Clinical Nurse Specialist in Pediatrics


A Clinical Nurse Specialist in Pediatrics (PCNS) is an advanced nursing practitioner who participates in the care of patients under the age of 21. This specialty is concerned with all aspects of care for children and adolescents, including developmental needs and chronic conditions.

Credentialing Organization

American Nurses Credentialing Center. You will be required to take a computer-based examination, the fee for which will depend on whether you are a member of the American Nurses Association or the National Association of Clinical Nurse Specialists. Upon passing the examination, you will be given the following credential: PCNS-BC (Pediatric Clinical Nurse Specialist-Board Certified). You'll need to renew your certification after five years. Please apply to the American Nurses Credentialing Center at least three months before your current certificate expires.


Before being certified as a Clinical Nurse Specialist in Pediatrics, you'll need:

  • A current license as a registered nurse (RN). This license should either be issued by an official body in the United States or by a legally recognized licensing body elsewhere.
  • A degree on at least the Master's level from an educational body accredited by one of these two bodies: the National League for Nursing Accrediting Commission (NLNAC) or the Commission on the Collegiate of Nursing Education (CCNE). The degree should be in a program relating to the development, psychology, or physiology of children less than 21 years of age.
  • 500 or more hours as a clinical nurse specialist in pediatrics supervised by faculty as part of your degree program.
  • Course work in the following subjects:
    • advanced health assessment
    • advanced pathophysiology
    • advanced pharmacology

About the Certification Exam

The exam consists of 175 questions divided into six domains: Growth and Development Theories, Concepts, and Findings (36 questions or 23.33 percent of the test), Advanced Practice Nursing (49 questions or 32.87 percent of the test), Advanced Nursing Practice Environments (9 questions or 6 percent of the test), Basic and Applied Science (33 or 22 percent of the test), Research (8 questions or 5.33 percent of the test) and Education and Health Teaching (16 questions or 10.67 percent of the test). Of these questions, 150 count toward the final score. (The remainder are questions being statistically tested for inclusion in future exams.)

CNS Certification Options

Free Pediatric CNS Practice Test

1. Which of the following leadership attributes is most likely to characterize the effective pediatric clinical nurse specialist?

A.Sacrificing personal life and priorities for the sake of professional life
B.Having the willingness and self-confidence to take risks and occasionally fail
C.Getting one's point across rather than listening to the viewpoints of others
D.Focusing on the day-to-day issues rather than focusing on long-term goals

2. Common signs of stress in the young school-aged child (5-9 years-old) include all of the following EXCEPT:

A.vague persistent physical complaints (e.g., headaches, abdominal pain).
B.aggressive behavior or "acting out."
C.regression to past behaviors (e.g., bedwetting, thumb-sucking).
D.suicidal thoughts.

3. The Southeast Asian healing practice known as coining has which of the following characteristics?

A.It produces bruise-like lesions where a coin is rubbed against the skin.
B.It leads to elevated serum lead levels.
C.It should be reported to the appropriate agency as physical abuse of a child.
D.It requires needle insertion at points on the body that correspond to energy pathways.

4. The Emergency Medical Treatment and Active Labor Act requires that hospitals provide:

A.definitive medical care, regardless of the patient's ability to pay.
B.prenatal care for pregnant women, regardless of the patient's ability to pay.
C.a medical screening exam to determine if an emergency medical condition exists, regardless of the patient's ability to pay.
D.initial care for a nonemergency medical condition, even if the patient does not consent.

5. A healthy 4-year-old child is noted to have bilateral "knock-knee" (genu valgum) at a routine health maintenance visit. Growth, development, strength, and tone are within normal limits. Which of the following statements concerning genu valgum (knock-knee) is most accurate?

A.Orthopedic evaluation is indicated in this patient given that both legs are affected.
B.No further evaluation or treatment is indicated unless the genu valgum persists beyond mid-childhood (8-9 years of age).
C.Adolescent genu valgum is generally self-limited, while genu valgum in early childhood usually requires surgical correction.
D.Genu valgum in early childhood is usually accompanied by significant leg pain.

Pediatric CNS Answers and Explanations

1. B -- Taking risks based on one's self-confidence and overall vision is an important leadership attribute. This enables the clinical nurse specialist to develop unique and flexible solutions to difficult problems and to embrace the uncertainty that accompanies the change process. Focusing on long-term goals allows the effective leader to ensure that the day-to-day issues are tackled in a way that is compatible with an overall vision. Listening to team members and attempting to understand differing viewpoints are other important qualities in the effective leader. Balancing the demands of personal and professional life allows the clinical nurse specialist to avoid getting overextended in either arena.

2. D -- Common developmental and social challenges, such as increased peer influence, academic pressure, and excessive extracurricular activities, are sources of stress for many children. Additionally, violence in the home or at school, poverty, divorce, bullying, and drug or alcohol abuse in family members are unfortunately common sources of stress for many school-aged children. Children often manifest chronic stress in indirect ways, such as vague physical complaints, sleep disturbances, appetite changes, developmental regression, social withdrawal, and behavior problems. Suicidal thoughts or attempts are uncommon in the 5-9-year-old age-group but become more common among adolescents.

3. A -- Coining (cao gio) is a common practice in many Southeast Asian cultures; its name translates to "catch the wind." Some Southeast Asian families believe that excessive wind in the blood causes illness (e.g., fever, headache, cough, flu) and that the "bad wind" can be released by bringing affected blood to the surface of the skin. Warm oil is applied to the skin (usually on the back), and the skin is then rubbed vigorously with a coin until red marks appear. These contusions may be mistaken for physical abuse. Coining is not known to be associated with elevated lead levels but commonly causes minor skin burns.

4. C-- The Emergency Medical Treatment and Active Labor Act (EMTALA) was designed by Congress to ensure that patients have access to emergency medical care regardless of their ability to pay. The statute mandates that any patient presenting to the emergency department requesting treatment must be provided a medical screening exam to determine if an "emergency medical condition" exists. If the patient is determined to be suffering from an emergency medical condition, including active labor, the hospital must initiate care. The patient must be stabilized, if possible, before transfer to another facility. EMTALA applies only to emergency medical conditions.

5. B -- Genu valgum, or "knock-knee" deformity, is a well-recognized common physiologic variant in the 2-6-year-old child. In the otherwise healthy patient with symmetric genu valgum, normal growth, normal development, and functional lower extremity use, no further evaluation or treatment is indicated unless the deformity persists beyond early-to-mid childhood. Genu valgum that is asymmetric, painful, or accompanied by abnormalities in leg length, growth, development, or lower extremity function requires orthopedic evaluation. Genu valgum in the adolescent patient is not self-limited and often causes pain, gait abnormalities, and functional difficulty.


Last Updated: 07/05/2018

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