NR602 Pediatric Primary Care Week 8 Final Exam Case Studies
& Rationales
Exam Title: NR602 Pediatric Primary Care - Week 8 Final
Comprehensive Assessment
Version: 2026 Verified Examplify Pack
Total Questions: 100
Time Allotted: 2.5 Hours
Instructions: This exam consists of multiple-choice questions designed to test your understanding of
pediatric primary care concepts covered throughout the NR602 course. Each question includes case
study scenarios, the correct answer, and a rationale in italics for comprehensive review. Select the single
best answer for each question.
1. A 2-month-old infant is brought to the clinic for a well-child visit. The mother reports the infant has
been feeding well but seems to have a cold. The infant's temperature is 100.4°F (38°C) rectally. The
nurse practitioner should:
A. Reassure the mother that this is normal for a 2-month-old
B. Recommend acetaminophen and follow up in 24 hours
C. Refer the infant to the emergency department for further evaluation
D. Prescribe an antibiotic for suspected bacterial infection
Correct Answer: C
Rationale: A rectal temperature of 100.4°F (38°C) or higher in an infant younger than 3 months
is considered a fever of unknown origin and requires immediate evaluation. Infants this age
have immature immune systems and may not show localized signs of serious bacterial infections
such as sepsis, meningitis, or urinary tract infection. Immediate referral to the emergency
department for a full sepsis workup is indicated.
2. A 4-year-old child is brought to the clinic with a complaint of ear pain. The nurse practitioner
observes a bulging, red tympanic membrane on otoscopic examination. The child has a history of
recurrent otitis media. The most appropriate initial management is:
A. Watchful waiting for 48 hours
B. Prescribe amoxicillin 80-90 mg/kg/day divided twice daily
C. Prescribe amoxicillin 40 mg/kg/day divided three times daily
D. Refer for tympanostomy tube placement
Correct Answer: B
Rationale: For a child with acute otitis media (AOM) who has a history of recurrent infections
,and presents with a bulging, red tympanic membrane, antibiotic therapy is indicated. High-dose
amoxicillin (80-90 mg/kg/day) is the first-line treatment for AOM in children to overcome
penicillin-resistant Streptococcus pneumoniae. Watchful waiting is appropriate for children
older than 2 years with non-severe illness and no recent antibiotic use. Tympanostomy tube
referral is considered after multiple episodes.
3. A 6-year-old child presents with a "barking" cough, hoarseness, and inspiratory stridor. The
symptoms worsen at night. The most likely diagnosis is:
A. Epiglottitis
B. Croup (laryngotracheobronchitis)
C. Bronchiolitis
D. Asthma
Correct Answer: B
Rationale: Croup, or laryngotracheobronchitis, is characterized by a barking cough, hoarseness,
and inspiratory stridor. It is most commonly caused by parainfluenza virus and typically affects
children between 6 months and 6 years of age. Symptoms often worsen at night. Epiglottitis
presents with high fever, drooling, and tripod positioning. Bronchiolitis typically affects infants
and presents with wheezing and crackles. Asthma presents with wheezing and difficulty
breathing.
4. A 15-year-old adolescent is brought to the clinic by her mother for a sports physical. The adolescent
reports regular menstrual cycles but complains of severe cramping during her period that interferes
with school. The nurse practitioner should recommend:
A. Oral contraceptives
B. Ibuprofen 400-600 mg every 6 hours starting 1-2 days before menses
C. Acetaminophen 500 mg every 4 hours as needed
D. Heating pad and bed rest
Correct Answer: B
Rationale: Primary dysmenorrhea is caused by prostaglandin release during menstruation,
leading to uterine contractions and cramping. Nonsteroidal anti-inflammatory drugs (NSAIDs)
such as ibuprofen are the first-line treatment because they inhibit prostaglandin synthesis. They
are most effective when started 1-2 days before the onset of menses and continued through the
first 2-3 days. Oral contraceptives may be considered if NSAIDs are ineffective.
5. A 9-month-old infant is brought to the clinic for a well-child visit. The nurse practitioner assesses
the infant's developmental milestones. Which of the following findings would be concerning?
A. The infant can sit without support
B. The infant can pull to a standing position
C. The infant cannot roll over in either direction
D. The infant can transfer objects from one hand to the other
Correct Answer: C
Rationale: By 6 months of age, most infants can roll over in both directions. The inability to roll
,over by 9 months is a developmental red flag that warrants further evaluation. Sitting without
support, pulling to stand, and transferring objects are all milestones that are typically achieved
by 9 months and are reassuring findings.
