Pediatric FNP Fitzgerald Exam
Questions and Answers
1. Which of the following is appropriate advice to give to a mother who is breastfeeding
her 10-day-old infant? A. "Your milk will come in today." B. "To minimize breast
tenderness, the baby should not be kept on either breast for more than 5 to 10 minutes."
C. "A clicking sound made by the baby during feedings signifies a good latch and suck."
D. "The baby's urine should be light or colorless." - correct Answer-1. Correct: D. "The
baby's urine should be light or colorless." Urine that is light and colorless is a good
indication that the baby is well hydrated and feeding sufficiently (D). Incorrect: The
transition from colostrum to mature milk typically occurs between days 2 to 5 after
childbirth and not 10 days after birth (A). Proper breastfeeding of the newborn should
have a minimum of 10 minutes on each breast every 1.5 to 3 hours (B). A clicking
sound made during nursing would indicate an improper latch (C).
2. Which of the following is appropriate advice to give to a mother who is breastfeeding
her 12-hour-old infant? A. "You will likely have enough milk to feed the baby within a few
hours of birth." B. "The baby might need to be awakened to be fed." C. "Supplemental
feeding is needed unless the baby has at least four wet diapers in the first day of life."
D. "The baby will likely have a seedy, yellow bowel movement today." - correct Answer-
2. Correct: B. "The baby might need to be awakened to be fed." A newborn who is
breastfed should feed every 1.5 to 3 hours (about 8 to 12 times per day), which may
require waking the baby to ensure adequate feeding (B). Incorrect: The transition from
colostrum to mature milk typically occurs between days 2 and 5 after childbirth (A).
However, supplemental feeding with formula or dextrose and water should be avoided
as this will interfere with the baby's hunger drive to breastfeed and can delay or reduce
production of breast milk (C). The first bowel movements of the newborn consist of
meconium, which is a thick, black or dark green substance that eventually transitions to
a yellow-green stool (D).
3. Compared with the use of infant formula, advantages for the breastfed baby include
all of the following except: A. lower incidence of diarrheal illness. B. greater weight gain
in the first few weeks of life. C. reduced risk of allergic disorders. D. lower occurrence of
constipation. - correct Answer-3. Correct: B. greater weight gain in the first few weeks of
life. Newborns that are formula-fed typically have greater weight gain during the first few
weeks of life when compared to breastfed babies (B). However, the overall benefits of
breastfeeding far outweigh this small difference in weight gain, and this likely represents
excessive weight gain. Incorrect: Breastfeeding offers several benefits to the newborn
as it provides the ideal form of nutrition and transfers the mother's antibodies to the
infant to help prevent disease. Breastfed infants have been shown to have a lower
,incidence of diarrheal illness (A), a lower risk of allergic disorders (C), and a lower
occurrence of constipation (D).
4. At 3 weeks of age, the average-weight, formula-fed infant should be expected to take:
A. 2 to 3 oz, or 60 to 90 mL, every 2 to 3 hours. B. 2 to 3 oz, or 60 to 90 mL, every 3 to
4 hours. C. 3 to 4 oz, or 90 to 118 mL, every 2 to 3 hours. D. 3 to 4 oz, or 90 to 118 mL,
every 3 to 4 hours. - correct Answer-4. Correct: A. 2 to 3 oz, or 60 to 90 mL, every 2 to 3
hours. During the first month of life, a formula-fed infant should be expected to consume
2 to 3 oz of formula every 2 to 3 hours (A). For breastfed infants, feeding should occur
at least 10 minutes on each breast every 1.5 to 3 hours. Incorrect: A newborn infant that
is formula-fed should be fed approximately every 2 to 3 hours (B, D) and would expect
to take 2 to 3 oz at each feeding (C).
5. In infants, solid foods are best introduced no earlier than: A. 1 to 3 months. B. 3 to 5
months. C. 4 to 6 months. D. 6 to 8 months. - correct Answer-5. Correct: C. 4 to 6
months. Solid foods should not be introduced to infants earlier than 4 to 6 months of
age (C). The infant should have at least doubled the birth weight and consume at least
32 oz of formula per day or more than 8 to 10 feedings (breast or bottle) per day. Other
signs would include being able to sit upright with little support, having good head
control, and opening the mouth and leaning forward when food is offered. Incorrect: The
introduction of solid foods should wait until at least 4 to 6 months of age (A, B) as
certain developmental milestones are needed to be reached. Waiting up to 6 to 8
months is not needed for most infants (D).
