NSG 5442 FINAL EXAM | PRACTICE QUESTIONS AND ANSWERS
2026/2027 | COMPLETE QUESTIONS AND ANSWERS (VERIFIED
ANSWERS) | EXAM PREP | COMPREHENSIVE EXAM GUIDE
2026&2027
1. A 4-year-old child is evaluated during a routine well-child visit. The parent reports that
the child becomes frustrated when asked to stop one activity and immediately begin
another. Which developmental domain should the primary care pediatric nurse
practitioner assess most closely?
A. Receptive language
B. Cognitive flexibility
C. Fine motor coordination
D. Visual acuity
Answer: B
Cognitive flexibility allows a child to shift attention and behavior from one activity or
expectation to another. Difficulty with transitions is commonly associated with immature
flexibility and executive-function skills.
2. A 6-year-old child has difficulty remaining seated during classroom activities, frequently
interrupts others, and has trouble waiting for a turn. Which additional finding would most
strongly support a diagnosis of attention-deficit/hyperactivity disorder (ADHD)?
A. Symptoms occur only at home
B. Symptoms began after a recent family move
C. Symptoms are present in more than one setting and impair functioning
D. Symptoms occur only during mathematics lessons
Answer: C
ADHD requires persistent symptoms that cause functional impairment and are evident in
more than one setting. Symptoms limited to one environment suggest that other factors
should be investigated before diagnosing ADHD.
3. During a health-literacy assessment, a parent correctly repeats medication instructions
but cannot explain how the medication should be incorporated into the child's daily
routine. What should the nurse practitioner do next?
A. Provide the same written instructions again
B. Ask the parent to demonstrate or explain the plan in their own words
C. Document that the parent has adequate health literacy
D. Ask the pharmacist to contact the family
,Answer: B
Teach-back requires the patient or caregiver to explain the information in their own words or
demonstrate the recommended action. It evaluates understanding rather than simply asking
whether instructions were understood.
4. A newborn is delivered at term and has a respiratory rate of 58/minute shortly after
birth. The infant is pink, vigorous, feeding well, and has no retractions or grunting. What
is the most appropriate interpretation?
A. The respiratory rate may be within the expected newborn range
B. The infant has respiratory failure
C. The infant requires immediate intubation
D. The finding confirms neonatal sepsis
Answer: A
Newborn respiratory rates are normally higher than adult rates, generally about 30–60
breaths/minute. Clinical assessment for distress is more important than an isolated rate
within the expected range.
5. A mother asks why vitamin K is routinely administered to her newborn shortly after
delivery. Which explanation is most appropriate?
A. It prevents physiologic jaundice
B. It prevents neonatal hypoglycemia
C. Newborns have limited vitamin K stores and immature vitamin-K-dependent clotting activity
D. It prevents respiratory distress syndrome
Answer: C
Newborns have low vitamin K stores and relatively limited intestinal bacterial production,
increasing the risk of vitamin K deficiency bleeding. Prophylactic vitamin K substantially
reduces this risk.
6. A healthy 2-month-old infant is brought for a preventive visit. Which developmental
finding would be most concerning if absent?
A. Sitting independently
B. Social smiling
C. Using two-word phrases
D. Walking without support
Answer: B
,Social smiling is an expected early developmental milestone. Independent sitting, two-word
phrases, and walking occur later in normal development.
7. A 9-month-old infant is not yet crawling but rolls, sits independently, transfers objects
between hands, and interacts socially. What is the most appropriate response?
A. Diagnose gross motor delay
B. Refer immediately for neurosurgical evaluation
C. Recognize that crawling is variable and assess the overall developmental pattern
D. Begin stimulant therapy
Answer: C
Crawling is not a required milestone for every infant. Development should be evaluated
across multiple domains, with attention to functional abilities and developmental
progression.
8. A 15-month-old child walks independently but does not use any meaningful words.
Which action is most appropriate?
A. Reassure the parent because speech always develops after walking
B. Wait until age 3 years before evaluating language
C. Assess hearing and language development and consider early intervention referral
D. Diagnose autism spectrum disorder immediately
Answer: C
Absence of meaningful words at this age warrants further developmental assessment.
