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CPNP-PC practice questions

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Question 1Health Promotion, Maintenance, and Anticipatory Guidance

A healthy 4-month-old who has received all prior immunizations on schedule presents for a well-child visit. Which set of vaccines is due at this visit?

  1. Hepatitis B and Haemophilus influenzae type b only
  2. DTaP, IPV, Hib, PCV13, and rotavirus Correct answer.
  3. MMR, varicella, and hepatitis A
  4. Tdap, HPV, and meningococcal conjugate

Explanation

The 4-month visit is the third dose in the primary series for DTaP, IPV, Hib, and PCV13, and the second dose of rotavirus vaccine. These are given together at 2, 4, and 6 months. MMR, varicella, and hepatitis A begin at 12 months or later, and Tdap, HPV, and meningococcal conjugate are adolescent vaccines.

Question 2Health Promotion, Maintenance, and Anticipatory Guidance

A new mother asks how long she should plan to feed her infant breast milk exclusively. Which recommendation should the pediatric nurse practitioner provide?

  1. Exclusive breastfeeding until the infant begins to crawl and pull to stand independently
  2. Breastfeeding only until the infant starts sleeping through the night
  3. Exclusive breastfeeding for 3 months, then switching to whole cow's milk
  4. About 6 months exclusively, then continued as complementary foods are introduced Correct answer.

Explanation

Exclusive breastfeeding is recommended for about the first 6 months, after which iron-rich complementary foods are added while breastfeeding continues to 12 months and beyond as desired. Cow's milk is avoided before 12 months, and motor milestones or sleep patterns do not determine weaning.

Question 3Health Promotion, Maintenance, and Anticipatory Guidance

Parents of a 15-month-old ask when they may turn the child's car seat to face forward. What is the most appropriate guidance?

  1. At 12 months of age, regardless of the child's weight or height on the growth chart
  2. As soon as the child can sit without support and pull to a stand
  3. When the child weighs 20 pounds or can walk across a room without help
  4. Once the seat's rear-facing limit is outgrown, and at least to age 2 Correct answer.

Explanation

Children should remain rear-facing until they reach the highest weight or height allowed by the seat, and at minimum until age 2. Age alone is not the deciding factor, and outdated 20-pound or 12-month thresholds should not be used. After forward-facing, a harnessed seat is used until the child outgrows it.

Question 4Health Promotion, Maintenance, and Anticipatory Guidance

Parents of a 4-month-old ask when to begin offering solid foods. Which response is most appropriate?

  1. Begin pureed foods now, because starting solids earlier helps the infant sleep through the night
  2. At about 6 months, when readiness cues appear and the infant sits with support Correct answer.
  3. Begin only after the infant has cut at least four teeth
  4. Begin at 4 months by adding rice cereal to the infant's bottle

Explanation

Readiness signs include good head and neck control, sitting with support, showing interest in food, and loss of the tongue-thrust reflex, which usually appear around 6 months. Iron-rich foods are recommended first. Cereal in a bottle is discouraged and tooth eruption is not a prerequisite for eating.

Question 5Health Promotion, Maintenance, and Anticipatory Guidance

Parents of a 2-year-old ask how much fluoride toothpaste to use when brushing. What should the pediatric nurse practitioner recommend?

  1. A pea-sized amount
  2. No fluoride toothpaste until age 6
  3. A full brush length of paste
  4. A thin smear about the size of a grain of rice Correct answer.

Explanation

For children younger than 3 years, a thin smear of fluoridated toothpaste roughly the size of a grain of rice is recommended twice daily. Children aged 3 to 6 years use a pea-sized amount. Brushing should be supervised and the child encouraged to spit rather than rinse.

Question 6Health Promotion, Maintenance, and Anticipatory Guidance

Which instruction should the pediatric nurse practitioner give parents to reduce the risk of sleep-related infant death?

  1. Keep the room warm and use a soft bumper pad along the crib sides
  2. Place the infant on the side with a rolled blanket behind the back for support
  3. Offer a pacifier only after 6 months of age and never at bedtime
  4. Place the infant supine on a firm surface with no loose bedding Correct answer.

Explanation

Infants should be placed wholly on their back for every sleep on a firm, flat surface free of soft objects, with room-sharing but not bed-sharing. Overheating and bumper pads increase risk. A pacifier offered at sleep onset is associated with reduced risk once breastfeeding is established.

