During a well-baby visit, a 9-month-old still shows a full Moro reflex when startled. The nurse should interpret this finding as:

A finding that needs neurological evaluation

Evidence of normal hearing in both ears

An expected finding for an infant of 9 months

A sign of advanced motor development

Of these four newborns in the nursery, the nurse should go first to:

A 6-hour-old with a respiratory rate of 72/min and nasal flaring

A 12-hour-old with a heart rate of 168/min while crying

A 2-day-old with yellow skin on the face and chest

A 1-day-old with a bluish tinge to the hands and feet

Newborn screening for phenylketonuria and other metabolic disorders is most reliable when the heel-stick sample is collected:

After 24 hours of age, once feeding is established

Within the first hour of life, before the first feeding

At the 2-week visit, when liver enzymes mature

Only after the infant has regained birth weight

A 20-month-old in hospital screams and clings to the parent who is leaving, then cries loudly for a long time and refuses comfort from the nurse. The nurse recognises this behaviour as:

The protest phase of separation anxiety

The detachment phase of separation anxiety

A sign of uncontrolled pain needing analgesia

A sign of insecure parent-child attachment

Before discharge, the nurse checks the parents' understanding of newborn care. Which statement shows the teaching was understood?

"We'll call if his temperature is 100.4°F (38°C) or higher."

"We'll cover the cord with a wet cloth after each bath."

"We'll give him water between feeds on hot days."

"We'll put a soft pillow in the crib so he is comfortable."

