GCU NSG 434 Exam 1 – Nursing Care of Children – (2026)
Actual Questions & Answers — 100 Questions
Section 1: Growth and Development (Questions 1-10)
1 A nurse is evaluating a child's growth pattern over the past year. The child's height has increased from the 25th
percentile to the 10th percentile, while weight has remained at the 50th percentile. Which of the following is the
most appropriate interpretation?
A) The child is experiencing catch-up growth.
B) The child may have a growth hormone deficiency.
C) This is a normal variation in growth velocity.
D) The child is likely entering a period of rapid growth.
Answer: B
Rationale: A decrease in height percentile with stable weight percentile suggests a deceleration in linear growth,
which is a red flag for growth hormone deficiency or other endocrine disorders. Catch-up growth would show an
increase in percentile. Normal variation typically maintains a consistent channel. Rapid growth would increase
percentile.
2 According to Erikson's psychosocial theory, a toddler who is not allowed to make simple choices (e.g., which
cup to use) is at risk for developing which of the following?
A) Inferiority
B) Guilt
C) Shame and doubt
D) Mistrust
Answer: C
Rationale: Erikson's stage for toddlers is 'Autonomy vs. Shame and Doubt'. When autonomy is thwarted, the child
develops shame and doubt. Inferiority is from the school-age stage, guilt from preschool stage, and mistrust from
infancy.
3 A nurse is assessing a child who can build a tower of 8 cubes, copy a circle, and button large buttons. Which age
range is most consistent with these fine motor skills?
A) 12-15 months
B) 18-24 months
C) 30-36 months
D) 48-60 months
Answer: C
Rationale: Building a tower of 8 cubes, copying a circle, and buttoning large buttons are typical of a 3-year-old
(30-36 months). At 12-15 months, a child can build a tower of 2 cubes and scribble. At 18-24 months, a tower of
4-6 cubes and imitating a vertical line. At 4-5 years, copying a square and tying shoes.
4 A nurse is providing anticipatory guidance to the family of a child with a new diagnosis of type 1 diabetes.
Which of the following developmental considerations is most important to include?
A) School-age children can independently manage insulin dosing.
B) Adolescents may have difficulty adhering to the regimen due to peer pressure.
C) Toddlers are able to recognize symptoms of hypoglycemia.
,D) Preschoolers can understand the concept of balancing food and activity.
Answer: B
Rationale: Adolescents often struggle with adherence due to peer pressure and desire for normalcy. School-age
children need supervision, not independence. Toddlers cannot recognize hypoglycemia. Preschoolers cannot grasp
abstract concepts like balance.
5 A nurse is using the Denver Developmental Screening Test II (DDST-II) on a child. The child passes all items in
the personal-social, fine motor, and language sectors but fails two items in the gross motor sector that are to the
right of the age line. Which of the following is the most appropriate conclusion?
A) The child has a developmental delay in gross motor skills.
B) The child is advanced in gross motor skills.
C) The child's gross motor development is within normal limits.
D) The test is invalid because the child refused some items.
Answer: A
Rationale: On the DDST-II, items passed or failed are compared to the age line. Failure of items to the right of the
age line (which are expected to be passed by most children at that age) indicates a delay. Passing items to the left
indicates advanced skills. Refusal is scored as fail, but the test remains valid.
6 A nurse is evaluating the nutritional status of a child with failure to thrive. Which of the following laboratory
values is most indicative of chronic malnutrition?
A) Elevated serum albumin
B) Decreased prealbumin
C) Elevated transferrin
D) Decreased hemoglobin
Answer: B
Rationale: Prealbumin has a short half-life (2-3 days) and is a sensitive marker for recent protein intake. Albumin
has a longer half-life (20 days) and is more reflective of chronic status; it would be decreased in chronic
malnutrition. Transferrin is often decreased, not elevated. Hemoglobin may be low but is not specific to
malnutrition.
7 A nurse is teaching a parenting class about injury prevention. Which of the following statements by a parent
indicates correct understanding of developmental risks?
A) My 6-month-old can roll over, so I will never leave him unattended on the changing table.
B) My 2-year-old is ready to ride a tricycle because he can pedal.
C) My 4-year-old can swim alone in the pool because she took lessons.
D) My 8-year-old can cross the street alone because she knows traffic rules.
Answer: A
Rationale: A 6-month-old who can roll over is at risk for falls from elevated surfaces; never leaving unattended is
correct. A 2-year-old typically cannot pedal a tricycle (that's a 3-year-old skill). A 4-year-old should never swim
alone regardless of lessons. An 8-year-old still needs supervision crossing streets due to impulsivity.
8 A nurse is assessing a child who speaks in two-word phrases, follows simple commands, and points to named
body parts. Which of the following developmental milestones is the child most likely achieving?
A) 12 months
B) 18 months
C) 24 months
D) 36 months
, Answer: C
Rationale: A 24-month-old typically uses two-word phrases, follows simple commands, and points to body parts. At
12 months, one-word utterances. At 18 months, vocabulary of about 10 words. At 36 months, three-word sentences
and knows body parts.
