NR 602 MIDTERM/FINAL EXAM QUESTIONS AND ANSWERS | NR602
EXAM QUESTIONS BANK, LATEST 2025 -CHAMBERLAIN
NR 602 MIDTERM EXAM
Week 1 Concepts
Immunizations
Vaccines for Children (VFC)
• What is the recommendation(s) for human papillomavirus (HPV) vaccine? All 11- through 12- year olds should get a 2-shot series of
HPV vaccine. A 3-shot series is needed for those with weakened immune systems and those who start the series at 15 years or older.
• What population(s) at-risk for contracting meningococcal infection? children younger than 1 year old, with a second peak in adolescence.
Among teens and young adults, those 16 through 23 years old have the highest rates of meningococcal disease.
o All 11- through 12- year olds should get one shot of meningococcal conjugate (MenACWY). A booster shot is recommended at age
16.
• What vaccines are contraindicated in pregnancy or those planning to become pregnant?
o Human papillomavirus (HPV) vaccine. o Varicella (chicken pox) vaccine.
o Measles, mumps, and rubella (MMR) vaccine. o Certain travel vaccines: yellow fever,
o Live influenza vaccine (nasal flu vaccine) typhoid fever, and Japanese encephalitis.
• Sudden Infant Death Syndrome (SIDS) Prevention
o Offer a pacifier during sleep times
o Infants should be placed on their back for sleep until the age of 1
o Do not have any sok objects like pillows, toys, or bumpers in the bed
o Use infant sleep clothing rather than blankets
o Use a firm mattress with a fitted sheet and no other bedding
o Have the infants sleep in the same room as the parents, but in their own bed
o BreasVeed if possible
o Avoid overheating (in general infants would have 1 layer more than an adult would need)
o Do not use commercial devices for safe sleep
o Do not allow smoke in the home or use drugs or alcohol when caring for an infant
• Lead Poisoning: deaths with the highest numbers in low- and middle-income countries. Lead is highly toxic to solid organs, bones, and the
nervous system. Severe lead poisoning may cause anemia, hypertension, and toxicity and lead to coma or death. At lower levels, no symptoms
may be obvious, although damage is occurring. Lead can affect brain development, causing lower intelligence quotient (IQ), attention spans,
antisocial behaviors, and lower educational attainment.
o All children with Medicaid are recommended to have lead testing two times: at 12 months and 24 months
o if the initial screening level is higher than 3.5 µg/dl, a venous blood lead level should be obtained to confirm findings.
o education about lead exposure prevention, environmental investigation into potential sources, report test results to the local
health department, assess for calcium and iron deficiencies, obtain abdominal X-ray, contact a Pediatric Environmental Health
Specialty Unit (PEHSU) or poison control center, repeat test in 2 weeks to 1 month
Week 2 Concepts
Newborn assessment (including eye screenings): APGAR: 1 minute and 5 minutes aker birth for all infants, and at 5-minute intervals thereaker until 20
minutes for infants with a score less than 7
• height, weight and head circumference
• HR 90-160, RR 30-60, BP not critical in healthy infants, pulse ox may be abnormal for 1st 10 minutes.
• HEAD: feel the sutures; anterior and posterior fontanels. EYES: check red-reflex. EARS: check for pits, tags and malformation. MOUTH:
put finger in mouth to check roof of mouth and palate, check for clek palate/lip, check for sucking reflex. NOSE: assess patency of nose and
for resp distress. NECK: check for abnormalities, extend the neck, palpate clavicles for fractures. Listen to heart and lung sounds, ½ of
normal newborns have a murmur in first day of life. ABD/GENITAL: liver should be palpable 3cm below costal margin, spleen and
kidneys may be palpable, check for patent rectum and genital abnormalities. EXTREMITIES: check stability of hips, inspect spine for
sacral dimples, acrocyanosis is normal and common, check fingers/toes. NEURO: high flexor tone; should be balled up and not relaxed,
suck, root, grasp and moro reflex, DTRs.
Well-Child Visits head-to-toe examination, including measurement of growth, screening and risk assessments, immunizations, health education, and
anticipatory guidance.
