NU580 Midterm Exam Review

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Purdue University Global

NU580 FNP II – Primary Care of Children and Adolescents’ Health

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Date

Pediatric Nursing Practice Questions and Answers:

This pediatric nursing question guide provides evidence-based answers to common pediatric primary care and nursing exam questions. It covers important topics including cyclic vomiting syndrome, newborn jaundice, dehydration, asthma management, pediatric pain assessment, immunizations, congenital conditions, and common childhood disorders. Each answer is explained using current pediatric healthcare principles to support exam preparation and clinical understanding.

Cyclic Vomiting Syndrome and Newborn Dehydration

1. Cyclic vomiting syndrome may:

A. Last for days
B. Require SSRIs to stop symptoms
C. Not be associated with a headache
D. Require pain medication and Zofran

Correct Answer: C. Not be associated with a headache

Cyclic vomiting syndrome (CVS) is characterized by repeated episodes of severe nausea and vomiting separated by symptom-free periods. Although CVS can occur with migraine-related conditions, a headache is not always present.

Important points:

Episodes may last hours to several days.
Management focuses on symptom control and prevention.
Migraine-related therapies may be considered in selected patients.

2. A 5-day-old infant presents with jaundice, a slightly sunken anterior fontanel, decreased wet diapers, and breastfeeding difficulties. Bilirubin level is 18 mg/dL. Which nursing interventions are required?

A. Phototherapy
B. Provide breastfeeding support and education
C. Strict monitoring of intake and output
D. All of the above

Correct Answer: D. All of the above

A newborn with dehydration and significant jaundice requires treatment to improve hydration, support feeding, and reduce bilirubin levels.

Nursing interventions include:

Monitoring urine output and hydration status.
Supporting proper breastfeeding techniques.
Assessing the need for phototherapy based on bilirubin levels and clinical guidelines.
Educating parents about feeding frequency and signs of dehydration.

3. An infant admitted with dehydration weighs 6 kg. What urinary output indicates adequate hydration?

A. 0.5 mL/kg/hr
B. 0.5–2.5 mL/kg/hr
C. 1–3 mL/kg/hr
D. Wet diapers alone are sufficient

Correct Answer: C. 1–3 mL/kg/hr

Adequate urine output in infants is generally approximately 1–3 mL/kg/hr.

Monitoring urinary output helps healthcare providers evaluate:

Fluid balance.
Kidney function.
Response to hydration therapy.

Pediatric Asthma Management

4. A 5-year-old child with asthma is prescribed an oral steroid and a short-acting beta-adrenergic medication through a metered-dose inhaler for acute symptoms. What education is most important?

A. Provide an asthma action plan
B. Explain medication effects and side effects
C. Provide information about spirometry testing
D. Explain medication use at school

Correct Answer: A. Provide an asthma action plan

An asthma action plan helps families recognize symptoms, manage worsening asthma, and understand when emergency care is needed.

An asthma action plan should include:

Daily asthma management steps.
Warning signs of worsening symptoms.
Medication instructions.
Emergency response guidance.

5. A child with severe asthma does not respond to conventional treatments. A pulmonology referral is ordered. What should the pulmonologist provide?

A. Confirm the diagnosis for parents
B. Recommend alternative disease management strategies
C. Emphasize medication adherence only
D. Take over all chronic illness management

Correct Answer: B. Recommend alternative disease management strategies

A pulmonologist helps evaluate severe or uncontrolled asthma and recommends advanced treatment approaches.

The specialist may:

Review the diagnosis.
Assess triggers and severity.
Recommend additional therapies.
Optimize long-term asthma control.

Pediatric Fever and Pain Assessment

6. An 18-month-old child has a rectal temperature of 100.4°F (38°C). The child is playful, drinking fluids, and has slightly decreased appetite. What should the nurse practitioner recommend?

A. Give antipyretic medication
B. Bring the child to the clinic immediately
C. Offer extra fluids and call if symptoms change
D. Order laboratory testing

Correct Answer: C. Offer extra fluids and call if symptoms change

A well-appearing child with a low-grade fever usually requires supportive care and monitoring.

