1|Page
PNCB CPNP-PC EXAM – PRIMARY CARE PEDIATRIC
NURSE PRACTITIONER CERTIFICATION EXAM
WITH QUESTIONS AND EXAM STRATEGIES WITH
RATIONALES
CONSISTS A STUDY GUIDE AT THE END
2025/2026 UPDATE
Bupropion is an antidepressant medication used to treat major depressive disorder and seasonal
affective disorder. Which of the following is a true statement about this drug?
A) Seizure risk is not dose-dependent.
B) Bupropion can safely be used in patients with anorexia
C) There is no withdrawal syndrome associated with abrupt discontinuation of bupropion.
D) Bupropion is a selective serotonin reuptake inhibitor
C) There is no withdrawal syndrome associated with abrupt discontinuation of bupropion.
A child develops osteomyelitis and the culture grows salmonella. The child most likely has:
A) Leukemia
B) IgG deficiency
C) A pet iguana
D) Sickle cell anemia
D) Sickle cell anemia
Patients with sickle cell anemia are prone to salmonella osteomyelitis. Capillary occlusion may
allow easier salmonella invasion through the gut. There is also reduced splenic function that
prevents clearing of the bacteria. Finally, sluggish flow through an expanded bone marrow
allows for bone involvement. Osteomyelitis usually occurs in long bones and in early childhood.
Among children, which is the most common cause of pancreatitis?
A) Biliary tract disease
,2|Page
B) Trauma
C) Alcohol
D) Coxsackievirus infection
B) Trauma
Intellectual disability is not equally distributed throughout the population. Which of the
following statements is true of intellectual disability's prevalence of diagnosis?
A) Rates of psychopathology among those with intellectual disability are equal to that in the
general population.
B) 50% of institutionalized patients with intellectual disability have psychopathology or behavior
disorders.
C) Diagnostic overshadowing makes diagnosing psychiatric disorders difficult.
D) Most intellectual disability specialists over-pathologize behavior in developmentally disabled
patients.
C) Diagnostic overshadowing makes diagnosing psychiatric disorders difficult.
A 10 year old boy presents with elbow pain after falling while playing indoor soccer.
Radiographic visualization of which of the following usually indicates an occult elbow fracture?
A) Anterior fat pad
B) Posterior fat pad
C) Baumann's angle of 75 degrees
D) Bilaterally equal Baumann's angles
B) Posterior fat pad
The skin lesion shown below is seen on the forehead of a patient with a neurocutaneous disorder
associated with seizures and hamartomas in multiple body parts. What is the most likely
diagnosis in a patient with such a lesion?
A) Tuberous sclerosis complex
B) Neurofibromatosis type 1
,3|Page
C) Hypomelanosis of Ito
D) Sturge-Weber syndrome
A) Tuberous sclerosis complex
Septo-optic dysplasia (DeMorsier Syndrome)
Triad of symptoms including:
• Optic nerve hypoplasia
• Midline developmental defects (dysgenesis or absence of the septum pellucidum,
thinning or absence of the corpus callosum
• Hypopituitarism
Patients must have 2 of the 3 features for diagnosis but only 30% of individuals with septo-optic
dysplasia will have all 3 features. Septo-optic dysplasia can present at birth or later on, following
the diagnosis of growth failure and/or vision abnormalities, including nystagmus.
Almost two-thirds of patients with septo-optic dysplasia have hypopituitarism and this can also
evolve over time. Growth hormone deficiency is the most common endocrine abnormality in
patients with septo-optic dysplasia and can occur in isolation or be associated with other
endocrine abnormalities, including hypothyroidism, diabetes insipidus centralis,
hypogonadotropic hypogonadism, and adrenal insufficiency.
A parent is concerned that her 4 month old baby is not getting adequate nutrition. She is currently
breastfeeding only. On examination, you notice generalized dermatitis and a scaly and crusted
plaque around the mouth and perianal area. Which of the following deficiencies would support
these findings?
A) Zinc and essential fatty acids
B) Vitamin C
C) Fluoride
D) Niacin, folate, riboflavin, and B12
A) Zinc and essential fatty acids
, 4|Page
A 6 year old boy presents for his annual well-child examination after moving to the area 2
months ago. His mother reports that he was the product of a full-term uncomplicated pregnancy
but in the newborn period a heart murmur was noted. A subsequent echocardiogram revealed
pulmonary valvular stenosis, which has been followed by cardiology and has remained stable
without intervention. In the office he is below the 3rd percentile for height and 30th percentile
for weight. His heart has a regular rate and rhythm with a grade 2/6 murmur, his lungs are clear
to auscultation bilaterally, and his abdomen is soft and not distended. You note webbing of his
neck, a low posterior hairline, hypertelorism, and downslanting palpebral fissures. What is the
most likely karyotype in this patient?
A) 46,XY
B) 47, XXY
C) 46, XY with triplet repeat expansion
D) 47, XY + 21
A) 46, XY
Which of the following scenarios represents an indication for closure of a ventricular septal
defect in an infant or young child?
A) Significant shunt flow with Qp/Qs > 2:1
B) Infant 8 months of age with controlled heart failure
C) Pulmonary artery pressure higher than systemic pressure
D) Irreversible pulmonary hypertension
A) Significant shunt flow with Qp/Qs > 2:1
Which of the following is true regarding isopropanol poisoning?
A) Blood urea nitrogen (BUN) may be falsely elevated.
B) Ketosis without acidosis is the characteristic lab abnormality.
C) Elevated anion gap is seen in most patients.
D) Ocular accumulation causing blindness is the typical pathophysiological finding.
B) Ketosis without acidosis is the characteristic lab abnormality.
