ciprofloxacin ear drops alone
D. Oral trimethoprim-sulfamethoxazole
Answer: A. Oral amoxicillin
Rationale: A bulging tympanic membrane accompanied by middle-ear
effusion and acute symptoms strongly supports acute otitis media. In
an otherwise healthy child without recent amoxicillin exposure or
purulent conjunctivitis, high-dose amoxicillin is generally first-line
therapy. Macrolides are generally reserved for selected patients with
significant beta-lactam allergy. Topical antibiotics alone do not
adequately treat uncomplicated acute otitis media when the tympanic
membrane is intact.
4. Croup
A 3-year-old child presents with a barking cough, hoarse voice, and
inspiratory stridor that worsens at night. The child is alert and has mild
stridor at rest without drooling or toxic appearance. Which intervention
is most appropriate?
A. Immediate endotracheal intubation
B. Nebulized epinephrine and systemic corticosteroid therapy
C. Oral antibiotics for presumed bacterial infection
D. Albuterol nebulization as the primary treatment
Answer: B. Nebulized epinephrine and systemic corticosteroid
therapy
Rationale: The classic barking cough, hoarseness, and inspiratory
stridor indicate viral croup. Corticosteroids reduce airway
inflammation and are appropriate even in relatively mild disease.
Nebulized epinephrine is particularly useful when stridor occurs at
3
, rest or symptoms are moderate to severe. Albuterol targets lower-
airway bronchospasm and is not the primary treatment for upper-
airway edema caused by croup.
5. Epiglottitis
A previously unimmunized 4-year-old develops abrupt high fever,
severe sore throat, drooling, muffled voice, and a tripod posture. The
child appears toxic and becomes increasingly anxious when approached.
What is the priority action?
A. Obtain a throat culture using a tongue depressor
B. Place the child supine for a complete oral examination
C. Maintain the child's position of comfort and urgently secure the
airway
D. Administer oral corticosteroids and discharge the patient
Answer: C. Maintain the child's position of comfort and urgently
secure the airway
Rationale: This presentation is highly concerning for epiglottitis, a
potentially life-threatening upper-airway emergency. Agitating the
child, forcing a supine position, or attempting an aggressive
oropharyngeal examination can precipitate complete airway
obstruction. The priority is controlled airway management in an
appropriate setting, with appropriate antimicrobial therapy after
stabilization.
6. Bronchiolitis
A 5-month-old infant presents with rhinorrhea followed by cough,
tachypnea, wheezing, and increased work of breathing. Oxygen
saturation is 94% on room air. The infant is feeding adequately and has
no apnea. Which management is most appropriate?
4
PRIMARY CARE CERTIFICATION EXAM
WITH ACTUAL QUESTIONS AND VERIFIED
ANSWERS, PLUS EXPLAINED
RATIONALES/EXPERT VERIFIED FOR
GUARANTEED 100% PASS 2026/LATEST
UPDATE/INSTANT DOWNLOAD PDF
1. Neonatal assessment — Harlequin sign
A pediatric primary care nurse practitioner examines a healthy 3-day-old
newborn. When the newborn is placed in a lateral position, the
dependent side of the body becomes distinctly erythematous while the
upper side remains pale. The infant is afebrile, feeding well, has normal
oxygen saturation, and has no respiratory distress or neurologic
abnormalities. Which explanation is most appropriate?
A. Polycythemia causing dependent vascular congestion
B. Immaturity of autonomic vasomotor regulation producing a harlequin
color change
C. Unilateral arterial obstruction caused by congenital heart disease
D. Neonatal sepsis causing asymmetric peripheral vasoconstriction
Answer: B. Immaturity of autonomic vasomotor regulation
producing a harlequin color change
Rationale: The harlequin sign is a benign transient phenomenon
caused by immature autonomic regulation of cutaneous vascular tone.
