NSG 548 Final Exam V1 | NSG 548 FNP
Role: Children & Families | Actual Q&A
with Rationale (NSG548 Final Exam) |
Wilkes University
1. According to Bright Futures guidelines, at which age should universal screening for autism
spectrum disorder (ASD) using a tool like the M-CHAT-R occur?
A. 12 and 15 months
B. 24 and 36 months
C. 18 and 24 months
D. 9 and 18 months
Answer: C
Rationale: The American Academy of Pediatrics (AAP) and Bright Futures recommend
universal screening for ASD at the 18-month and 24-month well-child visits. Early
identification is crucial as it allows for prompt referral to early intervention services which
significantly improve long-term outcomes. The M-CHAT-R is a validated parent-report
screening tool designed to identify children who may benefit from a more thorough
developmental evaluation.
2. A 4-year-old child presents with a ‘barking’ cough, inspiratory stridor, and hoarseness.
What is the most likely diagnosis and first-line treatment?
A. Epiglottitis; Emergent Intubation
,B. Croup (Laryngotracheobronchitis); Single dose of Dexamethasone
C. Bacterial Tracheitis; IV Antibiotics
D. Bronchiolitis; Albuterol nebulizer
Answer: B
Rationale: The clinical presentation of a barking cough and inspiratory stridor is classic for
viral croup, most commonly caused by parainfluenza virus. Management for mild to
moderate croup includes a single dose of oral dexamethasone to reduce airway
inflammation. Families should also be educated on monitoring for signs of respiratory
distress and the use of cool mist or cold air to alleviate symptoms.
3. In a family-centered care model, which tool is best used to assess the internal structure of
a family, including relationships and health history over three generations?
A. Genogram
B. Ecomap
C. Family APGAR
D. Kinship Circle
Answer: A
Rationale: A genogram is a visual representation of a family’s structure and history that
spans at least three generations. It helps the Family Nurse Practitioner identify patterns of
illness, hereditary conditions, and complex relationship dynamics. Unlike an ecomap which
,focuses on external social connections, the genogram is specifically designed to map
internal lineage and medical trends.
4. A mother brings in her 9-month-old infant for a well-check. Which developmental
milestone should the FNP expect the infant to have achieved?
A. Walking independently
B. Stacking three blocks
C. Speaking 4-6 clear words
D. Using a neat pincer grasp
Answer: D
Rationale: By 9 months of age, infants typically develop the fine motor skill of a pincer
grasp, allowing them to pick up small objects with the thumb and forefinger. Gross motor
milestones for this age include sitting without support and potentially pulling to stand.
Lack of a pincer grasp by 12 months would warrant further developmental screening.
5. A 2-week-old neonate presents with a total serum bilirubin of 18 mg/dL. What is the most
appropriate next step according to AAP guidelines?
A. Initiate phototherapy immediately
B. Discontinue breastfeeding and switch to formula
C. Repeat bilirubin in 48 hours
D. Administer IV immunoglobulin
, Answer: A
Rationale: A bilirubin level of 18 mg/dL in a 2-week-old neonate exceeds the threshold for
phototherapy based on AAP nomograms for most risk categories. Phototherapy is
necessary to convert bilirubin into water-soluble isomers that can be excreted to prevent
kernicterus. The provider must also investigate the underlying cause, such as ABO
incompatibility or breastfeeding jaundice.
6. Which of the following findings in a 15-month-old child’s physical exam requires immediate
further evaluation?
A. Presence of an umbilical hernia
B. Lack of babbling or pointing
C. Weight at the 10th percentile
D. Anterior fontanelle is closed
Answer: B
Rationale: The absence of babbling or social gestures like pointing by 15 months is a
significant ‘red flag’ for developmental or hearing issues. While the anterior fontanelle
usually closes between 12-18 months, its closure at 15 months is normal. An umbilical
hernia often resolves by age 4, and the 10th percentile for weight may be normal for that
specific child’s growth curve.
