NR 602 Primary Care of the Childbearing and
Childrearing Family Practicum Midterm Review
Section 1: Growth and Development
1. A 4-month-old infant is brought in for a well-child visit. The parent asks when the infant
will be able to sit without support. What is the most appropriate response?
A) 4-5 months
B) 6-7 months
C) 8-9 months
D) 10-12 months
Answer: C) 8-9 months
Rationale: Infants typically achieve independent sitting between 8-9 months of age. While
they may sit with support at 6 months, unsupported sitting requires trunk control and
balance that develops later. Providing accurate developmental expectations helps prevent
parental anxiety and supports appropriate developmental surveillance .
2. At what age does birth weight typically triple in a healthy infant?
A) 6 months
B) 9 months
C) 12 months
D) 15 months
Answer: C) 12 months
Rationale: Birth weight typically triples by 12 months of age. Height increases by
approximately 50% during the first year. This rapid growth pattern is an important marker of
adequate nutrition and overall health during infancy .
3. A 3-month-old infant is able to lift the head and clasp hands. What additional gross motor
skill should the nurse practitioner expect at this age?
A) Rolling over
B) Sitting without support
C) Standing while holding onto furniture
D) Transferring objects hand-to-hand
Answer: A) Rolling over
,Rationale: At 3 months, infants can lift their heads and clasp hands. By 6 months, they
typically roll over, sit with support, reach for objects, and transfer them hand-to-hand.
Understanding the sequence of developmental milestones allows for appropriate
anticipatory guidance .
4. A 12-month-old child is not yet standing or taking steps. The parent expresses concern.
What is the most appropriate initial action?
A) Reassure the parent that this is within normal limits
B) Refer immediately to a developmental specialist
C) Order genetic testing
D) Recommend physical therapy
Answer: A) Reassure the parent that this is within normal limits
Rationale: While many 12-month-olds can stand and begin taking steps, there is a normal
range of development. The key is to assess for other developmental delays and continue
monitoring. Reassurance with anticipatory guidance is appropriate while maintaining
surveillance for any additional concerns .
5. When should evaluation for delayed puberty be initiated in females?
A) No breast development by age 6
B) No breast development by age 10
C) No breast development by age 13
D) No breast development by age 16
Answer: C) No breast development by age 13
Rationale: Delayed puberty in females is defined as no breast development (thelarche) by
age 13 years. In males, evaluation is indicated for no testicular enlargement by age 14. Early
recognition of abnormal pubertal timing allows for appropriate endocrine referral and
management .
6. A 9-year-old female presents with breast development. The mother is concerned about
early puberty. What is the most appropriate response?
A) This is precocious puberty requiring immediate intervention
B) Breast development between 8-13 years is within normal limits
C) This will likely cause short stature
D) Hormone therapy must be initiated immediately
Answer: B) Breast development between 8-13 years is within normal limits
Rationale: Thelarche (breast development) typically occurs between 8-13 years in females.
Early breast development (before 8 years) or delayed development (after 13 years) requires
evaluation. Reassurance is appropriate when development falls within the normal range .
,7. A 14-year-old male has no testicular enlargement. What is the most appropriate next
step?
A) Reassure that he is a late bloomer
B) Refer to endocrinology
C) Order a bone age study
D) Check testosterone levels
Answer: B) Refer to endocrinology
Rationale: Delayed puberty in males is defined as no testicular enlargement by age 14 years.
This requires evaluation by an endocrinologist to assess for underlying causes such as
hypogonadotropic hypogonadism, constitutional delay, or other endocrine disorders .
8. Which statement is true regarding pubertal development in males versus females?
A) Males typically begin puberty earlier than females
B) Females typically begin puberty earlier than males
C) Both genders begin puberty at the same age
D) Males typically have a shorter pubertal growth spurt
Answer: B) Females typically begin puberty earlier than males
Rationale: Females typically begin puberty approximately 2 years earlier than males
(thelarche at 8-13 years vs. testicular enlargement at 9-14 years). This difference is
important for anticipatory guidance and distinguishing normal variants from pathologic
conditions .
9. A 15-month-old toddler has not yet begun walking independently. What is the most
appropriate action?
