NUR 254 Exam 3 Study Guide | Galen College
of Nursing | Questions and Answers
2026/2027 | Exam Review
Q1. The nurse is caring for a 2-year-old child hospitalized for pneumonia. Which nursing
intervention best supports the child's developmental needs according to Erikson's theory?
A. Allow the parents to stay with the child and participate in care
B. Restrict choices to prevent the child from becoming overwhelmed
C. Provide opportunities for the child to make simple choices, such as choosing between apple
juice and water
D. Explain all procedures in detail using medical terminology to promote understanding
Answer: C. Provide opportunities for the child to make simple choices, such as choosing
between apple juice and water
Rationale: According to Erikson, toddlers (ages 1–3 years) are in the Autonomy vs. Shame and
Doubt stage. They are learning self-control, willpower, and independence. Providing simple
choices ("Do you want the red cup or blue cup?") supports autonomy and reduces the sense of
shame and doubt .
Q2. The parents of a 4-month-old infant ask the nurse what type of play is appropriate for
their child. Which response by the nurse is most accurate?
A. "Your infant will enjoy playing peek-a-boo and patty-cake now."
B. "At this age, infants enjoy playing with rattles and reaching for objects."
C. "Your infant is ready for cooperative play with other children."
D. "Parallel play with same-aged peers is the primary type of play at this age."
Answer: B. "At this age, infants enjoy playing with rattles and reaching for objects."
Rationale: At 4 months, infants demonstrate these milestones: Moro/tonic neck/rooting reflexes
gone, able to sit propped, rolls from back to side, plays with hands, laughs aloud, and reaches
for objects. Solitary play with rattles and grasping toys is developmentally appropriate. Peek-a-
boo requires object permanence developed around 9–10 months; cooperative play is typical of
school-age children; parallel play is characteristic of toddlers .
Q3. The nurse is assessing a 9-month-old infant during a well-child visit. Which finding
should the nurse identify as a developmental delay?
,A. The infant pulls to standing
B. The infant creeps on hands and knees
C. The infant has not yet developed object permanence
D. The infant has a pincer grasp
Answer: C. The infant has not yet developed object permanence
Rationale: Object permanence (understanding objects exist even when out of sight) should be
fully developed by 8–9 months. Absence at 9 months suggests cognitive delay and requires
further evaluation. Pulling to standing, creeping, and pincer grasp are all expected at 9 months .
Q4. Which best describes unoccupied behavior in children?
A. Playing with others toward a goal
B. Watching other children play
C. No apparent purpose; briefly focuses attention
D. Playing alone with toys
Answer: C. No apparent purpose; briefly focuses attention
Rationale: Unoccupied behavior has no clear purpose. The child may briefly focus on something
but does not engage in structured play .
Q5. Onlooker play is best described as:
A. Playing independently next to others
B. Watching other children play without joining
C. Playing with a common goal
D. Borrowing and lending toys
Answer: B. Watching other children play without joining
Rationale: In onlooker play, common in toddlers, the child observes others but does not actively
join .
Q6. Parallel play typically occurs in toddlers aged 1–3 years. Which describes this play?
A. Organized group play
B. Playing independently next to each other
C. Playing with rules
D. No purpose
Answer: B. Playing independently next to each other
Rationale: In parallel play, toddlers play side by side but do not interact significantly .
,Q7. Which best describes cooperative play?
A. Playing alone with toys
B. Watching others play
C. Organized group play with a goal
D. Playing next to others without interaction
Answer: C. Organized group play with a goal
Rationale: Cooperative play (6–12 years) involves organized activities with shared goals and a
sense of belonging .
Q8. The nurse expects which primary communication behaviors in infants?
A. Asking "why" questions
B. Egocentric speech
C. Cooing and crying
D. Logical reasoning
Answer: C. Cooing and crying
Rationale: Infants communicate through crying and cooing and respond to nonverbal cues .
Q9. Which communication characteristic is typical of toddlers?
A. Desire for privacy
B. Egocentric focus
C. Abstract thinking
D. Logical reasoning
Answer: B. Egocentric focus
Rationale: Toddlers are egocentric, meaning they focus communication around themselves .
Q10. Which pain scale is appropriate for a 6-month-old infant?
A. Numeric (0–10)
B. Wong-Baker Faces
C. FLACC
D. Visual Analog Scale
Answer: C. FLACC
Rationale: FLACC is used for children >2 months to 7 years. NIP is for <2 months .
, Q11. Which finding requires notifying the healthcare provider?
A. Posterior fontanelle closed at 2 months
B. Anterior fontanelle open at 12 months
C. Weight doubled at 6 months
D. Bulging fontanelle
Answer: D. Bulging fontanelle
Rationale: A bulging fontanelle may indicate increased intracranial pressure and requires
immediate evaluation. Posterior fontanelle closes at 2 months, anterior fontanelle closes at 18
months, and weight doubles at 6 months—all normal findings .
Q12. When assessing a toddler, the nurse should:
A. Perform invasive procedures first
B. Separate child from parents
C. Keep equipment out of sight initially
D. Perform ear exam first
Answer: C. Keep equipment out of sight initially
Rationale: Keeping equipment out of sight reduces fear. Invasive procedures are done last .
Q13. The nurse is assessing a 4-month-old infant. Which finding indicates a need for
further evaluation?
A. The infant can hold head steady when upright
B. The infant has a social smile
C. The infant does not reach for objects
D. The infant coos and gurgles
Answer: C. The infant does not reach for objects
Rationale: At 4 months, infants should be reaching for objects. Absence of this milestone may
indicate developmental delay .
Q14. At what age does the posterior fontanelle typically close?