Question 7Health Promotion, Maintenance, and Anticipatory Guidance

A 12-month-old enrolled in Medicaid is seen for a well-child visit. When should blood lead screening be performed for this child?

  1. Only if the parents report pica
  2. Only when the family moves into an older home
  3. At 12 and 24 months of age Correct answer.
  4. Once at 5 years of age before school entry

Explanation

Children covered by Medicaid are screened universally with a blood lead level at 12 months and again at 24 months. For other children, a risk questionnaire is used and testing is performed when risk factors are present. Pica and older housing are risk factors but are not the basis for the Medicaid requirement.

Question 8Health Promotion, Maintenance, and Anticipatory Guidance

Parents ask when their infant should first see a dentist. What is the recommended timing?

  1. At school entry, around 5 years of age
  2. By the first birthday or within 6 months of the first tooth Correct answer.
  3. At 3 years of age, once all of the primary teeth have erupted
  4. Only when a cavity or discoloration is first noticed

Explanation

A dental home should be established by the first birthday or within 6 months of eruption of the first tooth, whichever comes first. Early visits allow fluoride varnish, caries risk assessment, and anticipatory guidance. Waiting for pain or visible decay is reactive rather than preventive care.

Question 9Health Promotion, Maintenance, and Anticipatory Guidance

Parents of a 4-year-old ask about screen media use. Which advice is consistent with current recommendations?

  1. Permit 3 hours of screen time daily, but only after homework is finished
  2. No more than 1 hour daily of high-quality programming, co-viewed when possible Correct answer.
  3. Allow unlimited screen time as long as the content is educational
  4. Avoid all screens until age 6, then allow up to 2 hours of educational media per day

Explanation

For children 2 to 5 years, screen media should be limited to about 1 hour per day of high-quality programming, viewed together when possible. Consistent limits should also apply to meals and the hour before bedtime. Unlimited use and multi-hour allowances exceed these recommendations.

Question 10Health Promotion, Maintenance, and Anticipatory Guidance

At which well-child visits should the pediatric nurse practitioner perform standardized autism-specific screening for a child with no developmental concerns?

  1. 9 and 12 months
  2. 18 and 24 months Correct answer.
  3. 4 and 5 years
  4. Only when a parent raises a concern

Explanation

Developmental surveillance occurs at every well-child visit, with standardized autism-specific screening at the 18- and 24-month visits. Screening at both ages captures children who regress after 18 months. Waiting for a parent to raise a concern misses children who would be identified by routine screening.

Question 11Health Promotion, Maintenance, and Anticipatory Guidance

A 12-year-old presents for a well-child visit and is up to date on all vaccines. Which recommendation regarding HPV vaccination is correct?

  1. Two doses given 6 to 12 months apart, started at 11 to 12 years Correct answer.
  2. HPV vaccine is not recommended until 15 years of age
  3. Three doses are required at any age, regardless of when the series starts
  4. A single dose is sufficient if it is given before age 15

Explanation

When the HPV series is started before the 15th birthday, a two-dose schedule with doses 6 to 12 months apart is recommended. Three doses are needed if the series begins at 15 years or later, or if the child is immunocompromised. The series may be started as early as age 9.

Question 12Health Promotion, Maintenance, and Anticipatory Guidance

Which guidance best supports iron status in a 9-month-old who is breastfed?

  1. Delay all solid foods until 12 months of age
  2. Switch from breast milk to iron-fortified formula
  3. Introduce whole cow's milk now, since it is an excellent source of dietary iron
  4. Offer iron-rich foods such as pureed meats, beans, and iron-fortified cereal Correct answer.

Explanation

Breast milk contains little iron, and fetal iron stores are largely depleted by about 6 months, so iron-rich complementary foods are needed. Pureed meats, legumes, and iron-fortified cereals are appropriate first foods. Cow's milk is avoided before 12 months because it is iron-poor and can cause gastrointestinal blood loss.

Question 13Health Promotion, Maintenance, and Anticipatory Guidance

At which age should routine visual acuity screening using an eye chart first be attempted in a cooperative child?

