RN PEDIATRIC NURSING COMPREHENSIVE EXAM
STUDY GUIDE | 200 PRACTICE MULTIPLE-CHOICE
QUESTIONS & ANSWERS WITH DETAILED
RATIONALES | NCLEX-RN PEDIATRIC EXAM PREP
SECTION 1: GROWTH AND DEVELOPMENT (Questions 1-30)
1. A nurse is assessing a 4-month-old infant during a well-child visit. Which developmental
milestone should the nurse expect to observe?
A) Sits without support
B) Rolls from front to back
C) Transfers objects from hand to hand
D) Walks independently
Answer: B) Rolls from front to back
Rationale: Rolling from front to back typically occurs at 4 months of age. Sitting without
support is expected at 6-8 months, transferring objects occurs at 7 months, and walking
independently occurs at 12-15 months.
2. The nurse is assessing a 2-week-old infant. Which finding requires immediate
intervention?
A) Slight nasal flaring during feeding
B) Periodic breathing with pauses of 5 seconds
C) Presence of a startle reflex
D) Yellowish discoloration of the skin and sclera
Answer: D) Yellowish discoloration of the skin and sclera
Rationale: Yellowish discoloration indicates jaundice. In a 2-week-old, persistent jaundice
may indicate pathologic conditions such as biliary atresia, sepsis, or hemolytic disease,
requiring immediate evaluation.
,3. A mother asks when her infant will be able to sit unsupported. The nurse's best response
is:
A) 4-5 months
B) 6-7 months
C) 8-9 months
D) 10-12 months
Answer: B) 6-7 months
Rationale: Most infants achieve the ability to sit unsupported between 6-7 months of age.
At 4-5 months, infants typically sit with support. At 8-9 months, they are usually crawling
and pulling to stand.
4. According to Erikson's psychosocial development theory, a 3-year-old child is in which
stage?
A) Trust vs. Mistrust
B) Autonomy vs. Shame and Doubt
C) Initiative vs. Guilt
D) Industry vs. Inferiority
Answer: C) Initiative vs. Guilt
Rationale: The Initiative vs. Guilt stage occurs during the preschool years (3-5 years). Trust
vs. Mistrust is birth to 1 year; Autonomy vs. Shame and Doubt is 1-3 years; Industry vs.
Inferiority is 6-12 years.
5. Which play activity is most developmentally appropriate for a 3-year-old child?
A) Playing a board game with rules
B) Playing with a large cardboard box
C) Playing with a remote-controlled car
D) Playing competitive sports
Answer: B) Playing with a large cardboard box
Rationale: Preschoolers (3-5 years) engage in imaginative and symbolic play. A large
cardboard box can become a house, car, or spaceship, fostering creativity. Board games
with rules are more appropriate for school-age children.
6. The parent of a 9-month-old asks why the infant cries when left with a babysitter. The
nurse explains:
,A) "This is colic."
B) "Your baby has separation anxiety, which is normal at this age."
C) "It indicates a developmental delay."
D) "Offer a pacifier immediately."
Answer: B) "Your baby has separation anxiety, which is normal at this age."
Rationale: Separation anxiety peaks between 9-12 months and is a normal developmental
milestone. Colic typically resolves by 4 months.
7. According to Piaget, a 2-year-old child is in which stage of cognitive development?
A) Sensorimotor
B) Preoperational
C) Concrete operational
D) Formal operational
Answer: B) Preoperational
Rationale: The preoperational stage occurs from ages 2-7 years and is characterized by
egocentrism and magical thinking. The sensorimotor stage is birth to 2 years.
8. A parent asks when to expect the anterior fontanelle to close. The nurse responds:
A) 2-3 months
B) 6-8 months
C) 12-18 months
D) 24-36 months
Answer: C) 12-18 months
Rationale: The anterior fontanelle typically closes by 12-18 months of age. The posterior
fontanelle closes by 2-3 months.
