NR 509 Week 6 Pediatric SOAP Note, Summer 2021
complete solution.
Question 1
The nurse practitioner is observing a full-term infant male during a routine well-
child visit. The infant can pull to a stand, uses "mama" and "dada" specifically, and
indicates his wants by vocalization and pointing. Based on these observations,
what is the infant's approximate developmental age?
A) 6 months
B) 9 months
C) 12 months ✅
D) 15 months
- answer;-: C
Rationale: Pulling to stand typically occurs around 9-12 months. Specific use of
"mama"/"dada" and pointing to indicate wants are 12-month milestones. At 6
months, infants cannot pull to stand; at 9 months, language is less specific; at 15
months, they typically walk independently and have larger vocabularies .
Question 2
According to the lesson, goal-directed exploration, increased physical and
cognitive abilities, and achievements by trial and error are hallmarks of which
stage of development?
A) Toddlerhood
B) Middle childhood ✅
C) Adolescence
D) Early childhood
,- answer;-: B
Rationale: Middle childhood is an active period of growth and development
characterized by goal-directed exploration, increased physical and cognitive
abilities, and achievements through trial and error. This stage typically spans ages
6-12 years .
Question 3
A grandmother brings her 9-year-old granddaughter for a routine physical and
asks privately if the child has started puberty. During examination, the NP notes
asymmetric projection of the areola and nipple of the right chest to form a
secondary mound above the level of the breast. The left breast is
underdeveloped. These findings are consistent with which Tanner Stage?
A) Stage II
B) Stage III
C) Stage IV ✅
D) Stage V
- answer;-: C
Rationale: Tanner Stage IV is characterized by the areola and nipple forming a
secondary mound above the breast level. Asymmetric breast development is
common during puberty and does not indicate pathology. Stage II shows breast
buds, Stage III shows enlargement without separation of contours, and Stage V
shows recession of the areola to the breast contour .
Question 4
The NP assesses for the Moro Reflex as part of an infant routine physical
examination. The NP should suspect a neurologic disease if the reflex has not
disappeared by what specific timeframe?
A) 8 weeks
B) 16 weeks ✅
C) 24 weeks
D) 32 weeks
, - answer;-: B
Rationale: The Moro reflex (startle reflex) typically disappears by 4-6 months (16-
24 weeks). Persistence beyond 16 weeks warrants evaluation for potential
neurologic disease. Other primitive reflexes have different timelines for
integration .
Question 5
A mother brings her 15-day-old female infant for evaluation of a rash that
appeared suddenly after visiting family in Florida. It is August and the house did
not have air conditioning. The infant is afebrile, eating well, and not in distress.
You note scattered vesicles on an erythematous base involving the face and trunk.
What is the likely diagnosis?
A) Erythema Toxicum
B) Miliaria Rubra (heat rash) ✅
C) Neonatal herpes
D) Candidiasis
- answer;-: B
Rationale: Miliaria rubra (heat rash) presents as erythematous vesicles and
papules in areas prone to overheating. The history of hot environment (Florida in
August, no AC) and benign presentation supports this diagnosis. Erythema
toxicum typically appears in the first few days of life. Neonatal herpes would
present with systemic symptoms .
Question 6
The NP is observing a female pediatric patient during a routine physical. She can
jump in place and balance on one foot. She speaks in full sentences and her
mother states that she can feed herself. Based on these observations, what is her
developmental age?
A) 2 years
B) 4 years ✅
C) 6 years
D) 8 years
complete solution.
Question 1
The nurse practitioner is observing a full-term infant male during a routine well-
child visit. The infant can pull to a stand, uses "mama" and "dada" specifically, and
indicates his wants by vocalization and pointing. Based on these observations,
what is the infant's approximate developmental age?
A) 6 months
B) 9 months
C) 12 months ✅
D) 15 months
- answer;-: C
Rationale: Pulling to stand typically occurs around 9-12 months. Specific use of
"mama"/"dada" and pointing to indicate wants are 12-month milestones. At 6
months, infants cannot pull to stand; at 9 months, language is less specific; at 15
months, they typically walk independently and have larger vocabularies .
Question 2
According to the lesson, goal-directed exploration, increased physical and
cognitive abilities, and achievements by trial and error are hallmarks of which
stage of development?
A) Toddlerhood
B) Middle childhood ✅
C) Adolescence
D) Early childhood
,- answer;-: B
Rationale: Middle childhood is an active period of growth and development
characterized by goal-directed exploration, increased physical and cognitive
abilities, and achievements through trial and error. This stage typically spans ages
6-12 years .
Question 3
A grandmother brings her 9-year-old granddaughter for a routine physical and
asks privately if the child has started puberty. During examination, the NP notes
asymmetric projection of the areola and nipple of the right chest to form a
secondary mound above the level of the breast. The left breast is
underdeveloped. These findings are consistent with which Tanner Stage?
A) Stage II
B) Stage III
C) Stage IV ✅
D) Stage V
- answer;-: C
Rationale: Tanner Stage IV is characterized by the areola and nipple forming a
secondary mound above the breast level. Asymmetric breast development is
common during puberty and does not indicate pathology. Stage II shows breast
buds, Stage III shows enlargement without separation of contours, and Stage V
shows recession of the areola to the breast contour .
Question 4
The NP assesses for the Moro Reflex as part of an infant routine physical
examination. The NP should suspect a neurologic disease if the reflex has not
disappeared by what specific timeframe?
A) 8 weeks
B) 16 weeks ✅
C) 24 weeks
D) 32 weeks
, - answer;-: B
Rationale: The Moro reflex (startle reflex) typically disappears by 4-6 months (16-
24 weeks). Persistence beyond 16 weeks warrants evaluation for potential
neurologic disease. Other primitive reflexes have different timelines for
integration .
Question 5
A mother brings her 15-day-old female infant for evaluation of a rash that
appeared suddenly after visiting family in Florida. It is August and the house did
not have air conditioning. The infant is afebrile, eating well, and not in distress.
You note scattered vesicles on an erythematous base involving the face and trunk.
What is the likely diagnosis?
A) Erythema Toxicum
B) Miliaria Rubra (heat rash) ✅
C) Neonatal herpes
D) Candidiasis
- answer;-: B
Rationale: Miliaria rubra (heat rash) presents as erythematous vesicles and
papules in areas prone to overheating. The history of hot environment (Florida in
August, no AC) and benign presentation supports this diagnosis. Erythema
toxicum typically appears in the first few days of life. Neonatal herpes would
present with systemic symptoms .
Question 6
The NP is observing a female pediatric patient during a routine physical. She can
jump in place and balance on one foot. She speaks in full sentences and her
mother states that she can feed herself. Based on these observations, what is her
developmental age?
A) 2 years
B) 4 years ✅
C) 6 years
D) 8 years