Hearing impairment should be excluded, and early intervention can be beneficial when
language delay is identified.
9. A 2-year-old child uses approximately 50 words and combines two words but becomes
frustrated when unfamiliar adults cannot understand the child. Which interpretation is
most appropriate?
A. The language pattern can be developmentally appropriate
B. The child definitely has expressive language disorder
C. The child has intellectual disability
D. The child requires immediate speech medication
Answer: A
Two-word combinations and an expanding vocabulary are expected during the second year of
life. Speech intelligibility to unfamiliar listeners increases progressively with age.
, 10. A parent reports that a 3-year-old child has recently stopped using previously acquired
words and no longer makes eye contact. What is the priority response?
A. Reassure the parent that regression is normal
B. Recommend increased television exposure
C. Perform developmental and neurologic evaluation and arrange appropriate referral
D. Wait until kindergarten for formal assessment
Answer: C
Developmental regression is not considered a normal milestone and requires prompt
evaluation. The assessment should consider neurologic, developmental, behavioral, and
medical causes.
11. A 5-year-old child has recurrent nighttime episodes characterized by sudden
screaming, autonomic arousal, and no recall the following morning. The episodes occur
during the first part of the night. What is the most likely diagnosis?
A. Nightmare disorder
B. Sleep terror
C. Narcolepsy
D. Sleep-onset association disorder
Answer: B
Sleep terrors typically occur during non-REM sleep early in the night and are characterized by
autonomic arousal with little or no recall the next morning.
12. A parent reports that a 7-year-old child requires a parent to remain in the room until
the child falls asleep every night and awakens when the parent leaves. Which intervention
is most appropriate?
A. Establish a consistent bedtime routine and gradually reduce the sleep association
B. Allow unlimited screen use before bed
C. Wake the child every hour during the night
D. Encourage daytime naps lasting several hours
Answer: A
Sleep-onset association problems improve when children develop independent sleep initiation
skills. A predictable routine and gradual reduction of the parental association are appropriate
behavioral strategies.
13. A school-age child is evaluated for obesity. Which measurement should be used to
interpret weight status appropriately?
2026/2027 | COMPLETE QUESTIONS AND ANSWERS (VERIFIED
ANSWERS) | EXAM PREP | COMPREHENSIVE EXAM GUIDE
2026&2027
1. A 4-year-old child is evaluated during a routine well-child visit. The parent reports that
the child becomes frustrated when asked to stop one activity and immediately begin
another. Which developmental domain should the primary care pediatric nurse
practitioner assess most closely?
A. Receptive language
B. Cognitive flexibility
C. Fine motor coordination
D. Visual acuity
Answer: B
Cognitive flexibility allows a child to shift attention and behavior from one activity or
expectation to another. Difficulty with transitions is commonly associated with immature
flexibility and executive-function skills.
2. A 6-year-old child has difficulty remaining seated during classroom activities, frequently
interrupts others, and has trouble waiting for a turn. Which additional finding would most
strongly support a diagnosis of attention-deficit/hyperactivity disorder (ADHD)?
A. Symptoms occur only at home
B. Symptoms began after a recent family move
C. Symptoms are present in more than one setting and impair functioning
D. Symptoms occur only during mathematics lessons
Answer: C
ADHD requires persistent symptoms that cause functional impairment and are evident in
more than one setting. Symptoms limited to one environment suggest that other factors
should be investigated before diagnosing ADHD.
3. During a health-literacy assessment, a parent correctly repeats medication instructions
but cannot explain how the medication should be incorporated into the child's daily
routine. What should the nurse practitioner do next?
A. Provide the same written instructions again
B. Ask the parent to demonstrate or explain the plan in their own words
C. Document that the parent has adequate health literacy
D. Ask the pharmacist to contact the family
,Answer: B
Teach-back requires the patient or caregiver to explain the information in their own words or
demonstrate the recommended action. It evaluates understanding rather than simply asking
whether instructions were understood.
4. A newborn is delivered at term and has a respiratory rate of 58/minute shortly after
birth. The infant is pink, vigorous, feeding well, and has no retractions or grunting. What
is the most appropriate interpretation?