9. The nurse is educating parents of a 9-month-old infant regarding injury prevention.
Which statement indicates a need for further teaching?
A) "We will set our water heater temperature to 120°F."
B) "We will keep small objects like coins out of reach."
C) "We will place the baby's crib near the window for fresh air."
D) "We will use a rear-facing car seat until age 2."
Answer: C) "We will place the baby's crib near the window for fresh air."
, Rationale: Placing a crib near a window poses risks of falls, entanglement in cords, and
exposure to drafts. All other statements reflect appropriate safety measures.
10. The mother of a 3-year-old reports the child has a new imaginary friend. How should the
nurse respond?
A) "This is abnormal and needs further evaluation."
B) "Imaginary friends are common and support creativity."
C) "Tell your child the friend is not real."
D) "This indicates social anxiety."
Answer: B) "Imaginary friends are common and support creativity."
Rationale: Imaginary friends are developmentally appropriate in preschool years, aiding
social and emotional development.
11. A nurse is assessing a 6-year-old school-age child. Which developmental task is
expected?
A) The child understands conservation of mass
B) The child thinks abstractly
C) The child has an imaginary friend
D) The child is egocentric
Answer: A) The child understands conservation of mass
Rationale: School-age children in the concrete operational stage (Piaget) understand
conservation of mass, number, and volume. Abstract thinking develops in adolescence.
Imaginary friends and egocentrism are characteristic of preschoolers.
12. The nurse is providing anticipatory guidance to parents of a 15-month-old toddler.
Which statement indicates the parents understand toddler development?
A) "We expect our child to share toys with others."
B) "We understand that negativism is a normal part of toddler development."
C) "Our child should be able to tie shoelaces."
D) "We will begin teaching our child to ride a bicycle."
Answer: B) "We understand that negativism is a normal part of toddler development."
Rationale: Negativism is a normal developmental characteristic of toddlers as they assert
independence. Sharing is not developmentally expected until preschool years. Tying
shoelaces and riding bicycles are skills for older children.
13. Which gross motor milestone is expected in a 10-month-old infant?
STUDY GUIDE | 200 PRACTICE MULTIPLE-CHOICE
QUESTIONS & ANSWERS WITH DETAILED
RATIONALES | NCLEX-RN PEDIATRIC EXAM PREP
SECTION 1: GROWTH AND DEVELOPMENT (Questions 1-30)
1. A nurse is assessing a 4-month-old infant during a well-child visit. Which developmental
milestone should the nurse expect to observe?
A) Sits without support
B) Rolls from front to back
C) Transfers objects from hand to hand
D) Walks independently
Answer: B) Rolls from front to back
Rationale: Rolling from front to back typically occurs at 4 months of age. Sitting without
support is expected at 6-8 months, transferring objects occurs at 7 months, and walking
independently occurs at 12-15 months.
2. The nurse is assessing a 2-week-old infant. Which finding requires immediate
intervention?
A) Slight nasal flaring during feeding
B) Periodic breathing with pauses of 5 seconds
C) Presence of a startle reflex
D) Yellowish discoloration of the skin and sclera
Answer: D) Yellowish discoloration of the skin and sclera
Rationale: Yellowish discoloration indicates jaundice. In a 2-week-old, persistent jaundice
may indicate pathologic conditions such as biliary atresia, sepsis, or hemolytic disease,
requiring immediate evaluation.
,3. A mother asks when her infant will be able to sit unsupported. The nurse's best response
is:
A) 4-5 months
B) 6-7 months
C) 8-9 months
D) 10-12 months
Answer: B) 6-7 months
Rationale: Most infants achieve the ability to sit unsupported between 6-7 months of age.
At 4-5 months, infants typically sit with support. At 8-9 months, they are usually crawling
and pulling to stand.
4. According to Erikson's psychosocial development theory, a 3-year-old child is in which
stage?
