NRNP 6541 PEDIATRIC AND ADOLESCENT PRIMARY
CARE ACROSS THE LIFESPAN WALDEN UNIVERSITY -
NEWEST 2026 TEST BANK MIDTERM & FINAL EXAM -
ACTUAL QUESTIONS WITH CORRECT VERIFIED
ANSWERS (A+ GRADED) - 150 Questions
Section 1: Growth and Development (Questions 1-15)
1 A pediatric clinician is assessing a child whose height and weight have consistently tracked at the 5th percentile
for age and sex. The child's midparental height is at the 75th percentile. Which of the following is the most
appropriate next step in evaluation?
A) Reassure the family that this represents normal familial short stature and schedule routine follow-up.
B) Order bone age radiography and refer to pediatric endocrinology for possible growth hormone deficiency.
C) Calculate the child's body mass index percentile and initiate dietary counseling for failure to thrive.
D) Assess for psychosocial stressors and consider neglect as a cause of growth faltering.
Answer: B
Rationale: The child's height is significantly below the expected range based on midparental height, suggesting a
pathologic process such as growth hormone deficiency. Bone age assessment and endocrine referral are indicated.
Familial short stature typically tracks within the parental range. Failure to thrive (FTT) usually presents with
weight faltering before height; here weight is also low but the discrepancy with midparental height points to
endocrine etiology.
2 In the context of Piaget's theory of cognitive development, which of the following behaviors indicates that an
infant has achieved object permanence?
A) The infant shakes a rattle to produce sound repeatedly.
B) The infant searches for a toy that has been hidden under a blanket.
C) The infant imitates the examiner's facial expressions.
D) The infant shows distress when separated from the primary caregiver.
Answer: B
Rationale: Object permanence is the understanding that objects continue to exist even when out of sight. Searching
for a hidden toy demonstrates this ability, typically emerging around 8-12 months. Shaking a rattle shows
cause-and-effect but not object permanence. Imitation (C) is a social skill. Stranger anxiety (D) is an emotional
milestone related to attachment, not cognitive development.
3 A clinician is reviewing the growth chart of a 14-year-old adolescent. The height velocity over the past 12
months has been 4 cm/year. The adolescent is Tanner stage 4 for pubic hair and genital development. Which of
the following is the most likely explanation for this growth velocity?
A) Normal growth velocity for this pubertal stage; the adolescent is approaching final adult height.
B) Constitutional delay of growth, which will accelerate once growth hormone secretion increases.
C) Growth hormone deficiency, requiring immediate endocrine referral.
D) Hypothyroidism, given the deceleration in height velocity.
Answer: A
Rationale: Peak height velocity typically occurs at Tanner stage 3-4 in males. By Tanner stage 4, growth velocity
,decelerates toward adult height. A velocity of 4 cm/year is expected at this stage. Constitutional delay (B) would
present with delayed puberty and slower initial progression. Growth hormone deficiency (C) would cause more
severe deceleration and short stature. Hypothyroidism (D) would also affect weight and other systems.
4 According to Erikson's psychosocial stages, an adolescent who is unable to form a cohesive sense of self and
experiences role confusion is at risk for which of the following outcomes?
A) Inability to trust others in future relationships.
B) Lack of initiative in academic and social pursuits.
C) Difficulty establishing intimate relationships in young adulthood.
D) Feelings of inferiority and incompetence compared to peers.
Answer: C
Rationale: Erikson's stage for adolescence is Identity vs. Role Confusion. Successful resolution leads to fidelity and
the ability to form intimate relationships in young adulthood (Intimacy vs. Isolation). Failure to develop identity
leads to difficulty with intimacy. Trust (A) is infancy, Initiative (B) is preschool, Industry vs. Inferiority (D) is
school age.
5 A 6-month-old infant is being evaluated for delayed motor development. Which of the following findings would
be most concerning for a neuromuscular disorder rather than a benign variant?
A) The infant can roll from supine to prone but cannot sit without support.
B) The infant has head lag when pulled to sit.
C) The infant bears weight on legs when held upright but has a positive scarf sign.
D) The infant reaches for objects with a palmar grasp but does not transfer objects between hands.
Answer: B
Rationale: Head lag beyond 4-5 months is a red flag for hypotonia or neuromuscular dysfunction. By 6 months,
infants should have good head control. Rolling (A) is expected by 6 months; sitting without support emerges
around 6-8 months. Weight bearing (C) is normal; scarf sign assesses tone but is not specific for neuromuscular
disorder. Palmar grasp and no transfer (D) is typical at 6 months; transfer develops around 7-8 months.
