NR 602 Final Exam | Primary Care of the Childbearing &
Childrearing Family (2026) | 3 Full Exam Sets with Actual
Questions & Verified Answers
Question 1
A mother presents with her 3-month-old child and complains of a "goopy" eye that is
sometimes matted shut after naps. Upon exam, the conjunctiva is clear with some mild
crusting to the eyelashes. What is the diagnosis and patient teaching?
A) Bacterial conjunctivitis; prescribe erythromycin ointment TID
B) Probable lacrimal duct obstruction; daily massage and warm compresses
C) Viral conjunctivitis; cold compresses and artificial tears
D) Blepharitis; lid scrubs with baby shampoo
Answer: B) Probable lacrimal duct obstruction; daily massage and warm
compresses
Rationale: Clear conjunctiva with crusting in an infant indicates nasolacrimal duct
obstruction rather than infection. Parents should be taught lacrimal duct massage
and warm compresses while monitoring for signs of bacterial superinfection or
periorbital cellulitis; most resolve spontaneously by 6–12 months .
,Question 2
A mother brings her nine-year-old overweight son to the clinic with complaints of pain
to the groin, knee, and right hip. She reports the patient has been walking with a limp
for the last couple days but is unable to ambulate today. Mother denies any recent
trauma. Upon inspection there is external rotation of the right foot. What is the
diagnosis and treatment?
A) Toxic transient synovitis; NSAIDs and non-weight bearing status
B) Legg-Calvé-Perthes disease; refer to orthopedics for casting
C) Slipped capital femoral epiphysis; immediate referral to ER for surgery
D) Septic arthritis; emergency joint aspiration and IV antibiotics
Answer: C) Slipped capital femoral epiphysis; immediate referral to ER for surgery
Rationale: Hip pathology presenting as knee pain with external rotation of the foot
in an obese adolescent is pathognomonic for SCFE, a surgical emergency requiring
immediate fixation to prevent avascular necrosis of the femoral head .
Question 3
A father presents with his four-year-old son and states that the patient has been limping
since this morning and was crying all night complaining of left hip pain. Upon exam you
appreciate decreased range of motion of left hip but no external rotation or signs of
trauma. What is the probable diagnosis and appropriate treatment?
A) Transient synovitis; NSAIDs and rest
B) Legg-Calvé-Perthes disease; referral to orthopedics
C) Septic arthritis; immediate joint aspiration
D) Slipped capital femoral epiphysis; ER referral
,Answer: A) Transient synovitis; NSAIDs and rest
Rationale: Transient synovitis (toxic synovitis) is the most common cause of hip
pain in young children (ages 3–8) and presents with acute onset limping, hip pain,
and decreased range of motion without systemic toxicity. It is self-limiting and
managed with NSAIDs and rest. Unlike SCFE, there is no external rotation or
obesity association .
Question 4
A 15-year-old male presents to the clinic with complaints of feeling fullness in one ear,
dizziness, fluid discharge with foul smell, and decreased hearing. Upon assessment you
notice a tumor-like mass to the tympanic membrane. What is the diagnosis and
treatment?
A) Chronic otitis media with effusion; place tympanostomy tubes
B) Cholesteatoma; refer to ENT for surgical excision
C) Acoustic neuroma; urgent MRI with contrast
D) Cerumen impaction; irrigation and manual removal
Answer: B) Cholesteatoma; refer to ENT for surgical excision
Rationale: A pearly white mass behind the TM with foul-smelling discharge and
conductive hearing loss indicates cholesteatoma, a keratinizing epithelial growth
that erodes ossicles and can extend intracranially. Medical management is
ineffective; surgical tympanomastoidectomy is required to prevent complications .
Question 5
, A mother presents with a six-year-old male with complaints of fever times one week and
rash. Upon exam you find conjunctival injection, red, tender, edematous hands and feet,
cracked red dry lips, cervical lymphadenitis, and a red strawberry tongue. What is the
diagnosis and treatment?
A) Scarlet fever; oral penicillin and antipyretics
B) Kawasaki disease; IVIG and high-dose aspirin
C) Stevens-Johnson syndrome; immediate hospitalization
D) Measles; vitamin A and supportive care
Answer: B) Kawasaki disease; IVIG and high-dose aspirin
Rationale: The classic presentation of Kawasaki disease includes fever for ≥5 days,
bilateral conjunctival injection, oral mucosal changes (strawberry tongue, cracked
red lips), polymorphous rash, extremity changes (edema, erythema), and cervical
lymphadenopathy. Treatment is IVIG and high-dose aspirin to prevent coronary
artery aneurysms .
Question 6
A school-age child has a 3-month history of dull, aching epigastric pain that worsens
with eating and awakens the child from sleep. A complete blood count shows a
hemoglobin of 8 mg/dL. What is the next step in management?
