NR602 PEDIATRIC MIDTERM NEWEST TEST EXAM STUDY SET
2025/2026 COMPLETE STUDY QUESTIONS WITH CORRECT
ANSWERS GUARANTEED PASS | RATED A+
A 14-year-old female has menometrorrhagia with moderate increase in menstrual flow and
irregular periods. Her hemoglobin is 13.1 g/dL. How will this be managed?
Iron supplementation and prostaglandin inhibitors
One OCP twice daily for 3 to 4 days and then daily
Progestin every day for 10 to 14 days
Referral to a pediatric gynecologist for treatment - Answer>>> ANS: A
This patient has mild AUB and may be managed by observation and reassurance along with iron
to prevent anemia and prostaglandin inhibitors to reduce heavy bleeding. Patients with moderate
AUB may be prescribed OCPs or progestins. Referral to a gynecologist is warranted with severe
AUB.
The parents of a pre-pubertal female who is on the local swim team tell the primary care
pediatric nurse practitioner that their daughter wants to begin a strength training program to help
improve her swimming ability. What will the nurse practitioner recommend?
Avoiding strength training programs until after puberty to minimize the risk for injury
Enrolling their daughter in a program that uses fixed weight machines or resistance bands
Having their daughter participate in weight training 4 or 5 times each week for maximum effect
Making sure that their daughter begins with the greatest weight tolerable using lower repetitions
- Answer>>> ANS: B
Fixed weights or resistance bands are recommended for pre-pubertal youth to help prevent
injury. Strength training prior to menarche helps to strengthen long bones and is considered
beneficial. Weight training should be 2 to 3 times weekly with a day in between sessions.
Initially, youth should begin with a low number of sets and low intensity.
,An 18-month-old child has a 1-day history of intermittent, cramping abdominal pain with non-
bilious vomiting. The child is observed to scream and draw up his legs during pain episodes and
becomes lethargic in between. The primary care pediatric nurse practitioner notes a small amount
of bloody, mucous stool in the diaper. What is the most likely diagnosis?
Appendicitis
Gastroenteritis
Intussusception
Testicular torsion - Answer>>> ANS: C
Intussusception is characterized by intermittent pain associated with drawing up the legs,
"currant jelly" stools, and lethargy in between episodes. Appendicitis is characterized by pain
localizing to the RLQ and is not intermittent. Gastroenteritis is likely when vomiting precedes
symptoms of pain or discomfort. Testicular torsion involves the testicles and thus has different
physical findings and would not be accompanied with bloody stools.
A school-age child has several annular lesions on the abdomen characterized by central clearing
with scaly, red borders. What is the first step in managing this condition?
Fluoresce the lesions with a Wood's lamp.
Obtain fungal cultures of the lesions.
Perform KOH-treated scrapings of the lesion borders.
Treat empirically with antifungal cream. - Answer>>> ANS: D
Unless the diagnosis is questionable, or if treatment failure occurs, tinea corporis is treated
empirically with topical antifungal creams; therefore, it is not necessary to fluoresce the lesions,
culture the lesions, or complete KOH testing of scrapings as an initial management step.
A child who has been taking antibiotics is brought to the clinic with a rash. The parent reports
that the child had a fever associated with what looked like sunburn and now has "blisters" all
over. A physical examination shows coalescent target lesions and widespread bullae and areas of
peeled skin revealing moist, red surfaces. What will the primary care pediatric nurse practitioner
do?
,Consult with a pediatric intensivist for admission to a pediatric intensive care unit.
Order oral acyclovir 20 mg/kg/day in two doses for 6 to 12 months.
Prescribe systemic antihistamines and antimicrobial medications as prophylaxis.
Recommend analgesics, cool compresses, and oral antihistamines for comfort. - Answer>>>
ANS: A
This child has symptoms consistent with toxic epidermal necrolysis, which is potentially life-
threatening. Children with symptoms should be admitted to the PICU for management. The other
options are treatments for erythema multiforme, a more benign, viral-induced rash. Oral
acyclovir is given when herpes simplex infection is possible.
A child is brought to clinic with several bright red lesions on the buttocks. The primary care
pediatric nurse practitioner examines the lesions and notes sharp margins and an "orange peel"
look and feel. The child is afebrile and does not appear toxic. What is the course of treatment for
these lesions?
Hospitalize the child for intravenous antibiotics and possible I&D of the lesions.
Initiate empiric antibiotic therapy and follow up in 24 hours to assess response.
Obtain blood cultures prior to beginning antibiotic treatment.
