1|Page
PNCB PNPCP EXAM PREP 2025/2026 – PEDIATRIC NURSE
PRACTITIONER CERTIFICATION QUESTIONS, ANSWERS,
AND TEST BANK,100% CORRECT ALREADY GRADED A+
1. A 4-week-old term infant presents with rectal temperature 38.2°C
(100.8°F), appears well, feeding normally, and has normal vital signs.
According to AAP febrile infant guidance, what is the next best step
in management for a well-appearing term infant aged 29–60 days with
fever?
A. Immediate lumbar puncture and full sepsis workup
B. Outpatient observation with return precautions only
C. Perform age-appropriate evaluation including CBC, blood culture,
and consideration of urine testing; manage based on results
D. Prescribe oral antibiotics and discharge home
Correct answer: C
Topic: Febrile infant evaluation (AAP febrile infant guideline)
Rationale: For well-appearing febrile infants 29–60 days, AAP recommends
selective testing (blood, urine, possibly CSF based on age/risk), not
automatic empiric antibiotics for all; management depends on results and
clinical risk. Pediatrics Publications+1
2. An 8-month-old with wheeze and rhinorrhea is evaluated for
bronchiolitis. Which intervention is not routinely recommended by
current AAP bronchiolitis guidance?
A. Supportive care (hydration, suctioning, oxygen if hypoxic)
B. Routine chest radiography for all patients
C. Routine use of bronchodilators (albuterol) for all infants
D. Testing for specific viruses is generally not necessary
Correct answer: C (also B is incorrect recommendation; question asks which
is NOT recommended — both B and C are not routinely recommended; best
,2|Page
single choice reflecting pharmacologic not recommended = C)
Topic: Bronchiolitis management
Rationale: AAP bronchiolitis guidance emphasizes supportive care; routine
bronchodilators are not recommended because benefit is not consistent.
Imaging and routine viral testing are also generally not required. Pediatrics
Publications+1
3. A 3-year-old presents with barky cough and inspiratory stridor, worse
at night. Which is the most appropriate initial outpatient treatment for
mild croup?
A. Oral dexamethasone single dose
B. Inhaled racemic epinephrine at home
C. Immediate intubation
D. Oral antibiotics
Correct answer: A
Topic: Croup (laryngotracheobronchitis) management
Rationale: For mild croup, a single dose of oral dexamethasone reduces
symptoms; racemic epinephrine is reserved for moderate to severe distress;
antibiotics are not indicated unless bacterial infection suspected. (See
pediatric urgent care guidelines.) PNCB
4. A 7-year-old with known asthma presents after exercise with wheeze
relieved by a short-acting beta-agonist (SABA). Which of the
following indicates need for controller therapy (daily inhaled
corticosteroid) per current pediatric asthma management principles?
A. Symptoms only with vigorous exercise once monthly
B. Intermittent, <2 days/week daytime symptoms, <2 nighttime/month
C. Daytime symptoms >2 days/week or any nighttime awakenings
>2/month
D. Complete absence of symptoms for >6 months
Correct answer: C
Topic: Asthma control and step therapy
,3|Page
Rationale: Intermittent symptoms (<2 days/week) often managed with
SABA only; more frequent symptoms or nighttime awakenings indicate
persistent asthma and need for controller therapy. PNCB+1
5. A 2-year-old with fever and otalgia is diagnosed with acute otitis
media. Which antibiotic is first-line for most children without
penicillin allergy?
A. Azithromycin PO once daily for 3 days
B. Amoxicillin high-dose (80–90 mg/kg/day divided)
C. Ceftriaxone IM as first-line outpatient therapy
D. No antibiotics — always observe
Correct answer: B
Topic: Acute otitis media (AOM) treatment
Rationale: High-dose amoxicillin remains first-line for most children with
AOM unless recent beta-lactam exposure or severe disease; observation may
be appropriate for some age groups and mild disease per guidelines.
