CPN Certified pediatric nurse credential
recognizing specialized competencies in pediatric
assessment, treatment, and family support.
Question 1
A 4-year-old child is brought to the pediatric clinic for a well-child visit. The nurse
notes that the child's weight is below the 5th percentile on the growth chart, but
height and head circumference are at the 50th percentile. Which assessment should
the nurse prioritize?
A) Obtain a dietary history and assess for feeding difficulties
B) Evaluate for failure to thrive and obtain a 3-day food diary
C) Reassure the parents that this is a normal variation
D) Refer the child to a pediatric endocrinologist immediately
Rationale: A weight below the 5th percentile with normal height and head
circumference suggests possible failure to thrive (FTT) or nutritional deficiency
rather than a constitutional growth delay, which would show proportionate growth.
A 3-day food diary and dietary history are essential to identify caloric intake
issues. Reassurance without investigation is inappropriate, and endocrine referral is
premature without further assessment.
Question 2
A 7-year-old child with a history of asthma presents with wheezing, retractions,
and an oxygen saturation of 89% on room air. The nurse notes that the child is
speaking in short phrases. Which assessment finding indicates the MOST severe
respiratory distress?
A) Wheezing audible without a stethoscope
B) Respiratory rate of 32 breaths/min
C) Inability to speak in full sentences
D) Use of accessory muscles
Rationale: Inability to speak in full sentences is a sign of severe respiratory
distress and impending respiratory failure. Wheezing, tachypnea, and accessory
,muscle use are concerning but indicate moderate distress. The inability to speak
indicates that the child cannot generate adequate airflow for speech, requiring
immediate intervention.
Question 3
A 2-year-old child is being assessed for developmental milestones. The parent
reports that the child can walk independently, say approximately 50 words, and
point to body parts when named. The nurse should recognize that:
A) The child is developmentally delayed
B) The child is meeting developmental milestones for age
C) The child is advanced for age
D) The child should be referred for further evaluation
Rationale: At 24 months, a typically developing child can walk independently,
speak 50+ words, and point to named body parts. These milestones are consistent
with expected development for a 2-year-old. No referral is indicated.
Question 4
A 10-year-old child is admitted with suspected appendicitis. Which pain
assessment tool is MOST appropriate for this child?
A) FLACC scale
B) Wong-Baker FACES Pain Rating Scale
C) NIPS scale
D) CRIES scale
Rationale: The Wong-Baker FACES scale is appropriate for children aged 3 years
and older who can self-report pain. The FLACC scale is for infants and young
children (2 months to 7 years) who cannot self-report. NIPS and CRIES are for
neonates and infants.
Question 5
A 6-month-old infant is brought to the emergency department with fever,
irritability, and a bulging fontanelle. The nurse suspects meningitis. Which
assessment finding would further support this suspicion?
,A) Positive Brudzinski's sign
B) Sunken anterior fontanelle
C) Absent Moro reflex
D) Hyperactive bowel sounds
Rationale: Brudzinski's sign (neck stiffness with hip and knee flexion when the
neck is flexed) is a classic sign of meningeal irritation. A bulging fontanelle
already suggests increased intracranial pressure; a sunken fontanelle would
indicate dehydration. While an absent Moro reflex may occur in neurological
impairment, it is not specific to meningitis.
Question 6
An adolescent patient reports significant weight loss, fatigue, and polyuria over the
past month. The nurse notes a fruity odor to the breath. Which assessment should
the nurse perform FIRST?
A) Obtain a complete blood count
B) Check the blood glucose level
C) Assess for orthostatic hypotension
D) Obtain a urine culture
Rationale: The triad of weight loss, polyuria, and fruity breath odor suggests
diabetic ketoacidosis (DKA). The priority is to check blood glucose to confirm
hyperglycemia and guide immediate management. DKA is a medical emergency
requiring prompt intervention.
Question 7
A nurse is assessing a 3-year-old child for signs of physical abuse. Which finding
is MOST concerning for suspected maltreatment?
A) A bruise on the shin from a recent fall
B) Bruises in various stages of healing on the back and buttocks
C) A small laceration on the knee from playing outside
D) A healing abrasion on the palm from a fall
Rationale: Bruises in various stages of healing on the back, buttocks, or other
protected areas are highly concerning for physical abuse. These areas are not
, typically injured in normal play. Bruises on the shins, knees, and palms are
common in active children and are consistent with accidental injury.
Question 8
A 14-year-old patient is being assessed for scoliosis during a school physical. The
nurse asks the patient to bend forward at the waist with arms hanging freely. This
maneuver is used to assess for:
A) Kyphosis
B) Lordosis
C) Asymmetry of the rib cage (Adam's forward bend test)
D) Spinal flexibility
Rationale: The Adam's forward bend test is used to screen for scoliosis. When the
patient bends forward, asymmetry of the rib cage (a "rib hump") indicates spinal
curvature. Kyphosis (hunchback) and lordosis (swayback) are assessed through
visual inspection of spinal alignment.
Question 9
A 1-year-old child is being assessed for anemia during a routine visit. The nurse
notes pallor and tachycardia. Which additional assessment finding would MOST
support a diagnosis of iron deficiency anemia?
A) Pica (eating non-food items)
B) Jaundice
C) Petechiae
D) Hepatosplenomegaly
Rationale: Pica (eating non-food items such as dirt, ice, or paper) is a classic sign
of iron deficiency anemia. Jaundice suggests hemolytic anemia, petechiae suggests
thrombocytopenia or leukemia, and hepatosplenomegaly suggests hemolytic
disease or malignancy.
