Certified Pediatric Nurse (CPN) Exam — Questions and Answers

Question 1: Which ethical principle is most directly violated when a nurse shares a pediatric patient's HIV status with the child's school without consent?

Nonmaleficence
Beneficence
Confidentiality (Correct answer)
Justice

Correct answer: Confidentiality

Disclosing a patient's HIV status without consent violates confidentiality, a cornerstone of the nurse-patient relationship and HIPAA.

Question 2: When providing education to the parents of a child with a newly diagnosed chronic illness like asthma, the primary goal from a family-centered perspective is to:

empower the parents to become confident and competent partners in managing their child's health. (Correct answer)
ensure the parents can recite the names and doses of all prescribed medications.
have the parents sign a form indicating they understand the discharge instructions completely.
prevent all future hospital readmissions related to the child's chronic illness.

Correct answer: empower the parents to become confident and competent partners in managing their child's health.

While knowledge of medications and preventing readmissions are important outcomes, the fundamental goal of education in family-centered care is empowerment. This means equipping the family with the knowledge, skills, and confidence to manage the child's condition effectively, advocate for their child, and make informed decisions as part of the healthcare team.

Question 3: Which of the following vaccines is classified as a live attenuated vaccine?

Inactivated poliovirus vaccine (IPV)
Varicella (chickenpox) vaccine (Correct answer)
Hib conjugate vaccine
Hepatitis B vaccine

Correct answer: Varicella (chickenpox) vaccine

The varicella vaccine contains a live but weakened form of varicella-zoster virus and is contraindicated in severely immunocompromised patients.

Question 4: A 4-month-old infant is unable to hold their head steady when pulled to sitting. What is the nurse's priority action?

Notify the provider and document the finding (Correct answer)
Reassure the parents
Document as a normal finding
Schedule a recheck at 6 months

Correct answer: Notify the provider and document the finding

Head control when pulled to sitting should be present by 4 months; absence suggests a developmental delay requiring provider notification.

Question 5: When teaching a parent about acetaminophen dosing for a 3-year-old, the nurse emphasizes:

Doses are based on the child's age
The maximum dose is 15 mg/kg every 4 hours not exceeding 5 doses in 24 hours (Correct answer)
Alternate with aspirin for better fever control
Adult strength tablets are fine if halved

Correct answer: The maximum dose is 15 mg/kg every 4 hours not exceeding 5 doses in 24 hours

Pediatric acetaminophen dosing is weight-based at 10–15 mg/kg every 4–6 hours with a maximum of 5 doses per 24 hours.

Question 6: A pediatric patient is on gentamicin therapy. Which laboratory values are most important to monitor?

CBC and liver function tests
PT/INR and platelet count
Serum sodium and potassium only
BUN, creatinine, and peak/trough drug levels (Correct answer)

Correct answer: BUN, creatinine, and peak/trough drug levels

Gentamicin is nephrotoxic and ototoxic; monitoring renal function and serum drug levels prevents toxicity.

Question 7: The "Rights of Medication Administration" are a critical framework for safety. In pediatrics, an additional consideration often referred to as the "eighth right" is crucial. Which of the following best represents this additional right?

Right Documentation
Right Reason/Indication (Correct answer)
Right Patient
Right to Refuse

Correct answer: Right Reason/Indication

While all the traditional "rights" (patient, drug, dose, route, time, documentation, response) are essential, the "Right Reason/Indication" is often emphasized as a critical addition in all patient populations, including pediatrics. This involves the nurse understanding why a specific medication is being prescribed for the child and confirming it is appropriate for their condition. This cognitive step helps prevent errors by questioning orders that may not align with the child's diagnosis or current status. While the right to refuse is a patient right, the "Right Reason" is a key component of the nurse's safety check.

Question 8: Which newborn reflex is expected to disappear by 4–6 months of age?

Blink reflex
Rooting reflex at feeding times
Babinski reflex
Moro reflex (Correct answer)

Correct answer: Moro reflex

The Moro (startle) reflex is present at birth and normally disappears by 4–6 months as the nervous system matures.

Question 9: Which rash pattern is characteristic of Lyme disease?

Maculopapular rash beginning on the face and spreading downward
Petechial rash concentrated on the trunk
Erythema migrans — an expanding bull's-eye rash at the tick bite site (Correct answer)
Vesicular rash on the palms and soles

Correct answer: Erythema migrans — an expanding bull's-eye rash at the tick bite site

Erythema migrans, an expanding circular rash with central clearing resembling a bull's-eye, is pathognomonic for Lyme disease caused by Borrelia burgdorferi.

