South University NSG 5544 (NSG5544) – Exam 3 Review | Complete Questions & Answers | Latest Fall 2026–2027.

NSG 5544 Exam 3 – Review Questions and Answers | South University | Complete Fall 2026–2027 Study Guide A 15-month-old lives in a home with an in-ground pool. Which intervention is the single most effective way to reduce drowning risk? A. Rely on constant adult supervision alone. B. Enroll the toddler in swim lessons as the primary protection. C. Keep CPR training as the only household prevention strategy. D. Install four-sided fencing with a self-closing, self-latching gate that isolates the pool. Which developmental feature most increases drowning risk in a 15-month-old? A. Consistent ability to recognize water danger. B. Reliable self-rescue motor skills. C. Mature coordination that prevents falls into water. D. New mobility without judgment or hazard awareness. According to the guided notes, what is the leading cause of death in children ages 1–4? A. Drowning. B. Respiratory sinus arrhythmia. C. Osgood-Schlatter disease. D. Uncomplicated UTI. Parents of a 12-month-old report that the child is climbing on furniture and approaching stairs. What is the highest-priority intervention? A. Depend on verbal warnings because the child can understand danger. B. Wait until independent walking is fully established before modifying the home. C. Use swim lessons to improve balance and prevent falls. D. Install safety gates and control climbing and stair hazards in the environment. Which firearm-storage plan best matches the safe-storage criteria in the notes for a home with a 3-year-old? A. Keep the firearm loaded but hidden on a high shelf. B. Store the firearm unloaded but leave ammunition unlocked nearby. C. Store the firearm unloaded and locked, with ammunition locked separately. D. Teach the preschooler not to touch the firearm and rely on supervision. A 3-year-old has a spiral humerus fracture and the caregiver's story is inconsistent with the injury. What is the NP's legal obligation? A. Report reasonable suspicion of child abuse to Child Protective Services. B. Wait until abuse is proven before reporting. C. Ask the caregiver to investigate the mechanism at home. D. Document only if the caregiver admits abuse. Why is a spiral fracture concerning when the history does not match the injury in a young child? A. It always proves accidental injury. B. It is expected in every minor fall from a couch. C. A spiral fracture suggests a twisting mechanism that may indicate non-accidental trauma. D. It rules out the need for objective documentation. A non-mobile 9-month-old has a bruise on the lower back. How should this finding be regarded? A. As a normal developmental bruise in a non-mobile infant. B. As evidence that no further evaluation is needed. C. As a finding that should be ignored unless there is a fracture. D. As a sentinel injury that is highly suspicious for non-accidental trauma. Which finding is included in the TEN-4-FACESp bruising rule? A. Only bruises on the shins of running adolescents. B. Bruising of the torso, ears, or neck, with FACESp facial/patterned areas also considered concerning. C. Only bruises over the tibial tuberosity. D. Only bruises associated with Osgood-Schlatter disease. A child says, “My uncle plays games I don't like.” What is the best immediate response? A. Ask repeated leading questions to obtain detailed evidence. B. Stay calm and supportive, document the child's exact words, report the concern, and avoid conducting your own investigation. C. Promise the child that no one else will be told. D. Confront the uncle before documenting the disclosure. A 6-month-old has a holosystolic murmur at the left lower sternal border and failure to thrive. What is the most likely diagnosis? A. Ventricular septal defect (VSD). B. Atrial septal defect. C. Patent ductus arteriosus. D. Respiratory sinus arrhythmia. Why can a symptomatic VSD contribute to failure to thrive in an infant? A. It decreases all pulmonary blood flow and lowers metabolic demand. B. Left-to-right shunting causes pulmonary overcirculation, increased work of breathing, and increased metabolic demand. C. It causes only a normal respiratory sinus arrhythmia. D. It improves feeding