NUR 6130 ADVANCED PRACTICE NURSING III —
EXAM 2 PRACTICE BANK
QUESTIONS 1–100 | ORIGINAL PRACTICE QUESTIONS | 2026/2027
STUDY EDITION
INTRODUCTION
NUR 6130 Advanced Practice Nursing III Exam 2 focuses on advanced clinical
reasoning required of nurse practitioners caring for pediatric and adolescent patients.
Preparation requires more than memorizing diagnostic criteria: the clinician must
recognize abnormal growth and development, distinguish benign findings from urgent
pathology, interpret developmental and physical-assessment findings, select
appropriate diagnostic testing, initiate evidence-based management, and identify
situations requiring immediate referral.
This practice bank is designed as an original study resource, not a reproduction of an
institutional examination. The questions emphasize application, prioritization,
differential diagnosis, anticipatory guidance, prevention, and management decisions.
They are intentionally written at a challenging level to help learners practice thinking
through clinical presentations rather than simply recalling isolated facts. Publicly
indexed NUR 6130 Exam 2 study materials also identify pediatric/adolescent topics
including puberty, musculoskeletal conditions, immunizations, urinary complaints,
and common pediatric illnesses. (Docsity)
Use the rationales actively: after selecting an answer, explain why the other three
options are less appropriate. This approach strengthens clinical judgment and helps
identify knowledge gaps before an examination.
CORE DOMAINS TESTED
1.
Growth and Development — Normal developmental milestones, growth
patterns, developmental surveillance, and recognition of abnormal
development.
2.
3.
Puberty and Adolescent Health — Normal versus abnormal pubertal
development, precocious puberty, delayed puberty, sexual maturation, and
adolescent counseling.
4.
5.
1
,Pediatric Musculoskeletal Disorders — Developmental dysplasia of the hip,
Legg-Calvé-Perthes disease, slipped capital femoral epiphysis, gait
abnormalities, and common overuse conditions.
6.
7.
Pediatric Genitourinary Conditions — Dysuria, urinary tract infection,
epididymitis, testicular torsion, and adolescent GU assessment.
8.
9.
Common Pediatric Infectious Conditions — Viral exanthems, otitis-related
presentations, pharyngitis, fever, and supportive management.
10.
11.
Preventive Pediatric Care — Immunizations, screening, anticipatory
guidance, injury prevention, and health promotion.
12.
13.
Adolescent Risk Reduction — Substance use, sexual health, confidentiality,
mental-health screening, and safety counseling.
14.
15.
Childhood Obesity and Nutrition — BMI interpretation, lifestyle
intervention, obesity-associated risks, and family-centered counseling.
16.
17.
Clinical Assessment and Differential Diagnosis — Distinguishing benign
variants from findings requiring diagnostic evaluation or urgent referral.
18.
19.
Evidence-Based Management and Referral — Selecting appropriate first-
line management, diagnostic testing, follow-up, and escalation of care.
20.
2
, QUESTIONS 1-100
Q1: A 6-year-old girl is brought to the pediatric primary-care clinic because her
mother noticed breast development and axillary hair. The child has grown
approximately 2.5 cm during the last 3 months. Which action is most appropriate?
A) Reassure the parent that these findings represent normal puberty
B) B) Refer for prompt pediatric endocrinologic evaluation of possible
precocious puberty
C) Begin a combined oral contraceptive immediately
D) Reassess the child at the next annual physical
Rationale: The correct answer is B because development of secondary sexual
characteristics before the usual age range warrants evaluation for precocious puberty,
particularly when breast development is accompanied by accelerated linear growth.
Option A is incorrect because the timing is abnormal for a 6-year-old. Option C is
incorrect because oral contraceptives are not the standard initial treatment for
central precocious puberty. Option D is incorrect because delaying evaluation could
allow progression and compromise adult height or overlook an underlying
intracranial or endocrine disorder.
Q2: An otherwise healthy 7-year-old boy has begun developing pubic hair and
noticeable testicular enlargement. His parents are concerned that puberty is beginning
too early. Which finding most strongly supports true central puberty rather than
isolated adrenarche?
A) Mild axillary odor
B) Sparse pubic hair
C) Acne without genital enlargement
D) D) Progressive testicular enlargement with increasing growth velocity
Rationale: The correct answer is D because central activation of the hypothalamic-
pituitary-gonadal axis in boys produces testicular enlargement and subsequently
other secondary sexual characteristics, often accompanied by accelerated growth.
Options A and B can occur with adrenarche alone. Option C may occur with
androgen production without activation of central puberty. Progressive testicular
enlargement is therefore the strongest clue to true central puberty.
Q3: A 10-year-old girl presents for a routine visit. She has breast development but no
pubic hair. Her height and weight follow the same percentiles they have followed for
years. Which interpretation is most appropriate?