The dependent side becomes flushed while the upper side remains
pale. It usually resolves spontaneously and does not require treatment
in an otherwise well newborn. Polycythemia can cause generalized
ruddy coloration but does not typically produce this sharply
1
,demarcated positional pattern. Sepsis would generally produce
systemic illness rather than an isolated positional color change.
2. Developmental surveillance
A 9-month-old infant is evaluated during a well-child visit. The parents
report that the infant sits independently, transfers objects between hands,
uses repetitive consonant sounds, smiles responsively, and searches for
an object that has been hidden. Which finding would be most concerning
and warrant additional developmental evaluation?
A. Inability to walk independently
B. Inability to use two-word phrases
C. Inability to sit without support
D. Inability to draw a circle
Answer: C. Inability to sit without support
Rationale: Independent sitting is an important gross-motor milestone
expected well before 9 months. Failure to sit independently at this age
warrants developmental assessment and consideration of neurologic,
neuromuscular, or developmental disorders. Independent walking,
two-word phrases, and drawing circles occur substantially later and
are not expected milestones at 9 months.
3. Acute otitis media
A 2-year-old child presents with fever, irritability, and ear pulling.
Otoscopic examination reveals a moderately bulging, erythematous
tympanic membrane with decreased mobility and purulent middle-ear
effusion. The child has no penicillin allergy and has not received
amoxicillin during the previous month. Which treatment is most
appropriate?
2
,A. Oral amoxicillin
B. Oral azithromycin
C. Topical ciprofloxacin ear drops alone
D. Oral trimethoprim-sulfamethoxazole
Answer: A. Oral amoxicillin
Rationale: A bulging tympanic membrane accompanied by middle-ear
effusion and acute symptoms strongly supports acute otitis media. In
an otherwise healthy child without recent amoxicillin exposure or
purulent conjunctivitis, high-dose amoxicillin is generally first-line
therapy. Macrolides are generally reserved for selected patients with
significant beta-lactam allergy. Topical antibiotics alone do not
adequately treat uncomplicated acute otitis media when the tympanic
membrane is intact.
4. Croup
A 3-year-old child presents with a barking cough, hoarse voice, and
inspiratory stridor that worsens at night. The child is alert and has mild
stridor at rest without drooling or toxic appearance. Which intervention
is most appropriate?
A. Immediate endotracheal intubation
B. Nebulized epinephrine and systemic corticosteroid therapy
C. Oral antibiotics for presumed bacterial infection
D. Albuterol nebulization as the primary treatment
Answer: B. Nebulized epinephrine and systemic corticosteroid
therapy
Rationale: The classic barking cough, hoarseness, and inspiratory
stridor indicate viral croup. Corticosteroids reduce airway
inflammation and are appropriate even in relatively mild disease.
Nebulized epinephrine is particularly useful when stridor occurs at
3
, rest or symptoms are moderate to severe. Albuterol targets lower-
airway bronchospasm and is not the primary treatment for upper-
airway edema caused by croup.
5. Epiglottitis
A previously unimmunized 4-year-old develops abrupt high fever,
severe sore throat, drooling, muffled voice, and a tripod posture. The
child appears toxic and becomes increasingly anxious when approached.
What is the priority action?
A. Obtain a throat culture using a tongue depressor
B. Place the child supine for a complete oral examination
C. Maintain the child's position of comfort and urgently secure the
airway
D. Administer oral corticosteroids and discharge the patient
Answer: C. Maintain the child's position of comfort and urgently
secure the airway
Rationale: This presentation is highly concerning for epiglottitis, a
potentially life-threatening upper-airway emergency. Agitating the
child, forcing a supine position, or attempting an aggressive
oropharyngeal examination can precipitate complete airway
obstruction. The priority is controlled airway management in an
appropriate setting, with appropriate antimicrobial therapy after
stabilization.
6. Bronchiolitis
A 5-month-old infant presents with rhinorrhea followed by cough,
tachypnea, wheezing, and increased work of breathing. Oxygen
saturation is 94% on room air. The infant is feeding adequately and has
no apnea. Which management is most appropriate?
4