6. A 3-year-old child is brought to the clinic with a 2-day history of fever, irritability, and decreased
oral intake. The child has small, grayish-white vesicles on an erythematous base around the mouth
and on the palms and soles. The most likely diagnosis is:
A. Varicella (chickenpox)
B. Hand, foot, and mouth disease (HFMD)
C. Herpes simplex virus (HSV) infection
D. Impetigo
Correct Answer: B
Rationale: Hand, foot, and mouth disease (HFMD) is caused by coxsackievirus and is
characterized by fever, irritability, and vesicles on the mouth, palms, and soles. It commonly
affects children under 5 years of age. Varicella presents with vesicles in various stages of healing
on the trunk and extremities. HSV infection typically presents with grouped vesicles on the lips
or oral mucosa. Impetigo presents with honey-crusted lesions, usually around the nose and
mouth.
7. A 12-year-old child is brought to the clinic for a routine check-up. The child's BMI is at the 95th
percentile for age and gender. The nurse practitioner should:
A. Reassure the parent that this is normal for a 12-year-old
B. Diagnose the child with obesity and initiate a comprehensive weight management plan
C. Recommend a restrictive diet to promote weight loss
D. Refer the child to a pediatric endocrinologist immediately
Correct Answer: B
Rationale: A BMI at or above the 95th percentile for age and gender is classified as obesity in
children and adolescents. The nurse practitioner should diagnose obesity and initiate a
comprehensive weight management plan that includes dietary counseling, physical activity
promotion, and behavioral strategies. A restrictive diet is not appropriate for a growing child.
Referral to an endocrinologist is considered if there are concerns for secondary causes of
obesity.
8. A 5-year-old child presents with a 3-day history of sore throat, fever, and swollen tonsils with white
exudate. A rapid strep test is positive. The nurse practitioner should prescribe:
A. Amoxicillin 50 mg/kg/day divided twice daily for 10 days
B. Penicillin V 250 mg four times daily for 10 days
C. Azithromycin 10 mg/kg on day 1, then 5 mg/kg on days 2-5
D. Cephalexin 25 mg/kg/day divided four times daily for 10 days
Correct Answer: A
Rationale: Group A streptococcal pharyngitis (strep throat) is treated with penicillin or
amoxicillin. Amoxicillin 50 mg/kg/day divided twice daily for 10 days is a common and effective
, regimen. Penicillin V is also effective but requires four times daily dosing, which may affect
adherence. Azithromycin is used for penicillin-allergic patients. Cephalexin is also an option for
penicillin-allergic patients without anaphylaxis.
9. A 2-week-old newborn is brought to the clinic for a weight check. The infant was born at 7 lb 8 oz
and now weighs 7 lb 0 oz. The mother reports the infant is breastfeeding 8-10 times per day and has
6-8 wet diapers per day. The nurse practitioner should:
A. Recommend supplementation with formula
B. Reassure the mother that this weight loss is normal
C. Refer the infant to a gastroenterologist
D. Recommend increasing breastfeeding frequency
Correct Answer: B
Rationale: Newborns typically lose 5-10% of their birth weight in the first few days of life and
regain it by 2 weeks of age. This infant has lost approximately 6.7% of birth weight, which is
within normal limits. The infant is feeding well and has adequate output (6-8 wet diapers per
day), indicating adequate hydration. Reassurance is appropriate.
10. A 7-year-old child is brought to the clinic with a 1-week history of nocturnal enuresis. The child
was previously continent at night. The nurse practitioner should first:
A. Prescribe desmopressin (DDAVP)
B. Obtain a thorough history and urinalysis
C. Refer the child to a urologist
D. Recommend a bedwetting alarm
Correct Answer: B
Rationale: Secondary nocturnal enuresis (bedwetting that recurs after a period of continence)
requires a thorough evaluation to identify underlying causes such as urinary tract infection,
diabetes mellitus, or psychosocial stressors. A thorough history and urinalysis are the first steps
in evaluation. Desmopressin and bedwetting alarms are treatments for primary enuresis.
Urology referral is considered if there are concerns for anatomical abnormalities.
11. A 4-month-old infant is brought to the clinic for immunizations. Which of the following vaccines
should the nurse practitioner administer at this visit?
A. DTaP, IPV, Hib, PCV13, Rotavirus
B. MMR, Varicella, Hepatitis A
C. Tdap, HPV, Meningococcal
D. Influenza, Hepatitis B, Polio
Correct Answer: A
Rationale: At 4 months of age, the recommended vaccines include DTaP (diphtheria, tetanus,
acellular pertussis), IPV (inactivated poliovirus), Hib (Haemophilus influenzae type b), PCV13
(pneumococcal conjugate), and Rotavirus. MMR and Varicella are given at 12-15 months. Tdap,
HPV, and Meningococcal are given during adolescence. Influenza is recommended annually
starting at 6 months. Hepatitis B is given at birth, 1-2 months, and 6-18 months.
