Pearson Edexcel International
A+ Graded Paper
N631 Final Exam Study Guide (2025) – ACTUAL
EXAM – Verified Multiple-Choice Questions &
Answers – Complete Solutions – A+ Graded –
100% Correct!!
Questions and Mark scheme
Version: Final
,Care coordination and collaboration - ✔✔The primary care nurse practitioner has a cohort of patients who have
special health care needs. Which is an important role of the nurse practitioner when caring for these children?
a. Developing protocols for parents to follow
b. Monitoring Individual Education Plans (IEPs)
c. Care coordination and collaboration
d. Providing lists of resources for families.
b. Tethered cord - ✔✔A 4-year-old child who has previously met developmental milestones is not toilet trained.
The primary care nurse practitioner notes decreased reflexes in the lower extremities and observes a dimple
above the gluteal cleft. Which diagnosis may be considered for this child?
a. Arnold-Chiari malformation
b. Tethered cord
c. Spina bifida cystica
d. Reye syndrome
Arnold-Chiari malformation - ✔✔There are two types. Type 1 malformation involves the downward elongation
(herniation) of the caudal end of the cerebellar vermis through the foramen magnum. Type 2 malformation is
present in 0.521/1000 of children with spina bifida myelomeningocele. The herniation can lead to brain stem
and upper cervical cord compression that may ultimately cause necrosis of both structures Manifestations may
not be readily apparent. Type 1 may cause may cause headache, neck pain, atrophy and decrease reflexes in
lower extremities, sensory losses and scoliosis. Type 2 manifestations include hydrocephaly, respiratory
distress, syncope, poor feeding, vomiting, dysphagia, tongue paralysis, and cardiopulmonary failure. Diagnosis
is made by MRI. Treatment includes surgery to relieve the compression
Tethered cord - ✔✔the caudal end of the spinal cord is fixed by a ropelike filum terminal or below the level of
L2. This can cause abnormal stretching and damage to the nerve cells, fibers, and blood vessels. Common
findings include asymmetry of leg or foot growth, and muscle wasting in and infant, leg weakness, incontinence
of bladder and bowel, back leg pain, groin or genital pain, and loss of sensation and reflexes in the legs. An
MRI is the gold standard for diagnosis. Surgery is usually the treatment of choice.
Spina bifida cystica - ✔✔Refers to the protrusion of both the spinal cord nerve roots and the three layers of
membranes that cover the spinal cord and brain through the spinal defect. The protruding dural sac may contain
only the meninges (10-20% or both meninges) the remaining cases. Manifestations include: poor intake of folic
acid, exposure to known toxins, saclike cysts containing meninges and spinal fluid covered by thin layer of skin,
flaccid paralysis, absence of deep tendon reflexes, lack of response to touch or pain, constant urinary dribbling.
Management includes cranial ultrasounds to watch for development of hydrocephaly, surgical resection and
closure of the involved neural tube structures are done within a week of birth, and often shunting the
hydrocephaly is also required.
Reye syndrome - ✔✔An encephalopathy process often associated with a viral infection. Infrequently cases are
often seen with varicella or non-specific respiratory infections, notability H. influenza type B. This proceeds in
clinical stages unless treated. It starts with severe vomiting that progress to irrational behavior; to stupor and
coma; to apnea, fixed pupils, and decorticate posturing with increasing brain edema; to death. Management
includes supportive care.
d. Carrier testing - ✔✔Which type of testing will the primary care nurse practitioner recommend for a couple
, concerned about the potential for having children with cystic fibrosis?
a. Biochemical testing
b. Karyotype testing
c. FISH testing
d. Carrier testing
Five "domains of readiness" in regards to school-age children: - ✔✔1. Physical well-being and motor
development
2. Social and emotional development
3. Language development
4. Cognition and general knowledge
5. Child's approach to learning
a.Parental concerns about bullying in the school. - ✔✔During a well-child exam on a 5-year-old child, the nurse
practitioner assesses the child for school readiness. Which finding may be a factor in limiting school readiness
for this child?
a.Parental concerns about bullying in the school.
b.Adherence to daily family routines and regular activities.
c.Having two older siblings who attend the same school.
d.The child's ability to recognize four different colors.