9 A nurse is planning care for a hospitalized preschooler. Which of the following interventions best supports the
child's developmental needs?
A) Encouraging the child to keep a diary of feelings.
B) Allowing the child to play with medical equipment.
C) Providing a consistent routine and simple explanations.
D) Assigning the same nurse every shift.
Answer: C
Rationale: Preschoolers benefit from routine and simple explanations to reduce anxiety. A diary is more appropriate
for school-age children. Playing with medical equipment may increase fear. Consistent nurse assignment is
important for all ages but not specific to developmental needs of preschoolers.
10 A nurse is assessing a child's growth using the WHO growth standards. The child's weight-for-length is below
the 2nd percentile. Which of the following is the most appropriate nursing action?
A) Reassure the parents that the child is just small.
B) Refer the child for a nutritional assessment.
C) Plot the child's height on a different chart.
D) Recommend increasing caloric intake by 50%.
Answer: B
Rationale: Weight-for-length below the 2nd percentile indicates wasting, which requires further evaluation and
nutritional assessment. Reassurance is inappropriate. Different charts may not be valid. Increasing caloric intake
without assessment could be harmful or ineffective.
Section 2: Health Promotion and Maintenance (Questions 11-20)
11 A nurse is evaluating a family’s readiness for a scheduled well-child visit. The parent expresses concern about
the child’s frequent temper tantrums and difficulty with transitions. The nurse recognizes that these behaviors
are typical for which developmental stage when considering Erikson’s psychosocial theory?
A) Trust versus Mistrust
B) Autonomy versus Shame and Doubt
C) Initiative versus Guilt
D) Industry versus Inferiority
Answer: B
Rationale: Erikson’s stage of Autonomy versus Shame and Doubt occurs during toddlerhood (ages 1–3 years).
Temper tantrums and difficulty with transitions are hallmark behaviors as children assert independence. Trust
versus Mistrust is infancy; Initiative versus Guilt is preschool; Industry versus Inferiority is school-age.
12 During a health maintenance visit, a nurse reviews the immunization record of a 4-year-old child. The child
received the 4-dose series of DTaP, 3 doses of IPV, 1 dose of MMR, 1 dose of varicella, and 3 doses of hepatitis
B. According to the CDC’s recommended catch-up schedule, which vaccine(s) should be administered at this
visit?
A) DTaP, IPV, MMR, varicella
B) DTaP, IPV, hepatitis A
Actual Questions & Answers — 100 Questions
Section 1: Growth and Development (Questions 1-10)
1 A nurse is evaluating a child's growth pattern over the past year. The child's height has increased from the 25th
percentile to the 10th percentile, while weight has remained at the 50th percentile. Which of the following is the
most appropriate interpretation?
A) The child is experiencing catch-up growth.
B) The child may have a growth hormone deficiency.
C) This is a normal variation in growth velocity.
D) The child is likely entering a period of rapid growth.
Answer: B
Rationale: A decrease in height percentile with stable weight percentile suggests a deceleration in linear growth,
which is a red flag for growth hormone deficiency or other endocrine disorders. Catch-up growth would show an
increase in percentile. Normal variation typically maintains a consistent channel. Rapid growth would increase
percentile.
2 According to Erikson's psychosocial theory, a toddler who is not allowed to make simple choices (e.g., which
cup to use) is at risk for developing which of the following?
A) Inferiority
B) Guilt
C) Shame and doubt
D) Mistrust
Answer: C
Rationale: Erikson's stage for toddlers is 'Autonomy vs. Shame and Doubt'. When autonomy is thwarted, the child
develops shame and doubt. Inferiority is from the school-age stage, guilt from preschool stage, and mistrust from
infancy.
3 A nurse is assessing a child who can build a tower of 8 cubes, copy a circle, and button large buttons. Which age
range is most consistent with these fine motor skills?
A) 12-15 months
B) 18-24 months
C) 30-36 months
D) 48-60 months
Answer: C
Rationale: Building a tower of 8 cubes, copying a circle, and buttoning large buttons are typical of a 3-year-old
(30-36 months). At 12-15 months, a child can build a tower of 2 cubes and scribble. At 18-24 months, a tower of
4-6 cubes and imitating a vertical line. At 4-5 years, copying a square and tying shoes.
4 A nurse is providing anticipatory guidance to the family of a child with a new diagnosis of type 1 diabetes.
Which of the following developmental considerations is most important to include?
A) School-age children can independently manage insulin dosing.
B) Adolescents may have difficulty adhering to the regimen due to peer pressure.
C) Toddlers are able to recognize symptoms of hypoglycemia.
,D) Preschoolers can understand the concept of balancing food and activity.
Answer: B
Rationale: Adolescents often struggle with adherence due to peer pressure and desire for normalcy. School-age
children need supervision, not independence. Toddlers cannot recognize hypoglycemia. Preschoolers cannot grasp
abstract concepts like balance.
