NR602 PRIMARY CARE OF THE
CHILDBEARING AND CHILDREARING
FAMILY FINAL EXAM
1. A 2-month-old infant presents with a rectal temperature of 101.5°F (38.6°C). The infant is
feeding poorly and is lethargic. Which is the most appropriate next step in management?
A. Administer weight-based acetaminophen and discharge home with close follow-up
B. Perform a full septic workup and admit for parenteral antibiotics
C. Recheck the temperature orally to confirm the fever
D. Instruct the mother to provide oral rehydration and return in 24 hours
Answer: B
Conceptual Explanation: In an infant under 3 months of age, a fever of 100.4°F (38°C) or
higher is considered a medical emergency requiring a full septic workup (CBC, blood
culture, UA/UC, and potentially LP) and admission for antibiotics until cultures are
negative.
,2. A 28-year-old pregnant patient at 32 weeks gestation presents with a BP of 155/98 mmHg.
She has 2+ proteinuria on dipstick. She denies headache or vision changes. What is the most
likely diagnosis?
A. Chronic hypertension
B. Gestational hypertension
C. Preeclampsia with severe features
D. Preeclampsia without severe features
Answer: D
Conceptual Explanation: Preeclampsia is defined as new-onset hypertension (BP ≥
140/90) after 20 weeks gestation plus proteinuria (≥ 300mg/24h or 1+ dipstick). Since she
lacks severe features like headache, visual changes, or BP ≥ 160/110, it is categorized as
‘without severe features.’
3. During an 18-month-old well-child visit, which developmental milestone would be most
concerning if NOT met?
A. Ability to use a spoon and fork perfectly
B. Speaking in 4-5 word sentences
C. Walking independently
D. Knowing all primary colors
Answer: C
, Conceptual Explanation: While there is a range for development, walking independently
should be achieved by 18 months. Failure to walk by 18 months requires a developmental
evaluation. Sentences and colors are milestones for older children.
4. Which of the following is an absolute contraindication for the use of combined oral
contraceptives (COCs)?
A. History of gestational diabetes
B. Well-controlled hypothyroidism
C. Cigarette smoking (10 cigarettes/day) at age 30
D. Migraine with aura at any age
Answer: D
Conceptual Explanation: Migraine with aura is an absolute contraindication (CDC MEC
Category 4) due to the significantly increased risk of ischemic stroke. Smoking is only a
Category 4 contraindication for women ≥ 35 years who smoke ≥ 15 cigarettes/day.
5. A 6-year-old child uses a short-acting beta-agonist (SABA) more than two days a week but
not daily for asthma symptoms. How should this asthma be classified?
A. Intermittent
B. Severe Persistent
C. Moderate Persistent
D. Mild Persistent
CHILDBEARING AND CHILDREARING
FAMILY FINAL EXAM
1. A 2-month-old infant presents with a rectal temperature of 101.5°F (38.6°C). The infant is
feeding poorly and is lethargic. Which is the most appropriate next step in management?
A. Administer weight-based acetaminophen and discharge home with close follow-up
B. Perform a full septic workup and admit for parenteral antibiotics
C. Recheck the temperature orally to confirm the fever
D. Instruct the mother to provide oral rehydration and return in 24 hours
Answer: B
Conceptual Explanation: In an infant under 3 months of age, a fever of 100.4°F (38°C) or
higher is considered a medical emergency requiring a full septic workup (CBC, blood
culture, UA/UC, and potentially LP) and admission for antibiotics until cultures are
negative.
,2. A 28-year-old pregnant patient at 32 weeks gestation presents with a BP of 155/98 mmHg.
She has 2+ proteinuria on dipstick. She denies headache or vision changes. What is the most
likely diagnosis?
A. Chronic hypertension
B. Gestational hypertension
C. Preeclampsia with severe features
D. Preeclampsia without severe features
Answer: D
Conceptual Explanation: Preeclampsia is defined as new-onset hypertension (BP ≥
140/90) after 20 weeks gestation plus proteinuria (≥ 300mg/24h or 1+ dipstick). Since she
lacks severe features like headache, visual changes, or BP ≥ 160/110, it is categorized as
‘without severe features.’
3. During an 18-month-old well-child visit, which developmental milestone would be most
concerning if NOT met?
A. Ability to use a spoon and fork perfectly
B. Speaking in 4-5 word sentences
C. Walking independently
D. Knowing all primary colors
Answer: C
, Conceptual Explanation: While there is a range for development, walking independently
should be achieved by 18 months. Failure to walk by 18 months requires a developmental
evaluation. Sentences and colors are milestones for older children.
4. Which of the following is an absolute contraindication for the use of combined oral
contraceptives (COCs)?
A. History of gestational diabetes
B. Well-controlled hypothyroidism
C. Cigarette smoking (10 cigarettes/day) at age 30
D. Migraine with aura at any age
Answer: D
Conceptual Explanation: Migraine with aura is an absolute contraindication (CDC MEC
Category 4) due to the significantly increased risk of ischemic stroke. Smoking is only a
Category 4 contraindication for women ≥ 35 years who smoke ≥ 15 cigarettes/day.
5. A 6-year-old child uses a short-acting beta-agonist (SABA) more than two days a week but
not daily for asthma symptoms. How should this asthma be classified?
A. Intermittent
B. Severe Persistent
C. Moderate Persistent
D. Mild Persistent