Role: Children & Families | Actual Q&A
with Rationale (NSG548 Final Exam) |
Wilkes University
1. According to Bright Futures guidelines, at which age should universal screening for autism
spectrum disorder (ASD) using a tool like the M-CHAT-R occur?
A. 12 and 15 months
B. 24 and 36 months
C. 18 and 24 months
D. 9 and 18 months
Answer: C
Rationale: The American Academy of Pediatrics (AAP) and Bright Futures recommend
universal screening for ASD at the 18-month and 24-month well-child visits. Early
identification is crucial as it allows for prompt referral to early intervention services which
significantly improve long-term outcomes. The M-CHAT-R is a validated parent-report
screening tool designed to identify children who may benefit from a more thorough
developmental evaluation.
2. A 4-year-old child presents with a ‘barking’ cough, inspiratory stridor, and hoarseness.
What is the most likely diagnosis and first-line treatment?
A. Epiglottitis; Emergent Intubation
,B. Croup (Laryngotracheobronchitis); Single dose of Dexamethasone
C. Bacterial Tracheitis; IV Antibiotics
D. Bronchiolitis; Albuterol nebulizer
Answer: B
Rationale: The clinical presentation of a barking cough and inspiratory stridor is classic for
viral croup, most commonly caused by parainfluenza virus. Management for mild to
moderate croup includes a single dose of oral dexamethasone to reduce airway
inflammation. Families should also be educated on monitoring for signs of respiratory
distress and the use of cool mist or cold air to alleviate symptoms.
3. In a family-centered care model, which tool is best used to assess the internal structure of
a family, including relationships and health history over three generations?
A. Genogram
B. Ecomap
C. Family APGAR
D. Kinship Circle
Answer: A
Rationale: A genogram is a visual representation of a family’s structure and history that
spans at least three generations. It helps the Family Nurse Practitioner identify patterns of
illness, hereditary conditions, and complex relationship dynamics. Unlike an ecomap which
,focuses on external social connections, the genogram is specifically designed to map
internal lineage and medical trends.
4. A mother brings in her 9-month-old infant for a well-check. Which developmental
milestone should the FNP expect the infant to have achieved?
A. Walking independently
B. Stacking three blocks
C. Speaking 4-6 clear words
D. Using a neat pincer grasp
Answer: D
Rationale: By 9 months of age, infants typically develop the fine motor skill of a pincer
grasp, allowing them to pick up small objects with the thumb and forefinger. Gross motor
milestones for this age include sitting without support and potentially pulling to stand.
Lack of a pincer grasp by 12 months would warrant further developmental screening.
5. A 2-week-old neonate presents with a total serum bilirubin of 18 mg/dL. What is the most
appropriate next step according to AAP guidelines?
A. Initiate phototherapy immediately
B. Discontinue breastfeeding and switch to formula
C. Repeat bilirubin in 48 hours
D. Administer IV immunoglobulin
, Answer: A
Rationale: A bilirubin level of 18 mg/dL in a 2-week-old neonate exceeds the threshold for
phototherapy based on AAP nomograms for most risk categories. Phototherapy is
necessary to convert bilirubin into water-soluble isomers that can be excreted to prevent
kernicterus. The provider must also investigate the underlying cause, such as ABO
incompatibility or breastfeeding jaundice.
6. Which of the following findings in a 15-month-old child’s physical exam requires immediate
further evaluation?
A. Presence of an umbilical hernia
B. Lack of babbling or pointing
C. Weight at the 10th percentile
D. Anterior fontanelle is closed
Answer: B
Rationale: The absence of babbling or social gestures like pointing by 15 months is a
significant ‘red flag’ for developmental or hearing issues. While the anterior fontanelle
usually closes between 12-18 months, its closure at 15 months is normal. An umbilical
hernia often resolves by age 4, and the 10th percentile for weight may be normal for that
specific child’s growth curve.
