WGU MSN — PEDIATRIC PRIMARY CARE
WGU D119 OBJECTIVE ASSESSMENT
AND PRACTICE EXAM
A+
2026/2027 Official Exam
Pediatric Primary Care — Nurse Practitioner Competencies
A+ QUESTIONS 5 SECTIONS 100% RATIONALES
VERIFIED COMPLETE INCLUDED
CATEGORIES
Section 1: Growth, Development & Well-Child Care
Section 2: Immunizations & Preventive Care
Section 3: Common Acute Illnesses
Section 4: Chronic Conditions & Special Populations
Section 5: Adolescent Health, Behavioral & Safety
STUVIAACTUALEXAM
Original practice content aligned to public pediatric primary care competencies • For educational use
, Section 1: Growth, Development & Well-Child Care
Q1. A 15-month-old is seen for a well-child visit. The child walks independently, says “mama” and “dada” specifically, and points
to request objects. The parent is concerned because the child does not yet stack two blocks. Which interpretation is most
accurate?
A. The child should be referred for a full developmental evaluation today
B. The child has a significant fine-motor delay requiring immediate referral
C. Stacking two blocks is typically achieved closer to 18 months; current milestones are age-appropriate
D. Language is delayed and speech therapy should be initiated now
Correct Answer: C
Rationale:
Independent walking and specific mama/dada are expected by 12–15 months. Stacking two blocks is more consistently seen by 18 months. Current
development is within normal limits; continued surveillance is appropriate.
Q2. A newborn’s weight is 3.2 kg at birth. At the two-week visit the infant weighs 3.0 kg. The infant is breastfeeding well with
adequate wet diapers. Which counseling is most appropriate?
A. This degree of weight loss is abnormal and formula supplementation must be started immediately
B. Breastfeeding should be discontinued because of inadequate weight gain
C. The infant must be hospitalized for failure to thrive
D. Up to 10% weight loss is common in the first week; regain of birth weight by 2 weeks is expected and current trajectory is
acceptable
Correct Answer: D
Rationale:
Healthy newborns commonly lose up to 7–10% of birth weight in the first days of life and typically regain birth weight by 10–14 days. With good
feeding and output, continued exclusive breastfeeding and close follow-up are appropriate.
Q3. A 4-year-old draws a person with three parts and can hop on one foot. The parent asks whether these skills are on track.
Which response is correct?
A. The child should be referred for occupational therapy evaluation
B. Drawing a person with three parts is delayed; a five-part person is expected by age 4
C. Hopping on one foot is not expected until age 6
D. These skills are consistent with typical 4-year-old fine- and gross-motor development
Correct Answer: D
Rationale:
By age 4 most children can hop on one foot and draw a person with 3–4 body parts. These findings support age-appropriate motor development.
Q4. During a 9-month well visit the infant does not sit steadily without support and does not transfer objects from hand to hand.
Which action is most appropriate?
A. Begin physical therapy without further assessment
B. Reassure the parent that these skills will appear by 12 months
C. Order an MRI of the brain immediately
D. Schedule closer developmental surveillance and consider early-intervention referral if delays persist
Correct Answer: D
Rationale:
Steady independent sitting and object transfer are expected by 7–9 months. Isolated mild delays warrant enhanced surveillance and prompt referral
to early intervention if they do not resolve.
, WGU D119 OBJECTIVE ASSESSMENT AND PRACTICE EXAM — 2026/2027 Page 3
Q5. A 2-year-old uses two-word phrases, follows two-step commands, and engages in parallel play. The parent is worried
because the child does not yet share toys. Which guidance is accurate?
A. Failure to share at age 2 indicates an autism spectrum disorder
B. The child should be enrolled in structured social-skills therapy immediately
C. Parallel play and limited sharing are developmentally expected at age 2; cooperative play emerges later
D. Language is delayed and requires formal evaluation
Correct Answer: C
Rationale:
Two-year-olds typically engage in parallel play and are only beginning to understand sharing. Cooperative play and reliable turn-taking develop closer
to ages 3–4.
Q6. A 6-month-old’s length and weight have both fallen from the 50th to the 10th percentile since the 4-month visit. Head
circumference remains at the 50th percentile. The infant is exclusively breastfed. Which next step is most appropriate?
A. Start high-calorie formula immediately without further evaluation
B. Obtain a detailed feeding history, observe a feeding, and evaluate for organic and psychosocial contributors to growth faltering
C. Reassure the parent that crossing percentiles is always normal
D. Order a complete endocrine work-up as the first step
Correct Answer: B
Rationale:
Crossing two major percentile lines warrants evaluation. A careful feeding assessment and psychosocial history are the essential first steps before
extensive laboratory testing.
Q7. A 3-year-old is unable to ride a tricycle and cannot copy a circle. Language and social skills are age-appropriate. Which
interpretation is most accurate?
A. Global developmental delay is present
B. Isolated gross- and fine-motor delays should prompt targeted evaluation and possible early-intervention referral
C. These skills are not expected until age 5
D. No further action is needed until school entry
Correct Answer: B
Rationale:
Riding a tricycle and copying a circle are expected by age 3. Isolated motor delays merit focused assessment and early support while other domains
remain strong.
Q8. A newborn screening result is positive for congenital hypothyroidism. The infant appears well. Which action is required?
A. Confirm the diagnosis with serum TSH and free T4 and initiate levothyroxine promptly once confirmed
B. Refer only if the infant develops jaundice
C. Wait for clinical signs of hypothyroidism before treating
D. Repeat the screen in 2 weeks and begin treatment only if still abnormal
Correct Answer: A
Rationale:
Congenital hypothyroidism requires rapid confirmatory testing and early initiation of thyroid hormone to protect neurodevelopment. Treatment should
not be delayed for the appearance of clinical signs.