6. Nursing infants generally maximally receive about which percentage of the maternal
dose of a drug? A. 1% B. 3% C. 5% D. 10% - correct Answer-6. Correct: A. 1% When a
nursing mother takes a medication, the nursing infant typically receives 1% or less of
the maternal dose of medication from breast milk (A). Generally, if a medication is safe
to give to a child, then it is safe to prescribe to a nursing mother. Only a few drugs are
contraindicated in nursing mothers. Incorrect: Only 1% or less of a medication taken by
a nursing mother will pass to the infant while nursing (B, C, D).
7. Most drugs pass into breast milk through: A. active transport. B. facilitated transfer. C.
simple diffusion. D. creation of a pH gradient. - correct Answer-7. Correct: C. simple
diffusion. Most drugs pass into breast milk through simple diffusion, moving from areas
of high concentration to low concentration (C). For this reason, the pump-and-dump
approach is not effective in removing a medication from breast milk, as it creates an
area of low concentration in the empty breast. Incorrect: Active transport requires the
expenditure of energy to move substances or medications across membranes.
Facilitated transfer utilizes transmembrane proteins to move compounds across cell
membranes. Neither of these mechanisms is generally used in the movement of
medication from mother's serum to breast milk (A, B). Similarly, a pH gradient is not
created to facilitate movement of medications to breast milk (D).
8. To remove a drug from breast milk through "pump and dump," the nursing mother
should refrain from taking the offending medication and the process must be continued
,for: A. two infant feeding cycles. B. approximately 8 hours. C. three to five drug-free
half-lives of the medication. D. a period of time that is highly unpredictable. - correct
Answer-8. Correct: C. three to five drug-free half-lives of the medication. The pump-and-
dump approach is not effective in removing a medication from breast milk as it creates
an area of low concentration in the empty breast. The drug will then move from the area
of high concentration (i.e., mother's serum) to the breast. To ensure a minimal amount
of offending medication is present in breast milk, the mother should wait at least three to
five drug-free half-lives of the medication before nursing the baby (C). Incorrect: The
time required to ensure a minimal amount of drug is present in breast milk will depend
on the medication half-life and not a set time (B) or the interval of feeding cycles (A).
Half-life is a predictable pharmacokinetic property of the medication (D).
9. When counseling a breastfeeding woman about alcohol use during lactation, you
relate that: A. drinking a glass of wine or beer will enhance the let-down reflex. B.
because of its high molecular weight, relatively little alcohol is passed into breast milk.
C. maternal alcohol use causes a reduction in the amount of milk ingested by the infant.
D. infant intoxication can be seen with the mother having as few as one to two alcoholic
drinks. - correct Answer-9. Correct: C. maternal alcohol use causes a reduction in the
amount of milk ingested by the infant. Small amounts of alcohol ingestion by a nursing
mother can cause a reduction in the let-down reflex, decreased milk production, and
less rhythmic and frequent sucking by the infant, resulting in a smaller volume of milk
consumption (C). Incorrect: Alcohol has a low molecular weight that easily passes to
breast milk (B). Alcohol consumption can reduce the letdown reflex and result in
decreased milk production (A). One or two alcoholic drinks may not lead to infant
intoxication as less than 1% of the alcohol will pass to breast milk. However, even small
amounts of alcohol consumption can decrease the amount of milk consumption by the
nursing infant (D).
10. The anticipated average daily weight gain during the first 3 months of life is
approximately: A. 15 g or 0.53 oz. B. 20 g or 0.7 oz. C. 25 g or 0.88 oz. D. 30 g or 1 oz.
- correct Answer-10. Correct: D. 30 g or 1 oz. During the first 3 months of life, the
average daily weight gain is approximately 26 to 31 g (D). The anticipated daily weight
gain will then decrease to 17 to 18 g during months 3 to 6, and 12 to 13 g daily during
months 6 to 9. Incorrect: In a newborn up to 3 months of age, the average daily weight
gain should exceed 25 g and range near 30 g (A, B, C).
