NP Pediatric Nurse Practitioner 2 — Questions and Answers
Question 1: A 2-year-old presents with stridor at rest, drooling, and a toxic appearance. Which diagnosis is most concerning?
- Croup
- Epiglottitis (Correct answer)
- Foreign body aspiration
- Bacterial tracheitis
Correct answer: Epiglottitis
Epiglottitis presents with the classic triad of drooling, dysphagia, and distress, with a toxic appearance distinguishing it from croup.
Question 2: Which vaccine is contraindicated in a 6-month-old with a documented anaphylaxis to eggs?
- MMR
- Influenza (inactivated)
- Yellow fever (Correct answer)
- DTaP
Correct answer: Yellow fever
Yellow fever vaccine is produced in embryonated eggs and is contraindicated in individuals with severe egg allergy; influenza and MMR are generally safe even with egg allergy.
Question 3: A 10-year-old with obesity has a fasting glucose of 118 mg/dL and HbA1c of 5.8%. What is the correct classification?
- Normal glucose tolerance
- Prediabetes (Correct answer)
- Type 2 diabetes
- Type 1 diabetes
Correct answer: Prediabetes
Prediabetes is defined as fasting glucose 100-125 mg/dL or HbA1c 5.7-6.4%, indicating impaired glucose regulation without meeting diabetes criteria.
Question 4: Which finding on newborn exam is most indicative of congenital hypothyroidism?
- Jitteriness and tremor
- Large anterior fontanelle, macroglossia, and hypotonia (Correct answer)
- Petechiae and purpura
- High-pitched cry and microcephaly
Correct answer: Large anterior fontanelle, macroglossia, and hypotonia
Congenital hypothyroidism classically presents with a large fontanelle, macroglossia, hypotonia, prolonged jaundice, and poor feeding due to absent thyroid hormone.
Question 5: A 4-year-old is diagnosed with attention-deficit disorder. According to AAP guidelines, what is the first-line treatment?
- Methylphenidate
- Behavior therapy alone (Correct answer)
- Amphetamine salts
- Atomoxetine
Correct answer: Behavior therapy alone
AAP guidelines recommend behavior therapy as first-line treatment for preschool children (4-5 years) with ADHD before considering medication.
Question 6: Which finding in a 3-month-old warrants immediate evaluation for non-accidental trauma?
- Mongolian spot on sacrum
- Posterior rib fractures on chest X-ray (Correct answer)
- Café-au-lait spot on trunk
- Small subconjunctival hemorrhage after vaginal delivery
Correct answer: Posterior rib fractures on chest X-ray
Posterior rib fractures in infants are highly specific for non-accidental trauma because normal infant activity or CPR does not generate the forces needed to cause them.
Question 7: A 7-year-old presents with recurrent abdominal pain, pallor, and splenomegaly. CBC shows microcytic anemia with target cells. Which diagnosis fits best?
- Iron deficiency anemia
- Beta-thalassemia trait (Correct answer)
- Sickle cell disease
- Hereditary spherocytosis
Correct answer: Beta-thalassemia trait
Beta-thalassemia trait causes microcytic anemia with target cells and mild splenomegaly; unlike thalassemia major, growth is typically preserved.
NP Pediatric Nurse Practitioner 2
A 2-year-old presents with stridor at rest, drooling, and a toxic appearance.
Which diagnosis is most concerning?