NR 602 PEDIATRIC ASSESSMENT AND COMMON CONDITIONS
EXAM 2026 |NR 602 WEEK 1-8 QUIZZES + MIDTERM + FINAL EXAM
BUNDLE | 100% VERIFIED QUESTIONS WITH CORRECT ANSWERS
AND WELL EXPLAINED RATIONALES | A+ GRADED | GUARANTEED
PASS | CHAMBERLAIN BRANDNEW!!!!!!!!!
A 6-week-old infant presents with a two-day history of non-bilious, non-projectile
vomiting after most feeds. The infant is alert and afebrile. Which of the following is the
most appropriate next step?
A) Abdominal ultrasound
B) Upper gastrointestinal series
C) Trial of an elemental formula
D) Thorough history and physical examination with feeding evaluation
Correct Answer: D
Expert Rationale: In a 6-week-old with vomiting, the first and most critical step is a detailed
history and physical exam to assess for red flags (bilious emesis, lethargy, poor weight gain,
dehydration) and to differentiate benign causes (gastroesophageal reflux, overfeeding)
from surgical emergencies (pyloric stenosis, malrotation with volvulus). While ultrasound is
the diagnostic test of choice for pyloric stenosis, it should not be ordered before a clinical
assessment confirms suspicion. An upper GI series is indicated if malrotation is
suspected, but this is not the initial step. An elemental formula trial may be appropriate for
cow's milk protein allergy but would be premature without first ruling out more urgent
pathology.
A 4-month-old infant is brought in for a well-child visit. The parents report that the
infant has been rolling from back to tummy but not yet rolling back. Which of the
following developmental milestones is most consistent with this finding?
A) This is a delay, and referral to early intervention is warranted
B) This is a normal finding for a 4-month-old
C) The infant should be able to sit without support before rolling back
D) This indicates a possible neuromuscular disorder requiring EMG
Correct Answer: B
Expert Rationale: Rolling from back to tummy typically emerges between 4 and 6 months.
At 4 months, this is an expected and normal milestone. Rolling back to tummy often
,precedes the reverse, and the absence of tummy-to-back rolling at this age is not
concerning. Early intervention referral would be inappropriate at this stage. Sitting without
support generally occurs around 6–8 months, so that is not a prerequisite. Neuromuscular
disorders present with more global hypotonia or weakness, not an isolated delay in one
direction of rolling at 4 months.
A 2-year-old child presents with a two-week history of intermittent limping, low-grade
fevers, and night-time irritability. The parents report no history of trauma. On exam,
the child has limited internal rotation of the right hip. Which diagnosis is most likely?
A) Transient synovitis
B) Septic arthritis
C) Legg-Calvé-Perthes disease
D) Slipped capital femoral epiphysis
Correct Answer: C
Expert Rationale: Legg-Calvé-Perthes disease (LCPD) typically presents in children aged 2–
8 years with insidious onset of limp, hip or knee pain, and limited internal rotation. Low-
grade fever and night-time irritability are common due to ischemic necrosis of the femoral
head. Transient synovitis is more acute, often post-viral, with more rapid resolution and no
avascular changes. Septic arthritis presents acutely with high fever, severe pain, and an
inability to bear weight. SCFE typically occurs in older children (8–15 years), often obese,
with a more acute or chronic presentation and external rotation deformity.
A 15-month-old child with a history of recurrent acute otitis media is brought in for a
health maintenance visit. The parents ask whether a tympanostomy tube placement
is appropriate. Which of the following is the strongest indication for referral to ENT for
tube placement?
A) Three episodes of acute otitis media in the past 6 months
B) Persistent middle ear effusion for 2 months with hearing loss
C) Four episodes of acute otitis media in the past year
D) Two episodes of acute otitis media with perforation
Correct Answer: B
Expert Rationale: The most widely accepted indication for tympanostomy tube placement
is persistent middle ear effusion for 3 months or longer with associated hearing loss (≥20
dB) or structural abnormalities. While recurrent acute otitis media (3 episodes in 6 months
,or 4 in 12 months) is a relative indication, it is not as strong as chronic effusion with hearing
sequelae. Bilateral effusion with hearing loss is the classic indication supported by
guidelines. Perforation alone is not an automatic indication unless complicated by chronic
drainage.