6 A clinician is assessing a child's growth using the WHO growth standards. The child's weight-for-length is at
the 98th percentile. Which of the following interpretations is most accurate?
A) The child is overweight and at risk for obesity; counseling on diet and activity is warranted.
B) The child has a high lean body mass and is likely athletic; no intervention needed.
C) The child's growth is within the expected range for the population; no concern.
D) The child may have a growth hormone disorder; further endocrine workup is indicated.
Answer: A
Rationale: WHO standards define overweight as weight-for-length > 2 SD ("H97.7th percentile). A value at the 98th
percentile indicates overweight and risk for obesity. Lean body mass (B) is unlikely at this percentile without other
evidence. Normal (C) is incorrect; the 98th percentile is above the normal range. Growth hormone disorders (D)
typically cause tall stature, not isolated weight excess.
7 Which of the following findings on a Denver II screening test would be considered a delay in a 4-year-old
child?
A) Unable to balance on one foot for 5 seconds.
B) Cannot copy a circle.
C) Does not know own age and sex.
D) Unable to dress without assistance.
Answer: C
,Rationale: By 4 years, a child should know their age and sex. Failure to do so indicates a delay in personal-social
development. Balancing on one foot for 5 seconds is expected by 5 years, so (A) is not a delay. Copying a circle is
expected by 3 years; (B) would be a delay at 4 years only if not achieved earlier, but the question asks for a delay at
4 years. Dressing without assistance is achieved by 5 years; (D) is not a delay at 4.
8 A clinician is evaluating a 10-year-old child who has grown 3 cm in the past year. Bone age is read as 8 years.
Which of the following is the most likely diagnosis?
A) Constitutional growth delay.
B) Growth hormone deficiency.
C) Hypothyroidism.
D) Familial short stature.
Answer: A
Rationale: Constitutional growth delay presents with delayed bone age (often 2+ years behind chronological age)
and short stature during childhood, but eventual catch-up growth. Growth velocity is low but consistent with
delayed maturation. Growth hormone deficiency (B) typically shows more severe deceleration and bone age delay
is less pronounced. Hypothyroidism (C) causes bone age delay but also other systemic signs. Familial short stature
(D) has normal bone age.
9 An adolescent female is concerned about breast asymmetry. On examination, the left breast is Tanner stage 3
and the right is Tanner stage 2. Which of the following is the most appropriate management?
A) Reassure that asymmetry is common during puberty and typically resolves.
B) Refer to a pediatric surgeon for possible breast mass evaluation.
C) Order a mammogram to rule out underlying pathology.
D) Prescribe hormonal therapy to synchronize breast development.
Answer: A
Rationale: Breast asymmetry is a normal variant during puberty due to differential sensitivity to estrogen.
Reassurance and follow-up are sufficient. Surgical referral (B) is not indicated unless a discrete mass is palpable.
Mammography (C) is rarely used in adolescents due to dense breast tissue and radiation risk. Hormonal therapy (D)
is not indicated for asymmetric development.
10 A child's height velocity over 6 months is 3 cm (annualized 6 cm/year). The child is at the 10th percentile for
height. Which of the following additional data would most strongly suggest a pathologic cause of short stature?
A) Midparental height at the 25th percentile.
B) Bone age delayed by 1 year.
C) Weight at the 5th percentile.
D) History of asthma treated with inhaled corticosteroids.
Answer: C
Rationale: Weight faltering disproportionate to height (weight < height percentile) suggests undernutrition or
systemic illness. This combination of short stature and low weight indicates a pathologic process. Midparental
height (A) at 25th percentile is consistent with familial short stature. Bone age delay (B) of 1 year is common in
constitutional delay. Inhaled corticosteroids (D) can affect growth but weight is typically preserved.
11 A child presents with height and weight consistently below the 3rd percentile for age, with a normal growth
velocity and no evidence of endocrine dysfunction. Bone age is consistent with chronological age. Which of the
following best explains this pattern?
A) Constitutional growth delay
B) Familial short stature
, C) Growth hormone deficiency
D) Hypothyroidism
Answer: B
Rationale: Familial short stature is characterized by height below the 3rd percentile but normal growth velocity and
bone age consistent with chronological age. Constitutional growth delay has delayed bone age and growth velocity
is normal but often with delayed puberty. Growth hormone deficiency and hypothyroidism typically show
decreased growth velocity and delayed bone age.
