NR 602/ NR602 FINAL EXAM: PRIMARY CARE OF THE
CHILDBEARING & CHILDREARING FAMILY (2026
UPDATE) | QUESTIONS & ANSWERS WITH RATIONALE|
GRADE A| CHAMBERLAIN
Question 1
A 4-month-old infant is brought in with crying episodes lasting 3 hours per day,
occurring 4 days per week for the past 3 weeks. The infant is afebrile, eating well,
and has a normal physical exam. What is the most appropriate management?
A) Prescribe simethicone drops
B) Recommend a hypoallergenic formula
C) Provide parental reassurance and support
D) Order an abdominal ultrasound
Answer: C) Provide parental reassurance and support
Rationale: This presentation meets the "Rule of Threes" criteria for colic (crying
>3 hours/day, >3 days/week, for >3 weeks) in an otherwise healthy infant. Colic
typically resolves by 3-5 months of age. The most important intervention is
parental support and reassurance. While simethicone may provide some relief, it
is not the primary treatment. Hypoallergenic formula may be considered if there
are signs of milk protein allergy, but this is not indicated based on the
presentation .
Question 2
A 6-year-old child presents with a 2-day history of periumbilical pain that has now
shifted to the right lower quadrant. The child has a low-grade fever and anorexia.
Which physical exam finding would most strongly suggest appendicitis?
A) Rebound tenderness at McBurney's point
B) Positive Murphy's sign
C) Palpable sausage-shaped mass in the RUQ
D) Costovertebral angle tenderness
,Answer: A) Rebound tenderness at McBurney's point
Rationale: Appendicitis classically presents with periumbilical pain that migrates
to the right lower quadrant (McBurney's point). Rebound tenderness is a key
finding. A positive Rovsing's sign (pain in the RLQ with palpation of the LLQ) and
psoas/obturator signs may also be present. A palpable sausage-shaped mass in
the RUQ is characteristic of intussusception, not appendicitis. Murphy's sign is
associated with cholecystitis .
Question 3
A 9-month-old infant is brought to the clinic with episodes of sudden, severe
crying with knees drawn to the chest. The parent reports the child passed a stool
that looked like "red jelly." What is the most likely diagnosis?
A) Appendicitis
B) Intussusception
C) Meckel's diverticulum
D) Gastroenteritis
Answer: B) Intussusception
Rationale: Intussusception most commonly occurs between 5-10 months of age.
The classic triad consists of intermittent colicky abdominal pain, vomiting, and
"currant jelly" stools (blood and mucus). A sausage-shaped mass may be palpable
in the RUQ. Ultrasound typically shows the "target sign" or "pseudokidney" sign.
Treatment is air or barium enema, which is both diagnostic and therapeutic .
Question 4
A 2-month-old infant has had 5 episodes of watery diarrhea and 3 episodes of
vomiting in the past 8 hours. The infant is lethargic with sunken fontanel, dry
mucous membranes, and capillary refill of 4 seconds. What is the most
appropriate next step?
A) Provide oral rehydration solution at home
B) Admit for IV fluid rehydration
,C) Administer ondansetron and discharge
D) Order a stool culture and send home with pedialyte
Answer: B) Admit for IV fluid rehydration
Rationale: This infant shows signs of severe dehydration: lethargy, sunken
fontanel, dry mucous membranes, and prolonged capillary refill (>3 seconds).
Severe dehydration (>10% body weight loss) requires immediate and aggressive
IV rehydration. Oral rehydration is appropriate for mild to moderate dehydration
but is insufficient in this case .
Question 5
A 3-year-old child is brought in after swallowing a small coin. The child is
asymptomatic and breathing normally. What is the appropriate next step?
A) Immediate endoscopic removal
B) Observe and have parents check stools for passage
C) Order a single radiograph of the chest and abdomen
D) Refer to surgery for emergent removal
Answer: C) Order a single radiograph of the chest and abdomen
Rationale: Most ingested foreign bodies in children pass spontaneously. However,
the first step is to obtain a single frontal radiograph that includes the neck, chest,
and entire abdomen to locate the object. Most swallowed objects are
radiopaque. If the object is in the esophagus, endoscopic removal is generally
indicated. If it has passed beyond the stomach, expectant management with stool
monitoring is appropriate .
