D 1 1 9 • S T UD Y G UI D E
Western Governors University
WGU P E D I AT R I C P R I M A R Y C A R E
Leavitt School of Health · Nurse Practitioner Program
EST. 1997
D119 — Pediatric Primary Care
P E D I AT R I C P R I M A R Y C A R E F O R T H E A D V A N C E D P R A C T I C E N U R S E
INSTITUTION Western Governors University COUR SE CODE D119
PR OGR AM MSN — Family Nurse Practitioner ACADEMIC YEAR
EXAM TITL E Practice Questions & Rationales TOTAL QUESTIONS 102 Questions
COUR SE TITL E Pediatric Primary Care for the Advanced FOR MAT 102 single-best-answer · 11 content areas ·
Practice Nurse Prepared by DoctorKen
What’s Inside This D119 Study Guide.
102 practice questions: 11 topics, from milestones and Full rationales: why the right answer is right and why the
screening to rashes and puberty. others are wrong.
Updated for 2026: current AAP, CDC and USPSTF primary care Bonus Points: key takeaways and exam tips after each
guidance. section.
Problem check: two common reasons questions get missed, Rapid Review: 12 high-yield facts for the night before your
and how to fix them. exam.
PREVIEW From Section 5 · Question 45
45. A toddler with tetralogy of Fallot becomes deeply cyanotic while crying. What should the caregiver do first?
A. Place the child in a knee-chest position
B. Lay the child flat on the back
C. Have the child breathe into a paper bag
D. Give a dose of acetaminophen
COR R ECT ANSW ER A. Place the child in a knee-chest position
R ATIONAL E During a hypercyanotic (“tet”) spell, the knee-chest position (or squatting in older children) raises systemic
resistance, pushing more blood to the lungs. Lying flat does not help, paper-bag breathing is dangerous, and
acetaminophen does not treat hypoxia. Call for emergency care if the spell does not resolve.
,BE FORE YOU BE G IN
You Already Know This.
You already know more pediatrics than you think. You have assessed patients, spotted a sick child, and taught
worried families. You know which history questions matter. That clinical sense is your base.
D119 feels hard because it asks what is normal for this age, and what needs action now. This guide drills milestones,
screening, and common primary care problems, and each rationale explains the age-based reason. It does not cover
inpatient care, drug doses, or exact vaccine timing.
W H ER E I S YO U R P R EP A R AT I O N B R EA KI N G DO W N ?
Many missed questions come from one of two problems. See which one sounds like you.
P R OB L EM 1 P R OB L EM 2
“I Mix Up the Ages” “I Miss the Red Flag”
W H AT ' S H A P P E N I N G W H AT ' S H A P P E N I N G
You know the milestone or condition, but you attach it to the wrong Two answers look reasonable, and you reassure when the case
age, so a normal finding looks abnormal or a red flag looks normal. needs referral, or refer when watchful waiting is right.
WOR K ON T HI S WOR K ON T HI S
Anchor each topic to one age: walking by 15 months, two words by 2 Look for the one finding that changes the plan: loss of skills, bilious
years, torsion in teens, intussusception at 6–36 months. vomiting, absent red reflex, or fever in sickle cell disease.
EXAM I NAT I O N I NST R UC T I O NS
▸ Each question has one best answer. Read the bolded words in each question carefully.
▸ Allow about 1 minute per question. For timed practice, cover the green answer and blue rationale boxes.
▸ Check your answers, then read the rationale for every question you missed and every lucky guess.
GROWTH & DEVELOPMENTAL MILESTONES Questions 1 – 9
1. A healthy term infant weighed 3.4 kg at birth. At about what age should the weight be about 6.8 kg?
A. 5 to 6 months
B. About 2 months
C. About 9 months
D. At 12 months
COR R ECT ANSW ER A. 5 to 6 months
R ATIONAL E Healthy infants roughly double their birth weight by 5–6 months and triple it by 12 months. Two months is too
early. By 12 months the expected weight is about three times birth weight (about 10 kg here), so 9 and 12 months
are too late for doubling.
,2. How does head circumference compare with chest circumference during the first two years?
A. Chest is larger at birth and stays larger throughout childhood
B. Head and chest are always equal from birth through age 2
C. Head becomes larger than chest after the first birthday
D. Head larger at birth, equal near age 1, then chest larger
COR R ECT ANSW ER D. Head larger at birth, equal near age 1, then chest larger
R ATIONAL E At birth the head is larger. The two are about equal around 1 year, and then the chest becomes larger. A head that
stays disproportionately large or small, or crosses percentiles, needs evaluation.
3. A parent asks when the rooting reflex should go away. What is the best answer?
A. By about 2 weeks of age
B. By about 12 months of age
C. By about 4 months of age
D. It normally stays through early childhood
COR R ECT ANSW ER C. By about 4 months of age
R ATIONAL E Rooting (turning toward a touch on the cheek) usually disappears by about 4 months, when feeding becomes
voluntary. A primitive reflex that persists well past its expected age can signal a neurologic problem and needs
evaluation.
