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PED-BC study materials
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PED-BC practice questions

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Question 1Assessment and Monitoring

What is the typical resting heart rate range for a healthy newborn infant?

  1. 60 to 100 beats/min
  2. 80 to 120 beats/min
  3. 100 to 160 beats/min Correct answer.
  4. 120 to 200 beats/min

Explanation

Newborns normally have higher resting heart rates than older children, typically between 100 and 160 beats/min. Rates outside this range may indicate distress, fever, or arrhythmia and warrant further assessment.

Question 2Assessment and Monitoring

The FLACC scale is most appropriate for assessing pain in which pediatric population?

  1. Children with chronic pain only
  2. Newborns in the first 24 hours
  3. Preverbal or nonverbal children Correct answer.
  4. Adolescents able to self-report

Explanation

FLACC relies on observed behaviors-face, legs, activity, cry, and consolability-so it is intended for children who cannot reliably describe their pain. It is commonly used in infants, toddlers, and children with cognitive impairment.

Question 3Assessment and Monitoring

By what age does an infant typically double birth weight?

  1. 5 months Correct answer.
  2. 12 months
  3. 9 months
  4. 2 months

Explanation

Birth weight usually doubles by about 5 months of age and triples by about 12 months. These milestones are used to monitor adequacy of growth and feeding.

Question 4Assessment and Monitoring

At what age does a social smile typically first appear?

  1. 6 weeks to 2 months Correct answer.
  2. 6 months
  3. 4 months
  4. At birth

Explanation

A responsive social smile usually emerges between 6 weeks and 2 months of age. Its absence by about 2 to 3 months is a developmental red flag that warrants further evaluation.

Question 5Assessment and Monitoring

Which measurement best reflects brain growth during the first 2 years of life?

  1. Mid-arm circumference
  2. Crown-heel length
  3. Head circumference Correct answer.
  4. Chest circumference

Explanation

Head circumference is plotted serially to track brain and skull growth in infants and toddlers. Crossing percentile lines or disproportionate growth can signal hydrocephalus, microcephaly, or nutritional problems.

Question 6Assessment and Monitoring

When selecting a blood pressure cuff for a child, the bladder width should cover approximately what percentage of the upper arm?

  1. 60%
  2. 80%
  3. 20%
  4. 40% Correct answer.

Explanation

The cuff bladder should cover about 40% of the upper arm circumference and roughly two-thirds of its length. A cuff that is too small falsely elevates the reading, while one that is too large falsely lowers it.

Question 7Assessment and Monitoring

Which newborn screening test is used to detect critical congenital heart disease before discharge?

  1. Serum bilirubin
  2. Pulse oximetry screening Correct answer.
  3. Metabolic heel stick
  4. Newborn hearing screen

Explanation

Pre- and postductal pulse oximetry screening identifies newborns with low oxygen saturations that may indicate a critical congenital heart defect. Abnormal results require prompt echocardiography and cardiology evaluation.

Question 8Assessment and Monitoring

Which test is commonly used to screen hearing in newborns and does not require active participation?

  1. Tympanometry
  2. Automated auditory brainstem response Correct answer.
  3. Pure-tone audiometry
  4. Visual reinforcement audiometry

Explanation

Automated auditory brainstem response measures the neural response to sound and can be done while the infant sleeps. It is a standard newborn hearing screen because it requires no behavioral response.

Question 9Assessment and Monitoring

The red reflex is assessed primarily to detect which condition?

  1. Retinoblastoma or cataract Correct answer.
  2. Strabismus only
  3. Color blindness
  4. Refractive error

Explanation

An absent, white, or asymmetric red reflex can indicate a cataract, retinoblastoma, or other opacity of the visual axis. Any abnormality requires urgent ophthalmologic referral.

Question 10Assessment and Monitoring

Which of the following is one of the five components of the Apgar score?

  1. Reflex irritability Correct answer.
  2. Blood pressure
  3. Oxygen saturation
  4. Temperature

Explanation

The Apgar score evaluates heart rate, respiratory effort, muscle tone, reflex irritability, and color. Each component is scored 0 to 2 at 1 and 5 minutes after birth.

Question 11Assessment and Monitoring

The Wong-Baker FACES scale is designed for use in which age group?

  1. Toddlers under 2 years
  2. Adults only
  3. Neonates
  4. Children aged 3 years and older Correct answer.

Explanation

The Wong-Baker FACES scale uses drawings of faces and is validated for children from about 3 years of age who can match a face to their pain. It is not appropriate for preverbal infants.

