,NRNP 6820 Management of Complex
Pediatric Conditions Exam Prep —
Comprehensive Review + Practice
MCQs — Walden University 2025/2026
1. A 9-year-old with moderate persistent asthma is prescribed a low-dose inhaled corticosteroid (ICS) plus a
long-acting beta-agonist (LABA). The parent asks why two medications are needed. Which explanation best
reflects the rationale for combination therapy?
A. The LABA treats acute bronchospasm while the ICS prevents infection.
B. The ICS controls airway inflammation while the LABA provides long-term bronchodilation.
C. The LABA replaces the need for a rescue inhaler.
D. The ICS enhances the immediate effects of the LABA during acute attacks.
Correct Answer: B
Rationale: In moderate persistent asthma, combination therapy with ICS + LABA addresses both the
inflammatory component (ICS) and the bronchoconstrictive component (LABA) of the disease. ICS are
controller medications that reduce airway inflammation; LABAs provide sustained bronchodilation but should
never be used as monotherapy in asthma due to safety concerns. A rescue inhaler (SABA) is still required for
acute symptoms.
2. A 14-year-old with type 1 diabetes presents with polyuria, polydipsia, and a blood glucose of 480 mg/dL.
ABG shows pH 7.21, HCO₃⁻ 12 mEq/L, and moderate ketones in urine. Which is the priority initial intervention?
A. Administer subcutaneous insulin glargine
B. Begin intravenous fluid resuscitation with 0.9% normal saline
,C. Administer oral potassium supplementation
D. Start an insulin drip at 0.1 units/kg/hr immediately
Correct Answer: B
Rationale: This presentation is consistent with diabetic ketoacidosis (DKA). The priority initial intervention is IV
fluid resuscitation with isotonic saline to restore intravascular volume and perfusion. Insulin should follow after
initial fluid resuscitation. Potassium must be assessed before insulin administration, as insulin drives potassium
intracellularly and may precipitate life-threatening hypokalemia.
3. A 6-year-old with sickle cell disease (HbSS) presents with fever of 101.8°F, left upper quadrant pain, and
splenomegaly. Which complication should the PNP suspect first?
A. Acute chest syndrome
B. Splenic sequestration crisis
C. Aplastic crisis
D. Vaso-occlusive crisis
Correct Answer: B
Rationale: Splenic sequestration crisis is characterized by rapid splenic enlargement, left upper quadrant pain,
and a drop in hemoglobin, often accompanied by fever. It is a life-threatening complication, particularly in
young children with sickle cell disease, and requires urgent evaluation and possible transfusion. Acute chest
syndrome presents with respiratory symptoms and new infiltrates.
4. A 12-year-old with cystic fibrosis has a BMI at the 15th percentile. The PNP is reviewing nutritional
management. Which intervention is most appropriate?
A. Restrict dietary fat to reduce pancreatic enzyme requirements
B. Prescribe high-calorie, high-fat diet with pancreatic enzyme replacement therapy (PERT)
, C. Limit sodium intake to prevent electrolyte imbalance
D. Encourage a low-protein diet to reduce metabolic demand
Correct Answer: B
Rationale: Children with cystic fibrosis have increased caloric needs due to malabsorption, increased work of
breathing, and chronic infection. A high-calorie, high-fat diet with adequate PERT is standard to promote
growth and maintain nutritional status. Fat restriction is contraindicated. Sodium supplementation may
actually be needed, especially in hot weather.
5. A 10-year-old with obesity (BMI 97th percentile) has acanthosis nigricans and a fasting glucose of 118
mg/dL. Which condition should the PNP screen for next?
A. Type 1 diabetes mellitus
B. Type 2 diabetes mellitus
C. Hypothyroidism
D. Cushing syndrome
Correct Answer: B
Rationale: Acanthosis nigricans, obesity, and impaired fasting glucose are classic risk factors for type 2 diabetes
mellitus in children. The PNP should screen with HbA1c and/or oral glucose tolerance test. Type 1 diabetes
typically presents acutely with ketosis and autoantibodies. Hypothyroidism and Cushing syndrome have
different clinical presentations.
6. A 5-year-old with a history of prematurity and bronchopulmonary dysplasia (BPD) presents with increased
work of breathing and wheezing. Which medication is most appropriate for long-term management of his
reactive airway disease?