A) Trial of proton pump inhibitor therapy for 8 weeks
B) H. pylori stool antigen testing and empiric triple therapy
C) Referral for esophagogastroduodenoscopy (EGD)
D) Abdominal ultrasound to evaluate for gallbladder disease
Answer: C) Referral for esophagogastroduodenoscopy (EGD)
Childrearing Family (2026) | 3 Full Exam Sets with Actual
Questions & Verified Answers
Question 1
A mother presents with her 3-month-old child and complains of a "goopy" eye that is
sometimes matted shut after naps. Upon exam, the conjunctiva is clear with some mild
crusting to the eyelashes. What is the diagnosis and patient teaching?
A) Bacterial conjunctivitis; prescribe erythromycin ointment TID
B) Probable lacrimal duct obstruction; daily massage and warm compresses
C) Viral conjunctivitis; cold compresses and artificial tears
D) Blepharitis; lid scrubs with baby shampoo
Answer: B) Probable lacrimal duct obstruction; daily massage and warm
compresses
Rationale: Clear conjunctiva with crusting in an infant indicates nasolacrimal duct
obstruction rather than infection. Parents should be taught lacrimal duct massage
and warm compresses while monitoring for signs of bacterial superinfection or
periorbital cellulitis; most resolve spontaneously by 6–12 months .
,Question 2
A mother brings her nine-year-old overweight son to the clinic with complaints of pain
to the groin, knee, and right hip. She reports the patient has been walking with a limp
for the last couple days but is unable to ambulate today. Mother denies any recent
trauma. Upon inspection there is external rotation of the right foot. What is the
diagnosis and treatment?
A) Toxic transient synovitis; NSAIDs and non-weight bearing status
B) Legg-Calvé-Perthes disease; refer to orthopedics for casting
C) Slipped capital femoral epiphysis; immediate referral to ER for surgery
D) Septic arthritis; emergency joint aspiration and IV antibiotics
Answer: C) Slipped capital femoral epiphysis; immediate referral to ER for surgery
Rationale: Hip pathology presenting as knee pain with external rotation of the foot
in an obese adolescent is pathognomonic for SCFE, a surgical emergency requiring
immediate fixation to prevent avascular necrosis of the femoral head .
Question 3
A father presents with his four-year-old son and states that the patient has been limping
since this morning and was crying all night complaining of left hip pain. Upon exam you
appreciate decreased range of motion of left hip but no external rotation or signs of
trauma. What is the probable diagnosis and appropriate treatment?
A) Transient synovitis; NSAIDs and rest
B) Legg-Calvé-Perthes disease; referral to orthopedics
C) Septic arthritis; immediate joint aspiration
D) Slipped capital femoral epiphysis; ER referral
,Answer: A) Transient synovitis; NSAIDs and rest
Rationale: Transient synovitis (toxic synovitis) is the most common cause of hip
pain in young children (ages 3–8) and presents with acute onset limping, hip pain,
and decreased range of motion without systemic toxicity. It is self-limiting and
managed with NSAIDs and rest. Unlike SCFE, there is no external rotation or
obesity association .
Question 4
A 15-year-old male presents to the clinic with complaints of feeling fullness in one ear,
dizziness, fluid discharge with foul smell, and decreased hearing. Upon assessment you
notice a tumor-like mass to the tympanic membrane. What is the diagnosis and
treatment?
A) Chronic otitis media with effusion; place tympanostomy tubes
B) Cholesteatoma; refer to ENT for surgical excision
C) Acoustic neuroma; urgent MRI with contrast
D) Cerumen impaction; irrigation and manual removal
Answer: B) Cholesteatoma; refer to ENT for surgical excision
Rationale: A pearly white mass behind the TM with foul-smelling discharge and
conductive hearing loss indicates cholesteatoma, a keratinizing epithelial growth
that erodes ossicles and can extend intracranially. Medical management is
ineffective; surgical tympanomastoidectomy is required to prevent complications .
Question 5
, A mother presents with a six-year-old male with complaints of fever times one week and
rash. Upon exam you find conjunctival injection, red, tender, edematous hands and feet,
cracked red dry lips, cervical lymphadenitis, and a red strawberry tongue. What is the
diagnosis and treatment?
A) Scarlet fever; oral penicillin and antipyretics
B) Kawasaki disease; IVIG and high-dose aspirin
C) Stevens-Johnson syndrome; immediate hospitalization
D) Measles; vitamin A and supportive care
Answer: B) Kawasaki disease; IVIG and high-dose aspirin
Rationale: The classic presentation of Kawasaki disease includes fever for ≥5 days,
bilateral conjunctival injection, oral mucosal changes (strawberry tongue, cracked
red lips), polymorphous rash, extremity changes (edema, erythema), and cervical
lymphadenopathy. Treatment is IVIG and high-dose aspirin to prevent coronary
artery aneurysms .
Question 6
A school-age child has a 3-month history of dull, aching epigastric pain that worsens
with eating and awakens the child from sleep. A complete blood count shows a
hemoglobin of 8 mg/dL. What is the next step in management?
A) Trial of proton pump inhibitor therapy for 8 weeks
B) H. pylori stool antigen testing and empiric triple therapy
C) Referral for esophagogastroduodenoscopy (EGD)
D) Abdominal ultrasound to evaluate for gallbladder disease
Answer: C) Referral for esophagogastroduodenoscopy (EGD)