A) Trust vs. Mistrust
B) Autonomy vs. Shame and Doubt
C) Initiative vs. Guilt
D) Industry vs. Inferiority
Answer: C) Initiative vs. Guilt
Rationale: The Initiative vs. Guilt stage occurs during the preschool years (3-5 years). Trust
vs. Mistrust is birth to 1 year; Autonomy vs. Shame and Doubt is 1-3 years; Industry vs.
Inferiority is 6-12 years.
5. Which play activity is most developmentally appropriate for a 3-year-old child?
A) Playing a board game with rules
B) Playing with a large cardboard box
C) Playing with a remote-controlled car
D) Playing competitive sports
Answer: B) Playing with a large cardboard box
Rationale: Preschoolers (3-5 years) engage in imaginative and symbolic play. A large
cardboard box can become a house, car, or spaceship, fostering creativity. Board games
with rules are more appropriate for school-age children.
6. The parent of a 9-month-old asks why the infant cries when left with a babysitter. The
nurse explains:
,A) "This is colic."
B) "Your baby has separation anxiety, which is normal at this age."
C) "It indicates a developmental delay."
D) "Offer a pacifier immediately."
Answer: B) "Your baby has separation anxiety, which is normal at this age."
Rationale: Separation anxiety peaks between 9-12 months and is a normal developmental
milestone. Colic typically resolves by 4 months.
7. According to Piaget, a 2-year-old child is in which stage of cognitive development?
A) Sensorimotor
B) Preoperational
C) Concrete operational
D) Formal operational
Answer: B) Preoperational
Rationale: The preoperational stage occurs from ages 2-7 years and is characterized by
egocentrism and magical thinking. The sensorimotor stage is birth to 2 years.
8. A parent asks when to expect the anterior fontanelle to close. The nurse responds:
A) 2-3 months
B) 6-8 months
C) 12-18 months
D) 24-36 months
Answer: C) 12-18 months
Rationale: The anterior fontanelle typically closes by 12-18 months of age. The posterior
fontanelle closes by 2-3 months.
9. The nurse is educating parents of a 9-month-old infant regarding injury prevention.
Which statement indicates a need for further teaching?
A) "We will set our water heater temperature to 120°F."
B) "We will keep small objects like coins out of reach."
C) "We will place the baby's crib near the window for fresh air."
D) "We will use a rear-facing car seat until age 2."
Answer: C) "We will place the baby's crib near the window for fresh air."
, Rationale: Placing a crib near a window poses risks of falls, entanglement in cords, and
exposure to drafts. All other statements reflect appropriate safety measures.
10. The mother of a 3-year-old reports the child has a new imaginary friend. How should the
nurse respond?
A) "This is abnormal and needs further evaluation."
B) "Imaginary friends are common and support creativity."
C) "Tell your child the friend is not real."
D) "This indicates social anxiety."
Answer: B) "Imaginary friends are common and support creativity."
Rationale: Imaginary friends are developmentally appropriate in preschool years, aiding
social and emotional development.
11. A nurse is assessing a 6-year-old school-age child. Which developmental task is
expected?
A) The child understands conservation of mass
B) The child thinks abstractly
C) The child has an imaginary friend
D) The child is egocentric
Answer: A) The child understands conservation of mass
Rationale: School-age children in the concrete operational stage (Piaget) understand
conservation of mass, number, and volume. Abstract thinking develops in adolescence.
Imaginary friends and egocentrism are characteristic of preschoolers.
12. The nurse is providing anticipatory guidance to parents of a 15-month-old toddler.
Which statement indicates the parents understand toddler development?
A) "We expect our child to share toys with others."
B) "We understand that negativism is a normal part of toddler development."
C) "Our child should be able to tie shoelaces."
D) "We will begin teaching our child to ride a bicycle."
Answer: B) "We understand that negativism is a normal part of toddler development."
Rationale: Negativism is a normal developmental characteristic of toddlers as they assert
independence. Sharing is not developmentally expected until preschool years. Tying
shoelaces and riding bicycles are skills for older children.
13. Which gross motor milestone is expected in a 10-month-old infant?