11. The average required caloric intake in an infant from age 0 to 3 months is usually: A.
40 to 60 kcal/kg/day. B. 60 to 80 kcal/kg/day. C. 80 to 100 kcal/kg/day. D. 100 to 120
kcal/kg/day. - correct Answer-11. Correct: D. 100 to 120 kcal/kg/day. The required
caloric intake for an infant between 0 and 3 months of age is approximately 100 to 120
kcal/kg/day (D). This amount does not change substantially as the child grows, with a
requirement of 105 to 115 kcal/kg/ day for those 3 to 6 months of age and 100 to 105
kcal/ kg/day for those 6 to 9 months of age. Incorrect: During the first 3 months of life,
the average required caloric intake ranges from 100 to 120 kcal/kg/day (A, B, C).
, 12. Regarding physiological jaundice in the newborn, select all that are correct: A. It
occurs between the first 12 and 24 hours of life. B. It progresses from the abdomen
toward the head of the infant. C. Unconjugated bilirubin is elevated. D. Risk of
development of hyperbilirubinemia can be reduced in a breastfed infant with frequent
breastfeeding every 2 to 3 hours per 24 hours. E. It can be avoided by supplemental
water and dextrose feedings between breastfeeding in the first 3 to 4 days of life to
increase infant hydration while awaiting mother's milk to come in. - correct Answer-12.
Correct: C. Unconjugated bilirubin is elevated, and D. Risk of development of
hyperbilirubinemia can be reduced in a breastfed infant with frequent breastfeeding
every 2 to 3 hours per 24 hours. Physiological jaundice occurs as a result of elevated
levels of unconjugated bilirubin (C). The condition can be prevented by keeping the
newborn well hydrated by breastfeeding at least 8 to 12 times per day, or every 2 to 3
hours (D). Incorrect: Physiological jaundice typically occurs between days 3 to 5 (A) and
usually starts at the head and then spreads to the body (B). Supplemental water and
dextrose should be avoided as this will interfere with the infant's hunger drive to
breastfeed and will delay and reduce breast milk production (E).
13. The most likely consequence of inadequate feeding during the first few weeks of a
newborn is: A. hypercalcemia. B. hypernatremia. C. hypokalemia. D. hyperkalemia -
correct Answer-13. Correct: B. hypernatremia. Consequences of inadequate feeding
during the first few weeks of life can lead to dehydration, hypernatremia (B),
and hypoglycemia. Hypoglycemia is often characterized by a protracted high-pitched
cry, jitteriness, and potential seizures. Incorrect: Inadequate feeding of a newborn is not
typically associated with hypercalcemia (A), while hypernatremia is more likely than
hypokalemia (C) or hyperkalemia (D).
14. Which of the following would be a concern regarding weight change in a newborn?
A. weight loss of 2% by day 2 of life B. no weight gain after 3 days of life C. weight gain
of less than 3% after 1 week of life D. weight loss of greater than 7% at any time after
the first week of life - correct Answer-14. Correct: D. weight loss of greater than 7% at
any time after the first week of life A key criterion to assess for adequate feeding is slow
growth or weight loss during the first few weeks of life. A weight loss of greater than 7%
at any time, particularly after the first week of life, is particularly concerning as it
increases the likelihood of neonatal jaundice and hypernatremia (D). Incorrect: Weight
loss of greater than 7% at any time in a newborn is a major concern. Some weight loss
can be expected during the first few days of life (A, B) before the newborn begins to
gain weight (C).
15. A mother who has been breastfeeding her newborn is planning on returning to work
and asks about the use of breast pumps. The nurse practitioner (NP) counsels on all of
the following except: A. Some insurance companies will cover the costs of breast
pumps. B. Breast pumps can allow flexibility in allowing mothers to return to work or
school. C. Double pumps are not recommended as they express about half the amount
of milk as single pumps. D. Federal law requires the employer to provide adequate
breaks and a location for breast pumping. - correct Answer-15. Correct: C. Double
pumps are not recommended as they express about half the amount of milk as single
Questions and Answers
1. Which of the following is appropriate advice to give to a mother who is breastfeeding
her 10-day-old infant? A. "Your milk will come in today." B. "To minimize breast
tenderness, the baby should not be kept on either breast for more than 5 to 10 minutes."
