NR602 Final Exam PEDS 2026/2027 Actual Exam with Detailed
Rationales | Complete Exam-Style Questions | 100% Verified Pass
Guaranteed – A+ Graded
Total Questions: 75 | Time: 90 min | Pass: 80%
TABLE OF CONTENTS
Section 1 | Growth & Development Milestones | Q1 – Q15
Section 2 | Pediatric Acute Illnesses | Q16 – Q30
Section 3 | Pediatric Chronic Conditions | Q31 – Q45
Section 4 | Pediatric Pharmacology & Immunizations | Q46 – Q60
Section 5 | Adolescent Health & Behavioral Pediatrics | Q61 – Q75
Instructions: Choose the single best answer. Pass: 80% in 90 minutes.
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SECTION 1: GROWTH & DEVELOPMENT MILESTONES Q1 – Q15
══════════════════════════════════════
Question 1 of 75
A mother brings her 4-month-old infant to the clinic for a well-child visit. During the
physical exam, the nurse practitioner elicits the Moro reflex by allowing the infant's head
to drop back slightly while supporting the body. The mother asks when this reflex
should no longer be present.
A. By 2 months of age
B. By 4 to 6 months of age ✓ CORRECT
C. By 8 to 10 months of age
D. By 12 months of age
Correct Answer: B
Rationale: The Moro reflex typically disappears by 4 to 6 months of age, and its
persistence beyond this timeframe may indicate neuromuscular dysfunction. Waiting
,until 8 to 10 months or 12 months is too long, as the reflex should integrate well before
the infant begins sitting independently. Persistent primitive reflexes warrant referral for
further neurologic evaluation.
Question 2 of 75
During a routine 6-month well-child visit, a nurse practitioner measures the infant's head
circumference and plots it on the WHO growth chart. The measurement falls at the 90th
percentile, while the length and weight are both at the 50th percentile. The infant's
previous head circumference at 2 months was at the 50th percentile.
A. Reassure the parents that this is a normal variant of growth
B. Schedule the infant for a repeat measurement in 2 weeks
C. Order a thyroid function panel to evaluate for underlying pathology
D. Refer for neuroimaging and evaluate for possible hydrocephalus ✓ CORRECT
Correct Answer: D
Rationale: A rapid upward crossing of percentiles in head circumference, especially
when out of proportion to length and weight, is a red flag for pathologic head growth
such as hydrocephalus or intracranial mass. Reassurance is inappropriate when growth
curves show significant percentile crossing, and a thyroid panel does not address the
primary concern of accelerated head growth. Early imaging and neurosurgical
consultation can prevent long-term complications.
Question 3 of 75
A father expresses concern at his 20-month-old son's 18-month well-child visit, which
was delayed due to a family move. He notes that the toddler says "mama" and "dada"
but has not yet combined two words into short phrases. He asks if speech therapy
should be started immediately.
,A. Reassure the father that two-word phrases are expected closer to 24 months, and
recheck at the 2-year visit ✓ CORRECT
B. Refer immediately for speech therapy because the child is already 20 months old
C. Order a formal audiologic evaluation before making any decisions about speech
D. Explain that most children use three-word sentences by 18 months and this is
delayed
Correct Answer: A
Rationale: Expressive language milestones expect a vocabulary of about 50 words and
two-word phrases by 24 months, so a 20-month-old who uses single words
appropriately is still within normal limits. Immediate referral for speech therapy is
premature without additional red flags such as loss of previously acquired skills or lack
of social engagement. If the child is not combining words by the 24-month visit, then
further evaluation and early intervention referral would be warranted.
Question 4 of 75
A 9-month-old infant is seen for a routine checkup. The mother mentions that the baby
can now pick up small pieces of cereal using the thumb and forefinger. She asks the
nurse practitioner what the next fine motor milestone she should expect to see.
A. Transferring objects from one hand to the other
B. Scribbling with a crayon using a palmar grasp
C. Building a tower of two cubes ✓ CORRECT
D. Drawing a circle
Correct Answer: C
Rationale: The pincer grasp typically emerges around 9 to 10 months, and the next
sequential fine motor milestone is building a tower of two cubes by approximately 15
months. Scribbling with a crayon usually appears around 12 to 15 months, and drawing
a circle is not expected until approximately 3 years of age. Understanding the sequence
of fine motor development helps parents anticipate age-appropriate play and safety
needs.
, Question 5 of 75
A 10-month-old infant is brought to the clinic for a routine visit. The parents are
concerned because their baby is crawling but not yet walking independently. They note
that the older sibling walked at 10 months. The infant pulls to stand, cruises along
furniture, and walks with both hands held.
A. Order hip ultrasound to rule out developmental dysplasia
B. Reassure the parents that independent walking typically occurs by 12 months ✓
CORRECT
C. Refer to early intervention for gross motor delay
D. Recommend daily assisted walking with a push toy to accelerate development
Correct Answer: B
Rationale: Independent walking is a gross motor milestone typically achieved by 12
months, with a normal range extending to 15 months, so a 10-month-old who cruises
and walks with support is on track. Referring to early intervention or ordering imaging is
unnecessary without additional signs of neuromuscular or orthopedic pathology.
Comparing siblings often creates unnecessary anxiety, as developmental timelines vary
considerably among children.
Question 6 of 75
A nurse practitioner is performing developmental surveillance during a 15-month
well-child visit. The parents ask what the Denver-II screening tool actually measures,
since they remember it from a previous sibling's visit.
