NR 607 FINAL EXAM PREPARATION GUIDE
THREE DISTINCT VERSIONS WITH VERIFIED ANSWERS AND
RATIONALES
VERSION ONE: GROWTH, DEVELOPMENT, AND INFANT CARE
Question 1
The nurse practitioner is assessing a 4-month-old infant. Which of the following motor
milestones is expected at this age?
A. Sitting independently without support
B. Rolling from back to front
C. Walking with assistance
D. Transferring a toy from one hand to the other
Answer: D
Rationale: By 4 months of age, an infant should be able to bring their hands to the midline
and transfer objects from one hand to the other. Sitting independently typically occurs around
6 months. Rolling from back to front usually occurs around 5 to 6 months. Walking with
assistance is a 12-month milestone.
Question 2
A mother brings her 2-week-old newborn to the clinic because she notices the baby's breasts
are enlarged and there is a small amount of milky discharge from the nipples. What is the
most appropriate action by the nurse practitioner?
, A. Refer the infant to a pediatric endocrinologist immediately.
B. Tell the mother to stop breastfeeding immediately.
C. Reassure the mother that this is a common, transient finding caused by maternal estrogen
withdrawal.
D. Obtain a serum prolactin level to rule out a pituitary adenoma.
Answer: C
Rationale: Breast enlargement and galactorrhea (witch's milk) in newborns are very common
and benign. They are caused by the transplacental passage of maternal estrogen, which
stimulates the infant's breast tissue. Once the maternal hormones clear from the infant's
system, the swelling and discharge resolve spontaneously. Squeezing the breasts should be
discouraged to prevent infection.
Question 3
According to the American Academy of Pediatrics, what is the recommended daily Vitamin D
supplementation for exclusively breastfed infants?
A. 100 IU
B. 200 IU
C. 400 IU
D. 800 IU
Answer: C
Rationale: Because human milk contains relatively low amounts of Vitamin D, the AAP
recommends that all exclusively breastfed infants (and partially breastfed infants who do not
consume 1 liter of formula daily) receive a daily supplement of 400 IU of Vitamin D beginning
within the first few days of life to prevent rickets and Vitamin D deficiency.
Question 4
A 3-day-old infant presents to the clinic with a temperature of 100.8 degrees Fahrenheit (38.2
degrees Celsius) rectally. The infant is feeding well and appears well-organized. What is the
most appropriate next step in management?
A. Reassure the parent and instruct them to give Tylenol.
B. Obtain a full sepsis workup including blood cultures, urine culture, and lumbar puncture,
and initiate empiric parenteral antibiotics.
THREE DISTINCT VERSIONS WITH VERIFIED ANSWERS AND
RATIONALES
VERSION ONE: GROWTH, DEVELOPMENT, AND INFANT CARE
Question 1
The nurse practitioner is assessing a 4-month-old infant. Which of the following motor
milestones is expected at this age?
A. Sitting independently without support
B. Rolling from back to front
C. Walking with assistance
D. Transferring a toy from one hand to the other
Answer: D
Rationale: By 4 months of age, an infant should be able to bring their hands to the midline
and transfer objects from one hand to the other. Sitting independently typically occurs around
6 months. Rolling from back to front usually occurs around 5 to 6 months. Walking with
assistance is a 12-month milestone.
Question 2
A mother brings her 2-week-old newborn to the clinic because she notices the baby's breasts
are enlarged and there is a small amount of milky discharge from the nipples. What is the
most appropriate action by the nurse practitioner?
, A. Refer the infant to a pediatric endocrinologist immediately.
B. Tell the mother to stop breastfeeding immediately.
C. Reassure the mother that this is a common, transient finding caused by maternal estrogen
withdrawal.
D. Obtain a serum prolactin level to rule out a pituitary adenoma.
Answer: C
Rationale: Breast enlargement and galactorrhea (witch's milk) in newborns are very common
and benign. They are caused by the transplacental passage of maternal estrogen, which
stimulates the infant's breast tissue. Once the maternal hormones clear from the infant's
system, the swelling and discharge resolve spontaneously. Squeezing the breasts should be
discouraged to prevent infection.
Question 3
According to the American Academy of Pediatrics, what is the recommended daily Vitamin D
supplementation for exclusively breastfed infants?
A. 100 IU
B. 200 IU
C. 400 IU
D. 800 IU
Answer: C
Rationale: Because human milk contains relatively low amounts of Vitamin D, the AAP
recommends that all exclusively breastfed infants (and partially breastfed infants who do not
consume 1 liter of formula daily) receive a daily supplement of 400 IU of Vitamin D beginning
within the first few days of life to prevent rickets and Vitamin D deficiency.
Question 4
A 3-day-old infant presents to the clinic with a temperature of 100.8 degrees Fahrenheit (38.2
degrees Celsius) rectally. The infant is feeding well and appears well-organized. What is the
most appropriate next step in management?
A. Reassure the parent and instruct them to give Tylenol.
B. Obtain a full sepsis workup including blood cultures, urine culture, and lumbar puncture,
and initiate empiric parenteral antibiotics.