  1. 12 months
  2. 3 years Correct answer.
  3. 6 months
  4. 7 years

Explanation

Optotype acuity testing, such as with Lea symbols or picture charts, is first attempted at 3 years. Instrument-based photoscreening may begin at 12 months, and red reflex testing is done from the newborn period. Waiting until 7 years delays detection of amblyopia risk.

Question 14Health Promotion, Maintenance, and Anticipatory Guidance

Blood pressure measurement is recommended at every well-child visit beginning at which age?

  1. 6 years
  2. 12 years
  3. 3 years Correct answer.
  4. At birth

Explanation

Routine blood pressure measurement begins at 3 years and is obtained at every well-child visit thereafter. Children with risk factors such as prematurity, congenital heart disease, renal disease, diabetes, or obesity should be screened earlier. Delaying to 6 or 12 years misses treatable hypertension in younger children.

Question 15Health Promotion, Maintenance, and Anticipatory Guidance

Parents of a 2-year-old report frequent tantrums. Which advice is most appropriate?

  1. Ignore the tantrum as long as the child is safe, and praise calm behavior Correct answer.
  2. Send the child to bed without dinner each time a tantrum occurs
  3. Give in to the tantrum so that it does not escalate into a meltdown
  4. Spank the child promptly to establish limits and discourage future tantrums

Explanation

Tantrums are developmentally expected in toddlers and respond best to consistent, calm limits with attention shifted to positive behavior. Physical punishment is associated with increased aggression and is not recommended. Withholding meals is neither effective nor appropriate discipline.

Question 16Health Promotion, Maintenance, and Anticipatory Guidance

Which food should the pediatric nurse practitioner identify as a choking hazard for a 2-year-old?

  1. Soft-cooked pasta
  2. Mashed potatoes
  3. Whole grapes Correct answer.
  4. Scrambled eggs

Explanation

Round, firm foods such as whole grapes, hot dogs, nuts, hard candy, and popcorn pose a high choking risk for young children. Grapes and hot dogs should be cut lengthwise into small pieces, and children should sit while eating. Soft, mashable foods are lower risk.

Question 17Health Promotion, Maintenance, and Anticipatory Guidance

Parents of a 3-month-old plan a beach vacation. Which sun protection advice is most appropriate?

  1. Use a tanning oil so the skin gradually adapts to sunlight
  2. Apply a spray sunscreen with a high SPF to the entire body every hour
  3. Shade, hats, and light clothing; a small amount of sunscreen on exposed skin Correct answer.
  4. No protection is needed at this age because sunscreen is contraindicated

Explanation

Infants younger than 6 months should be kept out of direct sunlight using shade, hats, and lightweight clothing that covers the arms and legs. When shade is not available, a small amount of broad-spectrum sunscreen may be applied to exposed areas. Tanning oils provide no protection and increase burning risk.

Question 18Health Promotion, Maintenance, and Anticipatory Guidance

A 15-year-old is seen for an annual visit. Regarding confidentiality, which statement should guide the pediatric nurse practitioner?

  1. Adolescents cannot legally consent to any health service unless a parent is present in the room
  2. Explain the limits of confidentiality at the start and provide time alone with the teen Correct answer.
  3. All information must be shared with the parents regardless of the topic discussed
  4. Confidentiality should not be discussed during the visit because it upsets parents

Explanation

Confidentiality and its limits, such as safety concerns and reportable abuse, should be explained to both the adolescent and the parents at the start of the visit. The adolescent should then be interviewed alone as part of routine care. Many states permit minors to consent to certain services, including STI testing and mental health care.

Question 19Health Promotion, Maintenance, and Anticipatory Guidance

Parents of a 6-year-old who weighs 45 pounds ask about car restraints. What is appropriate guidance?

  1. Move the child to the front seat so that the child can see out of the window
  2. A seat belt alone is adequate once the child begins elementary school
  3. A backless booster becomes unsafe once the child turns 5 years old
  4. Booster seat until the seat belt fits properly, often near 4 feet 9 inches Correct answer.

Explanation

A belt-positioning booster should be used until the vehicle lap and shoulder belt fit correctly, typically when the child is about 4 feet 9 inches tall and 8 to 12 years old. The back seat is recommended until age 13. Backless boosters are appropriate for older children who meet the height and weight criteria.

Question 20Health Promotion, Maintenance, and Anticipatory Guidance

What is appropriate advice about cow's milk for a 12-month-old who is eating table foods?

