PEDIATRIC PRIMARY CARE PNCB 2 | COMPLETE QUESTIONS WITH 100% RATED CORRECT
ANSWERS | GRADED A+| 2025/2026 LATEST UPDATE
A 12 year old has a 4-week history of a paroxysmal cough and occasional post-tussive emesis.
Physical exam is essentially unremarkable except for signs of an upper respiratory infection. The
MOST likely causative organism is:
Streptococcus pneumoniae
Bordetella pertussis
Haemophilus influenzae
Mycoplasma pneumoniae Bordetella pertussis
Pertussis should be suspected in any individual who has a persistent cough especially in the
absence of fever, malaise, myalgia, tachypnea, wheezes or rales. Pertussis is a strong possibility
if the cough has lasted more than 14 days, with associated paroxysms, whoops or post-tussive
emesis. The characteristic whooping-type cough may be absent in adults or adolescents.
Pneumonia, due to Streptococcus pneumoniae, also may cause post-tussive emesis, but is
usually accompanied by a history of fever and headache along with rales heard on auscultation.
Haemophilus influenza, as a cause of pneumonia, is more common in younger children less than
4 years of age.
The MOST appropriate treatment for children with uncomplicated obstructive sleep apnea is:
positive airway pressure (Bi PAP)
oxygen therapy
,tonsillectomy and adenoidectomy
nasal steroids tonsillectomy and adenoidectomy
The most appropriate treatment for children with documented, uncomplicated obstructive
sleep apnea (OSA) is tonsillectomy and adenoidectomy. Research results indicate that signs and
symptoms of OSA improve after tonsillectomy and adenoidectomy, regardless of the use of
polysomnography or sleep study. Children treated with non-surgical means for OSA continued
to have symptoms.
A pediatric nurse practitioner is thinking of leaving primary care for a position in a mental health
clinic screening and managing medications for patients of all ages. Before making such a change
in employment it would be BEST to consult which of the following?
certification board
malpractice insurance carrier
professional organization's scope and standards of practice
state board of nursing's rules and regulations state board of nursing's rules and regulations
Nurse practitioners should be aware of their state board of nursing's rules and regulations
because these are what determine legal practice parameters. It would be prudent to check with
the insurance carrier, as well. Certification boards assure the public an individual has a certain
level of knowledge and skills in a specialty area but do not set age parameters for practice.
Membership organizations provide an arena for continuing education and suggestions for how
to practice in that specialty.
,An infant who is hypotonic with hypogonadism, short stature, and feeding problems is MOST
likely to have:
DiGeorge syndrome
fragile X
Prader-Willi syndrome
trisomy 21 Prader-Willi syndrome
Prader-Willi syndrome is characterized by hypogonadism, intellectual disability, short stature,
and obesity. Additional characteristics include a narrow bifrontal diameter, strabismus, almond
shaped eyes, and small hands and feet. Neonates are profoundly hypotonic and often have
feeding problems until 8-11 months of age. Prader-Willi syndrome is a genetic abnormality,
paternally derived and documented through the use of a fluorescence in situ hybridization
(FISH) study.
Characteristics of trisomy 21 include short stature, epicanthal folds, hypotonia, small mandible,
and developmental delays. Approximately one third of infants with complete DiGeorge
Syndrome have cardiac defects, growth or developmental retardation, and genital hypoplasia.
Fragile X syndrome accounts for 3% of males with mental disabilities. Characteristics include
cognitive delays, autistic behavior, macroorchidism, and characteristic facial features.
An obese 10 year old whose family history is unknown has a total cholesterol (TC) of 205 when
first screened for hyperlipidemia. The MOST appropriate course of action is to:
repeat TC level in 2-4 weeks.
, repeat TC level after 3 months on a low-fat diet.
perform a lipoprotein analysis now.
perform a lipoprotein analysis after 3 months on a low-fat diet. perform a lipoprotein
analysis now.
Children with a family history of premature cardiovascular disease and whose parents have
elevated cholesterol levels are at increased risk for developing heart disease as adults. The
American Academy of Pediatrics (AAP) recommends selective screening of these children for
hyperlipidemia. Selective screening of children whose family history is unknown is also
recommended, especially in the presence of other risk factors for early onset heart disease such
as obesity, diabetes, or hypertension.
The National Cholesterol Education Program has developed an algorithm summarizing
recommendations for hyperlipidemia screening in children. For a child being screened because
of parental elevated cholesterol and for those with an unknown family history, the
recommended initial screening test is a total cholesterol (TC) level.
A normal TC level, below 170 mg/dl, should be re-tested in 5 years. A borderline TC level
between 171 and 199 requires a repeat TC, which is averaged with the first TC. Mean TC greater
than 169 requires fractional lipoprotein analysis, while a high initial TC in excess of 199 indicates
lipoprotein analysis. If lipoprotein analysis shows a borderline low-density lipoprotein LDL level
of 110-129 mg/dL, the American Heart Association Step One Diet should be recommended,
along with advice about reducing other risk factors for heart disease such as obesity,
hypertension, cigarette smoking, and physical inactivity. If lipoprotein analysis shows LDL level
of 130 or greater, the child should begin the AHA Step One diet and be screened for thyroid,
renal, and liver disorders.