5 A nurse is using the Denver Developmental Screening Test II (DDST-II) on a child. The child passes all items in
the personal-social, fine motor, and language sectors but fails two items in the gross motor sector that are to the
right of the age line. Which of the following is the most appropriate conclusion?
A) The child has a developmental delay in gross motor skills.
B) The child is advanced in gross motor skills.
C) The child's gross motor development is within normal limits.
D) The test is invalid because the child refused some items.
Answer: A
Rationale: On the DDST-II, items passed or failed are compared to the age line. Failure of items to the right of the
age line (which are expected to be passed by most children at that age) indicates a delay. Passing items to the left
indicates advanced skills. Refusal is scored as fail, but the test remains valid.
6 A nurse is evaluating the nutritional status of a child with failure to thrive. Which of the following laboratory
values is most indicative of chronic malnutrition?
A) Elevated serum albumin
B) Decreased prealbumin
C) Elevated transferrin
D) Decreased hemoglobin
Answer: B
Rationale: Prealbumin has a short half-life (2-3 days) and is a sensitive marker for recent protein intake. Albumin
has a longer half-life (20 days) and is more reflective of chronic status; it would be decreased in chronic
malnutrition. Transferrin is often decreased, not elevated. Hemoglobin may be low but is not specific to
malnutrition.
7 A nurse is teaching a parenting class about injury prevention. Which of the following statements by a parent
indicates correct understanding of developmental risks?
A) My 6-month-old can roll over, so I will never leave him unattended on the changing table.
B) My 2-year-old is ready to ride a tricycle because he can pedal.
C) My 4-year-old can swim alone in the pool because she took lessons.
D) My 8-year-old can cross the street alone because she knows traffic rules.
Answer: A
Rationale: A 6-month-old who can roll over is at risk for falls from elevated surfaces; never leaving unattended is
correct. A 2-year-old typically cannot pedal a tricycle (that's a 3-year-old skill). A 4-year-old should never swim
alone regardless of lessons. An 8-year-old still needs supervision crossing streets due to impulsivity.
8 A nurse is assessing a child who speaks in two-word phrases, follows simple commands, and points to named
body parts. Which of the following developmental milestones is the child most likely achieving?
A) 12 months
B) 18 months
C) 24 months
D) 36 months
, Answer: C
Rationale: A 24-month-old typically uses two-word phrases, follows simple commands, and points to body parts. At
12 months, one-word utterances. At 18 months, vocabulary of about 10 words. At 36 months, three-word sentences
and knows body parts.
9 A nurse is planning care for a hospitalized preschooler. Which of the following interventions best supports the
child's developmental needs?
A) Encouraging the child to keep a diary of feelings.
B) Allowing the child to play with medical equipment.
C) Providing a consistent routine and simple explanations.
D) Assigning the same nurse every shift.
Answer: C
Rationale: Preschoolers benefit from routine and simple explanations to reduce anxiety. A diary is more appropriate
for school-age children. Playing with medical equipment may increase fear. Consistent nurse assignment is
important for all ages but not specific to developmental needs of preschoolers.
10 A nurse is assessing a child's growth using the WHO growth standards. The child's weight-for-length is below
the 2nd percentile. Which of the following is the most appropriate nursing action?
A) Reassure the parents that the child is just small.
B) Refer the child for a nutritional assessment.
C) Plot the child's height on a different chart.
D) Recommend increasing caloric intake by 50%.
Answer: B
Rationale: Weight-for-length below the 2nd percentile indicates wasting, which requires further evaluation and
nutritional assessment. Reassurance is inappropriate. Different charts may not be valid. Increasing caloric intake
without assessment could be harmful or ineffective.
Section 2: Health Promotion and Maintenance (Questions 11-20)
11 A nurse is evaluating a family’s readiness for a scheduled well-child visit. The parent expresses concern about
the child’s frequent temper tantrums and difficulty with transitions. The nurse recognizes that these behaviors
are typical for which developmental stage when considering Erikson’s psychosocial theory?
A) Trust versus Mistrust
B) Autonomy versus Shame and Doubt
C) Initiative versus Guilt
D) Industry versus Inferiority
Answer: B
Rationale: Erikson’s stage of Autonomy versus Shame and Doubt occurs during toddlerhood (ages 1–3 years).
Temper tantrums and difficulty with transitions are hallmark behaviors as children assert independence. Trust
versus Mistrust is infancy; Initiative versus Guilt is preschool; Industry versus Inferiority is school-age.
12 During a health maintenance visit, a nurse reviews the immunization record of a 4-year-old child. The child
received the 4-dose series of DTaP, 3 doses of IPV, 1 dose of MMR, 1 dose of varicella, and 3 doses of hepatitis
B. According to the CDC’s recommended catch-up schedule, which vaccine(s) should be administered at this
visit?
A) DTaP, IPV, MMR, varicella
B) DTaP, IPV, hepatitis A
