CPNP-PC Certified Pediatric Nurse Practitioner - Primary Care Practice Questions
Prepare for CPNP-PC with more than an answer.
- 1
While performing developmental surveillance at a 24-month preventive health visit, which expressive language finding indicates that a healthy toddler is achieving expected age-appropriate developmental milestones?
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Correct answer: C
By 24 months of age, a healthy toddler is expected to have an expressive vocabulary of at least 30 to 50 words, combine two words into meaningful phrases (e.g., "more milk," "mommy go"), and have speech that is approximately 50% intelligible to familiar caregivers. Telling a simple story, stating one's first and last name, and counting three objects with one-to-one correspondence are advanced language and cognitive milestones typically achieved between 3 and 4 years of age.
- 2
A 7-year-old boy is evaluated for short stature. Review of his World Health Organization (WHO) and CDC growth charts shows that his birth length was at the 50th percentile, decelerated smoothly between 6 and 24 months to the 5th percentile, and has since tracked steadily along the 5th percentile with a linear growth velocity of 5.5 cm/year over the past 3 years. His weight-for-stature and BMI are at the 40th percentile. Physical examination is normal. His mother is 163 cm (50th percentile), and his father is 175 cm (45th percentile); the father reports that he was the shortest boy in his class until age 15, when he had a late growth spurt. Left wrist radiograph reveals a bone age of 5 years. Which interpretation of these growth parameters is most accurate?
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Correct answer: D
Constitutional delay of growth and puberty is a benign normal variant characterized by normal birth size, a physiologic downward shift in length/height percentile between 6 and 36 months of age, and subsequent normal prepubertal linear growth velocity (5–6 cm/year) tracking parallel to the lower growth curve. Key distinguishing features include a delayed bone age compared to chronological age (but concordant with height age), a positive family history of delayed pubertal tempo (a "late bloomer" parent), and a predicted final adult height within the normal midparental target range. In familial short stature, bone age is consistent with chronological age and parents are short; in growth hormone deficiency or hypothyroidism, annual linear growth velocity is pathologically subnormal (<4 cm/year) with progressive downward crossing of percentiles after age 3 years.
flowchart TD Short[Short Stature: Height Velocity{Annual Growth Velocity After Age 3} Velocity -->|Normal: >= 5 cm/year| BoneAge{Evaluate Left Wrist Bone Age} Velocity -->|Subnormal: < 4 cm/year| Pathologic[Pathologic Short Stature] BoneAge -->|Delayed Bone Age & Family History of Late Puberty| CDGP[Constitutional Delay of Growth & Puberty] BoneAge -->|Bone Age = Chronological Age & Short Parents| FSS[Familial Short Stature] Pathologic --> WtHt{Weight-for-Height Ratio} WtHt -->|Increased Weight-to-Height| Endo[Endocrine: Hypothyroidism, GH Deficiency, Cushing] WtHt -->|Decreased Weight-to-Height| GI[Nutritional/GI: Celiac Disease, IBD, Malnutrition] - 3
An 8-year-old girl presents to the clinic with a 6-month history of fatigue, cold intolerance, constipation, and declining linear growth velocity despite a 3-kg weight gain. Physical examination reveals dry hair, sallow and coarse skin, periorbital puffiness, a heart rate of 62 beats/min, and a symmetrically enlarged, nontender thyroid gland. Which diagnostic laboratory studies are most useful to establish a diagnosis?
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Correct answer: B
The child's presentation—decelerating linear growth with weight gain, fatigue, constipation, cold intolerance, bradycardia, dry hair, sallow coarse skin, and a painless goiter—is classic for acquired hypothyroidism, most commonly caused by autoimmune (Hashimoto) thyroiditis in school-aged children. Ordering serum free thyroxine (free T4) and thyroid-stimulating hormone (TSH) is the most direct and useful initial diagnostic workup to establish the diagnosis (typically demonstrating a markedly elevated TSH and low free T4 in primary hypothyroidism, which can then be confirmed etiologically with anti-thyroid peroxidase and anti-thyroglobulin antibodies). Serum calcitonin evaluates medullary thyroid carcinoma, 24-hour urinary free cortisol evaluates Cushing syndrome, and radioactive iodine uptake scans are not indicated for routine acquired hypothyroidism.
