NURS6541 Exam 1 | NURS 6541 / NRNP 6541 Primary
Care of Adolescents & Children | Actual Q&A with
Rationale | Walden
1. A 6-month-old infant is brought for a well-child visit. The parent reports the infant can roll
from back to belly and sit with support but cannot sit independently. Which developmental
assessment is most appropriate?
A. Refer to early intervention for motor delay
B. Reassure the parent that this is within normal limits
C. Order a neurology consultation
D. Screen for hip dysplasia
[Answer] B
Rationale: Sitting without support typically develops around 6–8 months. At 6 months, sitting
with support is expected. Rolling back to belly also emerges around 5–6 months. This infant's
motor skills are age-appropriate; reassurance is indicated.
2. A 4-year-old child is brought for a well-child visit. The parent expresses concern that the child
still sucks their thumb. Which response is most appropriate?
A. Advise the parent to discourage the habit with bitter-tasting nail polish
B. Reassure that thumb sucking is common and typically resolves by school age
C. Refer to a pediatric dentist for an orthodontic evaluation
D. Recommend a reward system for stopping
[Answer] B
Rationale: Thumb sucking is a normal self-soothing behavior in early childhood and usually
resolves spontaneously between ages 2–4. Intervention is not needed unless it persists beyond
age 5 or causes dental problems. Reassurance is the best approach.
3. A 15-year-old female presents for a sports physical. She reports she has not yet started
menstruating. She has no chronic illnesses and is at Tanner stage 3. Which is the most
appropriate next step?
A. Reassure that menarche typically occurs within 2–3 years of breast budding
B. Order a pregnancy test
C. Refer to pediatric endocrinology
D. Check serum follicle-stimulating hormone and luteinizing hormone
[Answer] A
Rationale: Menarche usually occurs approximately 2–2.5 years after breast budding (thelarche),
which marks Tanner stage 2. At Tanner stage 3, menarche may still be 1–2 years away.
, Reassurance is appropriate; no workup is indicated unless there is no menarche by age 16 or no
breast development by age 13.
4. A 2-week-old newborn is brought for a weight check. Birth weight was 3.4 kg; current weight
is 3.2 kg. The infant is breastfeeding every 2–3 hours and has 6 wet diapers and 3 stools daily.
Which is the most appropriate action?
A. Admit for dehydration evaluation
B. Reassure that this weight loss is normal
C. Recommend formula supplementation
D. Refer to a lactation consultant
[Answer] B
Rationale: Newborns typically lose 5–7% of birth weight in the first week and regain by 10–14
days. A loss of 200 g (6%) is within normal limits. Adequate wet diapers and stools indicate
good hydration. Reassurance is appropriate.
5. A 12-month-old child is due for immunizations. The parent is concerned about giving multiple
vaccines at one visit. Which response is most evidence-based?
A. Spacing vaccines out reduces the risk of adverse reactions
B. Multiple vaccines are safe and do not overwhelm the immune system
C. Administer only the MMR and varicella today
D. Split the vaccines into two visits one month apart
[Answer] B
Rationale: Extensive evidence shows that giving multiple vaccines at one visit is safe and
effective. The infant immune system can handle many antigens simultaneously. Delaying
vaccines leaves the child unprotected longer.
6. A 9-year-old child is brought for a well-child visit. The parent reports the child has difficulty
concentrating in school and fidgets constantly. The teacher has suggested an ADHD evaluation.
Which screening tool is most appropriate for the primary care setting?
A. Conners Rating Scale
B. Vanderbilt Assessment Scale
C. Child Behavior Checklist (CBCL)
D. Beck Youth Inventory
[Answer] B
Rationale: The Vanderbilt Assessment Scale is a validated, widely used screening tool for ADHD
in primary care. It includes both parent and teacher forms and aligns with DSM-5 criteria. The
Conners scale is also used but the Vanderbilt is more common in primary care.
7. A 3-year-old child presents with a 2-day history of fever (max 39.5°C), cough, and diffuse
maculopapular rash that started on the face and spread downward. The child is unimmunized.
