Sentinel U APS Pediatric Wellness – Alonzo Harwood
2026/2027 | Advanced Practice Series Pediatric
Wellness Simulation Study Guide & Practice Questions
| Alonzo Harwood Pediatric Wellness Case Review,
Well-Child Assessment, Pediatric Growth &
Development, Developmental Milestones, Denver II,
Physical Examination, Growth Charts, BMI,
Immunizations, Preventive Care, Bright Futures,
Anticipatory Guidance, Nutrition, Safety, Family-
Centered Care, Clinical Decision-Making,
Documentation, SOAP Notes, Clinical Judgment &
Detailed Rationales
Question 1: A 4-year-old child like Alonzo should be able to
accomplish which fine motor skill?
A. Tying shoelaces
B. Drawing a circle
C. Using safety scissors
D. Writing first name
CORRECT ANSWER: B. Drawing a circle
Rationale: Drawing a circle is an age-appropriate fine motor milestone for a
4-year-old. Tying shoelaces typically emerges at age 6, using scissors at age
5, and writing a first name at age 5–6.
Question 2: Which developmental screening tool is most
appropriate for a wellness visit in a 4-year-old?
A. M-CHAT
B. Denver II
C. PHQ-9
D. CAGE questionnaire
CORRECT ANSWER: B. Denver II
Rationale: The Denver II screens personal-social, fine motor-adaptive,
language, and gross motor domains. M-CHAT is for toddlers (16–30
months). PHQ-9 and CAGE are for mental health/substance use in older
patients.
,Question 3: Alonzo speaks in 4–5 word sentences and asks "why"
questions constantly. This language development is typical for
which age?
A. 2 years
B. 3 years
C. 4 years
D. 5 years
CORRECT ANSWER: C. 4 years
Rationale: Four-year-olds typically use 4–5 word sentences, ask many
questions (especially "why"), and can tell simple stories. Two-year-olds use
2–3 word phrases; 3-year-olds use 3–4 word sentences.
Question 4: Which gross motor milestone is expected in a typically
developing 4-year-old?
A. Hopping on one foot
B. Skipping
C. Walking backward
D. Standing on tiptoes
CORRECT ANSWER: A. Hopping on one foot
Rationale: Hopping on one foot emerges at age 4. Skipping develops at age
5. Walking backward is a 3-year-old skill. Standing on tiptoes is a 2–3 year
skill.
Question 5: Red flags for developmental delay at age 4 include all
EXCEPT:
A. Unable to copy a circle
B. Does not use "me" and "you" correctly
C. Can brush teeth with help
D. No interest in interactive games
CORRECT ANSWER: C. Can brush teeth with help
Rationale: Brushing teeth with help is appropriate for age 4. The other
options represent developmental red flags requiring further evaluation.
Question 6: A 4-year-old's play behavior is typically described as:
,A. Solitary play
B. Parallel play
C. Associative play
D. Cooperative play
CORRECT ANSWER: C. Associative play
Rationale: Four-year-olds engage in associative play—playing with others
but without formal organization. They begin to interact, share, and engage
in simple group activities but may not have structured rules yet.
Question 7: Which Piaget stage corresponds to a 4-year-old child?
A. Sensorimotor
B. Preoperational
C. Concrete operational
D. Formal operational
CORRECT ANSWER: B. Preoperational
Rationale: Piaget's preoperational stage (ages 2–7) is characterized by
egocentrism, magical thinking, and symbolic play. Sensorimotor is birth–2
years; concrete operational is 7–11 years; formal operational is
adolescence.
Question 8: According to Erikson, a 4-year-old is in which
psychosocial stage?
A. Trust vs. Mistrust
B. Autonomy vs. Shame and Doubt
C. Initiative vs. Guilt
D. Industry vs. Inferiority
CORRECT ANSWER: C. Initiative vs. Guilt
Rationale: Initiative vs. Guilt (ages 3–6) is when children begin to assert
power and control over their environment. Trust vs. Mistrust is infancy;
Autonomy vs. Shame is toddlerhood; Industry vs. Inferiority is school age.
Question 9: What is the typical sleep pattern for a 4-year-old?
A. 14–16 hours per day including naps
B. 10–12 hours per night, no longer napping
C. 8–10 hours per night with two naps
D. Variable with frequent night wakings
, CORRECT ANSWER: B. 10–12 hours per night, no longer napping
Rationale: By age 4, most children sleep 10–12 hours per night and have
stopped napping. Infants and toddlers require more (11–14+ hours).
Question 10: At age 4, what is the expected vocabulary size?
A. 50–100 words
B. 200–300 words
C. 1,000–1,600 words
D. 5,000+ words
CORRECT ANSWER: C. 1,000–1,600 words
Rationale: Four-year-olds typically understand and use 1,000–1,600 words.
Two-year-olds use 50–300 words. Five-year-olds may use 2,000+ words.
Question 11: A 4-year-old who speaks in 3-word phrases and
cannot be understood by strangers may have:
A. Normal expressive language delay
B. A red flag for speech/language evaluation
C. A hearing deficit that will resolve
D. A personality trait
CORRECT ANSWER: B. A red flag for speech/language evaluation
Rationale: By age 4, speech should be mostly intelligible to strangers.
Limited phrase length and unintelligibility are red flags requiring further
evaluation.
Question 12: A 6-year-old child should be able to accomplish which
gross motor skill?
A. Hopping on one foot
B. Skipping
C. Walking backward
D. Standing on tiptoes
CORRECT ANSWER: B. Skipping
Rationale: Skipping develops at age 5–6. Hopping on one foot is a 4-year
skill. Walking backward is a 3-year skill. Standing on tiptoes is a 2–3 year
skill.
