A baby born at 28 weeks is now 6 months old by birth date. She holds her head steady, smiles socially and follows objects, but she cannot sit even with support or pass a toy between hands. How should the nurse interpret this?

Normal for a corrected age of 3 months

Delayed, as correction is not used after 6 months

Normal, as preterm babies always lag by 6 months

A 3-month delay needing referral now

Which finding in a child is a developmental red flag that needs referral?

Cannot ride a tricycle at 2 years

No clear hand preference at 12 months

No two-word phrases at 15 months

Which feature makes jaundice in a term newborn pathological rather than physiological?

Conjugated bilirubin above 2 mg/dL

Jaundice first seen on the third day

Fading of jaundice by the tenth day

Peak of 11 mg/dL on the fourth day

Growth, development and neonatal nursing

45 M.Sc Nursing Entrance (AIIMS, LBS, PGIMER, JIPMER) practice questions on Growth, development and neonatal nursing, part of Child Health Nursing. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Hard
A baby born at 28 weeks is now 6 months old by birth date. She holds her head steady, smiles socially and follows objects, but she cannot sit even with support or pass a toy between hands. How should the nurse interpret this?
1. ADelayed, as correction is not used after 6 months
2. BNormal, as preterm babies always lag by 6 months
3. CA 3-month delay needing referral now
4. DNormal for a corrected age of 3 months
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Answer: D · Normal for a corrected age of 3 months
The baby was born 12 weeks (3 months) early, so the corrected age is 6 - 3 = 3 months. Head control, a social smile and visual following are expected at 3 months, and sitting and transferring come later. Development of preterm babies is judged by corrected age until about 2 years. She still needs regular developmental follow-up because preterm babies are at higher risk of delay.
- A: Correction is applied until about 2 years of age, not stopped at 6 months.
- B: The lag is related to how early the baby was born, here 3 months, not a fixed 6 months.
- C: Judging her by the chronological age wrongly labels her as delayed.
Question 2 · Medium
By the rule that the number of teeth equals the age in months minus 6, a healthy 14-month-old usually has about:
1. A20 teeth
2. B14 teeth
3. C8 teeth
4. D6 teeth
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Answer: C · 8 teeth
The rule gives 14 - 6 = 8 teeth and applies from about 6 to 24 months. The first tooth, usually a lower central incisor, appears at about 6-7 months. All 20 primary teeth are present by about 2.5 years. Delayed teething is seen with hypothyroidism and rickets, while isolated late eruption is often normal.
- A: 20 is the full primary set, complete at about 2.5 years.
- B: 14 teeth uses the age in months without subtracting 6.
- D: 6 teeth would fit a 12-month-old by this rule.
Question 3 · Medium
Which finding in a child is a developmental red flag that needs referral?
1. ACannot ride a tricycle at 2 years
2. BNo clear hand preference at 12 months
3. CNot walking alone at 18 months
4. DNo two-word phrases at 15 months
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Answer: C · Not walking alone at 18 months
Most children walk alone by 12-15 months, and failure to walk by 18 months is a recognised red flag for motor delay, needing assessment for neuromuscular disease, cerebral palsy or global delay. Two-word phrases are expected by about 24 months, and tricycle riding by about 3 years. Hand preference normally settles after 18 months. A firm hand preference before 12 months is itself a warning sign of weakness in the other arm.
- A: Riding a tricycle is a 3-year milestone, so a 2-year-old who cannot is normal.
- B: Hand preference is not expected at 12 months; early handedness is the worrying sign.
- D: Two-word phrases are expected by about 2 years, so their absence at 15 months is normal.
Question 4 · Medium
At a well-baby clinic, an infant sits leaning forward on her hands, passes a block from one hand to the other and babbles 'ba' and 'da'. She cannot pull to stand or pick up a raisin with thumb and finger. Her age is most likely:
1. A9 months
2. B12 months
3. C6 months
4. D4 months
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Answer: C · 6 months
