NRNP 6541 NURS 6541 MIDTERM AND FINAL
EXAM QUESTIONS AND ANSWERS 2026
COMPREHENSIVE REVIEW GUIDE
◉ A mother brings to the clinic her 4-year-old son who began
complaining of right knee pain 2 weeks ago, is limping slightly, is
fatigued, and has had a fever to 100.4F. Which of the following lab
tests is most important?
A. Antinuclear antibodies
B. CBC with differential and platelets
C. Epstein-Barr virus titer
D. Rheumatoid factor
E. Sedimentation rate. Answer: B. This child has symptoms of JRA
and leukemia. The CBC with differential and platelets is the best
initial screening test. The leukocyte and platelet counts are normal
to increased in JRA, and no blast cells are present. Frequently, blast
cells are found on the peripheral smear with ALL. The child in the
question ultimately may require a bone marrow aspiration.
◉ (17) Two weeks after a viral syndrome, a 2-year-old develops
bruising and generalized petechiae that is more prominent over the
legs. He has neither hepatosplenomegaly nor lymph node
enlargement. Lab testing reveals a normal hemoglobin, hematocrit,
and white blood cell count and differential. The platelet count is
15,000/mm. Which of the following is the most likely diagnosis?
, A. Acute lymphoblastic leukemia
B. Aplastic anemia
C. Immune thrombocytopenic purpura
D. Thrombotic thrombocytopenic purpura
E. von Willebrand disease. Answer: C. Immune (or idiopathic)
thrombocytopenic purpura (ITP) is common in children. In most
cases, a preceding viral infection can be documented. The platelet
count frequently is less than 20,000/mm, but other laboratory test
results are normal, including the bone marrow aspiration (which
may show an increase in megakaryocytes). Treatment consists of
observation or possibly intravenous immunoglobulin (IVIG), anti-
RhD, immunosuppressives, or steroids. The history is explored for
other possible causes of thrombocytopenia, including recent MMR
vaccination, drug ingestion, and human immunodeficiency virus.
◉ (45) A mother recently feels a mass in the abdomen of her 4-year-
old son during a bath, and brings him to your clinic for evaluation.
He has no history of emesis, abnormal stooling, or abdominal pain.
Physical examination reveals a resting blood pressure of 130/88,
heart rate of 82, pallor, and a firm left-sided abdominal mass that
doesn't cross the midline. Which of the following is the most likely
explanation for these findings?
A. Constipation
B. Intussusception
C. Neuroblastoma
D. Wilms tumor
EXAM QUESTIONS AND ANSWERS 2026
COMPREHENSIVE REVIEW GUIDE
◉ A mother brings to the clinic her 4-year-old son who began
complaining of right knee pain 2 weeks ago, is limping slightly, is
fatigued, and has had a fever to 100.4F. Which of the following lab
tests is most important?
A. Antinuclear antibodies
B. CBC with differential and platelets
C. Epstein-Barr virus titer
D. Rheumatoid factor
E. Sedimentation rate. Answer: B. This child has symptoms of JRA
and leukemia. The CBC with differential and platelets is the best
initial screening test. The leukocyte and platelet counts are normal
to increased in JRA, and no blast cells are present. Frequently, blast
cells are found on the peripheral smear with ALL. The child in the
question ultimately may require a bone marrow aspiration.
◉ (17) Two weeks after a viral syndrome, a 2-year-old develops
bruising and generalized petechiae that is more prominent over the
legs. He has neither hepatosplenomegaly nor lymph node
enlargement. Lab testing reveals a normal hemoglobin, hematocrit,
and white blood cell count and differential. The platelet count is
15,000/mm. Which of the following is the most likely diagnosis?
, A. Acute lymphoblastic leukemia
B. Aplastic anemia
C. Immune thrombocytopenic purpura
D. Thrombotic thrombocytopenic purpura
E. von Willebrand disease. Answer: C. Immune (or idiopathic)
thrombocytopenic purpura (ITP) is common in children. In most
cases, a preceding viral infection can be documented. The platelet
count frequently is less than 20,000/mm, but other laboratory test
results are normal, including the bone marrow aspiration (which
may show an increase in megakaryocytes). Treatment consists of
observation or possibly intravenous immunoglobulin (IVIG), anti-
RhD, immunosuppressives, or steroids. The history is explored for
other possible causes of thrombocytopenia, including recent MMR
vaccination, drug ingestion, and human immunodeficiency virus.
◉ (45) A mother recently feels a mass in the abdomen of her 4-year-
old son during a bath, and brings him to your clinic for evaluation.
He has no history of emesis, abnormal stooling, or abdominal pain.
Physical examination reveals a resting blood pressure of 130/88,
heart rate of 82, pallor, and a firm left-sided abdominal mass that
doesn't cross the midline. Which of the following is the most likely
explanation for these findings?
A. Constipation
B. Intussusception
C. Neuroblastoma
D. Wilms tumor
