CDDN CERTIFIED DEVELOPMENTAL DISABILITIES
NURSE EXAM 2026 PRACTICE SCENARIOS
WITH ANSWERS & EXPERT RATIONALES
LATEST UPDATE
DOMAIN 1: HEALTH PROMOTION & DISEASE PREVENTION (ITEMS 1–100)
SUB-DOMAIN 1.1: STANDARD SCREENING & SURVEILLANCE (ITEMS 1–35)
1. An adult with Down syndrome presents for an annual wellness visit. The
caregiver reports increased fatigue and cold intolerance over the past 3 months.
Which screening panel is most critical to obtain at this visit?
A. Complete metabolic panel
B. Thyroid-stimulating hormone (TSH) and free T4
C. Serum vitamin B12 and folate
D. Iron studies with ferritin
E. Hepatic enzyme panel
✔ Correct Answer: B. Thyroid-stimulating hormone (TSH) and free T4
EXPERT RATIONALE: Fatigue and cold intolerance are classic hypothyroid
symptoms.
Down syndrome carries a 15–20% lifetime risk of autoimmune thyroiditis. Annual
TSH/free T4 screening is the standard of care; delaying it risks cognitive
decline, weight gain, and cardiac bradyarrhythmias. The other panels address
secondary possibilities but lack the same urgency and population-specific
evidence base.
2. A 45-year-old non-ambulatory female with cerebral palsy is seen for a
preventive health examination. She has a history of severe scoliosis and uses a
wheelchair full-time. Which screening test does the DDNA recommend prioritizing
1
,at this age?
A. Dual-energy X-ray absorptiometry (DEXA) scan
B. Screening mammogram
C. Colonoscopy
D. Fasting lipid panel
E. Serum creatinine
✔ Correct Answer: A. Dual-energy X-ray absorptiometry (DEXA) scan
EXPERT RATIONALE: Non-ambulatory individuals with cerebral palsy have
profound
mechanical unloading of bones, leading to rapid bone mineral density loss.
Fracture risk in this group is 3–4x higher than the general population. While
mammography and colonoscopy are age-appropriate, DEXA screening is the
highest
priority because osteoporotic fractures are often occult and catastrophic in
this population.
3. A 30-year-old male with Fragile X syndrome has no history of seizures but
exhibits intermittent hand-flapping and gaze avoidance. During a routine health
maintenance visit, which age-appropriate cardiac screening should the nurse
ensure is up to date?
A. Resting 12-lead EKG
B. Echocardiogram to evaluate aortic root diameter
C. Holter monitor for 24 hours
D. Cardiac stress test
E. Serum B-type natriuretic peptide (BNP)
✔ Correct Answer: B. Echocardiogram to evaluate aortic root diameter
2
,EXPERT RATIONALE: Fragile X syndrome is associated with connective tissue
dysplasia, which can cause progressive aortic root dilation and mitral valve
prolapse. A baseline echocardiogram is recommended in early adulthood,
repeated
every 3–5 years. An EKG alone misses structural changes, and stress testing is
not the first-line screening tool for this specific risk.
4. A 22-year-old with Down syndrome who is living in a group home has a new
onset of snoring and daytime somnolence. The BMI is 31. Which screening
intervention is the priority?
A. Overnight pulse oximetry with referral for polysomnography
B. Serum hemoglobin A1c
C. Audiometry testing
D. Dental panoramic X-ray
E. Serum testosterone level
✔ Correct Answer: A. Overnight pulse oximetry with referral for polysomnography
EXPERT RATIONALE: Obesity and craniofacial anatomy in Down syndrome strongly
predispose to obstructive sleep apnea (OSA). Snoring plus daytime sleepiness are
red flags. Untreated OSA leads to pulmonary hypertension and cognitive
exacerbation. Sleep study referral is the definitive next step; the other tests
do not address the immediate hypoxemic risk.
5. A 55-year-old woman with Rett syndrome has been losing weight and has
increasingly rigid posturing. She receives all care via a gastrostomy tube. In
addition to nutritional assessment, which screening exam is mandatory annually
for this age group?
A. Pelvic ultrasound
B. Dual-energy X-ray absorptiometry (DEXA)
3
, C. Serum ammonia level
D. Electroencephalogram (EEG)
E. Upper GI series
✔ Correct Answer: B. Dual-energy X-ray absorptiometry (DEXA)
EXPERT RATIONALE: Rett syndrome causes severe motor impairment and
immobility,
leading to early-onset osteoporosis. Weight loss and rigidity increase fracture
risk. The DDNA guidelines specifically mandate annual DEXA for non-ambulatory
women over 50. The other choices are problem-driven, not routine annual
screens.
6. A 16-year-old male with a history of autism spectrum disorder and pica is
brought to the clinic. The caregiver reports he has been eating paint chips from
an old windowsill. Which lab screening is the most immediate priority?
A. Serum lead level
B. Serum zinc level
C. Complete blood count with differential
D. Iron-binding capacity
E. Urine toxicology screen
✔ Correct Answer: A. Serum lead level
EXPERT RATIONALE: Pica combined with ingestion of paint chips from older
housing places this adolescent at high risk for lead toxicity. Lead
neurotoxicity can compound existing developmental delays. A venous lead level is
the definitive screen. The other labs may be useful later but do not address the
acute heavy-metal exposure.