Tripod sitting with support, transferring objects between hands and monosyllabic babbling are typical 6-month milestones. Pulling to stand and a mature pincer grasp appear at 9-12 months, so their absence fits. A 4-month-old cannot yet sit even with hand support or transfer objects. Assessing several domains together gives a more reliable age estimate than one skill.
- A: A 9-month-old sits steadily without support, crawls and pulls to stand.
- B: A 12-month-old walks with support, uses a neat pincer grasp and says a word or two.
- D: A 4-month-old holds the head well but cannot sit with hand support or transfer objects.
Question 5 · Medium
Which feature makes jaundice in a term newborn pathological rather than physiological?
1. AJaundice first seen on the third day
2. BFading of jaundice by the tenth day
3. CConjugated bilirubin above 2 mg/dL
4. DPeak of 11 mg/dL on the fourth day
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Answer: C · Conjugated bilirubin above 2 mg/dL
Physiological jaundice is unconjugated, appears after 24 hours, peaks on day 3-5 at moderate levels and fades within about 2 weeks in a term baby. A raised conjugated (direct) bilirubin, above about 2 mg/dL or more than 20% of the total, is always pathological. It points to cholestasis such as biliary atresia, neonatal hepatitis or infection. Other pathological features are onset within 24 hours, a rapid rise and persistence beyond 2 weeks.
- A: Onset on day 3 is the usual timing of physiological jaundice.
- B: Fading by day 10 is the expected course of physiological jaundice.
- D: A peak around 11-12 mg/dL on day 3-5 fits physiological jaundice in a term baby.
Question 6 · Medium
A newborn with respiratory distress becomes cold during transfer. Why can this cold stress worsen the baby's hypoxia?
1. ABrown fat heat production raises oxygen use and constricts pulmonary vessels
2. BCold directly destroys surfactant already present in the alveoli
3. CShivering tires the respiratory muscles and causes shallow breathing
4. DPeripheral vasodilation diverts blood away from the lungs
Answer and explanation in LearnFree account
Question 7 · Medium
During bag-and-mask ventilation of an apnoeic newborn, the chest does not move and the heart rate stays at 70/min. What should the nurse do next?
1. AStart chest compressions at a 3:1 ratio
2. BGive adrenaline through an umbilical line
3. CTake ventilation corrective steps, such as adjusting the mask
4. DRaise the oxygen to 100% and continue bagging
Answer and explanation in LearnFree account
Question 8 · Easy
A mother asks when her baby will first smile back at her face. The social (responsive) smile normally appears at about:
1. A6 to 7 months
2. B1 to 2 weeks
3. C4 to 5 months
4. D6 to 8 weeks
Answer and explanation in LearnFree account
Question 9 · Medium
The neutral thermal environment for a newborn is the surrounding temperature at which the baby:
1. AShivers least while keeping a normal core temperature
2. BLoses no heat at all by evaporation or radiation
3. CBurns brown fat fastest to keep the body warm
4. DKeeps a normal temperature with the least oxygen use
Answer and explanation in LearnFree account
Question 10 · Hard
A 3-week-old term baby is brought for jaundice that has not faded. He is breastfed and gaining weight. The mother says the stools are pale, like putty, and his urine stains the nappy dark yellow. What is the nurse's priority?
1. AArrange urgent conjugated bilirubin and specialist referral
2. BStart home phototherapy and review in a week
3. CStop breastfeeding for 48 hours to see if it fades
4. DReassure the mother that this is breast milk jaundice
Answer and explanation in LearnFree account
Question 11 · Hard
A 29-week baby in the NICU is on 40% oxygen. The unit's target SpO2 is 90-95%, and the monitor now shows 99% for the last hour. What should the nurse do?
1. ALeave it, since a high saturation is always safer
2. BRaise the oxygen to 100% before the next feed
3. CTurn the oxygen off completely and observe
4. DReduce the oxygen in small steps to reach the target
Answer and explanation in LearnFree account
Question 12 · Hard
A term baby's total serum bilirubin is 8 mg/dL at 30 hours of age and 14 mg/dL at 42 hours. What is the rate of rise, and what does it mean?
1. A0.5 mg/dL per hour, a pathological rise
2. B0.5 mg/dL per hour, a physiological rise
3. C0.25 mg/dL per hour, a physiological rise
4. D6 mg/dL per hour, a pathological rise
Answer and explanation in LearnFree account
Question 13 · Hard
