D119 NURS 6830
Pediatric Primary Care
Objective Assessment Review
2026
(With Solutions)
Multiple Choice (15 questions)
1. A 6-month-old infant presents with a persistent cough, wheezing, and difficulty feeding.
The most appropriate initial management includes: a) Oral corticosteroids b) Nebulized
albuterol c) Palivizumab administration d) Supportive care with hydration and monitoring
Correct Answer: d) Supportive care with hydration and monitoring Rationale: Bronchiolitis,
common in infants, is primarily treated supportively. Routine use of bronchodilators or
steroids is not recommended unless there is clear evidence of reactive airway disease.
2. A 15-year-old with type 1 diabetes reports frequent nocturnal hypoglycemia. Which
change is the best to suggest? a) Increase basal insulin dose at night b) Decrease bedtime
snack c) Adjust insulin pump basal rate downward overnight d) Ignore and monitor glucose
daily
Correct Answer: c) Adjust insulin pump basal rate downward overnight Rationale: Nocturnal
hypoglycemia in pump users is often due to excessive basal rates; adjustment is needed to
prevent hypoglycemia.
3. Which vaccine is contraindicated in a child undergoing chemotherapy for leukemia? a)
MMR (measles, mumps, rubella) b) Inactivated influenza vaccine c) Hepatitis B vaccine d)
Tetanus toxoid vaccine
Correct Answer: a) MMR (measles, mumps, rubella) Rationale: Live attenuated vaccines like
MMR are contraindicated during immunosuppression due to risk of vaccine-induced disease.
4. A 3-year-old with recurrent otitis media is scheduled for tympanostomy tube placement.
Which is the most common pathogen in this condition? a) Moraxella catarrhalis b)
Streptococcus pneumoniae c) Haemophilus influenzae type b d) Group A Streptococcus
Correct Answer: b) Streptococcus pneumoniae Rationale: S. pneumoniae is the leading
, pathogen causing acute otitis media.
5. A 7-year-old with mild persistent asthma uses low-dose inhaled corticosteroids. The nurse
recommends: a) Increase corticosteroid dose immediately b) Add a leukotriene receptor
antagonist c) Assess inhaler technique and adherence first d) Switch to oral corticosteroids
Correct Answer: c) Assess inhaler technique and adherence first Rationale: Poor control often
results from poor technique or poor adherence before medication escalation.
6. Which laboratory marker is best for assessing iron deficiency anemia in a toddler? a)
Serum ferritin b) Hemoglobin A1C c) Total bilirubin d) Serum calcium
Correct Answer: a) Serum ferritin Rationale: Serum ferritin is the most sensitive and specific
test for iron stores.
7. Which clinical feature differentiates Kawasaki disease from other pediatric febrile
illnesses? a) Persistent cough b) Bilateral non-purulent conjunctivitis c) Pharyngitis d)
Abdominal pain
Correct Answer: b) Bilateral non-purulent conjunctivitis Rationale: Bilateral conjunctival
injection without exudate is characteristic of Kawasaki disease.
8. A 4-year-old with suspected developmental delay needs screening for autism spectrum
disorder (ASD). Which tool is most appropriate? a) Wechsler Intelligence Scale for
Children b) M-CHAT (Modified Checklist for Autism in Toddlers) c) Denver Developmental
Screening Test d) Peabody Picture Vocabulary Test
Correct Answer: b) M-CHAT (Modified Checklist for Autism in Toddlers) Rationale: M-
CHAT is validated for early ASD screening in toddlers and young children.
9. In pediatric hypertension, the diagnosis requires: a) One measurement >95th percentile for
age and height b) Blood pressure >90th percentile on one occasion c) Three elevated readings
>95th percentile taken on separate visits d) Symptomatic presentation
Correct Answer: c) Three elevated readings >95th percentile taken on separate visits
Rationale: Diagnosis requires persistent elevations on multiple visits as per clinical
guidelines.
10. The most common cause of iron deficiency in toddlers is: a) Low dietary intake b) Blood
loss in the gastrointestinal tract c) Malabsorption syndromes d) Chronic hemolysis
Correct Answer: a) Low dietary intake Rationale: Excessive cow’s milk intake and poor iron-
rich food intake cause iron deficiency in toddlers.
