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!!!
The child at highest risk for having an elevated blood lead level is a:
3 month old exclusively breastfed infant
6 month old who lives in a home built after 1970
2 year old with iron deficiency anemia
2 year old who is a picky eater
D.
2 year old with iron deficiency anemia
The amount of lead absorbed from the gut is increased in children with nutritional deficiencies such
as iron deficiency anemia (IDA). Iron deficiency anemia is often a comorbidity of lead poisoning. The
hand-to-mouth behavior of infants and young children increases their lead exposure. However, living
in a home built after 1970 reduces the risk since residential paint used in that era should not have
been lead based. Infants more than 4 months of age exclusively breast fed without supplemental
iron are at increased risk of IDA. A child who is a picky eater may or may not be at high risk for IDA,
depending on foods actually eaten.
Which laboratory assessment is the BEST indicator of vitamin D deficiency?
25(OH)-D (cholecalciferol)
A+ TEST BANK 1
, CPNP-PC CERTIFIED PEDIATRIC
PRIMARY CARE NURSE
PRACTITIONER BOARD EXAM
1,25(OH)2-D (calcitriol)
PTH (parathyroid hormone)
25(OH)-D (cholecalciferol)
25(OH)-D (cholecalciferol)
The best diagnostic study of vitamin D deficiency is the level of 25(OH)-D (cholecalciferol). 1,25(OH)2-
D (calcitriol) is the active metabolite of 25(OH)-D, but due to its short half-life it is not a good
indicator of vitamin D sufficiency. The parathyroid hormone releases calcium from bone. Rachitic
changes can be seen at growth plates and decreased calcification leads to thickening of the growth
plate. Serum calcium and phosphorous are initial screening tests but not the best indicator of vitamin
D deficiency.
In a 2 month old with visible rib fractures on radiograph, the NEXT most critical evaluation to obtain
is a:
CT scan of the head
long bone series
coagulation profile
retinal ophthalmologic exam
CT scan of the head
Posterior rib fractures associated with accidental trauma are rare. Posterior fractures can be seen in
infants who have been shaken as the perpetrator hands are typically wrapped around the infant's
thorax during the shaking, with the vertebrae acting as a fulcrum. These findings should alert the
provider to consider shaken baby syndrome (SBS). Subdural and subarachnoid hemorrhages are the
most common acute intracranial injuries seen in SBS and are associated with high rates of morbidity
and mortality. Thus, the most important study to do next is a CT scan. Studies have shown that
nearly one third of confirmed abusive head trauma cases were missed on initial presentation, and
many infants then sustain additional brain injury along with poorer neurologic outcomes because of
A+ TEST BANK 2
, CPNP-PC CERTIFIED PEDIATRIC
PRIMARY CARE NURSE
PRACTITIONER BOARD EXAM
the delay in diagnosis. Long bone studies will be needed as part of a thorough work-up of non-
accidental trauma, but the skull would be the most critical area to image first. Coagulation studies
are done to rule out any coagulation problem associated with injury to the brain and are important
for medico-legal reasons, but again, brain studies take precedence. A thorough ophthalmologic
exam is needed in suspected cases of SBS—preferably done by a pediatric ophthalmologist.
The MOST common barrier related to transitioning health care for an adolescent with special needs
or chronic illness is
finding an adult health care provider for transition.
resistance of the family and adolescent to transition of care.
lack of health care provider time to plan for transition of care.
difficulty in talking with patients about transitioning care.
finding an adult health care provider for transition.
Finding an adult health care provider, one who is qualified to care for young adults with special
health care needs, is the most commonly perceived barrier to the successful transition of health care
as identified by family and young adults, pediatric health care providers, and adult internists.
Transitioning of care requires time and communication with the parents and adolescents involved.
