1
Barkley PNP-PC Diagnostic Readiness Test (DRT) #1
| 100 Pediatric NP Questions and Rationales
Section 1: Growth, Development & Health Promotion (Questions 1–15)
1. A mother brings her 2-month-old infant for a well-child visit. The infant was
born at term and has been exclusively breastfed. Which supplement should the
PNP recommend?
A. Iron 1 mg/kg/day starting now
B. Vitamin D 400 IU daily
C. Fluoride 0.25 mg daily
D. Multivitamin with zinc
: Correct Answer : B
Rationale: Exclusively breastfed infants should receive 400 IU of vitamin D daily
starting in the first few days of life, as breast milk contains insufficient vitamin D.
Iron supplementation begins at 4 months in term infants. Fluoride is not routinely
recommended until tooth eruption, and depends on water fluoridation.
2. A 4-year-old child is brought for a well visit. The PNP calculates a BMI at the
95th percentile for age and sex. According to CDC guidelines, this is classified as:
A. Overweight
B. Obesity
C. Normal weight
D. Morbid obesity
: Correct Answer : B
Rationale: In children, BMI ≥95th percentile defines obesity. Overweight is 85th to
<95th percentile. Morbid obesity is often defined as ≥99th percentile or >120% of
the 95th percentile. This child needs evaluation for comorbidities and lifestyle
intervention.
3. A 12-year-old girl is Tanner stage 2 for breast development and has no pubic
hair. She asks when she will get her first period. The PNP’s best response is:
A. Within the next 3 months
B. About 2–3 years after the start of breast development
pg. 1
,2
C. After pubic hair reaches Tanner stage 4
D. At age 14 regardless of Tanner stage
: Correct Answer : B
Rationale: Menarche typically occurs about 2–3 years after thelarche (breast
development), at an average age of 12.5 years in the US. Pubic hair development
(adrenarche) is a separate process not directly linked to menarche timing.
4. A 9-month-old infant is brought for well-child care. The PNP reviews the
immunization record. Which vaccine should the infant receive today?
A. MMR
B. Varicella
C. Hepatitis B (third dose) and influenza (if in season)
D. HPV
: Correct Answer : C
Rationale: The third dose of hepatitis B is given at 6–18 months. The influenza
vaccine is recommended annually starting at 6 months. MMR and varicella are
given at 12–15 months. HPV is given at 11–12 years.
5. A parent of a 15-month-old toddler is concerned that the child only says
“mama” and “dada.” The PNP’s most appropriate next step is:
A. Reassure that this is normal for age
B. Refer for a full speech and language evaluation
C. Advise hearing screen and if normal, observe; the child should have 3–5 words
by 15 months
D. Order a brain MRI
: Correct Answer : C
*Rationale: By 15 months, a child should have at least 3–5 words in addition to
“mama/dada.” This child has only two words, which warrants a hearing
evaluation. If hearing is normal, close monitoring and speech therapy referral may
be indicated if vocabulary does not increase.*
6. A 6-year-old child needs a physical for school. The PNP asks the child to draw
a person. This task primarily assesses:
A. Gross motor skills
B. Fine motor and cognitive development
pg. 2
,3
C. Hearing acuity
D. Social skills
: Correct Answer : B
*Rationale: Drawing a person is part of developmental screening (e.g., the Denver
II) and assesses fine motor skills and cognitive/visual-perceptual abilities. By age
6, a child should draw a person with at least 6 body parts. It is not a test of gross
motor or hearing.*
7. Which screening tool is recommended by the AAP for developmental
surveillance at all well-child visits?
A. M-CHAT
B. ASQ (Ages and Stages Questionnaire)
C. Denver II
D. Standardized developmental screen is recommended at 9, 18, and 30 months,
with surveillance at every visit
: Correct Answer : D
Rationale: The AAP recommends developmental surveillance at every well-child
visit and formal standardized screening at 9, 18, and 30 months (or 24 months).
The ASQ and M-CHAT are examples of validated screening tools but are not done
at every visit. The M-CHAT is specifically for autism screening at 18 and 24
months.