,11. A 12-year-old child with suspected ADHD is best initially evaluated by: a) MRI brain
scan b) Psychiatric comprehensive assessment and clinical history c) Serum thyroid function
tests d) Electroencephalogram (EEG)
Correct Answer: b) Psychiatric comprehensive assessment and clinical history Rationale:
ADHD diagnosis is clinical; neuroimaging or labs are not routinely required.
12. The first-line pharmacologic treatment for bacterial sinusitis in children is: a)
Amoxicillin-clavulanate b) Azithromycin c) Ciprofloxacin d) Doxycycline
Correct Answer: a) Amoxicillin-clavulanate Rationale: It covers common pathogens including
beta-lactamase producing strains.
13. Management of mild dehydration secondary to gastroenteritis in children primarily
includes: a) IV fluids immediately b) Oral rehydration solutions c) Antiemetic medications
d) Hospital admission for observation
Correct Answer: b) Oral rehydration solutions Rationale: Oral rehydration is first-line for mild
dehydration unless complications arise.
14. A neonate with jaundice within the first 24 hours of life requires: a) Observation only b)
Immediate phototherapy and workup for hemolysis c) Delay in treatment until 48 hours d)
Empiric antibiotic therapy
Correct Answer: b) Immediate phototherapy and workup for hemolysis Rationale: Early onset
jaundice suggests pathological causes needing urgent intervention.
15. Which neurological sign is earliest in Rett syndrome? a) Loss of purposeful hand skills b)
Myoclonic seizures c) Gait disturbance in adolescence d) Macrocephaly
Correct Answer: a) Loss of purposeful hand skills Rationale: Regression of hand skills early in
development is a hallmark of Rett syndrome.
True/False (8 questions)
16. True or False: The presence of a heart murmur always indicates congenital heart
disease in infants. Answer: False Rationale: Innocent murmurs are common and benign in
infants.
17. True or False: Children with cystic fibrosis typically have fat-soluble vitamin
deficiencies. Answer: True Rationale: Malabsorption due to pancreatic insufficiency leads
to deficiency of vitamins A, D, E, and K.
18. True or False: The Hepatitis B vaccine is given as a single dose in infancy. Answer:
, False Rationale: It is given as a multi-dose series to ensure immunity.
19. True or False: An elevated blood lead level in a child can cause developmental delays.
Answer: True Rationale: Lead toxicity is neurotoxic and impairs cognitive development.
20. True or False: ADHD can be diagnosed reliably with a single parent questionnaire.
Answer: False Rationale: Diagnosis requires multiple informants and clinical evaluation.
21. True or False: Pediatric asthma severity is classified based on symptom frequency and
lung function tests. Answer: True Rationale: Symptom frequency and spirometry guide
classification and treatment.
22. True or False: Oral antibiotics are typically ineffective in treating uncomplicated
urinary tract infections in children. Answer: False Rationale: Oral antibiotics are first-
line in uncomplicated UTIs.
23. True or False: Growth charts must be used to assess the nutritional status of children at
every well-child visit. Answer: True Rationale: Monitoring growth trends is essential for
identifying nutritional or health concerns early.
Short Answer (7 questions)
24. Name three risk factors for sudden infant death syndrome (SIDS). Answer: Prone
sleeping position, maternal smoking during pregnancy, soft bedding or co-sleeping.
Rationale: These are recognized modifiable risk factors for SIDS.
25. List two key signs of congestive heart failure in infants. Answer: Tachypnea,
hepatomegaly. Rationale: These signs reflect fluid overload and cardiac dysfunction.
26. Describe the priority management step for a child presenting with an acute asthma
exacerbation. Answer: Administer short-acting beta-agonist nebulization and assess
oxygenation. Rationale: Quick relief of bronchospasm and oxygen support improve
outcomes.
27. What is the hallmark laboratory finding in iron deficiency anemia? Answer: Low serum
ferritin with microcytic, hypochromic anemia. Rationale: Reflects depleted iron stores and
decreased Hb production.