12 A previously healthy child presents with a 6-month history of decelerating linear growth, now crossing
percentiles downward. Bone age is delayed by 2 years. Which diagnostic test is most likely to confirm the
underlying etiology?
A) Insulin-like growth factor 1 (IGF-1) level
B) Thyroid-stimulating hormone (TSH) and free T4
C) Karyotype analysis
D) Growth hormone stimulation test
Answer: D
Rationale: Growth hormone deficiency presents with growth deceleration and delayed bone age. A growth hormone
stimulation test is the gold standard for diagnosis. IGF-1 level is a screening test, not confirmatory. TSH/free T4
would evaluate hypothyroidism, but the pattern is more consistent with GH deficiency. Karyotype is for Turner
syndrome, which typically presents with short stature from early life.
13 A 14-year-old adolescent has not yet entered puberty. Bone age is 11 years. Which of the following laboratory
findings would most strongly suggest a pathologic cause of delayed puberty?
A) Low LH and FSH with low testosterone/estradiol
B) Elevated LH and FSH with low testosterone/estradiol
C) Normal LH and FSH with low testosterone/estradiol
D) Elevated LH and FSH with normal testosterone/estradiol
Answer: B
Rationale: Hypergonadotropic hypogonadism (elevated LH/FSH with low sex steroids) indicates primary gonadal
failure, a pathologic cause. Hypogonadotropic hypogonadism (low LH/FSH) can be constitutional or pathologic.
Normal gonadotropins with low sex steroids suggest a pituitary or hypothalamic defect. Elevated gonadotropins
with normal sex steroids are not typical for delayed puberty.
14 A child with a history of prematurity (born at 28 weeks) is being evaluated at 2 years corrected age. Which
growth parameter is most appropriate to assess for catch-up growth?
A) Weight-for-length
B) Head circumference
C) Length-for-age
D) Body mass index
Answer: C
Rationale: For preterm infants, length-for-age using corrected age is the best indicator of linear growth catch-up.
Weight and head circumference typically catch up earlier. BMI is not a standard growth parameter for this age.
Corrected age should be used until 2-3 years for length.
15 A 9-year-old child presents with breast development (Tanner stage 3) and pubic hair (Tanner stage 2). Bone age
is 13 years. Which of the following is the most appropriate next step in management?
A) Observation with growth monitoring every 6 months
CARE ACROSS THE LIFESPAN WALDEN UNIVERSITY -
NEWEST 2026 TEST BANK MIDTERM & FINAL EXAM -
ACTUAL QUESTIONS WITH CORRECT VERIFIED
ANSWERS (A+ GRADED) - 150 Questions
Section 1: Growth and Development (Questions 1-15)
1 A pediatric clinician is assessing a child whose height and weight have consistently tracked at the 5th percentile
for age and sex. The child's midparental height is at the 75th percentile. Which of the following is the most
appropriate next step in evaluation?
A) Reassure the family that this represents normal familial short stature and schedule routine follow-up.
B) Order bone age radiography and refer to pediatric endocrinology for possible growth hormone deficiency.
C) Calculate the child's body mass index percentile and initiate dietary counseling for failure to thrive.
D) Assess for psychosocial stressors and consider neglect as a cause of growth faltering.
Answer: B
Rationale: The child's height is significantly below the expected range based on midparental height, suggesting a
pathologic process such as growth hormone deficiency. Bone age assessment and endocrine referral are indicated.
Familial short stature typically tracks within the parental range. Failure to thrive (FTT) usually presents with
weight faltering before height; here weight is also low but the discrepancy with midparental height points to
endocrine etiology.
2 In the context of Piaget's theory of cognitive development, which of the following behaviors indicates that an
infant has achieved object permanence?
A) The infant shakes a rattle to produce sound repeatedly.
B) The infant searches for a toy that has been hidden under a blanket.
C) The infant imitates the examiner's facial expressions.
D) The infant shows distress when separated from the primary caregiver.
Answer: B
Rationale: Object permanence is the understanding that objects continue to exist even when out of sight. Searching
for a hidden toy demonstrates this ability, typically emerging around 8-12 months. Shaking a rattle shows
cause-and-effect but not object permanence. Imitation (C) is a social skill. Stranger anxiety (D) is an emotional
milestone related to attachment, not cognitive development.
3 A clinician is reviewing the growth chart of a 14-year-old adolescent. The height velocity over the past 12
months has been 4 cm/year. The adolescent is Tanner stage 4 for pubic hair and genital development. Which of
the following is the most likely explanation for this growth velocity?