Question 10: A 9-month-old infant is brought to the emergency department with a 2-day history of rhinorrhea, cough, and wheezing. Assessment reveals a respiratory rate of 65 breaths/minute, prominent intercostal retractions, and an oxygen saturation of 91% on room air. The infant is having difficulty breastfeeding. Which of the following is the priority nursing intervention?

Administering a prescribed bronchodilator via nebulizer.
Obtaining a nasopharyngeal swab for RSV testing.
Initiating intravenous fluids and supplemental oxygen. (Correct answer)
Encouraging the mother to continue breastfeeding frequently.

Correct answer: Initiating intravenous fluids and supplemental oxygen.

The infant is showing clear signs of respiratory distress (tachypnea, retractions, hypoxia) and dehydration (difficulty feeding), which are common in severe bronchiolitis. The priority is to stabilize the infant by correcting hypoxemia with supplemental oxygen and addressing dehydration with IV fluids, as oral intake is compromised. While an RSV test may be done, it is not the immediate priority over stabilization. Bronchodilators are not routinely recommended as they have not shown consistent efficacy. Encouraging breastfeeding is important but not the priority when the infant is in significant respiratory distress and unable to feed effectively.

Question 11: When teaching a parent about administering oral iron supplements to a toddler, the nurse should include:

Give with milk to reduce GI upset
Give between meals for better absorption and with dairy
Administer through a straw to protect tooth enamel (Correct answer)
Expect stools to turn yellow

Correct answer: Administer through a straw to protect tooth enamel

Iron can stain teeth, so using a straw or dropper placed toward the back of the mouth protects enamel.

Question 12: An 8-month-old infant is brought to the ED with a history of sudden, intermittent episodes of inconsolable crying and drawing his knees to his chest. The parent reports one diaper with bloody, mucus-like stool. Between episodes, the infant is lethargic. Which condition should the nurse suspect?

Intussusception (Correct answer)
Appendicitis
Pyloric Stenosis
Gastroenteritis

Correct answer: Intussusception

This clinical presentation is classic for intussusception, where one segment of the intestine telescopes into another. The key features are intermittent, severe, colicky abdominal pain; lethargy between episodes; and the passage of 'currant jelly' stool (a mixture of blood and mucus). Gastroenteritis typically presents with watery diarrhea. Pyloric stenosis involves projectile, non-bilious vomiting and is more common in younger infants. Appendicitis is rare in infants and presents with more constant, localizing pain.

Question 13: According to the Bright Futures guidelines, when should a child receive their first routine vision screening using an eye chart?

Age 2 years
Age 6 years
Age 3–4 years (Correct answer)
Age 1 year

Correct answer: Age 3–4 years

Formal visual acuity screening with an eye chart is typically initiated at ages 3–4 years when children can cooperate with the test.

Question 14: Palivizumab (Synagis) is administered monthly during RSV season to provide prophylaxis against which pathogen?

Respiratory syncytial virus (RSV) (Correct answer)
Bordetella pertussis
Influenza virus
Rotavirus

Correct answer: Respiratory syncytial virus (RSV)

Palivizumab is a monoclonal antibody targeting RSV, given monthly in fall/winter to high-risk infants such as those born prematurely or with congenital heart disease.

Question 15: A nurse is named in a malpractice lawsuit. Which document will be most critical to her defense?

Her nursing school diploma
Accurate and thorough nursing documentation from the time of care (Correct answer)
The hospital's general policy manual
Verbal testimony from coworkers

Correct answer: Accurate and thorough nursing documentation from the time of care

Contemporaneous, accurate nursing documentation is the strongest evidence of the care provided and is central to any malpractice defense.

Question 16: When teaching parents about administering iron supplements to their child, which instruction is most important?

Administer at bedtime for best absorption
Give with calcium-rich foods for improved tolerance
Mix with milk to reduce stomach upset
Give with vitamin C-rich juice to enhance absorption (Correct answer)

Correct answer: Give with vitamin C-rich juice to enhance absorption

Vitamin C (ascorbic acid) enhances iron absorption, while milk and calcium inhibit it.

Question 17: A school-age child understands that the volume of water remains the same when poured into a different-shaped container. Which Piagetian concept does this demonstrate?

Animism
Egocentrism
Centration
Conservation (Correct answer)

Correct answer: Conservation

Conservation is the understanding that quantity stays the same despite changes in shape or arrangement, mastered in the concrete operational stage.

