Download Burns' Pediatric Primary Care – Comprehensive Chapter-by-Chapter Practice Examination Base and more Exams Nursing in PDF only on Docsity!
Burns' Pediatric Primary Care – Comprehensive
Chapter-by-Chapter Practice Examination
Based on Garzon, Dirks, Driessnack, Duderstadt &
Gaylord 8th Edition – Chapters 1-
Original Questions with Detailed Answers & Clinical Rationales For Pediatric Nurse Practitioner Certification & Course Exam Preparation Question 1 Which region globally has the highest infant mortality rate according to current global health statistics? A) Southern Asia B) Sub-Saharan Africa C) Southeast Asia D) Eastern Europe Answer: B
Explanation: Sub-Saharan Africa has the highest infant mortality rate
globally, significantly higher than other regions, due to factors such as
limited access to healthcare, infectious diseases, malnutrition, and
inadequate sanitation.
Question 2 A primary care pediatric nurse practitioner understands that to achieve the greatest worldwide reduction in child mortality from pneumonia and diarrhea, which intervention is most effective? A) Antibiotics B) Optimal nutrition C) Vaccinations D) Water purification Answer: C
Explanation: Vaccinations (including pneumococcal, rotavirus, Haemophilus
influenzae type b, and measles vaccines) have been shown to be the most
cost-effective intervention for reducing child mortality from pneumonia and
diarrhea globally.
Question 3 Which statement is true about the health status of children in the United States? A) Globalism has relatively little impact on child health measures in the U.S. B) Obesity rates among 2 to 5 year olds have shown a recent significant decrease C) The rate of household poverty is lower than in other economically developed nations D) Young children who attend preschool or day care have higher food insecurity Answer: B *Explanation: Recent CDC data indicate that obesity rates among children
Answer: C
Explanation: The ACA requires most private health plans to cover
recommended preventive services for children without cost-sharing (copays,
deductibles). This includes well-child visits, immunizations, and
developmental screenings.
Question 6 A 3-year-old child has a febrile seizure lasting 8 minutes involving the whole body. After the seizure, the child is sleepy but arousable. What is the most appropriate classification of this seizure? A) Simple febrile seizure B) Complex febrile seizure C) Status epilepticus D) Atypical febrile seizure Answer: B
Explanation: A complex febrile seizure has one or more of the following
features: duration >15 minutes (though many experts include >10 minutes),
focal features, or recurrence within 24 hours. This seizure lasted 8 minutes
(not >15) but the wording may consider duration >10 minutes as complex.
Question 7 A 10-month-old infant is brought to the clinic with a 3-day history of fever, rhinorrhea, and cough. The infant's immunizations are up to date. On examination, the infant has tugging at the right ear. The tympanic membrane is erythematous, bulging, and has decreased mobility. What is
the most appropriate treatment? A) Amoxicillin 80-90 mg/kg/day for 10 days B) Observation without antibiotics for 48-72 hours C) Amoxicillin-clavulanate for 10 days D) Ceftriaxone 50 mg/kg IM once Answer: A Explanation: This child has acute otitis media with moderate to severe symptoms (fever, ear tugging). The AAP guidelines recommend antibiotic treatment with amoxicillin (80-90 mg/kg/day) for 10 days in children under 2 years or those with severe symptoms . Question 8 A 2-week-old breastfed newborn is noted to have jaundice. The bilirubin level is 14 mg/dL. The infant is feeding well, has gained weight, and has normal stool color. What is the most likely cause? A) Biliary atresia B) Breastfeeding jaundice C) Breast milk jaundice D) Hemolytic disease Answer: B
Explanation: Breastfeeding jaundice occurs in the first week of life due to
inadequate intake and dehydration. Breast milk jaundice appears after the
first week due to factors in breast milk that inhibit bilirubin conjugation. This
infant is 2 weeks old with adequate feeding, making breast milk jaundice
more likely.
Answer: B
Explanation: Varicella (chickenpox) presents with a pruritic vesicular rash in
different stages of development (crops) with fever. Hand-foot-mouth disease
has lesions on palms, soles, and oral mucosa. Impetigo has honey-crusted
lesions.
Question 11 A 5-year-old child with a history of recurrent wheezing triggered by viral illnesses has no interval symptoms and no personal history of eczema or allergies. What is the most likely diagnosis? A) Asthma B) Viral-induced wheezing (transient wheezing) C) Foreign body aspiration D) Cystic fibrosis Answer: B
Explanation: Many preschool children have viral-induced wheezing without
atopy or interval symptoms, often called transient wheezing. Most outgrow
this by school age. Asthma is more likely with interval symptoms, family
history, or atopy (eczema, allergies).
