NURS 629 Exam 2 (Maryville) 2026
Actual Questions & Answers
Pediatric Nursing Examination Preparation
Maryville University | 120 Questions with Comprehensive Rationales
Section 1: Pediatric Growth and Development (Q1-25)
Q1: A 6-month-old infant is brought to the pediatric clinic for a well-child visit. The infant was born at 39
weeks gestation with a birth weight of 3.5 kg. The nurse practitioner expects the infant's current weight to
be approximately:
A. 5.25 kg
B. 7.0 kg **[CORRECT]**
C. 8.75 kg
D. 10.5 kg
Correct Answer: B
Rationale:
Infants typically double their birth weight by 4-5 months and triple it by 12 months. At 6 months, an infant born at 3.5
kg should weigh approximately 7.0 kg (double the birth weight). A weight of 5.25 kg would be appropriate for a 2-3
month old, 8.75 kg approaches the expected weight for 9-10 months, and 10.5 kg is near the 12-month expectation.
These growth patterns follow established AAP guidelines for monitoring infant growth trajectories.
Q2: The parents of a 9-month-old infant ask the nurse practitioner when the anterior fontanelle typically
closes. Which response by the nurse practitioner is most accurate based on developmental milestones?
A. It typically closes between 2 and 3 months of age
B. It typically closes between 6 and 8 months of age
C. It typically closes between 12 and 18 months of age **[CORRECT]**
D. It typically closes between 24 and 36 months of age
Correct Answer: C
Rationale:
The anterior fontanelle typically closes between 12 and 18 months of age, which is a key developmental milestone
monitored during well-child visits. The posterior fontanelle closes much earlier, typically by 2-3 months of age. Early
closure of the anterior fontanelle may indicate craniosynostosis, while delayed closure can suggest raised intracranial
pressure, hypothyroidism, or rickets. Distinguishing between anterior and posterior fontanelle closure timing is
essential for accurate clinical assessment.
Q3: During a well-child visit for a 4-month-old infant, the nurse practitioner assesses developmental
milestones. Which finding would be considered a developmental red flag at this age?
, A. The infant can roll from front to back
B. The infant does not yet sit independently without support
C. The infant does not turn their head toward a loud noise or voice **[CORRECT]**
D. The infant cannot yet transfer objects from one hand to the other
Correct Answer: C
Rationale:
By 4 months of age, an infant should demonstrate orientation to sound by turning their head toward voices or sounds.
Absence of this response is a significant developmental red flag that warrants further hearing and neurological
evaluation. Rolling front to back is emerging at 4 months, not sitting independently is expected (sitting independently
typically occurs around 6 months), and transferring objects is not expected until approximately 7-9 months. Early
identification of hearing or neurological concerns is critical for timely intervention.
Q4: A nurse practitioner is providing anticipatory guidance to the parents of a 2-month-old infant. Which
recommendation is most appropriate for this age group according to AAP safe sleep guidelines?
A. Place the infant on their stomach for tummy time but always on the back for sleep **[CORRECT]**
B. Use a bumper pad around the crib to prevent head injuries
C. Keep the room warm with extra blankets to maintain body temperature
D. Co-sleeping is recommended to promote bonding and easier feeding
Correct Answer: A
Rationale:
The AAP recommends supine (back) positioning for all sleep times to reduce the risk of Sudden Infant Death
Syndrome (SIDS), while supervised tummy time while awake strengthens neck and shoulder muscles. Bumper pads
are discouraged due to suffocation and entrapment risks, extra blankets increase SIDS risk, and co-sleeping is
associated with increased suffocation hazards. These safe sleep guidelines remain a cornerstone of anticipatory
guidance at every well-child visit during infancy.
Q5: A 12-month-old infant is seen for their well-child checkup. Which developmental milestone is the
nurse practitioner LEAST likely to observe at this age?