Question 12Assessment and Monitoring

A numeric rating scale from 0 to 10 is generally most reliable in children of what minimum age?

  1. 8 years Correct answer.
  2. 2 years
  3. 3 years
  4. 5 years

Explanation

Children around 8 years and older can usually understand and use a 0-to-10 numeric scale accurately. Younger children do better with faces scales or observational tools.

Question 13Assessment and Monitoring

What is the approximate normal hemoglobin range for a healthy 1-year-old child?

  1. 6 to 9 g/dL
  2. 11 to 14 g/dL Correct answer.
  3. 15 to 18 g/dL
  4. 9 to 10 g/dL

Explanation

A hemoglobin of roughly 11 to 14 g/dL is typical for a healthy 1-year-old. Values below this range suggest anemia, often from iron deficiency at this age.

Question 14Assessment and Monitoring

Universal blood lead screening is recommended at which ages for most children?

  1. 6 and 12 months
  2. 3 and 5 years
  3. 12 and 24 months Correct answer.
  4. 7 and 9 years

Explanation

Most children should be screened for lead exposure at 12 and 24 months, with additional screening based on risk factors. Early detection allows intervention to prevent neurodevelopmental harm.

Question 15Assessment and Monitoring

The Denver Developmental Screening Test II assesses development in which domains?

  1. Social-emotional, behavioral, and attachment patterns
  2. Personal-social, fine motor, language, and gross motor Correct answer.
  3. Cognitive, academic, and problem-solving skills in older children
  4. Vision, hearing, and speech articulation screening

Explanation

The Denver II screens four developmental areas: personal-social, fine motor-adaptive, language, and gross motor. It identifies children who need more detailed developmental evaluation.

Question 16Assessment and Monitoring

The M-CHAT autism screening tool is typically administered at which age?

  1. 9 months
  2. 6 months
  3. 18 to 24 months Correct answer.
  4. 12 months

Explanation

The M-CHAT is validated for toddlers around 18 to 24 months of age, when early signs of autism may become apparent. Early identification supports timely referral for intervention.

Question 17Assessment and Monitoring

A 10-year-old with a BMI at the 96th percentile for age and sex is classified as:

  1. Underweight
  2. Overweight
  3. Normal weight
  4. Obese Correct answer.

Explanation

A BMI at or above the 95th percentile for age and sex is classified as obesity. The 85th to 94th percentile is overweight, and below the 5th percentile is underweight.

Question 18Assessment and Monitoring

The anterior fontanel normally closes by what age?

  1. 4 months
  2. 2 months
  3. 18 months Correct answer.
  4. 36 months

Explanation

The anterior fontanel typically closes between 9 and 18 months of age. Delayed closure may prompt evaluation for conditions such as hypothyroidism or increased intracranial pressure.

Question 19Assessment and Monitoring

The Moro reflex typically disappears by what age?

  1. 4 to 6 months Correct answer.
  2. 12 months
  3. 8 months
  4. 1 month

Explanation

The Moro reflex is present at birth and usually resolves by 4 to 6 months of age. Persistence beyond this period can indicate a neurologic abnormality.

Question 20Assessment and Monitoring

Which route of temperature measurement is generally considered most accurate in a 6-month-old infant in the clinic?

  1. Rectal Correct answer.
  2. Axillary
  3. Temporal artery
  4. Oral

Explanation

Rectal temperature is considered the most accurate reflection of core temperature in infants when performed correctly. It is used when precise measurement is needed, though less invasive routes are often preferred for comfort.

Question 21Assessment and Monitoring

A normal oxygen saturation reading on pulse oximetry at sea level is approximately:

  1. 90% to 94%
  2. 95% to 100% Correct answer.
  3. 80% to 85%
  4. 85% to 90%

Explanation

Normal arterial oxygen saturation at sea level is about 95% to 100%. Values persistently below 90% indicate hypoxemia and require prompt evaluation.

Question 22Assessment and Monitoring

A prolonged capillary refill time in a child is best defined as greater than:

  1. 3 seconds Correct answer.
  2. 7 seconds
  3. 5 seconds
  4. 1 second

Explanation

Capillary refill normally occurs within 2 seconds; a time greater than 3 seconds suggests poor peripheral perfusion. It is one component of the pediatric assessment of circulation.

Question 23Assessment and Monitoring

What is the minimum normal urine output for a child weighing 20 kg?