A 10-year-old girl with no significant medical history presents with a three-day history
of headache, photophobia, and neck stiffness. She is febrile to 39.0°C but is alert and
oriented. A lumbar puncture is performed. Which cerebrospinal fluid finding is most
consistent with viral meningitis?
A) Elevated protein, low glucose, and polymorphonuclear pleocytosis
B) Normal protein, normal glucose, and lymphocytic pleocytosis
C) Elevated protein, low glucose, and lymphocytic pleocytosis
D) Elevated protein, normal glucose, and monocytic pleocytosis
Correct Answer: B
Expert Rationale: Viral meningitis is characterized by a lymphocytic pleocytosis with
normal or mildly elevated protein and normal glucose. The absence of a significantly low
glucose helps differentiate it from bacterial meningitis, which typically shows low glucose,
markedly elevated protein, and a polymorphonuclear predominance. In early viral
meningitis, a neutrophil predominance can sometimes be seen, but over time it shifts to
lymphocytes. Monocytic predominance is more typical of fungal or tuberculous meningitis.
A newborn is noted to have a unilateral red reflex that is dull and white on the right eye
during a routine exam. The left eye has a normal red reflex. What is the most
appropriate next step?
A) Reassure the parents and follow up in 2 months
B) Refer urgently to ophthalmology
C) Order a cranial ultrasound
D) Perform a comprehensive dilated fundoscopic exam in the clinic
Correct Answer: B
Expert Rationale: An absent or dull red reflex, particularly if unilateral, is a concerning
finding that may indicate retinoblastoma, cataract, or other intraocular pathology. This
requires urgent referral to ophthalmology for a complete evaluation, including a dilated
fundoscopic exam. Reassurance and delayed follow-up are inappropriate. A cranial
ultrasound would not visualize the posterior chamber adequately. Performing a
, comprehensive dilated exam in a primary care setting is beyond the scope and expertise of
most pediatric providers and would delay definitive care.
A 5-year-old child presents with a rash consisting of small, erythematous macules and
papules with a "slapped cheek" appearance on the face. The rash is lacy and reticular
on the extremities. The child is afebrile and otherwise well. Which of the following is
the most likely diagnosis?
A) Measles
B) Scarlet fever
C) Fifth disease (erythema infectiosum)
D) Roseola infantum
Correct Answer: C
Expert Rationale: Fifth disease, caused by parvovirus B19, is classically described as a
"slapped cheek" facial rash followed by a lacy, reticular rash on the trunk and extremities.
The child is typically well-appearing with minimal systemic symptoms. Measles presents
with high fever, cough, coryza, conjunctivitis, and a more diffuse maculopapular rash.
Scarlet fever presents with a fine, sandpaper-like rash and pharyngitis. Roseola infantum
presents with high fever followed by a blanching maculopapular rash that appears as the
fever subsides.
A 7-year-old boy with known asthma presents with cough and wheezing. He has been
using his albuterol inhaler every 4 hours for the past 2 days. On exam, he has diffuse
expiratory wheezing, oxygen saturation of 95%, and is speaking in full sentences.
Which of the following is the most appropriate next step in management?
A) Start oral prednisolone and continue albuterol every 4 hours
B) Add a long-acting beta-agonist and increase albuterol to every 2 hours
C) Administer a systemic corticosteroid and consider a short course of oral steroids
D) Refer to the emergency department for continuous albuterol and magnesium sulfate
Correct Answer: C
Expert Rationale: This child has a moderate asthma exacerbation (wheezing, but speaking
in full sentences, SpO2 ≥95%). The standard of care is to add systemic corticosteroids
(prednisolone) to reduce airway inflammation. Continuing the same regimen is insufficient.
Adding LABA is not indicated in acute exacerbations. The ED is reserved for severe
exacerbations with marked respiratory distress, hypoxia, or poor response to initial therapy.
