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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
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