Pediatric Nursing Practice Examination
2026/2027 Academic 53 Questions with Correct Answers & Rationales
Instructions: This examination consists of 53 multiple-choice questions covering ten core
domains of pediatric nursing. Select the best answer for each question. Each question is worth 2
points for a total of 106 points. A passing score is 70% (75 points). You have 120 minutes to
complete this examination. No electronic devices or reference materials are permitted.
Section I: Growth & Development Milestones (Questions 1–8)
1. The nurse is assessing a 6-month-old infant. Which developmental milestone should the
nurse expect the infant to have achieved?
[A] Walking independently [B] Sitting without support
[C] Speaking two-word phrases [D] Tying shoelaces
Correct Answer: B. Sitting without support
Rationale: By 6 months of age, infants typically can sit with support and are beginning to sit
without support. Walking independently typically occurs around 12 months, two-word phrases emerge
around 18–24 months, and tying shoelaces is a fine motor skill expected around age 5–6 years.
This aligns with the Denver II developmental screening tool and AAP Bright Futures guidelines.
2. A mother asks the nurse when her infant should begin to say single words. According to
Piaget’s cognitive development theory and AAP milestones, what is the expected age range?
[A] 2–4 months [B] 6–8 months
[C] 10–14 months [D] 18–24 months
Correct Answer: C. 10–14 months
Rationale: Infants typically speak their first meaningful words between 10 and 14 months of age.
Piaget’s sensorimotor stage (birth to 2 years) describes how infants learn through sensory
experiences, and language development is a key marker during this period. The AAP Bright Futures
guidelines confirm this developmental window for first words.
3. According to Erikson’s psychosocial development theory, which developmental crisis is
most relevant for a preschool-aged child (3–6 years)?
[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: Erikson’s theory places Initiative vs. Guilt at the preschool stage (3–6 years).
Children this age begin to assert power and control through play and social interactions. Trust
1
,vs. Mistrust corresponds to infancy (0–1 year), Autonomy vs. Shame and Doubt to toddlers (1–3
years), and Industry vs. Inferiority to school-age children (6–12 years).
4. A 9-month-old infant is brought to the clinic for a well-child visit. Which behavior
should the nurse expect to observe?
[A] Building a tower of six blocks [B] Using a pincer grasp
[C] Walking up stairs with help [D] Drawing a circle on paper
Correct Answer: B. Using a pincer grasp
Rationale: By 9 months, infants develop the pincer grasp (thumb and index finger), which allows
them to pick up small objects. Building a six-block tower is expected around 24 months, walking
up stairs with help at 18–24 months, and drawing a circle at approximately 3 years. These
milestones are consistent with the Denver II and CDC developmental milestones.
5. The nurse is teaching parents about anticipatory guidance for a 12-month-old child.
Which developmental achievement is most characteristic of this age?
[A] Running smoothly [B] Stacking two blocks
[C] Writing first name [D] Riding a tricycle
Correct Answer: B. Stacking two blocks
Rationale: At 12 months, a child can typically stack two blocks. Running smoothly develops around
18–24 months, writing one’s name is expected at 4–5 years, and riding a tricycle is a skill
acquired around age 3. The AAP identifies block-stacking as a key gross and fine motor milestone
at the first birthday.
6. A nurse is assessing a 4-year-old child’s cognitive development based on Piaget’s
theory. In which stage should this child be classified?
[A] Sensorimotor stage [B] Preoperational stage
[C] Concrete operational stage [D] Formal operational stage
Correct Answer: B. Preoperational stage
Rationale: According to Piaget, the preoperational stage spans ages 2 to 7 years and is
characterized by symbolic thinking, egocentrism, and magical thinking. The sensorimotor stage
covers birth to 2 years, the concrete operational stage spans 7 to 11 years, and the formal
operational stage begins at approximately 11 years.
7. During a health assessment of a 2-month-old infant, the nurse observes the infant
turning their head toward a sound. Which developmental domain does this behavior represent?
[A] Gross motor development [B] Fine motor development
[C] Language and communication development [D] Social-emotional development
Correct Answer: C. Language and communication development
Rationale: Turning the head toward a sound demonstrates auditory orientation, which is part of
language and communication development in infants. This behavior indicates the infant’s developing
2
, ability to localize sound, a precursor to receptive language. The CDC milestones identify head
turning toward sounds as a 2-month communication milestone.
8. A 15-year-old adolescent is hospitalized. According to Erikson’s theory, which
psychosocial crisis is the adolescent navigating?
