Free CPNP-PC sample questions

Correct answer: 6,000 and 8,000 Hz

The Bright Futures/AAP Periodicity Schedule explicitly specifies that adolescent hearing screening should be conducted with audiometry that includes high frequencies of 6,000 and 8,000 Hz once between 11 and 14 years, once between 15 and 17 years, and once between 18 and 21 years. Conventional childhood pure-tone screening (500, 1,000, 2,000, and 4,000 Hz) frequently misses early acoustic trauma from personal listening devices, concerts, firearms, or recreational noise, which characteristically manifests as a high-frequency sensorineural notch between 3,000 and 6,000 Hz with recovery or progression at 8,000 Hz.

Correct answer: Advise immediate cessation of dry sanding in the pre-1978 home, order a blood lead level test, counsel on a diet rich in iron, calcium, and vitamin C, and instruct them to return the car seat to the rear-facing position until the child reaches the seat's maximum rear-facing weight or height limit

Homes built before 1978 frequently contain lead-based paint, and dry sanding or scraping generates hazardous respirable lead dust that toddlers ingest via hand-to-mouth activity. Parents should be advised to stop dry sanding immediately, keep the child out of renovation zones, use certified lead-safe contractors and wet-cleaning (HEPA/wet mop) methods, provide a diet adequate in iron, calcium, and vitamin C (which reduce gastrointestinal lead absorption), and complete a 24-month blood lead screening test. Regarding motor vehicle safety, current AAP guidelines state that children should remain in a rear-facing car safety seat as long as possible—until they reach the highest weight or height allowed by their car safety seat's manufacturer—rather than turning forward-facing simply upon turning 2 years old.

Correct answer: Conduct a brief motivational interviewing intervention, educate on illicit fentanyl contamination in counterfeit pills, prescribe or recommend intranasal naloxone, perform confidential STI and HIV testing, and counsel on HIV pre-exposure prophylaxis (PrEP)

Per the Bright Futures/AAP Recommendations for Preventive Pediatric Health Care, when substance or opioid use is identified as a concern via the CRAFFT screening tool, clinicians should conduct brief motivational interviewing, counsel on the high lethal risk of illicitly manufactured fentanyl in counterfeit pressed pills, and recommend or prescribe naloxone for overdose reversal. Simultaneously, sexually active adolescents should receive confidential STI and HIV screening (with universal HIV screening recommended at least once between ages 15 and 21 and at least annually for high-risk youth) and counseling on HIV pre-exposure and post-exposure prophylaxis (PrEP/PEP), while safeguarding adolescent privacy in the electronic health record under the 21st Century Cures Act privacy exceptions.

Correct answer: Speaking with an expressive vocabulary of at least 30 to 50 words and combining two words into simple phrases

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.

Correct answer: Constitutional delay of growth and puberty

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]

Correct answer: Serum thyroxine (free T4) and thyroid-stimulating hormone (TSH)

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.