SECTION 2: PEDIATRIC GENITOURINARY CONDITIONS
Question 6
A 7-year-old girl presents with dysuria, urinary frequency, and suprapubic pain.
She is afebrile. Urinalysis shows positive leukocyte esterase and nitrites. What is
the most appropriate treatment?
, A) Ceftriaxone IM x 1 dose
B) Amoxicillin for 10 days
C) Nitrofurantoin for 5 days
D) Ciprofloxacin for 3 days
Answer: C) Nitrofurantoin for 5 days
Rationale: This is an uncomplicated cystitis. Nitrofurantoin is a first-line treatment
for uncomplicated UTI in children. The 5-day course is appropriate. Trimethoprim-
sulfamethoxazole is another option if local resistance patterns are low.
Ceftriaxone is for more severe infections. Amoxicillin has high resistance rates.
Ciprofloxacin is not first-line in children due to cartilage concerns .
Question 7
An 8-year-old boy has a history of primary nocturnal enuresis. He has never had a
dry night. His physical exam is normal. What is the first-line treatment?
A) Desmopressin nasal spray nightly
B) Imipramine before bedtime
C) Behavioral modifications and motivational therapy
D) Oxybutynin chloride
Answer: C) Behavioral modifications and motivational therapy
Rationale: Primary nocturnal enuresis (child never achieved nighttime dryness) is
initially managed with behavioral modifications such as limiting fluids before
bedtime, scheduled voiding, and motivational therapy (reward systems). Enuresis
alarms and desmopressin are second-line or adjunctive treatments. Oxybutynin is
for overactive bladder with daytime symptoms. Imipramine is a third-line option
with significant side effects .
Question 8
A 14-year-old boy presents with sudden onset of severe, unilateral scrotal pain
accompanied by nausea and vomiting. On exam, the testis is high-riding and the
cremasteric reflex is absent. What is the priority intervention?
CHILDBEARING & CHILDREARING FAMILY (2026
UPDATE) | QUESTIONS & ANSWERS WITH RATIONALE|
GRADE A| CHAMBERLAIN
Question 1
A 4-month-old infant is brought in with crying episodes lasting 3 hours per day,
occurring 4 days per week for the past 3 weeks. The infant is afebrile, eating well,
and has a normal physical exam. What is the most appropriate management?
A) Prescribe simethicone drops
B) Recommend a hypoallergenic formula
C) Provide parental reassurance and support
D) Order an abdominal ultrasound
Answer: C) Provide parental reassurance and support
Rationale: This presentation meets the "Rule of Threes" criteria for colic (crying
>3 hours/day, >3 days/week, for >3 weeks) in an otherwise healthy infant. Colic
typically resolves by 3-5 months of age. The most important intervention is
parental support and reassurance. While simethicone may provide some relief, it
is not the primary treatment. Hypoallergenic formula may be considered if there
are signs of milk protein allergy, but this is not indicated based on the
presentation .
Question 2
A 6-year-old child presents with a 2-day history of periumbilical pain that has now
shifted to the right lower quadrant. The child has a low-grade fever and anorexia.
Which physical exam finding would most strongly suggest appendicitis?
A) Rebound tenderness at McBurney's point
B) Positive Murphy's sign
C) Palpable sausage-shaped mass in the RUQ
D) Costovertebral angle tenderness
,Answer: A) Rebound tenderness at McBurney's point
Rationale: Appendicitis classically presents with periumbilical pain that migrates
to the right lower quadrant (McBurney's point). Rebound tenderness is a key
finding. A positive Rovsing's sign (pain in the RLQ with palpation of the LLQ) and
psoas/obturator signs may also be present. A palpable sausage-shaped mass in
the RUQ is characteristic of intussusception, not appendicitis. Murphy's sign is
associated with cholecystitis .