Many families may be hesitant to leave the nurturing environment of pediatric care, and may
perceive differences in adult practices as a difficult adjustment. Internists may lack the training and
qualifications to address many of the complicated health care needs of adolescents with chronic
illnesses. Because of the delicate nature of such conversations, some pediatric providers may not be
comfortable in dealing with the complexities of transitioning care.
A toddler is unable to use the right arm normally after the caregiver pulled her arm to prevent the
child from falling. Which finding would confirm the diagnosis of subluxation of the radial head?
severe swelling and bruising of the elbow
elbow flexed with pronated forearm
point tenderness at ulnar aspect of elbow
obvious deformity of the forearm
A+ TEST BANK 3
, CPNP-PC CERTIFIED PEDIATRIC
PRIMARY CARE NURSE
PRACTITIONER BOARD EXAM
elbow flexed with pronated forearm
Subluxation of the radial head, also called nursemaid's elbow, must be differentiated from a fracture
prior to reducing the annular ligament of the elbow. Radiographic examination is not necessary if the
child's physical findings and history are consistent with subluxation. The typical presentation of this
injury includes the following: age 2-5 years; history of a longitudinal traction injury, possible "pop"
and immediate pain, inability to use the arm normally, and arm splinted against the side. On
examination the elbow appears normal, is flexed with a pronated forearm against the body, is tender
laterally over the radial head, and has limited flexion with no supination. If the child fell on his/her
elbow or there is no history of a traction injury, suspect a fracture and order the appropriate
radiograp
Education for caregivers whose child has sickle cell disease should include that the majority of pain
crises are triggered by which of the following?
no identifying cause
temperature changes
cigarette smoke exposure
stressful situations
no identifying cause
Sickle cell disease is a common genetic hematologic disorder. Pain is the most common and disabling
symptom of sickle cell disease. Environmental temperature and second-hand smoke exposure have
been studied as possible precipitating factors, but have not been supported by the research.
Negative emotions can facilitate the pain cycle. In general, pain episodes are erratic and
unpredictable and occur for various, unknown reasons.
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!!!
The child at highest risk for having an elevated blood lead level is a:
3 month old exclusively breastfed infant
6 month old who lives in a home built after 1970
2 year old with iron deficiency anemia
2 year old who is a picky eater
D.
2 year old with iron deficiency anemia
The amount of lead absorbed from the gut is increased in children with nutritional deficiencies such
as iron deficiency anemia (IDA). Iron deficiency anemia is often a comorbidity of lead poisoning. The
hand-to-mouth behavior of infants and young children increases their lead exposure. However, living
in a home built after 1970 reduces the risk since residential paint used in that era should not have
been lead based. Infants more than 4 months of age exclusively breast fed without supplemental
iron are at increased risk of IDA. A child who is a picky eater may or may not be at high risk for IDA,
depending on foods actually eaten.
Which laboratory assessment is the BEST indicator of vitamin D deficiency?
25(OH)-D (cholecalciferol)
A+ TEST BANK 1
, CPNP-PC CERTIFIED PEDIATRIC
PRIMARY CARE NURSE
PRACTITIONER BOARD EXAM
1,25(OH)2-D (calcitriol)
PTH (parathyroid hormone)
25(OH)-D (cholecalciferol)
25(OH)-D (cholecalciferol)
The best diagnostic study of vitamin D deficiency is the level of 25(OH)-D (cholecalciferol). 1,25(OH)2-
D (calcitriol) is the active metabolite of 25(OH)-D, but due to its short half-life it is not a good
indicator of vitamin D sufficiency. The parathyroid hormone releases calcium from bone. Rachitic
changes can be seen at growth plates and decreased calcification leads to thickening of the growth
plate. Serum calcium and phosphorous are initial screening tests but not the best indicator of vitamin
D deficiency.