A. Oral prednisolone burst
Pediatric Conditions Exam Prep —
Comprehensive Review + Practice
MCQs — Walden University 2025/2026
1. A 9-year-old with moderate persistent asthma is prescribed a low-dose inhaled corticosteroid (ICS) plus a
long-acting beta-agonist (LABA). The parent asks why two medications are needed. Which explanation best
reflects the rationale for combination therapy?
A. The LABA treats acute bronchospasm while the ICS prevents infection.
B. The ICS controls airway inflammation while the LABA provides long-term bronchodilation.
C. The LABA replaces the need for a rescue inhaler.
D. The ICS enhances the immediate effects of the LABA during acute attacks.
Correct Answer: B
Rationale: In moderate persistent asthma, combination therapy with ICS + LABA addresses both the
inflammatory component (ICS) and the bronchoconstrictive component (LABA) of the disease. ICS are
controller medications that reduce airway inflammation; LABAs provide sustained bronchodilation but should
never be used as monotherapy in asthma due to safety concerns. A rescue inhaler (SABA) is still required for
acute symptoms.
2. A 14-year-old with type 1 diabetes presents with polyuria, polydipsia, and a blood glucose of 480 mg/dL.
ABG shows pH 7.21, HCO₃⁻ 12 mEq/L, and moderate ketones in urine. Which is the priority initial intervention?
A. Administer subcutaneous insulin glargine
B. Begin intravenous fluid resuscitation with 0.9% normal saline
,C. Administer oral potassium supplementation
D. Start an insulin drip at 0.1 units/kg/hr immediately
Correct Answer: B
Rationale: This presentation is consistent with diabetic ketoacidosis (DKA). The priority initial intervention is IV
fluid resuscitation with isotonic saline to restore intravascular volume and perfusion. Insulin should follow after
initial fluid resuscitation. Potassium must be assessed before insulin administration, as insulin drives potassium
intracellularly and may precipitate life-threatening hypokalemia.
3. A 6-year-old with sickle cell disease (HbSS) presents with fever of 101.8°F, left upper quadrant pain, and
splenomegaly. Which complication should the PNP suspect first?
A. Acute chest syndrome
B. Splenic sequestration crisis
C. Aplastic crisis
D. Vaso-occlusive crisis
Correct Answer: B
Rationale: Splenic sequestration crisis is characterized by rapid splenic enlargement, left upper quadrant pain,
and a drop in hemoglobin, often accompanied by fever. It is a life-threatening complication, particularly in
young children with sickle cell disease, and requires urgent evaluation and possible transfusion. Acute chest
syndrome presents with respiratory symptoms and new infiltrates.
4. A 12-year-old with cystic fibrosis has a BMI at the 15th percentile. The PNP is reviewing nutritional
management. Which intervention is most appropriate?
A. Restrict dietary fat to reduce pancreatic enzyme requirements
B. Prescribe high-calorie, high-fat diet with pancreatic enzyme replacement therapy (PERT)
, C. Limit sodium intake to prevent electrolyte imbalance
D. Encourage a low-protein diet to reduce metabolic demand
Correct Answer: B
Rationale: Children with cystic fibrosis have increased caloric needs due to malabsorption, increased work of
breathing, and chronic infection. A high-calorie, high-fat diet with adequate PERT is standard to promote
growth and maintain nutritional status. Fat restriction is contraindicated. Sodium supplementation may
actually be needed, especially in hot weather.
5. A 10-year-old with obesity (BMI 97th percentile) has acanthosis nigricans and a fasting glucose of 118
mg/dL. Which condition should the PNP screen for next?
A. Type 1 diabetes mellitus
B. Type 2 diabetes mellitus
C. Hypothyroidism
D. Cushing syndrome
Correct Answer: B
Rationale: Acanthosis nigricans, obesity, and impaired fasting glucose are classic risk factors for type 2 diabetes
mellitus in children. The PNP should screen with HbA1c and/or oral glucose tolerance test. Type 1 diabetes
typically presents acutely with ketosis and autoantibodies. Hypothyroidism and Cushing syndrome have
different clinical presentations.
6. A 5-year-old with a history of prematurity and bronchopulmonary dysplasia (BPD) presents with increased
work of breathing and wheezing. Which medication is most appropriate for long-term management of his
reactive airway disease?
A. Oral prednisolone burst
