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ArticleFREE PNCB CPN Exam Guide 2026: Pass the Certified Pediatric Nurse Exam First Try26 min read

Exam Review

Key Facts: CPNP-AC Exam

78.84%

First-Time Pass Rate

PNCB 2025

175

Total Questions

150 scored

400

Passing Score

Scaled 200-800

Exam Time

Single session

37%

Management Domain

Largest section

$407

Exam Fee

PNCB

The PNCB CPNP-AC exam gives candidates 3 hours for 175 multiple-choice questions, including 150 scored items. Management has 56 scored items, Assessment 51, Diagnosis 36, and Professional Practice Role 7. The 2025 first-time pass rate was 78.84%.

Sample CPNP-AC Practice Questions

Try these sample questions to review concepts for the CPNP-AC exam. Each question includes a detailed explanation. Start the interactive quiz above for the full 200+ question experience with AI tutoring.

1A 4-year-old child is brought to the emergency department with respiratory distress. Which assessment finding would be most concerning for impending respiratory failure?

A.Mild subcostal retractions

B.Respiratory rate of 32 breaths per minute

C.Altered mental status and decreased respiratory effort

D.Use of accessory muscles during inspiration

Explanation: Altered mental status with decreased respiratory effort is a critical sign of impending respiratory failure. While accessory muscle use, retractions, and tachypnea are concerning, a declining mental status indicates hypoxemia and hypercapnia affecting the brain. This requires immediate intervention including potential intubation.

2When assessing a child with suspected sepsis, which vital sign change would be most concerning in a previously healthy 3-year-old?

A.Heart rate of 120 beats per minute

B.Blood pressure at the 25th percentile for age

C.Temperature of 38.5 degrees C (101.3°F)

D.Tachycardia with hypotension and altered perfusion

Explanation: Tachycardia with hypotension and altered perfusion (capillary refill >3 seconds, mottled skin, weak pulses) indicates septic shock. Children can maintain blood pressure through compensatory mechanisms until late in sepsis. The combination of tachycardia, hypotension, and poor perfusion signals decompensated shock requiring immediate resuscitation.

3A 6-month-old infant presents with bilious vomiting and abdominal distension. Which assessment finding would suggest midgut volvulus?

A.Mild abdominal tenderness on palpation

B.Normal bowel sounds throughout all quadrants

C.Episodic crying with legs drawn to abdomen

D.Bloody stools with mucus

Explanation: Episodic crying with legs drawn to the abdomen is characteristic of intussusception or malrotation with volvulus. Midgut volvulus causes intermittent abdominal pain as the bowel twists and untwists. This classic presentation, combined with bilious vomiting in an infant, is a surgical emergency requiring immediate evaluation.

4During the assessment of a child with diabetic ketoacidosis (DKA), which finding indicates severe dehydration?

A.Dry mucous membranes

B.Tachycardia with hypotension

C.Decreased skin turgor

D.Sunken fontanelle (in infants)

Explanation: Tachycardia with hypotension indicates severe dehydration with hypovolemic shock. While dry mucous membranes, decreased skin turgor, and sunken fontanelles are signs of moderate dehydration, cardiovascular compromise (tachycardia + hypotension) signals severe fluid deficit requiring aggressive fluid resuscitation. In DKA, this requires careful fluid management to prevent cerebral edema.

5A 2-year-old child presents with fever and a purpuric rash. Which assessment finding would be most concerning for meningococcemia?

A.Non-blanching petechial rash

B.Mild irritability

C.Temperature of 39°C (102.2°F)

D.Decreased appetite

Explanation: A non-blanching petechial or purpuric rash that does not blanch under pressure is characteristic of meningococcemia and indicates disseminated intravascular coagulation (DIC). This finding, combined with fever and ill appearance, is a medical emergency requiring immediate antibiotic therapy and supportive care.

6When performing a neurologic assessment on a child with suspected increased intracranial pressure (ICP), which finding would be most significant?

A.Mild headache

B.Papilledema on fundoscopic examination

C.Drowsiness but easily arousable

D.Mild nausea without vomiting

Explanation: Papilledema (swelling of the optic disc) on fundoscopic examination is a definitive sign of increased intracranial pressure. It indicates that the ICP has been elevated for a sufficient duration to cause optic nerve head edema. This finding requires urgent neuroimaging and intervention to prevent brain herniation.

7A 5-year-old presents with sudden onset of drooling, dysphagia, and a muffled "hot potato" voice. The child appears toxic and is sitting in the tripod position. What is the most likely diagnosis?

A.Viral pharyngitis

B.Peritonsillar abscess

C.Epiglottitis

D.Croup

Explanation: The combination of sudden onset drooling, dysphagia, muffled "hot potato" voice, toxic appearance, and tripod positioning is classic for epiglottitis. This is a life-threatening airway emergency caused by Haemophilus influenzae type b (Hib) or other bacterial pathogens. Immediate airway management is required.

8A 3-month-old infant presents with paroxysmal coughing, post-tussive vomiting, and apnea episodes. The infant has not received any immunizations. Which diagnosis is most likely?

A.Bronchiolitis

B.Pertussis

C.Pneumonia

D.Croup

Explanation: Paroxysmal coughing, post-tussive vomiting, and apnea episodes in an unimmunized infant are characteristic of pertussis (whooping cough). The paroxysms of coughing followed by a "whoop" or vomiting are pathognomonic. Infants under 6 months are at highest risk for complications including apnea, seizures, and death.