A) This is necessarily pathologic puberty
B) B) Breast development can be the first normal sign of puberty in girls
C) The child should immediately receive GnRH therapy
D) The child should be diagnosed with premature adrenarche
Rationale: The correct answer is B because normal female puberty commonly begins
with breast budding followed by pubic hair and other changes. Option A is incorrect
3
EXAM 2 PRACTICE BANK
QUESTIONS 1–100 | ORIGINAL PRACTICE QUESTIONS | 2026/2027
STUDY EDITION
INTRODUCTION
NUR 6130 Advanced Practice Nursing III Exam 2 focuses on advanced clinical
reasoning required of nurse practitioners caring for pediatric and adolescent patients.
Preparation requires more than memorizing diagnostic criteria: the clinician must
recognize abnormal growth and development, distinguish benign findings from urgent
pathology, interpret developmental and physical-assessment findings, select
appropriate diagnostic testing, initiate evidence-based management, and identify
situations requiring immediate referral.
This practice bank is designed as an original study resource, not a reproduction of an
institutional examination. The questions emphasize application, prioritization,
differential diagnosis, anticipatory guidance, prevention, and management decisions.
They are intentionally written at a challenging level to help learners practice thinking
through clinical presentations rather than simply recalling isolated facts. Publicly
indexed NUR 6130 Exam 2 study materials also identify pediatric/adolescent topics
including puberty, musculoskeletal conditions, immunizations, urinary complaints,
and common pediatric illnesses. (Docsity)
Use the rationales actively: after selecting an answer, explain why the other three
options are less appropriate. This approach strengthens clinical judgment and helps
identify knowledge gaps before an examination.
CORE DOMAINS TESTED
1.
Growth and Development — Normal developmental milestones, growth
patterns, developmental surveillance, and recognition of abnormal
development.
2.
3.
Puberty and Adolescent Health — Normal versus abnormal pubertal
development, precocious puberty, delayed puberty, sexual maturation, and
adolescent counseling.
4.
5.
1
,Pediatric Musculoskeletal Disorders — Developmental dysplasia of the hip,
Legg-Calvé-Perthes disease, slipped capital femoral epiphysis, gait
abnormalities, and common overuse conditions.
6.
7.
Pediatric Genitourinary Conditions — Dysuria, urinary tract infection,
epididymitis, testicular torsion, and adolescent GU assessment.
8.
9.
Common Pediatric Infectious Conditions — Viral exanthems, otitis-related
presentations, pharyngitis, fever, and supportive management.
10.
11.
Preventive Pediatric Care — Immunizations, screening, anticipatory
guidance, injury prevention, and health promotion.
12.
13.
Adolescent Risk Reduction — Substance use, sexual health, confidentiality,
mental-health screening, and safety counseling.
14.
15.
Childhood Obesity and Nutrition — BMI interpretation, lifestyle
intervention, obesity-associated risks, and family-centered counseling.
16.
17.
Clinical Assessment and Differential Diagnosis — Distinguishing benign
variants from findings requiring diagnostic evaluation or urgent referral.
18.
19.
Evidence-Based Management and Referral — Selecting appropriate first-
line management, diagnostic testing, follow-up, and escalation of care.
20.
2
, QUESTIONS 1-100
Q1: A 6-year-old girl is brought to the pediatric primary-care clinic because her
mother noticed breast development and axillary hair. The child has grown
approximately 2.5 cm during the last 3 months. Which action is most appropriate?
A) Reassure the parent that these findings represent normal puberty
B) B) Refer for prompt pediatric endocrinologic evaluation of possible
precocious puberty
C) Begin a combined oral contraceptive immediately
D) Reassess the child at the next annual physical
Rationale: The correct answer is B because development of secondary sexual
characteristics before the usual age range warrants evaluation for precocious puberty,
particularly when breast development is accompanied by accelerated linear growth.
Option A is incorrect because the timing is abnormal for a 6-year-old. Option C is
incorrect because oral contraceptives are not the standard initial treatment for
central precocious puberty. Option D is incorrect because delaying evaluation could
allow progression and compromise adult height or overlook an underlying
intracranial or endocrine disorder.
Q2: An otherwise healthy 7-year-old boy has begun developing pubic hair and
noticeable testicular enlargement. His parents are concerned that puberty is beginning
too early. Which finding most strongly supports true central puberty rather than
isolated adrenarche?
A) Mild axillary odor
B) Sparse pubic hair
C) Acne without genital enlargement
D) D) Progressive testicular enlargement with increasing growth velocity
Rationale: The correct answer is D because central activation of the hypothalamic-
pituitary-gonadal axis in boys produces testicular enlargement and subsequently
other secondary sexual characteristics, often accompanied by accelerated growth.
Options A and B can occur with adrenarche alone. Option C may occur with
androgen production without activation of central puberty. Progressive testicular
enlargement is therefore the strongest clue to true central puberty.
Q3: A 10-year-old girl presents for a routine visit. She has breast development but no
pubic hair. Her height and weight follow the same percentiles they have followed for
years. Which interpretation is most appropriate?
A) This is necessarily pathologic puberty
B) B) Breast development can be the first normal sign of puberty in girls
C) The child should immediately receive GnRH therapy
D) The child should be diagnosed with premature adrenarche
Rationale: The correct answer is B because normal female puberty commonly begins
with breast budding followed by pubic hair and other changes. Option A is incorrect
3