8. A 2-year-old child has a vocabulary of about 50 words and is beginning to
combine two words. This is:
A. Delayed; the child should speak in full sentences
B. Normal; 2-year-olds typically have a vocabulary of 50+ words and begin
two-word phrases
C. Advanced for age
D. Indicative of autism
: Correct Answer : B
Rationale: By age 2, most children have a vocabulary of at least 50 words and are
starting to combine two words (“more milk”). Strangers should understand about
50% of their speech. Speaking in full sentences is expected at 3–4 years. This is
normal development.
pg. 3
, 4
9. A 4-year-old child can balance on one foot for 4 seconds, copies a circle, and
plays cooperatively with peers. These milestones are consistent with:
A. 2-year-old development
B. 3-year-old development
C. 4-year-old development
D. 5-year-old development
: Correct Answer : C
Rationale: By age 4, a child can balance on one foot for several seconds, copy a
circle (but not a square), and engage in cooperative play. A 5-year-old can balance
longer, copy a square, and skip. These are age-appropriate 4-year-old skills.
10. The first dose of the hepatitis B vaccine is given:
A. At 2 months
B. At birth, before hospital discharge
C. At 6 months
D. At 12 months
: Correct Answer : B
Rationale: The birth dose of hepatitis B vaccine is recommended within 24 hours of
birth for all medically stable newborns. This reduces the risk of perinatal
transmission. The series continues at 1–2 months and 6–18 months.
11. A 5-year-old child can dress and undress independently, draw a person with
6 parts, and is able to name 4 colors. These skills are:
A. Delayed
B. Advanced for age
C. Age-appropriate
D. Need further evaluation
: Correct Answer : C
Rationale: By age 5, a child should be able to dress without help, draw a person
with at least 6 body parts, and name colors. These are appropriate 5-year-old
milestones. If the child were unable to perform these, further evaluation might be
needed, but they are exactly within expectations.
12. A 3-year-old child can walk up stairs alternating feet, speaks in 3-word
sentences, and can copy a circle. These skills are:
pg. 4
Barkley PNP-PC Diagnostic Readiness Test (DRT) #1
| 100 Pediatric NP Questions and Rationales
Section 1: Growth, Development & Health Promotion (Questions 1–15)
1. A mother brings her 2-month-old infant for a well-child visit. The infant was
born at term and has been exclusively breastfed. Which supplement should the
PNP recommend?
A. Iron 1 mg/kg/day starting now
B. Vitamin D 400 IU daily
C. Fluoride 0.25 mg daily
D. Multivitamin with zinc
: Correct Answer : B
Rationale: Exclusively breastfed infants should receive 400 IU of vitamin D daily
starting in the first few days of life, as breast milk contains insufficient vitamin D.
Iron supplementation begins at 4 months in term infants. Fluoride is not routinely
recommended until tooth eruption, and depends on water fluoridation.
2. A 4-year-old child is brought for a well visit. The PNP calculates a BMI at the
95th percentile for age and sex. According to CDC guidelines, this is classified as:
A. Overweight
B. Obesity
C. Normal weight
D. Morbid obesity
: Correct Answer : B
Rationale: In children, BMI ≥95th percentile defines obesity. Overweight is 85th to
<95th percentile. Morbid obesity is often defined as ≥99th percentile or >120% of
the 95th percentile. This child needs evaluation for comorbidities and lifestyle
intervention.
3. A 12-year-old girl is Tanner stage 2 for breast development and has no pubic
hair. She asks when she will get her first period. The PNP’s best response is:
A. Within the next 3 months
B. About 2–3 years after the start of breast development
pg. 1
,2
C. After pubic hair reaches Tanner stage 4
D. At age 14 regardless of Tanner stage
: Correct Answer : B
Rationale: Menarche typically occurs about 2–3 years after thelarche (breast
development), at an average age of 12.5 years in the US. Pubic hair development
(adrenarche) is a separate process not directly linked to menarche timing.
4. A 9-month-old infant is brought for well-child care. The PNP reviews the
immunization record. Which vaccine should the infant receive today?
