NURS 535 PEDIATRICS TEST 2
CARSON–NEWMAN UNIVERSITY Advanced
Pediatric Primary Care Assessment & Management
PEDIATRIC NURSE PRACTITIONER CERTIFICATION EXAM
QUESTIONS AND 100% VERIFIED ANSWERS WITH RATIONALES
GRADED A+ LATEST
1. A 4-month-old infant presents for a well-child visit. Which finding is most
concerning and requires further evaluation?
A. Absence of a social smile
B. Head lag when pulled to sitting
C. Inability to roll front to back
D. Hands predominantly fisted
Correct Answer: A
Rationale: By 2 months, infants should demonstrate a social smile. Absence at 4
months may indicate developmental delay or neurologic concern. Head lag may
still be present until 4–6 months. Rolling and hand opening develop later.
2. A school-aged child presents with periorbital edema and dark urine
following a recent streptococcal infection. Which laboratory finding is most
consistent with the diagnosis?
A. Elevated antistreptolysin O (ASO) titer
B. Decreased serum complement levels
C. Increased serum albumin
D. Hypercalcemia
Correct Answer: B
Rationale: Post-streptococcal glomerulonephritis is associated with low
complement levels due to immune complex deposition. ASO titers may be elevated
but are not diagnostic alone.
,3. A 6-year-old with asthma uses a short-acting beta-agonist inhaler daily.
What is the most appropriate next step in management?
A. Increase short-acting beta-agonist dose
B. Add a leukotriene modifier
C. Initiate daily inhaled corticosteroids
D. Begin oral corticosteroids
Correct Answer: C
Rationale: Daily reliance on rescue medication indicates poor control. Inhaled
corticosteroids are first-line controller therapy for persistent asthma.
4. A toddler presents with a barking cough, inspiratory stridor, and
hoarseness. Symptoms worsen at night. What is the most likely diagnosis?
A. Epiglottitis
B. Bronchiolitis
C. Croup
D. Bacterial tracheitis
Correct Answer: C
Rationale: Viral croup presents with a barking cough and stridor, often worsening
at night. Epiglottitis causes drooling and toxic appearance.
5. A 10-year-old child presents with heel pain that worsens during sports
activities. Physical exam reveals tenderness at the posterior heel. What is the
most likely diagnosis?
A. Plantar fasciitis
B. Achilles tendon rupture
C. Sever disease
D. Osteomyelitis
Correct Answer: C
Rationale: Sever disease (calcaneal apophysitis) is a common cause of heel pain in
active children during growth spurts.
,6. Which immunization is contraindicated in an immunocompromised child?
A. Inactivated influenza
B. Hepatitis B
C. Measles, mumps, rubella (MMR)
D. Pneumococcal conjugate
Correct Answer: C
Rationale: Live vaccines such as MMR are contraindicated in
immunocompromised patients due to risk of infection.
7. A newborn has delayed passage of meconium, abdominal distention, and
bilious vomiting. What condition is most suspected?
A. Pyloric stenosis
B. Hirschsprung disease
C. Necrotizing enterocolitis
D. Intussusception
Correct Answer: B
Rationale: Hirschsprung disease results from absence of ganglion cells, leading to
functional obstruction and delayed meconium passage.
8. Which finding best differentiates type 1 diabetes from type 2 diabetes in
children?
A. Obesity
B. Insulin resistance
C. Autoimmune beta-cell destruction
D. Family history of diabetes
Correct Answer: C
Rationale: Type 1 diabetes is characterized by autoimmune destruction of
pancreatic beta cells, leading to absolute insulin deficiency.
, 9. A 2-year-old presents with sudden onset of abdominal pain, drawing knees
to chest, and currant jelly stools. What is the priority diagnostic test?
A. Abdominal CT scan
B. Barium enema
C. Abdominal ultrasound
D. Upper GI series
Correct Answer: C
Rationale: Ultrasound is the preferred initial diagnostic test for intussusception,
showing a target or doughnut sign.
10. Which developmental milestone should a 12-month-old child demonstrate?
A. Two-word phrases
B. Pincer grasp
C. Riding a tricycle
D. Drawing a circle
Correct Answer: B
Rationale: Fine pincer grasp typically develops by 9–12 months. Two-word
phrases occur around age 2.
11. A child with nephrotic syndrome is most at risk for which complication?
A. Hypertension
B. Thrombosis
C. Hyperkalemia
D. Metabolic acidosis
Correct Answer: B
Rationale: Loss of anticoagulant proteins in urine increases the risk of
thromboembolic events.