WGU D119 OBJECTIVE ASSESSMENT
AND PRACTICE EXAM
A+
2026/2027 Official Exam
Pediatric Primary Care — Nurse Practitioner Competencies
A+ QUESTIONS 5 SECTIONS 100% RATIONALES
VERIFIED COMPLETE INCLUDED
CATEGORIES
Section 1: Growth, Development & Well-Child Care
Section 2: Immunizations & Preventive Care
Section 3: Common Acute Illnesses
Section 4: Chronic Conditions & Special Populations
Section 5: Adolescent Health, Behavioral & Safety
STUVIAACTUALEXAM
Original practice content aligned to public pediatric primary care competencies • For educational use
, Section 1: Growth, Development & Well-Child Care
Q1. A 15-month-old is seen for a well-child visit. The child walks independently, says “mama” and “dada” specifically, and points
to request objects. The parent is concerned because the child does not yet stack two blocks. Which interpretation is most
accurate?
A. The child should be referred for a full developmental evaluation today
B. The child has a significant fine-motor delay requiring immediate referral
C. Stacking two blocks is typically achieved closer to 18 months; current milestones are age-appropriate
D. Language is delayed and speech therapy should be initiated now
Correct Answer: C
Rationale:
Independent walking and specific mama/dada are expected by 12–15 months. Stacking two blocks is more consistently seen by 18 months. Current
development is within normal limits; continued surveillance is appropriate.
Q2. A newborn’s weight is 3.2 kg at birth. At the two-week visit the infant weighs 3.0 kg. The infant is breastfeeding well with
adequate wet diapers. Which counseling is most appropriate?
A. This degree of weight loss is abnormal and formula supplementation must be started immediately
B. Breastfeeding should be discontinued because of inadequate weight gain
C. The infant must be hospitalized for failure to thrive
D. Up to 10% weight loss is common in the first week; regain of birth weight by 2 weeks is expected and current trajectory is
acceptable
Correct Answer: D
Rationale:
Healthy newborns commonly lose up to 7–10% of birth weight in the first days of life and typically regain birth weight by 10–14 days. With good
feeding and output, continued exclusive breastfeeding and close follow-up are appropriate.
Q3. A 4-year-old draws a person with three parts and can hop on one foot. The parent asks whether these skills are on track.
Which response is correct?
A. The child should be referred for occupational therapy evaluation
B. Drawing a person with three parts is delayed; a five-part person is expected by age 4
C. Hopping on one foot is not expected until age 6
D. These skills are consistent with typical 4-year-old fine- and gross-motor development
Correct Answer: D
Rationale:
By age 4 most children can hop on one foot and draw a person with 3–4 body parts. These findings support age-appropriate motor development.
Q4. During a 9-month well visit the infant does not sit steadily without support and does not transfer objects from hand to hand.
Which action is most appropriate?
A. Begin physical therapy without further assessment
B. Reassure the parent that these skills will appear by 12 months
C. Order an MRI of the brain immediately
D. Schedule closer developmental surveillance and consider early-intervention referral if delays persist
Correct Answer: D
Rationale:
Steady independent sitting and object transfer are expected by 7–9 months. Isolated mild delays warrant enhanced surveillance and prompt referral
to early intervention if they do not resolve.
, WGU D119 OBJECTIVE ASSESSMENT AND PRACTICE EXAM — 2026/2027 Page 3
Q5. A 2-year-old uses two-word phrases, follows two-step commands, and engages in parallel play. The parent is worried
because the child does not yet share toys. Which guidance is accurate?
A. Failure to share at age 2 indicates an autism spectrum disorder
B. The child should be enrolled in structured social-skills therapy immediately
C. Parallel play and limited sharing are developmentally expected at age 2; cooperative play emerges later
D. Language is delayed and requires formal evaluation
Correct Answer: C
Rationale:
Two-year-olds typically engage in parallel play and are only beginning to understand sharing. Cooperative play and reliable turn-taking develop closer
to ages 3–4.
Q6. A 6-month-old’s length and weight have both fallen from the 50th to the 10th percentile since the 4-month visit. Head
circumference remains at the 50th percentile. The infant is exclusively breastfed. Which next step is most appropriate?
A. Start high-calorie formula immediately without further evaluation
B. Obtain a detailed feeding history, observe a feeding, and evaluate for organic and psychosocial contributors to growth faltering
C. Reassure the parent that crossing percentiles is always normal
D. Order a complete endocrine work-up as the first step
Correct Answer: B
Rationale:
Crossing two major percentile lines warrants evaluation. A careful feeding assessment and psychosocial history are the essential first steps before
extensive laboratory testing.
Q7. A 3-year-old is unable to ride a tricycle and cannot copy a circle. Language and social skills are age-appropriate. Which
interpretation is most accurate?
A. Global developmental delay is present
B. Isolated gross- and fine-motor delays should prompt targeted evaluation and possible early-intervention referral
C. These skills are not expected until age 5
D. No further action is needed until school entry
Correct Answer: B
Rationale:
Riding a tricycle and copying a circle are expected by age 3. Isolated motor delays merit focused assessment and early support while other domains
remain strong.
Q8. A newborn screening result is positive for congenital hypothyroidism. The infant appears well. Which action is required?
A. Confirm the diagnosis with serum TSH and free T4 and initiate levothyroxine promptly once confirmed
B. Refer only if the infant develops jaundice
C. Wait for clinical signs of hypothyroidism before treating
D. Repeat the screen in 2 weeks and begin treatment only if still abnormal
Correct Answer: A
Rationale:
Congenital hypothyroidism requires rapid confirmatory testing and early initiation of thyroid hormone to protect neurodevelopment. Treatment should
not be delayed for the appearance of clinical signs.