  1. 5 mL/kg/hr
  2. 0.1 mL/kg/hr
  3. 10 mL/kg/hr
  4. 1 mL/kg/hr Correct answer.

Explanation

A minimum urine output of about 1 mL/kg/hr indicates adequate renal perfusion in children. For a 20-kg child, this corresponds to roughly 20 mL/hr.

Question 24Assessment and Monitoring

In the pediatric Glasgow Coma Scale, which finding corresponds to a motor score of 5?

  1. Obeys commands
  2. Withdraws from pain
  3. Localizes pain Correct answer.
  4. Abnormal flexion

Explanation

The pediatric motor score assigns 5 points for localizing pain, 6 for spontaneous or command-following movement, and lower scores for withdrawal, flexion, extension, or no response. Serial scores are more useful than a single value.

Question 25Assessment and Monitoring

The Neonatal Infant Pain Scale (NIPS) includes which set of indicators?

  1. Verbal report, facial expression, and body movement
  2. Heart rate, blood pressure, and oxygen saturation changes
  3. Reflex irritability, muscle tone, respiratory effort, and color
  4. Facial expression, cry, breathing, arms, legs, arousal Correct answer.

Explanation

NIPS scores six behavioral indicators: facial expression, cry, breathing pattern, arms, legs, and state of arousal. Each indicator is scored to produce a total that guides pain management in neonates.

Question 26Assessment and Monitoring

When measuring the recumbent length of a 6-month-old infant, the nurse should:

  1. Place the infant supine with the head against a fixed board and extend the legs Correct answer.
  2. Have the infant stand against a wall-mounted stadiometer
  3. Measure from the crown of the head to the buttocks with the infant seated
  4. Use a tape measure from the heel to the top of the head while the infant is held upright

Explanation

Children younger than 2 years, or those who cannot stand, are measured supine on a length board with the head against a fixed headboard and the legs gently extended. Standing height is used for older children who can stand independently.

Question 27Assessment and Monitoring

To obtain an accurate head circumference in an infant, the tape measure should be placed:

  1. Around the forehead just above the eyebrows and the base of the skull
  2. Around the widest part of the occiput and the chin
  3. Around the widest part, above the eyebrows and over the occiput Correct answer.
  4. From the glabella to the inion in a straight line

Explanation

Head circumference is measured at the widest circumference of the head, passing above the eyebrows and around the occipital prominence. The tape should be snug and level to avoid measurement error.

Question 28Assessment and Monitoring

A term newborn weighed 3.4 kg at birth and weighs 3.1 kg at 4 days of age. The nurse should:

  1. Obtain a serum electrolyte panel immediately
  2. Begin supplementation with formula to restore weight
  3. Notify the provider because this weight loss is excessive
  4. Document as expected and continue feeding support Correct answer.

Explanation

Term newborns commonly lose up to about 7% to 10% of birth weight during the first week and regain it by about 2 weeks. A loss of 0.3 kg from 3.4 kg is approximately 8.8%, which is within the expected range.

Question 29Assessment and Monitoring

A blood pressure cuff that is too small for a child's upper arm is most likely to produce which measurement error?

  1. No effect if the cuff is placed over clothing
  2. A falsely low blood pressure reading
  3. An accurate reading only if the child is seated
  4. A falsely elevated blood pressure reading Correct answer.

Explanation

An undersized cuff requires excessive pressure to occlude the artery, which falsely elevates the measured blood pressure. Cuff bladder length and width must be matched to the child's arm circumference.

Question 30Assessment and Monitoring

According to Pediatric Advanced Life Support (PALS) criteria, hypotension in a 5-year-old child is defined as a systolic blood pressure below:

  1. 90 mm Hg
  2. 70 mm Hg
  3. 100 mm Hg
  4. 80 mm Hg Correct answer.

Explanation

For children 1 to 10 years old, PALS defines hypotension as a systolic blood pressure below 70 + (2 × age in years) mm Hg. For a 5-year-old, this equals 70 + 10, or 80 mm Hg.

Question 31Assessment and Monitoring

Which screening test is used to detect adolescent idiopathic scoliosis during a physical examination?

  1. Gower sign for proximal muscle weakness
  2. Adams forward bend test Correct answer.
  3. Trendelenburg test for hip abductor strength
  4. Ortolani maneuver for hip dysplasia

Explanation

The Adams forward bend test assesses for thoracic or lumbar asymmetry and rib hump, which suggest scoliosis. It is a standard screening maneuver during adolescent physical examinations.

