CPNP-PC Exam Content Outline 2026: Four Domains, Mental Health First
Assessment and Diagnosis is 52 of the 150 scored questions. The bigger shift is inside the domains: developmental, behavioral and mental health is now the most-tested clinical category.
- 175 (150 scored)Questions
- 3 hoursTime
- 4Sections
- YesWeights published
- 400/800Pass mark
- $407Fee
Table of Contents
The whole paper in one bar
The CPNP-PC exam content outline posted May 2023 and effective October 24, 2023 is the exam guide PNCB publishes for Certified Pediatric Nurse Practitioner - Primary Care (CPNP-PC), restated so you can see the shape of the paper before you read a word of the detail. The bar below is the entire syllabus: 4 sections, in the order the certifying body lists them.
- §1 Health Maintenance and Promotion — 30%
- §2 Assessment and Diagnosis — 35%
- §3 Management — 30%
- §4 Leadership, Ethics, and Practice Management — 5%
Those percentages are PNCB’s own, not an estimate. That matters more than it sounds: most pages ranking for this query quote weightings the certifying body never published.
The syllabus, section by section
Each block below is one section of the official outline. The bullets are the sub-objectives PNCB publishes underneath it — the actual scope statement, not a summary of it.
Health Maintenance and Promotion
- Anticipatory guidance on growth and development, birth to young adulthood
- Immunization counseling: indications, contraindications and adverse effects
- Vaccine hesitancy and the risks of non-adherence
- Injury prevention and safety: environmental exposure, violence, sports, vehicles, disasters
- Illness prevention and early warning signs of illness and emergencies
- Social, behavioral and mental health topics: social media, substance use, grief, trauma, sexual health
Assessment and Diagnosis
- Interpreting growth parameters and developmental surveillance
- History of present illness, review of systems, and comprehensive or interval histories
- Complete and focused physical examination
- Ordering and interpreting point-of-care, laboratory and imaging tests
- Developmental, behavioral and mental health screening tools
- Social determinants of health and disease-specific screening tools
- Integrating history, exam, test results and input from other clinicians
- Prioritized differential diagnosis and a final diagnosis
Management
- Condition-specific counseling, including drug benefits and adverse reactions
- Prescribing, over-the-counter recommendations and non-pharmacologic treatment
- Complementary and integrative therapies; shared decision-making
- Procedures and first response to life-threatening situations
- Advocacy, collaboration and referral to specialists and community resources
- Reporting suspected maltreatment or neglect to child protective services
- Coordinating care for chronic conditions, special healthcare needs and transition to adult care
- Evaluating and modifying the plan; follow-up
Leadership, Ethics, and Practice Management
- Serving as a clinical resource; evaluating and applying research
- Quality monitoring and clinical practice guidelines
- Advocacy at local, state and federal levels
- Regulation: HIPAA, scope of practice, informed consent
- Cultural awareness, ethics, licensure, credentialing and privileging
- Adverse and sentinel events and a culture of patient safety
- Documentation, billing and coding; widening access to care, e.g. interpreters, telehealth
The four domains describe what you do; a second list in the same outline decides what you do it to. PNCB ranks 21 clinical categories by how many items address them, and Developmental, Behavioral and Mental Health is first, ahead of Dermatology, Allergy/Immunology and Otolaryngology. The outline also names 10 procedures, from cerumen removal to wart removal, and 12 screening tools, including M-CHAT-R/F, Vanderbilt, PHQ, GAD-7, CRAFFT and ASQ. Of the 175 questions, 25 are unscored pretest items you cannot identify. The exam is delivered only at PSI test centers, within a 90-day window.
What the weightings really mean
A percentage in an exam guide is a promise about how many questions get drawn from a section, not about how hard those questions are. On a paper of roughly 150 items, Assessment and Diagnosis at 35% is worth about 52 questions and Leadership, Ethics, and Practice Management at 5% is worth about 8. Missing the whole of the smallest section still leaves you a pass on paper; missing the largest one does not.
The trap is treating that arithmetic as permission to skip. Weightings are the floor of what a section costs you, because the low-weight sections on almost every blueprint are the ones that supply context for questions filed under a different heading. You lose those marks in the heavy section and never find out why.
Reading the verbs in the objectives
The verb at the front of each sub-objective is the part candidates skim and examiners take literally. It sets the depth you are tested at, and it is the difference between recognising a term and being asked to choose between two answers that both look right.
| Verb | What a question at that depth looks like |
|---|---|
| Provide / Educate / Advise | Health maintenance: an age, a parent's concern, and the right anticipatory guidance. PNCB says you do not need to memorize vaccine schedules, but you do need the principles of safe vaccine use. |
| Select / Interpret | Screening tools and tests: choose the right instrument for the age and concern, or read a result. Lab values usually come without reference ranges - PNCB expects normal and abnormal to be obvious to a prepared candidate. |
| Integrate / Prioritize | Diagnosis: combine history, exam and results into the MOST likely diagnosis or the MOST useful next test. PNCB's sample gives a 14-year-old with constipation, fatigue, short stature and delayed puberty and asks which labs establish the diagnosis. |
| Prescribe / Refer | Management: the drug, the over-the-counter advice, the referral, the report to child protective services. Know common generic names; PNCB tries to use brand names only where they are still on the market. |
Every item has three or four options and one best answer, and PNCB describes the exam as testing whether you can apply knowledge and critical thinking to pick that answer. It is written for primary care across birth to young adulthood, against US standards of practice and US law.
Study it in this order, not the syllabus order
Exam guides are written to describe what a candidate must know, not to teach it. The published order is almost never the order that builds knowledge fastest. This is the sequence that front-loads the material everything else depends on.
| Order | Why here |
|---|---|
| 1. Assessment and Diagnosis | 35%, 52 items - the largest domain and the base for everything in Management. Growth, development surveillance, screening tools and differential diagnosis. |
| 2. Management | 30%, 45 items. Study it alongside Assessment and Diagnosis, condition by condition, so each diagnosis is learned with its treatment, referral and follow-up. |
| 3. Health Maintenance and Promotion | 30%, 45 items. Anticipatory guidance, immunization principles, injury prevention. Well-bounded well-child material that consolidates quickly once the clinical work is done. |
| 4. Leadership, Ethics, and Practice Management | 5%, 8 items. HIPAA, scope of practice, billing and coding, evidence-based practice. Small and largely definitional - leave it last. |
The first two rows are 97 of the 150 scored items. Work them one clinical category at a time in PNCB's ranked order: developmental, behavioral and mental health first, then dermatology, allergy/immunology, otolaryngology and gastroenterology.
What changed, and how to spot the next change
No new CPNP-PC outline has been announced. The one in force came from the 2022-23 job task analysis, was posted in May 2023 and has applied to every exam since October 24, 2023. Domain weights did not move from the 2018 outline (30/35/30/5). Domain IV was renamed from Professional Role and Responsibilities to Leadership, Ethics, and Practice Management; named lists of screening tools and knowledge areas were added; and developmental, behavioral and mental health rose from fifth to first in the clinical category ranking. PNCB says you do not need to study differently. The dated change ahead is eligibility: from January 1, 2030, candidates must have graduated from their PNP program within the previous five years. Fees in force since October 1, 2025: $407 for a first attempt and $288 to retake. Once certified, recertification is annual rather than every few years.
Two habits keep you from studying a retired outline. First, open the official exam guide and look for its revision date before you buy anything — courses and question banks lag a syllabus change by months, and the cheapest ones never catch up. Second, re-check it the week you book. A revision announced after you started studying is still a revision you sit.
Turn the syllabus into questions
Reading an outline tells you the shape of the paper. Answering questions tells you which sections you would actually lose marks on. Start free, then $5.99 unlocks the full CPNP-PC bank.
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What are the CPNP-PC domains and their weightings?
Four: Health Maintenance and Promotion 30% (45 items), Assessment and Diagnosis 35% (52 items), Management 30% (45 items), and Leadership, Ethics, and Practice Management 5% (8 items). That is 150 scored items; 25 unscored pretest items bring the exam to 175. These are PNCB's figures from the content outline posted May 2023 and in force since October 24, 2023.
What is the passing score for the CPNP-PC exam?
A scaled score of 400. PNCB reports scores from 200 (no items correct) to 800 (all correct), and 400 is the pass point on every form. The number of correct answers behind it varies slightly by form because PNCB equates for difficulty, so 400 is not a fixed percentage. Passing candidates are not given a scaled score. The first-time pass rate was 79.10% in 2025, across 1,263 candidates.
Can a family nurse practitioner or an acute care PNP sit the CPNP-PC?
Not without more education. You need a graduate degree or post-master's certificate in pediatric primary care, or a dual primary/acute care program, with at least 500 supervised direct-care clinical hours in primary care pediatrics - simulation does not count toward the 500 - plus separate advanced pathophysiology, health assessment and pharmacology courses, and a current, unencumbered RN license. FNP graduates need formal PNP education such as a post-master's certificate; acute care graduates are not eligible.
How much does the CPNP-PC cost?
$407 for the first attempt, of which $134 is a non-refundable registration fee. A retake costs $288, and extending your 90-day testing window, allowed once, costs $155. Those are PNCB's fees effective October 1, 2025. Missing your appointment or letting the window lapse forfeits the fees, and you must reapply. After you pass, recertification is annual, so budget a yearly fee and continuing education rather than a one-off renewal.
Sources
Every section title, sub-objective and number on this page comes from the certifying body:
- https://www.pncb.org/sites/default/files/resources/2023_CPNP-PC_Exam_Content_Outline_FINAL.pdf
- https://www.pncb.org/sites/default/files/resources/2018_CPNP-PC_Exam_Content_Outline_FINAL.pdf
- https://www.pncb.org/cpnp-pc-exam-faqs
- https://www.pncb.org/cpnp-pc-exam-eligibility
- https://www.pncb.org/sites/default/files/resources/PNCB_Exam_Candidate_Handbook.pdf
- https://www.pncb.org/sites/default/files/resources/PNCB_Exam_Statistics_2025_FINAL.pdf
Checked October 7, 2026. Exam guides are revised without notice — confirm against PNCB before you build a study plan around this page.