EXAM 2026 |NR 602 WEEK 1-8 QUIZZES + MIDTERM + FINAL EXAM
BUNDLE | 100% VERIFIED QUESTIONS WITH CORRECT ANSWERS
AND WELL EXPLAINED RATIONALES | A+ GRADED | GUARANTEED
PASS | CHAMBERLAIN BRANDNEW!!!!!!!!!
A 6-week-old infant presents with a two-day history of non-bilious, non-projectile
vomiting after most feeds. The infant is alert and afebrile. Which of the following is the
most appropriate next step?
A) Abdominal ultrasound
B) Upper gastrointestinal series
C) Trial of an elemental formula
D) Thorough history and physical examination with feeding evaluation
Correct Answer: D
Expert Rationale: In a 6-week-old with vomiting, the first and most critical step is a detailed
history and physical exam to assess for red flags (bilious emesis, lethargy, poor weight gain,
dehydration) and to differentiate benign causes (gastroesophageal reflux, overfeeding)
from surgical emergencies (pyloric stenosis, malrotation with volvulus). While ultrasound is
the diagnostic test of choice for pyloric stenosis, it should not be ordered before a clinical
assessment confirms suspicion. An upper GI series is indicated if malrotation is
suspected, but this is not the initial step. An elemental formula trial may be appropriate for
cow's milk protein allergy but would be premature without first ruling out more urgent
pathology.
A 4-month-old infant is brought in for a well-child visit. The parents report that the
infant has been rolling from back to tummy but not yet rolling back. Which of the
following developmental milestones is most consistent with this finding?
A) This is a delay, and referral to early intervention is warranted
B) This is a normal finding for a 4-month-old
C) The infant should be able to sit without support before rolling back
D) This indicates a possible neuromuscular disorder requiring EMG
Correct Answer: B
Expert Rationale: Rolling from back to tummy typically emerges between 4 and 6 months.
At 4 months, this is an expected and normal milestone. Rolling back to tummy often
,precedes the reverse, and the absence of tummy-to-back rolling at this age is not
concerning. Early intervention referral would be inappropriate at this stage. Sitting without
support generally occurs around 6–8 months, so that is not a prerequisite. Neuromuscular
disorders present with more global hypotonia or weakness, not an isolated delay in one
direction of rolling at 4 months.
A 2-year-old child presents with a two-week history of intermittent limping, low-grade
fevers, and night-time irritability. The parents report no history of trauma. On exam,
the child has limited internal rotation of the right hip. Which diagnosis is most likely?
A) Transient synovitis
B) Septic arthritis
C) Legg-Calvé-Perthes disease
D) Slipped capital femoral epiphysis
Correct Answer: C
Expert Rationale: Legg-Calvé-Perthes disease (LCPD) typically presents in children aged 2–
8 years with insidious onset of limp, hip or knee pain, and limited internal rotation. Low-
grade fever and night-time irritability are common due to ischemic necrosis of the femoral
head. Transient synovitis is more acute, often post-viral, with more rapid resolution and no
avascular changes. Septic arthritis presents acutely with high fever, severe pain, and an
inability to bear weight. SCFE typically occurs in older children (8–15 years), often obese,
with a more acute or chronic presentation and external rotation deformity.
A 15-month-old child with a history of recurrent acute otitis media is brought in for a
health maintenance visit. The parents ask whether a tympanostomy tube placement
is appropriate. Which of the following is the strongest indication for referral to ENT for
tube placement?
A) Three episodes of acute otitis media in the past 6 months
B) Persistent middle ear effusion for 2 months with hearing loss
C) Four episodes of acute otitis media in the past year
D) Two episodes of acute otitis media with perforation
Correct Answer: B
Expert Rationale: The most widely accepted indication for tympanostomy tube placement
is persistent middle ear effusion for 3 months or longer with associated hearing loss (≥20
dB) or structural abnormalities. While recurrent acute otitis media (3 episodes in 6 months
,or 4 in 12 months) is a relative indication, it is not as strong as chronic effusion with hearing
sequelae. Bilateral effusion with hearing loss is the classic indication supported by
guidelines. Perforation alone is not an automatic indication unless complicated by chronic
drainage.