ANSWERS | GRADED A+| 2025/2026 LATEST UPDATE
A 12 year old has a 4-week history of a paroxysmal cough and occasional post-tussive emesis.
Physical exam is essentially unremarkable except for signs of an upper respiratory infection. The
MOST likely causative organism is:
Streptococcus pneumoniae
Bordetella pertussis
Haemophilus influenzae
Mycoplasma pneumoniae Bordetella pertussis
Pertussis should be suspected in any individual who has a persistent cough especially in the
absence of fever, malaise, myalgia, tachypnea, wheezes or rales. Pertussis is a strong possibility
if the cough has lasted more than 14 days, with associated paroxysms, whoops or post-tussive
emesis. The characteristic whooping-type cough may be absent in adults or adolescents.
Pneumonia, due to Streptococcus pneumoniae, also may cause post-tussive emesis, but is
usually accompanied by a history of fever and headache along with rales heard on auscultation.
Haemophilus influenza, as a cause of pneumonia, is more common in younger children less than
4 years of age.
The MOST appropriate treatment for children with uncomplicated obstructive sleep apnea is:
positive airway pressure (Bi PAP)
oxygen therapy
,tonsillectomy and adenoidectomy
nasal steroids tonsillectomy and adenoidectomy
The most appropriate treatment for children with documented, uncomplicated obstructive
sleep apnea (OSA) is tonsillectomy and adenoidectomy. Research results indicate that signs and
symptoms of OSA improve after tonsillectomy and adenoidectomy, regardless of the use of
polysomnography or sleep study. Children treated with non-surgical means for OSA continued
to have symptoms.
A pediatric nurse practitioner is thinking of leaving primary care for a position in a mental health
clinic screening and managing medications for patients of all ages. Before making such a change
in employment it would be BEST to consult which of the following?
certification board
malpractice insurance carrier
professional organization's scope and standards of practice
state board of nursing's rules and regulations state board of nursing's rules and regulations
Nurse practitioners should be aware of their state board of nursing's rules and regulations
because these are what determine legal practice parameters. It would be prudent to check with
the insurance carrier, as well. Certification boards assure the public an individual has a certain
level of knowledge and skills in a specialty area but do not set age parameters for practice.
Membership organizations provide an arena for continuing education and suggestions for how
to practice in that specialty.
,An infant who is hypotonic with hypogonadism, short stature, and feeding problems is MOST
likely to have:
DiGeorge syndrome
fragile X
Prader-Willi syndrome
trisomy 21 Prader-Willi syndrome
Prader-Willi syndrome is characterized by hypogonadism, intellectual disability, short stature,
and obesity. Additional characteristics include a narrow bifrontal diameter, strabismus, almond
shaped eyes, and small hands and feet. Neonates are profoundly hypotonic and often have
feeding problems until 8-11 months of age. Prader-Willi syndrome is a genetic abnormality,
paternally derived and documented through the use of a fluorescence in situ hybridization
(FISH) study.
Characteristics of trisomy 21 include short stature, epicanthal folds, hypotonia, small mandible,
and developmental delays. Approximately one third of infants with complete DiGeorge
Syndrome have cardiac defects, growth or developmental retardation, and genital hypoplasia.
Fragile X syndrome accounts for 3% of males with mental disabilities. Characteristics include
cognitive delays, autistic behavior, macroorchidism, and characteristic facial features.
An obese 10 year old whose family history is unknown has a total cholesterol (TC) of 205 when
first screened for hyperlipidemia. The MOST appropriate course of action is to:
repeat TC level in 2-4 weeks.
, repeat TC level after 3 months on a low-fat diet.
perform a lipoprotein analysis now.
perform a lipoprotein analysis after 3 months on a low-fat diet. perform a lipoprotein
analysis now.
Children with a family history of premature cardiovascular disease and whose parents have
elevated cholesterol levels are at increased risk for developing heart disease as adults. The
American Academy of Pediatrics (AAP) recommends selective screening of these children for
hyperlipidemia. Selective screening of children whose family history is unknown is also
recommended, especially in the presence of other risk factors for early onset heart disease such
as obesity, diabetes, or hypertension.
The National Cholesterol Education Program has developed an algorithm summarizing
recommendations for hyperlipidemia screening in children. For a child being screened because
of parental elevated cholesterol and for those with an unknown family history, the
recommended initial screening test is a total cholesterol (TC) level.
A normal TC level, below 170 mg/dl, should be re-tested in 5 years. A borderline TC level
between 171 and 199 requires a repeat TC, which is averaged with the first TC. Mean TC greater
than 169 requires fractional lipoprotein analysis, while a high initial TC in excess of 199 indicates
lipoprotein analysis. If lipoprotein analysis shows a borderline low-density lipoprotein LDL level
of 110-129 mg/dL, the American Heart Association Step One Diet should be recommended,
along with advice about reducing other risk factors for heart disease such as obesity,
hypertension, cigarette smoking, and physical inactivity. If lipoprotein analysis shows LDL level
of 130 or greater, the child should begin the AHA Step One diet and be screened for thyroid,
renal, and liver disorders.
