CPNP-PC CERTIFIED PEDIATRIC
PRIMARY CARE NURSE
PRACTITIONER BOARD EXAM
CPNP-PC CERTIFIED PEDIATRIC
PRIMARY CARE NURSE PRACTITIONER
BOARD EXAM PREP 2025/2026
COMPLETE 450 QUESTIONS AND
CORRECT ANSWERS WITH
RATIONALES |ALREADY GRADED
A+||BRAND NEW!!!
An adolescent female reports being sexually active with a single male partner. When discussing
contraceptive options, which of the following methods should be identified as having the HIGHEST
failure rate?
A. depot medroxyprogesterone acetate (DMPA)
B. intrauterine device (IUD)
C. male condom
D. vaginal diaphragm
The correct answer is D - vaginal diaphragm
The vaginal diaphragm has the highest rate of failure among the methods listed. Use of vaginal
diaphragms requires determining proper fit and placement, use of spermicide, and must remain in
place for a minimum of 6 hours after intercourse.
Depot medroxyprogesterone acetate (DMPA) is very effective given that it is a hormonal injection
and does not have to be repeated during each episode of intercourse. Intrauterine devices (IUD) are
safe and effective and can last 5-10 years after being placed at an experienced provider's office. Male
condoms are less effective than hormonal contraceptives or an IUD but have a higher success rate
than vaginal diaphragm as they are easier to use.
A caregiver who is primarily Spanish-speaking reports during a visit that her 24 month old is bilingual
and speaks four words. Which of the following is the BEST initial management?
A. refer to a pediatric speech pathologist with access to translators
B. encourage caregiver to choose one language for communication
A+ TEST BANK 1
, CPNP-PC CERTIFIED PEDIATRIC
PRIMARY CARE NURSE
PRACTITIONER BOARD EXAM
C. advise the caregiver to read to the child daily
D. refer to audiology for a hearing evaluation
The correct answer is A - refer to a pediatric speech pathologist with access to translators
Language and speech development is a critical area to address at preventative exams. At two years
of age a child should be speaking short phrases of two to three words and about 50 words of which
25% are intelligible to strangers. Children from bilingual homes or who are bilingual tend to develop
language more slowly, mixing words and phrases from the two languages; however, milestones
should continue to fall within expected ranges. Bilingual children with significant delays in vocabulary
require the same evaluation as delayed monolingual children. The first step in management for
children with delayed vocabulary is referral to a pediatric speech pathologist with access to
translators. Having older siblings monitor speech at home is not culturally appropriate and does not
address the needs of the child. Daily reading does help with language development and should be a
part of the anticipatory guidance at this age; however, this child is showing signs of language delay.
A hearing evaluation is an appropriate option for assessing speech and language delays, but the
initial step is referral to pediatric speech pathologist.
Shortly after administration of vaccines, a child develops generalized pruritus and dyspnea. What is
the MOST appropriate initial action?
A. administer supplemental oxygen
B. call 911 for transport to an emergency facility
C. administer intramuscular epinephrine
D. provide monitoring until symptoms subside
The correct answer is C - administer intramuscular epinephrine
Although rare, vaccines are not without adverse effects. The measles, mumps and rubella (MMR),
varicella zoster, influenza, hepatitis B, meningococcal, and tetanus-containing vaccines all have the
potential for an anaphylactic reaction. Anaphylaxis is a serious allergic reaction that is rapid in onset
and may cause death. Most cases of anaphylaxis are the result of activation of mast cells and
basophils by allergen-specific IgE molecules. Patients initially must be exposed to the responsible
allergen to generate allergen-specific antibodies, then when re-exposed, mast cells and basophils
release a variety of mediators (histamine, tryptase) and cytokines that can produce allergic
symptoms in any or all target organs. Initial symptoms vary but may include any of the following:
pruritis, a sensation of warmth, weakness, apprehension (feeling of impending doom), flushing,
urticaria and angioedema, tightness in throat, dry staccato cough and hoarseness, nasal congestion,
sneezing, dyspnea, deep cough and wheezing, nausea, abdominal cramping, vomiting, faintness, and
loss of consciousness.