Perform gram stain and culture of the lesions before initiating antibiotics. - Answer>>> ANS: B
The child has clinical signs of erysipelas, which is a superficial variant of cellulitis. Because the
child is afebrile and doesn't appear toxic, outpatient antibiotics with 24-hour follow-up can be
initiated. If the child does not respond or becomes toxic, hospitalization and IV antibiotics are
indicated. Blood cultures rarely are positive. Gram stain and cultures are performed if unusual
organisms are suspected or if pus is present.
A 16-year-old female reports dull, achy cramping pain in her lower abdomen lasting 2 or 3 hours
that occurs between her menstrual periods each month. The adolescent is not sexually active.
What is the treatment for this condition?
Abdominal ultrasound to rule out ovarian cyst
, Oral contraceptives to suppress ovulation
Prostaglandin inhibitor analgesics and a heating pad
Referral to a pediatric gynecologist - Answer>>> ANS: C
The adolescent is experiencing mittelschmerz pain, which is thought to occur when the follicle
ruptures at the time of ovulation. Unless the pain is severe, the adolescent should be reassured
and offered strategies to relieve discomfort, such as a heating pad and NSAIDs. The pain is
intermittent and occurs between periods; if it were persistent and severe, abdominal US would be
indicated. Oral contraceptives are rarely used to suppress ovulation when symptoms are severe.
Referral to a pediatric gynecologist is not indicated.
A 9-year-old girl has a history of frequent vomiting and her mother has frequent migraine
headaches. The child has recently begun having more frequent and prolonged episodes
accompanied by headaches. An exam reveals abnormal eye movements and mild ataxia. What is
the correct action?
Begin using an anti-migraine medication to prevent headaches.
Prescribe ondansetron and lorazepam to help manage symptoms.
Reassure the parent that this is expected with cyclic vomiting syndrome.
Refer to a pediatric gastroenterologist for further workup. - Answer>>> ANS: D
This child has an abnormal neurologic examination, which is a red flag warranting referral for
further workup for children with cyclic vomiting syndrome. Anti-migraine medications are used
in children over age 12 years and therefore should not be used for this patient. Ondansetron and
lorazepam may be useful for unrelenting nausea and poor sleep, but this child needs to be
referred to evaluate neurologic symptoms. These signs are not expected.
An adolescent has right-sided flank pain without fever. A dipstick urinalysis reveals gross
hematuria without signs of infection or bacteriuria, and the primary care pediatric nurse
practitioner diagnoses possible nephrolithiasis. What is the initial treatment for this condition?
Extracorporeal shockwave lithotripsy (ESWL)
Increasing fluid intake up to 2 L daily
2025/2026 COMPLETE STUDY QUESTIONS WITH CORRECT
ANSWERS GUARANTEED PASS | RATED A+
A 14-year-old female has menometrorrhagia with moderate increase in menstrual flow and
irregular periods. Her hemoglobin is 13.1 g/dL. How will this be managed?
Iron supplementation and prostaglandin inhibitors
One OCP twice daily for 3 to 4 days and then daily
Progestin every day for 10 to 14 days
Referral to a pediatric gynecologist for treatment - Answer>>> ANS: A
This patient has mild AUB and may be managed by observation and reassurance along with iron
to prevent anemia and prostaglandin inhibitors to reduce heavy bleeding. Patients with moderate
AUB may be prescribed OCPs or progestins. Referral to a gynecologist is warranted with severe
AUB.
The parents of a pre-pubertal female who is on the local swim team tell the primary care
pediatric nurse practitioner that their daughter wants to begin a strength training program to help
improve her swimming ability. What will the nurse practitioner recommend?
Avoiding strength training programs until after puberty to minimize the risk for injury
Enrolling their daughter in a program that uses fixed weight machines or resistance bands
Having their daughter participate in weight training 4 or 5 times each week for maximum effect
Making sure that their daughter begins with the greatest weight tolerable using lower repetitions
- Answer>>> ANS: B
Fixed weights or resistance bands are recommended for pre-pubertal youth to help prevent
injury. Strength training prior to menarche helps to strengthen long bones and is considered
beneficial. Weight training should be 2 to 3 times weekly with a day in between sessions.
Initially, youth should begin with a low number of sets and low intensity.
,An 18-month-old child has a 1-day history of intermittent, cramping abdominal pain with non-
bilious vomiting. The child is observed to scream and draw up his legs during pain episodes and
becomes lethargic in between. The primary care pediatric nurse practitioner notes a small amount
of bloody, mucous stool in the diaper. What is the most likely diagnosis?
Appendicitis
Gastroenteritis
Intussusception
Testicular torsion - Answer>>> ANS: C
Intussusception is characterized by intermittent pain associated with drawing up the legs,
"currant jelly" stools, and lethargy in between episodes. Appendicitis is characterized by pain
localizing to the RLQ and is not intermittent. Gastroenteritis is likely when vomiting precedes
symptoms of pain or discomfort. Testicular torsion involves the testicles and thus has different
physical findings and would not be accompanied with bloody stools.
