Growth and development assessment is a cornerstone of pediatric nursing practice and represents one of the most heavily tested areas on the CPN certification exam. This topic spans across multiple domains, comprising 30% of the Health Promotion section and significant portions of the Assessment domain. Understanding developmental milestones, age-appropriate behaviors, and anticipatory guidance is essential for providing comprehensive pediatric care. Pediatric nurses must be proficient in recognizing normal versus abnormal developmental patterns, as early identification of delays can significantly impact a child’s long-term outcomes. The ability to assess cognitive, physical, social, and emotional development across all age groups—from infancy through adolescence—is fundamental to effective pediatric nursing practice. Growth and development knowledge directly influences clinical decision-making, family education, and care planning. This topic requires nurses to understand not only what constitutes normal development but also how to provide appropriate anticipatory guidance to families. The CPN exam frequently tests scenarios involving developmental milestones, age-appropriate activities, and interventions for developmental concerns. Mastery of this content area is crucial for success on the certification exam and for providing evidence-based, family-centered pediatric care. These practice questions will help reinforce key concepts and prepare you for the types of developmental scenarios commonly encountered on the CPN examination.
Practice Questions
Question 1:
A 15-month-old toddler is brought to the clinic for a well-child visit. Which developmental milestone would the nurse expect to observe at this age?
A) Walks independently without support
B) Says 2-3 words clearly
C) Builds a tower of 6 blocks
D) Pedals a tricycle
Correct Answer: A) Walks independently without support
Explanation: By 15 months, most toddlers can walk independently without support. This typically occurs between 12-15 months. Option B (2-3 words clearly) usually occurs around 12 months. Option C (tower of 6 blocks) is expected around 24 months. Option D (pedaling a tricycle) typically occurs around 3 years of age.
Question 2:
The parents of a 2-year-old ask the nurse about their child’s language development. Which response indicates normal language development for this age?
A) Uses 10-15 words consistently
B) Speaks in 2-3 word sentences
C) Follows complex, multi-step directions
D) Tells detailed stories about events
Correct Answer: B) Speaks in 2-3 word sentences
Explanation: By age 2, children typically speak in 2-3 word sentences and have a vocabulary of 50+ words. Option A (10-15 words) is more appropriate for 12-15 months. Option C (complex directions) and Option D (detailed stories) are skills that develop later in the preschool years.
Question 3:
A nurse is assessing a 6-month-old infant. Which finding would be most concerning and require immediate follow-up?
A) Cannot sit without support
B) Has not started crawling
C) Shows no social smile or eye contact
D) Cannot pick up small objects with pincer grasp
Correct Answer: C) Shows no social smile or eye contact
Explanation: Social smile should appear by 2-3 months, and lack of eye contact by 6 months is concerning for autism spectrum disorder or other developmental delays. Option A is normal (sitting without support occurs around 6-8 months). Option B is normal (crawling typically begins 7-10 months). Option D is normal (pincer grasp develops around 9-12 months).
Question 4:
The nurse is providing anticipatory guidance to parents of a 4-year-old preschooler. Which activity would be most appropriate to recommend for this age group?
A) Playing simple board games with rules
B) Riding a two-wheel bicycle
C) Writing their full name legibly
D) Understanding abstract concepts like time
Correct Answer: A) Playing simple board games with rules
Explanation: Four-year-olds can understand and follow simple rules, making board games appropriate. Option B (two-wheel bicycle) typically occurs around 5-6 years. Option C (writing full name) usually develops around 5 years. Option D (abstract concepts) develops during school-age years.
Question 5:
A 12-month-old infant is brought for evaluation of possible developmental delay. Which assessment finding would be most concerning?
A) Cannot walk independently
B) Does not respond to their name when called
C) Cannot build a tower of 3 blocks
D) Does not use a spoon effectively
Correct Answer: B) Does not respond to their name when called
Explanation: By 9-12 months, infants should respond to their name, and failure to do so may indicate hearing problems or developmental delays. Option A is normal (walking occurs 12-15 months). Option C is normal (tower building develops later). Option D is normal (spoon use develops gradually through toddlerhood).
Question 6:
The nurse is educating parents about toilet training readiness for their 2.5-year-old. Which sign indicates the child may be ready to begin toilet training?
A) Stays dry for longer periods during the day
B) Can count to 10 accurately
C) Shows interest in playing with other children
D) Can dress themselves completely
Correct Answer: A) Stays dry for longer periods during the day
Explanation: Staying dry for 2+ hours indicates bladder control development, a key readiness sign for toilet training. Option B (counting) is a cognitive skill not related to toilet training. Option C (social play) and Option D (independent dressing) are separate developmental milestones.
Question 7:
A 5-year-old child is starting kindergarten. Which developmental milestone should the nurse expect the child to have achieved?
