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Health Promotion and Maintenance

NCLEX Growth and Development Practice Questions

Quick answer

Growth and development questions on the NCLEX-RN belong to Health Promotion and Maintenance and ask you to match an age to a milestone, a play style, an Erikson task or a Piaget stage, then pick the nursing action that fits. Expect two to four items per exam, often hidden inside a pediatric or older adult scenario rather than labeled as a development question.

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Most students memorize the milestone chart the night before and still miss these. The reason is that the exam rarely asks "when does a baby sit?" It gives you a 9 month old who cannot sit without support and asks what the nurse should do, or it describes a 4 year old who thinks the IV is punishment for being bad and asks which response is best. You need the ages, but you also need to know what a child at that age fears, how that child plays, and what counts as a delay worth referring. The trap that catches people most often is reading a finding as abnormal when it is simply normal for the age, or the opposite, shrugging off a real red flag like no words at 18 months because "every child is different." Learn the hard cutoffs for referral and treat them like lab values.

Practice questions

1

The nurse is reviewing milestones with the parent of an 8 month old. Which statement by the parent shows an understanding of what is expected at this age?

  1. A"She only just started holding her head steady, which is right on time."
  2. B"She can sit on her own for a few minutes and rakes toys toward her with her whole hand."
  3. C"She should be able to pick up a cereal piece between her thumb and finger."
  4. D"She should be saying two or three real words besides mama."
Show answer

Answer: B

Sitting without support around 7 to 8 months and a raking grasp are both on target. The neat pincer grasp (thumb and index finger) usually arrives around 9 to 10 months, and the first real words show up around 12 months.

Why the others are wrong

Option A is wrong because steady head control is a 4 month skill, so reaching it only now at 8 months is a delay, not on time. Option C describes the pincer grasp, which is a little early at 8 months and is not something the nurse would present as expected. Option D describes 12 months and beyond, so a parent saying it at 8 months has the timeline wrong.

2

A 2 year old is admitted to the pediatric unit for dehydration. The child's parent says, "He plays next to the other kids in the playroom but never actually plays with them. Is something wrong?" Which response by the nurse is best?

  1. A"That is called parallel play and it is exactly what we expect at his age."
  2. B"Toddlers should be sharing toys by now, so I will ask the child life specialist to work with him."
  3. C"He is probably just shy because he is in the hospital."
  4. D"Most 2 year olds prefer to play alone, so playing near other children is a little ahead of schedule."
Show answer

Answer: A

Toddlers play alongside other children without interacting, each absorbed in their own activity. This is parallel play and it is the normal pattern from roughly 1 to 3 years. Naming it and reassuring the parent is the right teaching.

Why the others are wrong

Option B treats a normal stage as a problem and sharing is not expected at 2. Option C guesses at a cause instead of answering with the developmental fact. Option D confuses solitary play, which is the infant pattern, with the toddler pattern, and calls normal behavior advanced.

3

A 4 year old who is scheduled for a tonsillectomy tells the nurse, "I have to get my throat cut because I was bad and yelled at my sister." Which response by the nurse is most appropriate?

  1. A"Surgery is not a punishment. Let's play with this doll and I will show you exactly what the doctors will fix in your throat."
  2. B"You will be asleep the whole time and you will not feel anything, so there is nothing to worry about."
  3. C"Your parents can explain why you need the surgery when they come back."
  4. D"Yelling at your sister is not a nice thing to do, but that is not why you are here."
Show answer

Answer: A

Preschoolers use magical thinking and often believe illness or procedures are punishment for something they did. They also fear body harm and mutilation. The nurse corrects the misunderstanding in simple words and uses a doll or medical play so the child can see what will happen and that the body will stay whole.

Why the others are wrong

Option B skips the child's real worry and the phrase "asleep" can frighten a preschooler who connects sleep with the family pet that "went to sleep." Option C hands off a question the nurse should answer now. Option D repeats the idea that the child did something wrong and reinforces the guilt.

4

The nurse is choosing an activity for a 4 year old who is on bed rest in a private room. Which activity is the most developmentally appropriate?