During a double-volume exchange transfusion with citrated blood, a newborn becomes jittery and the cardiac monitor shows a prolonged QT interval. Blood glucose is 60 mg/dL. The most likely cause is:
1. AHypothermia from blood that was not warmed
2. BHyperkalaemia from stored donor red cells
3. CHypocalcaemia from citrate binding calcium
4. DHypoglycaemia from the glucose load ending
Answer and explanation in LearnFree account
Question 14 · Medium
Before giving a gavage feed to a preterm baby, the nurse checks that the orogastric tube is in the stomach. Which bedside check is most reliable?
1. ANo bubbles when the tube end is placed in water
2. BAn aspirate pH of 5.5 or below
3. CA 'whoosh' heard over the stomach as air is pushed in
4. DThe baby does not cough or change colour
Answer and explanation in LearnFree account
Question 15 · Easy
In neonatal resuscitation, the 'Golden Minute' means that a baby who is not breathing should be receiving ventilation within:
1. A3 minutes of birth
2. B30 seconds of birth
3. C5 minutes of birth
4. D60 seconds of birth
Answer and explanation in LearnFree account
Question 16 · Easy
A breastfeeding mother feels tingling in her breasts and milk drips when she hears her baby cry. This milk ejection reflex is caused by:
1. AOxytocin
2. BHuman placental lactogen
3. CProlactin
4. DOestrogen
Answer and explanation in LearnFree account
Question 17 · Medium
A 5-year-old admitted for appendicectomy tells the nurse he got the tummy pain because he hit his little sister. This belief best reflects:
1. AConcrete operational logical thinking
2. BFormal operational abstract thinking
3. CErikson's stage of industry versus inferiority
4. DPreoperational magical thinking
Answer and explanation in LearnFree account
Question 18 · Easy
In a healthy term newborn, how does the head circumference compare with the chest circumference?
1. AChest is larger by about 2-3 cm
2. BHead and chest are about equal
3. CHead is larger by about 6-8 cm
4. DHead is larger by about 2-3 cm
Answer and explanation in LearnFree account
Question 19 · Easy
Phototherapy for neonatal jaundice works best with light in the wavelength band of:
1. A620-700 nm (red)
2. B560-590 nm (yellow)
3. C290-320 nm (ultraviolet B)
4. D460-490 nm (blue-green)
Answer and explanation in LearnFree account
Question 20 · Easy
Breast milk jaundice, as distinct from jaundice due to poor breastfeeding intake, typically:
1. AStarts on day 2-3 and peaks by day 4-5
2. BBegins late in the first week and peaks at 2-3 weeks
3. CAppears within 24 hours of birth
4. DStarts only after 6 weeks of age
Answer and explanation in LearnFree account
Question 21 · Medium
Under the WHO/UNICEF Ten Steps to Successful Breastfeeding (2018), which practice should a baby-friendly maternity unit follow?
1. AGlucose water before the first breastfeed
2. BRooming-in of mother and baby 24 hours a day
3. CBottle teats for babies who feed slowly
4. DFeeds at fixed three-hourly intervals
Answer and explanation in LearnFree account
Question 22 · Medium
When plotting a 20-month-old child's linear growth on the WHO growth standards, the measurement should be taken as:
1. ASitting height on a flat stool
2. BRecumbent length on an infantometer
3. CArm span between the fingertips
4. DStanding height against a wall scale
Answer and explanation in LearnFree account
Question 23 · Hard
A 10-day-old preterm baby in the NICU has temperature instability, more frequent apnoea, poor feeding and a mottled skin. A cannula is in place and IV antibiotics are prescribed. What should the nurse do first?
1. ATake a blood culture, then give the first antibiotic dose
2. BIncrease the incubator temperature and observe for a day
3. CWait for the CRP result before starting antibiotics
4. DGive the antibiotics now and take cultures tomorrow
Answer and explanation in LearnFree account
Question 24 · Easy
A 4-year-old in the ward says the moon follows the car because it wants to come home with her. According to Piaget, this is an example of:
1. AReversibility
2. BObject permanence
3. CAnimism
4. DConservation
Answer and explanation in LearnFree account
Question 25 · Medium
A baby's head circumference was 35 cm at birth. Using the rule of 2 cm per month for months 1-3, 1 cm per month for months 4-6 and 0.5 cm per month for months 7-12, the expected head circumference at 1 year is:
1. A59 cm
2. B47 cm
3. C44 cm
4. D41 cm
Answer and explanation in LearnFree account

