Primary Care Pediatric Nurse Practitioner (CPNP-
PC) Certification Exam 2026 | Complete PNCB
Practice Test Bank | Updated Questions, Answers
& Detailed Rationales
Question 1
Caregiver education for an infant with croup includes that urgent medical re-evaluation
is needed if the infant has:
A. audible stridor when calm
B. barky cough in the morning
C. fever of 102°F (38.9°C) or higher
D. retractions between ribs with crying
Correct Answer: A. audible stridor when calm
Rationale: Stridor at rest indicates significant airway obstruction and requires urgent
evaluation. Barky cough, fever, and retractions with crying are expected in croup but
stridor when calm is a red flag.
Question 2
A preschooler is evaluated for a history of fever and intermittent bone pain and is noted
to have an abdominal mass. Which is the MOST likely diagnosis?
A. neuroblastoma
B. non-Hodgkin's lymphoma
C. osteogenic sarcoma
D. Wilms tumor
Correct Answer: A. neuroblastoma
Rationale: The median age at diagnosis is 22 months, and approximately 90% of cases
have been diagnosed by 5 years of age. Signs and symptoms reflect the tumor site and
extent of disease, but may include fever, failure to thrive, bone pain, cytopenia, orbital
proptosis, masses, bowel obstruction, or spinal cord compression. Wilms tumor is an
embryonal malignancy of the kidney that can also present with an abdominal mass.
Sarcomas of the extremities are more likely to occur in older children.
Question 3
An adolescent presenting for a pre-college physical describes herself as a sexually active
1|Page
,lesbian. Which is the MOST immediate action?
A. assess for potential psychosocial difficulties
B. ensure human papilloma virus vaccination is up-to-date
C. provide confidential and nonjudgmental care
D. counsel about sexually transmitted infections and contraception
Correct Answer: D. counsel about sexually transmitted infections and
contraception
Rationale: Adolescent lesbian and bisexual females are more likely to have been
pregnant when compared to their heterosexual peers. LGB adolescents and young adults
are at greater risk for unplanned pregnancy, and it is important to counsel about
accidental pregnancy even with females who have sex with females. Providing sexual
and reproductive health education that includes information about abstinence,
contraception, and sexually transmitted infections (STIs) is necessary for all adolescents
and young adults. Additionally, information about contraception should be offered to all
females regardless of their sexual orientation.
Question 4
While some characteristics of an Individualized Education Plan (IEP) and 504 Plan are
similar, the IEP differs in that it uniquely requires:
A. a specific medical diagnosis for eligibility
B. a modification in curriculum to meet the student's needs
C. an evaluation typically completed through school system resources
D. a written plan be developed that specifies individualized accommodations
Correct Answer: B. a modification in curriculum to meet the student's
needs
Rationale: Eligibility for both plans requires a medical diagnosis. For a 504 Plan, this
can be any psychologic or physical disorder which substantially limits the individual's
learning. These children can follow the curriculum without modification but may
require assistance in the school setting. In order to be eligible for an IEP, a child has to
also have a medical diagnosis, but that diagnosis must specifically meet criteria as a
qualifying disability that seriously affects learning or behavior and, therefore, requires
modification of the school curriculum.
Question 5
When used in treatment of acne vulgaris, topical retinoids act to:
A. normalize desquamation of the follicular epithelium
B. minimize development of antibiotic-resistant Cutibacterium acnes
C. generate free radicals to oxidize proteins in the cell wall of Cutibacterium acnes
2|Page
,D. work within the cell ribosomes to alter upstream signals affecting inflammatory
pathways
Correct Answer: A. normalize desquamation of the follicular epithelium
Rationale: Topical retinoids normalize desquamation of the follicular epithelium to
prevent new formation of microcomedones, the precursors of both comedoal and
inflammatory lesions. Additionally, retinoids promote clearing of existing
microcomedones and work within the nucleus to alter downstream signals that affect
inflammatory pathways.
Question 6
A caregiver expresses concern for her 12 month old's lack of interest in playing with
other children, especially due to a family history of autism spectrum disorder. Which of
the following is the MOST appropriate next step?
A. suggest the caregiver attempt to engage the child in imitating behaviors
B. screen for social interactions such as peek-a-boo and pat-a-cake
C. offer reassurance that interactive play begins at age 3
D. refer for a developmental evaluation
Correct Answer: D. refer for a developmental evaluation
Rationale: Given the family history of autism spectrum disorder and the caregiver's
specific concern, referral for a developmental evaluation is the most appropriate next
step to either rule out or confirm developmental concerns.