  1. Use skim milk to help prevent childhood obesity and heart disease
  2. Offer whole cow's milk, limited to about 16 to 24 ounces per day Correct answer.
  3. Offer unlimited whole milk to maximize calcium intake and growth
  4. Replace solid foods with milk to ensure adequate calorie intake

Explanation

Whole cow's milk may be introduced at 12 months and provides fat needed for brain development through age 2. Intake should be limited to roughly 16 to 24 ounces daily because larger volumes displace iron-rich foods and can cause iron deficiency. Skim milk is not recommended before age 2.

Question 21Health Promotion, Maintenance, and Anticipatory Guidance

A 9-month-old born at the 50th percentile for weight has fallen to the 5th percentile over two visits, while length and head circumference track near the 25th percentile. The infant is alert and playful. What is the most appropriate next step?

  1. Reassure the parents that some percentile crossing is normal and recheck in 1 year
  2. Admit for a full failure-to-thrive workup, including head imaging
  3. Order immediate growth hormone stimulation testing and a thyroid panel
  4. Take a feeding history and intake diary, then recheck weight in 2 weeks Correct answer.

Explanation

Crossing two major weight percentile lines downward suggests faltering growth and warrants a careful feeding, intake, and psychosocial history with close follow-up weights. Laboratory testing is reserved for cases that do not respond to feeding optimization or that have other red flags. An alert, playful infant without other findings does not require admission or growth hormone testing as a first step.

Question 22Health Promotion, Maintenance, and Anticipatory Guidance

Parents report that their 18-month-old, who previously said several words, has stopped speaking and no longer waves or points. What is the most appropriate action?

  1. Reassure the parents that a brief speech regression is common and recheck at the 24-month visit
  2. Refer promptly for audiology evaluation and early intervention services Correct answer.
  3. Recommend a trial of sign language instruction for 3 months before any referral
  4. Advise reducing screen time and returning for re-evaluation in 6 months

Explanation

Loss of previously acquired language or social skills is a red flag that warrants immediate evaluation. Hearing testing and referral to early intervention should occur concurrently rather than sequentially. A watch-and-wait approach delays identification of autism or hearing loss and misses the window for early therapy.

Question 23Health Promotion, Maintenance, and Anticipatory Guidance

A 7-year-old with no immunization record is starting school. Which approach is correct for catch-up vaccination?

  1. Restart the entire immunization series from birth because no records are available
  2. Withhold all vaccines until written records can be located from every prior provider
  3. Give age-appropriate vaccines using the catch-up schedule's minimum intervals Correct answer.
  4. Give only the vaccines that the school district requires for enrollment

Explanation

A child without documentation should be vaccinated according to the catch-up schedule, using the minimum intervals between doses; the series is not restarted. Delaying vaccination leaves the child unprotected while records are sought. Only school-required vaccines would leave meaningful gaps, such as hepatitis A and varicella.

Question 24Health Promotion, Maintenance, and Anticipatory Guidance

A 15-year-old had an episode of syncope while playing basketball; the physical examination is normal. What is the most appropriate guidance regarding sports participation?

  1. Allow participation as long as the athlete feels well on the day of the game
  2. Allow full participation because the physical examination is normal
  3. Restrict only from contact sports such as football and hockey
  4. Withhold clearance until the episode is evaluated by cardiology Correct answer.

Explanation

Exertional syncope is a red flag for structural heart disease such as hypertrophic cardiomyopathy or an anomalous coronary artery. A normal examination does not exclude these conditions, and clearance should await cardiology evaluation. Symptom-based or sport-specific restriction is not adequate protection.

Question 25Health Promotion, Maintenance, and Anticipatory Guidance

At which well-child visits should the pediatric nurse practitioner screen a mother for postpartum depression using a validated tool?

  1. At the 12-month visit, once breastfeeding has ended
  2. Only at the 2-week newborn visit
  3. Only if the mother appears tearful during the visit
  4. At the 1-, 2-, 4-, and 6-month visits Correct answer.

Explanation

Maternal depression screening with a validated instrument such as the Edinburgh Postnatal Depression Scale is recommended at the 1-, 2-, 4-, and 6-month well-child visits. Screening is universal rather than based on appearance, because depressed mothers may not appear tearful. Positive screens warrant further assessment and referral.