4. Which finding is expected in a 9-month-old?
A. Walks alone and says three or more words
B. Sits without support; wary of strangers
C. Copies a circle and pedals a tricycle
D. Speaks in two-word phrases and runs
COR R ECT ANSW ER B. Sits without support; wary of strangers
R ATIONAL E At 9 months, infants sit without support, move objects hand to hand, babble (“mamama”), and often show
stranger anxiety. Walking with several words fits about 15–18 months, copying a circle fits 3 years, and two-word
phrases fit 2 years.
5. Which skill best fits a typical 12-month-old?
A. Walks up stairs alone and kicks a ball forward
B. Pulls to stand; uses a thumb-finger pincer grasp
C. Stacks six blocks and uses a spoon without spilling
D. Hops on one foot and names several colors
COR R ECT ANSW ER B. Pulls to stand; uses a thumb-finger pincer grasp
R ATIONAL E At 12 months, children pull to stand, cruise along furniture, use a pincer grasp, and say “mama” or “dada” with
meaning. Stair-walking, kicking and stacking six blocks come at about 2 years. Hopping and naming colors come
at 4–5 years.
, 6. An 18-month-old is not yet walking on his own. What is the best action?
A. Reassure the parent and recheck at age 3
B. Advise a walker to build leg strength
C. Refer for developmental evaluation now
D. Wait until the 24-month visit to decide
COR R ECT ANSW ER C. Refer for developmental evaluation now
R ATIONAL E Most children walk alone by 12–15 months, and not walking by 18 months is a gross-motor red flag that needs
evaluation. Waiting delays early intervention. Baby walkers are not recommended because they cause injuries
and do not speed walking.
7. Which language skill is expected by age 2?
A. Speaks in full sentences of five or more words
B. Tells a story with a beginning, middle and end
C. Says only “mama” and “dada” with meaning
D. Combines two words, such as “more milk”
COR R ECT ANSW ER D. Combines two words, such as “more milk”
R ATIONAL E By 2 years, children combine two words and point to body parts. Full sentences and storytelling come at 4–5
years. Only “mama” and “dada” is a 12-month skill, so it would be a language delay at age 2.
8. During a well visit, a child copies a circle, uses a fork, and talks in short conversations. Which age fits best?
A. 3 years
B. 18 months
C. 12 months
D. 6 years
COR R ECT ANSW ER A. 3 years
R ATIONAL E Copying a circle, using a fork, and holding a back-and-forth conversation are 3-year skills. An 18-month-old
scribbles, a 12-month-old cannot draw shapes, and by 6 years a child draws a more detailed person and prints
letters.
Western Governors University
WGU P E D I AT R I C P R I M A R Y C A R E
Leavitt School of Health · Nurse Practitioner Program
EST. 1997
D119 — Pediatric Primary Care
P E D I AT R I C P R I M A R Y C A R E F O R T H E A D V A N C E D P R A C T I C E N U R S E
INSTITUTION Western Governors University COUR SE CODE D119
PR OGR AM MSN — Family Nurse Practitioner ACADEMIC YEAR
EXAM TITL E Practice Questions & Rationales TOTAL QUESTIONS 102 Questions
COUR SE TITL E Pediatric Primary Care for the Advanced FOR MAT 102 single-best-answer · 11 content areas ·
Practice Nurse Prepared by DoctorKen
What’s Inside This D119 Study Guide.
102 practice questions: 11 topics, from milestones and Full rationales: why the right answer is right and why the
screening to rashes and puberty. others are wrong.
Updated for 2026: current AAP, CDC and USPSTF primary care Bonus Points: key takeaways and exam tips after each
guidance. section.
Problem check: two common reasons questions get missed, Rapid Review: 12 high-yield facts for the night before your
and how to fix them. exam.
PREVIEW From Section 5 · Question 45
45. A toddler with tetralogy of Fallot becomes deeply cyanotic while crying. What should the caregiver do first?
A. Place the child in a knee-chest position
B. Lay the child flat on the back
C. Have the child breathe into a paper bag
D. Give a dose of acetaminophen
COR R ECT ANSW ER A. Place the child in a knee-chest position
R ATIONAL E During a hypercyanotic (“tet”) spell, the knee-chest position (or squatting in older children) raises systemic
resistance, pushing more blood to the lungs. Lying flat does not help, paper-bag breathing is dangerous, and
acetaminophen does not treat hypoxia. Call for emergency care if the spell does not resolve.
,BE FORE YOU BE G IN
You Already Know This.
You already know more pediatrics than you think. You have assessed patients, spotted a sick child, and taught
worried families. You know which history questions matter. That clinical sense is your base.
D119 feels hard because it asks what is normal for this age, and what needs action now. This guide drills milestones,
screening, and common primary care problems, and each rationale explains the age-based reason. It does not cover
inpatient care, drug doses, or exact vaccine timing.
W H ER E I S YO U R P R EP A R AT I O N B R EA KI N G DO W N ?
Many missed questions come from one of two problems. See which one sounds like you.