endurance and calorie retention. A 14-year-old faints during basketball. What is the most important immediate action? A. Reassure and clear the adolescent for unrestricted sports. B. Treat the episode as normal respiratory sinus arrhythmia. C. Remove the adolescent from sports and obtain urgent cardiac evaluation with ECG and cardiology referral. D. Delay evaluation unless syncope occurs at rest. Which diagnosis is listed as the number-one test answer in the differential for exertional syncope in an adolescent athlete? A. Hypertrophic cardiomyopathy. B. Simple febrile seizure. C. Nursemaid's elbow. D. Poststreptococcal glomerulonephritis. A child's heart rate increases with inspiration and decreases with expiration. How is this finding classified? A. A pathologic arrhythmia requiring immediate antiarrhythmic therapy. B. Evidence of testicular torsion. C. A sign of acute lymphoblastic leukemia. D. Normal physiologic respiratory sinus arrhythmia. What autonomic change explains the rise in heart rate during inspiration in respiratory sinus arrhythmia? A. Vagal tone increases during inspiration. B. There is no autonomic change with breathing. C. Vagal tone decreases during inspiration. D. The annular ligament slips over the radial head. Which murmur description best fits a VSD in the guided notes? A. Fixed split S2 with left upper sternal border murmur. B. Holosystolic murmur at the left lower sternal border. C. Continuous machine murmur in the left upper chest. D. Musical murmur in an otherwise healthy child. Which auscultatory finding is most characteristic of an atrial septal defect (ASD) in the review notes? A. Continuous machine murmur with bounding pulses. B. Fixed split S2 with a murmur at the left upper sternal border. C. Holosystolic murmur at the left lower sternal border. D. Harsh systolic murmur with tet spells and cyanosis. An 18-month-old has Hgb 9.5, MCV 72, and RBC 5.8. The Mentzer index is about 12.4. Which interpretation is correct? A. A Mentzer index below 13 suggests thalassemia. B. A Mentzer index below 13 suggests only iron deficiency anemia. C. The Mentzer index cannot be used with microcytosis. D. A high RBC count rules out thalassemia. For the microcytic anemia pattern of low MCV, elevated RBC count, and Mentzer index below 13, what is the most appropriate next test? A. Urine pregnancy test. B. Hemoglobin electrophoresis. C. Noncontrast CT scan. D. CRAFFT screening. A 3-year-old has WBC 45 with 65% blasts, Hgb 8.2, and platelets 40. What is the most likely diagnosis? A. Physiologic genu varum. B. Osgood-Schlatter disease. C. Acute lymphoblastic leukemia (ALL). D. Uncomplicated cystitis. What level of urgency is appropriate for a child with circulating blasts, anemia, and thrombocytopenia? A. Routine annual follow-up. B. Emergent same-day hospital admission. C. Reassurance without further testing. D. Sports clearance with outpatient recheck in several months. Why is routine outpatient follow-up inappropriate when a child has blasts with cytopenias? A. The high WBC guarantees normal immune function. B. Low platelets reduce bleeding risk. C. Circulating blasts are described as benign in children. D. There is risk of infection, bleeding, and rapid clinical deterioration despite a high WBC count. Which test is listed as an immediate confirmatory step for suspected childhood leukemia? A. First-morning urine only. B. Bone marrow biopsy. C. M-CHAT screening. D. Daily symptom diary for two cycles. An adolescent's heart rate rises by 45 beats/min within 10 minutes of standing without a significant blood-pressure drop and with orthostatic symptoms. Which diagnosis fits the notes? A. Testicular torsion. B. Tourette syndrome. C. Postural orthostatic tachycardia syndrome (POTS). D. Patent ductus arteriosus. What is first-line management for adolescent POTS? A. Start an antipsychotic immediately. B. Increase fluids and salt and begin a regular conditioning exercise program. C. Begin long-term anticonvulsants. D. Restrict fluids and salt. Which duration criterion is part of a simple febrile seizure? A. More than 30 minutes by definition. B. Any duration only if focal. C. Less than 15 minutes. D. Repeated episodes throughout the same 24 hours are required. What