  1. AA 500 piece jigsaw puzzle
  2. BA mobile hung above the bed
  3. CCrayons, paper and a set of puppets
  4. DA handheld video game with a competitive leaderboard
Show answer

Answer: C

Preschoolers are in Erikson's initiative stage and learn through imaginative, creative play. Drawing and puppet play let the child act out feelings about the hospital, which is a form of therapeutic play, and both fit bed rest.

Why the others are wrong

Option A is far beyond a preschooler's fine motor and attention span. Option B is an infant stimulation toy. Option D suits a school-age child who enjoys rules and competition, and it does nothing for a preschooler's need to express fear through pretend play.

5

A 9 year old with a new diagnosis of type 1 diabetes becomes tearful and says, "I will never be able to do this right. All the other kids can go to camp and I can't." According to Erikson, which nursing action best supports this child's developmental stage?

  1. AHave the parent perform all insulin injections until the child is a teenager
  2. BTeach the child to check a fingerstick glucose and praise each step done correctly
  3. CExplain that many children with diabetes feel sad and the feeling will pass
  4. DLimit talk about diabetes so the child does not feel different from peers
Show answer

Answer: B

School-age children are in industry versus inferiority. They need to master tasks and feel competent, and praise for real accomplishment builds industry. Letting the child own a piece of the care, step by step, is the most direct way to counter the "I can't do anything right" belief.

Why the others are wrong

Option A takes away the chance to master a skill and feeds inferiority. Option C labels the feeling but offers nothing to work with, and a 9 year old thinks concretely and needs something to do. Option D is avoidance, and this child would still feel different, just without the skills to manage it.

6

The nurse is giving discharge instructions to an 8 year old and the parent about a new inhaler. Based on Piaget's stage for this age, which teaching approach is most effective?

  1. ADescribe how bronchodilators relax smooth muscle in the airways
  2. BAsk the child to imagine how the lungs might feel if the medicine were never taken
  3. CLet the child handle the inhaler and spacer and demonstrate each step in order
  4. DGive the parent the instructions and let the parent teach the child at home
Show answer

Answer: C

An 8 year old is in Piaget's concrete operational stage. Children at this stage learn best with hands-on, step-by-step instruction tied to real objects they can see and touch. A return demonstration with the actual device matches how they think.

Why the others are wrong

Option A uses abstract physiology the child cannot picture. Option B asks for hypothetical reasoning, which belongs to formal operations in adolescence. Option D cuts the child out of teaching that the child is fully capable of learning, and it misses the chance to check the technique.

7

A 16 year old is seen alone in the clinic for a sports physical. During the visit the teen says, "I need to ask you something but you cannot tell my mom." Which response by the nurse is best?

  1. A"I cannot keep secrets from your parents while you are under 18."
  2. B"What you tell me stays private unless you are in danger of being hurt or hurting someone else. What is on your mind?"
  3. C"Let's bring your mom in so we can talk about it together."
  4. D"I will have to check with the provider before I can promise anything."
Show answer

Answer: B

Adolescents are working on identity and are highly sensitive to peer judgment and loss of privacy. Confidential care, with the limits stated honestly up front (risk of harm to self or others, abuse), is the standard for teens and is what keeps them talking about risky behavior, sexual health and mood.

Why the others are wrong

Option A is not accurate, since minors have confidentiality rights for many types of care in most states, and it shuts the conversation down. Option C overrides the teen's request before even hearing the concern. Option D stalls and signals that the nurse cannot be trusted with the information.

8

An 82 year old client in a long-term care facility spends much of the day talking with the nurse about growing up on a farm, raising children and losing a spouse. The client says, "I had a good life. I did the best I could with what I had." Which interpretation by the nurse is accurate?

  1. AThe client is showing early signs of dementia and should be screened
  2. BThe client is in despair and needs a referral for depression
  3. CThe client is achieving ego integrity and the nurse should encourage the reminiscing
  4. DThe client is avoiding the present and should be redirected to current activities
Show answer

Answer: C

Erikson's final stage is integrity versus despair. Looking back over life with acceptance and a sense that it had meaning is integrity, and life review is the normal and healthy work of this stage. The nurse supports it by listening and asking about the stories.

