ANCC PPCNP-BC Practice Exam – 260 Questions
with Rationales | Pediatric Primary Care Nurse
Practitioner Certification | Updated 2026
TABLE OF CONTENTS
Domain 1: Assessment and Diagnosis Questions 1 to 65
Domain 2: Planning and Implementation Questions 66 to 130
Domain 3: Evaluation Questions 131 to 195
Domain 4: Professional Role and Leadership Questions 196 to 260
DOMAIN 1: ASSESSMENT AND DIAGNOSIS QUESTIONS 1 TO 65
Question 1
A 2-year-old child presents with a barking cough, stridor, and mild
respiratory distress. The symptoms worsened overnight and are worse when
the child is lying down. Which of the following is the most likely diagnosis?
A. Croup
B. Epiglottitis
C. Bacterial tracheitis
D. Foreign body aspiration
,Correct Answer: A
Rationale: Croup is a viral respiratory infection causing laryngeal and
subglottic edema. It typically presents with a barking cough and stridor that
worsens at night. The absence of high fever, drooling, and toxic appearance
makes epiglottitis less likely. Bacterial tracheitis presents with high fever
and toxic appearance. Foreign body aspiration typically has a sudden onset
of coughing and wheezing.
Question 2
A 6-month-old infant is brought to the clinic for a well-child visit. The
infant was born at 38 weeks gestation and has no significant medical history.
Which of the following developmental milestones would the nurse
practitioner expect this infant to have achieved?
A. Sitting without support
B. Rolling from back to front
C. Pincer grasp
D. Standing while holding onto furniture
Correct Answer: B
Rationale: Rolling from back to front is typically achieved by 6 months of
age. Sitting without support is a 7 to 8 month milestone. Pincer grasp is an 8
to 9 month milestone. Standing while holding onto furniture is a 9 to 10
month milestone.
Question 3
,A 4-year-old child is brought to the clinic with a fever, sore throat, and
difficulty swallowing. On exam, you note tonsillar exudate, tender anterior
cervical lymphadenopathy, and a scarlatiniform rash. Which of the
following is the most likely diagnosis?
A. Streptococcal pharyngitis
B. Viral pharyngitis
C. Infectious mononucleosis
D. Peritonsillar abscess
Correct Answer: A
Rationale: Streptococcal pharyngitis presents with tonsillar exudate, anterior
cervical lymphadenopathy, fever, and may be accompanied by a
scarlatiniform rash. Viral pharyngitis typically lacks exudate and rash.
Infectious mononucleosis presents with posterior cervical lymphadenopathy,
fatigue, and atypical lymphocytes. Peritonsillar abscess presents with
unilateral swelling and trismus.
Question 4
A 3-year-old child is brought to the emergency department with a sudden
onset of high fever, drooling, and stridor. The child is sitting upright and
leaning forward. Which of the following is the most appropriate immediate
action?
A. Prepare for intubation
B. Obtain a throat culture
, C. Administer oral antibiotics
D. Perform a chest x-ray
Correct Answer: A
Rationale: The presentation of high fever, drooling, stridor, and sitting in the
tripod position is classic for epiglottitis, which is a medical emergency
requiring immediate airway management. Obtaining a throat culture could
precipitate airway obstruction. Oral antibiotics are not appropriate for acute
management. A chest x-ray is not the priority.
Question 5
A 10-year-old child presents with a history of recurrent episodes of
wheezing, coughing, and shortness of breath that occur after exposure to
cold air and exercise. Which of the following is the most likely diagnosis?
A. Asthma
B. Bronchiolitis
C. Pneumonia
D. Cystic fibrosis
Correct Answer: A
Rationale: Asthma is characterized by recurrent episodes of wheezing,
coughing, and shortness of breath triggered by exercise and cold air.
