NLE Paediatric Nursing Reviewer 2026

Answer: C. 12 months (1 year)

Step 1 – Recall the weight milestones: Birth weight DOUBLES by ~4–6 months, TRIPLES by 12 months (1 year), and QUADRUPLES by ~24 months (2 years). Step 2 – The question asks specifically about tripling, which corresponds to 12 months. Step 3 – Why the other options are wrong: 4–6 months is when weight doubles, not triples. Nine months is between doubling and tripling. Twenty-four months is when birth weight quadruples. Step 4 – Clinical relevance: Using these benchmarks during well-baby visits (e.g., Operation Timbang in the RHU) helps the nurse assess nutritional adequacy and detect malnutrition early.

Answer: B. Document it as a normal finding

Step 1 – Recall the closure timetable: The posterior fontanelle closes by ~2 months; the anterior fontanelle (diamond-shaped) closes between 12–18 months. Step 2 – At 14 months, the anterior fontanelle is still within the normal range for closure; an open, flat fontanelle is therefore a normal finding. Step 3 – Why the distractors are wrong: Hydrocephalus or increased ICP would present with a BULGING fontanelle, not a flat one. A CT scan is not indicated without other neurologic signs. Telling the mother it should have closed at 6 months is incorrect — that is the timeline for the posterior fontanelle, not the anterior. Step 4 – Nursing implication: Always assess fontanelle tension, not just whether it is open — bulging suggests ↑ICP; sunken suggests dehydration.

Answer: B. Autonomy vs Shame and Doubt

Step 1 – Recall Erikson's age-to-stage mapping: Infant (0–1 yr) = Trust vs Mistrust; Toddler (1–3 yr) = Autonomy vs Shame & Doubt; Preschool (3–6 yr) = Initiative vs Guilt; School-age (6–12 yr) = Industry vs Inferiority; Adolescent (12–18 yr) = Identity vs Role Confusion. Step 2 – The toddler's core task is developing autonomy — asserting independence through saying 'No!', temper tantrums, and toilet training. Step 3 – Why the other options are wrong: Trust vs Mistrust is for infants. Initiative vs Guilt is the preschool stage. Industry vs Inferiority is the school-age stage. Step 4 – Nursing implication: Offer toddlers simple choices (e.g., 'Do you want water or juice?') to support autonomy while maintaining necessary limits.

Answer: C. 8–9 months

Step 1 – Object permanence develops at approximately 8–9 months within Piaget's Sensorimotor stage (birth–2 years). Step 2 – Before this milestone, an infant acts as if an object that is hidden simply ceases to exist ('out of sight, out of mind'). Step 3 – Clinical significance: Object permanence is the developmental basis of separation anxiety (the infant now understands that the caregiver still exists even when absent, and therefore protests when separated) and the game of peek-a-boo. Step 4 – Why other options are wrong: At 2–3 months, the infant is still in the early sensorimotor phase with reflexive behavior. At 5–6 months, object permanence is not yet fully developed. At 12–15 months, the concept is already well established.

Answer: B. Normal; the Babinski reflex is expected until about 1–2 years

Step 1 – The described response (great toe dorsiflexion, other toes fanning) is the positive Babinski sign. Step 2 – In infants, an upgoing Babinski (positive sign) is NORMAL because the corticospinal tracts are not yet fully myelinated. It is expected to remain present until approximately 1–2 years of age. Step 3 – After 2 years, a positive Babinski is ABNORMAL and suggests upper motor neuron (corticospinal tract) damage — this distinction is frequently tested on the NLE. Step 4 – Why other options are wrong: Referring immediately is inappropriate since this is a normal finding in a 5-month-old. It does not disappear by 3 months — that timeline applies to the Moro, rooting, and palmar grasp reflexes. Calling it abnormal at 5 months is incorrect.

Answer: B. Parallel play

Step 1 – Identify the key behavior: the children are playing alongside each other, using similar toys, but not interacting or playing together. Step 2 – This is the definition of parallel play, which is characteristic of toddlers (1–3 years). Step 3 – Why the other options are wrong: Solitary play (infant) involves playing completely alone without awareness of others. Associative play (preschool) involves playing with others, sharing materials and talking, but without organized goals. Cooperative play (school-age) is organized, rule-based, and involves assigned roles and team goals. Step 4 – Memory tip: Think of 'parallel lines' — they go in the same direction but never meet, just like toddlers in parallel play.