Question 13: Which fine motor skill is expected at age 5?
2026/2027 | Advanced Practice Series Pediatric
Wellness Simulation Study Guide & Practice Questions
| Alonzo Harwood Pediatric Wellness Case Review,
Well-Child Assessment, Pediatric Growth &
Development, Developmental Milestones, Denver II,
Physical Examination, Growth Charts, BMI,
Immunizations, Preventive Care, Bright Futures,
Anticipatory Guidance, Nutrition, Safety, Family-
Centered Care, Clinical Decision-Making,
Documentation, SOAP Notes, Clinical Judgment &
Detailed Rationales
Question 1: A 4-year-old child like Alonzo should be able to
accomplish which fine motor skill?
A. Tying shoelaces
B. Drawing a circle
C. Using safety scissors
D. Writing first name
CORRECT ANSWER: B. Drawing a circle
Rationale: Drawing a circle is an age-appropriate fine motor milestone for a
4-year-old. Tying shoelaces typically emerges at age 6, using scissors at age
5, and writing a first name at age 5–6.
Question 2: Which developmental screening tool is most
appropriate for a wellness visit in a 4-year-old?
A. M-CHAT
B. Denver II
C. PHQ-9
D. CAGE questionnaire
CORRECT ANSWER: B. Denver II
Rationale: The Denver II screens personal-social, fine motor-adaptive,
language, and gross motor domains. M-CHAT is for toddlers (16–30
months). PHQ-9 and CAGE are for mental health/substance use in older
patients.
,Question 3: Alonzo speaks in 4–5 word sentences and asks "why"
questions constantly. This language development is typical for
which age?
A. 2 years
B. 3 years
C. 4 years
D. 5 years
CORRECT ANSWER: C. 4 years
Rationale: Four-year-olds typically use 4–5 word sentences, ask many
questions (especially "why"), and can tell simple stories. Two-year-olds use
2–3 word phrases; 3-year-olds use 3–4 word sentences.
Question 4: Which gross motor milestone is expected in a typically
developing 4-year-old?
A. Hopping on one foot
B. Skipping
C. Walking backward
D. Standing on tiptoes
CORRECT ANSWER: A. Hopping on one foot
Rationale: Hopping on one foot emerges at age 4. Skipping develops at age
5. Walking backward is a 3-year-old skill. Standing on tiptoes is a 2–3 year
skill.
Question 5: Red flags for developmental delay at age 4 include all
EXCEPT:
A. Unable to copy a circle
B. Does not use "me" and "you" correctly
C. Can brush teeth with help
D. No interest in interactive games
CORRECT ANSWER: C. Can brush teeth with help
Rationale: Brushing teeth with help is appropriate for age 4. The other
options represent developmental red flags requiring further evaluation.
Question 6: A 4-year-old's play behavior is typically described as:
,A. Solitary play
B. Parallel play
C. Associative play
D. Cooperative play
CORRECT ANSWER: C. Associative play
Rationale: Four-year-olds engage in associative play—playing with others
but without formal organization. They begin to interact, share, and engage
in simple group activities but may not have structured rules yet.
Question 7: Which Piaget stage corresponds to a 4-year-old child?
A. Sensorimotor
B. Preoperational
C. Concrete operational
D. Formal operational
CORRECT ANSWER: B. Preoperational
Rationale: Piaget's preoperational stage (ages 2–7) is characterized by
egocentrism, magical thinking, and symbolic play. Sensorimotor is birth–2
years; concrete operational is 7–11 years; formal operational is
adolescence.
Question 8: According to Erikson, a 4-year-old is in which
psychosocial stage?
A. Trust vs. Mistrust
B. Autonomy vs. Shame and Doubt
C. Initiative vs. Guilt
D. Industry vs. Inferiority
CORRECT ANSWER: C. Initiative vs. Guilt
Rationale: Initiative vs. Guilt (ages 3–6) is when children begin to assert
power and control over their environment. Trust vs. Mistrust is infancy;
Autonomy vs. Shame is toddlerhood; Industry vs. Inferiority is school age.
Question 9: What is the typical sleep pattern for a 4-year-old?
A. 14–16 hours per day including naps
B. 10–12 hours per night, no longer napping
C. 8–10 hours per night with two naps
D. Variable with frequent night wakings
, CORRECT ANSWER: B. 10–12 hours per night, no longer napping
Rationale: By age 4, most children sleep 10–12 hours per night and have
stopped napping. Infants and toddlers require more (11–14+ hours).
Question 10: At age 4, what is the expected vocabulary size?
A. 50–100 words
B. 200–300 words
C. 1,000–1,600 words
D. 5,000+ words
CORRECT ANSWER: C. 1,000–1,600 words
Rationale: Four-year-olds typically understand and use 1,000–1,600 words.
Two-year-olds use 50–300 words. Five-year-olds may use 2,000+ words.
Question 11: A 4-year-old who speaks in 3-word phrases and
cannot be understood by strangers may have:
A. Normal expressive language delay
B. A red flag for speech/language evaluation
C. A hearing deficit that will resolve
D. A personality trait
CORRECT ANSWER: B. A red flag for speech/language evaluation
Rationale: By age 4, speech should be mostly intelligible to strangers.
Limited phrase length and unintelligibility are red flags requiring further
evaluation.
Question 12: A 6-year-old child should be able to accomplish which
gross motor skill?
A. Hopping on one foot
B. Skipping
C. Walking backward
D. Standing on tiptoes
CORRECT ANSWER: B. Skipping
Rationale: Skipping develops at age 5–6. Hopping on one foot is a 4-year
skill. Walking backward is a 3-year skill. Standing on tiptoes is a 2–3 year
skill.
Question 13: Which fine motor skill is expected at age 5?