A 10-year-old girl with no significant medical history presents with a three-day history
of headache, photophobia, and neck stiffness. She is febrile to 39.0°C but is alert and
oriented. A lumbar puncture is performed. Which cerebrospinal fluid finding is most
consistent with viral meningitis?
A) Elevated protein, low glucose, and polymorphonuclear pleocytosis
B) Normal protein, normal glucose, and lymphocytic pleocytosis
C) Elevated protein, low glucose, and lymphocytic pleocytosis
D) Elevated protein, normal glucose, and monocytic pleocytosis
Correct Answer: B
Expert Rationale: Viral meningitis is characterized by a lymphocytic pleocytosis with
normal or mildly elevated protein and normal glucose. The absence of a significantly low
glucose helps differentiate it from bacterial meningitis, which typically shows low glucose,
markedly elevated protein, and a polymorphonuclear predominance. In early viral
meningitis, a neutrophil predominance can sometimes be seen, but over time it shifts to
lymphocytes. Monocytic predominance is more typical of fungal or tuberculous meningitis.
A newborn is noted to have a unilateral red reflex that is dull and white on the right eye
during a routine exam. The left eye has a normal red reflex. What is the most
appropriate next step?
A) Reassure the parents and follow up in 2 months
B) Refer urgently to ophthalmology
C) Order a cranial ultrasound
D) Perform a comprehensive dilated fundoscopic exam in the clinic
Correct Answer: B
Expert Rationale: An absent or dull red reflex, particularly if unilateral, is a concerning
finding that may indicate retinoblastoma, cataract, or other intraocular pathology. This
requires urgent referral to ophthalmology for a complete evaluation, including a dilated
fundoscopic exam. Reassurance and delayed follow-up are inappropriate. A cranial
ultrasound would not visualize the posterior chamber adequately. Performing a
, comprehensive dilated exam in a primary care setting is beyond the scope and expertise of
most pediatric providers and would delay definitive care.
A 5-year-old child presents with a rash consisting of small, erythematous macules and
papules with a "slapped cheek" appearance on the face. The rash is lacy and reticular
on the extremities. The child is afebrile and otherwise well. Which of the following is
the most likely diagnosis?
A) Measles
B) Scarlet fever
C) Fifth disease (erythema infectiosum)
D) Roseola infantum
Correct Answer: C
Expert Rationale: Fifth disease, caused by parvovirus B19, is classically described as a
"slapped cheek" facial rash followed by a lacy, reticular rash on the trunk and extremities.
The child is typically well-appearing with minimal systemic symptoms. Measles presents
with high fever, cough, coryza, conjunctivitis, and a more diffuse maculopapular rash.
Scarlet fever presents with a fine, sandpaper-like rash and pharyngitis. Roseola infantum
presents with high fever followed by a blanching maculopapular rash that appears as the
fever subsides.
A 7-year-old boy with known asthma presents with cough and wheezing. He has been
using his albuterol inhaler every 4 hours for the past 2 days. On exam, he has diffuse
expiratory wheezing, oxygen saturation of 95%, and is speaking in full sentences.
Which of the following is the most appropriate next step in management?
A) Start oral prednisolone and continue albuterol every 4 hours
B) Add a long-acting beta-agonist and increase albuterol to every 2 hours
C) Administer a systemic corticosteroid and consider a short course of oral steroids
D) Refer to the emergency department for continuous albuterol and magnesium sulfate
Correct Answer: C
Expert Rationale: This child has a moderate asthma exacerbation (wheezing, but speaking
in full sentences, SpO2 ≥95%). The standard of care is to add systemic corticosteroids
(prednisolone) to reduce airway inflammation. Continuing the same regimen is insufficient.
Adding LABA is not indicated in acute exacerbations. The ED is reserved for severe
exacerbations with marked respiratory distress, hypoxia, or poor response to initial therapy.
