NSG 5442 Exam 2: Questions and Answers| Updated|
Pass Guaranteed- South College
Advanced Pediatric Primary Care Nursing
1. Which approach is best when examining a 2-year-old at a well-child
visit?
A. Place the child alone on the examination table and examine from head
to toe
B. Give a long, detailed explanation of each step before beginning
C. Offer choices for every step, such as 'May I look in your ears?'
D. Examine the child on the parent's lap, let the child handle the
stethoscope, and do the least intrusive parts first
Answer: D. Examine the child on the parent's lap, let the child handle
the stethoscope, and do the least intrusive parts first
Rationale: Toddlers have separation anxiety, short attention spans, and
limited language. Using the parent's lap, allowing play with equipment,
using simple direct statements, and saving ears, throat, and other
invasive steps for last improves cooperation. Offer choices only when a
true choice exists.
2. A 4-year-old fears that an injection will 'make a hole' and her
insides will leak out. Which response is most appropriate?
A. Tell her the injection will not hurt at all
B. Explain the pharmacology of the vaccine in detail
C. Give a simple, honest explanation using a doll, then apply a bandage
after the injection
D. Avoid discussing the injection until it is given
Answer: C. Give a simple, honest explanation using a doll, then
apply a bandage after the injection
Rationale: Preschoolers use magical thinking and fear bodily mutilation.
Simple, honest explanations, demonstration with dolls, and bandages
reassure them. Never tell a child that a procedure will not hurt.
NSG 5442 Exam 2 Questions - Page 1
,3. A modest 9-year-old is anxious about undressing for the physical
examination. What is the best action?
A. Require full undressing for a complete examination
B. Provide privacy, allow partial undressing with a gown, and explain
procedures using simple physiologic explanations
C. Perform the examination with several staff members present
D. Examine the child without explanation to save time
Answer: B. Provide privacy, allow partial undressing with a gown,
and explain procedures using simple physiologic explanations
Rationale: School-age children value privacy, modesty, and
understanding how their body works. Allowing a gown, exposing only the
area being examined, and offering explanations promote cooperation and
trust.
4. Until what age is head circumference routinely plotted at well-child
visits using WHO growth standards?
A. 24 months
B. 6 months
C. 5 years
D. 18 years
Answer: A. 24 months
Rationale: Head circumference is measured and plotted routinely through
24 months to detect microcephaly, macrocephaly, and abnormal head
growth. After this age it is measured only when there is a clinical concern.
5. Which measurement technique is correct for a 3-year-old?
A. Recumbent length on a length board plotted on the WHO chart
B. Weight-for-length plotted on the WHO chart
C. Arm span instead of height
D. Standing height on a stadiometer and BMI plotted on the CDC chart
Answer: D. Standing height on a stadiometer and BMI plotted on the
CDC chart
Rationale: Recumbent length is used until 24 months, and standing
height is used from age 2 years. BMI-for-age is plotted from age 2 years
on CDC growth charts.
NSG 5442 Exam 2 Questions - Page 2
,6. At what age should routine annual blood pressure measurement
begin in children without risk factors?
A. 1 year
B. 6 years
C. 3 years
D. 12 years
Answer: C. 3 years
Rationale: The AAP recommends annual blood pressure screening
beginning at age 3 years. Children with obesity, renal disease, congenital
heart disease, or certain medications should be screened at every visit
starting earlier. Use an appropriate cuff size covering about 40% of arm
circumference.
7. During a 4-month-old well visit, the nurse practitioner sees a white
pupillary reflex (leukocoria) in the right eye. What is the best action?
A. Reassure that this is an artifact of the flash
B. Urgent referral to pediatric ophthalmology
C. Recheck at the 6-month visit
D. Start empiric antibiotic eye drops
Answer: B. Urgent referral to pediatric ophthalmology
Rationale: An absent or white red reflex may be caused by
retinoblastoma, congenital cataract, retinal detachment, or retinopathy of
prematurity. It requires urgent ophthalmology referral because delay risks
vision loss and, in retinoblastoma, loss of life.
NSG 5442 Exam 2 Questions - Page 3
, 8. A 9-month-old has an asymmetric corneal light reflex (Hirschberg
test) and the eye drifts inward on cover testing. What is the most
important concern?
A. Amblyopia, so refer to pediatric ophthalmology promptly
B. Normal infant variation that resolves by 12 months with no action
C. Retinal hemorrhage
D. Color blindness
Answer: A. Amblyopia, so refer to pediatric ophthalmology promptly
Rationale: Persistent strabismus after 4 months of age is abnormal and
may cause amblyopia (permanent vision loss in the deviating eye).
Treatment may include patching, glasses, or surgery. Pseudostrabismus
from epicanthal folds shows a symmetric light reflex.
9. A 10-year-old says her friends and her club are the most important
part of her life and she dislikes being different. What is the best
interpretation?
A. A sign of oppositional defiant disorder
B. Evidence of delayed attachment to parents
C. Typical of toddler development
D. Normal school-age development in which peer acceptance and group
identity grow in importance
Answer: D. Normal school-age development in which peer
acceptance and group identity grow in importance
Rationale: School-age children (Erikson's industry versus inferiority) form
same-sex friendships, clubs, and strong desires for conformity. Parents
continue to influence values, and sustained isolation or rejection by peers
should prompt assessment.
