NRNP 6541 Advanced Simplified Nursing Final
Actual Exam – Walden University – 2026/2027
Academic Year – Verified Questions and Answers
1. A 4-year-old child insists that a tall, thin glass contains more juice than a short, wide glass
even after watching the same amount poured from one to the other. According to Piaget, this
child has not yet achieved which principle?
A) Object permanence
B) Conservation
C) Reversibility
D) Seriation
Correct Answer: B
Rationale: Piaget's preoperational stage (2–7 years) is marked by centration and lack of
conservation; the child focuses on one dimension (height) and cannot mentally reverse the
pouring action. Object permanence is achieved in the sensorimotor stage. Seriation and
reversibility are concrete operational achievements (7–11 years).
2. A mother reports that her 2-year-old can put two words together, follows one-step
commands, and points to body parts when named. The nurse recognizes these skills as which
of the following?
A) Advanced for age
B) Typical for a 2-year-old
C) Delayed, requiring speech therapy
D) Typical for a 12-month-old
Correct Answer: B
Rationale: At 2 years, a child speaks in 2- to 3-word sentences, understands simple
commands, and knows body parts. These are age-appropriate milestones. A 12-month-old says
single words and points. Advanced skills would include 3-word sentences. No speech therapy is
needed.
,3. During a well-child visit, a 3-year-old is asked to copy a circle. The child produces a closed,
round shape. This fine motor skill is considered which of the following?
A) A 2-year milestone
B) A 3-year milestone
C) A 4-year milestone
D) A 5-year milestone
Correct Answer: B
Rationale: Copying a circle is a fine motor milestone expected at 3 years. A 2-year-old copies
a vertical line; a 4-year-old copies a cross; a 5-year-old copies a square. Mastering circle copying
reflects appropriate hand-eye coordination and pencil control for this age.
4. A parent of a 6-month-old infant reports the child can roll from back to stomach, reach for
objects, and transfer a toy between hands but does not wave bye-bye. The nurse should take
which action?
A) Refer for early intervention
B) Reassure that these are normal findings
C) Evaluate for hearing loss
D) Order a brain MRI
Correct Answer: B
Rationale: At 6 months, infants roll, grasp, transfer objects, and reach, but waving bye-bye
emerges around 9–10 months. The described skills are developmentally appropriate; no referral
or testing is needed. Providing reassurance supports parental confidence and accurate
expectations.
5. A 30-month-old child walks on tiptoes, identifies six body parts, and speaks in short phrases
that are 50% understandable to strangers. Which gross motor skill would the nurse expect to
be absent at this age?
A) Jumping with both feet
B) Balancing on one foot for 1 second
C) Walking up stairs alternating feet
D) Kicking a ball forward
Correct Answer: B
, Rationale: At 30 months, a child cannot yet balance on one foot for 1 second; that skill
emerges around 3–4 years. Jumping with both feet appears at 30 months. Kicking a ball and
walking up stairs alternating feet are also seen. The milestone pattern aligns with typical
development.
6. Which term describes a misalignment of the eyes where they are unable to simultaneously
focus on the same object?
A) Nystagmus
B) Amblyopia
C) Strabismus
D) Astigmatism
Correct Answer: C
Rationale: Strabismus is misalignment of the eyes where they cannot simultaneously focus
on the same object. Nystagmus is involuntary eye movement. Amblyopia is reduced vision
despite correctable optics. Astigmatism is a refractive error from irregular corneal curvature.
7. Inward deviation of one eye relative to the other is termed which of the following?
A) Exotropia
B) Hypertropia
C) Esotropia
D) Hypotropia
Correct Answer: C
Rationale: Esotropia is nasal (inward) turning of the eye. Exotropia is outward deviation.
Hypertropia is upward deviation, and hypotropia is downward deviation. Early identification of
esotropia is critical to prevent amblyopia and preserve binocular vision.
8. A child's head circumference is routinely measured on each well visit until what age?
A) 12 months
B) 18 months
C) 2 years
D) 3 years
, Correct Answer: C
Rationale: Head circumference is routinely measured at every well-child visit until 2 years of
age, as this is the period of rapid brain growth. After age 2, head circumference measurements
are no longer routinely indicated unless there are specific concerns. This standardized practice
helps track neurological development and detect abnormalities such as microcephaly or
hydrocephalus.
9. You see a 3-year-old for a well-child visit. His mother informs you that potty training has
been very easy because he "has an amazing internal clock. He falls asleep, gets hungry, and
has bowel movements at the same time every day." This describes which aspect of
temperament?
A) Activity level
B) Rhythmicity
C) Adaptability
D) Distractibility
Correct Answer: B
Rationale: Rhythmicity refers to the predictability of biological functions such as sleep-wake
cycles, hunger, and elimination patterns. A child with high rhythmicity has regular, predictable
patterns, which can make potty training easier. Activity level refers to motor activity, adaptability
refers to response to change, and distractibility refers to attention focus.
10. An expected milestone of a 4-year-old is the ability to:
A) Copy a circle
B) Copy a cross
C) Copy a square
D) Draw a person with six parts
Correct Answer: B
Rationale: A 4-year-old can copy a cross. Copying a circle is a 3-year milestone. Copying a
square is a 5-year milestone. Drawing a person with six parts is expected at 5–6 years.
