NURS 5432 PEDIATRIC PRIMARY CARE MIDTERM 2026/2027
| Modules 1-4 & Case Studies | Complete Solutions | UTA |
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SECTION 1: MODULE 1 - PEDIATRIC GROWTH & DEVELOPMENT
MILESTONES (QUESTIONS 1-25)
Q1. A mother brings her 4-month-old infant for a well-child visit. According to the Denver
II Developmental Screening Test, which of the following represents a developmental red
flag at this age?
A. Not yet rolling from back to front
B. Not yet reaching for objects
C. Not yet smiling responsively
D. Not yet sitting without support
Rationale: Not smiling responsively by 3 months is a significant red flag for
social-emotional development and may indicate autism spectrum disorder or other
developmental concerns. Rolling typically occurs by 4-5 months, reaching by 4 months,
and sitting without support by 6 months. Correct Answer: C
Q2. During a 9-month well-child visit, which fine motor milestone would the nurse
practitioner expect to observe?
A. Building a tower of two cubes
B. Using a pincer grasp to pick up a Cheerio
C. Scribbling with a crayon
,D. Drawing a circle
Rationale: The pincer grasp (thumb and forefinger) typically develops around 9-10
months. Building a two-cube tower occurs at 15 months, scribbling at 12-15 months,
and drawing a circle at approximately 3 years. Correct Answer: B
Q3. A 15-month-old child is seen for a routine visit. The parent reports the child says
"mama" and "dada" specifically but has no other words. The child follows simple
commands, points to desired objects, and uses gestures. Based on language
development norms, the NP should:
A. Refer immediately for speech-language evaluation
B. Reassure the parent and continue routine surveillance
C. Order formal hearing testing
D. Initiate early intervention services
Rationale: By 15 months, children typically have 3-5 words. However, using "mama" and
"dada" specifically, following commands, pointing, and using gestures are all appropriate
communication skills. This pattern warrants continued surveillance rather than
immediate referral, though vocabulary should be monitored closely at the 18-month
visit. Correct Answer: B
Q4. Which of the following gross motor milestones is MOST developmentally
concerning if NOT achieved by 12 months of age?
A. Pulling to stand
B. Cruising along furniture
C. Independent walking
D. Sitting without support
,Rationale: Sitting without support is a critical milestone that should be achieved by 8-9
months. Failure to sit independently by 12 months is a significant red flag for gross
motor delay and requires immediate evaluation for conditions such as cerebral palsy,
hypotonia, or neuromuscular disorders. Correct Answer: D
Q5. A nurse practitioner is administering the M-CHAT-R/F to an 18-month-old during a
well-child visit. Which of the following responses would be considered a PASS (typical)
response?
A. The child does not look at the examiner's face when his or her name is called
B. The child points to indicate interest in something across the room
C. The child does not bring objects to show the parent
D. The child does not imitate activities during play
Rationale: Pointing to indicate interest (protodeclarative pointing) is a key
social-communication milestone that typically emerges by 12-14 months and is a PASS
response on the M-CHAT-R/F. The other options are all FAIL responses indicating
potential autism spectrum risk. Correct Answer: B
Q6. According to Piaget's theory of cognitive development, a 7-year-old child who
understands that the amount of water remains the same when poured into a taller,
narrower glass is demonstrating which stage?
A. Sensorimotor stage
B. Preoperational stage
C. Concrete operational stage
D. Formal operational stage
Rationale: The concrete operational stage (ages 7-11 years) is characterized by
conservation—the understanding that quantity remains constant despite changes in
, appearance. The preoperational child (ages 2-7) would be unable to demonstrate
conservation. Correct Answer: C
Q7. A 3-year-old child is playing alongside another child at the park, occasionally looking
at what the other child is doing but not interacting directly. According to Parten's stages
of play, this represents:
A. Solitary play
B. Parallel play
C. Associative play
D. Cooperative play
Rationale: Parallel play (ages 2-3 years) involves playing near other children with similar
toys but without direct interaction. Solitary play involves playing alone, associative play
(ages 3-4) involves some interaction without organized goals, and cooperative play
(ages 4+) involves organized group play with shared goals. Correct Answer: B
Q8. During a 6-month well-child visit, the parent reports the infant has not yet developed
stranger anxiety. The NP should recognize that:
A. This is always abnormal and requires immediate referral
B. Stranger anxiety typically develops between 6-9 months and may not yet be present
C. The infant likely has an attachment disorder
D. This indicates the infant has a secure attachment
Rationale: Stranger anxiety typically develops between 6-9 months as part of normal
cognitive and social-emotional development. Absence at 6 months is still within normal
limits. However, if it has not developed by 9-12 months, further evaluation may be
warranted. Correct Answer: B
| Modules 1-4 & Case Studies | Complete Solutions | UTA |
Pass Guaranteed - A+ Graded
SECTION 1: MODULE 1 - PEDIATRIC GROWTH & DEVELOPMENT
MILESTONES (QUESTIONS 1-25)
Q1. A mother brings her 4-month-old infant for a well-child visit. According to the Denver
II Developmental Screening Test, which of the following represents a developmental red
flag at this age?