Parents should:

Encourage fluids.
Monitor symptoms.
Seek medical attention if the child develops worsening symptoms.

7. A 10-year-old child reports shooting pain in both legs with aching, tingling, and burning sensations. The child cannot identify specific pain locations. What type of pain is suspected?

A. Chronic pain
B. Neuropathic pain
C. Somatic pain
D. Visceral pain

Correct Answer: B. Neuropathic pain

Neuropathic pain results from nerve dysfunction and is commonly described as:

Burning.
Tingling.
Shooting sensations.
Electric-like pain.

8. A 3-year-old child recovering from injuries after a motor vehicle accident requires pain assessment. Which method is appropriate?

A. Use a detailed pain discrimination scale
B. Ask the child to describe pain as no pain, a little pain, or a lot of pain
C. Ask about exact pain intensity and location
D. Depend only on nonverbal behaviors

Correct Answer: B. Ask the child to describe pain as no pain, a little pain, or a lot of pain

Young children may not understand numerical pain scales. Simple descriptive scales are more appropriate for preschool-aged children.

9. A 4-year-old child after orthopedic surgery points to “1” on a faces pain scale. What should the nurse practitioner do next?

A. Assess vital signs and mobility without pain
B. Refill narcotic medication
C. Recommend acetaminophen only
D. Teach parents to give medication based only on pain reports

Correct Answer: A. Assess vital signs and mobility without pain

Pain assessment should include the child’s overall function, behavior, and physical findings—not only the reported pain score.

Key Pediatric Nursing Exam Concepts

High-yield pediatric concepts from these questions include:

Evaluate hydration through intake, output, and physical assessment.
Use age-appropriate pain assessment tools.
Provide asthma education with written action plans.
Support breastfeeding to prevent newborn dehydration.
Consider developmental stage when assessing symptoms.

Pediatric Nursing Practice Questions and Answers: Pain Management, Immunizations, Down Syndrome, and Ear Disorders

Pediatric Pain Management and Medication Safety

10. A developmentally and cognitively disabled 10-year-old child cannot communicate pain before multiple surgeries. What pain assessment tool should the parent be taught to use?

A. Comfort scale
B. FLACC scale
C. NCCPCR
D. Nonverbal observations

Correct Answer: C. NCCPCR

Children who cannot communicate verbally require specialized pain assessment approaches. The NCCPCR (Non-Communicating Children’s Pain Checklist–Revised) helps identify pain through behavioral and physiological indicators.

Assessment may include:

Facial expressions.
Vocalizations.
Body movements.
Changes in behavior.
Physiological responses.

11. A 4-month-old infant is undergoing a painful procedure. Besides local anesthesia, which intervention provides additional analgesic effects?

A. Providing toys
B. Singing or music
C. Sucrose solution
D. Swaddling or cuddling

Correct Answer: C. Sucrose solution

Oral sucrose is an evidence-based comfort measure for infants undergoing painful procedures.

It may:

Reduce procedural pain responses.
Provide calming effects.
Work best when combined with other comfort measures.

12. An adolescent female reports moderate dysmenorrhea. Ibuprofen 400 mg every 6–8 hours controls pain. What should the nurse practitioner recommend?

A. Increase ibuprofen to 600–800 mg every 6–8 hours
B. Use acetaminophen 1000 mg every 4–6 hours
C. Use naproxen 500 mg initially, then 250 mg every 6–8 hours
D. Use extended-release naproxen 500 mg every 12 hours

Correct Answer: C. Use naproxen 500 mg initially, then 250 mg every 6–8 hours

NSAIDs are first-line therapy for dysmenorrhea because they reduce prostaglandin production.

Important considerations:

Use the lowest effective dose.
Monitor gastrointestinal side effects.
Educate adolescents about correct timing of medication.

