1
PNCB Acute Care Exam 2026/2027 Actual Exam
| Verified Questions & Correct Answers with
Detailed Rationales | CPNP-AC Study Guide |
Pass Guaranteed - A+ Graded
Section 1: Pediatric Acute Care Assessment
Q1: A 3-year-old child is brought to the emergency department with respiratory distress. Using
the Pediatric Assessment Triangle (PAT), which of the following components is assessed FIRST?
A. Airway patency and breath sounds
B. Appearance, work of breathing, and circulation to skin [CORRECT]
C. Blood pressure and heart rate
D. Oxygen saturation and capnography
Correct Answer: B
Rationale: The Pediatric Assessment Triangle (PAT) is a rapid, hands-off assessment evaluating
appearance, work of breathing, and circulation to skin. This initial assessment takes 30-60
seconds and guides the urgency of intervention. Options A, C, and D are part of the primary and
secondary assessments which are hands-on evaluations performed after the PAT.
Q2: A 6-month-old infant is evaluated for acute dehydration. Which of the following clinical
findings is the most reliable indicator of moderate (5-10%) dehydration?
A. Sunken fontanelle and dry mucous membranes [CORRECT]
B. Blood pressure of 80/50 mmHg
C. Capillary refill of 1 second
D. Prolonged capillary refill (>3 seconds) and mottled skin
Correct Answer: A
Rationale: Sunken fontanelle and dry mucous membranes are classic signs of moderate
dehydration (5-10% fluid loss). Blood pressure is typically maintained in children until severe
,2
dehydration or shock (Option B is normal for age). Capillary refill of 1 second (Option C) is
normal. Option D describes severe dehydration/shock.
Q3: During the primary survey of a trauma patient, the "A" stands for Airway with cervical spine
protection. Which intervention is most appropriate for a child with a suspected cervical spine
injury who is unable to maintain an airway?
A. Head tilt-chin lift maneuver
B. Jaw thrust maneuver [CORRECT]
C. Placement of a nasopharyngeal airway
D. Suctioning of the oropharynx
Correct Answer: B
Rationale: The jaw thrust maneuver is the preferred technique for opening the airway in a patient
with a suspected cervical spine injury as it minimizes neck movement. The head tilt-chin lift
(Option A) can exacerbate spinal injury. Nasopharyngeal airways (Option C) are contraindicated
in basilar skull fractures. Suctioning (Option D) clears secretions but does not establish an
airway.
Q4: A 2-year-old presents with altered mental status. His blood glucose is 40 mg/dL. Which
concentration of dextrose is appropriate for initial intravenous administration?
A. Dextrose 5% in water (D5W)
B. Dextrose 10% in water (D10W) [CORRECT]
C. Dextrose 25% in water (D25W)
D. Dextrose 50% in water (D50W)
Correct Answer: B
Rationale: For pediatric patients, D10W is the preferred concentration to avoid hyperosmolar
injury to the veins and risk of extravasation injury associated with higher concentrations like D25
or D50. D5W is essentially water and is not hypertonic enough to effectively raise serum glucose
rapidly in severe hypoglycemia.
,3
Q5: When calculating maintenance fluid rates for a 15-kg child using the Holliday-Segar
method, what is the total hourly fluid rate?
A. 40 mL/hr
B. 50 mL/hr [CORRECT]
C. 60 mL/hr
D. 75 mL/hr
Correct Answer: B
Rationale: Using the 4-2-1 rule: For the first 10 kg: 10 kg x 4 mL = 40 mL. For the next 5 kg: 5
kg x 2 mL = 10 mL. Total = 40 + 10 = 50 mL/hr. Option A is too low, and Options C and D
exceed the calculation.
Q6: A 5-year-old presents with a 3-day history of fever and sore throat. On examination, you
note inspiratory stridor, drooling, and a "sniffing" position. What is the most likely diagnosis?
A. Viral croup (Laryngotracheobronchitis)
B. Bacterial tracheitis
C. Epiglottitis [CORRECT]
D. Peritonsillar abscess
Correct Answer: C
Rationale: Epiglottitis is characterized by the abrupt onset of high fever, toxic appearance,
drooling, and inspiratory stridor, with the child preferring to sit in the tripod or sniffing position
to optimize the airway. Croup (Option A) typically has a barking cough and lacks drooling.
Tracheitis (Option B) often presents similarly but with a productive cough. Peritonsillar abscess
(Option D) causes trismus and a "hot potato" voice but rarely stridor.
Q7: Which of the following is a component of the "Disability" assessment in the primary survey
(ABCDE)?
A. Blood glucose level
B. Glasgow Coma Scale (GCS) score [CORRECT]
, 4
C. Pupillary response to light
D. Serum electrolytes
Correct Answer: B
Rationale: Disability in the primary survey involves a rapid assessment of neurologic status,
primarily using AVPU (Alert, Verbal, Pain, Unresponsive) or the Glasgow Coma Scale (GCS).