A) Normal growth velocity for this pubertal stage; the adolescent is approaching final adult height.
B) Constitutional delay of growth, which will accelerate once growth hormone secretion increases.
C) Growth hormone deficiency, requiring immediate endocrine referral.
D) Hypothyroidism, given the deceleration in height velocity.
Answer: A
Rationale: Peak height velocity typically occurs at Tanner stage 3-4 in males. By Tanner stage 4, growth velocity
,decelerates toward adult height. A velocity of 4 cm/year is expected at this stage. Constitutional delay (B) would
present with delayed puberty and slower initial progression. Growth hormone deficiency (C) would cause more
severe deceleration and short stature. Hypothyroidism (D) would also affect weight and other systems.
4 According to Erikson's psychosocial stages, an adolescent who is unable to form a cohesive sense of self and
experiences role confusion is at risk for which of the following outcomes?
A) Inability to trust others in future relationships.
B) Lack of initiative in academic and social pursuits.
C) Difficulty establishing intimate relationships in young adulthood.
D) Feelings of inferiority and incompetence compared to peers.
Answer: C
Rationale: Erikson's stage for adolescence is Identity vs. Role Confusion. Successful resolution leads to fidelity and
the ability to form intimate relationships in young adulthood (Intimacy vs. Isolation). Failure to develop identity
leads to difficulty with intimacy. Trust (A) is infancy, Initiative (B) is preschool, Industry vs. Inferiority (D) is
school age.
5 A 6-month-old infant is being evaluated for delayed motor development. Which of the following findings would
be most concerning for a neuromuscular disorder rather than a benign variant?
A) The infant can roll from supine to prone but cannot sit without support.
B) The infant has head lag when pulled to sit.
C) The infant bears weight on legs when held upright but has a positive scarf sign.
D) The infant reaches for objects with a palmar grasp but does not transfer objects between hands.
Answer: B
Rationale: Head lag beyond 4-5 months is a red flag for hypotonia or neuromuscular dysfunction. By 6 months,
infants should have good head control. Rolling (A) is expected by 6 months; sitting without support emerges
around 6-8 months. Weight bearing (C) is normal; scarf sign assesses tone but is not specific for neuromuscular
disorder. Palmar grasp and no transfer (D) is typical at 6 months; transfer develops around 7-8 months.
6 A clinician is assessing a child's growth using the WHO growth standards. The child's weight-for-length is at
the 98th percentile. Which of the following interpretations is most accurate?
A) The child is overweight and at risk for obesity; counseling on diet and activity is warranted.
B) The child has a high lean body mass and is likely athletic; no intervention needed.
C) The child's growth is within the expected range for the population; no concern.
D) The child may have a growth hormone disorder; further endocrine workup is indicated.
Answer: A
Rationale: WHO standards define overweight as weight-for-length > 2 SD ("H97.7th percentile). A value at the 98th
percentile indicates overweight and risk for obesity. Lean body mass (B) is unlikely at this percentile without other
evidence. Normal (C) is incorrect; the 98th percentile is above the normal range. Growth hormone disorders (D)
typically cause tall stature, not isolated weight excess.
7 Which of the following findings on a Denver II screening test would be considered a delay in a 4-year-old
child?
A) Unable to balance on one foot for 5 seconds.
B) Cannot copy a circle.
C) Does not know own age and sex.
D) Unable to dress without assistance.
Answer: C
,Rationale: By 4 years, a child should know their age and sex. Failure to do so indicates a delay in personal-social
development. Balancing on one foot for 5 seconds is expected by 5 years, so (A) is not a delay. Copying a circle is
expected by 3 years; (B) would be a delay at 4 years only if not achieved earlier, but the question asks for a delay at
4 years. Dressing without assistance is achieved by 5 years; (D) is not a delay at 4.
8 A clinician is evaluating a 10-year-old child who has grown 3 cm in the past year. Bone age is read as 8 years.
Which of the following is the most likely diagnosis?
A) Constitutional growth delay.
B) Growth hormone deficiency.
C) Hypothyroidism.
D) Familial short stature.
Answer: A
Rationale: Constitutional growth delay presents with delayed bone age (often 2+ years behind chronological age)
and short stature during childhood, but eventual catch-up growth. Growth velocity is low but consistent with
delayed maturation. Growth hormone deficiency (B) typically shows more severe deceleration and bone age delay
is less pronounced. Hypothyroidism (C) causes bone age delay but also other systemic signs. Familial short stature
(D) has normal bone age.
