PNCB CPNP-PCFree Pediatric Nurse Practitioner Primary Care practice test

Correct answer: C. Whether the nipple is inverted

An inverted nipple can be harder for a newborn to grasp during the first days of breastfeeding since it resists being drawn into the infant's mouth. Although a nipple may appear inverted on visual inspection, compressing the areola -- the pinch test -- is needed to confirm this. If compression draws the nipple inward, it is truly inverted; if it stays put or protrudes outward (the more typical result), the nipple is classified as flat rather than inverted. As nursing continues with a genuinely inverted nipple, the tissue gradually stretches inside the infant's mouth, and the latching difficulty often eases over time. With patience and good technique, breastfeeding can still succeed. Flat and inverted nipples usually don't change shape on their own, but infants typically learn to adapt their latch.

Correct answer: D. Down syndrome

These exam and imaging findings point to tetralogy of Fallot (TOF), a congenital cardiac anomaly comprising four structural abnormalities that arise from progressive obstruction of right ventricular outflow: a ventricular septal defect, pulmonary stenosis, an aorta that overrides the septum, and right ventricular hypertrophy. TOF is the leading cause of cyanotic congenital heart disease, is somewhat more frequent in boys, and ranges widely in severity. Infants with Down syndrome or 22q11.2 deletion (DiGeorge) syndrome carry an elevated likelihood of this defect.

Correct answer: B. Mycoplasma pneumoniae

Among school-age children, community-acquired bacterial pneumonia is most often driven by M. pneumoniae, C. pneumoniae, S. pneumoniae, and M. tuberculosis. Infection with M. pneumoniae tends to develop gradually, producing a lingering cough, malaise, and headache, typically alongside a fever above roughly 102 F. H. influenzae can also cause pneumonia in this age range but is encountered less frequently. C. trachomatis pneumonia is characteristic of infants between 1 and 3 months old, while viral causes such as RSV predominate in children younger than 2.

Correct answer: A. Wiskott-Aldrich syndrome

Wiskott-Aldrich syndrome is an X-linked immunodeficiency marked by the classic triad of low platelets, eczema, and recurrent infection. Affected infants commonly show easy bruising, petechiae, and bleeding tendencies from thrombocytopenia, paired with atopic skin disease and frequent infections starting early in life. Selective IgA deficiency usually causes repeated mucosal infections without low platelets or eczema. Severe combined immunodeficiency produces severe, life-threatening infections very early in infancy with marked lymphocyte abnormalities, but eczema and thrombocytopenia are not part of its defining picture. DiGeorge syndrome involves cardiac defects, low calcium, thymic underdevelopment, and distinctive facial features rather than the eczema-thrombocytopenia combination seen here.

Correct answer: C. Increased lymphocytes

Aseptic meningitis reflects meningeal inflammation, usually presenting with the acute triad of headache, neck stiffness, and fever. CSF analysis typically shows a mononuclear pleocytosis dominated by monocytes, macrophages, and lymphocytes; protein that is normal or only mildly elevated; glucose that is normal or occasionally low; and no organisms seen on Gram stain or recovered on culture. Viral pathogens, not bacteria, cause the large majority of cases, with enteroviruses and arboviruses responsible for up to 90%. Fever and headache are the most consistent symptoms. In short, expect a lymphocyte-predominant CSF profile with normal glucose, normal-to-mildly-elevated protein, and negative bacterial antigen testing.

Correct answer: B. Increased mechanical load across an open proximal femoral growth plate

Slipped capital femoral epiphysis occurs when shear forces act on a still-open proximal femoral growth plate during adolescence, especially amid rapid growth. Excessive mechanical stress on a hormonally softened physis allows the epiphysis to displace relative to the metaphysis, which is why the condition correlates strongly with higher body weight and accelerated growth. Autoimmune synovitis characterizes inflammatory joint disease but does not destabilize the physis or cause epiphyseal slippage. Long-standing high blood sugar damages small vessels and nerves but doesn't directly soften the growth plate or trigger mechanical displacement. A sudden systemic infection might cause transient synovitis or a septic joint but isn't responsible for the chronic biomechanical failure underlying this condition.

Correct answer: D. Type IV

A fracture spanning the metaphysis, physis, and epiphysis matches the Type IV pattern, which often needs precise -- frequently surgical -- realignment to heal properly. A Type II fracture involves the physis and metaphysis with a metaphyseal fragment on the compression side. A Type III fracture separates through the physis and extends into the joint via the epiphysis. A Type V fracture represents a crush injury to the growth plate itself.

Correct answer: B. Pityriasis rosea

Pityriasis rosea typically begins in teens with a herald patch, followed by a more widespread eruption distributed along Langer's lines in a pattern often likened to a Christmas tree. It is self-resolving, has low contagiousness, and characteristically fails to respond to antifungal treatment -- a clue that helps rule out a fungal infection. Counseling should focus on reassurance, symptom relief, and return-to-sport guidance. Tinea corporis usually shows ring-shaped lesions that keep expanding outward and generally does respond to antifungal therapy rather than spreading along skin tension lines. Stevens-Johnson syndrome is a severe, acute mucocutaneous reaction with systemic illness, target-shaped lesions, and mucosal involvement -- none of which are present here. Guttate psoriasis produces numerous small, drop-shaped papules, often after a strep infection, and doesn't begin with a herald patch or follow the tension-line distribution described.

Correct answer: C. Pelvic exam and cervical cultures

This presentation is consistent with pelvic inflammatory disease (PID), which often has subtle and variable symptoms in teenagers and can therefore go unrecognized -- raising the risk of complications such as tubal scarring leading to ectopic pregnancy and infertility, chronic pelvic pain, and tubo-ovarian abscess. Risk factors include young age, multiple partners, and the high background rate of STIs in this population. Onset tends to cluster within a week of the last menstrual period. Typical features include diffuse pelvic discomfort (often with lower-quadrant or even right-upper-quadrant tenderness), fever, nausea, cervical discharge, and pain with intercourse, along with cervical motion, uterine, and adnexal tenderness on exam. No single test reliably diagnoses PID, and many cases are subclinical. The diagnosis rests on clinical judgment, with labs and imaging mainly useful to exclude other causes. Current guidance supports presumptive treatment in sexually active young women with pelvic or lower abdominal pain lacking another clear explanation. A CBC may hint at infection but won't establish the diagnosis. Urinalysis and culture are reserved for suspected pyelonephritis or cystitis. Pelvic ultrasound becomes useful if adnexal enlargement or tubo-ovarian abscess is suspected.

Correct answer: B. Congenital hypothyroidism

Congenital hypothyroidism (CH) affects roughly 1 in 2,500 infants in North America, with rates varying by region and ethnicity and a higher frequency in girls. It stems from abnormal fetal thyroid development or impaired hormone synthesis. CH is the leading preventable cause of intellectual disability; left untreated, it can cause permanent brain injury along with growth failure, hearing loss, and other neurologic deficits. Although newborn screening programs test for CH nationwide, recognizing its clinical signs remains important in case a child was never screened or a lab error occurred. Classic early signs include prolonged jaundice, an umbilical hernia, and constipation, often accompanied by enlarged anterior and posterior fontanelles, low muscle tone, and poor feeding. Some infants also show breathing difficulty and poor circulation. Kernicterus -- bilirubin-related brain injury from very high bilirubin levels -- would need more supporting evidence to be the diagnosis here. CF and PKU are also part of newborn screening; CF often presents with meconium ileus (failure to pass meconium), while PKU causes a distinctive musty urine odor from impaired phenylalanine metabolism.