Which is the most likely diagnosis?
Care of Adolescents & Children | Actual Q&A with
Rationale | Walden
1. A 6-month-old infant is brought for a well-child visit. The parent reports the infant can roll
from back to belly and sit with support but cannot sit independently. Which developmental
assessment is most appropriate?
A. Refer to early intervention for motor delay
B. Reassure the parent that this is within normal limits
C. Order a neurology consultation
D. Screen for hip dysplasia
[Answer] B
Rationale: Sitting without support typically develops around 6–8 months. At 6 months, sitting
with support is expected. Rolling back to belly also emerges around 5–6 months. This infant's
motor skills are age-appropriate; reassurance is indicated.
2. A 4-year-old child is brought for a well-child visit. The parent expresses concern that the child
still sucks their thumb. Which response is most appropriate?
A. Advise the parent to discourage the habit with bitter-tasting nail polish
B. Reassure that thumb sucking is common and typically resolves by school age
C. Refer to a pediatric dentist for an orthodontic evaluation
D. Recommend a reward system for stopping
[Answer] B
Rationale: Thumb sucking is a normal self-soothing behavior in early childhood and usually
resolves spontaneously between ages 2–4. Intervention is not needed unless it persists beyond
age 5 or causes dental problems. Reassurance is the best approach.
3. A 15-year-old female presents for a sports physical. She reports she has not yet started
menstruating. She has no chronic illnesses and is at Tanner stage 3. Which is the most
appropriate next step?
A. Reassure that menarche typically occurs within 2–3 years of breast budding
B. Order a pregnancy test
C. Refer to pediatric endocrinology
D. Check serum follicle-stimulating hormone and luteinizing hormone
[Answer] A
Rationale: Menarche usually occurs approximately 2–2.5 years after breast budding (thelarche),
which marks Tanner stage 2. At Tanner stage 3, menarche may still be 1–2 years away.
, Reassurance is appropriate; no workup is indicated unless there is no menarche by age 16 or no
breast development by age 13.
4. A 2-week-old newborn is brought for a weight check. Birth weight was 3.4 kg; current weight
is 3.2 kg. The infant is breastfeeding every 2–3 hours and has 6 wet diapers and 3 stools daily.
Which is the most appropriate action?
A. Admit for dehydration evaluation
B. Reassure that this weight loss is normal
C. Recommend formula supplementation
D. Refer to a lactation consultant
[Answer] B
Rationale: Newborns typically lose 5–7% of birth weight in the first week and regain by 10–14
days. A loss of 200 g (6%) is within normal limits. Adequate wet diapers and stools indicate
good hydration. Reassurance is appropriate.
5. A 12-month-old child is due for immunizations. The parent is concerned about giving multiple
vaccines at one visit. Which response is most evidence-based?
A. Spacing vaccines out reduces the risk of adverse reactions
B. Multiple vaccines are safe and do not overwhelm the immune system
C. Administer only the MMR and varicella today
D. Split the vaccines into two visits one month apart
[Answer] B
Rationale: Extensive evidence shows that giving multiple vaccines at one visit is safe and
effective. The infant immune system can handle many antigens simultaneously. Delaying
vaccines leaves the child unprotected longer.
6. A 9-year-old child is brought for a well-child visit. The parent reports the child has difficulty
concentrating in school and fidgets constantly. The teacher has suggested an ADHD evaluation.
Which screening tool is most appropriate for the primary care setting?
A. Conners Rating Scale
B. Vanderbilt Assessment Scale
C. Child Behavior Checklist (CBCL)
D. Beck Youth Inventory
[Answer] B
Rationale: The Vanderbilt Assessment Scale is a validated, widely used screening tool for ADHD
in primary care. It includes both parent and teacher forms and aligns with DSM-5 criteria. The
Conners scale is also used but the Vanderbilt is more common in primary care.
7. A 3-year-old child presents with a 2-day history of fever (max 39.5°C), cough, and diffuse
maculopapular rash that started on the face and spread downward. The child is unimmunized.
Which is the most likely diagnosis?