Question 12 A 9-month-old infant is not yet sitting independently. The infant can roll over and bear weight on legs when held. There are no other developmental concerns. What is the most appropriate next step? A) Reassure parents and monitor
B) Refer for early intervention (physical therapy) C) Order MRI of the brain D) Genetic testing Answer: A Explanation: Sitting independently is typically achieved by 6-8 months, but up to 10 months is still within normal limits. If there are no other concerns, reassurance and monitoring are appropriate. If not sitting by 12 months, further evaluation is indicated . Question 13 A 12-year-old boy is concerned about breast enlargement. He has palpable breast tissue bilaterally with tenderness. He is otherwise healthy and at Tanner stage 3 puberty. What is the most likely diagnosis? A) Male breast cancer B) Pubertal gynecomastia C) Klinefelter syndrome D) Prolactinoma Answer: B Explanation: Pubertal gynecomastia occurs in up to 50% of adolescent boys, usually starting in mid-puberty (Tanner stage 3-4). It is benign, self-limited, and typically resolves within 6-24 months. Reassurance is appropriate unless severe or persistent .
must be ruled out first, even if cycles have historically been irregular. After
negative pregnancy test, irregular cycles can be evaluated further.
Question 16 A 2-year-old child has a fever of 39.5°C for 4 days. On day 4 of fever, the child develops a maculopapular rash starting on the trunk. The fever resolves as the rash appears. What is the most likely diagnosis? A) Measles B) Roseola (exanthem subitum) C) Scarlet fever D) Fifth disease Answer: B Explanation: Roseola (HHV-6) presents with high fever for 3-5 days followed by defervescence and appearance of a maculopapular rash. The rash begins on the trunk and spreads peripherally. It occurs most commonly in children 6-24 months . Question 17 A 5-year-old child has a fever of 39°C for 3 days, conjunctival injection, cracked red lips, and a rash on the trunk. What is the most likely diagnosis? A) Measles B) Kawasaki disease C) Scarlet fever D) Roseola
Answer: B
Explanation: Kawasaki disease is an acute vasculitis of childhood presenting
with fever >5 days, bilateral conjunctival injection, oral mucosal changes
(cracked red lips, strawberry tongue), polymorphous rash, cervical
lymphadenopathy, and changes to the extremities.
Question 18 A 3-year-old child has a 2-day history of fever, cough, and runny nose. The child now has stridor at rest and a barking cough. What is the most appropriate treatment? A) Oral dexamethasone B) Nebulized epinephrine and oral dexamethasone C) Intramuscular ceftriaxone D) Observation at home Answer: B
Explanation: Croup with stridor at rest (moderate to severe croup) requires
treatment with nebulized epinephrine (racemic or L-epinephrine) for rapid
relief of airway edema and oral/intramuscular dexamethasone for sustained
effect. Mild croup (no stridor at rest) can be treated with dexamethasone
alone as outpatient.
Question 19 A 2-week-old newborn presents with jaundice. The bilirubin level is 15 mg/dL. The infant is breastfeeding well, has normal stool color, and is otherwise healthy. What is the most likely cause?
Question 21 A 10-year-old child has a 3-day history of fever, headache, and vomiting. The child now has a non-blanching petechial rash on the trunk. The child appears ill. What is the most appropriate next step? A) Oral antibiotics B) IV ceftriaxone and hospital admission C) Antihistamines and observation D) Observation at home Answer: B
Explanation: Fever with non-blanching petechial rash in an ill-appearing child
is meningococcal sepsis until proven otherwise. Immediate IV antibiotics
(ceftriaxone or cefotaxime) and hospitalization are required.
Question 22 A 12-month-old infant is brought to the clinic for a well-child visit. The parents report the infant says "mama" and "dada" and waves "bye-bye." The infant can stand independently but is not yet walking. What is the most appropriate next step? A) Reassure that development is within normal limits B) Refer for developmental evaluation C) Order hearing test D) Refer for physical therapy Answer: A *Explanation: At 12 months, expected milestones include standing
independently (10-14 months) and saying 1-2 words. Walking typically occurs between 12-15 months. This infant's development is within normal limits; reassurance is appropriate .* Question 23 A 9-year-old child has a 3-day history of fever, sore throat, and headache. On examination, there is conjunctival injection, palatal petechiae, and a sandpaper-like rash on the trunk. What is the most likely diagnosis? A) Measles B) Scarlet fever C) Kawasaki disease D) Adenovirus Answer: B
Explanation: Scarlet fever is caused by group A streptococcus and presents
with fever, pharyngitis, palatal petechiae, strawberry tongue, and a fine,
sandpaper-like rash (typically starts on trunk). The rash is due to
erythrogenic toxin.