Barlow-Ortolani maneuvers - ✔✔A.T. is a 6 month old female presenting to the clinic with her 26 year old
mother for a well child examination. The history and examination are normal. The mother states she is
concerned because her husband had a congenital hip disorder when he was born and she heard it is genetically
passed to offspring. As part of your exam you completed which test to check for this disorder?
a. Neonatal Behavioral Assessment Scale (NBAS)
b. Barlow-Ortolani maneuvers
c. Beckwith-Wiedemann Syndrome
d. Pierre Robin Syndrome
Pierre Robin Syndrome - ✔✔This syndrome is a congenital condition recently linked to genetic anomalies at
chromosomes 2, 11 or 17. The disease is a chain of developmental malformations, each leading to the next. The
condition is characterized by a smaller-than-normal lower jaw, a tongue that falls back in the throat and airway
obstruction. In many cases, the child will also have cleft palate.
Beckwith-Wiedemann Syndrome - ✔✔Manifestations include omphalocele, umbilical hernia, macroglossia,
facial nevus flammeus, prominent eyes, anterior ear lobe creases, large placenta/long umbilical cord,
hypoglycemia, cardiomegaly, dental malocclusion with maxillary underdevelopment.
Neonatal Behavioral Assessment Scale (NBAS) - ✔✔This was developed by Dr. T. Berry Brazelton and his
colleagues and today is regarded as the most comprehensive examination of newborn behavior available. It is
best described as a neurobehavioral assessment scale, designed to describe the newborn's responses to his/her
new extrauterine environment and to document the contribution of the newborn infant to the development of the
emerging parent-child relationship.
How to perform the Barlow-Ortolani maneuvers - ✔✔The Barlow maneuver dislocates an unstable or
A+ Graded Paper
N631 Final Exam Study Guide (2025) – ACTUAL
EXAM – Verified Multiple-Choice Questions &
Answers – Complete Solutions – A+ Graded –
100% Correct!!
Questions and Mark scheme
Version: Final
,Care coordination and collaboration - ✔✔The primary care nurse practitioner has a cohort of patients who have
special health care needs. Which is an important role of the nurse practitioner when caring for these children?
a. Developing protocols for parents to follow
b. Monitoring Individual Education Plans (IEPs)
c. Care coordination and collaboration
d. Providing lists of resources for families.
b. Tethered cord - ✔✔A 4-year-old child who has previously met developmental milestones is not toilet trained.
The primary care nurse practitioner notes decreased reflexes in the lower extremities and observes a dimple
above the gluteal cleft. Which diagnosis may be considered for this child?
a. Arnold-Chiari malformation
b. Tethered cord
c. Spina bifida cystica
d. Reye syndrome
Arnold-Chiari malformation - ✔✔There are two types. Type 1 malformation involves the downward elongation
(herniation) of the caudal end of the cerebellar vermis through the foramen magnum. Type 2 malformation is
present in 0.521/1000 of children with spina bifida myelomeningocele. The herniation can lead to brain stem
and upper cervical cord compression that may ultimately cause necrosis of both structures Manifestations may
not be readily apparent. Type 1 may cause may cause headache, neck pain, atrophy and decrease reflexes in
lower extremities, sensory losses and scoliosis. Type 2 manifestations include hydrocephaly, respiratory
distress, syncope, poor feeding, vomiting, dysphagia, tongue paralysis, and cardiopulmonary failure. Diagnosis
is made by MRI. Treatment includes surgery to relieve the compression
Tethered cord - ✔✔the caudal end of the spinal cord is fixed by a ropelike filum terminal or below the level of
L2. This can cause abnormal stretching and damage to the nerve cells, fibers, and blood vessels. Common
findings include asymmetry of leg or foot growth, and muscle wasting in and infant, leg weakness, incontinence
of bladder and bowel, back leg pain, groin or genital pain, and loss of sensation and reflexes in the legs. An
MRI is the gold standard for diagnosis. Surgery is usually the treatment of choice.