Question 32Assessment and Monitoring

A 4-year-old cannot yet identify letters. Which method is most appropriate for screening visual acuity?

  1. Snellen letter chart
  2. Lea symbols chart Correct answer.
  3. Cover-uncover test
  4. Confrontation visual field testing

Explanation

The Lea symbols chart uses simple shapes and is designed for young children who cannot yet name letters. Snellen letters require letter knowledge, while the other tests assess different visual functions.

Question 33Assessment and Monitoring

The cover-uncover test is used to evaluate which of the following?

  1. Color vision
  2. Visual acuity
  3. Peripheral visual fields
  4. Strabismus Correct answer.

Explanation

The cover-uncover test detects misalignment of the eyes by observing movement when one eye is covered and then uncovered. It is a standard screening test for strabismus.

Question 34Assessment and Monitoring

Which fine motor milestone is expected in a typically developing 10-month-old?

  1. Scribbling spontaneously with a crayon on paper
  2. Copying a circle with a crayon after demonstration
  3. Building a tower of six or more cubes
  4. Using a pincer grasp to pick up a small object Correct answer.

Explanation

A neat pincer grasp, using the thumb and index finger to pick up a small object, typically develops between about 9 and 12 months. Building towers, copying shapes, and spontaneous scribbling are later fine motor skills.

Question 35Assessment and Monitoring

By what age should a typically developing child be combining two words into short phrases?

  1. 36 months
  2. 18 months
  3. 12 months
  4. 24 months Correct answer.

Explanation

Two-word combinations typically emerge between 18 and 24 months and should be present by about 24 months. A 36-month-old is expected to use short sentences of three or more words.

Question 36Assessment and Monitoring

A 9-month-old's weight has dropped from the 50th percentile to below the 5th percentile over 3 months. This finding is most consistent with:

  1. Familial short stature
  2. Constitutional growth delay
  3. Normal weight fluctuation
  4. Failure to thrive Correct answer.

Explanation

Failure to thrive is suggested by weight below the 5th percentile or by crossing two or more major percentile lines downward over time. This pattern reflects inadequate growth and warrants further evaluation.

Question 37Assessment and Monitoring

When reading a tuberculin skin test (Mantoux) in a child, the nurse should:

  1. Measure induration in millimeters at 48 to 72 hours Correct answer.
  2. Read the test immediately after injection
  3. Measure the area of erythema in millimeters after 24 hours
  4. Record only whether the site is red or not

Explanation

A tuberculin skin test is read 48 to 72 hours after placement by measuring the diameter of induration, not erythema. The result is recorded in millimeters.

Question 38Assessment and Monitoring

The CRIES pain scale was developed for use in which patient population?

  1. Preterm and term neonates Correct answer.
  2. School-age children after surgery
  3. Children with cognitive impairment
  4. Adolescents with chronic pain

Explanation

The CRIES scale assesses crying, requires oxygen, increased vital signs, expression, and sleeplessness in neonates. It is designed for preterm and term infants who cannot self-report pain.

Question 39Assessment and Monitoring

A 2-year-old's head circumference has increased from the 50th percentile to the 95th percentile over 6 months. Which condition should the nurse suspect?

  1. Failure to thrive
  2. Normal familial macrocephaly
  3. Hydrocephalus Correct answer.
  4. Dehydration

Explanation

A rapid upward crossing of head circumference percentiles suggests abnormal head growth, such as hydrocephalus and increased intracranial pressure. Familial macrocephaly usually follows a consistent percentile over time.

Question 40Assessment and Monitoring

A 15-month-old comes for a well-child visit, and the parent reports no developmental concerns. According to AAP Bright Futures recommendations, at which age should the next autism-specific screening be performed?

  1. 36 months
  2. 30 months
  3. 18 months Correct answer.
  4. 12 months

Explanation

AAP Bright Futures recommends universal autism-specific screening (for example, with the M-CHAT-R/F) at both the 18-month and 24-month visits, layered on top of developmental surveillance performed at every well-child visit. Because this child is already 15 months old, the next scheduled autism-specific screen is at 18 months. A 15-month visit involves surveillance and general developmental screening, not the autism-specific tool.

Question 41Growth and Development

At what age do most healthy term infants sit steadily without support?