A school-age child has several annular lesions on the abdomen characterized by central clearing
with scaly, red borders. What is the first step in managing this condition?
Fluoresce the lesions with a Wood's lamp.
Obtain fungal cultures of the lesions.
Perform KOH-treated scrapings of the lesion borders.
Treat empirically with antifungal cream. - Answer>>> ANS: D
Unless the diagnosis is questionable, or if treatment failure occurs, tinea corporis is treated
empirically with topical antifungal creams; therefore, it is not necessary to fluoresce the lesions,
culture the lesions, or complete KOH testing of scrapings as an initial management step.
A child who has been taking antibiotics is brought to the clinic with a rash. The parent reports
that the child had a fever associated with what looked like sunburn and now has "blisters" all
over. A physical examination shows coalescent target lesions and widespread bullae and areas of
peeled skin revealing moist, red surfaces. What will the primary care pediatric nurse practitioner
do?
,Consult with a pediatric intensivist for admission to a pediatric intensive care unit.
Order oral acyclovir 20 mg/kg/day in two doses for 6 to 12 months.
Prescribe systemic antihistamines and antimicrobial medications as prophylaxis.
Recommend analgesics, cool compresses, and oral antihistamines for comfort. - Answer>>>
ANS: A
This child has symptoms consistent with toxic epidermal necrolysis, which is potentially life-
threatening. Children with symptoms should be admitted to the PICU for management. The other
options are treatments for erythema multiforme, a more benign, viral-induced rash. Oral
acyclovir is given when herpes simplex infection is possible.
A child is brought to clinic with several bright red lesions on the buttocks. The primary care
pediatric nurse practitioner examines the lesions and notes sharp margins and an "orange peel"
look and feel. The child is afebrile and does not appear toxic. What is the course of treatment for
these lesions?
Hospitalize the child for intravenous antibiotics and possible I&D of the lesions.
Initiate empiric antibiotic therapy and follow up in 24 hours to assess response.
Obtain blood cultures prior to beginning antibiotic treatment.
Perform gram stain and culture of the lesions before initiating antibiotics. - Answer>>> ANS: B
The child has clinical signs of erysipelas, which is a superficial variant of cellulitis. Because the
child is afebrile and doesn't appear toxic, outpatient antibiotics with 24-hour follow-up can be
initiated. If the child does not respond or becomes toxic, hospitalization and IV antibiotics are
indicated. Blood cultures rarely are positive. Gram stain and cultures are performed if unusual
organisms are suspected or if pus is present.
A 16-year-old female reports dull, achy cramping pain in her lower abdomen lasting 2 or 3 hours
that occurs between her menstrual periods each month. The adolescent is not sexually active.
What is the treatment for this condition?
Abdominal ultrasound to rule out ovarian cyst
, Oral contraceptives to suppress ovulation
Prostaglandin inhibitor analgesics and a heating pad
Referral to a pediatric gynecologist - Answer>>> ANS: C
The adolescent is experiencing mittelschmerz pain, which is thought to occur when the follicle
ruptures at the time of ovulation. Unless the pain is severe, the adolescent should be reassured
and offered strategies to relieve discomfort, such as a heating pad and NSAIDs. The pain is
intermittent and occurs between periods; if it were persistent and severe, abdominal US would be
indicated. Oral contraceptives are rarely used to suppress ovulation when symptoms are severe.
Referral to a pediatric gynecologist is not indicated.
A 9-year-old girl has a history of frequent vomiting and her mother has frequent migraine
headaches. The child has recently begun having more frequent and prolonged episodes
accompanied by headaches. An exam reveals abnormal eye movements and mild ataxia. What is
the correct action?
Begin using an anti-migraine medication to prevent headaches.
Prescribe ondansetron and lorazepam to help manage symptoms.
Reassure the parent that this is expected with cyclic vomiting syndrome.
Refer to a pediatric gastroenterologist for further workup. - Answer>>> ANS: D
This child has an abnormal neurologic examination, which is a red flag warranting referral for
further workup for children with cyclic vomiting syndrome. Anti-migraine medications are used
in children over age 12 years and therefore should not be used for this patient. Ondansetron and
lorazepam may be useful for unrelenting nausea and poor sleep, but this child needs to be
referred to evaluate neurologic symptoms. These signs are not expected.
An adolescent has right-sided flank pain without fever. A dipstick urinalysis reveals gross
hematuria without signs of infection or bacteriuria, and the primary care pediatric nurse
practitioner diagnoses possible nephrolithiasis. What is the initial treatment for this condition?
Extracorporeal shockwave lithotripsy (ESWL)
Increasing fluid intake up to 2 L daily
