Family Nurse Practitioner (FNP) Barkley
Post-Test Fall 2025 Comprehensive Final
Exam with Verified Rationales Practice
Questions and Answers 2026 with
complete solution
Pediatrics & Development
Question 1
A 15-year-old female has gone from having many close friends to being virtually
friendless. Her school performance has declined, but she is unconcerned and
focused only on a boy she likes. Which behavior is NOT considered a
developmental warning sign?
A) Apparent personality change
B) Poor adjustment to school
C) Difficulty accepting failure
D) Withdrawal from friends and family
Answer: B) Poor adjustment to school
Rationale: While a decline in school performance is concerning, during
adolescence (specifically the mid-adolescent stage ages 14-17), a temporary dip in
academic focus due to social/romantic preoccupation can occur. "Poor
adjustment to school" as listed here is not a classic "red flag" warning sign in the
same way that a sudden personality change, inability to accept failure, or social
withdrawal are. The key warning signs that indicate a deeper issue (like depression
or anxiety) are personality changes, withdrawal, and inability to handle
stress/failure .
,Question 2
A 12-month-old infant is brought in because her left foot is turned inward. The
parents are very concerned. What is the most appropriate initial management?
A) Cast the foot immediately
B) Advise the parents that the child should not bear weight on the foot
C) Observe for six months to a year
D) Specialist referral
Answer: D) Specialist referral
Rationale: A foot deformity persisting to 12 months of age (walking age) is
concerning for a structural deformity such as clubfoot (talipes equinovarus) .
While some positional deformities self-correct, by 12 months, a persistent "turned-
in" foot requires referral to a pediatric orthopedist for evaluation and likely casting
or surgical correction. . Simply observing for another 6-12 months delays necessary
intervention and allows the deformity to become more rigid.
Question 3
A 2-year-old child presents with an abdominal mass, drastic weight loss, recurring
diarrhea, profuse sweating, and tachycardia. Which condition should be in your
differential?
A) Gastroenteritis
B) Neuroblastoma
C) Appendicitis
D) Irritable bowel syndrome
Answer: B) Neuroblastoma
Rationale: The combination of an abdominal mass with paraneoplastic
symptoms (weight loss, diarrhea, sweating, tachycardia) in a toddler is highly
suspicious for Neuroblastoma. Neuroblastoma is the most common extracranial
solid tumor in children and often presents with an abdominal mass plus systemic
symptoms caused by catecholamine secretion. Gastroenteritis and IBS do not
,cause a palpable mass. Appendicitis usually presents with pain and fever, not this
systemic syndrome .
Question 4
A 2.5-year-old girl is diagnosed with iron deficiency anemia (Hgb 10.9, Hct 32%,
Ferritin 25 ug/L). She retains good color and normal breathing. What is the most
appropriate treatment?
A) Blood transfusion
B) 3 to 6 mg/kg/day of elemental iron
C) 2 mg/kg/day of elemental iron
D) Intravenous iron supplementation
Answer: B) 3 to 6 mg/kg/day of elemental iron
Rationale: For a child with mild-to-moderate iron deficiency anemia who
is asymptomatic (normal color, normal breathing), oral iron replacement is the
standard of care. The recommended dose is 3 to 6 mg/kg/day of elemental
iron given in divided doses. This effectively replenishes iron stores and corrects the
anemia over 3-6 months . Lower doses (2 mg/kg) are used for prophylaxis, not
treatment. Transfusion is reserved for severe, symptomatic anemia or
hemodynamic instability.
Question 5
A 2-week-old newborn exam reveals a normal penis, but the scrotum is smooth
(absent rugae) and the testicle is not palpable. What should the nurse practitioner
tell the parents?
A) This indicates a serious genetic abnormality requiring immediate surgery.
B) "It's normal for the testicle to not be descended by this age, but the smooth
scrotum is concerning."
C) "We will need to do further testing before discharge today."
D) "This is completely normal and will resolve on its own."
, Answer: B) "It's normal for the testicle to not be descended by this age, but the
smooth scrotum is concerning."
Rationale: A non-palpable testicle at 2 weeks is common as it may still descend;
re-evaluation is needed at 3-6 months. However, the scrotum should have
rugae (wrinkles) by term, stimulated by testosterone. A smooth scrotum
suggests testicular absence or dysfunction (anorchia or cryptorchidism with poor
testosterone production) and requires endocrinology or urology follow-up. It is not a
surgical emergency but does need evaluation .
Question 6
A 12-year-old child with sickle cell disease has been hospitalized four times this
year for pain crises (Hgb 9 g/dL, WBC 10,500). What is the most appropriate
treatment?
A) Schedule monthly blood transfusions
B) Start penicillin twice daily for one year
C) Meperidine for pain
D) Refer to a hematologist to begin hydroxyurea
Answer: D) Refer to a hematologist to begin hydroxyurea
Rationale: A child with recurrent (≥3 per year) severe pain crises qualifies
for Hydroxyurea therapy. Hydroxyurea reduces the frequency of pain crises, acute
chest syndrome, and hospitalizations by increasing fetal hemoglobin (HbF). .
Penicillin is for infection prophylaxis (starts by 2 months of age). Meperidine is
avoided in sickle cell due to neurotoxicity risk. Monthly transfusions are for stroke
prevention or severe complications, not first-line for pain crises alone.
Dermatology & Infectious Disease
Question 7
A 2-year-old girl presents with ulceration and inflammation of the soft palate and
papulovesicular lesions on her hands and feet. What is the most likely diagnosis?