Growth, development and newborn care across the lifespan

50 NCLEX-RN practice questions on Growth, development and newborn care across the lifespan, part of Health Promotion and Maintenance. 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 · Medium
During a well-baby visit, a 9-month-old still shows a full Moro reflex when startled. The nurse should interpret this finding as:
1. AEvidence of normal hearing in both ears
2. BAn expected finding for an infant of 9 months
3. CA sign of advanced motor development
4. DA finding that needs neurological evaluation
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Answer: D · A finding that needs neurological evaluation
The Moro reflex is strongest at birth and normally fades by about 4 to 6 months as the cortex matures. A persistent primitive reflex at 9 months can indicate a neurological problem such as cerebral palsy. The nurse documents it and refers for further evaluation. This item tests analysing cues against the expected timeline of newborn reflexes.
- A: A startle shows some response to sound, but persistence is the concern.
- B: The Moro reflex should be gone by 6 months, so it is not expected at 9 months.
- C: Persistent primitive reflexes delay, rather than advance, motor milestones.
Question 2 · Hard
Of these four newborns in the nursery, the nurse should go first to:
1. AA 12-hour-old with a heart rate of 168/min while crying
2. BA 6-hour-old with a respiratory rate of 72/min and nasal flaring
3. CA 2-day-old with yellow skin on the face and chest
4. DA 1-day-old with a bluish tinge to the hands and feet
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Answer: B · A 6-hour-old with a respiratory rate of 72/min and nasal flaring
A respiratory rate above 60/min with nasal flaring is a sign of respiratory distress and threatens oxygenation, so this infant is seen first. A heart rate up to about 180/min is expected while a newborn cries. Jaundice on day 2 is likely physiologic and acrocyanosis is normal in the first days. This item tests prioritising hypotheses using the airway and breathing priority.
- A: A heart rate of 168/min during crying is within the expected range.
- C: Day-2 jaundice is likely physiologic and can be assessed after the unstable infant.
- D: Acrocyanosis is an expected finding in the first days of life.
Question 3 · Medium
Newborn screening for phenylketonuria and other metabolic disorders is most reliable when the heel-stick sample is collected:
1. AAfter 24 hours of age, once feeding is established
2. BWithin the first hour of life, before the first feeding
3. CAt the 2-week visit, when liver enzymes mature
4. DOnly after the infant has regained birth weight
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Answer: A · After 24 hours of age, once feeding is established
Disorders such as phenylketonuria are detected by a rise in metabolites that builds up only after the infant has taken in protein through feeding. A sample collected before 24 hours can give a false-negative result, so a repeat test is advised if the first one was drawn early. Most programmes collect the sample at 24 to 48 hours of age. This item tests taking action at the correct time to avoid a missed diagnosis.
- B: Before feeding, phenylalanine has not risen yet, so the result can be falsely normal.
- C: Waiting 2 weeks delays treatment and is not standard timing.
- D: Waiting until birth weight is regained delays diagnosis without making the test more reliable.
Question 4 · Medium
A 20-month-old in hospital screams and clings to the parent who is leaving, then cries loudly for a long time and refuses comfort from the nurse. The nurse recognises this behaviour as:
1. AThe detachment phase of separation anxiety
2. BThe protest phase of separation anxiety
3. CA sign of uncontrolled pain needing analgesia
4. DA sign of insecure parent-child attachment
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Answer: B · The protest phase of separation anxiety
Separation anxiety peaks between about 6 and 30 months, and protest is its first phase: crying, clinging and rejecting strangers. Despair, with withdrawal and quiet sadness, follows if separation continues, and detachment, with apparent adjustment, comes only after prolonged separation. Protest is a normal response and reflects a healthy attachment. This item tests analysing cues to identify a developmental response.
- A: Detachment looks like calm adjustment and appears only after long separation.
- C: The behaviour is triggered by the parent leaving, which points to separation rather than pain.
- D: Strong protest shows healthy attachment, not insecure attachment.
Question 5 · Hard
Before discharge, the nurse checks the parents' understanding of newborn care. Which statement shows the teaching was understood?
1. A"We'll cover the cord with a wet cloth after each bath."
2. B"We'll give him water between feeds on hot days."
3. C"We'll call if his temperature is 100.4°F (38°C) or higher."
4. D"We'll put a soft pillow in the crib so he is comfortable."
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Answer: C · "We'll call if his temperature is 100.4°F (38°C) or higher."
A temperature of 100.4°F (38°C) or higher in a young infant may be the only sign of serious infection and needs prompt medical evaluation. Pillows and soft bedding in the crib raise the risk of suffocation and sudden infant death. The cord should be kept clean and dry, and young infants should not be given water because it can cause hyponatraemia. This item tests evaluating outcomes of discharge teaching.
- A: The cord should be kept clean and dry to help it separate.
- B: Water can cause hyponatraemia in young infants; breast milk or formula provides fluid.
- D: Soft bedding and pillows increase the risk of sudden infant death.
Question 6 · Medium
A 15-year-old comes to the clinic with a parent for a sports physical. When taking the health history, the best approach is to:
1. AInterview the adolescent alone for part of the visit
2. BKeep the parent in the room for the whole of the visit
3. CTell the teen that all answers go to the parent
4. DAsk the parent to answer the history questions
Answer and explanation in LearnFree account
Question 7 · Hard
A breastfed newborn weighed 3,600 g at birth. On day 3 the infant weighs 3,240 g. What is the weight loss, and what should the nurse do?
1. A3.6%; this is within expected limits for day 3
2. B10%; assess the feeding and notify the provider
3. C11%; start formula supplements right away
4. D10%; this is expected, so no action is needed
Answer and explanation in LearnFree account
Question 8 · Easy
The change in hearing most typical of normal aging is that:
1. AHigh-pitched sounds are lost first
2. BHearing drops suddenly in one ear
3. CLow-pitched sounds are lost first
4. DLoud sounds become easier to tolerate