NSG 5442 Exam 2 Questions - Page 4
Pass Guaranteed- South College
Advanced Pediatric Primary Care Nursing
1. Which approach is best when examining a 2-year-old at a well-child
visit?
A. Place the child alone on the examination table and examine from head
to toe
B. Give a long, detailed explanation of each step before beginning
C. Offer choices for every step, such as 'May I look in your ears?'
D. Examine the child on the parent's lap, let the child handle the
stethoscope, and do the least intrusive parts first
Answer: D. Examine the child on the parent's lap, let the child handle
the stethoscope, and do the least intrusive parts first
Rationale: Toddlers have separation anxiety, short attention spans, and
limited language. Using the parent's lap, allowing play with equipment,
using simple direct statements, and saving ears, throat, and other
invasive steps for last improves cooperation. Offer choices only when a
true choice exists.
2. A 4-year-old fears that an injection will 'make a hole' and her
insides will leak out. Which response is most appropriate?
A. Tell her the injection will not hurt at all
B. Explain the pharmacology of the vaccine in detail
C. Give a simple, honest explanation using a doll, then apply a bandage
after the injection
D. Avoid discussing the injection until it is given
Answer: C. Give a simple, honest explanation using a doll, then
apply a bandage after the injection
Rationale: Preschoolers use magical thinking and fear bodily mutilation.
Simple, honest explanations, demonstration with dolls, and bandages
reassure them. Never tell a child that a procedure will not hurt.
NSG 5442 Exam 2 Questions - Page 1
,3. A modest 9-year-old is anxious about undressing for the physical
examination. What is the best action?
A. Require full undressing for a complete examination
B. Provide privacy, allow partial undressing with a gown, and explain
procedures using simple physiologic explanations
C. Perform the examination with several staff members present
D. Examine the child without explanation to save time
Answer: B. Provide privacy, allow partial undressing with a gown,
and explain procedures using simple physiologic explanations
Rationale: School-age children value privacy, modesty, and
understanding how their body works. Allowing a gown, exposing only the
area being examined, and offering explanations promote cooperation and
trust.
4. Until what age is head circumference routinely plotted at well-child
visits using WHO growth standards?
A. 24 months
B. 6 months
C. 5 years
D. 18 years
Answer: A. 24 months
Rationale: Head circumference is measured and plotted routinely through
24 months to detect microcephaly, macrocephaly, and abnormal head
growth. After this age it is measured only when there is a clinical concern.
5. Which measurement technique is correct for a 3-year-old?
A. Recumbent length on a length board plotted on the WHO chart
B. Weight-for-length plotted on the WHO chart
C. Arm span instead of height
D. Standing height on a stadiometer and BMI plotted on the CDC chart
Answer: D. Standing height on a stadiometer and BMI plotted on the
CDC chart
Rationale: Recumbent length is used until 24 months, and standing
height is used from age 2 years. BMI-for-age is plotted from age 2 years
on CDC growth charts.
NSG 5442 Exam 2 Questions - Page 2
,6. At what age should routine annual blood pressure measurement
begin in children without risk factors?
A. 1 year
B. 6 years
C. 3 years
D. 12 years
Answer: C. 3 years
Rationale: The AAP recommends annual blood pressure screening
beginning at age 3 years. Children with obesity, renal disease, congenital
heart disease, or certain medications should be screened at every visit
starting earlier. Use an appropriate cuff size covering about 40% of arm
circumference.
7. During a 4-month-old well visit, the nurse practitioner sees a white
pupillary reflex (leukocoria) in the right eye. What is the best action?
A. Reassure that this is an artifact of the flash
B. Urgent referral to pediatric ophthalmology
C. Recheck at the 6-month visit
D. Start empiric antibiotic eye drops
Answer: B. Urgent referral to pediatric ophthalmology
Rationale: An absent or white red reflex may be caused by
retinoblastoma, congenital cataract, retinal detachment, or retinopathy of
prematurity. It requires urgent ophthalmology referral because delay risks
vision loss and, in retinoblastoma, loss of life.
NSG 5442 Exam 2 Questions - Page 3
, 8. A 9-month-old has an asymmetric corneal light reflex (Hirschberg
test) and the eye drifts inward on cover testing. What is the most
important concern?
A. Amblyopia, so refer to pediatric ophthalmology promptly
B. Normal infant variation that resolves by 12 months with no action
C. Retinal hemorrhage
D. Color blindness
Answer: A. Amblyopia, so refer to pediatric ophthalmology promptly
Rationale: Persistent strabismus after 4 months of age is abnormal and
may cause amblyopia (permanent vision loss in the deviating eye).
Treatment may include patching, glasses, or surgery. Pseudostrabismus
from epicanthal folds shows a symmetric light reflex.
9. A 10-year-old says her friends and her club are the most important
part of her life and she dislikes being different. What is the best
interpretation?
A. A sign of oppositional defiant disorder
B. Evidence of delayed attachment to parents
C. Typical of toddler development
D. Normal school-age development in which peer acceptance and group
identity grow in importance
Answer: D. Normal school-age development in which peer
acceptance and group identity grow in importance
Rationale: School-age children (Erikson's industry versus inferiority) form
same-sex friendships, clubs, and strong desires for conformity. Parents
continue to influence values, and sustained isolation or rejection by peers
should prompt assessment.
NSG 5442 Exam 2 Questions - Page 4
