Certified Pediatric Nurse Free Sample Questions

In biological females, normal puberty begins between ages 8 and 13 years, most commonly presenting with thelarche (breast bud development), which can initially be unilateral and slightly tender. Peak height velocity (the maximum linear growth spurt) occurs during Tanner stages II to III, approximately 6 to 12 months prior to menarche. Menarche typically occurs 2 to 2.5 years after the onset of thelarche, after which linear growth slows significantly due to epiphyseal plate closure.

Stranger anxiety and separation protest peak between 8 and 12 months of age as the infant develops object permanence (understanding that people and objects continue to exist when out of sight) and secure attachment to primary caregivers. Playing peek-a-boo reinforces that the caregiver reliably returns after disappearing, while brief, honest, and predictable goodbye routines build trust. Sneaking away undermines trust and heightens hypervigilance in the infant.

For preterm infants born prior to 37 weeks' gestation, growth parameters and developmental milestones are evaluated using corrected gestational age until 24 months of chronological age. Corrected age is calculated by subtracting the number of weeks born prematurely from 40 weeks' full-term gestation (40 weeks - 28 weeks = 12 weeks, or 3 months) from the infant's chronological age (10 months - 3 months = 7 months). Therefore, anticipatory guidance should focus on 7-month developmental milestones such as sitting unsupported and transferring objects from hand to hand.

American Academy of Pediatrics (AAP) safe sleep guidelines recommend placing infants supine (on the back) on a firm, flat, non-inclined sleep surface for every sleep period. Elevating the head of a crib or using inclined sleep positioners is ineffective in reducing gastroesophageal reflux and significantly increases the risk that the infant will slide into a chin-to-chest posture or roll onto the stomach, causing positional asphyxiation. In the supine position, the trachea lies anatomically superior to the esophagus, protecting against aspiration.

School-age children who have outgrown the weight or height limit of their forward-facing 5-point harness seat must use a belt-positioning booster seat in the rear seat until the vehicle seat belt fits properly—typically when the child reaches 145 cm (4 ft 9 in) tall between 8 and 12 years of age. Proper fit requires the shoulder belt to cross the middle of the chest and shoulder and the lap belt to lie low across the upper thighs rather than the abdomen.

Evidence-based firearm injury prevention requires that if firearms are kept in the home, they must be stored unloaded in a locked gun safe or lockbox, with the ammunition locked in a separate location. Simply hiding a firearm on a high closet shelf or educating young children not to touch guns is insufficient to prevent unintentional pediatric firearm injuries.

High-dose intravenous immune globulin (IVIG 2 g/kg) provides high levels of circulating passive maternal/donor antibodies that persist for months and interfere with the active replication required for parenteral live attenuated viral vaccines (MMR and varicella) to generate an endogenous immune response. Therefore, MMR and varicella vaccinations must be deferred for 11 months following a 2 g/kg IVIG dose. Inactivated toxoid/subunit vaccines such as DTaP are not meaningfully inhibited by circulating passive antibodies and should be administered on schedule.