Question 26Health Promotion, Maintenance, and Anticipatory Guidance

A 2-month-old is exclusively breastfed. Which supplement should the nurse practitioner recommend at this visit?

  1. Iron 5 mg/kg daily
  2. No supplement is needed while breastfeeding
  3. Vitamin D 1,000 IU daily
  4. Vitamin D 400 IU daily Correct answer.

Explanation

Breast milk contains little vitamin D, so the AAP recommends 400 IU/day for all breastfed and partially breastfed infants beginning in the first days of life and continuing until the infant takes at least 1 L/day of vitamin D-fortified formula or milk. Exclusively breastfed infants also need iron 1 mg/kg/day starting at about 4 months until iron-rich foods are well established.

Question 27Health Promotion, Maintenance, and Anticipatory Guidance

What is the maximum amount of 100% fruit juice recommended each day for a 4-year-old?

  1. 4 to 6 ounces Correct answer.
  2. No 100% juice at any age
  3. 2 ounces
  4. 8 to 12 ounces

Explanation

The AAP limits 100% fruit juice to 4 ounces per day for children 1 to 3 years, 4 to 6 ounces per day for children 4 to 6 years, and 8 ounces per day for children 7 years and older. Juice is not recommended before 12 months, and whole fruit is preferred because it provides fiber and is more satiating.

Question 28Health Promotion, Maintenance, and Anticipatory Guidance

Parents of a 7-month-old ask when they may offer honey. What is the appropriate response?

  1. Honey should be avoided until 12 months of age Correct answer.
  2. Pasteurized honey is safe for infants
  3. Honey should be avoided until 24 months of age
  4. Honey can be offered once solid foods are started at 6 months

Explanation

Honey may contain Clostridium botulinum spores, which can colonize the immature intestine and cause infant botulism, and pasteurization does not reliably destroy the spores. The risk becomes negligible after 12 months, when gut flora and immune defenses are more mature.

Question 29Health Promotion, Maintenance, and Anticipatory Guidance

Parents of a 6-year-old who is learning to ride a bicycle ask about helmet use. Which advice is correct?

  1. A helmet is needed until the child can ride without training wheels
  2. A helmet is needed only when riding on busy roads
  3. A helmet is needed only for children younger than 5 years
  4. A correctly fitted helmet should be worn on every ride Correct answer.

Explanation

Head injury is the leading cause of serious bicycle-related death and disability, and helmets substantially reduce that risk, so one should be worn on every ride regardless of distance, road type, or rider age. Helmets should also be used for scooters, skates, and skateboards, and should sit level and snug with the straps forming a V beneath the ears.

Question 30Health Promotion, Maintenance, and Anticipatory Guidance

An 11-year-old is up to date on all vaccines. In addition to human papillomavirus vaccine and annual influenza vaccine, which vaccines are due at this visit?

  1. Measles-mumps-rubella and varicella
  2. Tdap and meningococcal conjugate Correct answer.
  3. Tdap and hepatitis B
  4. Meningococcal conjugate and pneumococcal conjugate

Explanation

At the 11- to 12-year visit the CDC and AAP schedule adds Tdap and the first dose of quadrivalent meningococcal conjugate vaccine to the adolescent platform, which also includes HPV and annual influenza vaccination. A booster dose of meningococcal conjugate vaccine is then given at about 16 years.

Question 31Health Promotion, Maintenance, and Anticipatory Guidance

Which water heater setting should the nurse practitioner recommend for a home with young children to reduce scald risk?

  1. 140 degrees F (60 degrees C)
  2. 120 degrees F (49 degrees C) Correct answer.
  3. 100 degrees F (38 degrees C)
  4. 160 degrees F (71 degrees C)

Explanation

Setting the water heater to no more than 120 degrees F limits the maximum tap-water temperature and greatly lengthens the time needed to produce a serious burn; at 140 degrees F a young child can sustain a full-thickness burn in seconds. Families should also test bath water before placing a child in the tub and supervise children in the bathroom.

Question 32Health Promotion, Maintenance, and Anticipatory Guidance

Parents of a 3-year-old who smoke ask how to reduce their child's exposure. Which advice is most appropriate?

  1. Use fans and air purifiers to clear the smoke
  2. Smoke only in rooms where a window is open
  3. Smoke only while the child is asleep
  4. Keep the home and car completely smoke-free Correct answer.