,Anticipatory guidance
• lifelong health for families and communities (Social • healthy weight
Determinants of Health (SDOH) screening) • healthy nutrition
• family support • physical activity
• health for children and youth with special health care • oral health
needs • healthy sexual development and sexuality
• healthy development • healthy and safe use of social media
• mental health • safety and injury prevention
Screening for abuse
• social inequality difficulty bonding/nurturing child age 4 years or younger/adolescent
• poverty victim of violence being unwanted
• unemployment lack of knowledge regarding normal child behaviors physical disabilities or abnormal features
• low education drug/alcohol abuse developmental disabilities
• lack of support low self esteem Chronic illness
• rigid gender roles or norms poor impulse control questioning/identifying as LGBTQ
Privacy and mandatory reporting HIPAA allows a parent/guardian to have access to the child’s medical records if access is not inconsistent with state or
other laws and there are no concerns of abuse, neglect, or endangerment by the parent/guardian.
• If a parent/guardian did not consent to the emergent treatment, the parent/guardian is the child’s representative under the HIPAA Privacy
Rule and can access information unless exceptions are present.
• Parents/guardians are denied access to their children’s medical records in the following situations: the child consents to care and the consent
of the parent is not required under State law, the child obtains care at the direction of a court, the parent/guardian agrees that the child and
the provider may have a confidential relationship, the child reaches the age of majority or becomes emancipated.
Gender identity development Children start to become aware of physical differences in boys and girls around age 2. Around age 4, most children have
established their gender identity. Parents are encouraged to explore different gender roles and different styles of play with children's books and a wide
range of toys.
Pediatric Assessment What should be included in your history questions?
Health History Social of Family History
• gestational and birth history (including maternal • who the child lives with
gestational history) • members of the household in the home and ages
• immunizations • smoking in the home
• hospitalizations • social determinants of health (home environment,
• major illnesses or trauma (includes fractures, stitches, etc.) transportation)
• parents or guardians’ education and reading level
• family history of disease • current school – grade and aker school activities
• risky behaviors
Pediatric physical exam What should be included in your physical exam?
• Infant-toddler: Length/weight measurements, head circumference, developmental surveillance, behavioral assessment, and immunizations if
needed. The mother should also be screened for maternal depression.
• Early-middle childhood: Height/weight measurements, body mass index, vision and hearing screening, developmental surveillance, and
behavioral assessment as well as immunizations if needed.
• Late childhood-adolescents: Height/weight measurements, vital signs, vision, and mental health screening.
Growth and development Each child must be weighed and measured at each visit and recorded.
• For premature infants born at less than 36 weeks’ gestation, height and weight documentation should be corrected with a documented
gestational age assessment, completed in the first 24 hours.
• Recumbent height measurement (when the child is lying down) is utilized until 2 years of age.
• Head circumference should be measured until age 3 and measured three times for congruence and the highest number used.
• Infants should be weighed with no clothes or diaper.
• In older children, height must be with shoes off, against a wall, and with heels to the wall at every visit.
• Height should be measured three times for congruence and the highest number used
,Common growth and development health problems Endocrine/Metabolic
Adrenal insufficiency - Babies can be born with congenital adrenal hyperplasia (CAH), a genetic disorder caused by a mutation in the gene
encoding 21-hydroxylase enzyme.
• Slow weight gain, Fatigue and generalized weakness, Headache, Nausea or vomiting, Dehydration, Low blood pressure & Salt cravings
Hypothyroidism What are s/sx of hypothyroidism in pediatric clients? slowed growth rate. Additional symptoms include sluggishness, pallor, dry and
itchy scalp, increased sensitivity to cold and constipation.
• What is the process of screening pediatric clients for endocrine/metabolic disorders? The Newborn Metabolic Screen is performed
by pricking your baby's heel and puṄng a few drops of blood onto special filter paper. Blood tests in pediatric patients.
