A 5-day-old exclusively breastfed girl born at 39 weeks is seen for her first office visit. Her mother reports 8 feedings, 4 wet diapers and 2 yellow stools in the past 24 hours. The weights recorded so far are shown. Time point Weight Birth 3,200 g Hospital discharge (day 2) 3,010 g Today (day 5) 2,880 g The infant is alert and has a normal exam. Based on the data, which of the following is the most appropriate interpretation and plan?

A 10% loss; observe a feeding, give lactation help and recheck in 1-2 days

A 10% loss; stop breastfeeding and use formula until she regains weight

A 9% loss; this is expected, so continue the current feeding routine

A 10% loss; this is expected, so recheck her weight at the 1-month visit

A 15-year-old girl with moderate major depressive disorder has started fluoxetine and weekly CBT. She has no suicidal ideation today, and a safety plan is in place. Which follow-up plan is most appropriate for the first several weeks of treatment?

Close follow-up to watch for new suicidal thinking

Monthly visits only to repeat the PHQ-A score

Follow up in 3 months once the full dose takes effect

Follow up only if she or her parents report a problem

A 6-year-old girl with persistent asthma uses a fluticasone metered-dose inhaler twice daily and an albuterol metered-dose inhaler as needed. At a follow-up visit her father shows how she sprays each inhaler directly into her mouth as she breathes in. Which of the following is the most appropriate teaching?

Use a valved spacer with both inhalers, every dose

Exhale fully after spraying each puff into the mouth

Use a spacer for albuterol but not for fluticasone

Switch both medications to a home nebulizer instead

A 12-year-old boy whose BMI is at the 97th percentile has had left knee pain and a limp for 3 weeks. There is no history of trauma. The knee exam is normal, but when the NP flexes his left hip, the thigh rolls into external rotation, and internal rotation of that hip is limited. Which of the following is the most appropriate next step?

AP and frog-leg lateral x-rays of both hips

Physical therapy referral for patellofemoral pain

Left knee x-rays and a 2-week trial of ibuprofen

MRI of the left knee to evaluate the menisci

A 10-month-old girl is seen for a weight check after a nurse noted poor gain. Her WHO growth chart percentiles at recent visits are listed in the following data. Visit Weight-for-length Length-for-age Head circumference 4 months 50th 25th 25th 6 months 25th 25th 25th 10 months Below 2nd 25th 25th She has no vomiting, diarrhea or recurrent infections, and her physical exam is otherwise normal. Which of the following is the most appropriate initial step?

Take a detailed feeding history with a 3-day food record

Order a sweat chloride test and a celiac antibody panel

Refer to endocrinology for growth hormone evaluation

Order a skeletal survey and contact protective services

A 16-year-old girl has moderate major depressive disorder and agrees to start an SSRI. Her father has bipolar I disorder. Before prescribing, which of the following is most important?

Screen her for past manic or hypomanic episodes

Order a baseline liver panel and lipid profile

Obtain a baseline EEG to exclude seizures

Obtain a baseline ECG to measure the QTc interval

A 6-year-old boy is on day 9 of oral cefaclor for sinusitis. He now has fever, an itchy rash of large urticarial plaques with dusky centers on his trunk and limbs, and painful swelling of both hands and ankles. His lips and mouth are normal, there is no blistering, and his urinalysis is normal. Which of the following is the most likely diagnosis?

Systemic juvenile idiopathic arthritis

A 2-month-old girl born at term has had 2 days of congestion and cough. She is feeding well with normal wet diapers, her respiratory rate is 44/min with no retractions, and her oxygen saturation is 97%. The NP diagnoses mild bronchiolitis and plans home care. Which of the following is the most appropriate teaching for her parents?

Symptoms often peak on days 3-5; return for pauses in breathing

Honey at bedtime is a safe and effective way to ease her cough

The cough should be gone within 3 days, so return if it persists

Use albuterol at home if the wheezing increases overnight

A 7-year-old girl fell on her outstretched hand and has tenderness over the distal radius. X-rays show a buckle (torus) fracture of the distal radial metaphysis with no angulation and an intact cortex on the opposite side. Which of the following is the most appropriate management?

