Introduction
Assessment and diagnosis represent the cornerstone of pediatric nursing practice, accounting for approximately 34% of the CPN certification exam content and serving as the foundation for all subsequent nursing interventions. The ability to accurately assess and diagnose pediatric patients requires specialized knowledge of age-specific developmental milestones, growth patterns, and the unique physiological differences that distinguish children from adults. Pediatric nurses must master both physical and psychosocial assessment techniques, understanding how illness and hospitalization impact children differently across various developmental stages. Critical thinking skills become paramount when interpreting assessment findings, as children may present with subtle or atypical symptoms that require careful observation and clinical judgment. The assessment process in pediatrics is inherently family-centered, requiring nurses to consider cultural factors, family dynamics, and the child’s developmental capacity when gathering information and formulating diagnoses. Early recognition of conditions such as dehydration, respiratory distress, or neurological changes can be life-saving in pediatric populations, making this domain essential for safe practice. Diagnostic skills extend beyond identifying acute conditions to include screening for developmental delays, nutritional deficiencies, and psychosocial concerns that may impact a child’s overall health and well-being. The integration of evidence-based assessment tools and standardized screening instruments is crucial for maintaining consistency and accuracy in pediatric care. Understanding the normal parameters for vital signs, growth measurements, and behavioral indicators across different age groups enables nurses to quickly identify deviations that warrant immediate attention. Effective communication with both children and their families during the assessment process requires specialized skills in age-appropriate interaction and therapeutic rapport building. The CPN certification exam emphasizes practical application of assessment knowledge through scenario-based questions that test clinical reasoning and prioritization skills. Mastery of this domain is essential not only for exam success but for providing high-quality, evidence-based care that promotes optimal outcomes for pediatric patients and their families.
Practice Questions
Question 1
A 2-year-old child is brought to the emergency department with a 24-hour history of vomiting and decreased oral intake. Which assessment finding would be the EARLIEST indicator of dehydration in this child?
A) Decreased blood pressure and increased heart rate
B) Capillary refill time greater than 2 seconds
C) Sunken fontanelles and decreased skin elasticity
D) Oliguria and concentrated urine
Correct Answer: B) Capillary refill time greater than 2 seconds
Explanation: Capillary refill time greater than 2 seconds is one of the earliest and most sensitive indicators of dehydration in pediatric patients. In toddlers, this assessment can be easily performed and provides immediate feedback about circulatory status. Blood pressure changes (option A) are late signs of dehydration in children, as they have excellent compensatory mechanisms that maintain blood pressure until severe dehydration occurs. While fontanelles may be present in some 2-year-olds, they are typically closed by 18 months, making this less reliable (option C). Oliguria (option D) is also a later sign and may be difficult to assess immediately upon presentation. Early recognition through capillary refill assessment allows for prompt intervention before more serious complications develop.
Question 2
When assessing a 6-month-old infant during a routine well-child visit, which developmental milestone should the pediatric nurse expect to observe?
A) Sitting without support for extended periods
B) Transferring objects from one hand to another
C) Walking while holding onto furniture (cruising)
D) Speaking first words with meaning
Correct Answer: B) Transferring objects from one hand to another
Explanation: By 6 months of age, infants typically develop the ability to transfer objects from one hand to another, demonstrating improved bilateral coordination and cognitive development. This milestone reflects normal fine motor development and hand-eye coordination expected at this age. Sitting without support (option A) typically develops around 6-8 months, but initially requires some support. Cruising (option C) usually begins around 9-12 months as part of gross motor development leading to independent walking. First meaningful words (option D) typically emerge around 10-14 months as part of language development. Understanding these developmental milestones is crucial for pediatric nurses to identify potential delays and provide appropriate anticipatory guidance to families.
Question 3
A 15-year-old patient presents with complaints of fatigue and difficulty concentrating. Which assessment approach would be MOST appropriate for this adolescent?
A) Conducting the entire interview with parents present
B) Asking direct questions about risk-taking behaviors immediately
C) Beginning with general questions, then moving to more sensitive topics
D) Focusing primarily on physical symptoms and avoiding psychological assessment
Correct Answer: C) Beginning with general questions, then moving to more sensitive topics
Explanation: When assessing adolescents, it’s important to build rapport and trust by starting with general, non-threatening questions before gradually moving to more sensitive topics such as sexual activity, substance use, or mental health concerns. This approach respects the developmental need for privacy and autonomy while ensuring comprehensive assessment. Keeping parents present throughout (option A) may inhibit honest communication about sensitive issues. Asking direct questions about risk behaviors immediately (option B) may cause the adolescent to become defensive or provide inaccurate information. Avoiding psychological assessment (option D) would miss important aspects of adolescent health, including depression, anxiety, and other mental health concerns that commonly present during this developmental stage.
Question 4
During assessment of a 3-year-old child with suspected pneumonia, which finding would indicate the need for IMMEDIATE intervention?
A) Temperature of 101.5°F (38.6°C) and mild cough
B) Respiratory rate of 35 breaths per minute with nasal flaring
C) Decreased appetite and increased sleep duration
D) Complaints of chest discomfort when coughing
Correct Answer: B) Respiratory rate of 35 breaths per minute with nasal flaring
Explanation: A respiratory rate of 35 breaths per minute with nasal flaring indicates respiratory distress in a 3-year-old child. Normal respiratory rate for this age group is 20-30 breaths per minute, and nasal flaring is a sign of increased work of breathing. These findings suggest significant respiratory compromise requiring immediate assessment and intervention. While fever (option A) is concerning, the temperature is not extremely high and mild cough alone doesn’t indicate immediate distress. Decreased appetite and increased sleep (option C) are common with illness but not immediately life-threatening. Chest discomfort (option D) is expected with pneumonia but doesn’t indicate immediate respiratory compromise like the signs of increased work of breathing.
Question 5
When assessing pain in a 4-year-old child, which assessment tool would be MOST appropriate?
A) Numeric rating scale (0-10)
B) FACES Pain Scale-Revised (FPS-R)
C) Visual analog scale with unmarked line
D) Behavioral Pain Scale (BPS)
Correct Answer: B) FACES Pain Scale-Revised (FPS-R)
Explanation: The FACES Pain Scale-Revised is the most appropriate tool for assessing pain in a 4-year-old child. This scale uses facial expressions to represent different levels of pain intensity and is designed for children ages 3 years and older who can understand the concept of “more” or “less” pain. Preschoolers can easily relate to facial expressions and point to the face that matches their pain level. The numeric rating scale (option A) is typically used for children 8 years and older who understand numbers and their relative values. Visual analog scales (option C) require abstract thinking that develops later in childhood. The Behavioral Pain Scale (option D) is primarily used for non-verbal patients or those unable to self-report pain, rather than for developmentally appropriate 4-year-olds.
Question 6
A 9-month-old infant presents with a bulging anterior fontanelle. Which associated assessment finding would be MOST concerning?
A) Crying when examined by strangers
B) Fever of 102.8°F (39.3°C) with irritability
C) Sleeping for longer periods than usual
D) Decreased interest in playing with toys
Correct Answer: B) Fever of 102.8°F (39.3°C) with irritability
Explanation: A bulging fontanelle combined with high fever and irritability strongly suggests increased intracranial pressure, possibly due to meningitis or other serious intracranial pathology. This combination requires immediate medical attention and further evaluation. The fontanelle should be assessed when the infant is in an upright, calm position, as crying can cause temporary bulging. However, when combined with high fever and irritability, this triad indicates a medical emergency. Stranger anxiety (option A) is normal developmental behavior at 9 months. While increased sleeping (option C) and decreased play interest (option D) can indicate illness, they are less specific and concerning than the fever-irritability-bulging fontanelle combination that suggests serious intracranial pathology.
Question 7
When assessing a 7-year-old child’s blood pressure, which approach demonstrates proper technique?
A) Using an adult-sized cuff for accuracy
B) Taking the measurement while the child is crying
C) Using a cuff that covers 2/3 of the upper arm
D) Measuring only if the child appears ill
Correct Answer: C) Using a cuff that covers 2/3 of the upper arm
Explanation: Proper blood pressure measurement in children requires using an appropriately sized cuff that covers approximately 2/3 of the upper arm length and encircles at least 80% of the arm circumference. Using the correct cuff size is essential for accurate readings, as improper sizing can lead to false high or low readings. An adult-sized cuff (option A) would be too large and could give falsely low readings. Taking measurements while the child is crying (option B) will result in artificially elevated readings due to stress and increased cardiac output. Blood pressure should be measured routinely in children over 3 years of age (option D), not only when they appear ill, as hypertension can be asymptomatic in children and early detection is important for preventing complications.
Question 8
A 16-year-old patient reports feeling sad and hopeless for the past month. Which assessment question would be MOST important to ask initially?
A) “How are your grades in school this semester?”
B) “Have you been getting enough sleep lately?”
C) “Have you had thoughts of hurting yourself or ending your life?”
D) “Are you having conflicts with your parents?”
Correct Answer: C) “Have you had thoughts of hurting yourself or ending your life?”
Explanation: When an adolescent reports persistent sadness and hopelessness, it’s crucial to immediately assess for suicidal ideation, as these are significant risk factors for suicide. Adolescents have high rates of depression and suicide, making this assessment a priority for safety. While academic performance (option A), sleep patterns (option B), and family conflicts (option D) are all important aspects of adolescent mental health assessment, none take precedence over ensuring immediate safety by screening for suicidal thoughts. Direct questioning about suicide does not increase the risk and actually demonstrates care and concern. If suicidal ideation is present, immediate safety measures and mental health referrals are necessary.
Question 9
During assessment of a 5-year-old child with asthma, which finding would indicate worsening respiratory status?
A) Peak flow reading at 85% of personal best
B) Ability to speak in full sentences without pausing
C) Use of accessory muscles and tripod positioning
D) Respiratory rate of 22 breaths per minute
Correct Answer: C) Use of accessory muscles and tripod positioning
Explanation: The use of accessory muscles (such as intercostal, supraclavicular, or abdominal muscles) and tripod positioning (leaning forward with arms supported) indicates significant respiratory distress and increased work of breathing. These are signs that the child is struggling to maintain adequate ventilation and oxygenation. Peak flow at 85% of personal best (option A) is in the green zone and indicates good asthma control. Speaking in full sentences (option B) suggests adequate air movement and is reassuring. A respiratory rate of 22 breaths per minute (option D) is within normal limits for a 5-year-old (normal range 20-25 breaths per minute). Recognition of signs of respiratory distress is crucial for timely intervention in pediatric asthma management.
Question 10
When assessing hydration status in a 10-month-old infant, which finding would be MOST indicative of mild dehydration?
A) Absence of tears when crying
B) Sticky mucous membranes
C) Sunken eyes and decreased skin turgor
D) Weak pulse and delayed capillary refill
Correct Answer: B) Sticky mucous membranes
Explanation: Sticky mucous membranes are an early and reliable indicator of mild dehydration (3-5% fluid loss) in infants. This can be assessed by gently touching the gums or inside of the cheek, which should normally feel moist. Absence of tears (option A) can indicate moderate dehydration but may not be reliable in very young infants who may not produce many tears normally. Sunken eyes and decreased skin turgor (option C) indicate moderate to severe dehydration (6-9% fluid loss). Weak pulse and delayed capillary refill (option D) are signs of severe dehydration (>10% fluid loss) and represent cardiovascular compromise. Early recognition of mild dehydration allows for prompt oral rehydration therapy before more severe symptoms develop.
Question 11
A 12-year-old child presents with abdominal pain. Which assessment technique would be MOST appropriate to begin the abdominal examination?
A) Deep palpation of all quadrants
B) Percussion of the liver and spleen
C) Auscultation for bowel sounds
D) Light palpation starting away from the painful area
Correct Answer: C) Auscultation for bowel sounds
Explanation: When performing an abdominal assessment, auscultation should always be performed first, before palpation or percussion, as these manipulations can alter bowel sounds and potentially increase pain. This is especially important in pediatric patients who may be anxious about the examination. After auscultation, inspection should be completed, followed by gentle palpation starting away from areas of reported pain. Deep palpation (option A) should never be the starting point and should be performed last and with caution in children with abdominal pain. Percussion (option B) comes after auscultation and light palpation. While light palpation away from painful areas (option D) is appropriate, it should follow auscultation in the sequence of abdominal examination.