13. What is the most important dose-limiting factor when prescribing acetaminophen with hydrocodone?

A. Acetaminophen dose
B. Gastrointestinal side effects
C. Pruritus symptoms
D. Urinary retention

Correct Answer: A. Acetaminophen dose

Combination opioid medications containing acetaminophen require careful monitoring because excessive acetaminophen can cause liver toxicity.

14. An adolescent takes ibuprofen, acetaminophen, and a tricyclic antidepressant for phantom limb pain. The medications are no longer effective. What should the nurse practitioner do?

A. Change the tricyclic antidepressant to an SSRI
B. Evaluate for drug-seeking behavior
C. Increase the tricyclic antidepressant dose
D. Refer to a pain management specialist

Correct Answer: D. Refer to a pain management specialist

Complex chronic pain conditions often require multidisciplinary care.

Pain specialists may provide:

Medication optimization.
Behavioral interventions.
Physical therapy recommendations.
Advanced pain management strategies.

15. A school-age child with chronic pain wants to stay home from school more often. The physical examination and medication review are unchanged. What should the nurse practitioner recommend?

A. Assess pain daily
B. Keep the child in bed during pain episodes
C. Have the child complete homework when staying home
D. Require school attendance despite pain

Correct Answer: C. Have the child complete homework when staying home

Maintaining normal activities helps prevent disability associated with chronic pain.

Recommended approaches include:

Encouraging school participation.
Maintaining routines.
Avoiding unnecessary activity restriction.

Transient Tachypnea of the Newborn (TTN)

16. A 2-week-old infant was diagnosed with transient tachypnea of the newborn shortly after birth. What does the nurse practitioner understand about this condition?

A. Antibiotics are usually required
B. Home oxygen is always needed
C. Recovery is usually complete with minimal intervention
D. Mechanical ventilation and surfactant are required

Correct Answer: C. Recovery is usually complete with minimal intervention

TTN occurs because of delayed clearance of fetal lung fluid.

Characteristics include:

Early respiratory distress after birth.
Usually temporary symptoms.
Supportive care is commonly sufficient.

17. A 2-month-old infant has a staccato cough and fever. Which history finding is most important?

A. Daycare attendance
B. Immunization history
C. Medication history
D. Past medical history

Correct Answer: B. Immunization history

Immunization status helps evaluate the likelihood of vaccine-preventable respiratory infections.

Childhood Immunization Questions

18. Research suggests which population may have higher rates of under-immunization?

A. Communities with higher Asian populations
B. Communities with higher graduate degree rates
C. Communities with lower poverty rates
D. Communities with fewer primary care providers

Correct Answer: B. Communities with higher graduate degree rates

Vaccine hesitancy can occur across socioeconomic groups and may be influenced by education level, beliefs, and access factors.

19. A parent of a 2-month-old infant is hesitant about vaccines. What is the best initial response?

A. Explain vaccines contain no thimerosal
B. Provide Vaccine Information Statements only
C. Ask about the parent’s concerns regarding vaccines
D. Remind the parent about exposure to germs

Correct Answer: C. Ask about the parent’s concerns regarding vaccines

A respectful conversation helps identify specific concerns and allows healthcare providers to provide targeted education.

20. According to Institute of Medicine findings, what information should parents receive about vaccine risks?

A. Multiple vaccines cause type 1 diabetes
B. MMR may be associated with febrile seizures
C. Hepatitis B vaccine causes CNS disorders
D. Thimerosal vaccines cause developmental disorders

Correct Answer: B. MMR may be associated with febrile seizures

Some vaccines may have rare adverse effects, but evidence does not support claims linking vaccines to autism or widespread developmental disorders.

21. A 2-month-old infant receives initial immunizations. What should the nurse practitioner recommend for comfort?

A. Give ibuprofen or acetaminophen as needed
B. Avoid all antipyretics
C. Give medication only after vaccines
D. Give both medications before vaccination

Correct Answer: A. Give ibuprofen or acetaminophen as needed

Parents should treat discomfort when needed while avoiding unnecessary medication.

22. An 18-month-old child received MMR vaccine two days before the first birthday. What should the nurse practitioner do?