A. Pulling to a standing position
B. Saying 2-3 specific words such as 'mama' or 'dada' with meaning
C. Walking independently without support **[CORRECT]**
D. Using a pincer grasp to pick up small objects
Correct Answer: C
Rationale:
Walking independently typically emerges between 12 and 15 months, so many 12-month-olds may not yet be walking
without support. Pulling to stand, speaking 2-3 words, and using a pincer grasp are all expected milestones by 12
months. The pincer grasp typically develops by 9-12 months, pulling to stand by 9-12 months, and first meaningful
words emerge around 12 months. The nurse practitioner should recognize the normal range of variability in gross
motor development while identifying true delays.
Q6: According to Erikson's stages of psychosocial development, which developmental task is central to
the infant period from birth to 12 months?
A. Autonomy versus shame and doubt
B. Trust versus mistrust **[CORRECT]**
, C. Initiative versus guilt
D. Industry versus inferiority
Correct Answer: B
Rationale:
Erikson's first stage, trust versus mistrust, spans from birth to approximately 12-18 months. Infants develop trust
when their basic needs for food, comfort, and affection are consistently met by caregivers. Autonomy versus shame
and doubt is the toddler stage (1-3 years), initiative versus guilt corresponds to the preschool period (3-6 years), and
industry versus inferiority characterizes the school-age period (6-12 years). Understanding Erikson's framework is
essential for providing developmentally appropriate anticipatory guidance to families.
Q7: The mother of a 3-month-old exclusively breastfed infant asks about vitamin D supplementation. What
is the most appropriate recommendation according to the AAP?
A. No supplementation is needed because breast milk provides adequate vitamin D
B. Supplement with 200 IU of vitamin D daily
C. Supplement with 400 IU of vitamin D daily beginning shortly after birth **[CORRECT]**
D. Supplement with 800 IU of vitamin D daily beginning at 6 months of age
Correct Answer: C
Rationale:
The AAP recommends 400 IU of vitamin D supplementation daily beginning within the first few days of life for all
exclusively or partially breastfed infants. Breast milk alone does not provide sufficient vitamin D to prevent rickets. A
dosage of 200 IU is below the recommended amount, and 800 IU exceeds the recommended daily supplementation
for infants unless specifically prescribed for treatment of deficiency. This recommendation is a key component of
nutritional anticipatory guidance at newborn and early infant visits.
Q8: A nurse practitioner is evaluating head circumference growth in a 6-month-old infant. The infant's
head circumference was 34 cm at birth (50th percentile) and is now 43 cm. Which interpretation is most
accurate?
A. This represents accelerated head growth and requires immediate neuroimaging
B. This represents normal head circumference growth for age **[CORRECT]**
C. This represents slowed head growth and may indicate microcephaly
D. Head circumference should be the same as chest circumference at this age
Correct Answer: B
Rationale:
Head circumference increases approximately 12 cm during the first 6 months (from about 34-35 cm at birth to about
43-44 cm at 6 months), making this measurement consistent with normal growth. Head circumference typically
exceeds chest circumference until approximately 6-12 months when they equalize, after which chest circumference
becomes larger. Accelerated growth would cross two or more percentile lines on the growth chart, warranting
evaluation. Monitoring head circumference trajectory on standardized growth charts is essential for detecting
abnormal brain development.
Q9: At a 9-month well-child visit, the parents report their infant can crawl, pull to stand, and babble using
consonant-vowel combinations such as 'da-da' and 'ba-ba,' but does not yet say any specific words with
meaning. The nurse practitioner should:
A. Refer the infant immediately to a speech-language pathologist for evaluation
B. Reassure the parents that this is within normal developmental expectations **[CORRECT]**
, C. Order a hearing evaluation and brain MRI
D. Recommend early intervention services for language delay
Correct Answer: B
Rationale:
Babbling with consonant-vowel combinations at 9 months is a normal pre-linguistic milestone. First meaningful words
typically emerge around 10-12 months of age, so the absence of specific words at 9 months is within expected
developmental parameters. Crawling and pulling to stand are also appropriate gross motor milestones for this age.
Immediate referral for speech therapy or diagnostic testing would be premature without additional red flags.
Continued monitoring at the 12-month visit is the appropriate next step.
