CPNP-PC paediatric Primary Care Nurse Practitioner Certification
Exam 2026: Comprehensive Board Practice Test — Growth &
Development, Health Promotion, paediatric Assessment, Acute &
Chronic Conditions, Immunization & Preventive Care — 190 Multiple-
Choice Questions with Answers & Detailed Rationales
Section 1: Growth and Development (Questions 1-20)
Question 1
A 6-month-old infant is brought to the clinic for a well-child visit. The parent reports the
infant can sit with support, rolls from front to back, and reaches for objects with a palmar
grasp. Which developmental milestone should the nurse practitioner expect the infant to
achieve NEXT?
A. Sitting without support
B. Transferring objects hand to hand
C. Pulling to stand
D. Using a pincer grasp
Correct Answer: B
Explanation:
Transferring objects hand to hand typically develops at 6-7 months, following palmar grasp.
Sitting without support occurs at 8 months, pulling to stand at 9 months, and pincer grasp at
9-10 months.
Question 2
A 4-year-old child is presented for a wellness visit. The parent expresses concern that the
child has developed a vocabulary of approximately 1,500 words, can tell simple stories, and
engages in pretend play. The nurse practitioner recognizes these findings as:
,A. Advanced for age
B. Appropriate for age
C. Delayed for age
D. Requiring speech therapy referral
Correct Answer: B
Explanation:
A 4-year-old typically has 1,500-2,000 words, tells stories, and engages in imaginative play.
These milestones are developmentally appropriate and require no intervention.
Question 3
During a 2-month well-child visit, the nurse practitioner assesses the infant's social
development. Which behavior indicates appropriate social-emotional development at this
age?
A. Stranger anxiety
B. Social smile
C. Parallel play
D. Separation anxiety
Correct Answer: B
Explanation:
The social smile emerges at 6-8 weeks (2 months). Stranger anxiety appears at 6-9 months,
separation anxiety at 8-12 months, and parallel play at 2-3 years.
,Question 4
A 15-month-old toddler is brought for a checkup. The parent reports the child uses 3-5
words, points to desired objects, and can walk independently. The nurse practitioner should:
A. Reassure the parent that development is normal
B. Refer for audiology evaluation
C. Refer for speech-language pathology
D. Order developmental screening
Correct Answer: C
Explanation:
A 15-month-old should have 10-20 words. Using only 3-5 words indicates expressive
language delay requiring speech-language pathology referral for early intervention.
Question 5
A 10-year-old child is being evaluated for school performance. The parent reports the child
can read chapter books, solve multi-step math problems, and understand concepts of
fractions. According to Piaget, this child is in which cognitive stage?
A. Sensorimotor
B. Preoperational
C. Concrete operational
D. Formal operational
Correct Answer: C
, Explanation:
Concrete operational stage (7-11 years) involves logical thinking about concrete events,
understanding conservation, and mastering math operations. Formal operational begins at
11 years with abstract reasoning.
Question 6
A 5-year-old child is brought to the clinic. The parent reports the child can hop on one foot,
skip, and dress independently. Which fine motor skill should the nurse practitioner expect at
this age?
A. Drawing a circle
B. Drawing a person with 6 parts
C. Tying shoelaces
D. Using scissors to cut shapes
Correct Answer: D
Explanation:
A 5-year-old can use scissors to cut shapes, draw a person with 6 parts, and copy a triangle.
Drawing a circle occurs at 3 years, and tying shoelaces at 5-6 years.
Question 7
An 18-month-old toddler is assessed during a health supervision visit. Which gross motor
milestone is most concerning if not achieved?
A. Running
B. Walking independently
C. Kicking a ball
Exam 2026: Comprehensive Board Practice Test — Growth &
Development, Health Promotion, paediatric Assessment, Acute &
Chronic Conditions, Immunization & Preventive Care — 190 Multiple-
Choice Questions with Answers & Detailed Rationales
Section 1: Growth and Development (Questions 1-20)
Question 1
A 6-month-old infant is brought to the clinic for a well-child visit. The parent reports the
infant can sit with support, rolls from front to back, and reaches for objects with a palmar
grasp. Which developmental milestone should the nurse practitioner expect the infant to
achieve NEXT?
A. Sitting without support
B. Transferring objects hand to hand
C. Pulling to stand
D. Using a pincer grasp
Correct Answer: B
Explanation:
Transferring objects hand to hand typically develops at 6-7 months, following palmar grasp.
Sitting without support occurs at 8 months, pulling to stand at 9 months, and pincer grasp at
9-10 months.
Question 2
A 4-year-old child is presented for a wellness visit. The parent expresses concern that the
child has developed a vocabulary of approximately 1,500 words, can tell simple stories, and
engages in pretend play. The nurse practitioner recognizes these findings as:
,A. Advanced for age
B. Appropriate for age
C. Delayed for age
D. Requiring speech therapy referral
Correct Answer: B
Explanation:
A 4-year-old typically has 1,500-2,000 words, tells stories, and engages in imaginative play.
These milestones are developmentally appropriate and require no intervention.
Question 3
During a 2-month well-child visit, the nurse practitioner assesses the infant's social
development. Which behavior indicates appropriate social-emotional development at this
age?
A. Stranger anxiety
B. Social smile
C. Parallel play
D. Separation anxiety
Correct Answer: B
Explanation:
The social smile emerges at 6-8 weeks (2 months). Stranger anxiety appears at 6-9 months,
separation anxiety at 8-12 months, and parallel play at 2-3 years.
,Question 4
A 15-month-old toddler is brought for a checkup. The parent reports the child uses 3-5
words, points to desired objects, and can walk independently. The nurse practitioner should:
A. Reassure the parent that development is normal
B. Refer for audiology evaluation
C. Refer for speech-language pathology
D. Order developmental screening
Correct Answer: C
Explanation:
A 15-month-old should have 10-20 words. Using only 3-5 words indicates expressive
language delay requiring speech-language pathology referral for early intervention.
Question 5
A 10-year-old child is being evaluated for school performance. The parent reports the child
can read chapter books, solve multi-step math problems, and understand concepts of
fractions. According to Piaget, this child is in which cognitive stage?
A. Sensorimotor
B. Preoperational
C. Concrete operational
D. Formal operational
Correct Answer: C
, Explanation:
Concrete operational stage (7-11 years) involves logical thinking about concrete events,
understanding conservation, and mastering math operations. Formal operational begins at
11 years with abstract reasoning.
Question 6
A 5-year-old child is brought to the clinic. The parent reports the child can hop on one foot,
skip, and dress independently. Which fine motor skill should the nurse practitioner expect at
this age?
A. Drawing a circle
B. Drawing a person with 6 parts
C. Tying shoelaces
D. Using scissors to cut shapes
Correct Answer: D
Explanation:
A 5-year-old can use scissors to cut shapes, draw a person with 6 parts, and copy a triangle.
Drawing a circle occurs at 3 years, and tying shoelaces at 5-6 years.
Question 7
An 18-month-old toddler is assessed during a health supervision visit. Which gross motor
milestone is most concerning if not achieved?
A. Running
B. Walking independently
C. Kicking a ball
