PNCB PEDIATRIC NURSE
PRACTITIONER – ACUTE CARE
(CPNP-AC) EXAM QUESTIONS
AND CORRECT ANSWERS WITH
RATIONALES GRADED A+
LATEST
1. A 6-year-old child with severe asthma is admitted to the PICU in
respiratory distress. Which finding indicates impending respiratory failure?
A. Tachypnea with prolonged expiratory phase
B. Hyperresonance on percussion
C. Decreasing wheezing with diminished breath sounds
D. Use of accessory muscles
Correct Answer: C
Rationale: Diminished or absent breath sounds (“silent chest”) indicate severely
decreased airflow and impending respiratory failure, a late and dangerous sign.
,2. A neonate presents with cyanosis that does not improve with oxygen
therapy. Which condition is most likely?
A. Persistent pulmonary hypertension of the newborn
B. Transposition of the great arteries
C. Neonatal pneumonia
D. Meconium aspiration syndrome
Correct Answer: B
Rationale: Cyanosis unresponsive to oxygen suggests a ductal-dependent
congenital heart defect such as transposition of the great arteries.
3. A 10-year-old with diabetic ketoacidosis develops headache and decreased
level of consciousness during treatment. The priority action is to:
A. Increase insulin infusion
B. Administer IV sodium bicarbonate
C. Reduce IV fluid rate and give mannitol
D. Obtain serum ketone levels
Correct Answer: C
Rationale: These findings suggest cerebral edema, a life-threatening complication
of DKA treatment requiring immediate intervention.
4. Which laboratory value is most concerning in a child with suspected sepsis?
A. Elevated C-reactive protein
B. Platelet count of 90,000/mm³
C. Mild hyponatremia
D. Elevated white blood cell count
Correct Answer: B
Rationale: Thrombocytopenia is a marker of severe sepsis and possible
disseminated intravascular coagulation.
,5. A 3-month-old infant presents with lethargy, vomiting, and a bulging
fontanelle. Which action is most appropriate?
A. Administer oral acetaminophen
B. Obtain lumbar puncture immediately
C. Start broad-spectrum IV antibiotics
D. Place infant in Trendelenburg position
Correct Answer: C
Rationale: Suspected bacterial meningitis requires immediate empiric antibiotic
therapy; diagnostic procedures should not delay treatment.
6. A child with sickle cell disease presents with chest pain, fever, and hypoxia.
Which diagnosis is most likely?
A. Pulmonary embolism
B. Acute chest syndrome
C. Pneumothorax
D. Pleural effusion
Correct Answer: B
Rationale: Acute chest syndrome is a leading cause of mortality in sickle cell
disease and presents with respiratory symptoms and fever.
7. Which medication is contraindicated in children with suspected Reye
syndrome?
A. Acetaminophen
B. Ibuprofen
C. Aspirin
D. Ondansetron
Correct Answer: C
Rationale: Aspirin use in children with viral illnesses is associated with Reye
syndrome.
, 8. A 7-year-old with head trauma has unequal pupils and hypertension with
bradycardia. These findings indicate:
A. Hypovolemic shock
B. Increased intracranial pressure
C. Spinal cord injury
D. Neurogenic shock
Correct Answer: B
Rationale: Cushing’s triad (hypertension, bradycardia, irregular respirations)
reflects increased intracranial pressure.
9. A ventilated pediatric patient develops sudden hypotension and absent
breath sounds on one side. What is the priority intervention?
A. Increase oxygen concentration
B. Administer IV fluids
C. Perform needle decompression
D. Obtain chest radiograph
Correct Answer: C
Rationale: Findings suggest tension pneumothorax, which requires immediate
decompression before imaging.
10. A toddler presents with barking cough, stridor, and hoarseness. Which is
the best initial treatment?
A. Oral antibiotics
B. Racemic epinephrine
C. Albuterol nebulization
D. Chest physiotherapy
Correct Answer: B
Rationale: These symptoms indicate croup; racemic epinephrine reduces airway
edema in moderate to severe cases.