Removable wrist splint for about 3 weeks

Closed reduction under sedation by an orthopedist

Long-arm cast for 6 weeks with x-rays every week

Elastic bandage only, with full sports the next day

Pediatric Primary Care Nurse Practitioner Exam

Free Pediatric Primary Care NP Practice Questions

10 sample questions for the Pediatric Primary Care Nurse Practitioner Exam, with the correct answer and an explanation for each. No account needed. Try each one before you open the answer.

Sections covered on the exam: Growth, Development and Health Supervision, Immunizations, Nutrition and Injury Prevention, Developmental, Behavioral and Mental Health, Dermatology, Allergy, Immunology and Rheumatology, Ear, Nose, Throat and Eye Disorders, Respiratory Disorders, Cardiovascular Disorders, Genitourinary, Renal and Reproductive Health, Musculoskeletal Disorders, Professional Role, Ethics and Practice Management.

Question 1 · Growth, Development and Health Supervision
A 5-day-old exclusively breastfed girl born at 39 weeks is seen for her first office visit. Her mother reports 8 feedings, 4 wet diapers and 2 yellow stools in the past 24 hours. The weights recorded so far are shown.
Time point Weight
Birth 3,200 g
Hospital discharge (day 2) 3,010 g
Today (day 5) 2,880 g
The infant is alert and has a normal exam. Based on the data, which of the following is the most appropriate interpretation and plan?
- A.A 10% loss; observe a feeding, give lactation help and recheck in 1-2 days
- B.A 10% loss; stop breastfeeding and use formula until she regains weight
- C.A 9% loss; this is expected, so continue the current feeding routine
- D.A 10% loss; this is expected, so recheck her weight at the 1-month visit
Show answer and explanation
Answer: A. A 10% loss; observe a feeding, give lactation help and recheck in 1-2 days
The loss is 3,200 - 2,880 = 320 g, and 320 / 3,200 = 10%, the upper limit of expected newborn weight loss. A loss this large with fewer wet diapers than expected at this age calls for direct observation of breastfeeding, lactation support and a weight check within 1-2 days. Waiting a month misses an infant at risk for dehydration and worsening jaundice, and stopping breastfeeding is not indicated.
Question 2 · Developmental, Behavioral and Mental Health
A 15-year-old girl with moderate major depressive disorder has started fluoxetine and weekly CBT. She has no suicidal ideation today, and a safety plan is in place. Which follow-up plan is most appropriate for the first several weeks of treatment?
- A.Close follow-up to watch for new suicidal thinking
- B.Monthly visits only to repeat the PHQ-A score
- C.Follow up in 3 months once the full dose takes effect
- D.Follow up only if she or her parents report a problem
Show answer and explanation
Answer: A. Close follow-up to watch for new suicidal thinking
Antidepressants carry a boxed warning for increased suicidal thinking and behavior in youth, with risk highest in the first weeks of treatment and after dose changes. Close follow-up, in person or by phone, allows early detection of suicidality, agitation or adverse effects. Waiting months or relying on the family to call misses this window.
Question 3 · Allergy, Immunology and Rheumatology
A 6-year-old boy was diagnosed last week with IgA vasculitis (Henoch-Schonlein purpura). His mother reports that the rash on his legs is fading and his knee pain has resolved. Today's findings are listed as follows.
Finding Result
Blood pressure 98/60 mm Hg
Skin Fading palpable purpura on buttocks and legs
Abdomen Soft, nontender
Urinalysis Negative for blood and protein
Platelet count at diagnosis 310,000/mm3
Which of the following is the most important monitoring for the coming months?
- A.Weekly platelet counts until the purpura has cleared
- B.Urinalysis and blood pressure checks for about 6 months
- C.Monthly abdominal ultrasound to detect intussusception
- D.Renal ultrasound now and again in 3 months
Show answer and explanation
Answer: B. Urinalysis and blood pressure checks for about 6 months