  1. 6 to 8 months Correct answer.
  2. 2 to 3 months
  3. 14 to 16 months
  4. 11 to 12 months

Explanation

Independent sitting requires adequate head and trunk control and is typically achieved between 6 and 8 months. Sitting with support and brief propping usually appears around 4 to 5 months, and unsupported sitting is a reliable 6- to 8-month milestone.

Question 42Growth and Development

At what age does a typically developing infant first demonstrate a neat pincer grasp using the thumb and index finger?

  1. 6 to 7 months
  2. 9 to 12 months Correct answer.
  3. 3 to 4 months
  4. 18 to 20 months

Explanation

A neat pincer grasp emerges between 9 and 12 months as fine motor coordination matures. Before this, infants use a raking or whole-hand palmar grasp to bring objects to the palm.

Question 43Growth and Development

A healthy term newborn weighs 3.2 kg. Which weight would be expected at 12 months of age?

  1. 8.0 kg
  2. 4.8 kg
  3. 6.4 kg
  4. 9.6 kg Correct answer.

Explanation

Term infants typically triple their birth weight by 12 months, so 3.2 kg becomes approximately 9.6 kg. Birth weight is doubled by about 4 to 5 months and tripled by 1 year.

Question 44Growth and Development

The Moro reflex of a healthy term infant normally disappears by which age?

  1. 12 months
  2. 8 to 9 months
  3. 6 to 7 months
  4. 3 to 4 months Correct answer.

Explanation

The Moro reflex is present at birth and normally resolves by about 3 to 4 months as cortical control matures. Persistence beyond this period suggests a central nervous system abnormality.

Question 45Growth and Development

The anterior fontanelle of a healthy infant normally closes between which ages?

  1. 2 to 4 months
  2. 24 to 36 months
  3. 5 to 8 months
  4. 9 to 18 months Correct answer.

Explanation

The anterior fontanelle is usually soft and flat in infancy and closes between about 9 and 18 months of age. Delayed closure beyond 2 years raises concern for hypothyroidism, rickets, skeletal dysplasia, or raised intracranial pressure.

Question 46Growth and Development

The first primary tooth in a healthy infant typically erupts at approximately which age?

  1. By 10 months
  2. By 2 months
  3. By 6 months Correct answer.
  4. By 18 months

Explanation

The mandibular central incisors are usually the first teeth and erupt around 6 months, with a normal range of roughly 4 to 10 months. Eruption follows a fairly predictable sequence thereafter.

Question 47Growth and Development

A boy born at 28 weeks' gestation is now 10 months old chronologically, and his mother worries he is not yet pulling to stand. How should his development be interpreted?

  1. Compare his milestones with those of a 10-month-old term infant without adjustment
  2. Add 12 weeks to his chronological age when evaluating milestones
  3. Delay all developmental assessment until he reaches 24 months of age
  4. Correct his age by subtracting the weeks of prematurity Correct answer.

Explanation

Corrected age is calculated by subtracting the number of weeks born early from the chronological age, and this correction is applied until about 24 months. A 28-week infant born 12 weeks early has a corrected age of roughly 7 months, at which pulling to stand is not yet expected.

Question 48Growth and Development

A social, responsive smile first appears in most term infants at which age?

  1. Birth to 1 week
  2. 6 to 8 weeks Correct answer.
  3. 4 to 5 months
  4. 8 to 9 months

Explanation

A true social smile that the infant gives in response to a face or voice typically appears at 6 to 8 weeks. Smiles seen in the first days of life are reflexive and sleep-related rather than social.

Question 49Growth and Development

A 6-year-old boy is evaluated for short stature. His father is 170 cm tall and his mother is 158 cm tall. What is his midparental (target) height?

  1. 164 cm
  2. 170.5 cm Correct answer.
  3. 157 cm
  4. 177 cm

Explanation

For boys, midparental height equals (father's height + mother's height + 13 cm) divided by 2, giving (170 + 158 + 13)/2 = 170.5 cm. The target range is this value plus or minus about 8.5 cm.

Question 50Growth and Development

A 9-year-old boy is at the 3rd percentile for height and has grown 5.5 cm in the past year. His bone age is 7 years. What is the most likely explanation?

  1. Familial short stature
  2. Primary hypothyroidism
  3. Constitutional delay Correct answer.
  4. Growth hormone deficiency

Explanation

Constitutional delay produces short stature in childhood with a normal growth velocity and a bone age delayed by roughly 2 years, with eventual normal adult height. Familial short stature instead shows a bone age concordant with chronological age.