Pediatrics milestones NCLEX-RN Practice Questions

Pediatrics milestones NCLEX-RN Practice Questions

Pediatric developmental milestones are core to safe, effective nursing care in Health Promotion and Maintenance. On the NCLEX-RN, you will be expected to recognize normal versus delayed development, prioritize screenings, and provide anticipatory guidance tailored to age-appropriate abilities. This topic-wise question set focuses on gross and fine motor, language, social, and cognitive milestones from birth through the preschool years, integrating safety and parent teaching. Designed for rigorous practice, these questions mirror exam-level complexity and require you to apply milestone timelines to clinical scenarios, identify red flags, and select the best nursing action or teaching point. Use this set to sharpen assessment skills and reinforce evidence-based expectations across infancy, toddlerhood, and preschool.

Q1. Which age should the nurse expect a consistent social smile to emerge in an otherwise healthy infant?

• 2 months
• 4 months
• 6 months
• 9 months

Correct Answer: 2 months

Q2. The nurse evaluates growth in a 1-year-old. Which finding reflects expected weight gain since birth?

• Birth weight doubled
• Birth weight tripled
• Birth weight quadrupled
• Birth weight increased by 25%

Correct Answer: Birth weight tripled

Q3. A parent asks when a child should be able to pick up a raisin using fingertips and thumb (neat pincer). The nurse responds that this typically occurs by:

• 8 months
• 9 months
• 12 months
• 15 months

Correct Answer: 12 months

Q4. During a 4-month well visit, which gross motor milestone is the nurse most likely to observe?

• Pulls to stand
• Rolls from front to back
• Walks holding one hand
• Sits without support

Correct Answer: Rolls from front to back

Q5. The nurse reviews fontanel closure with new parents. The anterior fontanel normally closes by:

• 2–3 months
• 6–9 months
• 12–18 months
• 24–30 months

Correct Answer: 12–18 months

Q6. The posterior fontanel is expected to close by which age?

• 2–3 months
• 6 months
• 12 months
• 18 months

Correct Answer: 2–3 months

Q7. Applying the primary teeth eruption rule of thumb (age in months minus 6), about how many teeth would a 14-month-old typically have?

• 6 teeth
• 8 teeth
• 10 teeth
• 12 teeth

Correct Answer: 8 teeth

Q8. Which language behavior is developmentally appropriate for a 24-month-old toddler?

• Uses single words only
• Speaks in two-word phrases (e.g., “more milk”)
• Speaks in paragraphs
• Names four colors consistently

Correct Answer: Speaks in two-word phrases (e.g., “more milk”)

Q9. A nurse counsels a parent about social development. When does stranger anxiety typically begin?

• 2 months
• 4 months
• 6–8 months
• 18 months

Correct Answer: 6–8 months

Q10. The nurse anticipates peak separation anxiety to occur most commonly at which age?

• 4–6 months
• 8–10 months
• 12–18 months
• 24–30 months

Correct Answer: 12–18 months

Q11. During an assessment, which finding is expected by 4 months regarding head control?

• Marked head lag when pulled to sit
• Intermittent head lag when pulled to sit
• No head control when prone
• Unable to lift head past 45 degrees

Correct Answer: Intermittent head lag when pulled to sit

Q12. Which motor skill is most appropriate to expect at 6 months of age?

• Rolls from back to front
• Walks independently
• Rides a tricycle
• Jumps with two feet

Correct Answer: Rolls from back to front

Q13. A 9-month-old infant is examined. Which gross motor milestone should the nurse expect?

• Sits without support
• Balances on one foot
• Walks up stairs
• Skips on one foot

Correct Answer: Sits without support

Q14. Which is an expected gross motor milestone for a 15-month-old?

• Walks independently
• Hops on one foot
• Rides a bicycle
• Skips with alternating feet

Correct Answer: Walks independently

Q15. The nurse teaches parents about toilet training readiness. Which behavior indicates readiness to begin training?

• Shows no discomfort with a wet diaper
• Remains dry for at least 2 hours at a time
• Inability to follow one-step commands
• Nighttime dryness achieved

Correct Answer: Remains dry for at least 2 hours at a time

Q16. A nurse assesses cognitive development in a 10-month-old. Which behavior demonstrates object permanence?

• Refuses to play peek-a-boo
• Ignores a toy once hidden
• Actively searches for a hidden toy
• Smiles in response to a face

Correct Answer: Actively searches for a hidden toy

Q17. The best developmentally appropriate play activity to encourage for a 9-month-old is:

• Playing peek-a-boo
• Board games with rules
• Complex puzzles
• Team sports

Correct Answer: Playing peek-a-boo

Q18. According to current recommendations, autism-specific screening (e.g., M-CHAT-R/F) should be performed at which well-child visits?

• 9 months and 12 months
• 12 months and 18 months
• 18 months and 24 months
• 24 months and 36 months

Correct Answer: 18 months and 24 months

Q19. Which anticipatory guidance about tummy time is most accurate for preventing positional plagiocephaly?

• Start tummy time after 4 months
• Begin supervised tummy time from birth when awake
• Place infant prone for sleep to shape the head
• Delay tummy time until sitting independently

Correct Answer: Begin supervised tummy time from birth when awake

Q20. During a neurologic assessment, the Babinski reflex is present in an 18-month-old. The nurse should interpret this as:

• A normal finding for age
• An urgent neurologic emergency
• Evidence of spinal cord injury
• A sign of cerebellar dysfunction

Correct Answer: A normal finding for age

Q21. Persistence of which primitive reflex beyond 6 months would prompt the nurse to refer for neurologic evaluation?

• Rooting reflex
• Moro reflex
• Sucking reflex

Correct Answer: Moro reflex

Q22. Anticipatory guidance for growth should include that an infant’s length typically increases by what percentage by 12 months?

• 25%
• 50%
• 75%
• 100%

Correct Answer: 50%

Q23. At approximately what age do head circumference and chest circumference become roughly equal?

• 6 months
• 12 months
• 24 months
• 36 months

Correct Answer: 12 months

Q24. In assessing fine motor skills, the nurse expects a 3-year-old to be able to:

• Copy a circle
• Copy a square
• Copy a triangle
• Tie shoelaces

Correct Answer: Copy a circle

Q25. Which gross motor skill is developmentally appropriate for a 3-year-old child?

• Rides a tricycle
• Hops on one foot
• Skips with alternating feet
• Balances on one foot for 10 seconds

Correct Answer: Rides a tricycle

Q26. A 4-year-old should be expected to:

• Hop on one foot
• Skip rope
• Tie shoelaces
• Ride a bicycle without training wheels

Correct Answer: Hop on one foot

Q27. By which age should a toddler be able to use a spoon with minimal spilling?

• 12 months
• 18 months
• 24 months
• 36 months

Correct Answer: 24 months

Q28. Using the “rule of fours” for speech intelligibility, what percentage of a 3-year-old’s speech should be understandable to a stranger?

• 25%
• 50%
• 75%
• 100%

Correct Answer: 75%

Q29. Which staircase skill is typical for a 3-year-old?

• Goes up stairs two feet per step
• Goes up stairs alternating feet
• Goes down stairs alternating feet
• Jumps down stairs independently

Correct Answer: Goes up stairs alternating feet

Q30. When assessing fine motor development, which block tower is appropriate for a 2-year-old?

• Tower of 2 blocks
• Tower of 4 blocks
• Tower of 6 blocks
• Tower of 10 blocks

Correct Answer: Tower of 6 blocks

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