NUR 128 – PEDIATRIC NURSING Comprehensive
Pediatric Nursing Study Guide Child Health
Assessment, Pediatric Disorders, Growth and
Development, and Practice Questions with Detailed
Answers & Rationales
1. A 4-month-old infant is brought to the well-child clinic for a routine visit.
The nurse assesses the infant's developmental milestones. Which finding
indicates that the infant is meeting expected developmental milestones for this
age?
A) Sits without support
B) Rolls from back to abdomen
C) Transfers objects from hand to hand
D) Exhibits stranger anxiety
Answer: B
Rationale: At 4 months, infants typically can roll from back to abdomen, hold
their head steady, and bring objects to their mouth. Sitting without support occurs
at 6-8 months. Transferring objects occurs at 6-7 months. Stranger anxiety begins
at 6-9 months. The nurse should assess for these age-appropriate milestones and
document findings.
2. A 2-year-old child is demonstrating temper tantrums and says "no"
frequently. The parents express concern about this behavior. What is the best
response by the nurse?
A) "Your child is exhibiting oppositional defiant disorder and needs evaluation."
B) "This is normal behavior for a 2-year-old who is developing autonomy."
C) "You should discipline the child more strictly to stop this behavior."
D) "This behavior indicates a developmental delay."
Answer: B
Rationale: According to Erikson's psychosocial development theory, the toddler
stage (ages 1-3 years) is characterized by the conflict of autonomy vs. shame and
doubt. Saying "no" and having temper tantrums are normal expressions of
,developing autonomy and independence. The nurse should educate parents about
age-appropriate behaviors and provide guidance on setting limits.
3. A school-age child is struggling with feelings of inferiority because they
cannot keep up with peers in reading. According to Erikson, which stage of
development is this child experiencing?
A) Trust vs. Mistrust
B) Autonomy vs. Shame and Doubt
C) Initiative vs. Guilt
D) Industry vs. Inferiority
Answer: D
Rationale: According to Erikson, school-age children (6-12 years) are in the
industry vs. inferiority stage. During this stage, children develop a sense of
competence and achievement through learning new skills. If children struggle to
meet expectations, they may develop feelings of inferiority. The nurse should
support the child's strengths and help them develop a sense of accomplishment.
4. A 15-year-old adolescent is exploring different identities and questioning
parental values. Which developmental task is the adolescent primarily
engaged in?
A) Developing autonomy from parents
B) Forming intimate relationships
C) Achieving a sense of identity
D) Establishing a career path
Answer: C
Rationale: According to Erikson, adolescence (12-18 years) is the identity vs. role
confusion stage. Adolescents explore different identities, question values, and try
to develop a sense of self. While autonomy is important, the primary task is
forming a coherent identity. Intimacy is the focus of young adulthood (Erikson's
intimacy vs. isolation stage).
,5. The nurse is performing a developmental screening on a 9-month-old
infant. Which finding would be concerning at this age?
A) Babbles and imitates sounds
B) Crawls on hands and knees
C) Pulls to standing position
D) Does not respond to name or sounds
Answer: D
Rationale: By 9 months, infants should respond to their name and turn toward
sounds. Lack of response to name or sounds may indicate hearing impairment or
developmental delay. Babbles, crawling, and pulling to stand are expected at this
age. The nurse should refer for further hearing and developmental evaluation.
6. A 3-year-old child is playing alongside other children but not interacting
with them. The parent asks the nurse if this is normal. Which developmental
stage of play does this describe?
A) Solitary play
B) Onlooker play
C) Parallel play
D) Associative play
Answer: C
Rationale: Parallel play is common in toddlers and preschoolers (ages 2-4), where
children play alongside each other without direct interaction. Solitary play is
typical in infants. Onlooker play is when children watch others. Associative play
involves interaction and begins in the preschool years. The nurse should reassure
the parent that this is normal for a 3-year-old.
7. A 7-year-old child is in Piaget's concrete operational stage. Which cognitive
ability would the nurse expect the child to demonstrate?
A) Abstract thinking
B) Conservation of mass and number
C) Object permanence
D) Egocentric thinking
, Answer: B
Rationale: In Piaget's concrete operational stage (ages 7-11), children develop the
ability to think logically about concrete events and understand conservation (the
understanding that quantity remains the same despite changes in shape). Abstract
thinking develops in the formal operational stage. Object permanence develops in
the sensorimotor stage. Egocentric thinking is characteristic of the preoperational
stage (ages 2-7).
8. A 16-year-old adolescent is in the emergency department after a motor
vehicle accident. The nurse notes that the adolescent is accompanied by
friends who are all very anxious. Which nursing intervention is most
appropriate for this age group?
A) Allow friends to stay with the adolescent
B) Restrict visitors to parents only
C) Send friends to the waiting room
D) Allow only the adolescent's best friend to stay
Answer: A
Rationale: During adolescence, peer relationships are very important. Allowing
friends to stay can provide emotional support and reduce anxiety. Adolescents
often rely on their peer group for support. The nurse should respect the adolescent's
need for peer support while also ensuring appropriate family involvement. Parents
should also be included in the care plan.
9. A 2-week-old infant is brought to the clinic for a well-child visit. The
mother asks the nurse about normal newborn reflexes. The nurse assesses the
infant's Moro reflex. Which response is expected?