Pediatric Primary Care
Objective Assessment Review
2026
(With Solutions)
Multiple Choice (15 questions)
1. A 6-month-old infant presents with a persistent cough, wheezing, and difficulty feeding.
The most appropriate initial management includes: a) Oral corticosteroids b) Nebulized
albuterol c) Palivizumab administration d) Supportive care with hydration and monitoring
Correct Answer: d) Supportive care with hydration and monitoring Rationale: Bronchiolitis,
common in infants, is primarily treated supportively. Routine use of bronchodilators or
steroids is not recommended unless there is clear evidence of reactive airway disease.
2. A 15-year-old with type 1 diabetes reports frequent nocturnal hypoglycemia. Which
change is the best to suggest? a) Increase basal insulin dose at night b) Decrease bedtime
snack c) Adjust insulin pump basal rate downward overnight d) Ignore and monitor glucose
daily
Correct Answer: c) Adjust insulin pump basal rate downward overnight Rationale: Nocturnal
hypoglycemia in pump users is often due to excessive basal rates; adjustment is needed to
prevent hypoglycemia.
3. Which vaccine is contraindicated in a child undergoing chemotherapy for leukemia? a)
MMR (measles, mumps, rubella) b) Inactivated influenza vaccine c) Hepatitis B vaccine d)
Tetanus toxoid vaccine
Correct Answer: a) MMR (measles, mumps, rubella) Rationale: Live attenuated vaccines like
MMR are contraindicated during immunosuppression due to risk of vaccine-induced disease.
4. A 3-year-old with recurrent otitis media is scheduled for tympanostomy tube placement.
Which is the most common pathogen in this condition? a) Moraxella catarrhalis b)
Streptococcus pneumoniae c) Haemophilus influenzae type b d) Group A Streptococcus
Correct Answer: b) Streptococcus pneumoniae Rationale: S. pneumoniae is the leading
, pathogen causing acute otitis media.
5. A 7-year-old with mild persistent asthma uses low-dose inhaled corticosteroids. The nurse
recommends: a) Increase corticosteroid dose immediately b) Add a leukotriene receptor
antagonist c) Assess inhaler technique and adherence first d) Switch to oral corticosteroids
Correct Answer: c) Assess inhaler technique and adherence first Rationale: Poor control often
results from poor technique or poor adherence before medication escalation.
6. Which laboratory marker is best for assessing iron deficiency anemia in a toddler? a)
Serum ferritin b) Hemoglobin A1C c) Total bilirubin d) Serum calcium
Correct Answer: a) Serum ferritin Rationale: Serum ferritin is the most sensitive and specific
test for iron stores.
7. Which clinical feature differentiates Kawasaki disease from other pediatric febrile
illnesses? a) Persistent cough b) Bilateral non-purulent conjunctivitis c) Pharyngitis d)
Abdominal pain
Correct Answer: b) Bilateral non-purulent conjunctivitis Rationale: Bilateral conjunctival
injection without exudate is characteristic of Kawasaki disease.
8. A 4-year-old with suspected developmental delay needs screening for autism spectrum
disorder (ASD). Which tool is most appropriate? a) Wechsler Intelligence Scale for
Children b) M-CHAT (Modified Checklist for Autism in Toddlers) c) Denver Developmental
Screening Test d) Peabody Picture Vocabulary Test
Correct Answer: b) M-CHAT (Modified Checklist for Autism in Toddlers) Rationale: M-
CHAT is validated for early ASD screening in toddlers and young children.
9. In pediatric hypertension, the diagnosis requires: a) One measurement >95th percentile for
age and height b) Blood pressure >90th percentile on one occasion c) Three elevated readings
>95th percentile taken on separate visits d) Symptomatic presentation
Correct Answer: c) Three elevated readings >95th percentile taken on separate visits
Rationale: Diagnosis requires persistent elevations on multiple visits as per clinical
guidelines.
10. The most common cause of iron deficiency in toddlers is: a) Low dietary intake b) Blood
loss in the gastrointestinal tract c) Malabsorption syndromes d) Chronic hemolysis
Correct Answer: a) Low dietary intake Rationale: Excessive cow’s milk intake and poor iron-
rich food intake cause iron deficiency in toddlers.
