1
Barkley Pediatric Primary Care Nurse Practitioner
(PNP-PC) Certification Exam | 175 Actual Exam
Questions and Correct Answers
Domain I: Health Maintenance and Promotion (30% of Exam)
Question 1
A mother brings her 4-month-old daughter, Elena, for a well-child check. She
reports that Elena has a calm temperament and will let anyone hold her without
fussing. The parents are concerned that she is "too easygoing" and "too open to
strangers." Which of the following is the most appropriate response?
A. Children do not usually develop separation anxiety until 2 years of age
B. Fear of strangers usually develops at about 6 months of age; Elena's behavior is
normal for her age
C. Elena's behavior is abnormal, as she should be afraid of strangers at her age
D. Refer Elena to a pediatric neurologist for evaluation of social disinhibition
: : Correct Answer : : B
Explanation:
Fear of strangers (stranger anxiety) is a normal developmental milestone that
typically emerges around 6 to 9 months of age. At 4 months, infants are generally
sociable and do not yet discriminate between familiar and unfamiliar caregivers.
Elena's behavior is developmentally appropriate. Stranger anxiety is not expected
to appear until approximately 6 months, and it is a sign of healthy attachment.
Option A is incorrect because separation anxiety actually emerges earlier, around
9-12 months, not 2 years. Option C is incorrect because Elena's behavior is
normal. Option D is unnecessary; there are no signs of a neurological abnormality.
Question 2
A 12-year-old patient has just received the human papillomavirus (HPV) vaccine.
Regarding post-vaccination management, which of the following is
recommended?
pg. 1
,2
A. Massage the injection site vigorously to promote absorption
B. Have the patient sit for at least 15 minutes after the injection
C. Follow up with a second vaccine one week after the first dose
D. Test for antibodies to HPV immediately after vaccination
: : Correct Answer : : B
Explanation:
Syncope (fainting) is a known adverse event following vaccination, particularly in
adolescents. The CDC and ACIP recommend that patients be observed for at least
15 minutes after vaccination to monitor for syncope. Option A is not
recommended as it does not prevent syncope and may cause discomfort. Option
C is incorrect because the HPV vaccine series is given at 0, 1-2, and 6 months, not
one week apart. Option D is not standard practice; antibody testing is not
indicated post-vaccination.
Question 3
A parent asks at what age their child should first receive the influenza vaccine.
The child is currently 5 months old. Which response is most accurate?
A. The influenza vaccine is not recommended until 12 months of age
B. The child can receive the inactivated influenza vaccine starting at 6 months of
age
C. The child should receive the live attenuated influenza vaccine at 6 months
D. The influenza vaccine is only recommended for children with chronic medical
conditions
: : Correct Answer : : B
Explanation:
The CDC recommends annual influenza vaccination for all individuals aged 6
months and older. The inactivated influenza vaccine (IIV) is approved for use
starting at 6 months of age. The live attenuated influenza vaccine (LAIV) is not
approved for children under 2 years of age. Option A is incorrect because
vaccination begins at 6 months, not 12 months. Option C is incorrect because LAIV
is not used in infants. Option D is incorrect because universal vaccination is
recommended.
pg. 2
,3
Question 4
A mother of a 2-year-old asks about toilet training readiness. Which of the
following signs indicates that a child may be ready to begin toilet training?
A. The child can recite the alphabet
B. The child stays dry for at least 2 hours during the day
C. The child can walk up and down stairs independently
D. The child has all primary teeth erupted
: : Correct Answer : : B
Explanation:
Readiness for toilet training includes physiological, developmental, and behavioral
cues. Staying dry for at least 2 hours indicates developing bladder control. Other
signs include showing interest in the toilet, being able to follow simple
instructions, and expressing discomfort with wet or soiled diapers. Option A is a
cognitive milestone but not specifically related to toilet training. Option C is a
gross motor milestone. Option D is a dental milestone, not directly related.
Question 5
The parent of a healthy 6-month-old exclusively breastfed infant asks about
vitamin supplementation. Which of the following should the PNP recommend?