Adolescent sexuality, gender identity and gender expression Transgender youth have access to care that is safe and gender-affirming. Family-based
therapy is available to meet mental and emotional needs. Electronic health records, billing, and client notification systems should respect the asserted
gender identity while maintaining confidentiality and avoiding duplicate charts. Insurance plans should cover youth who identify with
transgender. Providers should be educated about best practices for youth who identify as transgender. Providers should have a role in educating
communities and promoting the acceptance of all children.
Gender dysphoria significant distress for at least six months and at least six of the following: strong desire to be of the other gender or an insistence that
they are the other gender. strong preference for wearing clothes typical of the opposite gender
Fetal alcohol spectrum disorder Fetal Alcohol Syndrome (FAS), Alcohol-Related Neurodevelopmental Disorder (ARND), Alcohol-Related Birth Defects
(ARBD), and Neurobehavioral Disorder Associated with Prenatal Alcohol Exposure (ND-PAE). FASDs are a challenge to diagnose since there is no
medical test to confirm the diagnosis and other disorders have similar symptoms. There is no cure but, early intervention can improve the child’s
development. Genetic testing When is further genetic testing warranted in children? families with genetic illnesses in close relatives. parents who
already have a child with a genetic illness. couples who plan to start a family and one of them or a close relative has a genetic illness. pregnant women
over age 34 or who have an abnormal prenatal screening test or amniocentesis
Down’s Syndrome What are possible complications for a person with Down’s syndrome? a low intelligence quotient (IQ), hearing loss, obstructive sleep
apnea, ear infections, eye diseases, and heart defects at birth. Since it is a lifelong condition, offering support services early will help improve the child’s
physical and intellectual abilities.
Week 3 Concepts
Fever Urinary tract infection, gastroenteritis, ear infections, croup, bronchiolitis, and Kawasaki disease are causes of pediatric fever. Kawasaki Disease is
an illness of unknown cause that affects children younger than 5 years of age.
See a child immediately if the following are associated with the fever:
• The child is less than 3 months of age with a fever > 100.4°F (38°C).
• The child is 3 to 36 months old with a fever > 100.4°F (38°C) for more than three days or looks sick.
• The child is 3 to 36 months old with a fever > 102°F (38.9°C).
• The child of any age has a fever > 104°F (40°C).
• The child with fever is crying inconsolably, lethargic, has a stiff neck, dyspnea, dysuria, or has had a seizure.
• The child with fever also has a chronic health condition, takes long-term steroids, or is undergoing chemotherapy
Treatment
• infant acetaminophen 15 mg/kg/dose every 4-6 hours and formula and/or breastmilk intake increased.
• Sponging and cool baths are generally not effective. Alcohol should not be used for sponging due to the risk of toxicity if absorbed through the
skin.
• Ibuprofen is not recommended for children under six months. Aspirin should not be used to treat fever in any child less than 18 years of age
due to the risk of Reye syndrome.
• Water and other cool liquids should be offered frequently to children over the age of 6 months.
Dermatologic disorders (skin rashes):
• Contact dermatitis: Diaper dermatitis can be divided into two categories: diaper and non-diaper related. Non-diaper-related rashes can
include causes such as seborrhea, atopic dermatitis, bacterial infections, psoriasis, and scabies.
• Scabies: Scabies is caused by mites that burrow under the skin. blisters or pimples: pink, raised bumps with a clear top filled with fluid.
Treatment: Permethrin 5% cream is usually recommended as the first treatment. Malathion 0.5% lotion is used if permethrin is ineffective.
• Chiggers: Chiggers are microscopic mites that live in warm, grassy or wooded areas near water that bite your skin and cause itching. When
scratched, chigger bites can become red and crusty. Chigger bites usually heal on their own within one to two weeks. Vigorously scrub the
area with soap and water to remove the mites. Control itching with calamine lotion or an over-the-counter anti-itch cream, such as
hydrocortisone cream.
• Pediculosis: Three types of lice live on humans: head louse, pubic louse, or body louse. Itching is a prominent symptom in lice. Treatment: the
removal of all nits or louse ova. Over-the-counter medications with permethrin (approved for children over 2 months) or pyrethrins (approved
for children over age 2). If lice persist, prescriptions, like benzyl alcohol, can be prescribed.