Q10: A nurse practitioner is assessing a newborn and notes the posterior fontanelle. Which statement
about the posterior fontanelle is most accurate?
A. It is larger than the anterior fontanelle at birth
B. It is located at the junction of the sagittal and coronal sutures
C. It typically closes by 2 to 3 months of age **[CORRECT]**
D. It remains open until 12 to 18 months of age
Correct Answer: C
Rationale:
The posterior fontanelle is smaller than the anterior fontanelle and typically closes by 2-3 months of age. It is located
at the junction of the sagittal and lambdoid sutures (not the coronal sutures, which meet at the anterior fontanelle).
The anterior fontanelle, located at the junction of the sagittal and coronal sutures, is the larger one and closes
between 12-18 months. Differentiating between these two fontanelles, their locations, and their closure timelines is
fundamental knowledge for pediatric assessment.
Q11: A 1-month-old infant's weight was 3.2 kg at birth and is now 4.0 kg. The nurse practitioner calculates
the infant's weight gain and determines it is:
A. Inadequate, requiring supplemental feeding evaluation
B. Approximately 20 grams per day, which is below expectations
C. Approximately 27 grams per day, which is within the expected range **[CORRECT]**
D. Excessive and may indicate overfeeding
Correct Answer: C
Rationale:
The infant gained 800 grams (0.8 kg) over approximately 30 days, averaging about 27 grams per day. Expected
weight gain in the first 3 months is approximately 20-30 grams per day (about 150-200 grams per week). Weight gain
below 15-20 grams per day would be concerning and warrant evaluation for feeding difficulties. Gains above 35
grams daily may suggest overfeeding but are less common. Accurate weight gain calculation is essential for
assessing nutritional adequacy in early infancy.
Q12: Which anticipatory guidance topic is most important for the nurse practitioner to discuss with parents
of a 6-month-old infant regarding nutrition?
A. Introduction of whole cow's milk to replace formula
B. Beginning introduction of iron-rich complementary foods **[CORRECT]**
C. Transitioning to a low-fat diet to prevent childhood obesity
D. Starting finger foods including pieces of hot dogs and grapes
Actual Questions & Answers
Pediatric Nursing Examination Preparation
Maryville University | 120 Questions with Comprehensive Rationales
Section 1: Pediatric Growth and Development (Q1-25)
Q1: A 6-month-old infant is brought to the pediatric clinic for a well-child visit. The infant was born at 39
weeks gestation with a birth weight of 3.5 kg. The nurse practitioner expects the infant's current weight to
be approximately:
A. 5.25 kg
B. 7.0 kg **[CORRECT]**
C. 8.75 kg
D. 10.5 kg
Correct Answer: B
Rationale:
Infants typically double their birth weight by 4-5 months and triple it by 12 months. At 6 months, an infant born at 3.5
kg should weigh approximately 7.0 kg (double the birth weight). A weight of 5.25 kg would be appropriate for a 2-3
month old, 8.75 kg approaches the expected weight for 9-10 months, and 10.5 kg is near the 12-month expectation.
These growth patterns follow established AAP guidelines for monitoring infant growth trajectories.
Q2: The parents of a 9-month-old infant ask the nurse practitioner when the anterior fontanelle typically
closes. Which response by the nurse practitioner is most accurate based on developmental milestones?
A. It typically closes between 2 and 3 months of age
B. It typically closes between 6 and 8 months of age
C. It typically closes between 12 and 18 months of age **[CORRECT]**
D. It typically closes between 24 and 36 months of age
Correct Answer: C
Rationale:
The anterior fontanelle typically closes between 12 and 18 months of age, which is a key developmental milestone
monitored during well-child visits. The posterior fontanelle closes much earlier, typically by 2-3 months of age. Early
closure of the anterior fontanelle may indicate craniosynostosis, while delayed closure can suggest raised intracranial
pressure, hypothyroidism, or rickets. Distinguishing between anterior and posterior fontanelle closure timing is
essential for accurate clinical assessment.
Q3: During a well-child visit for a 4-month-old infant, the nurse practitioner assesses developmental
milestones. Which finding would be considered a developmental red flag at this age?
