Introduction
Growth and development assessment represents one of the most critical competencies for pediatric nurses, forming the foundation for comprehensive child health care across all settings. As a high-yield topic on the CPN examination, growth and development encompasses the systematic evaluation of physical, cognitive, emotional, and social milestones from infancy through young adulthood. Understanding normal developmental patterns enables pediatric nurses to provide appropriate anticipatory guidance, identify early signs of developmental delays or concerns, and implement targeted interventions that support optimal child outcomes. This domain integrates seamlessly with health promotion activities, requiring nurses to assess not only what children can do at specific ages, but also how environmental factors, family dynamics, and individual variations influence developmental trajectories. Mastery of growth and development principles is essential for conducting thorough pediatric assessments, as developmental milestones serve as key indicators of neurological integrity, nutritional status, and overall well-being. The CPN exam frequently tests candidates’ ability to recognize age-appropriate behaviors, identify red flags that warrant further evaluation, and provide families with evidence-based guidance about normal developmental expectations. Additionally, understanding developmental stages helps nurses tailor their communication approaches, select appropriate pain assessment tools, and modify care plans to meet the unique needs of children at different developmental levels. This knowledge directly impacts patient safety, family satisfaction, and long-term health outcomes, making it a cornerstone of pediatric nursing practice. Effective application of growth and development principles also supports nurses in advocating for children’s developmental needs within healthcare systems and collaborating with interdisciplinary teams to address complex developmental concerns.
Practice Questions
Question 1:
A 15-month-old toddler is brought to the pediatric clinic for a well-child visit. Which developmental milestone would the nurse expect to observe at this age?
- Walks independently without support
- Speaks in 3-4 word sentences
- Demonstrates stranger anxiety
- Shows hand preference for activities
Correct Answer: A) Walks independently without support
Explanation: By 15 months, most toddlers can walk independently without support, which typically develops between 12-15 months. Option B is incorrect as 3-4 word sentences typically emerge around 24-30 months. Option C (stranger anxiety) typically peaks around 8-10 months and begins to diminish by 15 months. Option D (hand preference) usually becomes evident around 2-3 years of age.
Question 2:
When assessing a 6-month-old infant, which finding would indicate normal gross motor development?
- Pulls to standing position
- Sits without support for extended periods
- Rolls from back to front and front to back
- Walks while holding onto furniture
Correct Answer: C) Rolls from back to front and front to back
Explanation: Rolling both ways is typically achieved by 6 months of age. Option A (pulling to stand) usually occurs around 8-10 months. Option B (sitting without support) typically develops around 6-8 months but may not be sustained for extended periods at exactly 6 months. Option D (cruising/walking with support) typically begins around 9-12 months.
Question 3:
A nurse is providing anticipatory guidance to parents of a 2-year-old regarding language development. Which statement indicates normal language development for this age?
- “My child uses about 50 words and combines two words together.”
- “My child speaks clearly and strangers can understand everything.”
- “My child tells detailed stories about daily activities.”
- “My child asks ‘why’ questions constantly throughout the day.”
Correct Answer: A) “My child uses about 50 words and combines two words together.”
Explanation: By age 2, children typically have a vocabulary of 50+ words and begin combining two words (e.g., “more milk,” “go bye-bye”). Option B is incorrect as speech clarity develops gradually, with only about 50% being understood by strangers at age 2. Option C (detailed storytelling) typically emerges around 3-4 years. Option D (frequent “why” questions) is characteristic of 3-4 year olds.
Question 4:
During a developmental screening of a 4-year-old, which fine motor skill would the nurse expect the child to demonstrate?
- Ties shoelaces independently
- Copies a triangle shape accurately
- Draws a person with 6-8 body parts
- Writes their first name legibly
Correct Answer: C) Draws a person with 6-8 body parts
Explanation: By age 4, children typically can draw a person with 6-8 recognizable body parts (head, body, arms, legs, eyes, nose, mouth, hair). Option A (tying shoes) typically develops around 5-6 years. Option B (copying triangles) usually emerges around 5 years. Option D (writing name legibly) typically occurs around 4-5 years but may not be fully legible at age 4.
Question 5:
A 9-month-old infant is being assessed for developmental milestones. Which social-emotional behavior would be most concerning if absent?
- Plays peek-a-boo games
- Shows stranger anxiety
- Imitates simple gestures like waving
- Demonstrates separation anxiety
Correct Answer: B) Shows stranger anxiety
Explanation: Stranger anxiety typically emerges around 6-8 months and peaks around 8-10 months. Its absence at 9 months could indicate developmental concerns or attachment issues. Options A, C, and D are expected behaviors but their absence at 9 months would be less concerning than the absence of stranger anxiety, which is a key social-emotional milestone.
Question 6:
When evaluating the cognitive development of a 18-month-old toddler, which behavior would indicate normal development?
- Understands the concept of “tomorrow”
- Engages in pretend play activities
- Follows three-step commands consistently
- Demonstrates object permanence
Correct Answer: D) Demonstrates object permanence
Explanation: Object permanence (understanding that objects exist even when not visible) is typically well-established by 18 months, having developed around 8-12 months. Option A (time concepts) develops much later, around 3-4 years. Option B (pretend play) typically begins around 18-24 months but may not be fully developed at 18 months. Option C (three-step commands) is more appropriate for 2-3 year olds.