Question 7
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
C. advise the caregiver to read to the child daily
D. refer to audiology for a hearing evaluation
Correct Answer: A. refer to a pediatric speech pathologist with access to
translators
Rationale: At two years of age a child should be speaking short phrases of two to three
words with a vocabulary of about 50 words. Bilingual children with significant delays in
vocabulary require the same evaluation as monolingual children with language delays.
3|Page
, Question 8
Appropriate instruction for a young adolescent male considering strength training to
enhance muscle mass includes that:
A. workouts should focus on 1-2 muscle groups on any exercise day
B. powerlifting should be delayed until later in reproductive maturation
C. strength training should occur at least five times a week to be effective
D. other forms of exercise should be avoided on days that strength training is done
Correct Answer: B. powerlifting should be delayed until later in
reproductive maturation
Rationale: Powerlifting should be avoided in prepubescent children due to possible
injury to long bones and growth plates as well as the back.
Question 9
A school-age child is seen for a skin rash that began about 6 weeks ago along with
bilateral limping, and a recent 2-week history of fever. Examination reveals
inflammation of knee joints. Which is the MOST likely diagnosis?
A. acute rheumatic fever
B. dermatomyositis
C. systemic juvenile idiopathic arthritis
D. systemic lupus erythematosus
Correct Answer: C. systemic juvenile idiopathic arthritis
Rationale: Systemic JIA causes inflammation in one or more joints for 6 weeks'
duration in a child younger than 16 years of age and is often accompanied by fatigue,
inflammation of joints, skin rash, and a high fever (103°F [39.4°C] or higher) that lasts
at least 2 weeks.
Question 10
An adolescent used a prescribed emergency contraceptive after having unprotected
sexual intercourse. A return visit and pregnancy test should be advised if there is no
menstrual period within:
A. 1 week
B. 2 weeks
C. 3 weeks
D. 4 weeks
Correct Answer: C. 3 weeks
Rationale: After taking an emergency contraceptive, the adolescent should return for a
pregnancy test within 3 weeks if menses have not started.
4|Page
PC) Certification Exam 2026 | Complete PNCB
Practice Test Bank | Updated Questions, Answers
& Detailed Rationales
Question 1
Caregiver education for an infant with croup includes that urgent medical re-evaluation
is needed if the infant has:
A. audible stridor when calm
B. barky cough in the morning
C. fever of 102°F (38.9°C) or higher
D. retractions between ribs with crying
Correct Answer: A. audible stridor when calm
Rationale: Stridor at rest indicates significant airway obstruction and requires urgent
evaluation. Barky cough, fever, and retractions with crying are expected in croup but
stridor when calm is a red flag.
Question 2
A preschooler is evaluated for a history of fever and intermittent bone pain and is noted
to have an abdominal mass. Which is the MOST likely diagnosis?
A. neuroblastoma
B. non-Hodgkin's lymphoma
C. osteogenic sarcoma
D. Wilms tumor
Correct Answer: A. neuroblastoma
Rationale: The median age at diagnosis is 22 months, and approximately 90% of cases
have been diagnosed by 5 years of age. Signs and symptoms reflect the tumor site and
extent of disease, but may include fever, failure to thrive, bone pain, cytopenia, orbital
proptosis, masses, bowel obstruction, or spinal cord compression. Wilms tumor is an
embryonal malignancy of the kidney that can also present with an abdominal mass.
Sarcomas of the extremities are more likely to occur in older children.
Question 3
An adolescent presenting for a pre-college physical describes herself as a sexually active
1|Page
,lesbian. Which is the MOST immediate action?
A. assess for potential psychosocial difficulties
B. ensure human papilloma virus vaccination is up-to-date
C. provide confidential and nonjudgmental care
D. counsel about sexually transmitted infections and contraception
Correct Answer: D. counsel about sexually transmitted infections and
contraception
Rationale: Adolescent lesbian and bisexual females are more likely to have been
pregnant when compared to their heterosexual peers. LGB adolescents and young adults
are at greater risk for unplanned pregnancy, and it is important to counsel about
accidental pregnancy even with females who have sex with females. Providing sexual
and reproductive health education that includes information about abstinence,
contraception, and sexually transmitted infections (STIs) is necessary for all adolescents
and young adults. Additionally, information about contraception should be offered to all
females regardless of their sexual orientation.
