Pediatric Nurse Practitioner Certification Exam

The American Nurses Credentialing Center (ANCC) offers the Pediatric Nurse Practitioner Certification Exam for certification purposes. This computer-based assessment is for licensed RNs with completed graduate work in an accredited pediatric nurse practitioner program who have earned a master's, post-master's or doctorate degree. Candidates must have taken graduate classes in advanced health assessment, advanced pharmacology, advanced pathophysiology, health promotion and disease prevention and differential diagnosis and disease management. You also need to have completed at least 500 clinical hours in an accredited academic program, and have met specific requirements before taking this test. This test is taken as part of the Pediatric Nurse Practitioner - Board Certified (PNP-BC) credential.

This test has 175 questions; 25 questions on the test are not scored, as they are used for pre-trial purposes only, but the candidate will not know which questions are scored and which are not. The score is derived from the remaining 150. Candidates must get a minimum of 105 correct in order to receive a passing raw score. The actual score will be weighted on a 500-point scale, and candidates need a minimum of 350 to pass. If a candidate does not succeed on the assessment exam, an account is provided which will help pinpoint the areas that need improvement. The subject areas of the Pediatric Nurse Practitioner Certification Exam include:

• 29 questions on health promotion and disease prevention
• 35 questions on assessment of acute and chronic illness
• 41 questions on clinical management of acute and chronic illness
• 31 questions on the nurse practitioner and patient relationship
• 12 questions on professional role and policy
• 2 questions on using research

Pediatric Nurse Practitioner Practice Test

1. An important benefit of physical therapy for the patient with a moderate-to-severe ankle sprain is:

a. Therapeutic exercises assist with regaining full range of motion and stability of ankle joint
b. Rapid return to sports in the competitive athlete
c. Home ankle rehabilitation exercises are unnecessary
d. Lower incidence of compartment syndrome in association with ankle sprain

2. In evaluation of the healthy, toddler-age patient with asymptomatic microcytic anemia, the laboratory test(s) most likely to be diagnostic is:

a. Serum lead level
b. Serum folate level
c. Serum iron studies
d. Serum white blood cell count

3. The leading cause of death for children 1-18 years of age in the United States is:

a. Accidents
b Homicide
c. Cancer
d. Congenital anomalies

4. Which of the following statements is most accurate concerning the pediatric nurse practitioner's scope of practice?

a. Prescribing medications is not within the pediatric nurse practitioner's scope of practice
b. Pediatric nurse practitioners diagnose and treat most common childhood illnesses
c. Pediatric nurse practitioners may practice independently without physician oversight in all 50 states
d. Pediatric nurse practitioners may only provide routine health maintenance and immunizations

5. Which of the follow parental characteristics is associated with an increased risk of child maltreatment (abuse)?

a. Older parents
b. Immigrant parents
c. History of childhood abuse/neglect for the parent
d. Wealthy parents

Pediatric Nurse Practitioner Answers

1. A: Ankle sprains are a common injury in the pediatric patient - the majority of ankle sprains involve injury to the lateral ankle ligaments due to ankle inversion ("rolling the ankle"). Physical therapy programs can be very helpful to the patient with a moderate-to-severe ankle sprain. Patient/family education about a home rehabilitation program supplements the exercises offered during a session with the physical therapist. In the first few weeks after an ankle sprain (recovery phase), therapy is aimed at improving flexibility, range-of-motion, joint stability and strength. Further therapy (functional phase) aims to return the patient to his/her prior level of activity with advanced exercises.

2. C: Iron deficiency remains the most common cause of microcytic (MCV < 77 fl) anemia in the otherwise-healthy pediatric population. Iron-deficiency anemia in the pediatric patient is most often caused by inadequate iron intake (e.g., excess milk intake, vegetarianism) or blood loss (e.g., menstruation). Other causes of microcytic anemia include lead poisoning and thalassemia. Folate deficiency (or B12 deficiency) would generally cause a macrocytic (MCV > 95 fl) anemia. Supplemental oral iron in addition to the elimination of contributing factors is sufficient treatment for most cases of iron-deficiency anemia. Rarely, red blood cell transfusions may be indicated in the pediatric patient with iron-deficiency anemia.

3. A: In the infant population (0-12 months), most deaths are attributable to congenital anomalies, complications of low birth weight/prematurity, and sudden infant death syndrome (SIDS). After one year of age, accidents are the leading cause of death in the pediatric population. This includes falls, burns, motor vehicle accidents, head injuries, and drowning. Most pediatric accident deaths are preventable, making injury prevention education a crucial part of pediatric practice. In the toddler age group, congenital anomalies are the 2nd leading cause of death. In the young school-aged child, cancer is the 2nd leading cause of death. In the adolescent age group, homicide and suicide are the 2nd and 3rd leading causes of death.

4. B: The pediatric nurse practitioner's scope of practice varies widely by state. All 50 states now allow PNPs some prescriptive authority (with and without physician involvement), although restrictions on controlled substances are common. A handful of states allow nurse practitioners to practice independently without any physician oversight. More commonly, some degree of physician involvement is required. Most states allow PNPs to diagnose and treat medical conditions, but a few make a distinction between "nursing diagnoses" and "medical diagnoses." Finally, most states require pediatric nurse practitioners to obtain national certification.

5. C: Child maltreatment may occur in any family regardless of education level, socioeconomic status, ethnicity, or child-specific characteristics. However, studies have demonstrated parental, child, and environmental risk factors for child maltreatment. Parental factors found to increase the risk of child maltreatment include a parental history of abuse or neglect, socially isolated parents, teenage mothers, and mothers with low self-esteem. Child factors include a poor fit between the child's temperament/parent's ability to deal with that temperament, history of prematurity, and a history of difficult pregnancy/delivery. Environmental factors include poverty, addiction, poor housing, and unemployment.

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