Although transporting to an emergency facility and administering supplemental oxygen, in addition
to the administration of a PO H1-blocker, corticosteroids, nebulized albuterol, and volume expanders
may be necessary, the most important medication in treating any anaphylactic reaction is
A+ TEST BANK 2
, CPNP-PC CERTIFIED PEDIATRIC
PRIMARY CARE NURSE
PRACTITIONER BOARD EXAM
epinephrine. There should be no delay in its administration. Recognizing an anaphylactic reaction and
responding promptly will promote a culture of patient safety.
The developmental language assessment of an 18 month old reveals that the can understand
commands, speak 10 words, recognize names of body parts, and enjoys books and playing with
others. Caregivers are concerned that the toddler is not talking as much as older siblings did at this
age. The MOST appropriate response includes that
A. speaking at least 10 understandable words is developmentally appropriate.
B. sounds can also have meaning and be interpreted as words.
C. language comprehension is less advanced than expression.
D. subsequent children are often not quite as verbal.
The correct answer is A - speaking at least 10 understandable words is developmentally appropriate.
The normally developing 18 month old has an average of 10 words but can understand about 50
words and seeks to interact with others. Toddlers also use different sounds or jargon to
communicate. Language development occurs as the vocabulary increases rapidly, combining words
and jargon. Parents can usually understand what the child is saying when others cannot.
Around 18 months, the toddler uses 2-3 words omitting several to make a sentence and let his needs
or wants be known such as "go bye-bye".
Frequently second-born children or other subsequently born children are quite verbal because of an
older sibling talking to and playing with them.
For an adolescent presenting with a scaly, copper-penny colored rash limited to the torso, palms of
hands, and soles of feet, which is the next BEST step?
A. obtain a scrapped skin culture of the rash
B. obtain a treponemal automated test
C. prescribe topical steroids
D. prescribe oral antifungals
The correct answer is B - obtain a treponemal automated test
While non-specific scaly rashes are common in children and adolescents, it is important to
differentiate possible causes so that management is appropriate. Scaly patches that are copper-
penny in color and involve the torso, palms of the hands, and soles of feet should prompt
consideration of secondary syphilis for which the treponemal automated test is appropriate. In 2015-
2016, the rate of primary and secondary syphilis cases increased 13% among teens aged 15-19 years.
Active nonintervention is appropriate for pityriasis rosea, although oral antihistamines may be used
for those who have associated itching. Culturing of scrapped specimens is used for herpes infection
testing. While topical steroids are effective for eczematous lesions, eczema is rarely found on the
palms of hands and soles of feet. Oral antifungal medications may be used in the treatment of tinea
versicolor.
A+ TEST BANK 3
, CPNP-PC CERTIFIED PEDIATRIC
PRIMARY CARE NURSE
PRACTITIONER BOARD EXAM
Which of the following children would require an iron supplement for optimal growth and nutrition?
A. 2 month old born at 32 weeks gestation who is exclusively breastfed
B. 2 month old born at 37 weeks gestation who is receiving a combination of breast milk and formula
C. 2 month old born at 39 weeks gestation who is exclusively breastfed
D. 2 month old born at 41 weeks gestation who is receiving formula
The correct answer is A - 2 month old born at 32 weeks gestation who is exclusively breastfed
Infants born before 37 weeks gestation are at high risk of developing anemia of prematurity as their
iron stores are depleted rapidly during postnatal growth. They also have poor GI absorption and if
hospitalized, typically undergo frequent phlebotomy procedures causing further anemia. Anemia of
prematurity is most pronounced at 1-3 months of life as the infant's maternal red blood cell supply is
depleted and their own bone marrow production is just beginning. Treatment for anemia of
prematurity is dependent on co-morbid conditions such as cyanotic heart disease, respiratory
distress syndrome, and other conditions interfering with oxygen delivery and may include blood
transfusions.