A. No supplementation is needed as breast milk provides all necessary nutrients
B. Supplementation with vitamin D (400 IU daily) is recommended
C. Supplementation with vitamin C only
D. Supplementation with a multivitamin containing iron
: : Correct Answer : : B
Explanation:
The AAP recommends that all exclusively breastfed infants receive 400 IU of
vitamin D daily starting in the first few days of life because breast milk is low in
vitamin D. Iron supplementation may be needed after 4-6 months if the infant is
not consuming iron-fortified foods, but the routine recommendation for a 6-
pg. 3
, 4
month-old exclusively breastfed infant is vitamin D. Iron-rich complementary
foods should be introduced at 6 months.
Domain II: Assessment and Diagnosis (35% of Exam)
Question 6
A 3-day-old newborn is being examined. When turned on the side, a sharp line of
demarcation is noted: the dependent half of the body is bright red, while the
superior half is pale. The infant is otherwise well. What is the most likely etiology?
A. An immature autonomic regulatory system (harlequin sign)
B. Coarctation of the aorta causing decreased blood flow to the superior half
C. Sepsis causing peripheral vasoconstriction
D. Congenital rubella syndrome
: : Correct Answer : : A
Explanation:
The harlequin color change is a benign, transient phenomenon seen in newborns,
caused by immaturity of the autonomic regulation of vascular tone. When the
infant is placed on one side, the dependent half becomes erythematous and the
superior half becomes pale, with a sharp line of demarcation at the midline. It
resolves spontaneously and requires no treatment. Option B would present with
differential blood pressures between upper and lower extremities. Option C
would present with systemic signs of illness. Option D is not associated with this
finding.
Question 7
A 2-year-old presents with a tender, edematous, and erythematous knee. The
parent reports that two weeks ago, the child had a 5-day episode of fever and
bloody diarrhea. Which organism is the most likely cause of the current
symptoms?
A. Giardia lamblia
B. Salmonella enteritidis
pg. 4
Barkley Pediatric Primary Care Nurse Practitioner
(PNP-PC) Certification Exam | 175 Actual Exam
Questions and Correct Answers
Domain I: Health Maintenance and Promotion (30% of Exam)
Question 1
A mother brings her 4-month-old daughter, Elena, for a well-child check. She
reports that Elena has a calm temperament and will let anyone hold her without
fussing. The parents are concerned that she is "too easygoing" and "too open to
strangers." Which of the following is the most appropriate response?
A. Children do not usually develop separation anxiety until 2 years of age
B. Fear of strangers usually develops at about 6 months of age; Elena's behavior is
normal for her age
C. Elena's behavior is abnormal, as she should be afraid of strangers at her age
D. Refer Elena to a pediatric neurologist for evaluation of social disinhibition
: : Correct Answer : : B
Explanation:
Fear of strangers (stranger anxiety) is a normal developmental milestone that
typically emerges around 6 to 9 months of age. At 4 months, infants are generally
sociable and do not yet discriminate between familiar and unfamiliar caregivers.
Elena's behavior is developmentally appropriate. Stranger anxiety is not expected
to appear until approximately 6 months, and it is a sign of healthy attachment.
Option A is incorrect because separation anxiety actually emerges earlier, around
9-12 months, not 2 years. Option C is incorrect because Elena's behavior is
normal. Option D is unnecessary; there are no signs of a neurological abnormality.
Question 2
A 12-year-old patient has just received the human papillomavirus (HPV) vaccine.
Regarding post-vaccination management, which of the following is
recommended?
pg. 1
,2
A. Massage the injection site vigorously to promote absorption
B. Have the patient sit for at least 15 minutes after the injection
C. Follow up with a second vaccine one week after the first dose
D. Test for antibodies to HPV immediately after vaccination
: : Correct Answer : : B
Explanation:
Syncope (fainting) is a known adverse event following vaccination, particularly in
adolescents. The CDC and ACIP recommend that patients be observed for at least
15 minutes after vaccination to monitor for syncope. Option A is not
recommended as it does not prevent syncope and may cause discomfort. Option
C is incorrect because the HPV vaccine series is given at 0, 1-2, and 6 months, not
one week apart. Option D is not standard practice; antibody testing is not
indicated post-vaccination.