,11. A 12-year-old child with suspected ADHD is best initially evaluated by: a) MRI brain
scan b) Psychiatric comprehensive assessment and clinical history c) Serum thyroid function
tests d) Electroencephalogram (EEG)
Correct Answer: b) Psychiatric comprehensive assessment and clinical history Rationale:
ADHD diagnosis is clinical; neuroimaging or labs are not routinely required.
12. The first-line pharmacologic treatment for bacterial sinusitis in children is: a)
Amoxicillin-clavulanate b) Azithromycin c) Ciprofloxacin d) Doxycycline
Correct Answer: a) Amoxicillin-clavulanate Rationale: It covers common pathogens including
beta-lactamase producing strains.
13. Management of mild dehydration secondary to gastroenteritis in children primarily
includes: a) IV fluids immediately b) Oral rehydration solutions c) Antiemetic medications
d) Hospital admission for observation
Correct Answer: b) Oral rehydration solutions Rationale: Oral rehydration is first-line for mild
dehydration unless complications arise.
14. A neonate with jaundice within the first 24 hours of life requires: a) Observation only b)
Immediate phototherapy and workup for hemolysis c) Delay in treatment until 48 hours d)
Empiric antibiotic therapy
Correct Answer: b) Immediate phototherapy and workup for hemolysis Rationale: Early onset
jaundice suggests pathological causes needing urgent intervention.
15. Which neurological sign is earliest in Rett syndrome? a) Loss of purposeful hand skills b)
Myoclonic seizures c) Gait disturbance in adolescence d) Macrocephaly
Correct Answer: a) Loss of purposeful hand skills Rationale: Regression of hand skills early in
development is a hallmark of Rett syndrome.
True/False (8 questions)
16. True or False: The presence of a heart murmur always indicates congenital heart
disease in infants. Answer: False Rationale: Innocent murmurs are common and benign in
infants.
17. True or False: Children with cystic fibrosis typically have fat-soluble vitamin
deficiencies. Answer: True Rationale: Malabsorption due to pancreatic insufficiency leads
to deficiency of vitamins A, D, E, and K.
18. True or False: The Hepatitis B vaccine is given as a single dose in infancy. Answer:
, False Rationale: It is given as a multi-dose series to ensure immunity.
19. True or False: An elevated blood lead level in a child can cause developmental delays.
Answer: True Rationale: Lead toxicity is neurotoxic and impairs cognitive development.
20. True or False: ADHD can be diagnosed reliably with a single parent questionnaire.
Answer: False Rationale: Diagnosis requires multiple informants and clinical evaluation.
21. True or False: Pediatric asthma severity is classified based on symptom frequency and
lung function tests. Answer: True Rationale: Symptom frequency and spirometry guide
classification and treatment.
22. True or False: Oral antibiotics are typically ineffective in treating uncomplicated
urinary tract infections in children. Answer: False Rationale: Oral antibiotics are first-
line in uncomplicated UTIs.
23. True or False: Growth charts must be used to assess the nutritional status of children at
every well-child visit. Answer: True Rationale: Monitoring growth trends is essential for
identifying nutritional or health concerns early.
Short Answer (7 questions)
24. Name three risk factors for sudden infant death syndrome (SIDS). Answer: Prone
sleeping position, maternal smoking during pregnancy, soft bedding or co-sleeping.
Rationale: These are recognized modifiable risk factors for SIDS.
25. List two key signs of congestive heart failure in infants. Answer: Tachypnea,
hepatomegaly. Rationale: These signs reflect fluid overload and cardiac dysfunction.
26. Describe the priority management step for a child presenting with an acute asthma
exacerbation. Answer: Administer short-acting beta-agonist nebulization and assess
oxygenation. Rationale: Quick relief of bronchospasm and oxygen support improve
outcomes.
27. What is the hallmark laboratory finding in iron deficiency anemia? Answer: Low serum
ferritin with microcytic, hypochromic anemia. Rationale: Reflects depleted iron stores and
decreased Hb production.