• Nevi: oken appear as small, dark brown spots and are caused by clusters of pigment-forming cells (melanocytes). Treatment: most nevi are
removed with either a shave or excisional biopsy.
• Port wine stain: are a permanent birthmark and will only fade with treatment such as laser therapy.
Eye disorders
• eye injuries: Ocular trauma ranges in severity from mild scleral or conjunctival abrasion to a complete trauma of the globe. Lacerations or
force to the lid or eye orbit is also concerning and can have an associated ocular injury. Severe pain, particularly with restricted eye movement,
is a red flag for any eye trauma. All injuries should be examined since serious complications are not always obvious.
• congenital cataracts: Ophthalmologists do surgery to remove congenital cataracts in some cases. Some congenital cataracts do not need
surgery. When the baby's vision is affected, surgery usually happens soon aker the diagnosis, as early as 6–8 weeks of age.
• antibiotics for eye infections: treatment for methicillin-resistant Staphylococcus aureus (MRSA) cases is clindamycin.
• What is Retinoblastoma: malignant cells form in the tissues of the retina that occurs when nerve cells in the retina develop genetic mutations.
o What are the s/sx of Retinoblastoma: A white color in the center circle of the eye (pupil) when light is shone in the eye, such as when
someone takes a flash photograph of the child. Eyes that appear to be looking in different directions. Poor vision.
o When should children be screened for Retinoblastoma: recommend screening for at-risk children from birth up to the age of 7 years.
Aker age 7 years, no further screening of asymptomatic children is recommended, unless they are known to carry an RB1 mutation.
, o What are risk factors of Retinoblastoma: hereditary, diets low in fruits and vegetables among mothers during pregnancy, exposure to
chemicals in gasoline or diesel exhaust during pregnancy, exposure of fathers to radiation.
o The American Association of Ophthalmic Oncologist and Pathologists (AAOOP) screening recommendations for children at risk
for retinoblastoma: RB1 mutation carriers should be followed indefinitely, with exams every one to two years aker age 7.
Ear disorders
• Otitis media: AOM, and OME oken accompany or follow an upper respiratory infection. Treatment: Benzocaine otic drops can be used for
children older than 5 years old. Amoxicillin 80-90 mg/kg/day Q12H, x10d is recommended as a first-line treatment
• otitis externa: Tragus or pinna tenderness with external auditory canal redness and inflammation is expected with AOE. Treatment:
ciprofloxacin 0.3%/dexamethasone 0.1% otic suspension to right ear twice daily for seven days. Baths should be taken instead of showers and
no swimming. Acetaminophen or ibuprofen can be taken for discomfort.
• Foreign object: Suction or forceps may be used if the object is in the external auditory canal. Care must be taken to avoid lodging the object.
Irrigation can be used if the TM is intact.
• Mastoiditis: usually a result of an extension of the inflammation of the middle ear infection into the mastoid. Treatment: cekriaxone,
vancomycin or ciprofloxacin.
Allergic rhinitis: runny and itchy nose, sneezing, postnasal drip and nasal congestion. Treatment: antihistamines and decongestants
Mouth and throat disorders
• streptococcal pharyngitis: group A beta-hemolytic streptococcal (GABHS) infection causes nearly a third of all bacterial sore throats in
children. A throat culture or rapid antigen testing (RAD) should be performed to confirm a diagnosis. If the RAD result is negative, a
throat culture should still be obtained. Treatment: The first-line treatment is amoxicillin 50 mg/kg/day.