Question 3
A parent asks at what age their child should first receive the influenza vaccine.
The child is currently 5 months old. Which response is most accurate?
A. The influenza vaccine is not recommended until 12 months of age
B. The child can receive the inactivated influenza vaccine starting at 6 months of
age
C. The child should receive the live attenuated influenza vaccine at 6 months
D. The influenza vaccine is only recommended for children with chronic medical
conditions
: : Correct Answer : : B
Explanation:
The CDC recommends annual influenza vaccination for all individuals aged 6
months and older. The inactivated influenza vaccine (IIV) is approved for use
starting at 6 months of age. The live attenuated influenza vaccine (LAIV) is not
approved for children under 2 years of age. Option A is incorrect because
vaccination begins at 6 months, not 12 months. Option C is incorrect because LAIV
is not used in infants. Option D is incorrect because universal vaccination is
recommended.
pg. 2
,3
Question 4
A mother of a 2-year-old asks about toilet training readiness. Which of the
following signs indicates that a child may be ready to begin toilet training?
A. The child can recite the alphabet
B. The child stays dry for at least 2 hours during the day
C. The child can walk up and down stairs independently
D. The child has all primary teeth erupted
: : Correct Answer : : B
Explanation:
Readiness for toilet training includes physiological, developmental, and behavioral
cues. Staying dry for at least 2 hours indicates developing bladder control. Other
signs include showing interest in the toilet, being able to follow simple
instructions, and expressing discomfort with wet or soiled diapers. Option A is a
cognitive milestone but not specifically related to toilet training. Option C is a
gross motor milestone. Option D is a dental milestone, not directly related.
Question 5
The parent of a healthy 6-month-old exclusively breastfed infant asks about
vitamin supplementation. Which of the following should the PNP recommend?
A. No supplementation is needed as breast milk provides all necessary nutrients
B. Supplementation with vitamin D (400 IU daily) is recommended
C. Supplementation with vitamin C only
D. Supplementation with a multivitamin containing iron
: : Correct Answer : : B
Explanation:
The AAP recommends that all exclusively breastfed infants receive 400 IU of
vitamin D daily starting in the first few days of life because breast milk is low in
vitamin D. Iron supplementation may be needed after 4-6 months if the infant is
not consuming iron-fortified foods, but the routine recommendation for a 6-
pg. 3
, 4
month-old exclusively breastfed infant is vitamin D. Iron-rich complementary
foods should be introduced at 6 months.
Domain II: Assessment and Diagnosis (35% of Exam)
Question 6
A 3-day-old newborn is being examined. When turned on the side, a sharp line of
demarcation is noted: the dependent half of the body is bright red, while the
superior half is pale. The infant is otherwise well. What is the most likely etiology?
A. An immature autonomic regulatory system (harlequin sign)
B. Coarctation of the aorta causing decreased blood flow to the superior half
C. Sepsis causing peripheral vasoconstriction
D. Congenital rubella syndrome
: : Correct Answer : : A
Explanation:
The harlequin color change is a benign, transient phenomenon seen in newborns,
caused by immaturity of the autonomic regulation of vascular tone. When the
infant is placed on one side, the dependent half becomes erythematous and the
superior half becomes pale, with a sharp line of demarcation at the midline. It
resolves spontaneously and requires no treatment. Option B would present with
differential blood pressures between upper and lower extremities. Option C
would present with systemic signs of illness. Option D is not associated with this
finding.
Question 7
A 2-year-old presents with a tender, edematous, and erythematous knee. The
parent reports that two weeks ago, the child had a 5-day episode of fever and
bloody diarrhea. Which organism is the most likely cause of the current
symptoms?
A. Giardia lamblia
B. Salmonella enteritidis
pg. 4