& Rationales
Exam Title: NR602 Pediatric Primary Care - Week 8 Final
Comprehensive Assessment
Version: 2026 Verified Examplify Pack
Total Questions: 100
Time Allotted: 2.5 Hours
Instructions: This exam consists of multiple-choice questions designed to test your understanding of
pediatric primary care concepts covered throughout the NR602 course. Each question includes case
study scenarios, the correct answer, and a rationale in italics for comprehensive review. Select the single
best answer for each question.
1. A 2-month-old infant is brought to the clinic for a well-child visit. The mother reports the infant has
been feeding well but seems to have a cold. The infant's temperature is 100.4°F (38°C) rectally. The
nurse practitioner should:
A. Reassure the mother that this is normal for a 2-month-old
B. Recommend acetaminophen and follow up in 24 hours
C. Refer the infant to the emergency department for further evaluation
D. Prescribe an antibiotic for suspected bacterial infection
Correct Answer: C
Rationale: A rectal temperature of 100.4°F (38°C) or higher in an infant younger than 3 months
is considered a fever of unknown origin and requires immediate evaluation. Infants this age
have immature immune systems and may not show localized signs of serious bacterial infections
such as sepsis, meningitis, or urinary tract infection. Immediate referral to the emergency
department for a full sepsis workup is indicated.
2. A 4-year-old child is brought to the clinic with a complaint of ear pain. The nurse practitioner
observes a bulging, red tympanic membrane on otoscopic examination. The child has a history of
recurrent otitis media. The most appropriate initial management is:
A. Watchful waiting for 48 hours
B. Prescribe amoxicillin 80-90 mg/kg/day divided twice daily
C. Prescribe amoxicillin 40 mg/kg/day divided three times daily
D. Refer for tympanostomy tube placement
Correct Answer: B
Rationale: For a child with acute otitis media (AOM) who has a history of recurrent infections
,and presents with a bulging, red tympanic membrane, antibiotic therapy is indicated. High-dose
amoxicillin (80-90 mg/kg/day) is the first-line treatment for AOM in children to overcome
penicillin-resistant Streptococcus pneumoniae. Watchful waiting is appropriate for children
older than 2 years with non-severe illness and no recent antibiotic use. Tympanostomy tube
referral is considered after multiple episodes.
3. A 6-year-old child presents with a "barking" cough, hoarseness, and inspiratory stridor. The
symptoms worsen at night. The most likely diagnosis is:
A. Epiglottitis
B. Croup (laryngotracheobronchitis)
C. Bronchiolitis
D. Asthma
Correct Answer: B
Rationale: Croup, or laryngotracheobronchitis, is characterized by a barking cough, hoarseness,
and inspiratory stridor. It is most commonly caused by parainfluenza virus and typically affects
children between 6 months and 6 years of age. Symptoms often worsen at night. Epiglottitis
presents with high fever, drooling, and tripod positioning. Bronchiolitis typically affects infants
and presents with wheezing and crackles. Asthma presents with wheezing and difficulty
breathing.
4. A 15-year-old adolescent is brought to the clinic by her mother for a sports physical. The adolescent
reports regular menstrual cycles but complains of severe cramping during her period that interferes
with school. The nurse practitioner should recommend:
A. Oral contraceptives
B. Ibuprofen 400-600 mg every 6 hours starting 1-2 days before menses
C. Acetaminophen 500 mg every 4 hours as needed
D. Heating pad and bed rest
Correct Answer: B
Rationale: Primary dysmenorrhea is caused by prostaglandin release during menstruation,
leading to uterine contractions and cramping. Nonsteroidal anti-inflammatory drugs (NSAIDs)
such as ibuprofen are the first-line treatment because they inhibit prostaglandin synthesis. They
are most effective when started 1-2 days before the onset of menses and continued through the
first 2-3 days. Oral contraceptives may be considered if NSAIDs are ineffective.
5. A 9-month-old infant is brought to the clinic for a well-child visit. The nurse practitioner assesses
the infant's developmental milestones. Which of the following findings would be concerning?
A. The infant can sit without support
B. The infant can pull to a standing position
C. The infant cannot roll over in either direction
D. The infant can transfer objects from one hand to the other
Correct Answer: C
Rationale: By 6 months of age, most infants can roll over in both directions. The inability to roll
,over by 9 months is a developmental red flag that warrants further evaluation. Sitting without
support, pulling to stand, and transferring objects are all milestones that are typically achieved
by 9 months and are reassuring findings.