Nephritis is the main long-term complication of IgA vasculitis and can appear weeks to months after the rash, so serial urinalyses and blood pressure checks are continued for about 6 months even when the first urinalysis is normal. Platelets are normal in this vasculitis, so counts add nothing. Renal ultrasound does not detect early glomerular disease, and intussusception is assessed only if colicky abdominal pain or bloody stools develop.
Question 4 · Respiratory Disorders
A 6-year-old girl with persistent asthma uses a fluticasone metered-dose inhaler twice daily and an albuterol metered-dose inhaler as needed. At a follow-up visit her father shows how she sprays each inhaler directly into her mouth as she breathes in. Which of the following is the most appropriate teaching?
- A.Exhale fully after spraying each puff into the mouth
- B.Use a spacer for albuterol but not for fluticasone
- C.Use a valved spacer with both inhalers, every dose
- D.Switch both medications to a home nebulizer instead
Show answer and explanation
Answer: C. Use a valved spacer with both inhalers, every dose
A valved holding chamber (spacer) should be used with every metered-dose inhaler dose in children because it improves lung delivery and reduces the coordination needed; with an inhaled corticosteroid it also reduces oropharyngeal deposition and thrush, along with rinsing the mouth. Limiting the spacer to albuterol leaves the controller poorly delivered. A nebulizer is not more effective than an MDI with a spacer, and exhaling after actuation wastes the dose.
Question 5 · Musculoskeletal Disorders
A 12-year-old boy whose BMI is at the 97th percentile has had left knee pain and a limp for 3 weeks. There is no history of trauma. The knee exam is normal, but when the NP flexes his left hip, the thigh rolls into external rotation, and internal rotation of that hip is limited. Which of the following is the most appropriate next step?
- A.Physical therapy referral for patellofemoral pain
- B.Left knee x-rays and a 2-week trial of ibuprofen
- C.AP and frog-leg lateral x-rays of both hips
- D.MRI of the left knee to evaluate the menisci
Show answer and explanation
Answer: C. AP and frog-leg lateral x-rays of both hips
Obligate external rotation with hip flexion in an overweight early adolescent with a limp is classic for slipped capital femoral epiphysis, and hip pathology often presents as referred knee pain. Bilateral AP and frog-leg lateral hip x-rays make the diagnosis, and both hips are imaged because SCFE is often bilateral. He should be kept non-weight-bearing and referred urgently to orthopedics; focusing on the knee delays diagnosis and risks further slippage and avascular necrosis.
Question 6 · Growth, Development and Health Supervision
A 10-month-old girl is seen for a weight check after a nurse noted poor gain. Her WHO growth chart percentiles at recent visits are listed in the following data.
Visit Weight-for-length Length-for-age Head circumference
4 months 50th 25th 25th
6 months 25th 25th 25th
10 months Below 2nd 25th 25th
She has no vomiting, diarrhea or recurrent infections, and her physical exam is otherwise normal. Which of the following is the most appropriate initial step?
- A.Order a sweat chloride test and a celiac antibody panel
- B.Refer to endocrinology for growth hormone evaluation
- C.Take a detailed feeding history with a 3-day food record
- D.Order a skeletal survey and contact protective services
Show answer and explanation
Answer: C. Take a detailed feeding history with a 3-day food record
Her weight-for-length has crossed two major percentile lines and is below the 2nd percentile, which defines faltering growth, while length and head growth are preserved. Most faltering growth is caused by inadequate intake, so a detailed feeding history with a food record and observation of feeding is the first step. Broad testing without clues from the history and exam has low yield, and preserved length makes an endocrine cause unlikely.
Question 7 · Developmental, Behavioral and Mental Health
A 16-year-old girl has moderate major depressive disorder and agrees to start an SSRI. Her father has bipolar I disorder. Before prescribing, which of the following is most important?
- A.Order a baseline liver panel and lipid profile
- B.Screen her for past manic or hypomanic episodes
- C.Obtain a baseline EEG to exclude seizures