A. The respiratory rate may be within the expected newborn range
B. The infant has respiratory failure
C. The infant requires immediate intubation
D. The finding confirms neonatal sepsis
Answer: A
Newborn respiratory rates are normally higher than adult rates, generally about 30–60
breaths/minute. Clinical assessment for distress is more important than an isolated rate
within the expected range.
5. A mother asks why vitamin K is routinely administered to her newborn shortly after
delivery. Which explanation is most appropriate?
A. It prevents physiologic jaundice
B. It prevents neonatal hypoglycemia
C. Newborns have limited vitamin K stores and immature vitamin-K-dependent clotting activity
D. It prevents respiratory distress syndrome
Answer: C
Newborns have low vitamin K stores and relatively limited intestinal bacterial production,
increasing the risk of vitamin K deficiency bleeding. Prophylactic vitamin K substantially
reduces this risk.
6. A healthy 2-month-old infant is brought for a preventive visit. Which developmental
finding would be most concerning if absent?
A. Sitting independently
B. Social smiling
C. Using two-word phrases
D. Walking without support
Answer: B
,Social smiling is an expected early developmental milestone. Independent sitting, two-word
phrases, and walking occur later in normal development.
7. A 9-month-old infant is not yet crawling but rolls, sits independently, transfers objects
between hands, and interacts socially. What is the most appropriate response?
A. Diagnose gross motor delay
B. Refer immediately for neurosurgical evaluation
C. Recognize that crawling is variable and assess the overall developmental pattern
D. Begin stimulant therapy
Answer: C
Crawling is not a required milestone for every infant. Development should be evaluated
across multiple domains, with attention to functional abilities and developmental
progression.
8. A 15-month-old child walks independently but does not use any meaningful words.
Which action is most appropriate?
A. Reassure the parent because speech always develops after walking
B. Wait until age 3 years before evaluating language
C. Assess hearing and language development and consider early intervention referral
D. Diagnose autism spectrum disorder immediately
Answer: C
Absence of meaningful words at this age warrants further developmental assessment.
Hearing impairment should be excluded, and early intervention can be beneficial when
language delay is identified.
9. A 2-year-old child uses approximately 50 words and combines two words but becomes
frustrated when unfamiliar adults cannot understand the child. Which interpretation is
most appropriate?
A. The language pattern can be developmentally appropriate
B. The child definitely has expressive language disorder
C. The child has intellectual disability
D. The child requires immediate speech medication
Answer: A
Two-word combinations and an expanding vocabulary are expected during the second year of
life. Speech intelligibility to unfamiliar listeners increases progressively with age.
, 10. A parent reports that a 3-year-old child has recently stopped using previously acquired
words and no longer makes eye contact. What is the priority response?
A. Reassure the parent that regression is normal
B. Recommend increased television exposure
C. Perform developmental and neurologic evaluation and arrange appropriate referral
D. Wait until kindergarten for formal assessment
Answer: C
Developmental regression is not considered a normal milestone and requires prompt
evaluation. The assessment should consider neurologic, developmental, behavioral, and
medical causes.
11. A 5-year-old child has recurrent nighttime episodes characterized by sudden
screaming, autonomic arousal, and no recall the following morning. The episodes occur
during the first part of the night. What is the most likely diagnosis?
A. Nightmare disorder
B. Sleep terror
C. Narcolepsy
D. Sleep-onset association disorder
Answer: B
Sleep terrors typically occur during non-REM sleep early in the night and are characterized by
autonomic arousal with little or no recall the next morning.
12. A parent reports that a 7-year-old child requires a parent to remain in the room until
the child falls asleep every night and awakens when the parent leaves. Which intervention
is most appropriate?
A. Establish a consistent bedtime routine and gradually reduce the sleep association
B. Allow unlimited screen use before bed
C. Wake the child every hour during the night
D. Encourage daytime naps lasting several hours
Answer: A
Sleep-onset association problems improve when children develop independent sleep initiation
skills. A predictable routine and gradual reduction of the parental association are appropriate
behavioral strategies.
13. A school-age child is evaluated for obesity. Which measurement should be used to
interpret weight status appropriately?