C. "A clicking sound made by the baby during feedings signifies a good latch and suck."
D. "The baby's urine should be light or colorless." - correct Answer-1. Correct: D. "The
baby's urine should be light or colorless." Urine that is light and colorless is a good
indication that the baby is well hydrated and feeding sufficiently (D). Incorrect: The
transition from colostrum to mature milk typically occurs between days 2 to 5 after
childbirth and not 10 days after birth (A). Proper breastfeeding of the newborn should
have a minimum of 10 minutes on each breast every 1.5 to 3 hours (B). A clicking
sound made during nursing would indicate an improper latch (C).
2. Which of the following is appropriate advice to give to a mother who is breastfeeding
her 12-hour-old infant? A. "You will likely have enough milk to feed the baby within a few
hours of birth." B. "The baby might need to be awakened to be fed." C. "Supplemental
feeding is needed unless the baby has at least four wet diapers in the first day of life."
D. "The baby will likely have a seedy, yellow bowel movement today." - correct Answer-
2. Correct: B. "The baby might need to be awakened to be fed." A newborn who is
breastfed should feed every 1.5 to 3 hours (about 8 to 12 times per day), which may
require waking the baby to ensure adequate feeding (B). Incorrect: The transition from
colostrum to mature milk typically occurs between days 2 and 5 after childbirth (A).
However, supplemental feeding with formula or dextrose and water should be avoided
as this will interfere with the baby's hunger drive to breastfeed and can delay or reduce
production of breast milk (C). The first bowel movements of the newborn consist of
meconium, which is a thick, black or dark green substance that eventually transitions to
a yellow-green stool (D).
3. Compared with the use of infant formula, advantages for the breastfed baby include
all of the following except: A. lower incidence of diarrheal illness. B. greater weight gain
in the first few weeks of life. C. reduced risk of allergic disorders. D. lower occurrence of
constipation. - correct Answer-3. Correct: B. greater weight gain in the first few weeks of
life. Newborns that are formula-fed typically have greater weight gain during the first few
weeks of life when compared to breastfed babies (B). However, the overall benefits of
breastfeeding far outweigh this small difference in weight gain, and this likely represents
excessive weight gain. Incorrect: Breastfeeding offers several benefits to the newborn
as it provides the ideal form of nutrition and transfers the mother's antibodies to the
infant to help prevent disease. Breastfed infants have been shown to have a lower
,incidence of diarrheal illness (A), a lower risk of allergic disorders (C), and a lower
occurrence of constipation (D).
4. At 3 weeks of age, the average-weight, formula-fed infant should be expected to take:
A. 2 to 3 oz, or 60 to 90 mL, every 2 to 3 hours. B. 2 to 3 oz, or 60 to 90 mL, every 3 to
4 hours. C. 3 to 4 oz, or 90 to 118 mL, every 2 to 3 hours. D. 3 to 4 oz, or 90 to 118 mL,
every 3 to 4 hours. - correct Answer-4. Correct: A. 2 to 3 oz, or 60 to 90 mL, every 2 to 3
hours. During the first month of life, a formula-fed infant should be expected to consume
2 to 3 oz of formula every 2 to 3 hours (A). For breastfed infants, feeding should occur
at least 10 minutes on each breast every 1.5 to 3 hours. Incorrect: A newborn infant that
is formula-fed should be fed approximately every 2 to 3 hours (B, D) and would expect
to take 2 to 3 oz at each feeding (C).
5. In infants, solid foods are best introduced no earlier than: A. 1 to 3 months. B. 3 to 5
months. C. 4 to 6 months. D. 6 to 8 months. - correct Answer-5. Correct: C. 4 to 6
months. Solid foods should not be introduced to infants earlier than 4 to 6 months of
age (C). The infant should have at least doubled the birth weight and consume at least
32 oz of formula per day or more than 8 to 10 feedings (breast or bottle) per day. Other
signs would include being able to sit upright with little support, having good head
control, and opening the mouth and leaning forward when food is offered. Incorrect: The
introduction of solid foods should wait until at least 4 to 6 months of age (A, B) as
certain developmental milestones are needed to be reached. Waiting up to 6 to 8
months is not needed for most infants (D).