Question 24 A 2-year-old child has a blood lead level of 15 mcg/dL. What is the most appropriate next step? A) Repeat lead level in 1 year B) Environmental investigation and chelation therapy C) Repeat lead level within 1-3 months and environmental investigation D) Immediate hospitalization for IV chelation
C) Add oral montelukast D) Refer to pulmonology Answer: A Explanation: A child with persistent symptoms (>2 days/week, > nights/month) warrants step-up therapy. Daily low-dose ICS (e.g., fluticasone, budesonide) is first-line controller therapy for persistent asthma in children . Question 27 A 6-month-old infant is noted to have a flat, bruise-like lesion on the sacrum that has been present since birth. It is non-blanching. What is this finding called? A) Café-au-lait spot B) Mongolian spot C) Port-wine stain D) Hemangioma Answer: B
Explanation: Mongolian spots are congenital, flat, bruise-like
hyperpigmented lesions most commonly found on the sacrum and buttocks
in darker-skinned infants. They typically fade by school age and are benign.
Café-au-lait spots are light brown and associated with neurofibromatosis if
multiple.
Question 28 A 14-year-old male presents with a painful, swollen right testicle. The pain began suddenly 2 hours ago. On examination, the testicle is tender and elevated. What is the most appropriate next step? A) Urinalysis and antibiotics for epididymitis B) Referral for emergent scrotal ultrasound to rule out testicular torsion C) Reassurance and ice packs D) Prescription for analgesics and follow-up in 1 week Answer: B
Explanation: Testicular torsion is a surgical emergency requiring prompt
diagnosis (ultrasound with Doppler) and intervention to save the testicle.
Sudden onset of severe pain in an adolescent male is torsion until proven
otherwise.
Question 29 A 4-week-old infant presents with projectile vomiting after feeds. The infant is hungry and feeds eagerly. On examination, visible peristaltic waves are seen, and an olive-shaped mass is palpated in the right upper quadrant. What is the most likely diagnosis? A) Gastroesophageal reflux B) Pyloric stenosis C) Malrotation with volvulus D) Intussusception Answer: B Explanation: Pyloric stenosis presents at 3-6 weeks with progressive non- bilious projectile vomiting in an otherwise healthy, hungry infant. Palpation of an olive-shaped mass is diagnostic. Ultrasound or upper GI series confirms .
Answer: A Explanation: Any febrile infant under 3 months (90 days) requires full sepsis evaluation (CBC, blood culture, urinalysis, lumbar puncture) and hospitalization for empiric IV antibiotics. The risk of serious bacterial infection is significant, even in well-appearing infants . Question 32 A 10-year-old boy has a 2-week history of polyuria, polydipsia, and nocturia. He has lost 5 pounds. Random blood glucose is 350 mg/dL. Urinalysis shows glucosuria and ketonuria. What is the most appropriate next step? A) Oral metformin B) Insulin therapy and diabetes education C) Dietary modification alone D) Referral to endocrinology in 2 weeks Answer: B Explanation: This presentation is consistent with new-onset type 1 diabetes mellitus (polyuria, polydipsia, weight loss, ketonuria). Immediate insulin therapy, diabetes education, and monitoring are required. Oral agents are not used in type 1 diabetes . Question 33 A 6-year-old child has a 2-week history of generalized lymphadenopathy, fatigue, and low-grade fever. The child has a negative Monospot test. What is the most appropriate next step? A) Repeat Monospot in 1 week
B) EBV serology (VCA IgM, VCA IgG, EBNA) C) Lymph node biopsy D) Observation Answer: B
Explanation: Monospot has false negatives, especially early in illness. EBV-
specific serology (VCA IgM for acute infection) is more sensitive and specific.
If EBV serology is negative, other causes of lymphadenopathy (CMV,
toxoplasmosis, HIV, lymphoma) should be considered.
Question 34 A 2-year-old child has a 1-day history of pulling at the right ear, fever, and fussiness. Otoscopy reveals a bulging, erythematous tympanic membrane with decreased mobility. What is the most appropriate treatment? A) Watchful waiting for 48-72 hours B) Amoxicillin 80-90 mg/kg/day for 10 days C) Amoxicillin-clavulanate D) Topical antibiotic drops Answer: B Explanation: Acute otitis media with severe symptoms (fever, pain) in a child under 2 years should be treated with antibiotics. Amoxicillin (80- mg/kg/day) is first-line in the absence of penicillin allergy or recent antibiotic use .