In a 2 month old with visible rib fractures on radiograph, the NEXT most critical evaluation to obtain
is a:
CT scan of the head
long bone series
coagulation profile
retinal ophthalmologic exam
CT scan of the head
Posterior rib fractures associated with accidental trauma are rare. Posterior fractures can be seen in
infants who have been shaken as the perpetrator hands are typically wrapped around the infant's
thorax during the shaking, with the vertebrae acting as a fulcrum. These findings should alert the
provider to consider shaken baby syndrome (SBS). Subdural and subarachnoid hemorrhages are the
most common acute intracranial injuries seen in SBS and are associated with high rates of morbidity
and mortality. Thus, the most important study to do next is a CT scan. Studies have shown that
nearly one third of confirmed abusive head trauma cases were missed on initial presentation, and
many infants then sustain additional brain injury along with poorer neurologic outcomes because of
A+ TEST BANK 2
, CPNP-PC CERTIFIED PEDIATRIC
PRIMARY CARE NURSE
PRACTITIONER BOARD EXAM
the delay in diagnosis. Long bone studies will be needed as part of a thorough work-up of non-
accidental trauma, but the skull would be the most critical area to image first. Coagulation studies
are done to rule out any coagulation problem associated with injury to the brain and are important
for medico-legal reasons, but again, brain studies take precedence. A thorough ophthalmologic
exam is needed in suspected cases of SBS—preferably done by a pediatric ophthalmologist.
The MOST common barrier related to transitioning health care for an adolescent with special needs
or chronic illness is
finding an adult health care provider for transition.
resistance of the family and adolescent to transition of care.
lack of health care provider time to plan for transition of care.
difficulty in talking with patients about transitioning care.
finding an adult health care provider for transition.
Finding an adult health care provider, one who is qualified to care for young adults with special
health care needs, is the most commonly perceived barrier to the successful transition of health care
as identified by family and young adults, pediatric health care providers, and adult internists.
Transitioning of care requires time and communication with the parents and adolescents involved.
Many families may be hesitant to leave the nurturing environment of pediatric care, and may
perceive differences in adult practices as a difficult adjustment. Internists may lack the training and
qualifications to address many of the complicated health care needs of adolescents with chronic
illnesses. Because of the delicate nature of such conversations, some pediatric providers may not be
comfortable in dealing with the complexities of transitioning care.
A toddler is unable to use the right arm normally after the caregiver pulled her arm to prevent the
child from falling. Which finding would confirm the diagnosis of subluxation of the radial head?
severe swelling and bruising of the elbow
elbow flexed with pronated forearm
point tenderness at ulnar aspect of elbow
obvious deformity of the forearm
A+ TEST BANK 3
, CPNP-PC CERTIFIED PEDIATRIC
PRIMARY CARE NURSE
PRACTITIONER BOARD EXAM
elbow flexed with pronated forearm
Subluxation of the radial head, also called nursemaid's elbow, must be differentiated from a fracture
prior to reducing the annular ligament of the elbow. Radiographic examination is not necessary if the
child's physical findings and history are consistent with subluxation. The typical presentation of this
injury includes the following: age 2-5 years; history of a longitudinal traction injury, possible "pop"
and immediate pain, inability to use the arm normally, and arm splinted against the side. On
examination the elbow appears normal, is flexed with a pronated forearm against the body, is tender
laterally over the radial head, and has limited flexion with no supination. If the child fell on his/her
elbow or there is no history of a traction injury, suspect a fracture and order the appropriate
radiograp
Education for caregivers whose child has sickle cell disease should include that the majority of pain
crises are triggered by which of the following?
no identifying cause
temperature changes
cigarette smoke exposure
stressful situations
no identifying cause
Sickle cell disease is a common genetic hematologic disorder. Pain is the most common and disabling
symptom of sickle cell disease. Environmental temperature and second-hand smoke exposure have
been studied as possible precipitating factors, but have not been supported by the research.
Negative emotions can facilitate the pain cycle. In general, pain episodes are erratic and
unpredictable and occur for various, unknown reasons.
A+ TEST BANK 4