PNCB+1
6. A 14-year-old with type 1 diabetes presents with polyuria, abdominal
pain, tachypnea, serum glucose 420 mg/dL, venous pH 7.18,
bicarbonate 10 mEq/L. Best next step in management?
A. Give subcutaneous insulin and send home with outpatient follow-
up
B. Start IV fluids and IV insulin infusion; evaluate electrolytes and
potassium — admit to monitored setting
C. Administer oral glucose and observe
D. Give bicarbonate immediately
Correct answer: B
Topic: Pediatric diabetic ketoacidosis (DKA) management
Rationale: DKA (pH <7.3, HCO3 low) requires IV fluids, insulin infusion,
frequent electrolyte (esp. potassium) monitoring and usually inpatient care.
, 4|Page
Routine bicarbonate therapy is not recommended except in extreme acidosis.
NCBI+1
7. A 4-year-old fails a basic developmental screen for language delay.
Which action is the most appropriate next step in primary care?
A. Wait until age 5 to reassess
B. Refer for immediate speech-language evaluation and consider
audiology testing
C. Start stimulant medication empirically
D. Begin occupational therapy without further evaluation
Correct answer: B
Topic: Developmental screening and early intervention
Rationale: Early referral to speech-language pathology and audiology (to
rule out hearing loss) is recommended once screening is concerning — early
intervention improves outcomes. PNCB
8. Which of the following urine findings in a febrile 3-year-old most
strongly suggests true urinary tract infection (UTI) requiring
antibiotics?
A. Dipstick positive for blood only
B. Urine nitrite positive and pyuria on microscopy
C. Cloudy urine reported by parent only
D. Single bacterial colony on catheterized specimen culture
Correct answer: B
Topic: Pediatric UTI diagnosis
Rationale: Positive nitrite plus pyuria increases likelihood of true UTI;
diagnosis should be confirmed with urine culture and treated appropriately.
PNCB
9. A newborn born at 36 weeks has respiratory distress and grunting;
chest x-ray shows ground-glass appearance and low volumes. Which
PNCB PNPCP EXAM PREP 2025/2026 – PEDIATRIC NURSE
PRACTITIONER CERTIFICATION QUESTIONS, ANSWERS,
AND TEST BANK,100% CORRECT ALREADY GRADED A+
1. A 4-week-old term infant presents with rectal temperature 38.2°C
(100.8°F), appears well, feeding normally, and has normal vital signs.
According to AAP febrile infant guidance, what is the next best step
in management for a well-appearing term infant aged 29–60 days with
fever?
A. Immediate lumbar puncture and full sepsis workup
B. Outpatient observation with return precautions only
C. Perform age-appropriate evaluation including CBC, blood culture,
and consideration of urine testing; manage based on results
D. Prescribe oral antibiotics and discharge home
Correct answer: C
Topic: Febrile infant evaluation (AAP febrile infant guideline)
Rationale: For well-appearing febrile infants 29–60 days, AAP recommends
selective testing (blood, urine, possibly CSF based on age/risk), not
automatic empiric antibiotics for all; management depends on results and
clinical risk. Pediatrics Publications+1
2. An 8-month-old with wheeze and rhinorrhea is evaluated for
bronchiolitis. Which intervention is not routinely recommended by
current AAP bronchiolitis guidance?
A. Supportive care (hydration, suctioning, oxygen if hypoxic)
B. Routine chest radiography for all patients
C. Routine use of bronchodilators (albuterol) for all infants
D. Testing for specific viruses is generally not necessary
Correct answer: C (also B is incorrect recommendation; question asks which
is NOT recommended — both B and C are not routinely recommended; best
,2|Page
single choice reflecting pharmacologic not recommended = C)
Topic: Bronchiolitis management
Rationale: AAP bronchiolitis guidance emphasizes supportive care; routine
bronchodilators are not recommended because benefit is not consistent.
Imaging and routine viral testing are also generally not required. Pediatrics
Publications+1
3. A 3-year-old presents with barky cough and inspiratory stridor, worse
at night. Which is the most appropriate initial outpatient treatment for
mild croup?