[A] Initiative vs. Guilt [B] Industry vs. Inferiority
[C] Identity vs. Role Confusion [D] Intimacy vs. Isolation
Correct Answer: C. Identity vs. Role Confusion
Rationale: Erikson’s Identity vs. Role Confusion stage occurs during adolescence (12–18 years).
The primary task is developing a coherent sense of self. Industry vs. Inferiority applies to
school-age children (6–12 years), and Intimacy vs. Isolation is the crisis of young adulthood.
This framework is widely referenced in pediatric nursing practice (NCSBN, 2024).
Section II: Pediatric Assessment Techniques (Questions 9–14)
9. The nurse is performing a head-to-toe assessment on a 3-year-old child. Which approach
is most developmentally appropriate?
[A] Assess the child from head to toe while [B] Allow the child to sit on the parent’s
the child lies supine lap and proceed from least to most invasive
[C] Perform the assessment in a standing [D] Separate the child from the parent to
position starting with the feet ensure objectivity
Correct Answer: B. Allow the child to sit on the parent’s lap and proceed from least to most
invasive
Rationale: Allowing a toddler to remain on the parent’s lap reduces anxiety and promotes
cooperation. Proceeding from least to most invasive (e.g., listening to heart sounds before
examining ears) minimizes distress. This approach is recommended by the AAP and is standard
pediatric nursing practice for children aged 1–3 years.
10. The nurse is assessing vital signs for a 6-month-old infant. Which finding is within
the expected range for this age?
[A] Heart rate 80 bpm [B] Respiratory rate 15 breaths/min
[C] Heart rate 120 bpm [D] Blood pressure 120/80 mmHg
Correct Answer: C. Heart rate 120 bpm
Rationale: The expected heart rate for a 6-month-old infant is 110–160 bpm, making 120 bpm within
normal limits. A respiratory rate of 15 breaths/min is too low (expected 25–40), and a blood
pressure of 120/80 mmHg is far above the expected range of approximately 85–105/40–65 mmHg.
These reference ranges are based on AAP Pediatric Advanced Life Support (PALS) guidelines.
11. A nurse is using the FLACC pain scale to assess a 10-month-old infant. Which parameter
is NOT evaluated by this scale?
[A] Facial expression [B] Leg movement
3
2026/2027 Academic 53 Questions with Correct Answers & Rationales
Instructions: This examination consists of 53 multiple-choice questions covering ten core
domains of pediatric nursing. Select the best answer for each question. Each question is worth 2
points for a total of 106 points. A passing score is 70% (75 points). You have 120 minutes to
complete this examination. No electronic devices or reference materials are permitted.
Section I: Growth & Development Milestones (Questions 1–8)
1. The nurse is assessing a 6-month-old infant. Which developmental milestone should the
nurse expect the infant to have achieved?
[A] Walking independently [B] Sitting without support
[C] Speaking two-word phrases [D] Tying shoelaces
Correct Answer: B. Sitting without support
Rationale: By 6 months of age, infants typically can sit with support and are beginning to sit
without support. Walking independently typically occurs around 12 months, two-word phrases emerge
around 18–24 months, and tying shoelaces is a fine motor skill expected around age 5–6 years.
This aligns with the Denver II developmental screening tool and AAP Bright Futures guidelines.
2. A mother asks the nurse when her infant should begin to say single words. According to
Piaget’s cognitive development theory and AAP milestones, what is the expected age range?
[A] 2–4 months [B] 6–8 months
[C] 10–14 months [D] 18–24 months
Correct Answer: C. 10–14 months
Rationale: Infants typically speak their first meaningful words between 10 and 14 months of age.
Piaget’s sensorimotor stage (birth to 2 years) describes how infants learn through sensory
experiences, and language development is a key marker during this period. The AAP Bright Futures
guidelines confirm this developmental window for first words.
3. According to Erikson’s psychosocial development theory, which developmental crisis is
most relevant for a preschool-aged child (3–6 years)?
[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: Erikson’s theory places Initiative vs. Guilt at the preschool stage (3–6 years).
Children this age begin to assert power and control through play and social interactions. Trust
1
,vs. Mistrust corresponds to infancy (0–1 year), Autonomy vs. Shame and Doubt to toddlers (1–3
years), and Industry vs. Inferiority to school-age children (6–12 years).
4. A 9-month-old infant is brought to the clinic for a well-child visit. Which behavior
should the nurse expect to observe?