A) Refer for immediate physical therapy
B) Order neurological imaging
C) Continue monitoring and provide anticipatory guidance
D) Diagnose developmental delay
Answer: C) Continue monitoring and provide anticipatory guidance
Rationale: While most infants walk by 12 months, the normal range extends to 15-18
months. Isolated mild gross motor delay without other concerns warrants monitoring and
parental education about exercises to encourage motor development. Referral is appropriate
if delays persist .
10. What are the key developmental milestones for a 1-year-old infant?
A) Lifts head, follows objects with eyes
, B) Rolls over, sits with support
C) Stands, begins taking steps, says first words
D) Runs, climbs stairs, uses 2-3 word phrases
Answer: C) Stands, begins taking steps, says first words
Rationale: By 12 months, infants typically stand independently, begin taking steps, say 1-2
words, and use gestures like pointing. This represents significant developmental progression
from earlier infancy and is a key marker for normal neurodevelopment .
11. Which assessment finding in an infant would prompt immediate evaluation for potential
developmental concerns?
A) Delayed gross motor skills but normal fine motor skills
B) Regression of previously achieved milestones
C) Mild speech delay in a 2-year-old
D) Night waking in a 6-month-old
Answer: B) Regression of previously achieved milestones
Rationale: Regression of previously achieved milestones is a red flag that warrants
immediate evaluation. Unlike isolated delays in one domain, regression may indicate
neurological, metabolic, or other serious underlying conditions .
12. A 6-month-old infant is not rolling over. The parent is concerned. What is the most
appropriate initial response?
A) This is a sign of developmental delay requiring specialist referral
B) Some infants skip rolling over and this may be normal
C) The infant needs immediate physical therapy
D) This indicates a neurological problem
Answer: B) Some infants skip rolling over and this may be normal
Rationale: While most infants roll over by 6 months, some may skip this milestone and
proceed to sitting or crawling. The key is to assess overall development and other
milestones. Isolated variations may be normal .
13. When should a child be evaluated for early puberty (precocious puberty)?
A) Any breast development before age 6 in females
B) Thelarche before age 8 in females
C) Testicular enlargement before age 12 in males
D) Pubic hair before age 10 in females
Answer: B) Thelarche before age 8 in females
Childrearing Family Practicum Midterm Review
Section 1: Growth and Development
1. A 4-month-old infant is brought in for a well-child visit. The parent asks when the infant
will be able to sit without support. What is the most appropriate response?
A) 4-5 months
B) 6-7 months
C) 8-9 months
D) 10-12 months
Answer: C) 8-9 months
Rationale: Infants typically achieve independent sitting between 8-9 months of age. While
they may sit with support at 6 months, unsupported sitting requires trunk control and
balance that develops later. Providing accurate developmental expectations helps prevent
parental anxiety and supports appropriate developmental surveillance .
2. At what age does birth weight typically triple in a healthy infant?
A) 6 months
B) 9 months
C) 12 months
D) 15 months
Answer: C) 12 months
Rationale: Birth weight typically triples by 12 months of age. Height increases by
approximately 50% during the first year. This rapid growth pattern is an important marker of
adequate nutrition and overall health during infancy .
3. A 3-month-old infant is able to lift the head and clasp hands. What additional gross motor
skill should the nurse practitioner expect at this age?
A) Rolling over
B) Sitting without support
C) Standing while holding onto furniture
D) Transferring objects hand-to-hand
Answer: A) Rolling over
,Rationale: At 3 months, infants can lift their heads and clasp hands. By 6 months, they
typically roll over, sit with support, reach for objects, and transfer them hand-to-hand.
Understanding the sequence of developmental milestones allows for appropriate
anticipatory guidance .
4. A 12-month-old child is not yet standing or taking steps. The parent expresses concern.
What is the most appropriate initial action?
A) Reassure the parent that this is within normal limits
B) Refer immediately to a developmental specialist
C) Order genetic testing
D) Recommend physical therapy
Answer: A) Reassure the parent that this is within normal limits
Rationale: While many 12-month-olds can stand and begin taking steps, there is a normal
range of development. The key is to assess for other developmental delays and continue
monitoring. Reassurance with anticipatory guidance is appropriate while maintaining
surveillance for any additional concerns .