A. Oral dexamethasone single dose
B. Inhaled racemic epinephrine at home
C. Immediate intubation
D. Oral antibiotics
Correct answer: A
Topic: Croup (laryngotracheobronchitis) management
Rationale: For mild croup, a single dose of oral dexamethasone reduces
symptoms; racemic epinephrine is reserved for moderate to severe distress;
antibiotics are not indicated unless bacterial infection suspected. (See
pediatric urgent care guidelines.) PNCB
4. A 7-year-old with known asthma presents after exercise with wheeze
relieved by a short-acting beta-agonist (SABA). Which of the
following indicates need for controller therapy (daily inhaled
corticosteroid) per current pediatric asthma management principles?
A. Symptoms only with vigorous exercise once monthly
B. Intermittent, <2 days/week daytime symptoms, <2 nighttime/month
C. Daytime symptoms >2 days/week or any nighttime awakenings
>2/month
D. Complete absence of symptoms for >6 months
Correct answer: C
Topic: Asthma control and step therapy
,3|Page
Rationale: Intermittent symptoms (<2 days/week) often managed with
SABA only; more frequent symptoms or nighttime awakenings indicate
persistent asthma and need for controller therapy. PNCB+1
5. A 2-year-old with fever and otalgia is diagnosed with acute otitis
media. Which antibiotic is first-line for most children without
penicillin allergy?
A. Azithromycin PO once daily for 3 days
B. Amoxicillin high-dose (80–90 mg/kg/day divided)
C. Ceftriaxone IM as first-line outpatient therapy
D. No antibiotics — always observe
Correct answer: B
Topic: Acute otitis media (AOM) treatment
Rationale: High-dose amoxicillin remains first-line for most children with
AOM unless recent beta-lactam exposure or severe disease; observation may
be appropriate for some age groups and mild disease per guidelines.
PNCB+1
6. A 14-year-old with type 1 diabetes presents with polyuria, abdominal
pain, tachypnea, serum glucose 420 mg/dL, venous pH 7.18,
bicarbonate 10 mEq/L. Best next step in management?
A. Give subcutaneous insulin and send home with outpatient follow-
up
B. Start IV fluids and IV insulin infusion; evaluate electrolytes and
potassium — admit to monitored setting
C. Administer oral glucose and observe
D. Give bicarbonate immediately
Correct answer: B
Topic: Pediatric diabetic ketoacidosis (DKA) management
Rationale: DKA (pH <7.3, HCO3 low) requires IV fluids, insulin infusion,
frequent electrolyte (esp. potassium) monitoring and usually inpatient care.
, 4|Page
Routine bicarbonate therapy is not recommended except in extreme acidosis.
NCBI+1
7. A 4-year-old fails a basic developmental screen for language delay.
Which action is the most appropriate next step in primary care?
A. Wait until age 5 to reassess
B. Refer for immediate speech-language evaluation and consider
audiology testing
C. Start stimulant medication empirically
D. Begin occupational therapy without further evaluation
Correct answer: B
Topic: Developmental screening and early intervention
Rationale: Early referral to speech-language pathology and audiology (to
rule out hearing loss) is recommended once screening is concerning — early
intervention improves outcomes. PNCB
8. Which of the following urine findings in a febrile 3-year-old most
strongly suggests true urinary tract infection (UTI) requiring
antibiotics?
A. Dipstick positive for blood only
B. Urine nitrite positive and pyuria on microscopy
C. Cloudy urine reported by parent only
D. Single bacterial colony on catheterized specimen culture
Correct answer: B
Topic: Pediatric UTI diagnosis
Rationale: Positive nitrite plus pyuria increases likelihood of true UTI;
diagnosis should be confirmed with urine culture and treated appropriately.
PNCB
9. A newborn born at 36 weeks has respiratory distress and grunting;
chest x-ray shows ground-glass appearance and low volumes. Which