A. 2 months
B. 6 months
C. 12 months
D. 18 months
of Nursing | Questions and Answers
2026/2027 | Exam Review
Q1. The nurse is caring for a 2-year-old child hospitalized for pneumonia. Which nursing
intervention best supports the child's developmental needs according to Erikson's theory?
A. Allow the parents to stay with the child and participate in care
B. Restrict choices to prevent the child from becoming overwhelmed
C. Provide opportunities for the child to make simple choices, such as choosing between apple
juice and water
D. Explain all procedures in detail using medical terminology to promote understanding
Answer: C. Provide opportunities for the child to make simple choices, such as choosing
between apple juice and water
Rationale: According to Erikson, toddlers (ages 1–3 years) are in the Autonomy vs. Shame and
Doubt stage. They are learning self-control, willpower, and independence. Providing simple
choices ("Do you want the red cup or blue cup?") supports autonomy and reduces the sense of
shame and doubt .
Q2. The parents of a 4-month-old infant ask the nurse what type of play is appropriate for
their child. Which response by the nurse is most accurate?
A. "Your infant will enjoy playing peek-a-boo and patty-cake now."
B. "At this age, infants enjoy playing with rattles and reaching for objects."
C. "Your infant is ready for cooperative play with other children."
D. "Parallel play with same-aged peers is the primary type of play at this age."
Answer: B. "At this age, infants enjoy playing with rattles and reaching for objects."
Rationale: At 4 months, infants demonstrate these milestones: Moro/tonic neck/rooting reflexes
gone, able to sit propped, rolls from back to side, plays with hands, laughs aloud, and reaches
for objects. Solitary play with rattles and grasping toys is developmentally appropriate. Peek-a-
boo requires object permanence developed around 9–10 months; cooperative play is typical of
school-age children; parallel play is characteristic of toddlers .
Q3. The nurse is assessing a 9-month-old infant during a well-child visit. Which finding
should the nurse identify as a developmental delay?
,A. The infant pulls to standing
B. The infant creeps on hands and knees
C. The infant has not yet developed object permanence
D. The infant has a pincer grasp
Answer: C. The infant has not yet developed object permanence
Rationale: Object permanence (understanding objects exist even when out of sight) should be
fully developed by 8–9 months. Absence at 9 months suggests cognitive delay and requires
further evaluation. Pulling to standing, creeping, and pincer grasp are all expected at 9 months .
Q4. Which best describes unoccupied behavior in children?
A. Playing with others toward a goal
B. Watching other children play
C. No apparent purpose; briefly focuses attention
D. Playing alone with toys
Answer: C. No apparent purpose; briefly focuses attention
Rationale: Unoccupied behavior has no clear purpose. The child may briefly focus on something
but does not engage in structured play .
Q5. Onlooker play is best described as:
A. Playing independently next to others
B. Watching other children play without joining
C. Playing with a common goal
D. Borrowing and lending toys
Answer: B. Watching other children play without joining
Rationale: In onlooker play, common in toddlers, the child observes others but does not actively
join .
Q6. Parallel play typically occurs in toddlers aged 1–3 years. Which describes this play?
A. Organized group play
B. Playing independently next to each other
C. Playing with rules
D. No purpose
Answer: B. Playing independently next to each other
Rationale: In parallel play, toddlers play side by side but do not interact significantly .
,Q7. Which best describes cooperative play?
A. Playing alone with toys
B. Watching others play
C. Organized group play with a goal
D. Playing next to others without interaction
Answer: C. Organized group play with a goal
Rationale: Cooperative play (6–12 years) involves organized activities with shared goals and a
sense of belonging .
Q8. The nurse expects which primary communication behaviors in infants?
A. Asking "why" questions
B. Egocentric speech
C. Cooing and crying
D. Logical reasoning
Answer: C. Cooing and crying
Rationale: Infants communicate through crying and cooing and respond to nonverbal cues .
Q9. Which communication characteristic is typical of toddlers?
A. Desire for privacy
B. Egocentric focus
C. Abstract thinking
D. Logical reasoning
Answer: B. Egocentric focus
Rationale: Toddlers are egocentric, meaning they focus communication around themselves .
Q10. Which pain scale is appropriate for a 6-month-old infant?
A. Numeric (0–10)
B. Wong-Baker Faces
C. FLACC
D. Visual Analog Scale
Answer: C. FLACC
Rationale: FLACC is used for children >2 months to 7 years. NIP is for <2 months .
, Q11. Which finding requires notifying the healthcare provider?
A. Posterior fontanelle closed at 2 months
B. Anterior fontanelle open at 12 months
C. Weight doubled at 6 months
D. Bulging fontanelle
Answer: D. Bulging fontanelle
Rationale: A bulging fontanelle may indicate increased intracranial pressure and requires
immediate evaluation. Posterior fontanelle closes at 2 months, anterior fontanelle closes at 18
months, and weight doubles at 6 months—all normal findings .
Q12. When assessing a toddler, the nurse should:
A. Perform invasive procedures first
B. Separate child from parents
C. Keep equipment out of sight initially
D. Perform ear exam first
Answer: C. Keep equipment out of sight initially
Rationale: Keeping equipment out of sight reduces fear. Invasive procedures are done last .
Q13. The nurse is assessing a 4-month-old infant. Which finding indicates a need for
further evaluation?
A. The infant can hold head steady when upright
B. The infant has a social smile
C. The infant does not reach for objects
D. The infant coos and gurgles
Answer: C. The infant does not reach for objects
Rationale: At 4 months, infants should be reaching for objects. Absence of this milestone may
indicate developmental delay .
Q14. At what age does the posterior fontanelle typically close?
A. 2 months
B. 6 months
C. 12 months
D. 18 months