9A 10-year-old with sickle cell disease presents with fever, chest pain, cough, and new infiltrate on chest X-ray. Which complication is most likely?

A.Asthma exacerbation

B.Acute chest syndrome

C.Community-acquired pneumonia

D.Pulmonary embolism

Explanation: Acute chest syndrome is characterized by fever, chest pain, cough, and new pulmonary infiltrate in a patient with sickle cell disease. It is a leading cause of mortality in sickle cell patients and requires urgent treatment with antibiotics, oxygen, hydration, and possibly exchange transfusion.

10A child in status epilepticus has received two doses of lorazepam without cessation of seizure activity. What is the next appropriate medication?

A.Give a third dose of lorazepam

B.Administer fosphenytoin or phenytoin

C.Begin propofol infusion

D.Call for emergency intubation only

Explanation: Per the established status epilepticus algorithm, after two doses of a benzodiazepine (lorazepam or diazepam), the next step is to administer a second-line agent such as fosphenytoin, phenytoin, or valproic acid. If seizures continue, third-line agents or general anesthesia may be required.

About the CPNP-AC Exam

The CPNP-AC certification exam validates competency in pediatric acute care nursing for nurse practitioners caring for acutely ill, chronically ill, and critically ill children in hospitals, emergency departments, and specialty clinics. The exam covers four domains: Assessment (34%), Diagnosis (24%), Management (37%), and Professional Practice Role (5%).

Exam sponsor: PNCB (Pediatric Nursing Certification Board). The requirements and fees below concern the certification or admission exam, separate from our free practice resources.

Questions

175 questions

Time Limit

3 hours

Passing Score

400 (scaled score)

Exam / Certification Fees

$407

Exam sponsor website

Reported exam pass rate: 78.84%. first-time pass rate (PNCB 2025) This describes exam candidates, not OpenExamPrep users or results from using our resources. Exam sponsor website

Fees, eligibility, and exam policies can change. Confirm them with the exam sponsor before applying or paying.

Official sources

Our practice resources: topics covered

We aim to reflect publicly available exam outlines and topic information in our study resources. Coverage, format, and difficulty may differ from the actual exam, and we cannot guarantee that every detail is accurate or current. Confirm exam requirements, fees, and policies with the official exam sponsor.

34%

Assessment

Health history, physical examination, diagnostic studies including hematologic, cardiac, pulmonary, imaging, laboratory studies, rapid diagnostic tests, and point-of-care testing

24%

Diagnosis

Differential diagnosis, clinical reasoning, critical analysis, risk stratification, diagnostic interpretation, and acuity assessment

37%

Management

Therapeutic interventions, pharmacologic management, resuscitation, stabilization, monitoring, interdisciplinary collaboration, patient/family education, and care transitions

Professional Practice Role

Advocacy, ethical decision-making, evidence-based practice, quality improvement, patient safety, systems thinking, leadership, and interprofessional practice

Preparing for the CPNP-AC Exam

What You Need to Know

Passing score: 400 (scaled score)
Exam length: 175 questions
Time limit: 3 hours
Exam / certification fees: $407 Official sources

Using Our Practice Resources

Work through all 200 available questions
Review every answer and explanation
Track weak areas and revisit them
Use our AI tutor for tough concepts

CPNP-AC: Suggested Study Strategy

1Focus on Assessment and Management. Together they account for 107 of the 150 scored items.

2Master pediatric assessment techniques: understand normal vs. abnormal findings across developmental stages

3Know critical care concepts: mechanical ventilation settings, hemodynamic monitoring, and vasoactive medications

4Review common acute conditions: status asthmaticus, DKA, sepsis, seizure management, and respiratory failure

5Practice clinical decision-making: prioritize interventions, identify red flags, and understand when to escalate care

Frequently Asked Questions

What is the CPNP-AC pass rate?

PNCB reported a CPNP-AC first-time pass rate of 78.84% in 2025 and 69.57% in 2024. Its 2025 report counted 569 total CPNP-AC candidates who tested that year.

How many questions are on the CPNP-AC exam?

The CPNP-AC exam consists of 175 multiple-choice questions, with 150 scored and 25 unscored pretest questions. Candidates have 3 hours to complete the examination.

What is the CPNP-AC passing score?

The CPNP-AC uses a standardized scaled scoring system with a passing score of 400. Scaled scores range from 200 to 800 across all exam forms, ensuring consistent standards.

How long should I study for the CPNP-AC?

Build a study plan around your experience and practice results. Start with cases that combine Assessment and Management, the two largest domains, and set aside time to review the Diagnosis and Professional Practice Role tasks.

What is the difference between CPNP-PC and CPNP-AC?

CPNP-PC covers primary care needs such as prevention, developmental screening, common illnesses and stable chronic conditions. CPNP-AC covers acute, critical and complex pediatric illness or injury. Patient needs, the clinician’s preparation and applicable scope rules determine which role is appropriate in a given setting.

What clinical conditions are covered on the CPNP-AC exam?

The exam covers cardiovascular (shock, heart failure, dysrhythmias, congenital heart disease), respiratory (respiratory failure, asthma, bronchiolitis, pneumonia, mechanical ventilation), neurological (seizures, status epilepticus, increased ICP, TBI), infectious disease (sepsis, meningitis), endocrine (DKA, adrenal crisis), hematology/oncology, trauma, and critical care procedures.