is the most appropriate plan after a first simple febrile seizure when the child otherwise fits the benign pattern in the notes? A. Start long-term anticonvulsants in every case. B. Order routine neuroimaging and EEG for all children. C. Reassure, treat the fever/source, educate the parents, and avoid routine imaging or EEG. D. Tell parents that antipyretics reliably prevent recurrence. A toddler holds the arm pronated and avoids using it after a sudden pull on the arm. What is the most likely diagnosis? A. Radial head subluxation (nursemaid's elbow). B. Osgood-Schlatter disease. C. Duchenne muscular dystrophy. D. Testicular torsion. Which reduction technique is acceptable for nursemaid's elbow? A. Deep palpation of a flank mass. B. Hyperpronation or supination followed by flexion. C. Knee-to-chest positioning. D. Immobilization without attempted reduction in every classic case. What response is expected after successful reduction of nursemaid's elbow? A. Persistent inability to use the arm is expected for several weeks. B. The child develops a fixed split S2. C. A new flank mass should appear. D. The child begins using the arm again within minutes, often 5–15 minutes. An adolescent athlete has pain localized at the tibial tuberosity during rapid growth. What mechanism best explains Osgood-Schlatter disease? A. Twisting of the spermatic cord. B. Repetitive traction of the patellar tendon on the tibial tubercle apophysis. C. Immune-complex deposition in the glomerulus. D. Left-to-right shunting between the ventricles. Which management plan is most appropriate for Osgood-Schlatter disease in the absence of red flags? A. Immediate surgical exploration. B. Mandatory CPS reporting. C. Long-term opioid therapy. D. Activity modification, NSAIDs and ice, plus stretching or physical therapy. Which murmur finding is most characteristic of patent ductus arteriosus (PDA) in the review notes? A. Fixed split S2 as the defining sound. B. A holosystolic murmur at the left lower sternal border only. C. A continuous machine murmur, often with bounding pulses. D. No murmur with every PDA. A parent reports that a child may have swallowed vitamins. What is the first instruction in the notes? A. Induce vomiting immediately. B. Wait for symptoms before seeking guidance. C. Give an opioid analgesic to prevent pain. D. Call Poison Control immediately, unless severe symptoms require 911 first. Why should parents not induce vomiting after a suspected ingestion? A. Vomiting reliably neutralizes all toxins. B. It can cause aspiration or esophageal injury and is not recommended as an effective toxin-removal strategy. C. It is required before calling Poison Control. D. It prevents aspiration in young children. A child living in a home built in 1955 is being evaluated for lead exposure. What is the initial diagnostic test? A. Hemoglobin electrophoresis only. B. ECG only. C. Blood lead level, with a venous sample used for confirmation. D. Daily menstrual symptom diary. Which nutritional advice is emphasized for a child at risk for lead exposure? A. Restrict iron and calcium intake. B. Use only sugary drinks for calories. C. Increase iron-rich and calcium-rich foods. D. Avoid all dairy and fortified cereals. Why can iron deficiency increase intestinal lead absorption? A. Iron and lead share intestinal transport pathways, and low iron increases absorption mechanisms. B. Iron deficiency blocks all intestinal transport. C. Lead absorption is unrelated to iron status. D. Iron deficiency causes the foreskin to be needed for urethral repair. A 15-month-old has symmetric bilateral genu varum with normal growth and no pain. Which interpretation is most appropriate? A. Blount disease is certain because all bowing is pathologic. B. Immediate surgery is required. C. The finding is diagnostic of Duchenne muscular dystrophy. D. Physiologic bowing is likely and can be observed. Which finding is a red flag for Blount disease rather than physiologic genu varum? A. Symmetric bowing that improves over time. B. Asymmetric or worsening deformity, especially if it persists beyond about age 2–3 years. C. Normal growth and a typical gait for age. D. Bowing that is resolving before age 2–3 years. What is the usual management for clearly physiologic genu varum in a toddler? A. Immediate noncontrast CT scan. B. Reassurance and observation with serial examinations. C. Automatic inpatient admission. D. Routine tramadol therapy. Which is an example of a protective factor that can buffer the effects of family financial stress? A. Housing instability. B. Food insecurity. C. A strong, stable caregiver relationship. D. Lack of social support. Which NP action best reflects the “science of thriving” approach in the notes? A. Screen for social determinants of health and connect the family with appropriate resources and supports. B. Avoid discussing food, housing, or financial stress. C. Focus only on the child's physical examination and ignore family context. D. Delay all referrals until stress becomes a medical emergency. Which major Jones criterion is highlighted as the most tested finding in rheumatic fever? A. Migratory polyarthritis. B. Orthostatic proteinuria. C. Respiratory sinus arrhythmia. D. Tibial tuberosity pain. Why is Trichomonas vaginalis in a prepubertal child a major red flag? A. It is expected as a normal pubertal variant. B. It is inherited genetically from an identical twin. C. It proves the child has physiologic vulvovaginitis only. D. It is a sexually transmitted infection that raises concern for sexual abuse. What is the most appropriate initial action when a prepubertal child has trichomonads on evaluation? A. Treat the infection only and ignore safety concerns. B. Provide hygiene education only. C. Assume the finding is hereditary. D. Evaluate for possible sexual abuse while arranging appropriate multidisciplinary assessment and reporting. An adolescent's identical twin is diagnosed with chlamydia. Which statement is correct? A. Chlamydia is acquired through exposure and is not hereditary. B. Identical twins automatically share chlamydia because they share DNA. C. A twin should be treated without considering exposure. D. Genetic similarity is the main determinant of STI risk. What primarily determines an adolescent's risk for an STI such as chlamydia? A. Individual sexual exposure, protection use, and partner infection status. B. Whether the adolescent has an identical twin. C. Whether the adolescent has physiologic genu varum. D. Whether the adolescent has a fixed split S2. A 16-year-old requests birth control confidentially. What must occur first in the clinical assessment? A. Notify the parent automatically before speaking with the teen. B. Start tramadol before discussing contraception. C. Assess pregnancy status and obtain a confidential sexual-health history, including STI risk. D. Order a renal ultrasound as the first step. How do the notes describe confidentiality for minor contraceptive care? A. It never applies to adolescents. B. It generally applies, but the clinician should verify state-specific law. C. It requires automatic parental notification in every state. D. It is irrelevant to access and honest disclosure. Before beginning a detailed sexual-risk assessment with an adolescent, what should the clinician explore as part of the HEADSS framework? A. Only menstrual cycle dates. B. Home and safety, mental health, and substance/peer influences. C. Only cardiac murmurs. D. Only renal imaging history. For pediatric hypertension without an immediate indication for medication, what is the initial treatment emphasized in the review? A. Immediate surgery for every child. B. Long-term tramadol therapy. C. Lifestyle changes such as weight management, exercise, a low-salt healthy diet, and limiting sugary drinks. D. No intervention until end-organ damage develops. A 16-year-old has excessive worry for at least 6 months with fatigue, sleep disturbance, and muscle tension. Which diagnosis best fits the notes? A. Tourette syndrome. B. Testicular torsion. C. Osgood-Schlatter disease. D. Generalized anxiety disorder (GAD). What is the most appropriate initial action for suspected adolescent GAD in the notes? A. Start a benzodiazepine immediately. B. Provide reassurance only. C. Refer every patient immediately for inpatient psychiatry regardless of severity. D. Use a validated screening tool to assess severity and establish a baseline. What is first-line treatment for pediatric