[A] Building a tower of six blocks [B] Using a pincer grasp
[C] Walking up stairs with help [D] Drawing a circle on paper
Correct Answer: B. Using a pincer grasp
Rationale: By 9 months, infants develop the pincer grasp (thumb and index finger), which allows
them to pick up small objects. Building a six-block tower is expected around 24 months, walking
up stairs with help at 18–24 months, and drawing a circle at approximately 3 years. These
milestones are consistent with the Denver II and CDC developmental milestones.
5. The nurse is teaching parents about anticipatory guidance for a 12-month-old child.
Which developmental achievement is most characteristic of this age?
[A] Running smoothly [B] Stacking two blocks
[C] Writing first name [D] Riding a tricycle
Correct Answer: B. Stacking two blocks
Rationale: At 12 months, a child can typically stack two blocks. Running smoothly develops around
18–24 months, writing one’s name is expected at 4–5 years, and riding a tricycle is a skill
acquired around age 3. The AAP identifies block-stacking as a key gross and fine motor milestone
at the first birthday.
6. A nurse is assessing a 4-year-old child’s cognitive development based on Piaget’s
theory. In which stage should this child be classified?
[A] Sensorimotor stage [B] Preoperational stage
[C] Concrete operational stage [D] Formal operational stage
Correct Answer: B. Preoperational stage
Rationale: According to Piaget, the preoperational stage spans ages 2 to 7 years and is
characterized by symbolic thinking, egocentrism, and magical thinking. The sensorimotor stage
covers birth to 2 years, the concrete operational stage spans 7 to 11 years, and the formal
operational stage begins at approximately 11 years.
7. During a health assessment of a 2-month-old infant, the nurse observes the infant
turning their head toward a sound. Which developmental domain does this behavior represent?
[A] Gross motor development [B] Fine motor development
[C] Language and communication development [D] Social-emotional development
Correct Answer: C. Language and communication development
Rationale: Turning the head toward a sound demonstrates auditory orientation, which is part of
language and communication development in infants. This behavior indicates the infant’s developing
2
, ability to localize sound, a precursor to receptive language. The CDC milestones identify head
turning toward sounds as a 2-month communication milestone.
8. A 15-year-old adolescent is hospitalized. According to Erikson’s theory, which
psychosocial crisis is the adolescent navigating?
[A] Initiative vs. Guilt [B] Industry vs. Inferiority
[C] Identity vs. Role Confusion [D] Intimacy vs. Isolation
Correct Answer: C. Identity vs. Role Confusion
Rationale: Erikson’s Identity vs. Role Confusion stage occurs during adolescence (12–18 years).
The primary task is developing a coherent sense of self. Industry vs. Inferiority applies to
school-age children (6–12 years), and Intimacy vs. Isolation is the crisis of young adulthood.
This framework is widely referenced in pediatric nursing practice (NCSBN, 2024).
Section II: Pediatric Assessment Techniques (Questions 9–14)
9. The nurse is performing a head-to-toe assessment on a 3-year-old child. Which approach
is most developmentally appropriate?
[A] Assess the child from head to toe while [B] Allow the child to sit on the parent’s
the child lies supine lap and proceed from least to most invasive
[C] Perform the assessment in a standing [D] Separate the child from the parent to
position starting with the feet ensure objectivity
Correct Answer: B. Allow the child to sit on the parent’s lap and proceed from least to most
invasive
Rationale: Allowing a toddler to remain on the parent’s lap reduces anxiety and promotes
cooperation. Proceeding from least to most invasive (e.g., listening to heart sounds before
examining ears) minimizes distress. This approach is recommended by the AAP and is standard
pediatric nursing practice for children aged 1–3 years.
10. The nurse is assessing vital signs for a 6-month-old infant. Which finding is within
the expected range for this age?
[A] Heart rate 80 bpm [B] Respiratory rate 15 breaths/min
[C] Heart rate 120 bpm [D] Blood pressure 120/80 mmHg
Correct Answer: C. Heart rate 120 bpm
Rationale: The expected heart rate for a 6-month-old infant is 110–160 bpm, making 120 bpm within
normal limits. A respiratory rate of 15 breaths/min is too low (expected 25–40), and a blood
pressure of 120/80 mmHg is far above the expected range of approximately 85–105/40–65 mmHg.
These reference ranges are based on AAP Pediatric Advanced Life Support (PALS) guidelines.
11. A nurse is using the FLACC pain scale to assess a 10-month-old infant. Which parameter
is NOT evaluated by this scale?
[A] Facial expression [B] Leg movement
3
