NURS 6541: PRIMARY CARE OF
ADOLESCENTS & CHILDREN
ADVANCED PRACTICE
COMPREHENSIVE REVIEW QUESTIONS
AND ANSWERS
1. A 4-week-old male presents with projectile, non-bilious vomiting after every feeding. On
physical examination, a small, olive-shaped mass is palpable in the right upper quadrant.
Which of the following is the most appropriate next step in management?
A. Barium enema to rule out intussusception
B. Upper GI series to evaluate for malrotation
C. Abdominal ultrasound to evaluate for pyloric stenosis
D. Switching to a soy-based formula for suspected cow milk protein allergy
Answer: C
Conceptual Explanation: The classic presentation of non-bilious projectile vomiting and
an ‘olive-shaped’ mass is highly suggestive of hypertrophic pyloric stenosis. Ultrasound is
the preferred imaging modality to confirm the diagnosis by measuring pyloric muscle
thickness and length.
,2. A 15-month-old child has received their first dose of MMR and Varicella vaccines at 12
months. The mother asks when the next doses should be administered. According to the CDC,
what is the standard schedule for the second dose?
A. 18 months of age
B. 2 years of age
C. 4 to 6 years of age
D. At the start of middle school (11-12 years)
Answer: C
Conceptual Explanation: The standard CDC schedule for the second dose of MMR and
Varicella vaccines is between 4 and 6 years of age, though the second dose can be
administered earlier if there is at least a 4-week interval between doses.
3. A 16-year-old female presents for a sports physical. During the cardiac exam, a Grade II/VI
systolic murmur is heard at the left upper sternal border. The murmur increases in intensity
when the patient moves from a squatting to a standing position. What is the most likely
diagnosis?
A. Innocent Still’s murmur
B. Hypertrophic Cardiomyopathy (HCM)
C. Atrial Septal Defect (ASD)
D. Mitral Valve Prolapse
, Answer: B
Conceptual Explanation: A systolic murmur that increases with standing or Valsalva
maneuver (which decreases preload) is characteristic of Hypertrophic Cardiomyopathy.
Most innocent or physiological murmurs decrease with standing.
4. According to the GINA guidelines, a 7-year-old child who experiences asthma symptoms 3
times a week, wakes up twice a month due to cough, and uses their SABA 3 days a week
would be classified as having:
A. Intermittent Asthma
B. Severe Persistent Asthma
C. Moderate Persistent Asthma
D. Mild Persistent Asthma
Answer: D
Conceptual Explanation: Mild Persistent Asthma is defined by symptoms occurring more
than 2 days per week but not daily, and nighttime awakenings 3-4 times per month for
children older than 5.
5. A 12-month-old infant is found to have a hemoglobin level of 9.8 g/dL during a routine
screening. The mother reports the infant drinks 32 ounces of cow’s milk per day. What is the
most appropriate initial intervention?
A. Perform a bone marrow biopsy immediately
B. Start iron supplementation and limit cow’s milk to 16-24 oz per day
ADOLESCENTS & CHILDREN
ADVANCED PRACTICE
COMPREHENSIVE REVIEW QUESTIONS
AND ANSWERS
1. A 4-week-old male presents with projectile, non-bilious vomiting after every feeding. On
physical examination, a small, olive-shaped mass is palpable in the right upper quadrant.
Which of the following is the most appropriate next step in management?
A. Barium enema to rule out intussusception
B. Upper GI series to evaluate for malrotation
C. Abdominal ultrasound to evaluate for pyloric stenosis
D. Switching to a soy-based formula for suspected cow milk protein allergy
Answer: C
Conceptual Explanation: The classic presentation of non-bilious projectile vomiting and
an ‘olive-shaped’ mass is highly suggestive of hypertrophic pyloric stenosis. Ultrasound is
the preferred imaging modality to confirm the diagnosis by measuring pyloric muscle
thickness and length.
,2. A 15-month-old child has received their first dose of MMR and Varicella vaccines at 12
months. The mother asks when the next doses should be administered. According to the CDC,
what is the standard schedule for the second dose?
A. 18 months of age
B. 2 years of age
C. 4 to 6 years of age
D. At the start of middle school (11-12 years)
Answer: C
Conceptual Explanation: The standard CDC schedule for the second dose of MMR and
Varicella vaccines is between 4 and 6 years of age, though the second dose can be
administered earlier if there is at least a 4-week interval between doses.
3. A 16-year-old female presents for a sports physical. During the cardiac exam, a Grade II/VI
systolic murmur is heard at the left upper sternal border. The murmur increases in intensity
when the patient moves from a squatting to a standing position. What is the most likely
diagnosis?
A. Innocent Still’s murmur
B. Hypertrophic Cardiomyopathy (HCM)
C. Atrial Septal Defect (ASD)
D. Mitral Valve Prolapse
, Answer: B
Conceptual Explanation: A systolic murmur that increases with standing or Valsalva
maneuver (which decreases preload) is characteristic of Hypertrophic Cardiomyopathy.
Most innocent or physiological murmurs decrease with standing.
4. According to the GINA guidelines, a 7-year-old child who experiences asthma symptoms 3
times a week, wakes up twice a month due to cough, and uses their SABA 3 days a week
would be classified as having:
A. Intermittent Asthma
B. Severe Persistent Asthma
C. Moderate Persistent Asthma
D. Mild Persistent Asthma
Answer: D
Conceptual Explanation: Mild Persistent Asthma is defined by symptoms occurring more
than 2 days per week but not daily, and nighttime awakenings 3-4 times per month for
children older than 5.
5. A 12-month-old infant is found to have a hemoglobin level of 9.8 g/dL during a routine
screening. The mother reports the infant drinks 32 ounces of cow’s milk per day. What is the
most appropriate initial intervention?
A. Perform a bone marrow biopsy immediately
B. Start iron supplementation and limit cow’s milk to 16-24 oz per day