20 more Growth, development and neonatal nursing questions

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Growth, development and neonatal nursing

A baby born at 28 weeks is now 6 months old by birth date. She holds her head steady, smiles socially and follows objects, but she cannot sit even with support or pass a toy between hands. How should the nurse interpret this?

By the rule that the number of teeth equals the age in months minus 6, a healthy 14-month-old usually has about:

Which finding in a child is a developmental red flag that needs referral?

At a well-baby clinic, an infant sits leaning forward on her hands, passes a block from one hand to the other and babbles 'ba' and 'da'. She cannot pull to stand or pick up a raisin with thumb and finger. Her age is most likely:

Which feature makes jaundice in a term newborn pathological rather than physiological?

A newborn with respiratory distress becomes cold during transfer. Why can this cold stress worsen the baby's hypoxia?

During bag-and-mask ventilation of an apnoeic newborn, the chest does not move and the heart rate stays at 70/min. What should the nurse do next?

A mother asks when her baby will first smile back at her face. The social (responsive) smile normally appears at about:

The neutral thermal environment for a newborn is the surrounding temperature at which the baby:

A 3-week-old term baby is brought for jaundice that has not faded. He is breastfed and gaining weight. The mother says the stools are pale, like putty, and his urine stains the nappy dark yellow. What is the nurse's priority?

A 29-week baby in the NICU is on 40% oxygen. The unit's target SpO2 is 90-95%, and the monitor now shows 99% for the last hour. What should the nurse do?

A term baby's total serum bilirubin is 8 mg/dL at 30 hours of age and 14 mg/dL at 42 hours. What is the rate of rise, and what does it mean?

During a double-volume exchange transfusion with citrated blood, a newborn becomes jittery and the cardiac monitor shows a prolonged QT interval. Blood glucose is 60 mg/dL. The most likely cause is:

Before giving a gavage feed to a preterm baby, the nurse checks that the orogastric tube is in the stomach. Which bedside check is most reliable?

In neonatal resuscitation, the 'Golden Minute' means that a baby who is not breathing should be receiving ventilation within:

A breastfeeding mother feels tingling in her breasts and milk drips when she hears her baby cry. This milk ejection reflex is caused by:

A 5-year-old admitted for appendicectomy tells the nurse he got the tummy pain because he hit his little sister. This belief best reflects:

In a healthy term newborn, how does the head circumference compare with the chest circumference?

Phototherapy for neonatal jaundice works best with light in the wavelength band of:

Breast milk jaundice, as distinct from jaundice due to poor breastfeeding intake, typically:

Under the WHO/UNICEF Ten Steps to Successful Breastfeeding (2018), which practice should a baby-friendly maternity unit follow?

When plotting a 20-month-old child's linear growth on the WHO growth standards, the measurement should be taken as:

A 10-day-old preterm baby in the NICU has temperature instability, more frequent apnoea, poor feeding and a mottled skin. A cannula is in place and IV antibiotics are prescribed. What should the nurse do first?

A 4-year-old in the ward says the moon follows the car because it wants to come home with her. According to Piaget, this is an example of:

A baby's head circumference was 35 cm at birth. Using the rule of 2 cm per month for months 1-3, 1 cm per month for months 4-6 and 0.5 cm per month for months 7-12, the expected head circumference at 1 year is: