I85PREP
⌘ K
CPN study materials
CPN study resources

CPN practice questions

One question at a time. Build your CPN understanding.

First 50 of 200 questions. Each one lists the choices, the correct answer, and an explanation. The checker at the top of this page saves progress in this browser when it is available.

Continue in the practice tool above to load more questions, 50 at a time.

Question 1Health Promotion, Growth, and Development

The AAP recommends exclusive breastfeeding for approximately how long?

  1. 6 months Correct answer.
  2. 9 months
  3. 12 months
  4. 3 months

Explanation

Exclusive breastfeeding is recommended for about the first 6 months of life. Around 6 months, iron-rich complementary foods are introduced while breastfeeding continues to at least 12 months or longer.

Question 2Health Promotion, Growth, and Development

At what age does a social smile typically first appear?

  1. 2 weeks
  2. 4 months
  3. 7 months
  4. 6 weeks Correct answer.

Explanation

A responsive social smile usually emerges between 6 and 8 weeks of age and signals the start of reciprocal social interaction. Its absence by about 3 months warrants developmental review.

Question 3Health Promotion, Growth, and Development

A 14-month-old weighs 23 lb. According to AAP recommendations, how should this child ride in a car?

  1. In a belt-positioning booster seat
  2. Forward-facing with a harness
  3. Rear-facing in a convertible seat Correct answer.
  4. On an adult lap with a lap belt

Explanation

AAP guidance is to keep children rear-facing until they reach the highest weight or height allowed by the seat manufacturer, which is usually beyond age 2. Weight and age alone do not justify turning the seat around.

Question 4Health Promotion, Growth, and Development

Which vaccine is routinely recommended at the 11- to 12-year well-child visit?

  1. Varicella
  2. Tdap Correct answer.
  3. Hepatitis B
  4. MMR

Explanation

A Tdap booster is recommended at 11 to 12 years, along with HPV and meningococcal conjugate vaccines. These are part of the adolescent platform of the immunization schedule.

Question 5Health Promotion, Growth, and Development

A 9-month-old reaches under a cloth to find a toy that was hidden while she watched. This behavior demonstrates acquisition of which concept?

  1. Symbolic play
  2. Conservation
  3. Object permanence Correct answer.
  4. Egocentrism

Explanation

Object permanence is the understanding that an object continues to exist when it is out of sight. It develops during Piaget's sensorimotor stage, usually by about 8 to 9 months.

Question 6Health Promotion, Growth, and Development

At what age do signs of readiness for toilet training usually begin to appear?

  1. 30 to 36 months
  2. 18 to 24 months Correct answer.
  3. 12 to 15 months
  4. 24 to 30 months

Explanation

Readiness signs such as staying dry for about 2 hours, following simple directions, and disliking a soiled diaper typically emerge between 18 and 24 months. Most children complete training by 3 to 4 years.

Question 7Health Promotion, Growth, and Development

A 4-year-old builds a block tower and announces, "I made it all by myself." According to Erikson, which psychosocial task is the child working through?

  1. Autonomy versus shame and doubt
  2. Industry versus inferiority
  3. Initiative versus guilt Correct answer.
  4. Trust versus mistrust

Explanation

Erikson's preschool stage is initiative versus guilt, in which children test their own ideas and take pride in their accomplishments. Excessive criticism or restriction leads to guilt rather than initiative.

Question 8Health Promotion, Growth, and Development

According to AAP guidance, a child enrolled in Medicaid should have blood lead testing at which ages?

  1. 24 and 36 months
  2. 6 and 12 months
  3. 12 and 24 months Correct answer.
  4. Only before school entry

Explanation

Blood lead testing is recommended at 12 months and again at 24 months for children enrolled in Medicaid or otherwise at risk. Targeted risk questionnaires guide testing for other children.

Question 9Health Promotion, Growth, and Development

Which nutrient is most likely to be insufficient for a breastfed infant at about 6 months, making iron-rich complementary foods necessary?

  1. Vitamin C
  2. Iron Correct answer.
  3. Protein
  4. Calcium

Explanation

Breast milk contains little iron and fetal iron stores are largely depleted by 4 to 6 months. Iron-fortified cereal or pureed meats are therefore introduced around 6 months.

Question 10Health Promotion, Growth, and Development

An infant's birth weight typically doubles by which age?

  1. 3 months
  2. 9 months
  3. 12 months
  4. 5 months Correct answer.

Explanation

Term infants usually double their birth weight by 4 to 5 months and triple it by about 12 months. These landmarks are used to judge adequacy of growth.

Question 11Health Promotion, Growth, and Development

A term newborn measures 50 cm in length at birth. Which length at 12 months is most consistent with normal growth?

  1. 95 cm
  2. 55 cm
  3. 75 cm Correct answer.
  4. 65 cm

Explanation

Length increases by about 50% during the first year, so a 50-cm newborn is roughly 75 cm at 12 months. Growth continues at a slower rate thereafter.

Question 12Health Promotion, Growth, and Development

At which age is the first dose of MMR vaccine routinely given?

  1. 12 months Correct answer.
  2. 9 months
  3. 2 months
  4. At birth

Explanation

MMR is given at 12 through 15 months of age, with a second dose at 4 through 6 years. An earlier dose at 6 to 11 months is reserved for travel or outbreak situations and does not count toward the routine series.

Question 13Health Promotion, Growth, and Development

Which sleep position is recommended for every healthy infant to reduce the risk of SIDS?

  1. Supine Correct answer.
  2. Semi-upright
  3. Side-lying
  4. Prone

Explanation

Infants should be placed fully on the back for every sleep. Prone and side-lying positions increase the risk of sudden infant death syndrome.

Question 14Health Promotion, Growth, and Development

A 10-month-old picks up a small raisin using the tips of the thumb and index finger. This skill is called the:

  1. Plantar grasp
  2. Pincer grasp Correct answer.
  3. Ulnar grasp
  4. Palmar grasp

Explanation

The pincer grasp, using the opposed thumb and index finger, appears around 9 to 10 months. It replaces the raking palmar grasp of younger infants.

Question 15Health Promotion, Growth, and Development

What is typically the first visible sign of puberty in girls?

  1. Menarche
  2. Axillary hair growth
  3. Breast budding Correct answer.
  4. Pubic hair growth

Explanation

Thelarche, or breast budding, usually initiates puberty in girls between 8 and 13 years. Pubic hair follows, then the growth spurt, and menarche occurs about 2 years after breast budding.

Question 16Health Promotion, Growth, and Development

At what point should fluoride varnish application begin for a child at average caries risk?

  1. At age 3 years
  2. At eruption of the first permanent molar
  3. At age 6 years
  4. When the first tooth erupts Correct answer.

Explanation

Fluoride varnish is applied every 3 to 6 months beginning when the first tooth erupts. Early application targets the highest-risk period for early childhood caries.

Question 17Health Promotion, Growth, and Development

Which newborn screening test assesses for congenital cataracts and retinoblastoma?

  1. Visual acuity testing
  2. Cover-uncover test
  3. Confrontation testing
  4. Red reflex Correct answer.

Explanation

The red reflex detects opacities such as congenital cataract and leukocoria from retinoblastoma. It is performed in the newborn period and at each well-child visit.

Question 18Health Promotion, Growth, and Development

By what age do most children use at least 50 words and begin combining two words?

  1. 36 months
  2. 15 months
  3. 12 months
  4. 24 months Correct answer.

Explanation

By 24 months most children have a vocabulary of at least 50 words and start two-word combinations. Fewer than 50 words or no word combinations at age 2 warrants developmental and hearing evaluation.

Question 19Health Promotion, Growth, and Development

A 9-month-old's weight has fallen from the 50th to the 10th percentile over 3 months. What is the most appropriate next step?

  1. Repeat the weight measurement in six months
  2. Assess feeding history and current intake Correct answer.
  3. Reassure the parent that growth is normal
  4. Switch the infant to whole cow's milk

Explanation

A drop across two or more major percentile lines suggests failure to thrive and requires prompt evaluation. The first step is a detailed feeding and intake history with assessment for organic causes.

Question 20Health Promotion, Growth, and Development

Which food, eaten with an iron-rich meal, best enhances absorption of nonheme iron?

  1. Tea
  2. Whole cow's milk
  3. Bran cereal
  4. Orange slices Correct answer.

Explanation

Vitamin C converts ferric iron to the more absorbable ferrous form and markedly increases nonheme iron absorption. Calcium, phytates, and tannins have the opposite effect.

Question 21Health Promotion, Growth, and Development

For a healthy 3-year-old, AAP guidance limits screen time to:

  1. 1 hour or less per day Correct answer.
  2. 2 hours or less per day
  3. 3 hours or less per day
  4. No specific limit

Explanation

Children 2 to 5 years should have no more than 1 hour per day of high-quality programming, ideally co-viewed with an adult. Consistent limits support language, sleep, and physical activity.

Question 22Health Promotion, Growth, and Development

Peak height velocity in girls usually occurs at what point relative to menarche?

  1. Before menarche Correct answer.
  2. After menarche
  3. At the time of menarche
  4. After epiphyseal closure

Explanation

Growth velocity peaks before menarche, generally around Tanner breast stage 3. After menarche growth decelerates and typically adds only about 5 to 7 cm of final height.

Question 23Health Promotion, Growth, and Development

A 7-year-old correctly states that a short, wide glass holds the same amount of water as a tall, narrow glass. This ability is called:

  1. Centration
  2. Animism
  3. Conservation Correct answer.
  4. Egocentrism

Explanation

Conservation is the understanding that quantity remains the same despite changes in appearance. It develops in Piaget's concrete operational stage, around age 7.

Question 24Health Promotion, Growth, and Development

A 10-year-old boy's BMI is at the 90th percentile for age and sex. How is this classified?

  1. Obese
  2. Normal weight
  3. Overweight Correct answer.
  4. Underweight

Explanation

For children and adolescents, BMI from the 85th to below the 95th percentile is classified as overweight. Obesity is at or above the 95th percentile, and normal weight is the 5th to below the 85th percentile.

Question 25Health Promotion, Growth, and Development

Which gross motor skill is expected of a typically developing 12-month-old?

  1. Riding a tricycle
  2. Hopping on one foot
  3. Pulling to stand and cruising Correct answer.
  4. Walking upstairs with alternating feet

Explanation

Pulling to stand and cruising along furniture are expected around 12 months, with independent walking soon after. The other skills listed emerge between 3 and 4 years.

Question 26Health Promotion, Growth, and Development

According to major pediatric guidelines, exclusive breastfeeding is recommended for approximately how long before complementary foods are introduced?

  1. 12 months
  2. 6 months Correct answer.
  3. 2 months
  4. 3 months

Explanation

Exclusive breastfeeding, without water, formula, or solid foods, is recommended for about the first 6 months. Complementary foods are then introduced while breastfeeding continues to 12 months or longer.

Question 27Health Promotion, Growth, and Development

Breastfed infants should receive a daily supplement of which vitamin to prevent rickets?

  1. Vitamin D Correct answer.
  2. Vitamin K
  3. Vitamin C
  4. Vitamin A

Explanation

Human milk contains little vitamin D, so 400 IU per day is recommended for breastfed and partially breastfed infants starting shortly after birth. Vitamin K is provided as a single intramuscular dose at birth rather than as a daily supplement.

Question 28Health Promotion, Growth, and Development

A social smile in response to a caregiver's face typically first appears at which age?

  1. 6-8 weeks Correct answer.
  2. At birth
  3. 2 weeks
  4. 6 months of age

Explanation

The social smile emerges around 6 to 8 weeks as an infant begins to respond to faces and voices. Smiles before this time are usually reflexive rather than social.

Question 29Health Promotion, Growth, and Development

Whole cow's milk can replace breast milk or formula as the primary drink at which age?

  1. 18 months
  2. 9 months
  3. 12 months Correct answer.
  4. 6 months

Explanation

Whole cow's milk is recommended starting at 12 months, after which it can serve as the main beverage. Before 12 months, cow's milk provides too much protein and too little iron compared with breast milk or formula.

Question 30Health Promotion, Growth, and Development

Current AAP guidance recommends that children ride in a rear-facing car safety seat until at least what age?

  1. 4 years
  2. 12 months
  3. 6 months
  4. 2 years Correct answer.

Explanation

Children should remain rear-facing until at least age 2, or until they reach the highest weight or height allowed by their seat. This position better protects the head and spine in a crash.

Question 31Health Promotion, Growth, and Development

The first dental visit should occur by which age or event?

  1. At the start of formal schooling
  2. By 3 years of age
  3. By 6 years of age
  4. First tooth or first birthday Correct answer.

Explanation

A dental home should be established when the first tooth erupts and no later than the first birthday. Early visits allow prevention and parent education.

Question 32Health Promotion, Growth, and Development

Which item is appropriate in an infant's sleep space?

  1. A loose knit blanket tucked under the sides
  2. A firm flat mattress with fitted sheet Correct answer.
  3. A padded bumper along the crib rail
  4. A plush stuffed animal in the corner

Explanation

A firm, flat sleep surface with a fitted sheet reduces the risk of suffocation and SIDS. Soft objects, bumpers, and loose bedding should be kept out of the sleep area.

Question 33Health Promotion, Growth, and Development

School-aged children and adolescents should accumulate how much moderate-to-vigorous physical activity daily?

  1. 60 minutes Correct answer.
  2. 30 minutes
  3. 90 minutes
  4. 15 minutes

Explanation

Guidelines recommend at least 60 minutes of moderate-to-vigorous physical activity each day for children and adolescents aged 6 years and older. Activity should include aerobic, muscle-strengthening, and bone-strengthening components.

Question 34Health Promotion, Growth, and Development

A 7-month-old who previously smiled at everyone now cries when a grandparent approaches. How should the nurse interpret this?

  1. Evidence of a developmental regression requiring referral
  2. An indication of hearing loss
  3. A normal developmental stage of stranger anxiety Correct answer.
  4. A sign of an attachment disorder

Explanation

Stranger anxiety typically emerges between 6 and 9 months as infants develop object permanence and discriminate familiar from unfamiliar people. It is a normal milestone rather than a sign of pathology.

Question 35Health Promotion, Growth, and Development

A nurse hides a toy under a cloth while an infant watches, and the infant lifts the cloth to retrieve it. This behavior indicates development of:

  1. Symbolic play
  2. Cause-and-effect reversal
  3. Object permanence Correct answer.
  4. Conservation

Explanation

Object permanence is the understanding that objects continue to exist when out of sight, and it typically develops around 8 to 9 months. Searching for the hidden toy demonstrates this understanding.

Question 36Health Promotion, Growth, and Development

Head circumference increases by approximately how much during the first 12 months?

  1. 12 cm Correct answer.
  2. 6 cm
  3. 20 cm
  4. 2 cm

Explanation

Head circumference rises from about 35 cm at birth to about 47 cm at 12 months, an increase of roughly 12 cm. This reflects rapid brain growth in infancy.

Question 37Health Promotion, Growth, and Development

A 3-year-old plays alongside other children with blocks but does not coordinate play or share goals. This pattern is best described as:

  1. Associative play
  2. Parallel play Correct answer.
  3. Cooperative play
  4. Solitary play

Explanation

Parallel play, in which children play side by side with similar toys but without shared goals, is typical of toddlers and young preschoolers. Cooperative play with shared goals and roles develops later.

Question 38Health Promotion, Growth, and Development

The first physical sign of puberty in boys is usually:

  1. Pubic hair growth
  2. A growth spurt
  3. Deepening of the voice
  4. Testicular enlargement Correct answer.

Explanation

Gonadarche with testicular enlargement is typically the first sign of puberty in boys, corresponding to Tanner stage G2. Pubic hair, voice change, and the growth spurt follow.

Question 39Health Promotion, Growth, and Development

For a healthy 2-year-old, the maximum daily intake of 100% fruit juice is:

  1. 8 oz
  2. 12 oz
  3. 2 oz
  4. 4 oz Correct answer.

Explanation

The AAP recommends no more than 4 ounces of 100% juice per day for children aged 1 to 3 years. Juice should not replace whole fruit or milk.

Question 40Health Promotion, Growth, and Development

For a child under 3 years, the recommended amount of fluoride toothpaste per brushing is:

  1. No toothpaste until age 3
  2. A rice-grain-sized smear Correct answer.
  3. A pea-sized amount
  4. A ribbon covering the brush

Explanation

A thin smear of fluoride toothpaste is recommended for children under 3 years, increasing to a pea-sized amount from ages 3 to 6. This balances caries prevention against the risk of fluorosis.

Question 41Health Promotion, Growth, and Development

Universal hemoglobin screening for anemia is recommended at which age for low-risk infants?

  1. 2 months
  2. 6 months
  3. 12 months Correct answer.
  4. 4 months

Explanation

The AAP recommends universal hemoglobin screening at approximately 12 months, with follow-up as indicated. Earlier screening is targeted at high-risk infants.

Question 42Health Promotion, Growth, and Development

Standardized autism-specific screening is recommended at which ages?

  1. 6 and 12 months
  2. 3 and 5 years
  3. Newborn and 2 months
  4. 18 and 24 months Correct answer.

Explanation

The AAP recommends autism-specific screening with a validated tool such as the M-CHAT at 18 and 24 months. Screening occurs in addition to general developmental surveillance at every visit.

Question 43Health Promotion, Growth, and Development

A 12-year-old girl has a BMI at the 97th percentile for age and sex. How is this classified?

  1. Overweight
  2. Obesity Correct answer.
  3. Normal weight
  4. Underweight

Explanation

A BMI at or above the 95th percentile for age and sex is classified as obesity in children and adolescents. Overweight corresponds to the 85th through 94th percentiles.

Question 44Health Promotion, Growth, and Development

What percentage of birth weight may a healthy term newborn normally lose in the first week?

  1. Up to 10% Correct answer.
  2. Up to 20%
  3. Up to 2%
  4. Up to 15%

Explanation

Term newborns commonly lose up to about 10% of birth weight in the first few days and regain it by about 2 weeks. Loss beyond 10% warrants assessment of feeding.

Question 45Health Promotion, Growth, and Development

A 2-year-old's length has dropped from the 75th to the 25th percentile over 6 months while weight is stable. What is the most appropriate action?

  1. Repeat the measurement in 1 year
  2. Change to a high-calorie formula
  3. Reassure the parent that percentile shifts are always normal
  4. Evaluate for an underlying cause of growth faltering Correct answer.

Explanation

Crossing downward across two major percentile lines suggests growth faltering and warrants evaluation for nutritional, endocrine, or chronic disease causes. Normal growth generally follows a consistent percentile over time.

Question 46Health Promotion, Growth, and Development

In girls, menarche typically occurs how long after thelarche?

  1. About 5 years
  2. Menarche precedes thelarche
  3. About 6 months
  4. About 2 to 2.5 years Correct answer.

Explanation

Breast budding (thelarche) is usually the first sign of puberty in girls, and menarche follows about 2 to 2.5 years later. This interval reflects the typical progression through Tanner stages.

Question 47Health Promotion, Growth, and Development

Which finding at a 16-month well-child visit warrants further evaluation?

  1. The child points to request objects
  2. The child follows one-step directions
  3. The child uses 10 words
  4. The child has no single words Correct answer.

Explanation

The absence of any single words by 16 months is a language red flag that warrants hearing and developmental evaluation. Using a few words, pointing to request, and following simple directions are all expected at this age.

Question 48Health Promotion, Growth, and Development

An infant with severe eczema and egg allergy is at high risk for peanut allergy. According to current guidance, peanut-containing foods should be introduced:

  1. At 4 to 6 months after evaluation Correct answer.
  2. Only after age 3 years
  3. Never, due to allergy
  4. Only after a skin test is positive

Explanation

Early introduction of peanut-containing foods at about 4 to 6 months reduces the risk of peanut allergy in high-risk infants. Evaluation by an allergy specialist may guide timing and setting but does not mean delaying beyond infancy.

Question 49Health Promotion, Growth, and Development

The Babinski reflex (dorsiflexion of the great toe with fanning of the other toes) is considered abnormal if it persists beyond which age?

  1. 6 months
  2. Until school age
  3. 12 to 24 months Correct answer.
  4. 3 months

Explanation

The Babinski response is normal in infants and usually disappears by about 12 to 24 months as the corticospinal tracts myelinate. Persistence beyond this age suggests upper motor neuron pathology.

Question 50Health Promotion, Growth, and Development

Using the mid-parental height method, a girl's predicted adult height is calculated by:

  1. Average parental height plus 6.5 cm
  2. Average parental height minus 6.5 cm Correct answer.
  3. Father's height minus 6.5 cm
  4. Sum of parental heights divided by 3

Explanation

For girls, mid-parental height is the average of the parents' heights minus 6.5 cm; for boys, 6.5 cm is added. The result estimates the child's genetic height potential.