,South College NSG 5442 Exam 2 | Pediatric Primary Care
(2026) Q&A
1. A 2-week-old full-term infant presents for a routine visit. During the oral exam, multiple
small, white, firm nodules are noted along the alveolar ridge. There is no erythema, swelling,
or feeding difficulty. The parents are concerned this may represent an infection. What will
the primary care pediatric nurse practitioner do?
A) Prescribe oral nystatin suspension
B) Refer the infant to a pediatric dentist
C) Reassure the parents that this is a benign finding that will resolve spontaneously
D) Obtain a swab for viral culture
Correct Answer: Reassure the parents that this is a benign finding that will resolve
spontaneously
Rationale: These white nodules are Epstein pearls, a common benign finding in newborns.
They are keratin-containing cysts that resolve spontaneously and do not require treatment
or referral. Recognizing normal findings allows appropriate reassurance and avoids
unnecessary intervention.
2. A 5-year-old child is hit in the face with a baseball bat and is brought to the clinic by a
parent. An exam reveals three avulsed front teeth. Radiologic studies are negative for facial
fractures. What is the recommended treatment?
A) Prescribe tetracycline 4.4 mg/kg twice daily for 7 to 10 days
B) Refer the child to a dentist for reimplantation of the avulsed teeth
C) Refer the child to a dentist immediately for further examination
D) Remove the teeth, place them in saline, and refer the child to a dentist
Correct Answer: Refer the child to a dentist immediately for further examination
,Rationale: Avulsed permanent teeth require immediate dental evaluation for possible
reimplantation. The child should be referred to a dentist immediately; the teeth should be
handled by the crown, not the root, and stored in appropriate media (e.g., milk, saline, or
the child's saliva) if possible. The primary care provider should not attempt reimplantation.
3. A 4-year-old child who has had extensive dental surgery to treat dental caries has white
spot lesions on the primary teeth. How often should this child receive fluoride varnish
applications?
A) Every 1 to 2 months
B) Every 3 to 6 months
C) Every 6 to 12 months
D) Once yearly
Correct Answer: Every 3 to 6 months
Rationale: Children at high risk for dental caries, including those with white spot lesions or a
history of extensive dental surgery, should receive fluoride varnish applications every 3 to 6
months. This provides additional protection against demineralization and caries progression.
4. A 9-month-old infant has developed two teeth since the 6-month check-up. The local
water supply contains fluoride. What will the primary care pediatric nurse practitioner do to
promote healthy dentition at this visit?
A) Prescribe oral fluoride supplements
B) Apply sodium fluoride varnish to the infant's teeth
C) Recommend brushing with a pea-sized amount of fluoride toothpaste
D) Schedule a dental referral for evaluation
Correct Answer: Apply sodium fluoride varnish to the infant's teeth
Rationale: The AAP recommends applying fluoride varnish to the teeth of infants and
children starting at the time of the first tooth eruption, typically at the 6- or 9-month visit.
, Even with fluoridated water, topical fluoride varnish provides additional caries prevention. A
smear of toothpaste is recommended for children under 3 years.
5. What will the primary care pediatric nurse practitioner recommend to the parent of an
infant who is teething who asks about comfort measures?
A) Rub the infant's gums with topical benzocaine
B) Give the infant acetaminophen every 4 hours around the clock
C) Give the infant a cold teething ring or wet washcloth to chew
D) Apply aspirin to the infant's gums
Correct Answer: Give the infant a cold teething ring or wet washcloth to chew
Rationale: Cold teething rings or wet washcloths provide safe, non-pharmacologic comfort
for teething infants. Topical benzocaine is not recommended due to the risk of
methemoglobinemia. Acetaminophen may be used sparingly, and aspirin is contraindicated
in children due to Reye syndrome.
6. An 18-month-old child has horizontal, bright white lines along the upper gum line of the
teeth. What is the most important question the primary care pediatric nurse practitioner will
ask the child's parents?
A) If the child uses a pacifier
B) If the child is still drinking milk from a bottle
C) How often the child's teeth are brushed
D) If the child has had any fluoride treatments
Correct Answer: If the child is still drinking milk from a bottle
Rationale: Horizontal, bright white lines along the gum line are consistent with enamel
hypoplasia, often associated with baby bottle tooth decay from prolonged bottle use,
especially with milk or juice at bedtime. This finding warrants a thorough history of feeding
practices and referral to a dentist.
(2026) Q&A
1. A 2-week-old full-term infant presents for a routine visit. During the oral exam, multiple
small, white, firm nodules are noted along the alveolar ridge. There is no erythema, swelling,
or feeding difficulty. The parents are concerned this may represent an infection. What will
the primary care pediatric nurse practitioner do?
A) Prescribe oral nystatin suspension
B) Refer the infant to a pediatric dentist
C) Reassure the parents that this is a benign finding that will resolve spontaneously
D) Obtain a swab for viral culture
Correct Answer: Reassure the parents that this is a benign finding that will resolve
spontaneously
Rationale: These white nodules are Epstein pearls, a common benign finding in newborns.
They are keratin-containing cysts that resolve spontaneously and do not require treatment
or referral. Recognizing normal findings allows appropriate reassurance and avoids
unnecessary intervention.
2. A 5-year-old child is hit in the face with a baseball bat and is brought to the clinic by a
parent. An exam reveals three avulsed front teeth. Radiologic studies are negative for facial
fractures. What is the recommended treatment?
A) Prescribe tetracycline 4.4 mg/kg twice daily for 7 to 10 days
B) Refer the child to a dentist for reimplantation of the avulsed teeth
C) Refer the child to a dentist immediately for further examination
D) Remove the teeth, place them in saline, and refer the child to a dentist
Correct Answer: Refer the child to a dentist immediately for further examination
,Rationale: Avulsed permanent teeth require immediate dental evaluation for possible
reimplantation. The child should be referred to a dentist immediately; the teeth should be
handled by the crown, not the root, and stored in appropriate media (e.g., milk, saline, or
the child's saliva) if possible. The primary care provider should not attempt reimplantation.
3. A 4-year-old child who has had extensive dental surgery to treat dental caries has white
spot lesions on the primary teeth. How often should this child receive fluoride varnish
applications?
A) Every 1 to 2 months
B) Every 3 to 6 months
C) Every 6 to 12 months
D) Once yearly
Correct Answer: Every 3 to 6 months
Rationale: Children at high risk for dental caries, including those with white spot lesions or a
history of extensive dental surgery, should receive fluoride varnish applications every 3 to 6
months. This provides additional protection against demineralization and caries progression.
4. A 9-month-old infant has developed two teeth since the 6-month check-up. The local
water supply contains fluoride. What will the primary care pediatric nurse practitioner do to
promote healthy dentition at this visit?
A) Prescribe oral fluoride supplements
B) Apply sodium fluoride varnish to the infant's teeth
C) Recommend brushing with a pea-sized amount of fluoride toothpaste
D) Schedule a dental referral for evaluation
Correct Answer: Apply sodium fluoride varnish to the infant's teeth
Rationale: The AAP recommends applying fluoride varnish to the teeth of infants and
children starting at the time of the first tooth eruption, typically at the 6- or 9-month visit.
, Even with fluoridated water, topical fluoride varnish provides additional caries prevention. A
smear of toothpaste is recommended for children under 3 years.
5. What will the primary care pediatric nurse practitioner recommend to the parent of an
infant who is teething who asks about comfort measures?
A) Rub the infant's gums with topical benzocaine
B) Give the infant acetaminophen every 4 hours around the clock
C) Give the infant a cold teething ring or wet washcloth to chew
D) Apply aspirin to the infant's gums
Correct Answer: Give the infant a cold teething ring or wet washcloth to chew
Rationale: Cold teething rings or wet washcloths provide safe, non-pharmacologic comfort
for teething infants. Topical benzocaine is not recommended due to the risk of
methemoglobinemia. Acetaminophen may be used sparingly, and aspirin is contraindicated
in children due to Reye syndrome.
6. An 18-month-old child has horizontal, bright white lines along the upper gum line of the
teeth. What is the most important question the primary care pediatric nurse practitioner will
ask the child's parents?
A) If the child uses a pacifier
B) If the child is still drinking milk from a bottle
C) How often the child's teeth are brushed
D) If the child has had any fluoride treatments
Correct Answer: If the child is still drinking milk from a bottle
Rationale: Horizontal, bright white lines along the gum line are consistent with enamel
hypoplasia, often associated with baby bottle tooth decay from prolonged bottle use,
especially with milk or juice at bedtime. This finding warrants a thorough history of feeding
practices and referral to a dentist.