Recommendations are that all breastfed preterm infants receive 2mg/kg/day of an elemental iron
supplement starting at 2 weeks of ages through 12 months. Formula-fed preterm infants should
receive 1mg/kg/day of iron supplementation to achieve a total daily dose of 2mg/kg/day. Full term
breastfed infants should receive 1mg/kg of an oral iron supplement beginning at 4 months of age,
preferably from an iron-fortified cereal; formula-fed term infants do not require supplementation.
In addition to hypoglycemia, the MOST common complications found in infants born to mothers with
diabetes or gestational diabetes include:
A. neural tube defects, anemia, and respiratory distress
B. cardiomegaly, polycythemia, and hypotonia
C. cardiomegaly, respiratory distress, and polycythemia
D. hepatosplenomegaly, hypotonia, and anemia
The correct answer is C - cardiomegaly, respiratory distress, and polycythemia
About 36% of infants born to mothers with diabetes or gestational diabetes are generally large for
gestational age (LGA) and predisposed to many anomalies and metabolic disorders related to
diabetic control throughout the pregnancy. Hypoglycemia develops in about 27% of these infants,
with only a small percentage actually demonstrating symptoms of jitteriness, hyperexcitability and
poor feeding. Five to 8% have major congenital malformations. Cardiomegaly is common in infants of
diabetic mothers, occurring about 30% of the time and associated with anomalies including
asymmetrical septal hypertrophy, subaortic stenosis, atrial septal defect, and transposition of the
great arteries. Additional anomalies can include neural tube defects, and defects of the GI tract and
kidneys. These infants have a higher risk of respiratory distress (34%), an increased incidence of
hyperbilirubinemia, renal vein thrombosis, and polycythemia (5%).
A+ TEST BANK 4
PRIMARY CARE NURSE
PRACTITIONER BOARD EXAM
CPNP-PC CERTIFIED PEDIATRIC
PRIMARY CARE NURSE PRACTITIONER
BOARD EXAM PREP 2025/2026
COMPLETE 450 QUESTIONS AND
CORRECT ANSWERS WITH
RATIONALES |ALREADY GRADED
A+||BRAND NEW!!!
An adolescent female reports being sexually active with a single male partner. When discussing
contraceptive options, which of the following methods should be identified as having the HIGHEST
failure rate?
A. depot medroxyprogesterone acetate (DMPA)
B. intrauterine device (IUD)
C. male condom
D. vaginal diaphragm
The correct answer is D - vaginal diaphragm
The vaginal diaphragm has the highest rate of failure among the methods listed. Use of vaginal
diaphragms requires determining proper fit and placement, use of spermicide, and must remain in
place for a minimum of 6 hours after intercourse.
Depot medroxyprogesterone acetate (DMPA) is very effective given that it is a hormonal injection
and does not have to be repeated during each episode of intercourse. Intrauterine devices (IUD) are
safe and effective and can last 5-10 years after being placed at an experienced provider's office. Male
condoms are less effective than hormonal contraceptives or an IUD but have a higher success rate
than vaginal diaphragm as they are easier to use.
A caregiver who is primarily Spanish-speaking reports during a visit that her 24 month old is bilingual
and speaks four words. Which of the following is the BEST initial management?