, A. The infant can roll from front to back
B. The infant does not yet sit independently without support
C. The infant does not turn their head toward a loud noise or voice **[CORRECT]**
D. The infant cannot yet transfer objects from one hand to the other
Correct Answer: C
Rationale:
By 4 months of age, an infant should demonstrate orientation to sound by turning their head toward voices or sounds.
Absence of this response is a significant developmental red flag that warrants further hearing and neurological
evaluation. Rolling front to back is emerging at 4 months, not sitting independently is expected (sitting independently
typically occurs around 6 months), and transferring objects is not expected until approximately 7-9 months. Early
identification of hearing or neurological concerns is critical for timely intervention.
Q4: A nurse practitioner is providing anticipatory guidance to the parents of a 2-month-old infant. Which
recommendation is most appropriate for this age group according to AAP safe sleep guidelines?
A. Place the infant on their stomach for tummy time but always on the back for sleep **[CORRECT]**
B. Use a bumper pad around the crib to prevent head injuries
C. Keep the room warm with extra blankets to maintain body temperature
D. Co-sleeping is recommended to promote bonding and easier feeding
Correct Answer: A
Rationale:
The AAP recommends supine (back) positioning for all sleep times to reduce the risk of Sudden Infant Death
Syndrome (SIDS), while supervised tummy time while awake strengthens neck and shoulder muscles. Bumper pads
are discouraged due to suffocation and entrapment risks, extra blankets increase SIDS risk, and co-sleeping is
associated with increased suffocation hazards. These safe sleep guidelines remain a cornerstone of anticipatory
guidance at every well-child visit during infancy.
Q5: A 12-month-old infant is seen for their well-child checkup. Which developmental milestone is the
nurse practitioner LEAST likely to observe at this age?
A. Pulling to a standing position
B. Saying 2-3 specific words such as 'mama' or 'dada' with meaning
C. Walking independently without support **[CORRECT]**
D. Using a pincer grasp to pick up small objects
Correct Answer: C
Rationale:
Walking independently typically emerges between 12 and 15 months, so many 12-month-olds may not yet be walking
without support. Pulling to stand, speaking 2-3 words, and using a pincer grasp are all expected milestones by 12
months. The pincer grasp typically develops by 9-12 months, pulling to stand by 9-12 months, and first meaningful
words emerge around 12 months. The nurse practitioner should recognize the normal range of variability in gross
motor development while identifying true delays.
Q6: According to Erikson's stages of psychosocial development, which developmental task is central to
the infant period from birth to 12 months?
A. Autonomy versus shame and doubt
B. Trust versus mistrust **[CORRECT]**
, C. Initiative versus guilt
D. Industry versus inferiority
Correct Answer: B
Rationale:
Erikson's first stage, trust versus mistrust, spans from birth to approximately 12-18 months. Infants develop trust
when their basic needs for food, comfort, and affection are consistently met by caregivers. Autonomy versus shame
and doubt is the toddler stage (1-3 years), initiative versus guilt corresponds to the preschool period (3-6 years), and
industry versus inferiority characterizes the school-age period (6-12 years). Understanding Erikson's framework is
essential for providing developmentally appropriate anticipatory guidance to families.
Q7: The mother of a 3-month-old exclusively breastfed infant asks about vitamin D supplementation. What
is the most appropriate recommendation according to the AAP?
A. No supplementation is needed because breast milk provides adequate vitamin D
B. Supplement with 200 IU of vitamin D daily
C. Supplement with 400 IU of vitamin D daily beginning shortly after birth **[CORRECT]**
D. Supplement with 800 IU of vitamin D daily beginning at 6 months of age
Correct Answer: C
Rationale:
The AAP recommends 400 IU of vitamin D supplementation daily beginning within the first few days of life for all
exclusively or partially breastfed infants. Breast milk alone does not provide sufficient vitamin D to prevent rickets. A
dosage of 200 IU is below the recommended amount, and 800 IU exceeds the recommended daily supplementation
for infants unless specifically prescribed for treatment of deficiency. This recommendation is a key component of
nutritional anticipatory guidance at newborn and early infant visits.