Why the others are wrong

Option A confuses purposeful reminiscing with memory loss, and nothing in the stem suggests confusion. Option B is the opposite of what is described, since despair sounds like regret, bitterness and fear of death. Option D treats a healthy developmental task as a problem to fix.

9

The nurse is assessing an 18 month old at a well visit. The parent reports the child is not yet walking alone and does not say any words, though the child babbles and points at things. Which action should the nurse take?

  1. AReassure the parent that boys often talk and walk later than girls
  2. BSuggest the parent spend more time reading to the child and recheck at the 2 year visit
  3. CRefer the child for a developmental and hearing evaluation
  4. DDocument the findings as a normal variation
Show answer

Answer: C

By 18 months a child should walk alone and should say at least a few single words. Missing either of these is a hard referral cutoff, and when both are missing, the nurse should not wait. A hearing test is part of any speech delay workup. Early intervention works best when it starts early.

Why the others are wrong

Option A is a myth used to excuse a real delay. Option B delays the referral by six months, which is lost time for intervention. Option D calls two missed milestones a variation, and it is the mistake the question is written to catch.

10

The nurse is performing an admission assessment on a 78 year old client. Which finding should the nurse report to the provider rather than attribute to normal aging?

  1. AThe client needs more light to read the admission paperwork
  2. BThe client has trouble hearing high-pitched sounds and asks the nurse to speak lower
  3. CThe client does not know the month or year and cannot name the hospital
  4. DThe client's skin on the back of the hand is thin and tents slightly when pinched
Show answer

Answer: C

Disorientation to time and place is never a normal part of aging. New confusion in an older adult often signals delirium from infection, medication, dehydration or hypoxia, and it needs a workup now. Loss of memory for recent events, confusion and personality change are findings to report, not findings to expect.

Why the others are wrong

Options A, B and D are expected age changes: the lens stiffens and the pupil shrinks so more light is needed (presbyopia), high-frequency hearing loss (presbycusis) comes first, and thinner skin with less elastin tents more easily even when the client is well hydrated. The nurse notes them and adapts care but does not report them as abnormal.

Quick tips

  • Memorize the referral cutoffs as hard numbers: no head control by 4 months, not sitting alone by 9 months, no pincer grasp by 12 months, not walking alone by 18 months, no words by 18 months, no two-word phrases by 24 months. When a stem hits one of these, the answer involves referral, not reassurance.
  • Match the play to the age: solitary (infant), parallel (toddler), associative and imaginative (preschool), cooperative with rules (school age), peer group activities (adolescent). The toy question is really a play-style question.
  • For hospitalized children, the main fear tells you the age: separation from the parent (toddler), body harm and punishment (preschool), loss of control and competence (school age), loss of privacy and separation from peers (adolescent). Pick the intervention that targets that fear.
  • Erikson and Piaget are usually tested through the nurse's action, not the name of the stage. Ask yourself what this age needs to accomplish and choose the option that lets the client do it.
  • In older adult questions, slow changes in vision, hearing, skin and reaction time are normal. Confusion, incontinence, falls and depression are not, and the exam wants you to report them.

Related topics

FAQ

How many growth and development questions are on the NCLEX?

Health Promotion and Maintenance is 6 to 12 percent of the exam, and growth and development is one slice of that. Most candidates see two to four items that directly test milestones, stages or age-appropriate care, plus several more where knowing the age changes the right answer.

Do I really need to memorize every month on the milestone chart?

No. Learn the anchor ages (2, 4, 6, 9, 12, 18 and 24 months) and the referral cutoffs. The NCLEX does not ask for the exact week a skill appears. It asks whether a described child is on track and what the nurse should do if not.

What is the difference between Erikson and Piaget on the NCLEX?

Erikson covers psychosocial tasks across the whole lifespan (trust, autonomy, initiative, industry, identity, intimacy, generativity, integrity). Piaget covers how children think (sensorimotor, preoperational, concrete operational, formal operational) and stops at adolescence. Questions about fears, independence and self-esteem are Erikson. Questions about how to explain or teach something are Piaget.

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