A. Not yet rolling from back to front
B. Not yet reaching for objects
C. Not yet smiling responsively
D. Not yet sitting without support
Rationale: Not smiling responsively by 3 months is a significant red flag for
social-emotional development and may indicate autism spectrum disorder or other
developmental concerns. Rolling typically occurs by 4-5 months, reaching by 4 months,
and sitting without support by 6 months. Correct Answer: C
Q2. During a 9-month well-child visit, which fine motor milestone would the nurse
practitioner expect to observe?
A. Building a tower of two cubes
B. Using a pincer grasp to pick up a Cheerio
C. Scribbling with a crayon
,D. Drawing a circle
Rationale: The pincer grasp (thumb and forefinger) typically develops around 9-10
months. Building a two-cube tower occurs at 15 months, scribbling at 12-15 months,
and drawing a circle at approximately 3 years. Correct Answer: B
Q3. A 15-month-old child is seen for a routine visit. The parent reports the child says
"mama" and "dada" specifically but has no other words. The child follows simple
commands, points to desired objects, and uses gestures. Based on language
development norms, the NP should:
A. Refer immediately for speech-language evaluation
B. Reassure the parent and continue routine surveillance
C. Order formal hearing testing
D. Initiate early intervention services
Rationale: By 15 months, children typically have 3-5 words. However, using "mama" and
"dada" specifically, following commands, pointing, and using gestures are all appropriate
communication skills. This pattern warrants continued surveillance rather than
immediate referral, though vocabulary should be monitored closely at the 18-month
visit. Correct Answer: B
Q4. Which of the following gross motor milestones is MOST developmentally
concerning if NOT achieved by 12 months of age?
A. Pulling to stand
B. Cruising along furniture
C. Independent walking
D. Sitting without support
,Rationale: Sitting without support is a critical milestone that should be achieved by 8-9
months. Failure to sit independently by 12 months is a significant red flag for gross
motor delay and requires immediate evaluation for conditions such as cerebral palsy,
hypotonia, or neuromuscular disorders. Correct Answer: D
Q5. A nurse practitioner is administering the M-CHAT-R/F to an 18-month-old during a
well-child visit. Which of the following responses would be considered a PASS (typical)
response?
A. The child does not look at the examiner's face when his or her name is called
B. The child points to indicate interest in something across the room
C. The child does not bring objects to show the parent
D. The child does not imitate activities during play
Rationale: Pointing to indicate interest (protodeclarative pointing) is a key
social-communication milestone that typically emerges by 12-14 months and is a PASS
response on the M-CHAT-R/F. The other options are all FAIL responses indicating
potential autism spectrum risk. Correct Answer: B
Q6. According to Piaget's theory of cognitive development, a 7-year-old child who
understands that the amount of water remains the same when poured into a taller,
narrower glass is demonstrating which stage?
A. Sensorimotor stage
B. Preoperational stage
C. Concrete operational stage
D. Formal operational stage
Rationale: The concrete operational stage (ages 7-11 years) is characterized by
conservation—the understanding that quantity remains constant despite changes in
, appearance. The preoperational child (ages 2-7) would be unable to demonstrate
conservation. Correct Answer: C
Q7. A 3-year-old child is playing alongside another child at the park, occasionally looking
at what the other child is doing but not interacting directly. According to Parten's stages
of play, this represents:
A. Solitary play
B. Parallel play
C. Associative play
D. Cooperative play
Rationale: Parallel play (ages 2-3 years) involves playing near other children with similar
toys but without direct interaction. Solitary play involves playing alone, associative play
(ages 3-4) involves some interaction without organized goals, and cooperative play
(ages 4+) involves organized group play with shared goals. Correct Answer: B
Q8. During a 6-month well-child visit, the parent reports the infant has not yet developed
stranger anxiety. The NP should recognize that:
A. This is always abnormal and requires immediate referral
B. Stranger anxiety typically develops between 6-9 months and may not yet be present
C. The infant likely has an attachment disorder
D. This indicates the infant has a secure attachment
Rationale: Stranger anxiety typically develops between 6-9 months as part of normal
cognitive and social-emotional development. Absence at 6 months is still within normal
limits. However, if it has not developed by 9-12 months, further evaluation may be
warranted. Correct Answer: B