PRACTITIONER – ACUTE CARE
(CPNP-AC) EXAM QUESTIONS
AND CORRECT ANSWERS WITH
RATIONALES GRADED A+
LATEST
1. A 6-year-old child with severe asthma is admitted to the PICU in
respiratory distress. Which finding indicates impending respiratory failure?
A. Tachypnea with prolonged expiratory phase
B. Hyperresonance on percussion
C. Decreasing wheezing with diminished breath sounds
D. Use of accessory muscles
Correct Answer: C
Rationale: Diminished or absent breath sounds (“silent chest”) indicate severely
decreased airflow and impending respiratory failure, a late and dangerous sign.
,2. A neonate presents with cyanosis that does not improve with oxygen
therapy. Which condition is most likely?
A. Persistent pulmonary hypertension of the newborn
B. Transposition of the great arteries
C. Neonatal pneumonia
D. Meconium aspiration syndrome
Correct Answer: B
Rationale: Cyanosis unresponsive to oxygen suggests a ductal-dependent
congenital heart defect such as transposition of the great arteries.
3. A 10-year-old with diabetic ketoacidosis develops headache and decreased
level of consciousness during treatment. The priority action is to:
A. Increase insulin infusion
B. Administer IV sodium bicarbonate
C. Reduce IV fluid rate and give mannitol
D. Obtain serum ketone levels
Correct Answer: C
Rationale: These findings suggest cerebral edema, a life-threatening complication
of DKA treatment requiring immediate intervention.
4. Which laboratory value is most concerning in a child with suspected sepsis?
A. Elevated C-reactive protein
B. Platelet count of 90,000/mm³
C. Mild hyponatremia
D. Elevated white blood cell count
Correct Answer: B
Rationale: Thrombocytopenia is a marker of severe sepsis and possible
disseminated intravascular coagulation.
,5. A 3-month-old infant presents with lethargy, vomiting, and a bulging
fontanelle. Which action is most appropriate?
A. Administer oral acetaminophen
B. Obtain lumbar puncture immediately
C. Start broad-spectrum IV antibiotics
D. Place infant in Trendelenburg position
Correct Answer: C
Rationale: Suspected bacterial meningitis requires immediate empiric antibiotic
therapy; diagnostic procedures should not delay treatment.
6. A child with sickle cell disease presents with chest pain, fever, and hypoxia.
Which diagnosis is most likely?
A. Pulmonary embolism
B. Acute chest syndrome
C. Pneumothorax
D. Pleural effusion
Correct Answer: B
Rationale: Acute chest syndrome is a leading cause of mortality in sickle cell
disease and presents with respiratory symptoms and fever.
7. Which medication is contraindicated in children with suspected Reye
syndrome?
A. Acetaminophen
B. Ibuprofen
C. Aspirin
D. Ondansetron
Correct Answer: C
Rationale: Aspirin use in children with viral illnesses is associated with Reye
syndrome.
, 8. A 7-year-old with head trauma has unequal pupils and hypertension with
bradycardia. These findings indicate:
A. Hypovolemic shock
B. Increased intracranial pressure
C. Spinal cord injury
D. Neurogenic shock
Correct Answer: B
Rationale: Cushing’s triad (hypertension, bradycardia, irregular respirations)
reflects increased intracranial pressure.
9. A ventilated pediatric patient develops sudden hypotension and absent
breath sounds on one side. What is the priority intervention?
A. Increase oxygen concentration
B. Administer IV fluids
C. Perform needle decompression
D. Obtain chest radiograph
Correct Answer: C
Rationale: Findings suggest tension pneumothorax, which requires immediate
decompression before imaging.
10. A toddler presents with barking cough, stridor, and hoarseness. Which is
the best initial treatment?
A. Oral antibiotics
B. Racemic epinephrine
C. Albuterol nebulization
D. Chest physiotherapy
Correct Answer: B
Rationale: These symptoms indicate croup; racemic epinephrine reduces airway
edema in moderate to severe cases.