Spina bifida cystica - ✔✔Refers to the protrusion of both the spinal cord nerve roots and the three layers of
membranes that cover the spinal cord and brain through the spinal defect. The protruding dural sac may contain
only the meninges (10-20% or both meninges) the remaining cases. Manifestations include: poor intake of folic
acid, exposure to known toxins, saclike cysts containing meninges and spinal fluid covered by thin layer of skin,
flaccid paralysis, absence of deep tendon reflexes, lack of response to touch or pain, constant urinary dribbling.
Management includes cranial ultrasounds to watch for development of hydrocephaly, surgical resection and
closure of the involved neural tube structures are done within a week of birth, and often shunting the
hydrocephaly is also required.
Reye syndrome - ✔✔An encephalopathy process often associated with a viral infection. Infrequently cases are
often seen with varicella or non-specific respiratory infections, notability H. influenza type B. This proceeds in
clinical stages unless treated. It starts with severe vomiting that progress to irrational behavior; to stupor and
coma; to apnea, fixed pupils, and decorticate posturing with increasing brain edema; to death. Management
includes supportive care.
d. Carrier testing - ✔✔Which type of testing will the primary care nurse practitioner recommend for a couple
, concerned about the potential for having children with cystic fibrosis?
a. Biochemical testing
b. Karyotype testing
c. FISH testing
d. Carrier testing
Five "domains of readiness" in regards to school-age children: - ✔✔1. Physical well-being and motor
development
2. Social and emotional development
3. Language development
4. Cognition and general knowledge
5. Child's approach to learning
a.Parental concerns about bullying in the school. - ✔✔During a well-child exam on a 5-year-old child, the nurse
practitioner assesses the child for school readiness. Which finding may be a factor in limiting school readiness
for this child?
a.Parental concerns about bullying in the school.
b.Adherence to daily family routines and regular activities.
c.Having two older siblings who attend the same school.
d.The child's ability to recognize four different colors.
Barlow-Ortolani maneuvers - ✔✔A.T. is a 6 month old female presenting to the clinic with her 26 year old
mother for a well child examination. The history and examination are normal. The mother states she is
concerned because her husband had a congenital hip disorder when he was born and she heard it is genetically
passed to offspring. As part of your exam you completed which test to check for this disorder?
a. Neonatal Behavioral Assessment Scale (NBAS)
b. Barlow-Ortolani maneuvers
c. Beckwith-Wiedemann Syndrome
d. Pierre Robin Syndrome
Pierre Robin Syndrome - ✔✔This syndrome is a congenital condition recently linked to genetic anomalies at
chromosomes 2, 11 or 17. The disease is a chain of developmental malformations, each leading to the next. The
condition is characterized by a smaller-than-normal lower jaw, a tongue that falls back in the throat and airway
obstruction. In many cases, the child will also have cleft palate.
Beckwith-Wiedemann Syndrome - ✔✔Manifestations include omphalocele, umbilical hernia, macroglossia,
facial nevus flammeus, prominent eyes, anterior ear lobe creases, large placenta/long umbilical cord,
hypoglycemia, cardiomegaly, dental malocclusion with maxillary underdevelopment.
Neonatal Behavioral Assessment Scale (NBAS) - ✔✔This was developed by Dr. T. Berry Brazelton and his
colleagues and today is regarded as the most comprehensive examination of newborn behavior available. It is
best described as a neurobehavioral assessment scale, designed to describe the newborn's responses to his/her
new extrauterine environment and to document the contribution of the newborn infant to the development of the
emerging parent-child relationship.
How to perform the Barlow-Ortolani maneuvers - ✔✔The Barlow maneuver dislocates an unstable or