A. Give a reduced MMR dose
B. Obtain antibody titers
C. Recommend the next dose at 4–5 years
D. Repeat the MMR vaccine

Correct Answer: D. Repeat the MMR vaccine

An MMR dose given before 12 months of age does not count as the routine first dose because maternal antibodies may interfere with immunity.

23. A 5-year-old child with previous pertussis infection needs kindergarten immunizations. Which vaccine is recommended?

A. DTaP
B. DTP
C. Td
D. Tdap

Correct Answer: A. DTaP

Previous infection does not replace routine vaccination.

Puberty and Developmental Milestones

24. Which statement best describes thelarche in female puberty?

A. Appearance of pubic hair
B. Appearance and maturation of breast tissue
C. Beginning of the first menstrual period
D. All of the above

Correct Answer: B. Appearance and maturation of breast tissue

Thelarche refers specifically to the beginning of breast development and is usually the first visible sign of puberty in females.

Key puberty milestones include:

Thelarche: Breast development.
Pubarche: Appearance of pubic and axillary hair.
Menarche: First menstrual period.

Down Syndrome Pediatric Care

25. Congenital hypothyroidism is common in infants with Down syndrome. After initial thyroid screening, thyroid studies should be performed at least:

A. Every 2 months
B. Every month
C. Every 6 months
D. Yearly

Correct Answer: D. Yearly

Children with Down syndrome have an increased risk of thyroid dysfunction and require ongoing monitoring.

Recommended surveillance includes:

Newborn thyroid screening.
Regular thyroid function testing.
Monitoring for symptoms of hypothyroidism.

26. Children with Down syndrome have an increased risk of which malignancy?

A. Colon cancer
B. Leukemia
C. Pancreatic cancer
D. Bladder cancer

Correct Answer: B. Leukemia

Children with Down syndrome have a significantly increased risk of hematologic malignancies, especially leukemia.

Important associations include:

Acute lymphoblastic leukemia (ALL).
Acute myeloid leukemia (AML).
Transient abnormal myelopoiesis in infancy.

27. Children with Down syndrome may develop cervical spine instability. What symptoms should caregivers monitor?

A. Changes in reflexes
B. Changes in bowel function
C. All of the above
D. None of the above

Correct Answer: C. All of the above

Atlantoaxial instability can cause spinal cord compression.

Warning signs include:

Changes in gait.
Weakness.
Altered reflexes.
Loss of bowel or bladder control.
Neck pain.

Pediatric Ear Disorders

Acute Otitis Media (AOM)

28. An 18-month-old child has ear pain, fever, erythematous bulging tympanic membrane, and no history of ear infections. What is the recommended treatment?

A. Amoxicillin 80–90 mg/kg/day
B. Analgesic medication and watchful waiting
C. Ceftriaxone injection
D. Antibiotic ear drops

Correct Answer: B. Analgesic medication and watchful waiting

For selected children with mild symptoms, observation with pain control is appropriate.

Management depends on:

Age.
Severity of symptoms.
Fever level.
Bilateral versus unilateral infection.
Follow-up availability.

29. A 7-month-old infant has persistent otitis media despite amoxicillin and amoxicillin-clavulanate therapy. What is the next step?

A. Repeat amoxicillin-clavulanate
B. Perform tympanocentesis
C. Prescribe clindamycin
D. Refer to an otolaryngologist

Correct Answer: D. Refer to an otolaryngologist

Persistent or recurrent infections may require specialist evaluation.

Possible interventions include:

Assessment for tympanostomy tubes.
Evaluation of hearing.
Further diagnostic testing.

30. A child with pressure equalizing tubes has ear pain but no drainage, normal visualization of the tube, and a type A tympanogram. What should the nurse practitioner do?

A. Prescribe antibiotic/steroid ear drops
B. Give prophylactic antibiotics
C. Reassure the parent this is a normal exam
D. Refer immediately to ENT

Correct Answer: A. Prescribe antibiotic/steroid ear drops

When tympanostomy tubes are present, topical therapy is preferred for uncomplicated tube-associated infections.