P R OB L EM 1 P R OB L EM 2
“I Mix Up the Ages” “I Miss the Red Flag”
W H AT ' S H A P P E N I N G W H AT ' S H A P P E N I N G
You know the milestone or condition, but you attach it to the wrong Two answers look reasonable, and you reassure when the case
age, so a normal finding looks abnormal or a red flag looks normal. needs referral, or refer when watchful waiting is right.
WOR K ON T HI S WOR K ON T HI S
Anchor each topic to one age: walking by 15 months, two words by 2 Look for the one finding that changes the plan: loss of skills, bilious
years, torsion in teens, intussusception at 6–36 months. vomiting, absent red reflex, or fever in sickle cell disease.
EXAM I NAT I O N I NST R UC T I O NS
▸ Each question has one best answer. Read the bolded words in each question carefully.
▸ Allow about 1 minute per question. For timed practice, cover the green answer and blue rationale boxes.
▸ Check your answers, then read the rationale for every question you missed and every lucky guess.
GROWTH & DEVELOPMENTAL MILESTONES Questions 1 – 9
1. A healthy term infant weighed 3.4 kg at birth. At about what age should the weight be about 6.8 kg?
A. 5 to 6 months
B. About 2 months
C. About 9 months
D. At 12 months
COR R ECT ANSW ER A. 5 to 6 months
R ATIONAL E Healthy infants roughly double their birth weight by 5–6 months and triple it by 12 months. Two months is too
early. By 12 months the expected weight is about three times birth weight (about 10 kg here), so 9 and 12 months
are too late for doubling.
,2. How does head circumference compare with chest circumference during the first two years?
A. Chest is larger at birth and stays larger throughout childhood
B. Head and chest are always equal from birth through age 2
C. Head becomes larger than chest after the first birthday
D. Head larger at birth, equal near age 1, then chest larger
COR R ECT ANSW ER D. Head larger at birth, equal near age 1, then chest larger
R ATIONAL E At birth the head is larger. The two are about equal around 1 year, and then the chest becomes larger. A head that
stays disproportionately large or small, or crosses percentiles, needs evaluation.
3. A parent asks when the rooting reflex should go away. What is the best answer?
A. By about 2 weeks of age
B. By about 12 months of age
C. By about 4 months of age
D. It normally stays through early childhood
COR R ECT ANSW ER C. By about 4 months of age
R ATIONAL E Rooting (turning toward a touch on the cheek) usually disappears by about 4 months, when feeding becomes
voluntary. A primitive reflex that persists well past its expected age can signal a neurologic problem and needs
evaluation.
4. Which finding is expected in a 9-month-old?
A. Walks alone and says three or more words
B. Sits without support; wary of strangers
C. Copies a circle and pedals a tricycle
D. Speaks in two-word phrases and runs
COR R ECT ANSW ER B. Sits without support; wary of strangers
R ATIONAL E At 9 months, infants sit without support, move objects hand to hand, babble (“mamama”), and often show
stranger anxiety. Walking with several words fits about 15–18 months, copying a circle fits 3 years, and two-word
phrases fit 2 years.
5. Which skill best fits a typical 12-month-old?
A. Walks up stairs alone and kicks a ball forward
B. Pulls to stand; uses a thumb-finger pincer grasp
C. Stacks six blocks and uses a spoon without spilling
D. Hops on one foot and names several colors
COR R ECT ANSW ER B. Pulls to stand; uses a thumb-finger pincer grasp
R ATIONAL E At 12 months, children pull to stand, cruise along furniture, use a pincer grasp, and say “mama” or “dada” with
meaning. Stair-walking, kicking and stacking six blocks come at about 2 years. Hopping and naming colors come
at 4–5 years.
, 6. An 18-month-old is not yet walking on his own. What is the best action?
A. Reassure the parent and recheck at age 3
B. Advise a walker to build leg strength
C. Refer for developmental evaluation now
D. Wait until the 24-month visit to decide
COR R ECT ANSW ER C. Refer for developmental evaluation now
R ATIONAL E Most children walk alone by 12–15 months, and not walking by 18 months is a gross-motor red flag that needs
evaluation. Waiting delays early intervention. Baby walkers are not recommended because they cause injuries
and do not speed walking.
7. Which language skill is expected by age 2?
A. Speaks in full sentences of five or more words
B. Tells a story with a beginning, middle and end
C. Says only “mama” and “dada” with meaning
D. Combines two words, such as “more milk”
COR R ECT ANSW ER D. Combines two words, such as “more milk”
R ATIONAL E By 2 years, children combine two words and point to body parts. Full sentences and storytelling come at 4–5
years. Only “mama” and “dada” is a 12-month skill, so it would be a language delay at age 2.
8. During a well visit, a child copies a circle, uses a fork, and talks in short conversations. Which age fits best?
A. 3 years
B. 18 months
C. 12 months
D. 6 years
COR R ECT ANSW ER A. 3 years
R ATIONAL E Copying a circle, using a fork, and holding a back-and-forth conversation are 3-year skills. An 18-month-old
scribbles, a 12-month-old cannot draw shapes, and by 6 years a child draws a more detailed person and prints
letters.