9 An adolescent female is concerned about breast asymmetry. On examination, the left breast is Tanner stage 3
and the right is Tanner stage 2. Which of the following is the most appropriate management?
A) Reassure that asymmetry is common during puberty and typically resolves.
B) Refer to a pediatric surgeon for possible breast mass evaluation.
C) Order a mammogram to rule out underlying pathology.
D) Prescribe hormonal therapy to synchronize breast development.
Answer: A
Rationale: Breast asymmetry is a normal variant during puberty due to differential sensitivity to estrogen.
Reassurance and follow-up are sufficient. Surgical referral (B) is not indicated unless a discrete mass is palpable.
Mammography (C) is rarely used in adolescents due to dense breast tissue and radiation risk. Hormonal therapy (D)
is not indicated for asymmetric development.
10 A child's height velocity over 6 months is 3 cm (annualized 6 cm/year). The child is at the 10th percentile for
height. Which of the following additional data would most strongly suggest a pathologic cause of short stature?
A) Midparental height at the 25th percentile.
B) Bone age delayed by 1 year.
C) Weight at the 5th percentile.
D) History of asthma treated with inhaled corticosteroids.
Answer: C
Rationale: Weight faltering disproportionate to height (weight < height percentile) suggests undernutrition or
systemic illness. This combination of short stature and low weight indicates a pathologic process. Midparental
height (A) at 25th percentile is consistent with familial short stature. Bone age delay (B) of 1 year is common in
constitutional delay. Inhaled corticosteroids (D) can affect growth but weight is typically preserved.
11 A child presents with height and weight consistently below the 3rd percentile for age, with a normal growth
velocity and no evidence of endocrine dysfunction. Bone age is consistent with chronological age. Which of the
following best explains this pattern?
A) Constitutional growth delay
B) Familial short stature
, C) Growth hormone deficiency
D) Hypothyroidism
Answer: B
Rationale: Familial short stature is characterized by height below the 3rd percentile but normal growth velocity and
bone age consistent with chronological age. Constitutional growth delay has delayed bone age and growth velocity
is normal but often with delayed puberty. Growth hormone deficiency and hypothyroidism typically show
decreased growth velocity and delayed bone age.
12 A previously healthy child presents with a 6-month history of decelerating linear growth, now crossing
percentiles downward. Bone age is delayed by 2 years. Which diagnostic test is most likely to confirm the
underlying etiology?
A) Insulin-like growth factor 1 (IGF-1) level
B) Thyroid-stimulating hormone (TSH) and free T4
C) Karyotype analysis
D) Growth hormone stimulation test
Answer: D
Rationale: Growth hormone deficiency presents with growth deceleration and delayed bone age. A growth hormone
stimulation test is the gold standard for diagnosis. IGF-1 level is a screening test, not confirmatory. TSH/free T4
would evaluate hypothyroidism, but the pattern is more consistent with GH deficiency. Karyotype is for Turner
syndrome, which typically presents with short stature from early life.
13 A 14-year-old adolescent has not yet entered puberty. Bone age is 11 years. Which of the following laboratory
findings would most strongly suggest a pathologic cause of delayed puberty?
A) Low LH and FSH with low testosterone/estradiol
B) Elevated LH and FSH with low testosterone/estradiol
C) Normal LH and FSH with low testosterone/estradiol
D) Elevated LH and FSH with normal testosterone/estradiol
Answer: B
Rationale: Hypergonadotropic hypogonadism (elevated LH/FSH with low sex steroids) indicates primary gonadal
failure, a pathologic cause. Hypogonadotropic hypogonadism (low LH/FSH) can be constitutional or pathologic.
Normal gonadotropins with low sex steroids suggest a pituitary or hypothalamic defect. Elevated gonadotropins
with normal sex steroids are not typical for delayed puberty.
14 A child with a history of prematurity (born at 28 weeks) is being evaluated at 2 years corrected age. Which
growth parameter is most appropriate to assess for catch-up growth?
A) Weight-for-length
B) Head circumference
C) Length-for-age
D) Body mass index
Answer: C
Rationale: For preterm infants, length-for-age using corrected age is the best indicator of linear growth catch-up.
Weight and head circumference typically catch up earlier. BMI is not a standard growth parameter for this age.
Corrected age should be used until 2-3 years for length.
15 A 9-year-old child presents with breast development (Tanner stage 3) and pubic hair (Tanner stage 2). Bone age
is 13 years. Which of the following is the most appropriate next step in management?
A) Observation with growth monitoring every 6 months
