Pediatric Primary Care PNCB 2 Exam Questions and Answers
with Rationales.
A female athlete experiences anaphylaxis during a soccer game. The only significant
history is that she had lunch about 1 hour before the incident. Food-dependent exercise-
induced anaphylaxis is diagnosed. Of the following, the MOST likely cause is:
chocolate milkshake
pineapple
tomatoes
whole wheat bread - Correct Answer whole wheat bread
Exercise is a known co-factor in some children who experience anaphylaxis. Food-
dependent exercise-induced anaphylaxis (FDEIA) is defined as a food induced allergic
reaction that occurs during or soon after exercise. Children should not exercise within 2-3
hours of ingesting the triggering food. Nuts, wheat, apples, bananas, kiwi, peaches and
eggs frequently are the cause for anaphylaxis.
A healthy 24 month old can be expected to have achieved which of the following language
milestones?
counts three objects correctly
speaks using 30 - 50 words
states full name
tells a story - Correct Answer speaks using 30 - 50 words
Utilizing the Early Language Milestone Scale, beginning at the age of 11 months and
continuing to 24 months of age, the child should have a vocabulary of 50 words. This child
should be able to put words together in short, 2 - 3 word sentences and name at least one
,object in a picture. The child at age 3 - 4 years will be able to tell a short story and begin to
count. A 2 year old may know his first name, but usually cannot state full name until he/she
is older.
Which is the MOST important safety question to ask a 17 year old?
"Are you aware of ways to avoid accidents?"
"Do you play violent video games more than 2 hours a day?"
"Do you always wear a seat belt when driving or riding in a car?"
"Is there a gun anywhere in your house?" - Correct Answer "Do you always wear a seat
belt when driving or riding in a car?"
Motor vehicle accidents are the leading cause of death among children in the United
States, with 78% of all unintentional injury deaths related to MVA among adolescents.
When correctly used, restraint systems can prevent fatalities and reduce the number and
severity of injuries to children and adolescents. As adolescents begin to drive and carry
peer passengers, it is especially important to remind them of basic safety issues, including
the use of seat belts, emphasizing the danger of driving, drinking and drug use as well as
appropriate behavior while in the car. Reinforcing pedestrian safety is another important
issue with adolescents. Firearm injuries have decreased over recent years, especially
among older children, and there is no link between violent video games and increased
accidents.
The parent of an 8 month old, reports switching the baby's formula to cow's milk due to the
continued expense of formula. Which is the BEST response?
Cow's milk does not contain adequate nutrition, and poses a higher risk for allergy.
Cow's milk has a lower protein and fat content, which will impede growth of the baby.
Switching to cow's milk sooner than 1 year will not cause any harm.
,There is no need to continue formula as long as the child is receiving other baby foods. -
Correct Answer Cow's milk does not contain adequate nutrition, and poses a higher risk
for allergy.
During the first year of life, infants should receive only formula or breast milk. The use of
cow's milk is contraindicated because of its high protein content, inappropriate nutrition
composition, especially lack of iron sources, and the risk of gastrointestinal bleeding and
allergic reactions. If an infant is switched sooner than one year, the practitioner should
encourage the family to resume use of formula or breast milk until the one year birthday.
Despite the addition of table foods or baby solid foods, formula and breast milk are still the
dietary mainstay.
A 10 month old has had apparent abdominal pain for the past 4 hours. During episodes of
pain, the infant screams inconsolably and draws his legs towards the abdomen, has
vomited twice, but has had no diarrhea. Between episodes the infant is calm and quiet.
The MOST likely diagnosis is:
Meckel's diverticulum
intussusception
acute appendicitis
acute gastroenteritis - Correct Answer intussusception
Acute onset of abdominal pain requires immediate investigation. The nurse practitioner
must be able to distinguish between conditions that can safely be managed at home and
those requiring immediate referral. Meckel's diverticulum usually involves painless rectal
bleeding. Acute appendicitis can occur in infants and must be considered in the
differential diagnosis. The pain history of acute appendicitis is usually more continuous,
and there is no palpable mass. Acute gastroenteritis may involve intermittent pain and
cramping, but more typically the child appears ill, and vomiting and diarrhea play a more
prominent role. The pain of intussusception is very severe, with periods of well-being in
between. There is frequently vomiting, however stools initially are normal. Later stools can
be like red jelly in appearance. A sausage shaped mass is frequently palpable in the right
upper quadrant and aids in diagnosis.
, For the parents of an 8 month old, the MOST appropriate age-related anticipatory
guidance regarding safety includes which of the following?
cover electrical outlets, keep small objects out of reach, turn car seat to forward-facing
position
keep medications out of reach, continue to use car seat in rear-facing position, cover
electrical outlets
avoid finger foods that can be easily aspirated, teach stranger safety, place Mr. Yuk
stickers on toxic materials
keep matches out of reach, place Mr. Yuk stickers on toxic materials, teach stranger
safety - Correct Answer keep medications out of reach, continue to use car seat in rear-
facing position, cover electrical outlets
An 8 month old is beginning to cruise, crawl and develop a fine pincer grasp. Keeping
medications and small objects out of reach in this age group assists in avoiding choking or
toxic ingestions. Covering electrical outlets helps to prevent accidental electrocution while
the infant is exploring his surroundings. An infant should maintain the rear-facing position
of the car seat until the age of one year. An 8 month old is not at a developmental level to
understand stranger caution nor Mr. Yuk stickers. Keeping matches out of reach is
important, although it is not as likely that an 8 month old would have the dexterity to strike
a match.
The INITIAL treatment for a school-age female with well-demarcated erythema and
mucoid discharge in the vulva area includes:
discontinuation of bubble baths.
instruction on front to back cleansing.
oral penicillin.
topical Premarin. - Correct Answer instruction on front to back cleansing.
with Rationales.