5. When should evaluation for delayed puberty be initiated in females?
A) No breast development by age 6
B) No breast development by age 10
C) No breast development by age 13
D) No breast development by age 16
Answer: C) No breast development by age 13
Rationale: Delayed puberty in females is defined as no breast development (thelarche) by
age 13 years. In males, evaluation is indicated for no testicular enlargement by age 14. Early
recognition of abnormal pubertal timing allows for appropriate endocrine referral and
management .
6. A 9-year-old female presents with breast development. The mother is concerned about
early puberty. What is the most appropriate response?
A) This is precocious puberty requiring immediate intervention
B) Breast development between 8-13 years is within normal limits
C) This will likely cause short stature
D) Hormone therapy must be initiated immediately
Answer: B) Breast development between 8-13 years is within normal limits
Rationale: Thelarche (breast development) typically occurs between 8-13 years in females.
Early breast development (before 8 years) or delayed development (after 13 years) requires
evaluation. Reassurance is appropriate when development falls within the normal range .
,7. A 14-year-old male has no testicular enlargement. What is the most appropriate next
step?
A) Reassure that he is a late bloomer
B) Refer to endocrinology
C) Order a bone age study
D) Check testosterone levels
Answer: B) Refer to endocrinology
Rationale: Delayed puberty in males is defined as no testicular enlargement by age 14 years.
This requires evaluation by an endocrinologist to assess for underlying causes such as
hypogonadotropic hypogonadism, constitutional delay, or other endocrine disorders .
8. Which statement is true regarding pubertal development in males versus females?
A) Males typically begin puberty earlier than females
B) Females typically begin puberty earlier than males
C) Both genders begin puberty at the same age
D) Males typically have a shorter pubertal growth spurt
Answer: B) Females typically begin puberty earlier than males
Rationale: Females typically begin puberty approximately 2 years earlier than males
(thelarche at 8-13 years vs. testicular enlargement at 9-14 years). This difference is
important for anticipatory guidance and distinguishing normal variants from pathologic
conditions .
9. A 15-month-old toddler has not yet begun walking independently. What is the most
appropriate action?
A) Refer for immediate physical therapy
B) Order neurological imaging
C) Continue monitoring and provide anticipatory guidance
D) Diagnose developmental delay
Answer: C) Continue monitoring and provide anticipatory guidance
Rationale: While most infants walk by 12 months, the normal range extends to 15-18
months. Isolated mild gross motor delay without other concerns warrants monitoring and
parental education about exercises to encourage motor development. Referral is appropriate
if delays persist .
10. What are the key developmental milestones for a 1-year-old infant?
A) Lifts head, follows objects with eyes
, B) Rolls over, sits with support
C) Stands, begins taking steps, says first words
D) Runs, climbs stairs, uses 2-3 word phrases
Answer: C) Stands, begins taking steps, says first words
Rationale: By 12 months, infants typically stand independently, begin taking steps, say 1-2
words, and use gestures like pointing. This represents significant developmental progression
from earlier infancy and is a key marker for normal neurodevelopment .
11. Which assessment finding in an infant would prompt immediate evaluation for potential
developmental concerns?
A) Delayed gross motor skills but normal fine motor skills
B) Regression of previously achieved milestones
C) Mild speech delay in a 2-year-old
D) Night waking in a 6-month-old
Answer: B) Regression of previously achieved milestones
Rationale: Regression of previously achieved milestones is a red flag that warrants
immediate evaluation. Unlike isolated delays in one domain, regression may indicate
neurological, metabolic, or other serious underlying conditions .
12. A 6-month-old infant is not rolling over. The parent is concerned. What is the most
appropriate initial response?
A) This is a sign of developmental delay requiring specialist referral
B) Some infants skip rolling over and this may be normal
C) The infant needs immediate physical therapy
D) This indicates a neurological problem
Answer: B) Some infants skip rolling over and this may be normal
Rationale: While most infants roll over by 6 months, some may skip this milestone and
proceed to sitting or crawling. The key is to assess overall development and other
milestones. Isolated variations may be normal .
13. When should a child be evaluated for early puberty (precocious puberty)?
A) Any breast development before age 6 in females
B) Thelarche before age 8 in females
C) Testicular enlargement before age 12 in males
D) Pubic hair before age 10 in females
Answer: B) Thelarche before age 8 in females
