NURS 6541 / NRNP 6541 PRIMARY CARE
OF ADOLESCENTS & CHILDREN
COMPREHENSIVE EXAM
1. A 15-month-old child is brought in for a routine check-up. The nurse practitioner notes the
child is unable to use a pincer grasp to pick up small objects. What is the most appropriate
next step?
A. Reassure the parent that this milestone is typically reached by 18 months.
B. Refer the child immediately to a pediatric neurologist for suspected cerebral palsy.
C. Perform a comprehensive developmental screening using a standardized tool like the
ASQ-3.
D. Order an MRI of the brain to rule out structural abnormalities.
Answer: C
Conceptual Explanation: A neat pincer grasp is typically achieved by 9 to 10 months of
age. Absence at 15 months is a developmental delay requiring further standardized
screening (like the Ages and Stages Questionnaire) before specialty referral.
,2. During a physical exam of an 11-year-old female, the nurse practitioner notes the elevation
of the breast and papilla as a small mound, with enlargement of the areolar diameter. Which
Tanner Stage does this represent?
A. Tanner Stage 2
B. Tanner Stage 1
C. Tanner Stage 3
D. Tanner Stage 4
Answer: A
Conceptual Explanation: Tanner Stage 2 is the ‘breast bud’ stage, characterized by
elevation of the breast and papilla as a small mound and enlargement of the areolar
diameter.
3. A 6-year-old child presents with a 2-day history of high fever, sore throat, and a
‘sandpaper-like’ rash that began on the chest and spread to the extremities. Examination
reveals a bright red tongue. What is the most likely diagnosis?
A. Kawasaki Disease
B. Fifth Disease (Erythema Infectiosum)
C. Measles (Rubeola)
D. Scarlet Fever
Answer: D
, Conceptual Explanation: Scarlet fever (Group A Strep) is characterized by a sandpaper
rash, fever, and ‘strawberry tongue.’ Kawasaki disease also has a red tongue but involves
longer fever and conjunctivitis without the sandpaper rash.
4. According to the AAP, at what age should universal screening for autism spectrum disorder
(ASD) occur using a tool such as the M-CHAT?
A. 18 months and 24 months
B. 12 months and 24 months
C. 9 months and 15 months
D. 24 months and 36 months
Answer: A
Conceptual Explanation: The American Academy of Pediatrics (AAP) recommends
universal screening for ASD at the 18-month and 24-month well-child visits.
5. A 4-week-old infant presents with projectile, non-bilious vomiting immediately after
feeding. The infant appears hungry and has a palpable ‘olive-shaped’ mass in the upper
abdomen. What is the initial diagnostic test of choice?
A. Abdominal X-ray
B. Abdominal Ultrasound
C. Upper GI series with barium
D. Endoscopy
OF ADOLESCENTS & CHILDREN
COMPREHENSIVE EXAM
1. A 15-month-old child is brought in for a routine check-up. The nurse practitioner notes the
child is unable to use a pincer grasp to pick up small objects. What is the most appropriate
next step?
A. Reassure the parent that this milestone is typically reached by 18 months.
B. Refer the child immediately to a pediatric neurologist for suspected cerebral palsy.
C. Perform a comprehensive developmental screening using a standardized tool like the
ASQ-3.
D. Order an MRI of the brain to rule out structural abnormalities.
Answer: C
Conceptual Explanation: A neat pincer grasp is typically achieved by 9 to 10 months of
age. Absence at 15 months is a developmental delay requiring further standardized
screening (like the Ages and Stages Questionnaire) before specialty referral.
,2. During a physical exam of an 11-year-old female, the nurse practitioner notes the elevation
of the breast and papilla as a small mound, with enlargement of the areolar diameter. Which
Tanner Stage does this represent?
A. Tanner Stage 2
B. Tanner Stage 1
C. Tanner Stage 3
D. Tanner Stage 4
Answer: A
Conceptual Explanation: Tanner Stage 2 is the ‘breast bud’ stage, characterized by
elevation of the breast and papilla as a small mound and enlargement of the areolar
diameter.
3. A 6-year-old child presents with a 2-day history of high fever, sore throat, and a
‘sandpaper-like’ rash that began on the chest and spread to the extremities. Examination
reveals a bright red tongue. What is the most likely diagnosis?
A. Kawasaki Disease
B. Fifth Disease (Erythema Infectiosum)
C. Measles (Rubeola)
D. Scarlet Fever
Answer: D
, Conceptual Explanation: Scarlet fever (Group A Strep) is characterized by a sandpaper
rash, fever, and ‘strawberry tongue.’ Kawasaki disease also has a red tongue but involves
longer fever and conjunctivitis without the sandpaper rash.
4. According to the AAP, at what age should universal screening for autism spectrum disorder
(ASD) occur using a tool such as the M-CHAT?
A. 18 months and 24 months
B. 12 months and 24 months
C. 9 months and 15 months
D. 24 months and 36 months
Answer: A
Conceptual Explanation: The American Academy of Pediatrics (AAP) recommends
universal screening for ASD at the 18-month and 24-month well-child visits.
5. A 4-week-old infant presents with projectile, non-bilious vomiting immediately after
feeding. The infant appears hungry and has a palpable ‘olive-shaped’ mass in the upper
abdomen. What is the initial diagnostic test of choice?
A. Abdominal X-ray
B. Abdominal Ultrasound
C. Upper GI series with barium
D. Endoscopy