Answer: B. Place the infant in a supine (back) position to sleep

Step 1 – The 'Back to Sleep' (now 'Safe to Sleep') campaign is the single most important SIDS-prevention measure. Supine (back) sleeping is recommended for all infants until 1 year of age. Step 2 – Why prone sleeping is dangerous: A face-down position increases the risk of rebreathing exhaled CO₂ and airway obstruction, both associated with SIDS. Step 3 – Why side-lying is not recommended: It is unstable and the infant can roll to prone. Step 4 – Why soft pillows are dangerous: Soft bedding increases suffocation risk. The sleep environment should be firm and flat with no loose items. Step 5 – Philippine context: The DOH and WHO reinforce this guidance through Garantisadong Pambata child health packages and well-baby counseling at the RHU.

Answer: B. 12 months

Step 1 – Recall the gross motor milestones for the first year: stands alone and may take first steps at ~12 months; walks alone well at ~15 months; runs stiffly at ~18 months. Step 2 – Twelve months (1 year) is the benchmark age for independent standing and first steps. Step 3 – Why other options are wrong: At 9 months, the infant can pull to stand and cruise along furniture but not walk independently. At 18 months, the child is running. At 24 months, the child walks up and down stairs and runs well. Step 4 – NLE tip: Know the progression: pulls to stand (10 mo) → walks 12 mo → walks well 15 mo → runs 18 mo. Step 5 – If a child is NOT walking by 15–18 months, further developmental assessment is warranted.

Answer: C. At 6 months, while continuing breastfeeding

Step 1 – The DOH and WHO recommend exclusive breastfeeding for the first 6 months — no water, no juice, no other food. Step 2 – Complementary feeding (solids) is introduced at exactly 6 months while breastfeeding continues up to 2 years and beyond. Step 3 – Why other options are wrong: Introducing solids at 3 or 4 months is too early; the infant's gut is not mature enough and it disrupts exclusive breastfeeding. At 9 months, the window for optimal complementary feeding introduction has already passed. Step 4 – First complementary food: Start with iron-fortified cereal or pureed vegetables/fruits; introduce one new food every 3–5–7 days to detect allergies. Step 5 – Philippine context: This policy is reinforced through the Garantisadong Pambata program and well-baby clinic visits at RHUs.

Answer: C. Phallic (Oedipal) stage

Step 1 – Identify the age: the child is 4 years old, which corresponds to the preschool period (3–6 years). Step 2 – Recall Freud's stage for preschoolers: the Phallic stage (also called the Oedipal stage for boys, Electra for girls), characterized by awareness of genitalia and the Oedipus/Electra complex — attachment to the opposite-sex parent and rivalry with the same-sex parent. Step 3 – Why other options are wrong: The Oral stage is for infants (0–1 yr) and involves feeding/sucking. The Anal stage is for toddlers (1–3 yr) and focuses on bowel control. The Latency stage is for school-age children (6–12 yr) and is characterized by the repression of sexual urges and focus on peer relationships. Step 4 – NLE tip: Phallic = Preschool; Latency = School-age (6–12 yr).

Answer: D. Throat and mouth

Step 1 – Recall the principle: In paediatric assessment, proceed from least distressing to most distressing to prevent crying, which distorts auscultation findings. Step 2 – Identify the least distressing steps: Auscultation of the heart, lungs, and abdomen should be done early while the child is calm. Step 3 – Identify the most distressing: Examining the ears, mouth, and throat typically triggers the most fear and crying in toddlers. Step 4 – Therefore, the throat and mouth are examined LAST. Step 5 – Eliminate distractors: Auscultation of the heart, lungs, and abdomen are all done BEFORE palpation or any invasive inspection, making the throat/mouth the correct last step.

Answer: B. It is within the normal range for a newborn.

Step 1 – Recall the normal newborn heart rate: 110–160 bpm at rest (may reach ~180 bpm when crying). Step 2 – Compare: 138 bpm falls squarely within 110–160 bpm. Step 3 – Eliminate option A: Bradycardia in a newborn is a heart rate below 100 bpm — 138 does not qualify. Step 4 – Eliminate option C: Tachycardia would be >160 bpm at rest in a newborn — 138 does not qualify. Step 5 – Eliminate option D: The 110–160 range applies to a resting newborn, not only during crying. The correct interpretation is that 138 bpm is a normal resting heart rate for a newborn.