- D.Obtain a baseline ECG to measure the QTc interval
Show answer and explanation
Answer: B. Screen her for past manic or hypomanic episodes
Before starting an SSRI, adolescents should be screened for bipolar disorder, because an antidepressant without a mood stabilizer can trigger mania, and a first-degree relative with bipolar disorder raises her risk. Routine ECG, liver tests, lipids and EEG are not required before an SSRI in a healthy adolescent. Close follow-up for suicidality is still needed once treatment begins.
Question 8 · Allergy, Immunology and Rheumatology
A 6-year-old boy is on day 9 of oral cefaclor for sinusitis. He now has fever, an itchy rash of large urticarial plaques with dusky centers on his trunk and limbs, and painful swelling of both hands and ankles. His lips and mouth are normal, there is no blistering, and his urinalysis is normal. Which of the following is the most likely diagnosis?
- A.Serum sickness-like reaction
- B.Systemic juvenile idiopathic arthritis
- C.Stevens-Johnson syndrome
- D.IgA vasculitis
Show answer and explanation
Answer: A. Serum sickness-like reaction
Fever, urticarial or annular plaques with dusky centers and arthralgia or periarticular swelling about 1 to 3 weeks into a course of an antibiotic, classically cefaclor or amoxicillin, is a serum sickness-like reaction. Treatment is stopping the drug and giving antihistamines and NSAIDs; it resolves without lasting damage. Stevens-Johnson syndrome involves mucosal erosions and epidermal detachment, IgA vasculitis causes palpable purpura on dependent areas, and systemic JIA requires 6 weeks of arthritis.
Question 9 · Respiratory Disorders
A 2-month-old girl born at term has had 2 days of congestion and cough. She is feeding well with normal wet diapers, her respiratory rate is 44/min with no retractions, and her oxygen saturation is 97%. The NP diagnoses mild bronchiolitis and plans home care. Which of the following is the most appropriate teaching for her parents?
- A.Honey at bedtime is a safe and effective way to ease her cough
- B.The cough should be gone within 3 days, so return if it persists
- C.Symptoms often peak on days 3-5; return for pauses in breathing
- D.Use albuterol at home if the wheezing increases overnight
Show answer and explanation
Answer: C. Symptoms often peak on days 3-5; return for pauses in breathing
Bronchiolitis symptoms usually worsen and peak around days 3 to 5, and the cough can last 2 to 4 weeks, so parents should be taught warning signs: apnea or pauses in breathing, increased work of breathing, cyanosis, poor feeding or fewer wet diapers. A cough lasting beyond 3 days is expected, not a reason for concern by itself. Honey is contraindicated before 12 months because of infant botulism, and albuterol is not recommended for bronchiolitis.
Question 10 · Musculoskeletal Disorders
A 7-year-old girl fell on her outstretched hand and has tenderness over the distal radius. X-rays show a buckle (torus) fracture of the distal radial metaphysis with no angulation and an intact cortex on the opposite side. Which of the following is the most appropriate management?
- A.Removable wrist splint for about 3 weeks
- B.Closed reduction under sedation by an orthopedist
- C.Long-arm cast for 6 weeks with x-rays every week
- D.Elastic bandage only, with full sports the next day
Show answer and explanation
Answer: A. Removable wrist splint for about 3 weeks
Buckle fractures are stable compression injuries, and a removable wrist splint for about 3 weeks gives outcomes equal to casting with better comfort and function. Repeat x-rays and orthopedic follow-up are generally not needed. Reduction is unnecessary without angulation, and an elastic bandage with immediate return to sports gives inadequate protection.

Time point	Weight
Birth	3,200 g
Hospital discharge (day 2)	3,010 g
Today (day 5)	2,880 g

Finding	Result
Blood pressure	98/60 mm Hg
Skin	Fading palpable purpura on buttocks and legs
Abdomen	Soft, nontender
Urinalysis	Negative for blood and protein
Platelet count at diagnosis	310,000/mm3

Visit	Weight-for-length	Length-for-age	Head circumference
4 months	50th	25th	25th
6 months	25th	25th	25th
10 months	Below 2nd	25th	25th

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