Q8: A nurse practitioner is evaluating head circumference growth in a 6-month-old infant. The infant's
head circumference was 34 cm at birth (50th percentile) and is now 43 cm. Which interpretation is most
accurate?
A. This represents accelerated head growth and requires immediate neuroimaging
B. This represents normal head circumference growth for age **[CORRECT]**
C. This represents slowed head growth and may indicate microcephaly
D. Head circumference should be the same as chest circumference at this age
Correct Answer: B
Rationale:
Head circumference increases approximately 12 cm during the first 6 months (from about 34-35 cm at birth to about
43-44 cm at 6 months), making this measurement consistent with normal growth. Head circumference typically
exceeds chest circumference until approximately 6-12 months when they equalize, after which chest circumference
becomes larger. Accelerated growth would cross two or more percentile lines on the growth chart, warranting
evaluation. Monitoring head circumference trajectory on standardized growth charts is essential for detecting
abnormal brain development.
Q9: At a 9-month well-child visit, the parents report their infant can crawl, pull to stand, and babble using
consonant-vowel combinations such as 'da-da' and 'ba-ba,' but does not yet say any specific words with
meaning. The nurse practitioner should:
A. Refer the infant immediately to a speech-language pathologist for evaluation
B. Reassure the parents that this is within normal developmental expectations **[CORRECT]**
, C. Order a hearing evaluation and brain MRI
D. Recommend early intervention services for language delay
Correct Answer: B
Rationale:
Babbling with consonant-vowel combinations at 9 months is a normal pre-linguistic milestone. First meaningful words
typically emerge around 10-12 months of age, so the absence of specific words at 9 months is within expected
developmental parameters. Crawling and pulling to stand are also appropriate gross motor milestones for this age.
Immediate referral for speech therapy or diagnostic testing would be premature without additional red flags.
Continued monitoring at the 12-month visit is the appropriate next step.
Q10: A nurse practitioner is assessing a newborn and notes the posterior fontanelle. Which statement
about the posterior fontanelle is most accurate?
A. It is larger than the anterior fontanelle at birth
B. It is located at the junction of the sagittal and coronal sutures
C. It typically closes by 2 to 3 months of age **[CORRECT]**
D. It remains open until 12 to 18 months of age
Correct Answer: C
Rationale:
The posterior fontanelle is smaller than the anterior fontanelle and typically closes by 2-3 months of age. It is located
at the junction of the sagittal and lambdoid sutures (not the coronal sutures, which meet at the anterior fontanelle).
The anterior fontanelle, located at the junction of the sagittal and coronal sutures, is the larger one and closes
between 12-18 months. Differentiating between these two fontanelles, their locations, and their closure timelines is
fundamental knowledge for pediatric assessment.
Q11: A 1-month-old infant's weight was 3.2 kg at birth and is now 4.0 kg. The nurse practitioner calculates
the infant's weight gain and determines it is:
A. Inadequate, requiring supplemental feeding evaluation
B. Approximately 20 grams per day, which is below expectations
C. Approximately 27 grams per day, which is within the expected range **[CORRECT]**
D. Excessive and may indicate overfeeding
Correct Answer: C
Rationale:
The infant gained 800 grams (0.8 kg) over approximately 30 days, averaging about 27 grams per day. Expected
weight gain in the first 3 months is approximately 20-30 grams per day (about 150-200 grams per week). Weight gain
below 15-20 grams per day would be concerning and warrant evaluation for feeding difficulties. Gains above 35
grams daily may suggest overfeeding but are less common. Accurate weight gain calculation is essential for
assessing nutritional adequacy in early infancy.
Q12: Which anticipatory guidance topic is most important for the nurse practitioner to discuss with parents
of a 6-month-old infant regarding nutrition?
A. Introduction of whole cow's milk to replace formula
B. Beginning introduction of iron-rich complementary foods **[CORRECT]**
C. Transitioning to a low-fat diet to prevent childhood obesity
D. Starting finger foods including pieces of hot dogs and grapes