A. refer to a pediatric speech pathologist with access to translators
B. encourage caregiver to choose one language for communication
A+ TEST BANK 1
, CPNP-PC CERTIFIED PEDIATRIC
PRIMARY CARE NURSE
PRACTITIONER BOARD EXAM
C. advise the caregiver to read to the child daily
D. refer to audiology for a hearing evaluation
The correct answer is A - refer to a pediatric speech pathologist with access to translators
Language and speech development is a critical area to address at preventative exams. At two years
of age a child should be speaking short phrases of two to three words and about 50 words of which
25% are intelligible to strangers. Children from bilingual homes or who are bilingual tend to develop
language more slowly, mixing words and phrases from the two languages; however, milestones
should continue to fall within expected ranges. Bilingual children with significant delays in vocabulary
require the same evaluation as delayed monolingual children. The first step in management for
children with delayed vocabulary is referral to a pediatric speech pathologist with access to
translators. Having older siblings monitor speech at home is not culturally appropriate and does not
address the needs of the child. Daily reading does help with language development and should be a
part of the anticipatory guidance at this age; however, this child is showing signs of language delay.
A hearing evaluation is an appropriate option for assessing speech and language delays, but the
initial step is referral to pediatric speech pathologist.
Shortly after administration of vaccines, a child develops generalized pruritus and dyspnea. What is
the MOST appropriate initial action?
A. administer supplemental oxygen
B. call 911 for transport to an emergency facility
C. administer intramuscular epinephrine
D. provide monitoring until symptoms subside
The correct answer is C - administer intramuscular epinephrine
Although rare, vaccines are not without adverse effects. The measles, mumps and rubella (MMR),
varicella zoster, influenza, hepatitis B, meningococcal, and tetanus-containing vaccines all have the
potential for an anaphylactic reaction. Anaphylaxis is a serious allergic reaction that is rapid in onset
and may cause death. Most cases of anaphylaxis are the result of activation of mast cells and
basophils by allergen-specific IgE molecules. Patients initially must be exposed to the responsible
allergen to generate allergen-specific antibodies, then when re-exposed, mast cells and basophils
release a variety of mediators (histamine, tryptase) and cytokines that can produce allergic
symptoms in any or all target organs. Initial symptoms vary but may include any of the following:
pruritis, a sensation of warmth, weakness, apprehension (feeling of impending doom), flushing,
urticaria and angioedema, tightness in throat, dry staccato cough and hoarseness, nasal congestion,
sneezing, dyspnea, deep cough and wheezing, nausea, abdominal cramping, vomiting, faintness, and
loss of consciousness.
Although transporting to an emergency facility and administering supplemental oxygen, in addition
to the administration of a PO H1-blocker, corticosteroids, nebulized albuterol, and volume expanders
may be necessary, the most important medication in treating any anaphylactic reaction is
A+ TEST BANK 2
, CPNP-PC CERTIFIED PEDIATRIC
PRIMARY CARE NURSE
PRACTITIONER BOARD EXAM
epinephrine. There should be no delay in its administration. Recognizing an anaphylactic reaction and
responding promptly will promote a culture of patient safety.
The developmental language assessment of an 18 month old reveals that the can understand
commands, speak 10 words, recognize names of body parts, and enjoys books and playing with
others. Caregivers are concerned that the toddler is not talking as much as older siblings did at this
age. The MOST appropriate response includes that
A. speaking at least 10 understandable words is developmentally appropriate.
B. sounds can also have meaning and be interpreted as words.
C. language comprehension is less advanced than expression.
D. subsequent children are often not quite as verbal.
The correct answer is A - speaking at least 10 understandable words is developmentally appropriate.
The normally developing 18 month old has an average of 10 words but can understand about 50
words and seeks to interact with others. Toddlers also use different sounds or jargon to
communicate. Language development occurs as the vocabulary increases rapidly, combining words
and jargon. Parents can usually understand what the child is saying when others cannot.
Around 18 months, the toddler uses 2-3 words omitting several to make a sentence and let his needs
or wants be known such as "go bye-bye".
Frequently second-born children or other subsequently born children are quite verbal because of an
older sibling talking to and playing with them.
For an adolescent presenting with a scaly, copper-penny colored rash limited to the torso, palms of
hands, and soles of feet, which is the next BEST step?