A. It assesses personal-social, fine motor, gross motor, and language milestones across
age groups ✓ CORRECT
B. It screens exclusively for autism spectrum disorder in children under 3 years
C. It measures intelligence quotient and predicts future academic performance
D. It evaluates only gross motor and visual tracking skills in newborns
Correct Answer: A
Rationales | Complete Exam-Style Questions | 100% Verified Pass
Guaranteed – A+ Graded
Total Questions: 75 | Time: 90 min | Pass: 80%
TABLE OF CONTENTS
Section 1 | Growth & Development Milestones | Q1 – Q15
Section 2 | Pediatric Acute Illnesses | Q16 – Q30
Section 3 | Pediatric Chronic Conditions | Q31 – Q45
Section 4 | Pediatric Pharmacology & Immunizations | Q46 – Q60
Section 5 | Adolescent Health & Behavioral Pediatrics | Q61 – Q75
Instructions: Choose the single best answer. Pass: 80% in 90 minutes.
══════════════════════════════════════
SECTION 1: GROWTH & DEVELOPMENT MILESTONES Q1 – Q15
══════════════════════════════════════
Question 1 of 75
A mother brings her 4-month-old infant to the clinic for a well-child visit. During the
physical exam, the nurse practitioner elicits the Moro reflex by allowing the infant's head
to drop back slightly while supporting the body. The mother asks when this reflex
should no longer be present.
A. By 2 months of age
B. By 4 to 6 months of age ✓ CORRECT
C. By 8 to 10 months of age
D. By 12 months of age
Correct Answer: B
Rationale: The Moro reflex typically disappears by 4 to 6 months of age, and its
persistence beyond this timeframe may indicate neuromuscular dysfunction. Waiting
,until 8 to 10 months or 12 months is too long, as the reflex should integrate well before
the infant begins sitting independently. Persistent primitive reflexes warrant referral for
further neurologic evaluation.
Question 2 of 75
During a routine 6-month well-child visit, a nurse practitioner measures the infant's head
circumference and plots it on the WHO growth chart. The measurement falls at the 90th
percentile, while the length and weight are both at the 50th percentile. The infant's
previous head circumference at 2 months was at the 50th percentile.
A. Reassure the parents that this is a normal variant of growth
B. Schedule the infant for a repeat measurement in 2 weeks
C. Order a thyroid function panel to evaluate for underlying pathology
D. Refer for neuroimaging and evaluate for possible hydrocephalus ✓ CORRECT
Correct Answer: D
Rationale: A rapid upward crossing of percentiles in head circumference, especially
when out of proportion to length and weight, is a red flag for pathologic head growth
such as hydrocephalus or intracranial mass. Reassurance is inappropriate when growth
curves show significant percentile crossing, and a thyroid panel does not address the
primary concern of accelerated head growth. Early imaging and neurosurgical
consultation can prevent long-term complications.
Question 3 of 75
A father expresses concern at his 20-month-old son's 18-month well-child visit, which
was delayed due to a family move. He notes that the toddler says "mama" and "dada"
but has not yet combined two words into short phrases. He asks if speech therapy
should be started immediately.
,A. Reassure the father that two-word phrases are expected closer to 24 months, and
recheck at the 2-year visit ✓ CORRECT
B. Refer immediately for speech therapy because the child is already 20 months old
C. Order a formal audiologic evaluation before making any decisions about speech
D. Explain that most children use three-word sentences by 18 months and this is
delayed
Correct Answer: A
Rationale: Expressive language milestones expect a vocabulary of about 50 words and
two-word phrases by 24 months, so a 20-month-old who uses single words
appropriately is still within normal limits. Immediate referral for speech therapy is
premature without additional red flags such as loss of previously acquired skills or lack
of social engagement. If the child is not combining words by the 24-month visit, then
further evaluation and early intervention referral would be warranted.
Question 4 of 75
A 9-month-old infant is seen for a routine checkup. The mother mentions that the baby
can now pick up small pieces of cereal using the thumb and forefinger. She asks the
nurse practitioner what the next fine motor milestone she should expect to see.
A. Transferring objects from one hand to the other
B. Scribbling with a crayon using a palmar grasp
C. Building a tower of two cubes ✓ CORRECT
D. Drawing a circle
Correct Answer: C
Rationale: The pincer grasp typically emerges around 9 to 10 months, and the next
sequential fine motor milestone is building a tower of two cubes by approximately 15
months. Scribbling with a crayon usually appears around 12 to 15 months, and drawing
a circle is not expected until approximately 3 years of age. Understanding the sequence
of fine motor development helps parents anticipate age-appropriate play and safety
needs.
, Question 5 of 75
A 10-month-old infant is brought to the clinic for a routine visit. The parents are
concerned because their baby is crawling but not yet walking independently. They note
that the older sibling walked at 10 months. The infant pulls to stand, cruises along
furniture, and walks with both hands held.
A. Order hip ultrasound to rule out developmental dysplasia
B. Reassure the parents that independent walking typically occurs by 12 months ✓
CORRECT
C. Refer to early intervention for gross motor delay
D. Recommend daily assisted walking with a push toy to accelerate development
Correct Answer: B
Rationale: Independent walking is a gross motor milestone typically achieved by 12
months, with a normal range extending to 15 months, so a 10-month-old who cruises
and walks with support is on track. Referring to early intervention or ordering imaging is
unnecessary without additional signs of neuromuscular or orthopedic pathology.
Comparing siblings often creates unnecessary anxiety, as developmental timelines vary
considerably among children.
Question 6 of 75
A nurse practitioner is performing developmental surveillance during a 15-month
well-child visit. The parents ask what the Denver-II screening tool actually measures,
since they remember it from a previous sibling's visit.
A. It assesses personal-social, fine motor, gross motor, and language milestones across
age groups ✓ CORRECT
B. It screens exclusively for autism spectrum disorder in children under 3 years
C. It measures intelligence quotient and predicts future academic performance
D. It evaluates only gross motor and visual tracking skills in newborns
Correct Answer: A