PNCB CPNP-PC EXAM – PRIMARY CARE PEDIATRIC
NURSE PRACTITIONER CERTIFICATION EXAM
WITH QUESTIONS AND EXAM STRATEGIES WITH
RATIONALES
CONSISTS A STUDY GUIDE AT THE END
2025/2026 UPDATE
Bupropion is an antidepressant medication used to treat major depressive disorder and seasonal
affective disorder. Which of the following is a true statement about this drug?
A) Seizure risk is not dose-dependent.
B) Bupropion can safely be used in patients with anorexia
C) There is no withdrawal syndrome associated with abrupt discontinuation of bupropion.
D) Bupropion is a selective serotonin reuptake inhibitor
C) There is no withdrawal syndrome associated with abrupt discontinuation of bupropion.
A child develops osteomyelitis and the culture grows salmonella. The child most likely has:
A) Leukemia
B) IgG deficiency
C) A pet iguana
D) Sickle cell anemia
D) Sickle cell anemia
Patients with sickle cell anemia are prone to salmonella osteomyelitis. Capillary occlusion may
allow easier salmonella invasion through the gut. There is also reduced splenic function that
prevents clearing of the bacteria. Finally, sluggish flow through an expanded bone marrow
allows for bone involvement. Osteomyelitis usually occurs in long bones and in early childhood.
Among children, which is the most common cause of pancreatitis?
A) Biliary tract disease
,2|Page
B) Trauma
C) Alcohol
D) Coxsackievirus infection
B) Trauma
Intellectual disability is not equally distributed throughout the population. Which of the
following statements is true of intellectual disability's prevalence of diagnosis?
A) Rates of psychopathology among those with intellectual disability are equal to that in the
general population.
B) 50% of institutionalized patients with intellectual disability have psychopathology or behavior
disorders.
C) Diagnostic overshadowing makes diagnosing psychiatric disorders difficult.
D) Most intellectual disability specialists over-pathologize behavior in developmentally disabled
patients.
C) Diagnostic overshadowing makes diagnosing psychiatric disorders difficult.
A 10 year old boy presents with elbow pain after falling while playing indoor soccer.
Radiographic visualization of which of the following usually indicates an occult elbow fracture?
A) Anterior fat pad
B) Posterior fat pad
C) Baumann's angle of 75 degrees
D) Bilaterally equal Baumann's angles
B) Posterior fat pad
The skin lesion shown below is seen on the forehead of a patient with a neurocutaneous disorder
associated with seizures and hamartomas in multiple body parts. What is the most likely
diagnosis in a patient with such a lesion?
A) Tuberous sclerosis complex
B) Neurofibromatosis type 1
,3|Page
C) Hypomelanosis of Ito
D) Sturge-Weber syndrome
A) Tuberous sclerosis complex
Septo-optic dysplasia (DeMorsier Syndrome)
Triad of symptoms including:
• Optic nerve hypoplasia
• Midline developmental defects (dysgenesis or absence of the septum pellucidum,
thinning or absence of the corpus callosum
• Hypopituitarism
Patients must have 2 of the 3 features for diagnosis but only 30% of individuals with septo-optic
dysplasia will have all 3 features. Septo-optic dysplasia can present at birth or later on, following
the diagnosis of growth failure and/or vision abnormalities, including nystagmus.
Almost two-thirds of patients with septo-optic dysplasia have hypopituitarism and this can also
evolve over time. Growth hormone deficiency is the most common endocrine abnormality in
patients with septo-optic dysplasia and can occur in isolation or be associated with other
endocrine abnormalities, including hypothyroidism, diabetes insipidus centralis,
hypogonadotropic hypogonadism, and adrenal insufficiency.
A parent is concerned that her 4 month old baby is not getting adequate nutrition. She is currently
breastfeeding only. On examination, you notice generalized dermatitis and a scaly and crusted
plaque around the mouth and perianal area. Which of the following deficiencies would support
these findings?
A) Zinc and essential fatty acids
B) Vitamin C
C) Fluoride
D) Niacin, folate, riboflavin, and B12
A) Zinc and essential fatty acids
, 4|Page
A 6 year old boy presents for his annual well-child examination after moving to the area 2
months ago. His mother reports that he was the product of a full-term uncomplicated pregnancy
but in the newborn period a heart murmur was noted. A subsequent echocardiogram revealed
pulmonary valvular stenosis, which has been followed by cardiology and has remained stable
without intervention. In the office he is below the 3rd percentile for height and 30th percentile
for weight. His heart has a regular rate and rhythm with a grade 2/6 murmur, his lungs are clear
to auscultation bilaterally, and his abdomen is soft and not distended. You note webbing of his
neck, a low posterior hairline, hypertelorism, and downslanting palpebral fissures. What is the
most likely karyotype in this patient?
A) 46,XY
B) 47, XXY
C) 46, XY with triplet repeat expansion
D) 47, XY + 21
A) 46, XY
Which of the following scenarios represents an indication for closure of a ventricular septal
defect in an infant or young child?
A) Significant shunt flow with Qp/Qs > 2:1
B) Infant 8 months of age with controlled heart failure
C) Pulmonary artery pressure higher than systemic pressure
D) Irreversible pulmonary hypertension
A) Significant shunt flow with Qp/Qs > 2:1
Which of the following is true regarding isopropanol poisoning?
A) Blood urea nitrogen (BUN) may be falsely elevated.
B) Ketosis without acidosis is the characteristic lab abnormality.
C) Elevated anion gap is seen in most patients.
D) Ocular accumulation causing blindness is the typical pathophysiological finding.
B) Ketosis without acidosis is the characteristic lab abnormality.