Question 7:
A nurse is assessing a 3-year-old’s readiness for toilet training. Which developmental indicator suggests the child may be ready?
- Stays dry for periods of 2+ hours
- Can climb stairs using alternating feet
- Shows interest in wearing underwear
- All of the above
Correct Answer: D) All of the above
Explanation: Toilet training readiness involves multiple developmental indicators including physiological readiness (staying dry for extended periods), physical readiness (motor skills like stair climbing indicate neurological maturity), and psychological readiness (showing interest in underwear/toileting). All these factors together suggest readiness for toilet training.
Question 8:
During a 12-month well-child visit, which gross motor milestone would be most concerning if not achieved?
- Walking independently
- Pulling to stand
- Cruising along furniture
- Standing momentarily without support
Correct Answer: B) Pulling to stand
Explanation: Pulling to stand typically occurs by 8-10 months, so its absence at 12 months would be most concerning and warrant further evaluation. Option A (independent walking) has a normal range of 9-18 months. Options C and D typically occur around 9-12 months, so slight delays would be less concerning than the absence of pulling to stand.
Question 9:
A 5-year-old child is being evaluated for school readiness. Which cognitive skill would the nurse expect to be present?
- Understands conservation of liquid
- Can count to 10 and recognize numbers
- Demonstrates abstract thinking abilities
- Understands complex cause-and-effect relationships
Correct Answer: B) Can count to 10 and recognize numbers
Explanation: By age 5, children typically can count to 10 and recognize numbers, which are important school readiness skills. Option A (conservation) typically develops around 6-7 years during concrete operational stage. Option C (abstract thinking) develops much later, around 11+ years. Option D (complex cause-and-effect) is more advanced and develops gradually throughout school years.
Question 10:
When assessing language development in a 30-month-old toddler, which finding would warrant further evaluation?
- Uses 2-3 word phrases consistently
- Has a vocabulary of approximately 200 words
- Speech is 75% intelligible to strangers
- Uses “me” and “you” correctly in sentences
Correct Answer: A) Uses 2-3 word phrases consistently
Explanation: By 30 months (2.5 years), children should be using 3-4 word sentences regularly. Using only 2-3 word phrases consistently at this age may indicate a language delay requiring evaluation. Options B, C, and D represent appropriate language development for a 30-month-old child.
Question 11:
A nurse is providing guidance about normal sleep patterns. How many hours of sleep would be expected for a healthy 2-year-old?
- 8-10 hours per night
- 10-12 hours per night plus one nap
- 14-16 hours including naps
- 12-14 hours including naps
Correct Answer: D) 12-14 hours including naps
Explanation: Two-year-olds typically need 12-14 hours of total sleep in a 24-hour period, including nighttime sleep and one daytime nap. Option A is insufficient for this age group. Option B doesn’t account for the full sleep needs. Option C is more appropriate for infants under 12 months.
Question 12:
During assessment of a 8-month-old infant, which feeding milestone would the nurse expect to observe?
- Drinks from a cup independently
- Uses a spoon to self-feed effectively
- Picks up small foods with pincer grasp
- Chews and swallows table foods safely
Correct Answer: C) Picks up small foods with pincer grasp
Explanation: The pincer grasp (thumb and forefinger) typically develops around 8-10 months, allowing infants to pick up small foods like cereal pieces. Option A (independent cup drinking) typically develops around 12-15 months. Option B (effective spoon use) occurs around 15-18 months. Option D (safe chewing of table foods) requires more advanced oral motor skills that develop later.
Question 13:
A 6-year-old child is being assessed for developmental appropriateness. Which social skill would be expected at this age?
- Prefers parallel play with peers
- Engages in competitive games with rules
- Shows strong attachment to transitional objects
- Demonstrates egocentric thinking patterns
Correct Answer: B) Engages in competitive games with rules
Explanation: Six-year-olds typically engage in competitive games and can follow rules, representing important social development. Option A (parallel play) is characteristic of toddlers. Option C (transitional objects) is more common in younger children. Option D (egocentric thinking) is typical of preschoolers but should be diminishing by age 6.
Question 14:
When evaluating motor development in a 15-month-old, which skill would indicate advanced development for this age?
- Walks up stairs with assistance
- Kicks a ball forward
- Throws a ball overhand
- Jumps with both feet off the ground
Correct Answer: A) Walks up stairs with assistance
Explanation: Walking up stairs with assistance typically develops around 15-18 months, so this would be appropriate or slightly advanced for a 15-month-old. Option B (kicking ball) typically occurs around 18-24 months. Option C (overhand throwing) develops around 18-24 months. Option D (jumping with both feet) typically occurs around 24-30 months.
Question 15:
A nurse is counseling parents about normal behavioral development in their 3-year-old. Which behavior would be considered typical for this age?
- Shares toys willingly with other children
- Shows occasional temper tantrums when frustrated
- Follows complex multi-step instructions consistently
- Demonstrates empathy and concern for others’ feelings
Correct Answer: B) Shows occasional temper tantrums when frustrated
Explanation: Temper tantrums are normal for 3-year-olds as they develop emotional regulation skills and language to express frustration. Option A (willing sharing) is still developing at this age. Option C (complex instructions) is more appropriate for 4-5 year olds. Option D (empathy) begins to emerge around 3-4 years but is not fully developed at age 3.