Answer and explanation in LearnFree account
Question 9 · Medium
A parent asks why the newborn needs an injection of vitamin K soon after birth. The nurse explains that newborns are at risk of bleeding because:
1. ATheir livers cannot yet store any iron or folate
2. BTheir intestines lack the bacteria that make vitamin K
3. CTheir red cells break down faster than adult cells
4. DTheir platelets are destroyed by antibodies from the mother
Answer and explanation in LearnFree account
Question 10 · Medium
The most appropriate activity for a hospitalised 4-year-old is:
1. APlaying a strategy board game with rules
2. BPlaying with a toy doctor kit and dolls
3. CCompleting a 500-piece jigsaw puzzle
4. DWatching a mobile that hangs over the bed
Answer and explanation in LearnFree account
Question 11 · Hard
During an annual visit, a 78-year-old client and her daughter describe several changes. The finding the nurse should report as not part of normal aging is:
1. ANeeding brighter light to read the newspaper
2. BWaking more often during the night
3. CTaking longer to recall a name she later remembers
4. DConfusion that began suddenly two days ago
Answer and explanation in LearnFree account
Question 12 · Medium
An 82-year-old client who has had two urinary infections this year says, "I hardly drink because I'm never thirsty." The nurse explains that older adults are at risk of dehydration because:
1. AThe thirst response weakens with aging
2. BAntidiuretic hormone is no longer produced
3. CTotal body water increases with aging
4. DThe kidneys concentrate urine better
Answer and explanation in LearnFree account
Question 13 · Medium
Among these newborn findings, the one that needs prompt reporting to the health care provider is:
1. AYellow skin on the face and chest on day 3
2. BTiny white papules across the nose and chin
3. CYellow skin on the face at 18 hours of age
4. DA red blotchy rash on the trunk on day 2
Answer and explanation in LearnFree account
Question 14 · Medium
Older adults often need lower doses of drugs cleared by the kidneys mainly because of:
1. AFaster emptying of the stomach
2. BA decline in glomerular filtration rate
3. CA rise in serum albumin levels
4. DAn increase in lean body mass and muscle
Answer and explanation in LearnFree account
Question 15 · Easy
In a healthy infant, the anterior fontanel normally closes by about:
1. ABetween 3 and 4 years of age
2. B6 to 8 weeks of age
3. C12 to 18 months of age
4. D3 to 4 months of age
Answer and explanation in LearnFree account
Question 16 · Medium
The nurse is about to start an IV on a 2-year-old. When should the nurse explain the procedure, and how?
1. AJust before the procedure, in short simple words
2. BThe day before, with a detailed description
3. COnly to the parent, as toddlers cannot understand
4. DAfterwards, once the child has calmed down
Answer and explanation in LearnFree account
Question 17 · Hard
At the 12-month visit, an infant who weighed 7 lb 8 oz (3.4 kg) at birth weighs 15 lb (6.8 kg). Length and head circumference are on the 50th percentile. How should the nurse interpret the weight?
1. AIt cannot be judged without the 6-month weight
2. BIt is above expected and suggests overfeeding
3. CIt has only doubled, well below the expected tripling
4. DIt is the expected weight gain for 12 months of age
Answer and explanation in LearnFree account
Question 18 · Hard
At a 9-month well-child visit, the finding that should be referred for further developmental evaluation is that the infant:
1. ACries when a stranger picks her up
2. BHas not yet taken a first step
3. CSays no clear words like mama
4. DCannot sit without support
Answer and explanation in LearnFree account
Question 19 · Hard
On a mother-baby unit, the task most suitable for assistive personnel (AP) is:
1. AWeighing the stable newborns and recording the weights
2. BCompleting the first full assessment of a new admission
3. CTeaching a first-time mother how to care for the cord
4. DAssessing a newborn whose mother reports a poor latch
Answer and explanation in LearnFree account
Question 20 · Easy
Two hours after birth, a term newborn has a heart rate of 140/min and a respiratory rate of 48/min. Which additional finding is expected and needs no intervention?
1. ABluish lips and tongue
2. BGrunting on expiration
3. CFlaring of the nostrils
4. DBluish hands and feet
Answer and explanation in LearnFree account
Question 21 · Medium
The parent of a 2-year-old says, "She says no to everything, even things she likes." The most appropriate advice by the nurse is to:
1. AExplain the reason for each rule in detail before asking
2. BOffer two acceptable choices instead of yes-or-no questions
3. CGive a time-out each time the child says the word no to you
4. DLet the child decide all daily routines without limits
Answer and explanation in LearnFree account
Question 22 · Medium
The nurse reviews feeding with the parent of a 7-month-old. Which statement by the parent indicates a need for further teaching?
1. A"I give her the vitamin D drops every day."
2. B"I add a little honey to her cereal so she eats it."
3. C"I will wait until 12 months to give her cow's milk."
4. D"I offer one new food and wait a few days."
Answer and explanation in LearnFree account
Question 23 · Hard
A 15-year-old with a femur fracture is in skeletal traction for several weeks. He is irritable, refuses to talk to his parents and says, "Everyone at school is going to forget about me." Which intervention best addresses his developmental needs?
1. APlan a daily schedule with his parents choosing his activities
2. BHelp him keep in touch with friends by phone and visits
3. CLimit his phone use so that he can rest and heal
4. DAsk his parents to stay with him through each night
Answer and explanation in LearnFree account
Question 24 · Hard
A 24-month-old boy says about 10 single words and no two-word phrases. He rarely points to show his mother things, makes little eye contact and lines up his toy cars for long periods. Hearing at birth was normal. What is the nurse's most appropriate action?
1. ATeach the mother to limit his time with toy cars
2. BPlan to recheck his speech at the 30-month visit
3. CRefer for developmental and autism evaluation now
4. DReassure the mother that boys often talk later
Answer and explanation in LearnFree account
Question 25 · Medium
The parent of a 3-year-old in hospital is upset that the child, who was toilet trained, is now wetting the bed. Which response by the nurse is best?
1. A"Wetting at this age means she may have a bladder infection."
2. B"She is doing it to get your attention, so it is best to ignore the wet bed."
3. C"Going back to earlier habits is common under stress and usually passes."
4. D"Remind her firmly that big girls use the toilet every time."
Answer and explanation in LearnFree account