Question 4
While some characteristics of an Individualized Education Plan (IEP) and 504 Plan are
similar, the IEP differs in that it uniquely requires:
A. a specific medical diagnosis for eligibility
B. a modification in curriculum to meet the student's needs
C. an evaluation typically completed through school system resources
D. a written plan be developed that specifies individualized accommodations
Correct Answer: B. a modification in curriculum to meet the student's
needs
Rationale: Eligibility for both plans requires a medical diagnosis. For a 504 Plan, this
can be any psychologic or physical disorder which substantially limits the individual's
learning. These children can follow the curriculum without modification but may
require assistance in the school setting. In order to be eligible for an IEP, a child has to
also have a medical diagnosis, but that diagnosis must specifically meet criteria as a
qualifying disability that seriously affects learning or behavior and, therefore, requires
modification of the school curriculum.
Question 5
When used in treatment of acne vulgaris, topical retinoids act to:
A. normalize desquamation of the follicular epithelium
B. minimize development of antibiotic-resistant Cutibacterium acnes
C. generate free radicals to oxidize proteins in the cell wall of Cutibacterium acnes
2|Page
,D. work within the cell ribosomes to alter upstream signals affecting inflammatory
pathways
Correct Answer: A. normalize desquamation of the follicular epithelium
Rationale: Topical retinoids normalize desquamation of the follicular epithelium to
prevent new formation of microcomedones, the precursors of both comedoal and
inflammatory lesions. Additionally, retinoids promote clearing of existing
microcomedones and work within the nucleus to alter downstream signals that affect
inflammatory pathways.
Question 6
A caregiver expresses concern for her 12 month old's lack of interest in playing with
other children, especially due to a family history of autism spectrum disorder. Which of
the following is the MOST appropriate next step?
A. suggest the caregiver attempt to engage the child in imitating behaviors
B. screen for social interactions such as peek-a-boo and pat-a-cake
C. offer reassurance that interactive play begins at age 3
D. refer for a developmental evaluation
Correct Answer: D. refer for a developmental evaluation
Rationale: Given the family history of autism spectrum disorder and the caregiver's
specific concern, referral for a developmental evaluation is the most appropriate next
step to either rule out or confirm developmental concerns.
Question 7
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
C. advise the caregiver to read to the child daily
D. refer to audiology for a hearing evaluation
Correct Answer: A. refer to a pediatric speech pathologist with access to
translators
Rationale: At two years of age a child should be speaking short phrases of two to three
words with a vocabulary of about 50 words. Bilingual children with significant delays in
vocabulary require the same evaluation as monolingual children with language delays.
3|Page
, Question 8
Appropriate instruction for a young adolescent male considering strength training to
enhance muscle mass includes that:
A. workouts should focus on 1-2 muscle groups on any exercise day
B. powerlifting should be delayed until later in reproductive maturation
C. strength training should occur at least five times a week to be effective
D. other forms of exercise should be avoided on days that strength training is done
Correct Answer: B. powerlifting should be delayed until later in
reproductive maturation
Rationale: Powerlifting should be avoided in prepubescent children due to possible
injury to long bones and growth plates as well as the back.
Question 9
A school-age child is seen for a skin rash that began about 6 weeks ago along with
bilateral limping, and a recent 2-week history of fever. Examination reveals
inflammation of knee joints. Which is the MOST likely diagnosis?
A. acute rheumatic fever
B. dermatomyositis
C. systemic juvenile idiopathic arthritis
D. systemic lupus erythematosus
Correct Answer: C. systemic juvenile idiopathic arthritis
Rationale: Systemic JIA causes inflammation in one or more joints for 6 weeks'
duration in a child younger than 16 years of age and is often accompanied by fatigue,
inflammation of joints, skin rash, and a high fever (103°F [39.4°C] or higher) that lasts
at least 2 weeks.
Question 10
An adolescent used a prescribed emergency contraceptive after having unprotected
sexual intercourse. A return visit and pregnancy test should be advised if there is no
menstrual period within:
A. 1 week
B. 2 weeks
C. 3 weeks
D. 4 weeks
Correct Answer: C. 3 weeks
Rationale: After taking an emergency contraceptive, the adolescent should return for a
pregnancy test within 3 weeks if menses have not started.
4|Page