6. A 3-year-old child is brought to the clinic with a 2-day history of fever, irritability, and decreased
oral intake. The child has small, grayish-white vesicles on an erythematous base around the mouth
and on the palms and soles. The most likely diagnosis is:
A. Varicella (chickenpox)
B. Hand, foot, and mouth disease (HFMD)
C. Herpes simplex virus (HSV) infection
D. Impetigo
Correct Answer: B
Rationale: Hand, foot, and mouth disease (HFMD) is caused by coxsackievirus and is
characterized by fever, irritability, and vesicles on the mouth, palms, and soles. It commonly
affects children under 5 years of age. Varicella presents with vesicles in various stages of healing
on the trunk and extremities. HSV infection typically presents with grouped vesicles on the lips
or oral mucosa. Impetigo presents with honey-crusted lesions, usually around the nose and
mouth.
7. A 12-year-old child is brought to the clinic for a routine check-up. The child's BMI is at the 95th
percentile for age and gender. The nurse practitioner should:
A. Reassure the parent that this is normal for a 12-year-old
B. Diagnose the child with obesity and initiate a comprehensive weight management plan
C. Recommend a restrictive diet to promote weight loss
D. Refer the child to a pediatric endocrinologist immediately
Correct Answer: B
Rationale: A BMI at or above the 95th percentile for age and gender is classified as obesity in
children and adolescents. The nurse practitioner should diagnose obesity and initiate a
comprehensive weight management plan that includes dietary counseling, physical activity
promotion, and behavioral strategies. A restrictive diet is not appropriate for a growing child.
Referral to an endocrinologist is considered if there are concerns for secondary causes of
obesity.
8. A 5-year-old child presents with a 3-day history of sore throat, fever, and swollen tonsils with white
exudate. A rapid strep test is positive. The nurse practitioner should prescribe:
A. Amoxicillin 50 mg/kg/day divided twice daily for 10 days
B. Penicillin V 250 mg four times daily for 10 days
C. Azithromycin 10 mg/kg on day 1, then 5 mg/kg on days 2-5
D. Cephalexin 25 mg/kg/day divided four times daily for 10 days
Correct Answer: A
Rationale: Group A streptococcal pharyngitis (strep throat) is treated with penicillin or
amoxicillin. Amoxicillin 50 mg/kg/day divided twice daily for 10 days is a common and effective
, regimen. Penicillin V is also effective but requires four times daily dosing, which may affect
adherence. Azithromycin is used for penicillin-allergic patients. Cephalexin is also an option for
penicillin-allergic patients without anaphylaxis.
9. A 2-week-old newborn is brought to the clinic for a weight check. The infant was born at 7 lb 8 oz
and now weighs 7 lb 0 oz. The mother reports the infant is breastfeeding 8-10 times per day and has
6-8 wet diapers per day. The nurse practitioner should:
A. Recommend supplementation with formula
B. Reassure the mother that this weight loss is normal
C. Refer the infant to a gastroenterologist
D. Recommend increasing breastfeeding frequency
Correct Answer: B
Rationale: Newborns typically lose 5-10% of their birth weight in the first few days of life and
regain it by 2 weeks of age. This infant has lost approximately 6.7% of birth weight, which is
within normal limits. The infant is feeding well and has adequate output (6-8 wet diapers per
day), indicating adequate hydration. Reassurance is appropriate.
10. A 7-year-old child is brought to the clinic with a 1-week history of nocturnal enuresis. The child
was previously continent at night. The nurse practitioner should first:
A. Prescribe desmopressin (DDAVP)
B. Obtain a thorough history and urinalysis
C. Refer the child to a urologist
D. Recommend a bedwetting alarm
Correct Answer: B
Rationale: Secondary nocturnal enuresis (bedwetting that recurs after a period of continence)
requires a thorough evaluation to identify underlying causes such as urinary tract infection,
diabetes mellitus, or psychosocial stressors. A thorough history and urinalysis are the first steps
in evaluation. Desmopressin and bedwetting alarms are treatments for primary enuresis.
Urology referral is considered if there are concerns for anatomical abnormalities.
11. A 4-month-old infant is brought to the clinic for immunizations. Which of the following vaccines
should the nurse practitioner administer at this visit?
A. DTaP, IPV, Hib, PCV13, Rotavirus
B. MMR, Varicella, Hepatitis A
C. Tdap, HPV, Meningococcal
D. Influenza, Hepatitis B, Polio
Correct Answer: A
Rationale: At 4 months of age, the recommended vaccines include DTaP (diphtheria, tetanus,
acellular pertussis), IPV (inactivated poliovirus), Hib (Haemophilus influenzae type b), PCV13
(pneumococcal conjugate), and Rotavirus. MMR and Varicella are given at 12-15 months. Tdap,
HPV, and Meningococcal are given during adolescence. Influenza is recommended annually
starting at 6 months. Hepatitis B is given at birth, 1-2 months, and 6-18 months.
