PNCB CPNFree Certified Pediatric Nurse practice test

Correct answer: B. Plan to introduce single-ingredient pureed foods around 6 months of age when the infant can also sit with minimal support

The American Academy of Pediatrics (AAP) and Bright Futures recommend exclusive breastfeeding or formula feeding until approximately 6 months, at which point solid foods are introduced when the infant demonstrates developmental readiness including sitting with minimal support, good head control, and interest in food. Although this infant shows some readiness signs at 4 months, the full constellation of readiness—including sitting with minimal support—is not yet present, making 6 months the appropriate target. Adding cereal to a bottle is unsafe (choking risk, overfeeding) and does not improve sleep; it is explicitly discouraged by the AAP. Introducing foods at 4 months is associated with increased obesity risk and is not consistent with current guidelines.

Correct answer: C. The prone (stomach) sleep position

Prone sleep position is the single most significant modifiable risk factor for sudden infant death syndrome (SIDS) and is the top counseling priority according to the AAP Safe Sleep guidelines. Infants should always be placed on their backs (supine) for every sleep until age 1 year. The blanket in the crib is also a hazard (soft object) and should be removed, but positional correction takes precedence because prone positioning carries the greatest independent risk. A firm, flat mattress is actually recommended and is not a problem in this scenario. The AAP recommends room-sharing (without bed-sharing) on a separate surface for at least 6 months; however, the sleep position correction must be addressed as the immediate safety priority regardless of room arrangement.

Correct answer: B. Provide a combined oral contraceptive prescription and STI screening without involving the parent, consistent with minor consent law, and review confidentiality limits with the patient

In states where minors can independently consent to contraceptive and STI services, the nurse is both legally and ethically obligated to provide those services confidentially, which supports the Bright Futures principle of promoting adolescent autonomy and health. Reviewing the limits of confidentiality (e.g., imminent safety concerns mandate disclosure) is standard practice and builds trust. Requiring parental consent for services the minor can legally consent to is incorrect and constitutes a barrier to care. Notifying the parent without a safety rationale would violate confidentiality and deter future healthcare-seeking. Deferring care is equally inappropriate and leaves the adolescent at ongoing risk for unintended pregnancy and STIs.

Correct answer: B. Advise the foster parent that the regression and behavioral changes most likely reflect stress responses to placement transitions; recommend a consistent, low-pressure toileting routine and connection-focused caregiving rather than a consequence-based schedule

Children in foster care experience frequent placement-related trauma and loss; toileting regression, emotional dysregulation, and sleep disturbance are well-documented stress responses rather than signs of developmental delay or physiologic pathology in an otherwise healthy child. Bright Futures and trauma-informed care frameworks recommend consistent routines, nurturing caregiving, and minimal pressure during regression periods. A consequence-based schedule can worsen shame and anxiety in children with early adversity, intensifying regression. Urology referral is not indicated without physical symptoms (dysuria, urgency, urinary tract infection signs). Consequence schedules from prior placements should never be presumed safe or transferable without assessment of their appropriateness.

Correct answer: D. His weight is below expected trajectory; infants should double their birth weight by 4–5 months and triple it by 12 months, so having just doubled at 9 months warrants further evaluation.

The expected milestones are that infants double their birth weight by approximately 4–5 months and triple it by 12 months. This infant's birth weight was 3.3 kg; he now weighs 6.6 kg (exactly doubled) at 9 months — meaning the doubling milestone, which should have been reached by 4–5 months, has been met very late. He has not yet tripled his birth weight (expected ~9.9 kg by 12 months), and his growth velocity is behind schedule, warranting further nutritional and developmental evaluation. Option A incorrectly states doubling is expected by 12 months. Option B jumps directly to nutritionist referral without first framing the expected milestones; the full evaluation should guide referrals. Option C correctly identifies the tripling milestone at 12 months but incorrectly labels his current weight as normal given he is still only at the doubled mark at 9 months.

Correct answer: B. Refer the child for a formal developmental evaluation and audiology assessment without delay.

By 12 months, children are expected to say at least one word, point to objects, and use gestures such as waving; absence of all three at 15 months constitutes multiple developmental red flags per AAP and PNCB guidance. Failure of any developmental surveillance red flag warrants immediate referral for a comprehensive developmental evaluation and audiology testing (to rule out hearing loss as a contributing cause) rather than a watchful wait. Option A is incorrect because delaying to 18 months loses critical intervention time during a sensitive developmental window. Option C delays necessary evaluation further. Option D is incomplete — autism-specific screening does not replace the broader developmental evaluation and audiology workup indicated by this clinical picture.

Correct answer: B. Menarche typically occurs 2–3 years after the onset of breast development, usually at Tanner stage 4.

Menarche in females typically occurs approximately 2–3 years after the onset of breast development (thelarche at Tanner stage 2), most commonly during Tanner stage 4 breast development. This girl is at Tanner stage 2, so menarche within approximately 2–3 years is expected and normal. Option A significantly underestimates the typical interval, which is 2–3 years, not 6 months. Option C is incorrect because menarche by age 13 in a girl who just reached Tanner stage 2 is not expected; primary amenorrhea is not a concern until age 15 or the absence of menses 3 years after thelarche. Option D is incorrect; while body composition influences puberty, menarche is reliably correlated with Tanner staging.

Correct answer: C. Extreme prematurity is an established adverse childhood experience (ACE) that can result in lasting neurodevelopmental differences, and early intervention services should be continued or reinstated.

Extreme prematurity (< 28 weeks) is a well-recognized biological ACE associated with ongoing neurodevelopmental differences — including cognitive, motor, behavioral, and learning challenges — well beyond age 3, due to disrupted brain development during a critical period of neurogenesis. Neurodevelopmental follow-up and access to early intervention or school-based services (IDEA Part B after age 3) remain important for children born extremely preterm. Option A is incorrect because outcomes are not uniformly permanent; neuroplasticity and early intervention can mitigate deficits. Option B is incorrect; while formal corrected-age adjustment is typically discontinued at age 2–3 for anthropometric measures, the neurodevelopmental impact of extreme prematurity persists and must still inform clinical expectations well into school age. Option D introduces a child abuse concern without supporting evidence and is not supported by the clinical picture.

Correct answer: B. Administer the 6-month doses today and schedule the 12–15-month doses at the earliest allowable interval; do not restart the series

ACIP catch-up guidance specifies that a missed dose does not require restarting a series; the provider simply administers the missed dose and resumes from where the child left off, respecting minimum intervals between doses. Restarting the series (A) is never indicated for a lapsed schedule and would unnecessarily delay protection and add doses. Deferring vaccines (C) has no clinical basis and prolongs susceptibility to preventable disease. Option D is incorrect; DTaP, Hib, PCV13, and IPV all have doses indicated at 12–18 months regardless of whether a mid-series dose was delayed.

Correct answer: A. The 9-valent HPV vaccine covers the high-risk strains responsible for approximately 90% of HPV-related cervical cancers as well as most genital warts

Gardasil 9, the 9-valent HPV vaccine currently used in the US, targets types 6, 11, 16, 18, 31, 33, 45, 52, and 58, covering approximately 90% of HPV-associated cervical cancers and nearly all genital warts caused by types 6 and 11. Option B is incorrect because the bivalent formulation (Cervarix) is no longer distributed in the US and did not cover genital wart strains; only the 9-valent formulation is in use. Option C overstates efficacy; approximately 10% of oncogenic strains are not covered, so ongoing cervical cancer screening remains essential. Option D is incorrect; the vaccine is recommended at 11–12 years regardless of sexual history, and Pap smears are not indicated before age 21.