• scarlet fever: a papular rash, similar in appearance to sandpaper, associated with bacterial pharyngitis, and common in school-aged and
adolescent children. The rash begins a few days aker flu-like symptoms and is caused by group A streptococcus (GAS). Treatment: Penicillin
is the first-line treatment for scarlet fever. A first-generation cephalosporin, clindamycin, or erythromycin may also be used if the client is
allergic to penicillin
• Peritonsillar abscess: a collection of pus that forms in tissues around the tonsils. It can occur as a result of strep throat. Treatment: Needle
aspiration remains the gold standard for diagnosis and treatment of peritonsillar abscess. Aker performing aspiration give penicillin,
clindamycin, cephalosporins, or metronidazole
Respiratory disorders
• Upper respiratory infection: Common cold, EpigloṄtis, Laryngitis, Pharyngitis (sore throat), Sinusitis (sinus infection). Common
symptoms include stuffy or runny nose, sore throat, cough, difficulty swallowing, and hoarseness or loss of voice.
• Asthma classifications
o Severe: symptoms throughout the day, nighṄme awakenings >1x/week (≤4 years)/Oken 7x/week (≥5 years), SABA use several times per
day, limitation of activity extreme, FEV1>60%
Treatment: Step 3 (≤4 years): Step 3: 0-4 years: Medium dose ICS + subspecialist referral; ≥5 years: Low dose ICS + LABA or medium
dose ICS
Step 3 or 4 (5-11 years): Medium dose ICS + LABA or montelukast + subspecialist referral
Step 4 or 5 (≥12 years): High dose ICS + LABA or montelukast + subspecialist referral
o Moderate: symptoms daily, nighṄme awakenings 3-4x/month (≤4 years)/>1x/week (≥5 years), SABA use daily, limitation of activity
some, FEV1>60%
Treatment: Step 3: 0-4 years: Medium dose ICS + subspecialist referral; ≥5 years: Low dose ICS + LABA or medium dose ICS
o Mild: symptoms >2 days/weeks, nighṄme awakenings 1-2x/month (≤4 years)/3-4x/month (≥5 years), SABA use >2 days/week,
limitation of activity minor, FEV1>80%
Treatment: Step 2: Low dose ICS
o Intermediate: symptoms ≤2 days/weeks, nighṄme awakenings 0 (≤4 years)/≤2x/month (≥5 years), SABA use ≤2 days/week, limitation
of activity none, FEV1>80%
Treatment: Step 1: SABA PRN
o Is imaging warranted in a pediatric client with Asthma – why or why not? Chest x-ray is helpful for assessment of peribronchial
cuffing, hyperinflation and atelectasis. Further imaging may be needed if other diagnosis is suspected.
• Acute viral bronchitis: begins as symptoms of a cold (nasal congestion, mild fever, cough) but develops into inflammation of the bronchioles in
the lower airways. Children can have difficulty breathing and wheezing present.
• Respiratory syncytial virus (RSV): a virus that can cause nasal drainage, decrease in appetite, coughing, sneezing, fever, and wheezing.
Anyone can get RSV but it is more serious in infants and older adults.
• Cystic fibrosis: genetically inherited disease that affects secretory cells throughout the body, produce thick and sticky mucus and
have high levels of salt in their sweat. The thick mucus can block respiratory passages, leading to wheezing and coughing, as well
as chronic respiratory infections.
Week 4 Concepts
Cardiovascular
• Kawasaki disease: an acute febrile illness of unknown cause that primarily affects children younger than 5 years of age. s/s include fever,
swollen hands and feet with skin peeling, and red eyes and tongue
o How is Kawasaki Disease diagnosed? fever of five days or more with at least four of five features: bilateral conjunctival injection,
changes in the lips and oral cavity, cervical lymphadenopathy, extremity changes, and polymorphous rash
o What is the treatment for Kawasaki disease? Initial treatments include aspirin and intravenous immunoglobulin therapy (gamma
globulin). Aker your child is given IVIG, their symptoms should improve within 36 hours. If their high temperature doesn't improve
aker 36 hours, they may be given a second dose of IVIG.
• Atrial Septal defect: Opening in septum between atria
o Signs: widely split S2, right ventricle heave, systolic murmur at pulmonic or diastolic murmur at tricuspid
o Symptoms: asymptomatic; older children may have fatigue or exercise intolerance
• Ventricular septal defect: Opening in septum between ventricles; most common congenital defect; most close spontaneously
o Signs: systolic murmur at Erb’s point or tricuspid; larger openings positive for heaves and thrill