6. Nursing infants generally maximally receive about which percentage of the maternal
dose of a drug? A. 1% B. 3% C. 5% D. 10% - correct Answer-6. Correct: A. 1% When a
nursing mother takes a medication, the nursing infant typically receives 1% or less of
the maternal dose of medication from breast milk (A). Generally, if a medication is safe
to give to a child, then it is safe to prescribe to a nursing mother. Only a few drugs are
contraindicated in nursing mothers. Incorrect: Only 1% or less of a medication taken by
a nursing mother will pass to the infant while nursing (B, C, D).
7. Most drugs pass into breast milk through: A. active transport. B. facilitated transfer. C.
simple diffusion. D. creation of a pH gradient. - correct Answer-7. Correct: C. simple
diffusion. Most drugs pass into breast milk through simple diffusion, moving from areas
of high concentration to low concentration (C). For this reason, the pump-and-dump
approach is not effective in removing a medication from breast milk, as it creates an
area of low concentration in the empty breast. Incorrect: Active transport requires the
expenditure of energy to move substances or medications across membranes.
Facilitated transfer utilizes transmembrane proteins to move compounds across cell
membranes. Neither of these mechanisms is generally used in the movement of
medication from mother's serum to breast milk (A, B). Similarly, a pH gradient is not
created to facilitate movement of medications to breast milk (D).
8. To remove a drug from breast milk through "pump and dump," the nursing mother
should refrain from taking the offending medication and the process must be continued
,for: A. two infant feeding cycles. B. approximately 8 hours. C. three to five drug-free
half-lives of the medication. D. a period of time that is highly unpredictable. - correct
Answer-8. Correct: C. three to five drug-free half-lives of the medication. The pump-and-
dump approach is not effective in removing a medication from breast milk as it creates
an area of low concentration in the empty breast. The drug will then move from the area
of high concentration (i.e., mother's serum) to the breast. To ensure a minimal amount
of offending medication is present in breast milk, the mother should wait at least three to
five drug-free half-lives of the medication before nursing the baby (C). Incorrect: The
time required to ensure a minimal amount of drug is present in breast milk will depend
on the medication half-life and not a set time (B) or the interval of feeding cycles (A).
Half-life is a predictable pharmacokinetic property of the medication (D).
9. When counseling a breastfeeding woman about alcohol use during lactation, you
relate that: A. drinking a glass of wine or beer will enhance the let-down reflex. B.
because of its high molecular weight, relatively little alcohol is passed into breast milk.
C. maternal alcohol use causes a reduction in the amount of milk ingested by the infant.
D. infant intoxication can be seen with the mother having as few as one to two alcoholic
drinks. - correct Answer-9. Correct: C. maternal alcohol use causes a reduction in the
amount of milk ingested by the infant. Small amounts of alcohol ingestion by a nursing
mother can cause a reduction in the let-down reflex, decreased milk production, and
less rhythmic and frequent sucking by the infant, resulting in a smaller volume of milk
consumption (C). Incorrect: Alcohol has a low molecular weight that easily passes to
breast milk (B). Alcohol consumption can reduce the letdown reflex and result in
decreased milk production (A). One or two alcoholic drinks may not lead to infant
intoxication as less than 1% of the alcohol will pass to breast milk. However, even small
amounts of alcohol consumption can decrease the amount of milk consumption by the
nursing infant (D).
10. The anticipated average daily weight gain during the first 3 months of life is
approximately: A. 15 g or 0.53 oz. B. 20 g or 0.7 oz. C. 25 g or 0.88 oz. D. 30 g or 1 oz.
- correct Answer-10. Correct: D. 30 g or 1 oz. During the first 3 months of life, the
average daily weight gain is approximately 26 to 31 g (D). The anticipated daily weight
gain will then decrease to 17 to 18 g during months 3 to 6, and 12 to 13 g daily during
months 6 to 9. Incorrect: In a newborn up to 3 months of age, the average daily weight
gain should exceed 25 g and range near 30 g (A, B, C).