Question 12
When assessing growth in a 2-year-old child, which measurement is MOST important for detecting failure to thrive?
A) Head circumference compared to age norms
B) Weight-for-height ratio and growth velocity
C) Absolute weight compared to siblings
D) Height measurement alone
Correct Answer: B) Weight-for-height ratio and growth velocity
Explanation: Weight-for-height ratio (also expressed as BMI-for-age in children over 2 years) and growth velocity over time are the most important indicators for detecting failure to thrive. This assessment evaluates whether the child is gaining weight appropriately for their height and whether growth is progressing at an expected rate. Growth velocity looks at the pattern of growth over time rather than a single measurement. While head circumference (option A) is important for neurological development assessment, it’s less sensitive for detecting failure to thrive. Comparing weight to siblings (option C) is not appropriate as normal growth varies significantly between individuals. Height alone (option D) doesn’t provide information about proportional growth or nutritional status.
Question 13
A 14-year-old presents with fatigue and pale conjunctivae. Which additional assessment finding would MOST support a diagnosis of iron deficiency anemia?
A) Enlarged lymph nodes in multiple regions
B) Spoon-shaped fingernails (koilonychia) and ice cravings
C) Petechial rash on the extremities
D) Joint swelling and morning stiffness
Correct Answer: B) Spoon-shaped fingernails (koilonychia) and ice cravings
Explanation: Koilonychia (spoon-shaped fingernails) and ice cravings (pagophagia) are classic signs of iron deficiency anemia. These findings, combined with fatigue and pale conjunctivae, strongly suggest iron deficiency. Koilonychia results from chronic iron deficiency affecting nail structure, while ice cravings are a form of pica commonly associated with iron deficiency anemia. Enlarged lymph nodes (option A) might suggest infection, malignancy, or other systemic conditions rather than iron deficiency. Petechial rash (option C) suggests thrombocytopenia or platelet dysfunction rather than anemia. Joint swelling and morning stiffness (option D) are more consistent with inflammatory or rheumatologic conditions rather than iron deficiency anemia.
Question 14
When assessing a 6-year-old child’s neurological status after a head injury, which finding would require IMMEDIATE intervention?
A) Complaint of mild headache
B) Brief period of confusion immediately after injury
C) Unequal pupil size with decreased reaction to light
D) Temporary amnesia about the events surrounding the injury
Correct Answer: C) Unequal pupil size with decreased reaction to light
Explanation: Unequal pupil size (anisocoria) with decreased reaction to light indicates possible increased intracranial pressure or brain stem injury, which requires immediate medical intervention. This finding suggests serious intracranial pathology that could rapidly progress to life-threatening complications. Mild headache (option A) is common after head trauma but not immediately concerning unless it worsens. Brief confusion immediately after injury (option B) may be expected but should be monitored. Temporary amnesia (option D) about the injury is relatively common in concussion but doesn’t indicate immediate danger. Pupillary changes, however, represent a neurological emergency requiring immediate evaluation and intervention to prevent permanent brain damage.
Question 15
A 8-month-old infant is being assessed for developmental delays. Which finding would be MOST concerning at this age?
A) Not yet walking independently
B) Unable to sit without support
C) Babbling but not saying clear words
D) Showing stranger anxiety
Correct Answer: B) Unable to sit without support
Explanation: By 8 months of age, infants should be able to sit without support, typically achieving this milestone between 6-8 months. Inability to sit without support at 8 months would be concerning for gross motor developmental delay and warrants further evaluation. Independent walking (option A) typically doesn’t occur until 9-15 months, so this is not concerning at 8 months. Babbling without clear words (option C) is appropriate for 8 months, as first words typically emerge around 10-14 months. Stranger anxiety (option D) is actually a positive developmental milestone that typically begins around 6-8 months, indicating normal social-emotional development. Early identification of developmental delays is crucial for implementing appropriate interventions and support services.
This practice test is designed to help you prepare for the CPN certification exam. Always refer to the most current PNCB content outline and recommended resources for comprehensive exam preparation.