Question 18: When documenting in a pediatric patient's electronic health record (EHR), which principle is most critical for legal protection?

Documenting assessments, interventions, and patient responses factually and contemporaneously. (Correct answer)
Using common abbreviations to save time and space.
Copying and pasting a previous note for a patient with a stable chronic condition.
Charting only at the end of the shift to ensure a complete summary.

Correct answer: Documenting assessments, interventions, and patient responses factually and contemporaneously.

For legal purposes, documentation must be accurate, objective, and timely (contemporaneous). Factual charting of what was assessed, what was done, and the patient's response provides the clearest and most defensible legal record. Delaying charting, using unapproved abbreviations, and copying previous notes can lead to inaccuracies, omissions, and legal vulnerabilities.

Question 19: A nurse is assessing a 6-month-old for developmental red flags. Which finding warrants further evaluation?

Does not respond to own name (Correct answer)
Does not sit without support
Cannot walk independently
Has a palmar grasp reflex

Correct answer: Does not respond to own name

By 6 months, infants should respond to their own name; failure to do so is a red flag for hearing loss or autism spectrum disorder.

Question 20: A nurse is providing anticipatory guidance to the parents of a 4-month-old infant. Which of the following topics is most crucial to include for preventing the leading cause of injury-related death in this age group?

Safe sleep practices to prevent SUID/SIDS. (Correct answer)
Introduction of solid foods to prevent choking.
Lowering the water heater temperature to 120°F (49°C).
Installation and use of childproof cabinet locks.

Correct answer: Safe sleep practices to prevent SUID/SIDS.

Sudden Unexpected Infant Death (SUID), which includes Sudden Infant Death Syndrome (SIDS), is the leading cause of injury-related death in infancy. Therefore, educating parents on safe sleep practices—such as placing the infant on their back to sleep, using a firm sleep surface, and keeping the crib free of soft bedding—is the highest priority for injury prevention at this age.

Question 21: Which action best exemplifies the nurse's role as a child advocate in the inpatient setting?

Following all physician orders without question
Deferring all ethical dilemmas to hospital administration
Ensuring the child's voice and preferences are communicated to the care team (Correct answer)
Limiting family visitation to reduce patient stimulation

Correct answer: Ensuring the child's voice and preferences are communicated to the care team

Child advocacy involves amplifying the patient's voice, preferences, and needs within the healthcare team to ensure patient-centered care.

Question 22: A 3-year-old is brought to the clinic following a witnessed choking episode while eating popcorn. The initial coughing has subsided, but the nurse auscultates wheezing and diminished breath sounds over the right lung fields. This presentation is most consistent with which of the following emergencies?

Laryngotracheobronchitis (Croup)
Bacterial pneumonia
Acute asthma exacerbation
Foreign body aspiration (Correct answer)

Correct answer: Foreign body aspiration

The history of a choking event followed by unilateral wheezing and diminished breath sounds is the classic presentation for a foreign body aspiration into a mainstem bronchus. The object is more likely to lodge in the right bronchus due to its wider angle and more direct path from the trachea. Asthma typically presents with bilateral wheezing. Croup is characterized by a barking cough and inspiratory stridor. Pneumonia would likely be accompanied by fever and other signs of infection.

Question 23: A nurse is caring for a 7-year-old in status asthmaticus who is not responding to repeated albuterol treatments. Which medication should the nurse anticipate administering next?

Subcutaneous terbutaline only
Oral prednisolone
Inhaled ipratropium alone
IV magnesium sulfate (Correct answer)

Correct answer: IV magnesium sulfate

IV magnesium sulfate is used as a second-line bronchodilator in severe asthma unresponsive to initial beta-agonist therapy.

Question 24: A 4-year-old child presents with a 24-hour history of vomiting, watery diarrhea, and a low-grade fever. The nurse assesses the child and notes dry mucous membranes, decreased skin turgor, and a capillary refill time of 3 seconds. The child is awake and alert but irritable. Which of the following is the most appropriate initial management strategy?

Administer an IV bolus of 0.9% normal saline.
Administer an anti-diarrheal medication as prescribed.
Initiate oral rehydration solution (ORS) in small, frequent amounts. (Correct answer)
Provide clear liquids such as water and apple juice as tolerated.

Correct answer: Initiate oral rehydration solution (ORS) in small, frequent amounts.