11. The average required caloric intake in an infant from age 0 to 3 months is usually: A.
40 to 60 kcal/kg/day. B. 60 to 80 kcal/kg/day. C. 80 to 100 kcal/kg/day. D. 100 to 120
kcal/kg/day. - correct Answer-11. Correct: D. 100 to 120 kcal/kg/day. The required
caloric intake for an infant between 0 and 3 months of age is approximately 100 to 120
kcal/kg/day (D). This amount does not change substantially as the child grows, with a
requirement of 105 to 115 kcal/kg/ day for those 3 to 6 months of age and 100 to 105
kcal/ kg/day for those 6 to 9 months of age. Incorrect: During the first 3 months of life,
the average required caloric intake ranges from 100 to 120 kcal/kg/day (A, B, C).
, 12. Regarding physiological jaundice in the newborn, select all that are correct: A. It
occurs between the first 12 and 24 hours of life. B. It progresses from the abdomen
toward the head of the infant. C. Unconjugated bilirubin is elevated. D. Risk of
development of hyperbilirubinemia can be reduced in a breastfed infant with frequent
breastfeeding every 2 to 3 hours per 24 hours. E. It can be avoided by supplemental
water and dextrose feedings between breastfeeding in the first 3 to 4 days of life to
increase infant hydration while awaiting mother's milk to come in. - correct Answer-12.
Correct: C. Unconjugated bilirubin is elevated, and D. Risk of development of
hyperbilirubinemia can be reduced in a breastfed infant with frequent breastfeeding
every 2 to 3 hours per 24 hours. Physiological jaundice occurs as a result of elevated
levels of unconjugated bilirubin (C). The condition can be prevented by keeping the
newborn well hydrated by breastfeeding at least 8 to 12 times per day, or every 2 to 3
hours (D). Incorrect: Physiological jaundice typically occurs between days 3 to 5 (A) and
usually starts at the head and then spreads to the body (B). Supplemental water and
dextrose should be avoided as this will interfere with the infant's hunger drive to
breastfeed and will delay and reduce breast milk production (E).
13. The most likely consequence of inadequate feeding during the first few weeks of a
newborn is: A. hypercalcemia. B. hypernatremia. C. hypokalemia. D. hyperkalemia -
correct Answer-13. Correct: B. hypernatremia. Consequences of inadequate feeding
during the first few weeks of life can lead to dehydration, hypernatremia (B),
and hypoglycemia. Hypoglycemia is often characterized by a protracted high-pitched
cry, jitteriness, and potential seizures. Incorrect: Inadequate feeding of a newborn is not
typically associated with hypercalcemia (A), while hypernatremia is more likely than
hypokalemia (C) or hyperkalemia (D).
14. Which of the following would be a concern regarding weight change in a newborn?
A. weight loss of 2% by day 2 of life B. no weight gain after 3 days of life C. weight gain
of less than 3% after 1 week of life D. weight loss of greater than 7% at any time after
the first week of life - correct Answer-14. Correct: D. weight loss of greater than 7% at
any time after the first week of life A key criterion to assess for adequate feeding is slow
growth or weight loss during the first few weeks of life. A weight loss of greater than 7%
at any time, particularly after the first week of life, is particularly concerning as it
increases the likelihood of neonatal jaundice and hypernatremia (D). Incorrect: Weight
loss of greater than 7% at any time in a newborn is a major concern. Some weight loss
can be expected during the first few days of life (A, B) before the newborn begins to
gain weight (C).
15. A mother who has been breastfeeding her newborn is planning on returning to work
and asks about the use of breast pumps. The nurse practitioner (NP) counsels on all of
the following except: A. Some insurance companies will cover the costs of breast
pumps. B. Breast pumps can allow flexibility in allowing mothers to return to work or
school. C. Double pumps are not recommended as they express about half the amount
of milk as single pumps. D. Federal law requires the employer to provide adequate
breaks and a location for breast pumping. - correct Answer-15. Correct: C. Double
pumps are not recommended as they express about half the amount of milk as single