- 4
A healthy, full-term newborn delivered vaginally at 39 weeks' gestation is discharged home at 36 hours of life after an uncomplicated nursery course. The mother is a primigravida who is exclusively breastfeeding. According to the Bright Futures/American Academy of Pediatrics (AAP) Recommendations for Preventive Pediatric Health Care, when must this newborn's initial outpatient follow-up evaluation take place, and what clinical assessments are prioritized?
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Correct answer: B
According to the Bright Futures/AAP Recommendations for Preventive Pediatric Health Care and the AAP clinical practice guideline on hyperbilirubinemia, any newborn discharged less than 48 hours after delivery must be evaluated in the outpatient setting within 48 hours of discharge (typically corresponding to 3 to 5 days of age). The primary focus of this visit is to assess breastfeeding latch and milk transfer, percentage of weight loss from birth, hydration status (voiding and stooling patterns), and clinical or transcutaneous/serum bilirubin levels as bilirubin peaks between days 3 and 5 of life. Waiting until 1 or 2 weeks of age risks missing severe hyperbilirubinemia (kernicterus) or hypernatremic dehydration. Critical congenital heart disease (CCHD) screening via pulse oximetry is completed after 24 hours of life prior to hospital discharge rather than deferred to 1 week.
flowchart TD Birth([Newborn Hospital Birth]) --> CheckDischarge{Length of Nursery Stay} CheckDischarge -->|Discharged < 48 Hours| EarlyVisit[Outpatient Visit Within 48 Hours of Discharge] CheckDischarge -->|Discharged >= 48 Hours| StandardVisit[Outpatient Visit Within 48-72 Hours of Discharge] EarlyVisit --> Assess[Assess Feeding, Weight Change, Hydration, & Jaundice at 3-5 Days] StandardVisit --> Assess Assess --> NextVisit([Next Scheduled Preventive Visit by 1 Month]) - 5
During a 12-month preventive health visit, the caregiver of a healthy toddler with four erupted primary incisors states that the child has not yet seen a dentist and asks when to begin using fluoride toothpaste. In addition to performing an oral health risk assessment and referring the family to establish a dental home, which anticipatory guidance should the pediatric nurse practitioner provide?
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Correct answer: D
Current AAP and Bright Futures oral health guidelines recommend that caregivers brush a child's teeth twice daily (after breakfast and before bedtime) with fluoridated toothpaste as soon as the first primary tooth erupts. For children younger than 3 years of age, the proper age-based dosage is a smear or grain-of-rice-sized amount (approximately 0.1 mg of fluoride), which provides topical caries protection while minimizing the risk of fluorosis if swallowed. At age 3 through 6 years, the dosage increases to a pea-sized amount (approximately 0.25 mg of fluoride). Non-fluoridated toothpaste does not prevent early childhood caries, and systemic fluoride supplementation is reserved only for children aged 6 months and older whose primary drinking water source is deficient in fluoride (<0.6 ppm).
- 6
At a 6-month well-child visit, the parents of an exclusively breastfed infant who now sits with minimal support, has lost the extrusion reflex, and shows strong interest in family meals ask how to safely introduce complementary foods. Which TWO dietary recommendations should the pediatric nurse practitioner emphasize during anticipatory guidance? (Select TWO)
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Correct answer: D, E
Honey (both raw and pasteurized/cooked) must be strictly avoided before 12 months of age because the infant gastrointestinal tract lacks sufficient acidity and mature flora to inhibit Clostridium botulinum spore germination and toxin production. Whole cow's milk must also be avoided as a main drink before 12 months because it is low in bioavailable iron, presents a high renal solute load, and can induce occult gastrointestinal blood loss. Conversely, delaying allergenic foods (peanut, egg) increases allergy risk, and 100% fruit juice is not recommended before 12 months of age.
By 6 months of age, a full-term infant's endogenous transplacental iron stores are largely depleted, and human milk alone does not provide sufficient iron or zinc to meet rapid growth demands; therefore, introducing bioavailable iron- and zinc-rich foods (such as puréed meats or iron-fortified infant cereal) is a top nutritional priority.