A) The infant extends and then flexes the arms and legs
B) The infant turns toward a stimulus on the cheek
C) The infant grasps the examiner's finger
D) The infant takes steps when held upright
Answer: A
Rationale: The Moro reflex (startle reflex) is elicited by a sudden change in
position or loud noise. The expected response is extension and abduction of the
Pediatric Nursing Study Guide Child Health
Assessment, Pediatric Disorders, Growth and
Development, and Practice Questions with Detailed
Answers & Rationales
1. A 4-month-old infant is brought to the well-child clinic for a routine visit.
The nurse assesses the infant's developmental milestones. Which finding
indicates that the infant is meeting expected developmental milestones for this
age?
A) Sits without support
B) Rolls from back to abdomen
C) Transfers objects from hand to hand
D) Exhibits stranger anxiety
Answer: B
Rationale: At 4 months, infants typically can roll from back to abdomen, hold
their head steady, and bring objects to their mouth. Sitting without support occurs
at 6-8 months. Transferring objects occurs at 6-7 months. Stranger anxiety begins
at 6-9 months. The nurse should assess for these age-appropriate milestones and
document findings.
2. A 2-year-old child is demonstrating temper tantrums and says "no"
frequently. The parents express concern about this behavior. What is the best
response by the nurse?
A) "Your child is exhibiting oppositional defiant disorder and needs evaluation."
B) "This is normal behavior for a 2-year-old who is developing autonomy."
C) "You should discipline the child more strictly to stop this behavior."
D) "This behavior indicates a developmental delay."
Answer: B
Rationale: According to Erikson's psychosocial development theory, the toddler
stage (ages 1-3 years) is characterized by the conflict of autonomy vs. shame and
doubt. Saying "no" and having temper tantrums are normal expressions of
,developing autonomy and independence. The nurse should educate parents about
age-appropriate behaviors and provide guidance on setting limits.
3. A school-age child is struggling with feelings of inferiority because they
cannot keep up with peers in reading. According to Erikson, which stage of
development is this child experiencing?
A) Trust vs. Mistrust
B) Autonomy vs. Shame and Doubt
C) Initiative vs. Guilt
D) Industry vs. Inferiority
Answer: D
Rationale: According to Erikson, school-age children (6-12 years) are in the
industry vs. inferiority stage. During this stage, children develop a sense of
competence and achievement through learning new skills. If children struggle to
meet expectations, they may develop feelings of inferiority. The nurse should
support the child's strengths and help them develop a sense of accomplishment.
4. A 15-year-old adolescent is exploring different identities and questioning
parental values. Which developmental task is the adolescent primarily
engaged in?
A) Developing autonomy from parents
B) Forming intimate relationships
C) Achieving a sense of identity
D) Establishing a career path
Answer: C
Rationale: According to Erikson, adolescence (12-18 years) is the identity vs. role
confusion stage. Adolescents explore different identities, question values, and try
to develop a sense of self. While autonomy is important, the primary task is
forming a coherent identity. Intimacy is the focus of young adulthood (Erikson's
intimacy vs. isolation stage).
,5. The nurse is performing a developmental screening on a 9-month-old
infant. Which finding would be concerning at this age?
A) Babbles and imitates sounds
B) Crawls on hands and knees
C) Pulls to standing position
D) Does not respond to name or sounds
Answer: D
Rationale: By 9 months, infants should respond to their name and turn toward
sounds. Lack of response to name or sounds may indicate hearing impairment or
developmental delay. Babbles, crawling, and pulling to stand are expected at this
age. The nurse should refer for further hearing and developmental evaluation.
6. A 3-year-old child is playing alongside other children but not interacting
with them. The parent asks the nurse if this is normal. Which developmental
stage of play does this describe?
A) Solitary play
B) Onlooker play
C) Parallel play
D) Associative play
Answer: C
Rationale: Parallel play is common in toddlers and preschoolers (ages 2-4), where
children play alongside each other without direct interaction. Solitary play is
typical in infants. Onlooker play is when children watch others. Associative play
involves interaction and begins in the preschool years. The nurse should reassure
the parent that this is normal for a 3-year-old.
7. A 7-year-old child is in Piaget's concrete operational stage. Which cognitive
ability would the nurse expect the child to demonstrate?
A) Abstract thinking
B) Conservation of mass and number
C) Object permanence
D) Egocentric thinking
, Answer: B
Rationale: In Piaget's concrete operational stage (ages 7-11), children develop the
ability to think logically about concrete events and understand conservation (the
understanding that quantity remains the same despite changes in shape). Abstract
thinking develops in the formal operational stage. Object permanence develops in
the sensorimotor stage. Egocentric thinking is characteristic of the preoperational
stage (ages 2-7).
8. A 16-year-old adolescent is in the emergency department after a motor
vehicle accident. The nurse notes that the adolescent is accompanied by
friends who are all very anxious. Which nursing intervention is most
appropriate for this age group?
A) Allow friends to stay with the adolescent
B) Restrict visitors to parents only
C) Send friends to the waiting room
D) Allow only the adolescent's best friend to stay
Answer: A
Rationale: During adolescence, peer relationships are very important. Allowing
friends to stay can provide emotional support and reduce anxiety. Adolescents
often rely on their peer group for support. The nurse should respect the adolescent's
need for peer support while also ensuring appropriate family involvement. Parents
should also be included in the care plan.
9. A 2-week-old infant is brought to the clinic for a well-child visit. The
mother asks the nurse about normal newborn reflexes. The nurse assesses the
infant's Moro reflex. Which response is expected?
A) The infant extends and then flexes the arms and legs
B) The infant turns toward a stimulus on the cheek
C) The infant grasps the examiner's finger
D) The infant takes steps when held upright
Answer: A
Rationale: The Moro reflex (startle reflex) is elicited by a sudden change in
position or loud noise. The expected response is extension and abduction of the