Post-Test Fall 2025 Comprehensive Final
Exam with Verified Rationales Practice
Questions and Answers 2026 with
complete solution
Pediatrics & Development
Question 1
A 15-year-old female has gone from having many close friends to being virtually
friendless. Her school performance has declined, but she is unconcerned and
focused only on a boy she likes. Which behavior is NOT considered a
developmental warning sign?
A) Apparent personality change
B) Poor adjustment to school
C) Difficulty accepting failure
D) Withdrawal from friends and family
Answer: B) Poor adjustment to school
Rationale: While a decline in school performance is concerning, during
adolescence (specifically the mid-adolescent stage ages 14-17), a temporary dip in
academic focus due to social/romantic preoccupation can occur. "Poor
adjustment to school" as listed here is not a classic "red flag" warning sign in the
same way that a sudden personality change, inability to accept failure, or social
withdrawal are. The key warning signs that indicate a deeper issue (like depression
or anxiety) are personality changes, withdrawal, and inability to handle
stress/failure .
,Question 2
A 12-month-old infant is brought in because her left foot is turned inward. The
parents are very concerned. What is the most appropriate initial management?
A) Cast the foot immediately
B) Advise the parents that the child should not bear weight on the foot
C) Observe for six months to a year
D) Specialist referral
Answer: D) Specialist referral
Rationale: A foot deformity persisting to 12 months of age (walking age) is
concerning for a structural deformity such as clubfoot (talipes equinovarus) .
While some positional deformities self-correct, by 12 months, a persistent "turned-
in" foot requires referral to a pediatric orthopedist for evaluation and likely casting
or surgical correction. . Simply observing for another 6-12 months delays necessary
intervention and allows the deformity to become more rigid.
Question 3
A 2-year-old child presents with an abdominal mass, drastic weight loss, recurring
diarrhea, profuse sweating, and tachycardia. Which condition should be in your
differential?
A) Gastroenteritis
B) Neuroblastoma
C) Appendicitis
D) Irritable bowel syndrome
Answer: B) Neuroblastoma
Rationale: The combination of an abdominal mass with paraneoplastic
symptoms (weight loss, diarrhea, sweating, tachycardia) in a toddler is highly
suspicious for Neuroblastoma. Neuroblastoma is the most common extracranial
solid tumor in children and often presents with an abdominal mass plus systemic
symptoms caused by catecholamine secretion. Gastroenteritis and IBS do not
,cause a palpable mass. Appendicitis usually presents with pain and fever, not this
systemic syndrome .
Question 4
A 2.5-year-old girl is diagnosed with iron deficiency anemia (Hgb 10.9, Hct 32%,
Ferritin 25 ug/L). She retains good color and normal breathing. What is the most
appropriate treatment?
A) Blood transfusion
B) 3 to 6 mg/kg/day of elemental iron
C) 2 mg/kg/day of elemental iron
D) Intravenous iron supplementation
Answer: B) 3 to 6 mg/kg/day of elemental iron
Rationale: For a child with mild-to-moderate iron deficiency anemia who
is asymptomatic (normal color, normal breathing), oral iron replacement is the
standard of care. The recommended dose is 3 to 6 mg/kg/day of elemental
iron given in divided doses. This effectively replenishes iron stores and corrects the
anemia over 3-6 months . Lower doses (2 mg/kg) are used for prophylaxis, not
treatment. Transfusion is reserved for severe, symptomatic anemia or
hemodynamic instability.
Question 5
A 2-week-old newborn exam reveals a normal penis, but the scrotum is smooth
(absent rugae) and the testicle is not palpable. What should the nurse practitioner
tell the parents?
A) This indicates a serious genetic abnormality requiring immediate surgery.
B) "It's normal for the testicle to not be descended by this age, but the smooth
scrotum is concerning."
C) "We will need to do further testing before discharge today."
D) "This is completely normal and will resolve on its own."
, Answer: B) "It's normal for the testicle to not be descended by this age, but the
smooth scrotum is concerning."
Rationale: A non-palpable testicle at 2 weeks is common as it may still descend;
re-evaluation is needed at 3-6 months. However, the scrotum should have
rugae (wrinkles) by term, stimulated by testosterone. A smooth scrotum
suggests testicular absence or dysfunction (anorchia or cryptorchidism with poor
testosterone production) and requires endocrinology or urology follow-up. It is not a
surgical emergency but does need evaluation .
Question 6
A 12-year-old child with sickle cell disease has been hospitalized four times this
year for pain crises (Hgb 9 g/dL, WBC 10,500). What is the most appropriate
treatment?
A) Schedule monthly blood transfusions
B) Start penicillin twice daily for one year
C) Meperidine for pain
D) Refer to a hematologist to begin hydroxyurea
Answer: D) Refer to a hematologist to begin hydroxyurea
Rationale: A child with recurrent (≥3 per year) severe pain crises qualifies
for Hydroxyurea therapy. Hydroxyurea reduces the frequency of pain crises, acute
chest syndrome, and hospitalizations by increasing fetal hemoglobin (HbF). .
Penicillin is for infection prophylaxis (starts by 2 months of age). Meperidine is
avoided in sickle cell due to neurotoxicity risk. Monthly transfusions are for stroke
prevention or severe complications, not first-line for pain crises alone.
Dermatology & Infectious Disease
Question 7
A 2-year-old girl presents with ulceration and inflammation of the soft palate and
papulovesicular lesions on her hands and feet. What is the most likely diagnosis?