A) Can tie shoelaces independently
B) Hops on one foot for several steps
C) Understands the concept of death as permanent
D) Can read simple sentences fluently
Correct Answer: B) Hops on one foot for several steps
Explanation: Hopping on one foot is typically achieved by age 4-5 years. Option A (tying shoelaces) usually occurs around 6-7 years. Option C (understanding death) develops around 7-10 years. Option D (reading sentences) varies widely but often occurs after formal instruction begins.
Question 8:
The parents of a 3-year-old are concerned about their child’s behavior during play. Which behavior would be considered normal for this age group?
A) Shares toys willingly with other children
B) Engages in parallel play alongside peers
C) Follows complex rules in group games
D) Shows empathy and comforts crying children
Correct Answer: B) Engages in parallel play alongside peers
Explanation: Parallel play (playing alongside but not directly with others) is typical for 2-3 year olds. Option A (sharing) develops around 4-5 years. Option C (complex rules) and Option D (empathy) develop during preschool and school-age years.
Question 9:
A nurse is assessing fine motor development in a 9-month-old infant. Which skill would be expected at this age?
A) Pincer grasp to pick up small objects
B) Scribbles with a crayon
C) Builds a tower of 2 blocks
D) Transfers objects from hand to hand
Correct Answer: D) Transfers objects from hand to hand
Explanation: Hand-to-hand transfer typically occurs around 6-7 months and should be well-established by 9 months. Option A (pincer grasp) develops around 10-12 months. Option B (scribbling) occurs around 12-15 months. Option C (tower building) begins around 15-18 months.
Question 10:
The nurse is providing guidance to parents of an 8-year-old about normal development. Which characteristic is typical for school-age children?
A) Prefers playing alone rather than with peers
B) Begins to understand rules and fairness
C) Shows little interest in academic achievement
D) Demonstrates magical thinking about cause and effect
Correct Answer: B) Begins to understand rules and fairness
Explanation: School-age children (6-12 years) develop a strong sense of rules, fairness, and justice. Option A is incorrect (peer relationships become very important). Option C is incorrect (academic achievement becomes significant). Option D describes preschool thinking patterns.
Question 11:
A 18-month-old toddler is being evaluated for speech development. Which finding would warrant referral to a speech therapist?
A) Uses only 5-10 recognizable words
B) Cannot follow two-step commands
C) Speaks mostly in jargon with few clear words
D) Does not attempt to imitate sounds or words
Correct Answer: D) Does not attempt to imitate sounds or words
Explanation: By 18 months, children should attempt to imitate sounds and words. Lack of imitation is concerning for hearing or developmental issues. Option A is borderline (should have 10-20 words). Options B and C may be within normal variation but should be monitored.
Question 12:
The nurse is assessing gross motor development in a 3-year-old. Which skill should the child be able to demonstrate?
A) Skips smoothly and rhythmically
B) Rides a tricycle using pedals
C) Jumps rope successfully
D) Catches a ball thrown from 5 feet away
Correct Answer: B) Rides a tricycle using pedals
Explanation: Three-year-olds typically can pedal a tricycle. Option A (skipping) develops around 5-6 years. Option C (jump rope) occurs around 6-7 years. Option D (catching balls) improves gradually but consistent success occurs later.
Question 13:
Parents ask the nurse when their 14-month-old should begin using a cup independently. What is the most appropriate response?
A) “Your child should already be using a cup independently”
B) “Most children can use a cup with minimal spilling by 15-18 months”
C) “Cup use typically doesn’t develop until after age 2”
D) “There’s no specific timeline; every child develops differently”
Correct Answer: B) “Most children can use a cup with minimal spilling by 15-18 months”
Explanation: Independent cup use with minimal spilling typically develops between 15-18 months. At 14 months, the child is approaching this milestone. Option A creates unnecessary concern. Option C is too late. Option D, while partially true, doesn’t provide helpful guidance.
Question 14:
A 6-year-old child is having difficulty with peer relationships at school. Which developmental understanding should guide the nurse’s assessment?
A) Six-year-olds prefer adult companionship over peers
B) Competitive games and rule-following become important
C) Children this age cannot understand others’ perspectives
D) Friendship at this age is based primarily on physical proximity
Correct Answer: B) Competitive games and rule-following become important
Explanation: School-age children (6-12 years) become very focused on rules, fairness, and competitive activities, which affects peer relationships. Option A is incorrect (peer relationships become crucial). Option C is incorrect (perspective-taking develops). Option D describes earlier developmental stages.
Question 15:
The nurse is counseling parents about normal adolescent development for their 13-year-old. Which information is most important to share?
A) Abstract thinking abilities are fully developed by age 13
B) Identity formation and independence-seeking are normal processes
C) Peer influence decreases significantly during early adolescence
D) Physical development is complete by the beginning of adolescence
Correct Answer: B) Identity formation and independence-seeking are normal processes
Explanation: Identity formation and seeking independence are hallmarks of adolescent development and help parents understand normal behavioral changes. Option A is incorrect (abstract thinking continues developing). Option C is incorrect (peer influence increases). Option D is incorrect (physical development continues through adolescence).