Bronchiolitis typically occurs in infants and young children. Pneumonia
presents with fever and productive cough. Cystic fibrosis presents with
chronic productive cough and failure to thrive.
with Rationales | Pediatric Primary Care Nurse
Practitioner Certification | Updated 2026
TABLE OF CONTENTS
Domain 1: Assessment and Diagnosis Questions 1 to 65
Domain 2: Planning and Implementation Questions 66 to 130
Domain 3: Evaluation Questions 131 to 195
Domain 4: Professional Role and Leadership Questions 196 to 260
DOMAIN 1: ASSESSMENT AND DIAGNOSIS QUESTIONS 1 TO 65
Question 1
A 2-year-old child presents with a barking cough, stridor, and mild
respiratory distress. The symptoms worsened overnight and are worse when
the child is lying down. Which of the following is the most likely diagnosis?
A. Croup
B. Epiglottitis
C. Bacterial tracheitis
D. Foreign body aspiration
,Correct Answer: A
Rationale: Croup is a viral respiratory infection causing laryngeal and
subglottic edema. It typically presents with a barking cough and stridor that
worsens at night. The absence of high fever, drooling, and toxic appearance
makes epiglottitis less likely. Bacterial tracheitis presents with high fever
and toxic appearance. Foreign body aspiration typically has a sudden onset
of coughing and wheezing.
Question 2
A 6-month-old infant is brought to the clinic for a well-child visit. The
infant was born at 38 weeks gestation and has no significant medical history.
Which of the following developmental milestones would the nurse
practitioner expect this infant to have achieved?
A. Sitting without support
B. Rolling from back to front
C. Pincer grasp
D. Standing while holding onto furniture
Correct Answer: B
Rationale: Rolling from back to front is typically achieved by 6 months of
age. Sitting without support is a 7 to 8 month milestone. Pincer grasp is an 8
to 9 month milestone. Standing while holding onto furniture is a 9 to 10
month milestone.
Question 3
,A 4-year-old child is brought to the clinic with a fever, sore throat, and
difficulty swallowing. On exam, you note tonsillar exudate, tender anterior
cervical lymphadenopathy, and a scarlatiniform rash. Which of the
following is the most likely diagnosis?
A. Streptococcal pharyngitis
B. Viral pharyngitis
C. Infectious mononucleosis
D. Peritonsillar abscess
Correct Answer: A
Rationale: Streptococcal pharyngitis presents with tonsillar exudate, anterior
cervical lymphadenopathy, fever, and may be accompanied by a
scarlatiniform rash. Viral pharyngitis typically lacks exudate and rash.
Infectious mononucleosis presents with posterior cervical lymphadenopathy,
fatigue, and atypical lymphocytes. Peritonsillar abscess presents with
unilateral swelling and trismus.
Question 4
A 3-year-old child is brought to the emergency department with a sudden
onset of high fever, drooling, and stridor. The child is sitting upright and
leaning forward. Which of the following is the most appropriate immediate
action?
A. Prepare for intubation
B. Obtain a throat culture
, C. Administer oral antibiotics
D. Perform a chest x-ray
Correct Answer: A
Rationale: The presentation of high fever, drooling, stridor, and sitting in the
tripod position is classic for epiglottitis, which is a medical emergency
requiring immediate airway management. Obtaining a throat culture could
precipitate airway obstruction. Oral antibiotics are not appropriate for acute
management. A chest x-ray is not the priority.
Question 5
A 10-year-old child presents with a history of recurrent episodes of
wheezing, coughing, and shortness of breath that occur after exposure to
cold air and exercise. Which of the following is the most likely diagnosis?
A. Asthma
B. Bronchiolitis
C. Pneumonia
D. Cystic fibrosis
Correct Answer: A
Rationale: Asthma is characterized by recurrent episodes of wheezing,
coughing, and shortness of breath triggered by exercise and cold air.
Bronchiolitis typically occurs in infants and young children. Pneumonia
presents with fever and productive cough. Cystic fibrosis presents with
chronic productive cough and failure to thrive.