31. What should parents expect after placement of pressure equalizing tubes?

A. Improved hearing
B. Complete prevention of ear infections
C. Need for earplugs during every bath
D. Tubes remain for 3–4 years

Correct Answer: A. Improved hearing

Tympanostomy tubes improve middle ear ventilation and hearing when fluid is present.

32. A child with recurrent otitis externa asks how to prevent future episodes. What should the nurse practitioner recommend?

A. Clean ear canals after swimming
B. Dry the ear canal with a hair dryer
C. Swim only in chlorinated pools
D. Use cerumenolytic agents daily

Correct Answer: B. Dry the ear canal with a hair dryer

Otitis externa, also called swimmer’s ear, is commonly caused by moisture trapped in the ear canal.

Prevention strategies:

Dry ears after swimming.
Avoid inserting objects into the ear canal.
Avoid excessive cleaning.

33. A child has itching, hearing difficulty, swelling of the ear canal, and severe pain with manipulation of the ear. What is appropriate treatment?

A. Culture the ear canal
B. Order antibiotic/corticosteroid ear drops
C. Prescribe oral amoxicillin-clavulanate
D. Refer to ENT

Correct Answer: B. Order antibiotic/corticosteroid ear drops

These findings are consistent with acute otitis externa.

34. A child with otitis externa has severe ear canal swelling after two days of topical therapy. What is the next treatment step?

A. Insert an ear wick
B. Irrigate the ear canal
C. Give systemic corticosteroids
D. Prescribe oral antibiotics

Correct Answer: A. Insert an ear wick

An ear wick allows medication to reach swollen areas of the ear canal.

35. A small foreign object is located near the tympanic membrane in a child’s ear canal. What should the nurse practitioner do?

A. Irrigate the ear
B. Refer to an otolaryngologist
C. Remove with a wire loop
D. Use forceps

Correct Answer: B. Refer to an otolaryngologist

Objects near the tympanic membrane require specialist removal to prevent injury.

Otitis Media Follow-Up

36. A 3-year-old child develops recurrent acute otitis media after previous amoxicillin treatment. Tympanogram shows middle ear fluid and fever. What medication should be ordered?

A. Tympanocentesis referral
B. Amoxicillin alone
C. Amoxicillin-clavulanate
D. Intramuscular ceftriaxone

Correct Answer: C. Amoxicillin-clavulanate

Amoxicillin-clavulanate is commonly used when recent amoxicillin exposure suggests resistant organisms.

37. A 2-year-old child has acute otitis media with a history of frequent ear infections. What is the recommended treatment?

A. Amoxicillin for 10 days
B. Analgesics and watchful waiting
C. Antibiotic ear drops
D. Ceftriaxone injection

Correct Answer: B. Analgesics and watchful waiting

Observation may be appropriate when symptoms are mild and follow-up is reliable.

38. A child treated for otitis media has persistent middle ear fluid but no fever or pain. What is the next step?

A. Ceftriaxone injection
B. Oral clindamycin
C. Monitor ear fluid for 3 months
D. Immediate antibiotic treatment

Correct Answer: C. Monitor ear fluid for 3 months

Otitis media with effusion often resolves without additional antibiotics.

39. A school-age child with chronic ear disease has vertigo, purulent drainage, and a pearly white lesion on the tympanic membrane. What condition is suspected?

A. Cholesteatoma
B. Mastoiditis
C. Otitis externa
D. Otitis media with effusion

Correct Answer: A. Cholesteatoma

A cholesteatoma is an abnormal skin growth in the middle ear that can cause hearing loss and complications.

References

American Academy of Pediatrics. (2021). Clinical practice guideline for the diagnosis and management of acute otitis media. Pediatrics.
https://publications.aap.org/pediatrics

American Academy of Pediatrics. (2023). Bright Futures guidelines for health supervision of infants, children, and adolescents (5th ed.).
https://www.aap.org/brightfutures

Centers for Disease Control and Prevention. (2024). Child and adolescent immunization schedule.
https://www.cdc.gov/vaccines/schedules/