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A 2-month-old infant is brought to the FNP for a routine well-
child examination. Which developmental finding is most
appropriate to expect at this age?
A. Walking independently
B. Social smiling
C. Using two-word phrases
D. copying a circle
Answer: B. Social smiling
Rationale: By approximately 2 months, infants typically
demonstrate a social smile and begin to show improved visual
tracking and social interaction. Walking and two-word phrases
occur much later in development.
,A parent of a 4-month-old infant reports that the infant wakes
several times during the night and requires rocking to return to
sleep. Which intervention is most appropriate?
A. Begin solid foods before bedtime
B. Allow the infant to self-soothe
C. Give a bottle whenever the infant awakens
D. Place the infant in the parents' bed
Answer: B. Allow the infant to self-soothe
Rationale: Establishing healthy sleep habits includes placing
infants down while drowsy but awake and allowing them
opportunities to self-soothe. Feeding or routinely rocking the
infant to sleep can reinforce sleep associations that make
independent sleep more difficult.
During a 12-month well-child examination, which developmental
finding should concern the FNP most?
A. Pulling to stand
B. Cruising around furniture
C. Not using any meaningful words
D. Picking up small objects with a pincer grasp
Answer: C. Not using any meaningful words
Rationale: By approximately 12 months, many children use at
least a few meaningful words or word approximations. Lack of
language development warrants further developmental
,assessment and consideration of hearing and speech-language
evaluation.
A 2-year-old child is unable to combine two words. What is the
most appropriate response by the FNP?
A. Reassure the parent that this is always normal
B. Refer for further language evaluation
C. Wait until the child enters kindergarten
D. Begin stimulant medication
Answer: B. Refer for further language evaluation
Rationale: Failure to combine words by approximately age 2 is a
language-development concern. The evaluation should consider
hearing, receptive and expressive language, social
communication, and broader developmental functioning.
A 3-year-old child speaks in sentences, but approximately 65% of
the child's speech is unintelligible to unfamiliar listeners. What
should the FNP do?
A. Consider the speech development normal for age
B. Recommend speech-language evaluation
C. Diagnose autism immediately
D. Reassure the parents and reassess at age 6
Answer: B. Recommend speech-language evaluation
, Rationale: Speech intelligibility should progressively increase
during early childhood. Speech that is substantially less
intelligible than expected should prompt assessment, particularly
when the child has a history of otitis media or other hearing
concerns.
A 3-year-old frequently plays beside other children but rarely
engages in cooperative play. Which interpretation is most
appropriate?
A. This necessarily indicates autism
B. This can be developmentally appropriate
C. This indicates oppositional defiant disorder
D. This indicates intellectual disability
Answer: B. This can be developmentally appropriate
Rationale: Parallel play is common during toddlerhood and early
preschool years. Cooperative and increasingly complex social play
develops progressively. The FNP should evaluate the child's
overall social communication and developmental pattern rather
than relying on one behavior.
A 5-year-old child is unable to copy a simple square and has
difficulty using scissors. What should the FNP do first?
A. Ignore the finding
B. Perform a comprehensive developmental assessment