A. MMR
B. Varicella
C. Hepatitis B (third dose) and influenza (if in season)
D. HPV
: Correct Answer : C
Rationale: The third dose of hepatitis B is given at 6–18 months. The influenza
vaccine is recommended annually starting at 6 months. MMR and varicella are
given at 12–15 months. HPV is given at 11–12 years.
5. A parent of a 15-month-old toddler is concerned that the child only says
“mama” and “dada.” The PNP’s most appropriate next step is:
A. Reassure that this is normal for age
B. Refer for a full speech and language evaluation
C. Advise hearing screen and if normal, observe; the child should have 3–5 words
by 15 months
D. Order a brain MRI
: Correct Answer : C
*Rationale: By 15 months, a child should have at least 3–5 words in addition to
“mama/dada.” This child has only two words, which warrants a hearing
evaluation. If hearing is normal, close monitoring and speech therapy referral may
be indicated if vocabulary does not increase.*
6. A 6-year-old child needs a physical for school. The PNP asks the child to draw
a person. This task primarily assesses:
A. Gross motor skills
B. Fine motor and cognitive development
pg. 2
,3
C. Hearing acuity
D. Social skills
: Correct Answer : B
*Rationale: Drawing a person is part of developmental screening (e.g., the Denver
II) and assesses fine motor skills and cognitive/visual-perceptual abilities. By age
6, a child should draw a person with at least 6 body parts. It is not a test of gross
motor or hearing.*
7. Which screening tool is recommended by the AAP for developmental
surveillance at all well-child visits?
A. M-CHAT
B. ASQ (Ages and Stages Questionnaire)
C. Denver II
D. Standardized developmental screen is recommended at 9, 18, and 30 months,
with surveillance at every visit
: Correct Answer : D
Rationale: The AAP recommends developmental surveillance at every well-child
visit and formal standardized screening at 9, 18, and 30 months (or 24 months).
The ASQ and M-CHAT are examples of validated screening tools but are not done
at every visit. The M-CHAT is specifically for autism screening at 18 and 24
months.
8. A 2-year-old child has a vocabulary of about 50 words and is beginning to
combine two words. This is:
A. Delayed; the child should speak in full sentences
B. Normal; 2-year-olds typically have a vocabulary of 50+ words and begin
two-word phrases
C. Advanced for age
D. Indicative of autism
: Correct Answer : B
Rationale: By age 2, most children have a vocabulary of at least 50 words and are
starting to combine two words (“more milk”). Strangers should understand about
50% of their speech. Speaking in full sentences is expected at 3–4 years. This is
normal development.
pg. 3
, 4
9. A 4-year-old child can balance on one foot for 4 seconds, copies a circle, and
plays cooperatively with peers. These milestones are consistent with:
A. 2-year-old development
B. 3-year-old development
C. 4-year-old development
D. 5-year-old development
: Correct Answer : C
Rationale: By age 4, a child can balance on one foot for several seconds, copy a
circle (but not a square), and engage in cooperative play. A 5-year-old can balance
longer, copy a square, and skip. These are age-appropriate 4-year-old skills.
10. The first dose of the hepatitis B vaccine is given:
A. At 2 months
B. At birth, before hospital discharge
C. At 6 months
D. At 12 months
: Correct Answer : B
Rationale: The birth dose of hepatitis B vaccine is recommended within 24 hours of
birth for all medically stable newborns. This reduces the risk of perinatal
transmission. The series continues at 1–2 months and 6–18 months.
11. A 5-year-old child can dress and undress independently, draw a person with
6 parts, and is able to name 4 colors. These skills are:
A. Delayed
B. Advanced for age
C. Age-appropriate
D. Need further evaluation
: Correct Answer : C
Rationale: By age 5, a child should be able to dress without help, draw a person
with at least 6 body parts, and name colors. These are appropriate 5-year-old
milestones. If the child were unable to perform these, further evaluation might be
needed, but they are exactly within expectations.
12. A 3-year-old child can walk up stairs alternating feet, speaks in 3-word
sentences, and can copy a circle. These skills are:
pg. 4
