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

a) Providing family-centered, culturally competent, and developmentally appropriate

care

b) Focusing on the diagnosis and treatment of acute and chronic illnesses

c) Referring children to specialists whenever they have complex health needs

d) Limiting preventive services to immunizations and screenings

Answer: A. Rationale: Pediatric primary care is based on the principle of providing care

that is family-centered, culturally competent, and developmentally appropriate, as well

as comprehensive, coordinated, continuous, and accessible. B, C, and D are not

accurate descriptions of pediatric primary care.

2. A 4-year-old child presents with fever, cough, and wheezing. The nurse practitioner

suspects bronchiolitis. What is the most appropriate diagnostic test to confirm this

diagnosis?

a) Chest x-ray

b) Nasopharyngeal swab for respiratory syncytial virus (RSV)

c) Sputum culture

d) Pulmonary function tests

Answer: B. Rationale: Bronchiolitis is a viral infection of the lower respiratory tract that

is most commonly caused by RSV. A nasopharyngeal swab for RSV can confirm the

diagnosis. A chest x-ray is not necessary unless there are signs of pneumonia or other

complications. Sputum culture is not useful in children with bronchiolitis because they

do not produce sputum. Pulmonary function tests are not feasible in young children.

3. A 12-year-old girl comes to the clinic for a well-child visit. She reports having her first

menstrual period 6 months ago and having irregular cycles since then. She denies any

sexual activity or contraceptive use. What is the best approach for the nurse

practitioner to address her reproductive health needs?

a) Reassure her that irregular cycles are normal in the first year after menarche and

provide education on menstrual hygiene and puberty changes

b) Order a pelvic ultrasound to rule out any structural abnormalities and prescribe oral

contraceptive pills to regulate her cycles

c) Refer her to a gynecologist for further evaluation and management

d) Perform a pelvic exam and obtain a Pap smear and sexually transmitted infection

(STI) testing

Answer: A. Rationale: Irregular cycles are common in the first year after menarche due

to anovulation and immature hypothalamic-pituitary-ovarian axis. The nurse practitioner

should provide reassurance and education on menstrual hygiene and puberty changes,

as well as anticipatory guidance on sexual health and contraception. B, C, and D are

not indicated for a healthy adolescent girl with no sexual activity or contraceptive use.

4. A 6-month-old boy is brought to the clinic for a routine immunization visit. His mother

reports that he is exclusively breastfed and has been growing well. She asks if he

needs any vitamin supplements. What is the best response by the nurse practitioner?

a) He needs vitamin D supplements of 400 IU per day until he is weaned from breast

milk

b) He needs iron supplements of 1 mg/kg per day until he starts eating iron-rich foods

c) He needs both vitamin D and iron supplements until he is 1 year old

d) He does not need any vitamin supplements as long as he continues to breastfeed

Answer: A. Rationale: Breastfed infants need vitamin D supplements of 400 IU per day