The child is exhibiting signs of mild to moderate dehydration. For children who are awake and alert, oral rehydration therapy with an ORS is the first-line treatment. ORS contains the appropriate balance of electrolytes and glucose to promote absorption. Small, frequent amounts help prevent vomiting. An IV bolus is typically reserved for severe dehydration or when oral rehydration fails. Clear liquids like apple juice can worsen diarrhea due to high sugar content, and water alone does not replace electrolytes. Anti-diarrheal medications are generally not recommended in children.

Question 25: When administering oral medication to a toddler, which of the following demonstrates the application of family-centered and atraumatic care principles?

Mixing the medication in a full bottle of formula to mask the taste.
Allowing the parent to hold the child in a comforting position while the nurse administers the medication with an oral syringe. (Correct answer)
Quickly restraining the child and administering the medication to get it over with.
Telling the child the medicine is candy to encourage them to take it.

Correct answer: Allowing the parent to hold the child in a comforting position while the nurse administers the medication with an oral syringe.

Involving the parent in a comforting manner is a key principle of family-centered care, which can reduce the child's distress. Using an oral syringe aimed at the buccal pouch is the recommended technique for accurate dosing and to prevent aspiration. Restraining the child can be traumatic. Mixing medication in a full bottle is not advised because the child may not finish it, resulting in an incomplete dose. Deceiving the child by calling medicine candy can erode trust and is unsafe.

Question 26: The nurse is aware of the following assessment finding as the most typical one in a child with ulcerative colitis:

Anal fissures
Intense abdominal cramps
Abdominal distention
Profuse diarrhea (Correct answer)

Correct answer: Profuse diarrhea

Ulcerative colitis is a chronic inflammatory bowel disease that primarily affects the large intestine and rectum. A hallmark symptom, especially in children, is profuse, often bloody, diarrhea due to the inflammation and ulceration of the colon lining. While other symptoms like abdominal pain can occur, severe diarrhea is a defining and most typical characteristic of the condition.

Question 27: A 2-year-old is prescribed oral metronidazole for a Clostridium difficile infection. Which food should the parents be counseled to avoid during treatment?

High-fiber foods
Foods containing alcohol or alcohol-based sauces (Correct answer)
Citrus fruits
Dairy products

Correct answer: Foods containing alcohol or alcohol-based sauces

Metronidazole causes a disulfiram-like reaction when combined with alcohol, resulting in nausea, vomiting, and flushing.

Question 28: A 2-year-old is brought to the emergency department after ingesting a handful of their mother's prenatal vitamins. The nurse should be prepared for which priority intervention, as it is the specific chelating agent for severe iron toxicity?

Activated charcoal
Deferoxamine (Correct answer)
Naloxone
N-acetylcysteine

Correct answer: Deferoxamine

Deferoxamine is the specific iron-chelating agent used to treat moderate to severe iron poisoning. It binds with iron in the bloodstream to form a complex that is excreted by the kidneys. N-acetylcysteine is the antidote for acetaminophen overdose. Activated charcoal is not effective because it does not bind well to iron. Naloxone is an opioid antagonist.

Question 29: Twelve-year-old Erithel is seven months pregnant. Which teaching method is least effective when teaching parenting skills to an adolescent, according to the nurse?

Providing a one-on-one demonstration and requesting a return demonstration, using a live infant model
Providing age-appropriate reading materials (Correct answer)
Using audiovisual aids that show discussions of feelings and skills
Initiating a teenage parent support group with first and second-time mothers

Correct answer: Providing age-appropriate reading materials

Adolescents, especially those facing the complexities of pregnancy and parenting, often learn best through active, hands-on, and interactive methods. While reading materials can supplement learning, they are generally less effective as a primary teaching method for developing practical parenting skills compared to demonstrations, return demonstrations, and peer support groups, which offer experiential learning and social support.

Question 30: A toddler throws a tantrum when a parent sets a limit. Which nursing explanation is most accurate?

This reflects normal autonomy development (Correct answer)
The parent is being too restrictive
The child needs more discipline
The child has a behavioral disorder

Correct answer: This reflects normal autonomy development

Temper tantrums in toddlers are a normal expression of developing autonomy as children strive for independence.

Certified Pediatric Nurse (CPN) Exam

The CPN exam, administered by the Pediatric Nursing Certification Board (PNCB), validates a nurse's specialized knowledge and skills in providing comprehensive care to pediatric patients from infancy through young adulthood. It covers health promotion, patient assessment, care planning and management, and professional responsibilities.

Questions

35 min

Time Limit

70%

To Pass

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These practice questions were written with AI tools. They are not real exam questions. Exam facts are checked against the official sources listed below. Not reviewed by a subject-matter expert. Editorial policy

Sources & references

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