NU 665 Final Practice Exam (Generated for 2026/2027) NU
665 Final Actual Exam| Updated 2026/2027| A Review of
Real 609 Past Papers Exam Questions With Correct Detailed
Answers|
Instructions: Select the best answer. Detailed rationales are provided.
Question 1
A 15-year-old transgender male (assigned female at birth) presents with moderate
anxiety. He has been using he/him pronouns for 18 months and wants to start gender-
affirming hormone therapy. His parents are supportive. What is the most appropriate
next step?
A. Prescribe testosterone after obtaining informed consent from the adolescent alone
B. Refer to pediatric endocrinology after confirming a diagnosis of gender dysphoria
and parental consent
C. Start an SSRI for anxiety before considering any gender-affirming care
D. Recommend delaying all medical intervention until age 18
Detailed Answer:
Correct Answer: B
• Rationale: The World Professional Association for Transgender Health
(WPATH) standards support gender-affirming hormone therapy in
adolescents with persistent gender dysphoria, supportive parents, and
, capacity for informed consent. A referral to endocrinology is appropriate
after diagnosis.
• Incorrect Options:
o A: Parental consent is legally required for minors in most states.
o C: Anxiety should be managed concurrently, not as a precondition.
o D: Delaying care contradicts evidence-based guidelines and may
worsen outcomes.
Question 2
A 6-year-old child is brought in by his mother after his father was arrested for domestic
violence. The child is quiet, avoids eye contact, and flinches when the provider reaches
toward him. Which is the priority intervention?
A. Complete a full physical exam including genitalia
B. Ask the mother to leave and interview the child alone
C. Ensure immediate safety and report suspected abuse per state law
D. Prescribe fluoxetine for possible PTSD
Detailed Answer:
Correct Answer: C
• Rationale: Trauma-informed care prioritizes safety. The child's flinching
and avoidance are red flags for possible physical abuse. Mandated
reporting laws require immediate reporting to child protective services.
• Incorrect Options:
o A: A complete exam may be traumatic and should be deferred
unless medically necessary.
, o B: Interviewing a young child alone without consent or training is
inappropriate.
o D: Medication is not first-line without a clear diagnosis and safety
plan.
Question 3
A 3-year-old is brought to the clinic because he refuses to use his right arm after being
lifted by his wrists. He holds his arm slightly flexed and pronated. No swelling or
deformity is noted. What is the most likely diagnosis and management?
A. Clavicle fracture; sling and ortho referral
B. Nursemaid's elbow; reduction via supination and flexion
C. Radial head fracture; immobilization and X-ray
D. Transient synovitis; observation and NSAIDs
Detailed Answer:
Correct Answer: B
• Rationale: Nursemaid's elbow (radial head subluxation) is common in
young children after axial traction. The classic presentation is a child
refusing to use the arm, held in slight flexion and pronation. Reduction is
achieved by supinating the forearm and flexing the elbow.
• Incorrect Options:
o A: No deformity or swelling, and mechanism is traction, not fall.
o C: X-ray is not needed if reduction is successful and history is classic.
o D: Transient synovitis affects the hip, not the elbow.
665 Final Actual Exam| Updated 2026/2027| A Review of
Real 609 Past Papers Exam Questions With Correct Detailed
Answers|
Instructions: Select the best answer. Detailed rationales are provided.
Question 1
A 15-year-old transgender male (assigned female at birth) presents with moderate
anxiety. He has been using he/him pronouns for 18 months and wants to start gender-
affirming hormone therapy. His parents are supportive. What is the most appropriate
next step?
A. Prescribe testosterone after obtaining informed consent from the adolescent alone
B. Refer to pediatric endocrinology after confirming a diagnosis of gender dysphoria
and parental consent
C. Start an SSRI for anxiety before considering any gender-affirming care
D. Recommend delaying all medical intervention until age 18
Detailed Answer:
Correct Answer: B
• Rationale: The World Professional Association for Transgender Health
(WPATH) standards support gender-affirming hormone therapy in
adolescents with persistent gender dysphoria, supportive parents, and
, capacity for informed consent. A referral to endocrinology is appropriate
after diagnosis.
• Incorrect Options:
o A: Parental consent is legally required for minors in most states.
o C: Anxiety should be managed concurrently, not as a precondition.
o D: Delaying care contradicts evidence-based guidelines and may
worsen outcomes.
Question 2
A 6-year-old child is brought in by his mother after his father was arrested for domestic
violence. The child is quiet, avoids eye contact, and flinches when the provider reaches
toward him. Which is the priority intervention?
A. Complete a full physical exam including genitalia
B. Ask the mother to leave and interview the child alone
C. Ensure immediate safety and report suspected abuse per state law
D. Prescribe fluoxetine for possible PTSD
Detailed Answer:
Correct Answer: C
• Rationale: Trauma-informed care prioritizes safety. The child's flinching
and avoidance are red flags for possible physical abuse. Mandated
reporting laws require immediate reporting to child protective services.
• Incorrect Options:
o A: A complete exam may be traumatic and should be deferred
unless medically necessary.
, o B: Interviewing a young child alone without consent or training is
inappropriate.
o D: Medication is not first-line without a clear diagnosis and safety
plan.
Question 3
A 3-year-old is brought to the clinic because he refuses to use his right arm after being
lifted by his wrists. He holds his arm slightly flexed and pronated. No swelling or
deformity is noted. What is the most likely diagnosis and management?
A. Clavicle fracture; sling and ortho referral
B. Nursemaid's elbow; reduction via supination and flexion
C. Radial head fracture; immobilization and X-ray
D. Transient synovitis; observation and NSAIDs
Detailed Answer:
Correct Answer: B
• Rationale: Nursemaid's elbow (radial head subluxation) is common in
young children after axial traction. The classic presentation is a child
refusing to use the arm, held in slight flexion and pronation. Reduction is
achieved by supinating the forearm and flexing the elbow.
• Incorrect Options:
o A: No deformity or swelling, and mechanism is traction, not fall.
o C: X-ray is not needed if reduction is successful and history is classic.
o D: Transient synovitis affects the hip, not the elbow.
