NUNP 6541 Primary Care of Adolescents
& Children
Midterm Exam Review
(Questions & Solutions)
2025
©2025
, Case: A 15-year-old male presents to your primary care clinic with
persistent insomnia, irritability, declining school performance, and recent
reports of experimenting with substances. His symptoms suggest an
emerging mood disorder with risk behaviors.
Question: What is the most appropriate initial intervention in primary
care for this patient?
a) Immediate hospitalization for safety
b) Referral for pharmacotherapy with SSRIs
c) Implementation of cognitive-behavioral techniques and motivational
interviewing
d) Observation with scheduled follow-up in six months
Correct ANS: c) Implementation of cognitive-behavioral techniques
and motivational interviewing
Rationale: In adolescents with depressive symptoms and substance
use, the primary care approach favors non-pharmacologic
interventions—such as CBT and motivational interviewing—to build trust
and address both mood and risk behaviors before considering
medication, especially in the absence of severe suicidal ideation or acute
risk.
---
2. Fill-in-the-Blank
Case: During a comprehensive well-child visit, you perform mental
health screening for a 16-year-old patient.
Question: The _______ questionnaire is frequently utilized as an
effective screening tool for depression in adolescents.
Correct ANS: PHQ-A
©2025
, Rationale: The Patient Health Questionnaire for Adolescents (PHQ-A) is
validated for identifying depressive symptoms in this age group,
facilitating early intervention.
---
3. True/False
Case: A 14-year-old overweight adolescent with a family history of type
2 diabetes is evaluated in primary care.
Question: True or False: Overweight adolescents with a significant
family history of type 2 diabetes should undergo early screening for
metabolic syndrome components.
Correct ANS: True
Rationale: Early screening is indicated due to the elevated risk;
detecting components of metabolic syndrome early can prompt
interventions that may prevent progression and reduce long-term
complications.
---
4. Multiple Choice
Case: A 12-year-old child with a known history of asthma presents with
frequent exacerbations. The parent admits the prescribed inhaled
corticosteroid is used inconsistently.
Question: Which intervention is most likely to improve the child’s
asthma control?
a) Increase the dose of inhaled corticosteroids immediately
b) Develop a patient- and family-centered asthma action plan with
education
c) Switch to oral corticosteroids on a scheduled basis
d) Recommend reliance solely on rescue inhalers during symptoms
©2025
, Correct ANS: b) Develop a patient- and family-centered asthma action
plan with education
Rationale: Educating the family and establishing an action plan targets
adherence and helps tailor self-management strategies, reducing
exacerbations and emergency visits.
---
5. Multiple Response
Case: A 14-year-old presents with mood instability, rapid changes in
energy levels, and occasional disruptive behavior. You suspect emerging
bipolar disorder.
Question: Which of the following components are essential in the
comprehensive evaluation of this adolescent? (Select all that apply)
a) A detailed family psychiatric history
b) Assessment of current and past substance use
c) Evaluation for co-morbid attention deficit hyperactivity disorder
(ADHD)
d) A thorough review of the adolescent’s sports participation history
Correct ANSs: a), b), and c)
Rationale: In evaluating suspected bipolar disorder, understanding
family history, substance use patterns, and coexisting conditions like
ADHD is critical. While sports participation is valuable background, it is
less directly related to psychiatric assessment.
---
6. Fill-in-the-Blank
Case: In routine adolescent immunizations, the HPV vaccine plays a key
role in preventing future malignancies.
©2025
& Children
Midterm Exam Review
(Questions & Solutions)
2025
©2025
, Case: A 15-year-old male presents to your primary care clinic with
persistent insomnia, irritability, declining school performance, and recent
reports of experimenting with substances. His symptoms suggest an
emerging mood disorder with risk behaviors.
Question: What is the most appropriate initial intervention in primary
care for this patient?
a) Immediate hospitalization for safety
b) Referral for pharmacotherapy with SSRIs
c) Implementation of cognitive-behavioral techniques and motivational
interviewing
d) Observation with scheduled follow-up in six months
Correct ANS: c) Implementation of cognitive-behavioral techniques
and motivational interviewing
Rationale: In adolescents with depressive symptoms and substance
use, the primary care approach favors non-pharmacologic
interventions—such as CBT and motivational interviewing—to build trust
and address both mood and risk behaviors before considering
medication, especially in the absence of severe suicidal ideation or acute
risk.
---
2. Fill-in-the-Blank
Case: During a comprehensive well-child visit, you perform mental
health screening for a 16-year-old patient.
Question: The _______ questionnaire is frequently utilized as an
effective screening tool for depression in adolescents.
Correct ANS: PHQ-A
©2025
, Rationale: The Patient Health Questionnaire for Adolescents (PHQ-A) is
validated for identifying depressive symptoms in this age group,
facilitating early intervention.
---
3. True/False
Case: A 14-year-old overweight adolescent with a family history of type
2 diabetes is evaluated in primary care.
Question: True or False: Overweight adolescents with a significant
family history of type 2 diabetes should undergo early screening for
metabolic syndrome components.
Correct ANS: True
Rationale: Early screening is indicated due to the elevated risk;
detecting components of metabolic syndrome early can prompt
interventions that may prevent progression and reduce long-term
complications.
---
4. Multiple Choice
Case: A 12-year-old child with a known history of asthma presents with
frequent exacerbations. The parent admits the prescribed inhaled
corticosteroid is used inconsistently.
Question: Which intervention is most likely to improve the child’s
asthma control?
a) Increase the dose of inhaled corticosteroids immediately
b) Develop a patient- and family-centered asthma action plan with
education
c) Switch to oral corticosteroids on a scheduled basis
d) Recommend reliance solely on rescue inhalers during symptoms
©2025
, Correct ANS: b) Develop a patient- and family-centered asthma action
plan with education
Rationale: Educating the family and establishing an action plan targets
adherence and helps tailor self-management strategies, reducing
exacerbations and emergency visits.
---
5. Multiple Response
Case: A 14-year-old presents with mood instability, rapid changes in
energy levels, and occasional disruptive behavior. You suspect emerging
bipolar disorder.
Question: Which of the following components are essential in the
comprehensive evaluation of this adolescent? (Select all that apply)
a) A detailed family psychiatric history
b) Assessment of current and past substance use
c) Evaluation for co-morbid attention deficit hyperactivity disorder
(ADHD)
d) A thorough review of the adolescent’s sports participation history
Correct ANSs: a), b), and c)
Rationale: In evaluating suspected bipolar disorder, understanding
family history, substance use patterns, and coexisting conditions like
ADHD is critical. While sports participation is valuable background, it is
less directly related to psychiatric assessment.
---
6. Fill-in-the-Blank
Case: In routine adolescent immunizations, the HPV vaccine plays a key
role in preventing future malignancies.
©2025