CARSON–NEWMAN UNIVERSITY Advanced
Pediatric Primary Care Assessment & Management
PEDIATRIC NURSE PRACTITIONER CERTIFICATION EXAM
QUESTIONS AND 100% VERIFIED ANSWERS WITH RATIONALES
GRADED A+ LATEST
1. A 4-month-old infant presents for a well-child visit. Which finding is most
concerning and requires further evaluation?
A. Absence of a social smile
B. Head lag when pulled to sitting
C. Inability to roll front to back
D. Hands predominantly fisted
Correct Answer: A
Rationale: By 2 months, infants should demonstrate a social smile. Absence at 4
months may indicate developmental delay or neurologic concern. Head lag may
still be present until 4–6 months. Rolling and hand opening develop later.
2. A school-aged child presents with periorbital edema and dark urine
following a recent streptococcal infection. Which laboratory finding is most
consistent with the diagnosis?
A. Elevated antistreptolysin O (ASO) titer
B. Decreased serum complement levels
C. Increased serum albumin
D. Hypercalcemia
Correct Answer: B
Rationale: Post-streptococcal glomerulonephritis is associated with low
complement levels due to immune complex deposition. ASO titers may be elevated
but are not diagnostic alone.
,3. A 6-year-old with asthma uses a short-acting beta-agonist inhaler daily.
What is the most appropriate next step in management?
A. Increase short-acting beta-agonist dose
B. Add a leukotriene modifier
C. Initiate daily inhaled corticosteroids
D. Begin oral corticosteroids
Correct Answer: C
Rationale: Daily reliance on rescue medication indicates poor control. Inhaled
corticosteroids are first-line controller therapy for persistent asthma.
4. A toddler presents with a barking cough, inspiratory stridor, and
hoarseness. Symptoms worsen at night. What is the most likely diagnosis?
A. Epiglottitis
B. Bronchiolitis
C. Croup
D. Bacterial tracheitis
Correct Answer: C
Rationale: Viral croup presents with a barking cough and stridor, often worsening
at night. Epiglottitis causes drooling and toxic appearance.
5. A 10-year-old child presents with heel pain that worsens during sports
activities. Physical exam reveals tenderness at the posterior heel. What is the
most likely diagnosis?
A. Plantar fasciitis
B. Achilles tendon rupture
C. Sever disease
D. Osteomyelitis
Correct Answer: C
Rationale: Sever disease (calcaneal apophysitis) is a common cause of heel pain in
active children during growth spurts.
,6. Which immunization is contraindicated in an immunocompromised child?
A. Inactivated influenza
B. Hepatitis B
C. Measles, mumps, rubella (MMR)
D. Pneumococcal conjugate
Correct Answer: C
Rationale: Live vaccines such as MMR are contraindicated in
immunocompromised patients due to risk of infection.
7. A newborn has delayed passage of meconium, abdominal distention, and
bilious vomiting. What condition is most suspected?
A. Pyloric stenosis
B. Hirschsprung disease
C. Necrotizing enterocolitis
D. Intussusception
Correct Answer: B
Rationale: Hirschsprung disease results from absence of ganglion cells, leading to
functional obstruction and delayed meconium passage.
8. Which finding best differentiates type 1 diabetes from type 2 diabetes in
children?
A. Obesity
B. Insulin resistance
C. Autoimmune beta-cell destruction
D. Family history of diabetes
Correct Answer: C
Rationale: Type 1 diabetes is characterized by autoimmune destruction of
pancreatic beta cells, leading to absolute insulin deficiency.
, 9. A 2-year-old presents with sudden onset of abdominal pain, drawing knees
to chest, and currant jelly stools. What is the priority diagnostic test?
A. Abdominal CT scan
B. Barium enema
C. Abdominal ultrasound
D. Upper GI series
Correct Answer: C
Rationale: Ultrasound is the preferred initial diagnostic test for intussusception,
showing a target or doughnut sign.
10. Which developmental milestone should a 12-month-old child demonstrate?
A. Two-word phrases
B. Pincer grasp
C. Riding a tricycle
D. Drawing a circle
Correct Answer: B
Rationale: Fine pincer grasp typically develops by 9–12 months. Two-word
phrases occur around age 2.
11. A child with nephrotic syndrome is most at risk for which complication?
A. Hypertension
B. Thrombosis
C. Hyperkalemia
D. Metabolic acidosis
Correct Answer: B
Rationale: Loss of anticoagulant proteins in urine increases the risk of
thromboembolic events.