Question 3
A 9-month-old infant is brought to the clinic with episodes of sudden, severe
crying with knees drawn to the chest. The parent reports the child passed a stool
that looked like "red jelly." What is the most likely diagnosis?
A) Appendicitis
B) Intussusception
C) Meckel's diverticulum
D) Gastroenteritis
Answer: B) Intussusception
Rationale: Intussusception most commonly occurs between 5-10 months of age.
The classic triad consists of intermittent colicky abdominal pain, vomiting, and
"currant jelly" stools (blood and mucus). A sausage-shaped mass may be palpable
in the RUQ. Ultrasound typically shows the "target sign" or "pseudokidney" sign.
Treatment is air or barium enema, which is both diagnostic and therapeutic .
Question 4
A 2-month-old infant has had 5 episodes of watery diarrhea and 3 episodes of
vomiting in the past 8 hours. The infant is lethargic with sunken fontanel, dry
mucous membranes, and capillary refill of 4 seconds. What is the most
appropriate next step?
A) Provide oral rehydration solution at home
B) Admit for IV fluid rehydration
,C) Administer ondansetron and discharge
D) Order a stool culture and send home with pedialyte
Answer: B) Admit for IV fluid rehydration
Rationale: This infant shows signs of severe dehydration: lethargy, sunken
fontanel, dry mucous membranes, and prolonged capillary refill (>3 seconds).
Severe dehydration (>10% body weight loss) requires immediate and aggressive
IV rehydration. Oral rehydration is appropriate for mild to moderate dehydration
but is insufficient in this case .
Question 5
A 3-year-old child is brought in after swallowing a small coin. The child is
asymptomatic and breathing normally. What is the appropriate next step?
A) Immediate endoscopic removal
B) Observe and have parents check stools for passage
C) Order a single radiograph of the chest and abdomen
D) Refer to surgery for emergent removal
Answer: C) Order a single radiograph of the chest and abdomen
Rationale: Most ingested foreign bodies in children pass spontaneously. However,
the first step is to obtain a single frontal radiograph that includes the neck, chest,
and entire abdomen to locate the object. Most swallowed objects are
radiopaque. If the object is in the esophagus, endoscopic removal is generally
indicated. If it has passed beyond the stomach, expectant management with stool
monitoring is appropriate .
SECTION 2: PEDIATRIC GENITOURINARY CONDITIONS
Question 6
A 7-year-old girl presents with dysuria, urinary frequency, and suprapubic pain.
She is afebrile. Urinalysis shows positive leukocyte esterase and nitrites. What is
the most appropriate treatment?
, A) Ceftriaxone IM x 1 dose
B) Amoxicillin for 10 days
C) Nitrofurantoin for 5 days
D) Ciprofloxacin for 3 days
Answer: C) Nitrofurantoin for 5 days
Rationale: This is an uncomplicated cystitis. Nitrofurantoin is a first-line treatment
for uncomplicated UTI in children. The 5-day course is appropriate. Trimethoprim-
sulfamethoxazole is another option if local resistance patterns are low.
Ceftriaxone is for more severe infections. Amoxicillin has high resistance rates.
Ciprofloxacin is not first-line in children due to cartilage concerns .
Question 7
An 8-year-old boy has a history of primary nocturnal enuresis. He has never had a
dry night. His physical exam is normal. What is the first-line treatment?
A) Desmopressin nasal spray nightly
B) Imipramine before bedtime
C) Behavioral modifications and motivational therapy
D) Oxybutynin chloride
Answer: C) Behavioral modifications and motivational therapy
Rationale: Primary nocturnal enuresis (child never achieved nighttime dryness) is
initially managed with behavioral modifications such as limiting fluids before
bedtime, scheduled voiding, and motivational therapy (reward systems). Enuresis
alarms and desmopressin are second-line or adjunctive treatments. Oxybutynin is
for overactive bladder with daytime symptoms. Imipramine is a third-line option
with significant side effects .
Question 8
A 14-year-old boy presents with sudden onset of severe, unilateral scrotal pain
accompanied by nausea and vomiting. On exam, the testis is high-riding and the
cremasteric reflex is absent. What is the priority intervention?