Actual Exam – Walden University – 2026/2027
Academic Year – Verified Questions and Answers
1. A 4-year-old child insists that a tall, thin glass contains more juice than a short, wide glass
even after watching the same amount poured from one to the other. According to Piaget, this
child has not yet achieved which principle?
A) Object permanence
B) Conservation
C) Reversibility
D) Seriation
Correct Answer: B
Rationale: Piaget's preoperational stage (2–7 years) is marked by centration and lack of
conservation; the child focuses on one dimension (height) and cannot mentally reverse the
pouring action. Object permanence is achieved in the sensorimotor stage. Seriation and
reversibility are concrete operational achievements (7–11 years).
2. A mother reports that her 2-year-old can put two words together, follows one-step
commands, and points to body parts when named. The nurse recognizes these skills as which
of the following?
A) Advanced for age
B) Typical for a 2-year-old
C) Delayed, requiring speech therapy
D) Typical for a 12-month-old
Correct Answer: B
Rationale: At 2 years, a child speaks in 2- to 3-word sentences, understands simple
commands, and knows body parts. These are age-appropriate milestones. A 12-month-old says
single words and points. Advanced skills would include 3-word sentences. No speech therapy is
needed.
,3. During a well-child visit, a 3-year-old is asked to copy a circle. The child produces a closed,
round shape. This fine motor skill is considered which of the following?
A) A 2-year milestone
B) A 3-year milestone
C) A 4-year milestone
D) A 5-year milestone
Correct Answer: B
Rationale: Copying a circle is a fine motor milestone expected at 3 years. A 2-year-old copies
a vertical line; a 4-year-old copies a cross; a 5-year-old copies a square. Mastering circle copying
reflects appropriate hand-eye coordination and pencil control for this age.
4. A parent of a 6-month-old infant reports the child can roll from back to stomach, reach for
objects, and transfer a toy between hands but does not wave bye-bye. The nurse should take
which action?
A) Refer for early intervention
B) Reassure that these are normal findings
C) Evaluate for hearing loss
D) Order a brain MRI
Correct Answer: B
Rationale: At 6 months, infants roll, grasp, transfer objects, and reach, but waving bye-bye
emerges around 9–10 months. The described skills are developmentally appropriate; no referral
or testing is needed. Providing reassurance supports parental confidence and accurate
expectations.
5. A 30-month-old child walks on tiptoes, identifies six body parts, and speaks in short phrases
that are 50% understandable to strangers. Which gross motor skill would the nurse expect to
be absent at this age?
A) Jumping with both feet
B) Balancing on one foot for 1 second
C) Walking up stairs alternating feet
D) Kicking a ball forward
Correct Answer: B
, Rationale: At 30 months, a child cannot yet balance on one foot for 1 second; that skill
emerges around 3–4 years. Jumping with both feet appears at 30 months. Kicking a ball and
walking up stairs alternating feet are also seen. The milestone pattern aligns with typical
development.
6. Which term describes a misalignment of the eyes where they are unable to simultaneously
focus on the same object?
A) Nystagmus
B) Amblyopia
C) Strabismus
D) Astigmatism
Correct Answer: C
Rationale: Strabismus is misalignment of the eyes where they cannot simultaneously focus
on the same object. Nystagmus is involuntary eye movement. Amblyopia is reduced vision
despite correctable optics. Astigmatism is a refractive error from irregular corneal curvature.
7. Inward deviation of one eye relative to the other is termed which of the following?
A) Exotropia
B) Hypertropia
C) Esotropia
D) Hypotropia
Correct Answer: C
Rationale: Esotropia is nasal (inward) turning of the eye. Exotropia is outward deviation.
Hypertropia is upward deviation, and hypotropia is downward deviation. Early identification of
esotropia is critical to prevent amblyopia and preserve binocular vision.
8. A child's head circumference is routinely measured on each well visit until what age?
A) 12 months
B) 18 months
C) 2 years
D) 3 years
, Correct Answer: C
Rationale: Head circumference is routinely measured at every well-child visit until 2 years of
age, as this is the period of rapid brain growth. After age 2, head circumference measurements
are no longer routinely indicated unless there are specific concerns. This standardized practice
helps track neurological development and detect abnormalities such as microcephaly or
hydrocephalus.
9. You see a 3-year-old for a well-child visit. His mother informs you that potty training has
been very easy because he "has an amazing internal clock. He falls asleep, gets hungry, and
has bowel movements at the same time every day." This describes which aspect of
temperament?
A) Activity level
B) Rhythmicity
C) Adaptability
D) Distractibility
Correct Answer: B
Rationale: Rhythmicity refers to the predictability of biological functions such as sleep-wake
cycles, hunger, and elimination patterns. A child with high rhythmicity has regular, predictable
patterns, which can make potty training easier. Activity level refers to motor activity, adaptability
refers to response to change, and distractibility refers to attention focus.
10. An expected milestone of a 4-year-old is the ability to:
A) Copy a circle
B) Copy a cross
C) Copy a square
D) Draw a person with six parts
Correct Answer: B
Rationale: A 4-year-old can copy a cross. Copying a circle is a 3-year milestone. Copying a
square is a 5-year milestone. Drawing a person with six parts is expected at 5–6 years.