Question 10
A 5-year-old child is admitted with a diagnosis of bacterial meningitis. The nurse
recognizing specialized competencies in pediatric
assessment, treatment, and family support.
Question 1
A 4-year-old child is brought to the pediatric clinic for a well-child visit. The nurse
notes that the child's weight is below the 5th percentile on the growth chart, but
height and head circumference are at the 50th percentile. Which assessment should
the nurse prioritize?
A) Obtain a dietary history and assess for feeding difficulties
B) Evaluate for failure to thrive and obtain a 3-day food diary
C) Reassure the parents that this is a normal variation
D) Refer the child to a pediatric endocrinologist immediately
Rationale: A weight below the 5th percentile with normal height and head
circumference suggests possible failure to thrive (FTT) or nutritional deficiency
rather than a constitutional growth delay, which would show proportionate growth.
A 3-day food diary and dietary history are essential to identify caloric intake
issues. Reassurance without investigation is inappropriate, and endocrine referral is
premature without further assessment.
Question 2
A 7-year-old child with a history of asthma presents with wheezing, retractions,
and an oxygen saturation of 89% on room air. The nurse notes that the child is
speaking in short phrases. Which assessment finding indicates the MOST severe
respiratory distress?
A) Wheezing audible without a stethoscope
B) Respiratory rate of 32 breaths/min
C) Inability to speak in full sentences
D) Use of accessory muscles
Rationale: Inability to speak in full sentences is a sign of severe respiratory
distress and impending respiratory failure. Wheezing, tachypnea, and accessory
,muscle use are concerning but indicate moderate distress. The inability to speak
indicates that the child cannot generate adequate airflow for speech, requiring
immediate intervention.
Question 3
A 2-year-old child is being assessed for developmental milestones. The parent
reports that the child can walk independently, say approximately 50 words, and
point to body parts when named. The nurse should recognize that:
A) The child is developmentally delayed
B) The child is meeting developmental milestones for age
C) The child is advanced for age
D) The child should be referred for further evaluation
Rationale: At 24 months, a typically developing child can walk independently,
speak 50+ words, and point to named body parts. These milestones are consistent
with expected development for a 2-year-old. No referral is indicated.
Question 4
A 10-year-old child is admitted with suspected appendicitis. Which pain
assessment tool is MOST appropriate for this child?
A) FLACC scale
B) Wong-Baker FACES Pain Rating Scale
C) NIPS scale
D) CRIES scale
Rationale: The Wong-Baker FACES scale is appropriate for children aged 3 years
and older who can self-report pain. The FLACC scale is for infants and young
children (2 months to 7 years) who cannot self-report. NIPS and CRIES are for
neonates and infants.
Question 5
A 6-month-old infant is brought to the emergency department with fever,
irritability, and a bulging fontanelle. The nurse suspects meningitis. Which
assessment finding would further support this suspicion?
,A) Positive Brudzinski's sign
B) Sunken anterior fontanelle
C) Absent Moro reflex
D) Hyperactive bowel sounds
Rationale: Brudzinski's sign (neck stiffness with hip and knee flexion when the
neck is flexed) is a classic sign of meningeal irritation. A bulging fontanelle
already suggests increased intracranial pressure; a sunken fontanelle would
indicate dehydration. While an absent Moro reflex may occur in neurological
impairment, it is not specific to meningitis.
Question 6
An adolescent patient reports significant weight loss, fatigue, and polyuria over the
past month. The nurse notes a fruity odor to the breath. Which assessment should
the nurse perform FIRST?
A) Obtain a complete blood count
B) Check the blood glucose level
C) Assess for orthostatic hypotension
D) Obtain a urine culture
Rationale: The triad of weight loss, polyuria, and fruity breath odor suggests
diabetic ketoacidosis (DKA). The priority is to check blood glucose to confirm
hyperglycemia and guide immediate management. DKA is a medical emergency
requiring prompt intervention.
Question 7
A nurse is assessing a 3-year-old child for signs of physical abuse. Which finding
is MOST concerning for suspected maltreatment?
A) A bruise on the shin from a recent fall
B) Bruises in various stages of healing on the back and buttocks
C) A small laceration on the knee from playing outside
D) A healing abrasion on the palm from a fall
Rationale: Bruises in various stages of healing on the back, buttocks, or other
protected areas are highly concerning for physical abuse. These areas are not
, typically injured in normal play. Bruises on the shins, knees, and palms are
common in active children and are consistent with accidental injury.
Question 8
A 14-year-old patient is being assessed for scoliosis during a school physical. The
nurse asks the patient to bend forward at the waist with arms hanging freely. This
maneuver is used to assess for:
A) Kyphosis
B) Lordosis
C) Asymmetry of the rib cage (Adam's forward bend test)
D) Spinal flexibility
Rationale: The Adam's forward bend test is used to screen for scoliosis. When the
patient bends forward, asymmetry of the rib cage (a "rib hump") indicates spinal
curvature. Kyphosis (hunchback) and lordosis (swayback) are assessed through
visual inspection of spinal alignment.
Question 9
A 1-year-old child is being assessed for anemia during a routine visit. The nurse
notes pallor and tachycardia. Which additional assessment finding would MOST
support a diagnosis of iron deficiency anemia?
A) Pica (eating non-food items)
B) Jaundice
C) Petechiae
D) Hepatosplenomegaly
Rationale: Pica (eating non-food items such as dirt, ice, or paper) is a classic sign
of iron deficiency anemia. Jaundice suggests hemolytic anemia, petechiae suggests
thrombocytopenia or leukemia, and hepatosplenomegaly suggests hemolytic
disease or malignancy.
Question 10
A 5-year-old child is admitted with a diagnosis of bacterial meningitis. The nurse
