1. Which of the following is a key component of the pediatric primary care model?

a) Providing comprehensive and coordinated care for children and their families

b) Focusing on acute and episodic care for children with common illnesses

c) Referring children to specialists for most of their health needs

d) Limiting preventive and developmental services to well-child visits

Answer: A. The pediatric primary care model emphasizes providing comprehensive and

coordinated care for children and their families, including preventive, acute, chronic,

and developmental services.

2. A 4-year-old child presents to the clinic with a fever of 38.5°C, sore throat, and

enlarged cervical lymph nodes. The nurse practitioner suspects streptococcal

pharyngitis and orders a rapid antigen detection test (RADT). The test result is

negative. What is the most appropriate next step for the nurse practitioner?

a) Prescribe antibiotics empirically based on the clinical presentation

b) Order a throat culture to confirm the diagnosis

c) Reassure the parents that the child has a viral infection and provide symptomatic

treatment

d) Repeat the RADT in 24 hours to rule out a false negative result

Answer: B. A throat culture is the gold standard for diagnosing streptococcal pharyngitis

and should be performed when the RADT result is negative and the clinical suspicion is

high.

3. A 12-year-old child with type 1 diabetes mellitus comes to the clinic for a routine

follow-up visit. The nurse practitioner reviews the child's blood glucose logs and notes

that the child has frequent episodes of hypoglycemia, especially before lunch and after

physical activity. The nurse practitioner also notes that the child's hemoglobin A1c level

is 9.5%, indicating poor glycemic control. What is the most likely explanation for this

paradoxical finding?

a) The child is experiencing the Somogyi effect, a rebound hyperglycemia caused by

excessive insulin dosage or action

b) The child is experiencing the dawn phenomenon, an early morning rise in blood

glucose due to increased growth hormone secretion

c) The child is experiencing diabetic ketoacidosis, a life-threatening complication of

insulin deficiency

d) The child is experiencing insulin resistance, a reduced response of peripheral tissues

to insulin action

Answer: A. The Somogyi effect is a phenomenon in which excessive insulin dosage or

action leads to hypoglycemia, which triggers counter-regulatory hormones such as

glucagon, cortisol, and epinephrine to raise blood glucose levels, resulting in rebound

hyperglycemia. This can mask poor glycemic control and cause wide fluctuations in

blood glucose levels.

4. A 6-month-old infant is brought to the clinic for a well-child visit. The nurse

practitioner assesses the infant's growth and development using standardized charts

and tools. Which of the following developmental milestones would be expected for an

infant of this age?

a) Sitting without support, babbling, transferring objects from one hand to another

b) Rolling over, cooing, grasping objects with the whole hand

c) Crawling, saying "mama" and "dada", picking up small objects with thumb and index