A female athlete experiences anaphylaxis during a soccer game. The only significant
history is that she had lunch about 1 hour before the incident. Food-dependent exercise-
induced anaphylaxis is diagnosed. Of the following, the MOST likely cause is:
chocolate milkshake
pineapple
tomatoes
whole wheat bread - Correct Answer whole wheat bread
Exercise is a known co-factor in some children who experience anaphylaxis. Food-
dependent exercise-induced anaphylaxis (FDEIA) is defined as a food induced allergic
reaction that occurs during or soon after exercise. Children should not exercise within 2-3
hours of ingesting the triggering food. Nuts, wheat, apples, bananas, kiwi, peaches and
eggs frequently are the cause for anaphylaxis.
A healthy 24 month old can be expected to have achieved which of the following language
milestones?
counts three objects correctly
speaks using 30 - 50 words
states full name
tells a story - Correct Answer speaks using 30 - 50 words
Utilizing the Early Language Milestone Scale, beginning at the age of 11 months and
continuing to 24 months of age, the child should have a vocabulary of 50 words. This child
should be able to put words together in short, 2 - 3 word sentences and name at least one
,object in a picture. The child at age 3 - 4 years will be able to tell a short story and begin to
count. A 2 year old may know his first name, but usually cannot state full name until he/she
is older.
Which is the MOST important safety question to ask a 17 year old?
"Are you aware of ways to avoid accidents?"
"Do you play violent video games more than 2 hours a day?"
"Do you always wear a seat belt when driving or riding in a car?"
"Is there a gun anywhere in your house?" - Correct Answer "Do you always wear a seat
belt when driving or riding in a car?"
Motor vehicle accidents are the leading cause of death among children in the United
States, with 78% of all unintentional injury deaths related to MVA among adolescents.
When correctly used, restraint systems can prevent fatalities and reduce the number and
severity of injuries to children and adolescents. As adolescents begin to drive and carry
peer passengers, it is especially important to remind them of basic safety issues, including
the use of seat belts, emphasizing the danger of driving, drinking and drug use as well as
appropriate behavior while in the car. Reinforcing pedestrian safety is another important
issue with adolescents. Firearm injuries have decreased over recent years, especially
among older children, and there is no link between violent video games and increased
accidents.
The parent of an 8 month old, reports switching the baby's formula to cow's milk due to the
continued expense of formula. Which is the BEST response?
Cow's milk does not contain adequate nutrition, and poses a higher risk for allergy.
Cow's milk has a lower protein and fat content, which will impede growth of the baby.
Switching to cow's milk sooner than 1 year will not cause any harm.
,There is no need to continue formula as long as the child is receiving other baby foods. -
Correct Answer Cow's milk does not contain adequate nutrition, and poses a higher risk
for allergy.
During the first year of life, infants should receive only formula or breast milk. The use of
cow's milk is contraindicated because of its high protein content, inappropriate nutrition
composition, especially lack of iron sources, and the risk of gastrointestinal bleeding and
allergic reactions. If an infant is switched sooner than one year, the practitioner should
encourage the family to resume use of formula or breast milk until the one year birthday.
Despite the addition of table foods or baby solid foods, formula and breast milk are still the
dietary mainstay.
A 10 month old has had apparent abdominal pain for the past 4 hours. During episodes of
pain, the infant screams inconsolably and draws his legs towards the abdomen, has
vomited twice, but has had no diarrhea. Between episodes the infant is calm and quiet.
The MOST likely diagnosis is:
Meckel's diverticulum
intussusception
acute appendicitis
acute gastroenteritis - Correct Answer intussusception
Acute onset of abdominal pain requires immediate investigation. The nurse practitioner
must be able to distinguish between conditions that can safely be managed at home and
those requiring immediate referral. Meckel's diverticulum usually involves painless rectal
bleeding. Acute appendicitis can occur in infants and must be considered in the
differential diagnosis. The pain history of acute appendicitis is usually more continuous,
and there is no palpable mass. Acute gastroenteritis may involve intermittent pain and
cramping, but more typically the child appears ill, and vomiting and diarrhea play a more
prominent role. The pain of intussusception is very severe, with periods of well-being in
between. There is frequently vomiting, however stools initially are normal. Later stools can
be like red jelly in appearance. A sausage shaped mass is frequently palpable in the right
upper quadrant and aids in diagnosis.
, For the parents of an 8 month old, the MOST appropriate age-related anticipatory
guidance regarding safety includes which of the following?
cover electrical outlets, keep small objects out of reach, turn car seat to forward-facing
position
keep medications out of reach, continue to use car seat in rear-facing position, cover
electrical outlets
avoid finger foods that can be easily aspirated, teach stranger safety, place Mr. Yuk
stickers on toxic materials
keep matches out of reach, place Mr. Yuk stickers on toxic materials, teach stranger
safety - Correct Answer keep medications out of reach, continue to use car seat in rear-
facing position, cover electrical outlets
An 8 month old is beginning to cruise, crawl and develop a fine pincer grasp. Keeping
medications and small objects out of reach in this age group assists in avoiding choking or
toxic ingestions. Covering electrical outlets helps to prevent accidental electrocution while
the infant is exploring his surroundings. An infant should maintain the rear-facing position
of the car seat until the age of one year. An 8 month old is not at a developmental level to
understand stranger caution nor Mr. Yuk stickers. Keeping matches out of reach is
important, although it is not as likely that an 8 month old would have the dexterity to strike
a match.
The INITIAL treatment for a school-age female with well-demarcated erythema and
mucoid discharge in the vulva area includes:
discontinuation of bubble baths.
instruction on front to back cleansing.
oral penicillin.
topical Premarin. - Correct Answer instruction on front to back cleansing.