Explanation

No level of secondhand smoke exposure is safe, and open windows, fans, air purifiers, and separate rooms do not remove the fine particles and gases that harm children. A strict smoke-free home and car policy is the effective recommendation, with quitting as the ultimate goal for caregivers.

Question 33Health Promotion, Maintenance, and Anticipatory Guidance

What physical activity recommendation applies to a healthy 10-year-old?

  1. 20 minutes of light activity three times per week
  2. One 60-minute session of vigorous activity each week
  3. Activity only during scheduled physical education classes
  4. At least 60 minutes of moderate-to-vigorous activity every day Correct answer.

Explanation

National guidelines call for 60 minutes or more of moderate-to-vigorous physical activity daily for children and adolescents aged 6 to 17 years, including aerobic activity plus muscle- and bone-strengthening activities on at least 3 days each week. Daily activity supports weight regulation, bone health, mood, and academic performance.

Question 34Health Promotion, Maintenance, and Anticipatory Guidance

Parents of a 2-year-old ask how much fluoride toothpaste to use when brushing the child's teeth. What should the nurse practitioner recommend?

  1. A pea-sized amount
  2. A thin smear, about the size of a grain of rice Correct answer.
  3. A strip the full length of the toothbrush
  4. No fluoride toothpaste until the child can spit reliably

Explanation

The AAP and AAPD recommend a smear of fluoride toothpaste the size of a grain of rice from eruption of the first tooth until age 3 years, then a pea-sized amount from 3 to 6 years. Parents should brush the child's teeth twice daily and wipe away excess paste rather than relying on the child to spit.

Question 35Health Promotion, Maintenance, and Anticipatory Guidance

A 6-month-old with mild eczema is developmentally ready for solid foods. What should the nurse practitioner advise about peanut-containing foods?

  1. Delay introduction of peanut until the child is 3 years old to reduce risk
  2. Obtain peanut-specific IgE testing before offering any peanut
  3. Avoid all peanut products indefinitely because of the eczema
  4. Introduce peanut-containing foods now in an age-appropriate form Correct answer.

Explanation

Guidelines derived from the LEAP trial recommend introducing peanut-containing foods at about 6 months for infants with mild to moderate eczema, at home and in an age-appropriate form such as peanut powder or peanut butter thinned with water or cereal, because early introduction lowers the risk of peanut allergy. Infants with severe eczema or egg allergy should undergo testing and possibly supervised introduction.

Question 36Health Promotion, Maintenance, and Anticipatory Guidance

A healthy 10-year-old has no family history of early heart disease or dyslipidemia. What is the recommended approach to lipid screening?

  1. Screening is unnecessary because there is no family history
  2. Screen only if the BMI is at or above the 95th percentile
  3. Screen once between ages 9 and 11 years with a nonfasting lipid panel Correct answer.
  4. Screening should be delayed until 18 years of age

Explanation

NHLBI and AAP guidance calls for universal lipid screening once between 9 and 11 years and again between 17 and 21 years, in addition to targeted screening of younger children with risk factors such as familial hypercholesterolemia or obesity. A nonfasting lipid panel is acceptable for the universal screen.

Question 37Health Promotion, Maintenance, and Anticipatory Guidance

A healthy term infant who has been growing well is seen for the 12-month well-child visit. Which laboratory screening is recommended?

  1. A complete metabolic panel
  2. Hemoglobin or hematocrit to screen for anemia Correct answer.
  3. Serum ferritin and transferrin saturation
  4. No routine laboratory screening at this age

Explanation

AAP and Bright Futures recommend universal screening for iron deficiency anemia with hemoglobin or hematocrit at about 12 months, when risk peaks as fetal iron stores are exhausted and cow's milk may displace iron-rich foods. Ferritin and other iron studies are used to characterize an abnormal hemoglobin result rather than as the universal first-line test.

Question 38Health Promotion, Maintenance, and Anticipatory Guidance

Parents of a 6-week-old ask about tummy time. Which guidance should the nurse practitioner give?

  1. Tummy time is not needed if the infant is frequently held during the day
  2. Begin tummy time only after the infant can roll over independently
  3. Infants should sleep prone to build strength, making tummy time unnecessary
  4. Supervised prone play while awake, a few minutes several times daily Correct answer.

Explanation

Prone play while the infant is awake and supervised should begin in the newborn period, starting with a few minutes several times a day and building toward 15 to 30 minutes total daily. It strengthens the head, neck, and shoulder muscles and helps prevent positional plagiocephaly, while supine positioning remains the rule for every sleep.

Question 39Health Promotion, Maintenance, and Anticipatory Guidance

How much sleep should a healthy 15-year-old get in a 24-hour period?

  1. 11 to 13 hours
  2. 8 to 10 hours Correct answer.
  3. At least 12 hours
  4. 6 to 7 hours

Explanation

The American Academy of Sleep Medicine and AAP recommend 8 to 10 hours of sleep per 24 hours for adolescents 13 to 18 years, while school-age children 6 to 12 years need 9 to 12 hours. Chronic short sleep in teens is linked to obesity, mood disorders, poor academic performance, and increased risk-taking.

Question 40Health Promotion, Maintenance, and Anticipatory Guidance

A 14-year-old presents for a routine well-child visit. Which approach to substance use screening is recommended?

  1. Screen confidentially each year with a validated tool such as CRAFFT Correct answer.
  2. Screen only if a parent raises a concern about drugs or alcohol
  3. Ask about substance use only when the teen presents with an injury
  4. Obtain a urine drug screen on all adolescents annually

Explanation

AAP guidance recommends annual confidential screening beginning at about 12 years using a validated instrument such as CRAFFT, conducted without the parent present, followed by brief intervention and referral when indicated. Nonjudgmental, confidential questioning improves disclosure.

Question 41Health Promotion, Maintenance, and Anticipatory Guidance

Which statement reflects the recommended approach to depression screening for adolescents?

  1. Screen all adolescents 12 years and older annually with a validated tool Correct answer.
  2. Screen only adolescents with a known family history of depression
  3. Screen adolescents once, at the 18-year visit
  4. Screening is not recommended until adulthood

Explanation

The AAP and USPSTF recommend annual screening for major depressive disorder in all youth 12 to 18 years using a validated instrument such as the PHQ-9 modified for adolescents. Screening should be paired with a plan for safety assessment, attention to confidentiality, and referral for treatment.

Question 42Health Promotion, Maintenance, and Anticipatory Guidance

Parents of a 4-year-old ask for guidance about using time-out. Which instruction is correct?

  1. Use time-out in place of praising good behavior
  2. Use about 1 minute per year of age in a safe, boring place Correct answer.
  3. Use at least 20 minutes so the lesson is remembered
  4. Use a locked room so the child cannot leave early

Explanation

Time-out works best when it is brief, immediate, and delivered in a safe, nonstimulating setting, typically about 1 minute per year of age, followed by a calm restatement of the rule. It is most effective alongside generous attention and praise for appropriate behavior; physical punishment and humiliation are not recommended.

Question 43Health Promotion, Maintenance, and Anticipatory Guidance

Parents of a 6-month-old ask when they should begin reading aloud to their child. What should the nurse practitioner advise?

  1. Begin when the child starts kindergarten
  2. Wait until the child can point at pictures and turn pages
  3. Begin now, sharing books together every day Correct answer.
  4. Wait until the child is 2 years old and can repeat words

Explanation

The AAP recommends shared reading beginning in infancy, and programs such as Reach Out and Read begin distributing books at the 6-month visit. Daily reading supports language development, early literacy, and the parent-child relationship, and it is normal for infants to mouth and pat books rather than follow the story.

Question 44Health Promotion, Maintenance, and Anticipatory Guidance

Which insect repellent recommendation is appropriate for a 3-year-old?

  1. Avoid all insect repellents until 12 years of age
  2. Use oil of lemon eucalyptus because it is plant-based
  3. Apply a 50% DEET product underneath clothing for all-day protection
  4. Use a product containing 10% to 30% DEET on exposed skin Correct answer.

Explanation

The AAP considers DEET safe for children older than 2 months at concentrations up to 30%, applied only to exposed skin and away from the hands, eyes, mouth, and broken skin, then washed off once protection is no longer needed. Oil of lemon eucalyptus is not recommended for children younger than 3 years.