7. A 40-year-old with intellectual disability secondary to perinatal hypoxia
4
NURSE EXAM 2026 PRACTICE SCENARIOS
WITH ANSWERS & EXPERT RATIONALES
LATEST UPDATE
DOMAIN 1: HEALTH PROMOTION & DISEASE PREVENTION (ITEMS 1–100)
SUB-DOMAIN 1.1: STANDARD SCREENING & SURVEILLANCE (ITEMS 1–35)
1. An adult with Down syndrome presents for an annual wellness visit. The
caregiver reports increased fatigue and cold intolerance over the past 3 months.
Which screening panel is most critical to obtain at this visit?
A. Complete metabolic panel
B. Thyroid-stimulating hormone (TSH) and free T4
C. Serum vitamin B12 and folate
D. Iron studies with ferritin
E. Hepatic enzyme panel
✔ Correct Answer: B. Thyroid-stimulating hormone (TSH) and free T4
EXPERT RATIONALE: Fatigue and cold intolerance are classic hypothyroid
symptoms.
Down syndrome carries a 15–20% lifetime risk of autoimmune thyroiditis. Annual
TSH/free T4 screening is the standard of care; delaying it risks cognitive
decline, weight gain, and cardiac bradyarrhythmias. The other panels address
secondary possibilities but lack the same urgency and population-specific
evidence base.
2. A 45-year-old non-ambulatory female with cerebral palsy is seen for a
preventive health examination. She has a history of severe scoliosis and uses a
wheelchair full-time. Which screening test does the DDNA recommend prioritizing
1
,at this age?
A. Dual-energy X-ray absorptiometry (DEXA) scan
B. Screening mammogram
C. Colonoscopy
D. Fasting lipid panel
E. Serum creatinine
✔ Correct Answer: A. Dual-energy X-ray absorptiometry (DEXA) scan
EXPERT RATIONALE: Non-ambulatory individuals with cerebral palsy have
profound
mechanical unloading of bones, leading to rapid bone mineral density loss.
Fracture risk in this group is 3–4x higher than the general population. While
mammography and colonoscopy are age-appropriate, DEXA screening is the
highest
priority because osteoporotic fractures are often occult and catastrophic in
this population.
3. A 30-year-old male with Fragile X syndrome has no history of seizures but
exhibits intermittent hand-flapping and gaze avoidance. During a routine health
maintenance visit, which age-appropriate cardiac screening should the nurse
ensure is up to date?
A. Resting 12-lead EKG
B. Echocardiogram to evaluate aortic root diameter
C. Holter monitor for 24 hours
D. Cardiac stress test
E. Serum B-type natriuretic peptide (BNP)
✔ Correct Answer: B. Echocardiogram to evaluate aortic root diameter
2
,EXPERT RATIONALE: Fragile X syndrome is associated with connective tissue
dysplasia, which can cause progressive aortic root dilation and mitral valve
prolapse. A baseline echocardiogram is recommended in early adulthood,
repeated
every 3–5 years. An EKG alone misses structural changes, and stress testing is
not the first-line screening tool for this specific risk.
4. A 22-year-old with Down syndrome who is living in a group home has a new
onset of snoring and daytime somnolence. The BMI is 31. Which screening
intervention is the priority?
A. Overnight pulse oximetry with referral for polysomnography
B. Serum hemoglobin A1c
C. Audiometry testing
D. Dental panoramic X-ray
E. Serum testosterone level
✔ Correct Answer: A. Overnight pulse oximetry with referral for polysomnography
EXPERT RATIONALE: Obesity and craniofacial anatomy in Down syndrome strongly
predispose to obstructive sleep apnea (OSA). Snoring plus daytime sleepiness are
red flags. Untreated OSA leads to pulmonary hypertension and cognitive
exacerbation. Sleep study referral is the definitive next step; the other tests
do not address the immediate hypoxemic risk.
5. A 55-year-old woman with Rett syndrome has been losing weight and has
increasingly rigid posturing. She receives all care via a gastrostomy tube. In
addition to nutritional assessment, which screening exam is mandatory annually
for this age group?
A. Pelvic ultrasound
B. Dual-energy X-ray absorptiometry (DEXA)
3
, C. Serum ammonia level
D. Electroencephalogram (EEG)
E. Upper GI series
✔ Correct Answer: B. Dual-energy X-ray absorptiometry (DEXA)
EXPERT RATIONALE: Rett syndrome causes severe motor impairment and
immobility,
leading to early-onset osteoporosis. Weight loss and rigidity increase fracture
risk. The DDNA guidelines specifically mandate annual DEXA for non-ambulatory
women over 50. The other choices are problem-driven, not routine annual
screens.
6. A 16-year-old male with a history of autism spectrum disorder and pica is
brought to the clinic. The caregiver reports he has been eating paint chips from
an old windowsill. Which lab screening is the most immediate priority?
A. Serum lead level
B. Serum zinc level
C. Complete blood count with differential
D. Iron-binding capacity
E. Urine toxicology screen
✔ Correct Answer: A. Serum lead level
EXPERT RATIONALE: Pica combined with ingestion of paint chips from older
housing places this adolescent at high risk for lead toxicity. Lead
neurotoxicity can compound existing developmental delays. A venous lead level is
the definitive screen. The other labs may be useful later but do not address the
acute heavy-metal exposure.
7. A 40-year-old with intellectual disability secondary to perinatal hypoxia
4
