What to Study for the PPCNP-BC Examination

You are almost to the finish line. You’ve graduated from your Pediatric Primary Care Nurse Practitioner Program (or nearly graduated!), and all that’s left is to pass the PPCNP exam! With the vast amount of information your program has covered, how do you know what to study? Thankfully, the American Nurses Credentialing Center (ANCC) has released a blueprint for the exam to guide your efforts. Read on to learn the weight of each category and which skills are deemed most important by the ANCC.

Your knowledge of all things regarding pediatric nursing will be tested in 200 questions. However, only 175 of these are scored; the remaining 25 are “pretest” questions. The ANCC uses current exam takers as guinea pigs for questions that will potentially be used for future tests. However, you won’t know which questions are the pretest questions.

The remaining 175 questions are divided as such:

I. Foundations for Advanced Practice (25%)
– Advanced Physiology/Pathophysiology
– Advanced Pharmacology
– Advanced Health/Physical Assessment

II. Advanced Professional Practice (26%)
– Quality Improvement and Safety
– Translational Science/Evidence-based Practice
– Information Systems/Technology
– Health Policy Advocacy
– Interprofessional Collaboration
– Ethical and Legal Considerations

III. Advanced Clinical Practice (49%)
– Health Promotion and Maintenance
– Illness/Disease Management
– Diagnostic Reasoning/Differential Diagnoses
– Care of Diverse Populations
– Clinical Prevention and Population Health

Foundations for Advanced Practice

Foundations for Advanced Practice questions include questions on physiology, pathophysiology, pharmacology, and health assessment (all advanced, of course!). Although this is a pediatric certification exam, you will still be tested on your knowledge of the pathophysiology of adult health alterations in addition to the infant, preschool, school-age, and adolescent populations. Be comfortable with normal and abnormal health states. Also, be prepared to evaluate the patient’s physiologic responses to treatment.

Advance pharmacology questions include the pharmacotherapeutics, pharmacodynamics, and pharmacokinetics of drug categories. Additionally, you should have knowledge of patient adherence and motivations for seeking medication. Drugs affecting the respiratory, neurologic, immunologic, genitourologic, gastrointestinal, endocrine, and cardiovascular systems are covered, as well as anti-infectives, respiratory agents, analgesics, neurologic, antineoplastic drugs, and drugs for the eyes, ears, and skin. The physiologic responses to each agent are covered as well.

The advanced health assessment portion of the exam tests your knowledge of common physical and mental disorders, normal growth and development, and the components of focused and comprehensive history and physical exams. Memorize your developmental and family theories and understand their application to clinical practice. Your advanced communication skills will be tested as well. All body systems will be covered in your assessments. When you are studying, be sure to familiarize yourself with the components of a comprehensive history (perinatal factors, environmental assessment, cultural assessment, psychosocial assessment, and developmental assessment). You will be required to make clinical decisions based on your critical thinking, observational skills, and advanced interviewing techniques. Risk assessments will be a necessity on the PPCNP exam. Also, it’s not just making the assessment; you’ll have to tie your findings to the physiologic/pathologic changes that contribute to the findings.

Advanced Professional Practice

In order to assess your ability to contribute to the nursing profession beyond your expertise at the bedside, the PPCNP certification board exam will ask 45 questions about advanced professional practice. The methods, standards, performance measures and tools of safety and quality and improvement are covered on the exam. Be prepared to be presented with a scenario, find the QI opportunities and discuss the implementation of those opportunities. Evidence-based practice questions will require you to critique evidence, apply research techniques to improve outcomes and determine key stakeholders. The regulatory guidelines, standardized terminology, and ethical/legal implications of technology and health informatics will be covered. Additionally, your ability to integrate technology into your practice is reviewed (think telehealth, decision support algorithms, EMR, patient education, data management).

Be familiar with healthcare policy and how it applies to clinical practice (globalization, health disparities, etc.). An understanding of root cause analysis, complexity science, and change and systems theories are essential to this portion of the exam. You should understand how to evaluate how the delivery of healthcare affects its stakeholders. The PPCNP exam assesses your knowledge of the theories and skills associated with successful interprofessional collaboration and communication. Coordination of care across multidisciplinary teams is important for your certification. The legal and ethical considerations of caring for the pediatric population and their support systems can be complicated and are the subject of questions you will encounter. Be firm in your understanding of your scope of practice and what lies outside of it. Regulatory guidelines such as mandated reporting of abuse and communicable disease, HIPAA, and reimbursement are covered in the exam.

Advanced Clinical Practice

The largest chunk of the Pediatric Primary Care Nurse Practitioner certification exam is the Advanced Clinical Practice portion. It consists of 86 questions and covers topics such as health promotion and maintenance, disease management, differential diagnoses and diagnostic reasoning, diverse populations, and community health/prevention. The health promotion and maintenance section focuses on providing anticipatory guidance to families, assessing health literacy, vaccines, nutrition, and safety. Have a firm understanding of recommendations for things such as screen time, exercise, weight management, and other safety considerations. Create plans of care based on well child visits, screening tools, and current recommendations. Evaluate the responses to a care plan and modify it as necessary.

Recognize important tenets of patient-centered and culturally sensitive care. Illness and disease management questions may cover current practice standards and guidelines, the risk/benefit ratio and costs of various treatments, physical and mental disorders, comorbidities, and palliative/end of life care. You should be comfortable choosing the correct medication for various physical illness and mental disorders as well as any non-pharmacological treatments that may apply. Questions in this section will also cover the general management and care plan creation, evaluation, and modification of these disorders. Partnership with the patient and his or her family in illness/injury management are reviewed as well. In order to successfully answer diagnostic reasoning and differential diagnosis questions, you should be knowledgeable in the diagnostic tests, procedures, and lab values for all body systems that are common in primary care settings. This may include choosing, performing, and interpreting these tests and their values. Be prepared to bring together many different sources of information to aid in clinical decision-making. You will be asked to determine differential and final diagnoses. Additionally, you need to determine which current/potential problems are the priority in patient-centered care.

Caring for diverse populations requires an understanding of genetic and physiologic differences that are specific to each population, as well as the population’s languages, values, beliefs, norms, and health behaviors. You will be required to incorporate these cultural differences into the plan of care as well as other considerations such as education level, immigration status, sexual orientation, and spirituality. Be familiar with global healthcare considerations, epidemiology, social determinants of health, and population-based health policy. This knowledge will be applied by choosing, implementing, and evaluating the success of appropriate clinical prevention strategies.


By utilizing exam review resources, you can assess your competence and knowledge in these categories. Let this overview be your guide in determining your strengths and weaknesses. Repetition can only help you, but be sure to maintain good study habits and work-life balance. This is a marathon, and you are almost to the finish line!

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