A. obtain a scrapped skin culture of the rash
B. obtain a treponemal automated test
C. prescribe topical steroids
D. prescribe oral antifungals
The correct answer is B - obtain a treponemal automated test
While non-specific scaly rashes are common in children and adolescents, it is important to
differentiate possible causes so that management is appropriate. Scaly patches that are copper-
penny in color and involve the torso, palms of the hands, and soles of feet should prompt
consideration of secondary syphilis for which the treponemal automated test is appropriate. In 2015-
2016, the rate of primary and secondary syphilis cases increased 13% among teens aged 15-19 years.
Active nonintervention is appropriate for pityriasis rosea, although oral antihistamines may be used
for those who have associated itching. Culturing of scrapped specimens is used for herpes infection
testing. While topical steroids are effective for eczematous lesions, eczema is rarely found on the
palms of hands and soles of feet. Oral antifungal medications may be used in the treatment of tinea
versicolor.
A+ TEST BANK 3
, CPNP-PC CERTIFIED PEDIATRIC
PRIMARY CARE NURSE
PRACTITIONER BOARD EXAM
Which of the following children would require an iron supplement for optimal growth and nutrition?
A. 2 month old born at 32 weeks gestation who is exclusively breastfed
B. 2 month old born at 37 weeks gestation who is receiving a combination of breast milk and formula
C. 2 month old born at 39 weeks gestation who is exclusively breastfed
D. 2 month old born at 41 weeks gestation who is receiving formula
The correct answer is A - 2 month old born at 32 weeks gestation who is exclusively breastfed
Infants born before 37 weeks gestation are at high risk of developing anemia of prematurity as their
iron stores are depleted rapidly during postnatal growth. They also have poor GI absorption and if
hospitalized, typically undergo frequent phlebotomy procedures causing further anemia. Anemia of
prematurity is most pronounced at 1-3 months of life as the infant's maternal red blood cell supply is
depleted and their own bone marrow production is just beginning. Treatment for anemia of
prematurity is dependent on co-morbid conditions such as cyanotic heart disease, respiratory
distress syndrome, and other conditions interfering with oxygen delivery and may include blood
transfusions.
Recommendations are that all breastfed preterm infants receive 2mg/kg/day of an elemental iron
supplement starting at 2 weeks of ages through 12 months. Formula-fed preterm infants should
receive 1mg/kg/day of iron supplementation to achieve a total daily dose of 2mg/kg/day. Full term
breastfed infants should receive 1mg/kg of an oral iron supplement beginning at 4 months of age,
preferably from an iron-fortified cereal; formula-fed term infants do not require supplementation.
In addition to hypoglycemia, the MOST common complications found in infants born to mothers with
diabetes or gestational diabetes include:
A. neural tube defects, anemia, and respiratory distress
B. cardiomegaly, polycythemia, and hypotonia
C. cardiomegaly, respiratory distress, and polycythemia
D. hepatosplenomegaly, hypotonia, and anemia
The correct answer is C - cardiomegaly, respiratory distress, and polycythemia
About 36% of infants born to mothers with diabetes or gestational diabetes are generally large for
gestational age (LGA) and predisposed to many anomalies and metabolic disorders related to
diabetic control throughout the pregnancy. Hypoglycemia develops in about 27% of these infants,
with only a small percentage actually demonstrating symptoms of jitteriness, hyperexcitability and
poor feeding. Five to 8% have major congenital malformations. Cardiomegaly is common in infants of
diabetic mothers, occurring about 30% of the time and associated with anomalies including
asymmetrical septal hypertrophy, subaortic stenosis, atrial septal defect, and transposition of the
great arteries. Additional anomalies can include neural tube defects, and defects of the GI tract and
kidneys. These infants have a higher risk of respiratory distress (34%), an increased incidence of
hyperbilirubinemia, renal vein thrombosis, and polycythemia (5%).
A+ TEST BANK 4