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Growth, development and newborn care across the lifespan

During a well-baby visit, a 9-month-old still shows a full Moro reflex when startled. The nurse should interpret this finding as:

Of these four newborns in the nursery, the nurse should go first to:

Newborn screening for phenylketonuria and other metabolic disorders is most reliable when the heel-stick sample is collected:

A 20-month-old in hospital screams and clings to the parent who is leaving, then cries loudly for a long time and refuses comfort from the nurse. The nurse recognises this behaviour as:

Before discharge, the nurse checks the parents' understanding of newborn care. Which statement shows the teaching was understood?

A 15-year-old comes to the clinic with a parent for a sports physical. When taking the health history, the best approach is to:

A breastfed newborn weighed 3,600 g at birth. On day 3 the infant weighs 3,240 g. What is the weight loss, and what should the nurse do?

The change in hearing most typical of normal aging is that:

A parent asks why the newborn needs an injection of vitamin K soon after birth. The nurse explains that newborns are at risk of bleeding because:

The most appropriate activity for a hospitalised 4-year-old is:

During an annual visit, a 78-year-old client and her daughter describe several changes. The finding the nurse should report as not part of normal aging is:

An 82-year-old client who has had two urinary infections this year says, "I hardly drink because I'm never thirsty." The nurse explains that older adults are at risk of dehydration because:

Among these newborn findings, the one that needs prompt reporting to the health care provider is:

Older adults often need lower doses of drugs cleared by the kidneys mainly because of:

In a healthy infant, the anterior fontanel normally closes by about:

The nurse is about to start an IV on a 2-year-old. When should the nurse explain the procedure, and how?

At the 12-month visit, an infant who weighed 7 lb 8 oz (3.4 kg) at birth weighs 15 lb (6.8 kg). Length and head circumference are on the 50th percentile. How should the nurse interpret the weight?

At a 9-month well-child visit, the finding that should be referred for further developmental evaluation is that the infant:

On a mother-baby unit, the task most suitable for assistive personnel (AP) is:

Two hours after birth, a term newborn has a heart rate of 140/min and a respiratory rate of 48/min. Which additional finding is expected and needs no intervention?

The parent of a 2-year-old says, "She says no to everything, even things she likes." The most appropriate advice by the nurse is to:

The nurse reviews feeding with the parent of a 7-month-old. Which statement by the parent indicates a need for further teaching?

A 15-year-old with a femur fracture is in skeletal traction for several weeks. He is irritable, refuses to talk to his parents and says, "Everyone at school is going to forget about me." Which intervention best addresses his developmental needs?

A 24-month-old boy says about 10 single words and no two-word phrases. He rarely points to show his mother things, makes little eye contact and lines up his toy cars for long periods. Hearing at birth was normal. What is the nurse's most appropriate action?

The parent of a 3-year-old in hospital is upset that the child, who was toilet trained, is now wetting the bed. Which response by the nurse is best?