OCD, especially mild-to-moderate disease? A. Antipsychotic medication alone as the first step. B. No treatment if compulsions impair school function. C. Cognitive behavioral therapy with exposure and response prevention (ERP). D. Tramadol for intrusive thoughts. A child has both motor and vocal tics for more than one year and describes a premonitory urge relieved by the tic. What is the most likely diagnosis? A. Generalized anxiety disorder. B. Tourette syndrome. C. POTS. D. Autism spectrum disorder solely on that basis. What is the preferred first-line management for Tourette syndrome when tics require treatment? A. Behavioral therapy using CBIT/habit-reversal approaches. B. Immediate antipsychotic therapy for every patient. C. Long-term opioid therapy. D. Routine surgery. Which cluster is most consistent with PTSD after a traumatic car accident? A. Only a fixed split S2. B. Only tibial tuberosity tenderness. C. Only tea-colored urine. D. Nightmares, avoidance, irritability, and hypervigilance or exaggerated startle. A teen has behavioral changes after trauma but says, “I'm fine.” What is the most appropriate initial step? A. Accept the denial and do not screen. B. Begin tramadol. C. Screen for PTSD with a validated tool and assess safety. D. Clear the teen from all follow-up. What most clearly differentiates Bipolar I disorder from ADHD in the review? A. ADHD always presents as distinct manic episodes. B. Bipolar disorder is defined only by chronic inattention since early childhood. C. Bipolar symptoms are episodic/cyclical, while ADHD symptoms are chronic and persistent across settings. D. There is no clinical distinction between the two. Why can misdiagnosing bipolar disorder as ADHD be dangerous? A. Stimulants always treat mania safely. B. Misdiagnosis has no effect on risky behavior or function. C. Bipolar disorder never requires different treatment from ADHD. D. Stimulants can trigger or worsen mania and delay appropriate mood-stabilizing treatment. After parent and teacher rating scales show possible ADHD symptoms in at least two settings, what is the next required step? A. Prescribe a stimulant before confirming the diagnosis. B. Confirm DSM-5 criteria and rule out alternative causes and comorbidities. C. Ignore sleep, learning, mood, vision, and hearing factors. D. Require symptoms to be present in only one setting. In macrocytic anemia, why should vitamin B12 deficiency be ruled out before giving folate alone? A. Folate always causes testicular torsion. B. Folate can improve the anemia while neurologic damage from B12 deficiency continues or worsens. C. B12 deficiency never produces neurologic symptoms. D. Macrocytosis is unrelated to B12 or folate. A child is aggressive at home but behaves normally at school. What does that pattern most strongly suggest in the notes? A. A disorder that must be present in every setting by definition. B. Immediate proof of autism. C. A cardiac cause of behavior. D. A situational or environmental behavior problem rather than a pervasive psychiatric disorder. What is first-line management for aggression that occurs only at home when the pattern appears situational? A. Immediate antipsychotic treatment in all cases. B. Parent management training and behavioral strategies with consistent expectations and reinforcement. C. Mandatory inpatient psychiatric admission. D. No intervention because the school behavior is normal. A child shows poor eye contact, limited joint attention, delayed speech, rigid routines, and repetitive behaviors. What is the most appropriate next step? A. Reassure and wait several years. B. Start tramadol. C. Order a noncontrast CT for kidney stones. D. Formal developmental evaluation and early-intervention referral. A child with sickle cell disease develops a fever. How should this be treated according to the high-yield review? A. As an emergency because of the risk of sepsis. B. As a routine finding that never needs urgent assessment. C. As proof of Osgood-Schlatter disease. D. As a normal effect of respiratory sinus arrhythmia. Which finding indicates medical instability in an adolescent with an eating disorder? A. Bradycardia with a heart rate below 50 beats/min. B. Normal vital signs with no orthostatic changes. C. A normal BMI percentile with stable weight. D. A normal ECG and electrolytes. What immediate workup is appropriate for an eating disorder with unstable vital signs? A. Only a menstrual symptom diary. B. Only a urine NAAT. C. No testing because refeeding syndrome is not a concern. D. Electrolytes including magnesium and phosphorus, ECG, orthostatic vitals, and weight trends. In the CRAFFT substance-use screen, what does the letter “C” stand for? A. Calcium. B. Car. C. Carditis. D. Cremasteric reflex. How is any “yes” response on CRAFFT interpreted in the guided notes? A. It is a positive screen that requires further assessment for substance-use risk. B. It automatically proves a substance-use disorder. C. It is considered negative unless every item is yes. D. It can be ignored if the adolescent feels well. A school-age child has an afebrile, uncomplicated UTI and is systemically well. What is the most appropriate management? A. Immediate surgery. B. Routine CT imaging before treatment. C. Oral empiric antibiotics plus a urine culture, then adjust therapy to culture results. D. No treatment because afebrile UTIs resolve without therapy. A child develops tea-colored urine after a recent upper-respiratory illness, and urine microscopy shows RBC casts. What is the most likely diagnosis? A. Nursemaid's elbow. B. POTS. C. Tourette syndrome. D. Poststreptococcal glomerulonephritis. Why can blood pressure be elevated in poststreptococcal glomerulonephritis? A. The condition always causes volume depletion only. B. The annular ligament slips over the radial head. C. The HPO axis is still maturing. D. Reduced GFR causes sodium and water retention, leading to volume overload and hypertension. An otherwise well child has asymptomatic proteinuria on a screening urinalysis. What is the most important next step? A. Repeat the urinalysis with a first-morning urine sample. B. Perform immediate surgical exploration. C. Start hydroxyurea. D. Begin Depo-Provera. Which imaging test is listed as the most sensitive and specific study for suspected kidney stone in the notes? A. Echocardiogram. B. Noncontrast CT scan. C. Skeletal survey. D. M-CHAT. A child has a flank mass and hypertension. Why should the examiner avoid deep palpation? A. Deep palpation is needed to reduce nursemaid's elbow. B. Deep palpation prevents tumor spread. C. The finding is always a kidney stone and should be massaged. D. A Wilms tumor could rupture and spread if deeply palpated. What is the most appropriate initial imaging step for a child with a suspected Wilms tumor? A. Renal ultrasound. B. Routine brain MRI first. C. No imaging until the mass is deeply palpated. D. Only a first-morning urinalysis. Which physical finding is highlighted as the most tested sign of Duchenne muscular dystrophy? A. Fixed split S2. B. Gower sign. C. Blue-dot sign. D. Peau d'orange. Why is circumcision contraindicated in a child with hypospadias? A. Circumcision causes POTS. B. The foreskin is required to treat a VSD. C. Hypospadias always resolves without urologic evaluation. D. The foreskin may be needed as tissue for surgical repair. What does an absent cremasteric reflex suggest in a boy with acute scrotal pain? A. Epididymitis with certainty. B. Physiologic puberty. C. Testicular torsion. D. Simple febrile seizure. What is the best salvage window for testicular torsion in the notes? A. Within 6 hours. B. Within 6 days. C. After 24 hours for best outcomes. D. Timing does not affect viability. A boy has sudden severe scrotal pain and an absent cremasteric reflex. What is the most appropriate action? A. Observe at home for 24 hours. B. Treat only with ice and NSAIDs before evaluating torsion. C. Schedule a routine clinic visit in several weeks. D. Immediate surgical exploration with urgent urology involvement; do not delay for imaging. Which pattern is more consistent with epididymitis than testicular torsion? A. Sudden severe pain with absent cremasteric reflex. B. Acute pain requiring immediate detorsion by definition. C. Gradual onset of pain with a preserved cremasteric reflex. D. Loss of the cremasteric reflex with ischemia. What supportive treatment is listed for epididymitis in the review? A. Rest, scrotal elevation, ice, and NSAIDs. B. Knee-to-chest positioning. C. Four-sided pool fencing. D. Exposure and response prevention. An adolescent has irregular menstrual cycles 18 months after menarche with no red flags. What is the most likely physiologic explanation? A. Testicular torsion. B. Anovulatory cycles while the hypothalamic-pituitary-ovarian axis is maturing. C. Wilms tumor. D. Acute lymphoblastic leukemia. What is the best diagnostic approach for distinguishing PMS from PMDD? A. A single blood lead level. B. Immediate renal ultrasound. C. Prospective daily symptom tracking for at least two cycles. D. One office visit without symptom tracking. What is first-line pharmacologic treatment for primary dysmenorrhea? A. An NSAID such as ibuprofen or naproxen started at or just before menses. B. Tramadol as first-line therapy. C. Long-term benzodiazepine treatment. D. Penicillin for every menstrual cycle. Why are scheduled NSAIDs more effective than waiting to take them only after dysmenorrhea becomes severe? A. Scheduled NSAIDs increase prostaglandin buildup. B. PRN dosing always prevents pain before it starts. C. Scheduled dosing limits prostaglandin buildup and maintains a consistent anti-inflammatory effect. D. Dysmenorrhea is unrelated to prostaglandins. A healthy 10-year-old has a new breast bud. Which interpretation is most appropriate? A. This is normal thelarche/Tanner stage II because puberty commonly begins between ages 8 and 13. B. Breast development at age 10 is automatically precocious puberty. C. It requires emergency imaging in every case. D. It is diagnostic of PMDD. Which counseling point is most important for an adolescent receiving Depo-Provera? A. Irregular bleeding is common and return to fertility may be delayed for months to more than a year after stopping. B. Fertility always returns immediately after the last injection. C. The method never causes spotting or amenorrhea. D. Bone-health counseling is unnecessary with long-term use. A 15-year-old may be pregnant. What is the immediate clinical step? A. Order a skeletal survey first. B. Begin hydroxyurea. C. Obtain a urine pregnancy test while protecting confidentiality. D. Perform deep palpation of the abdomen to rule out pregnancy. An adolescent male presents with urethral discharge. Which test is most accurate for gonorrhea/chlamydia evaluation in the notes? A. Nucleic acid amplification testing (NAAT) on urine or a urethral specimen. B. Urinalysis alone. C. Hemoglobin electrophoresis. D. First-morning urine protein only. Why should tramadol be avoided in a 9-year-old? A. It is contraindicated in children because of respiratory-depression risk and unpredictable CYP2D6 metabolism. B. It is the preferred first-line pediatric analgesic. C. It has no respiratory effects in children. D. Its metabolism is completely predictable in pediatric patients. How does infant gastric pH differ from that of older children/adults in the pharmacology review? A. Infants always have a much lower gastric pH. B. Infant gastric pH has no effect on drug absorption. C. Infants have a higher, more alkaline gastric pH. D. Infants lack a stomach pH altogether. Why does immature liver function matter for medication dosing in infants? A. Reduced hepatic enzyme activity can decrease metabolism, prolong half-life, and increase toxicity risk. B. It always speeds drug metabolism and shortens half-life. C. It has no effect on medication handling. D. It prevents all drug absorption from the gastrointestinal tract. In the murmur grading system, at what grade does a palpable thrill begin? A. Grade 1/6. B. Grade 4/6. C. Grade 2/6. D. Grade 3/6. Which maneuver is the most tested immediate intervention for a cyanotic “tet spell” in Tetralogy of Fallot? A. Deeply palpate the abdomen. B. Induce vomiting. C. Place the child in the knee-to-chest position. D. Clear the child for unrestricted exercise during the spell. A child with mild depression is being evaluated. What is the most important first step before choosing treatment? A. Assess directly for suicide risk, including suicidal thoughts, plan, and self-harm. B. Start fluoxetine before assessing safety. C. Avoid asking about suicidal thoughts. D. Treat irritability as unrelated to depression.