Question 45Health Promotion, Maintenance, and Anticipatory Guidance

Parents of a toddler ask about poison prevention and what to do after a suspected ingestion. Which advice is correct?

  1. Wait for symptoms such as vomiting to appear before calling poison control
  2. Give salt water to induce vomiting if a household cleaner is swallowed
  3. Lock up medicines and cleaners and call poison control after ingestion Correct answer.
  4. Keep syrup of ipecac on hand and induce vomiting after any ingestion

Explanation

Syrup of ipecac is no longer recommended and vomiting should never be induced, because caustic substances and hydrocarbons can cause additional injury to the esophagus and airway. Medications and household products should be stored locked, out of reach, and in their original containers, and poison control (1-800-222-1222) should be called immediately after any suspected ingestion.

Question 46Health Promotion, Maintenance, and Anticipatory Guidance

A 2-year-old drinks well water with a fluoride concentration of 0.1 ppm and has no other fluoride source. Which supplement should the nurse practitioner prescribe?

  1. Fluoride 1 mg daily
  2. Fluoride 0.25 mg daily Correct answer.
  3. No supplement; fluoride varnish alone is sufficient
  4. Fluoride 0.5 mg daily

Explanation

When the water fluoride concentration is below 0.3 ppm, the recommended daily supplement is 0.25 mg from 6 months to 3 years, 0.5 mg from 3 to 6 years, and 1 mg from 6 to 16 years. The dose is lower when water contains 0.3 to 0.6 ppm and is zero above 0.6 ppm.

Question 47Health Promotion, Maintenance, and Anticipatory Guidance

A newborn's initial hearing screening is abnormal. Which follow-up plan is correct?

  1. Repeat the screening at the 2-month well-child visit
  2. Repeat screening by 1 month; diagnostic testing by 3 months Correct answer.
  3. Wait until 9 months and use behavioral audiometry
  4. Refer directly to a cochlear implant team in the nursery

Explanation

The national Early Hearing Detection and Intervention benchmarks are screening by 1 month, diagnostic audiologic evaluation by 3 months, and enrollment in early intervention by 6 months. Early confirmation and treatment of hearing loss are critical for language acquisition.

Question 48Health Promotion, Maintenance, and Anticipatory Guidance

Which safety feature is most protective against drowning for a family with a backyard pool and a toddler?

  1. Swim lessons for the child beginning at 12 months of age
  2. A four-sided isolation fence with a self-latching gate Correct answer.
  3. A rigid pool cover kept in place whenever the pool is not in use
  4. A door alarm on the house that sounds when the pool area is entered

Explanation

Layers of protection are recommended, and a four-sided fence that completely separates the pool from the house and yard, with a self-closing and self-latching gate, is the environmental strategy most strongly associated with reduced drowning risk. Covers, alarms, and swim lessons add protection but do not substitute for a barrier plus close, constant supervision.

Question 49Health Promotion, Maintenance, and Anticipatory Guidance

Parents of a 16-year-old who has just received a learner permit ask about driving safety. Which counseling is most appropriate?

  1. Follow state graduated licensing limits on supervision, night driving, and passengers Correct answer.
  2. Seat belt use is only necessary when driving on highways
  3. Passenger and nighttime limits can be ignored once driver education is completed
  4. Unsupervised driving practice should begin as soon as the permit is issued

Explanation

Graduated driver licensing programs phase in driving privileges and typically include a supervised learner period, nighttime driving restrictions, and limits on teen passengers, and states with these components have lower crash rates among novice drivers. A written parent-teen driving agreement that also prohibits phone use and any alcohol or cannabis use reinforces the rules.

Question 50Health Promotion, Maintenance, and Anticipatory Guidance

A 12-year-old has a BMI at the 96th percentile. Which additional finding meets the criteria for screening for type 2 diabetes?

  1. A classmate who was recently diagnosed with type 2 diabetes
  2. A grandmother with hypothyroidism
  3. A parent with type 2 diabetes Correct answer.
  4. A paternal aunt with type 1 diabetes

Explanation

Screening for type 2 diabetes is recommended beginning at 10 years or at puberty for youth with a BMI at or above the 85th percentile plus at least one risk factor, such as a first- or second-degree relative with type 2 diabetes, high-risk race or ethnicity, or signs of insulin resistance. Screening is repeated at least every 3 years with fasting glucose or HbA1c.