While blood glucose (Option A) and pupils (Option C) are critical, the GCS/AVPU is the
defining metric for 'D'. Serum electrolytes (Option D) are part of the secondary survey or labs.
Q8: (Pediatric Resuscitation) A 4-year-old child is in pulseless ventricular tachycardia (pVT).
After the first dose of epinephrine, what is the next appropriate antiarrhythmic medication?
A. Lidocaine
B. Amiodarone [CORRECT]
C. Adenosine
D. Procainamide
Correct Answer: B
Rationale: In the PALS algorithm for pVT/VF, amiodarone (5 mg/kg) is the antiarrhythmic of
choice. Lidocaine (Option A) is an alternative but not the first-line antiarrhythmic in the current
algorithm. Adenosine (Option C) is used for SVT. Procainamide (Option D) is used for stable
VT, not pulseless arrest.
Q9: When assessing pain in a non-verbal, cognitively impaired child, which tool is most
appropriate?
A. The Numeric Rating Scale (NRS)
B. The Wong-Baker FACES Scale
C. The FLACC scale [CORRECT]
D. Visual Analog Scale (VAS)
Correct Answer: C
PNCB Acute Care Exam 2026/2027 Actual Exam
| Verified Questions & Correct Answers with
Detailed Rationales | CPNP-AC Study Guide |
Pass Guaranteed - A+ Graded
Section 1: Pediatric Acute Care Assessment
Q1: A 3-year-old child is brought to the emergency department with respiratory distress. Using
the Pediatric Assessment Triangle (PAT), which of the following components is assessed FIRST?
A. Airway patency and breath sounds
B. Appearance, work of breathing, and circulation to skin [CORRECT]
C. Blood pressure and heart rate
D. Oxygen saturation and capnography
Correct Answer: B
Rationale: The Pediatric Assessment Triangle (PAT) is a rapid, hands-off assessment evaluating
appearance, work of breathing, and circulation to skin. This initial assessment takes 30-60
seconds and guides the urgency of intervention. Options A, C, and D are part of the primary and
secondary assessments which are hands-on evaluations performed after the PAT.
Q2: A 6-month-old infant is evaluated for acute dehydration. Which of the following clinical
findings is the most reliable indicator of moderate (5-10%) dehydration?
A. Sunken fontanelle and dry mucous membranes [CORRECT]
B. Blood pressure of 80/50 mmHg
C. Capillary refill of 1 second
D. Prolonged capillary refill (>3 seconds) and mottled skin
Correct Answer: A
Rationale: Sunken fontanelle and dry mucous membranes are classic signs of moderate
dehydration (5-10% fluid loss). Blood pressure is typically maintained in children until severe
,2
dehydration or shock (Option B is normal for age). Capillary refill of 1 second (Option C) is
normal. Option D describes severe dehydration/shock.
Q3: During the primary survey of a trauma patient, the "A" stands for Airway with cervical spine
protection. Which intervention is most appropriate for a child with a suspected cervical spine
injury who is unable to maintain an airway?
A. Head tilt-chin lift maneuver
B. Jaw thrust maneuver [CORRECT]
C. Placement of a nasopharyngeal airway
D. Suctioning of the oropharynx
Correct Answer: B
Rationale: The jaw thrust maneuver is the preferred technique for opening the airway in a patient
with a suspected cervical spine injury as it minimizes neck movement. The head tilt-chin lift
(Option A) can exacerbate spinal injury. Nasopharyngeal airways (Option C) are contraindicated
in basilar skull fractures. Suctioning (Option D) clears secretions but does not establish an
airway.
Q4: A 2-year-old presents with altered mental status. His blood glucose is 40 mg/dL. Which
concentration of dextrose is appropriate for initial intravenous administration?
A. Dextrose 5% in water (D5W)
B. Dextrose 10% in water (D10W) [CORRECT]
C. Dextrose 25% in water (D25W)
D. Dextrose 50% in water (D50W)
Correct Answer: B
Rationale: For pediatric patients, D10W is the preferred concentration to avoid hyperosmolar
injury to the veins and risk of extravasation injury associated with higher concentrations like D25
or D50. D5W is essentially water and is not hypertonic enough to effectively raise serum glucose
rapidly in severe hypoglycemia.
,3
Q5: When calculating maintenance fluid rates for a 15-kg child using the Holliday-Segar
method, what is the total hourly fluid rate?
A. 40 mL/hr
B. 50 mL/hr [CORRECT]
C. 60 mL/hr
D. 75 mL/hr
Correct Answer: B
Rationale: Using the 4-2-1 rule: For the first 10 kg: 10 kg x 4 mL = 40 mL. For the next 5 kg: 5
kg x 2 mL = 10 mL. Total = 40 + 10 = 50 mL/hr. Option A is too low, and Options C and D
exceed the calculation.
Q6: A 5-year-old presents with a 3-day history of fever and sore throat. On examination, you
note inspiratory stridor, drooling, and a "sniffing" position. What is the most likely diagnosis?
A. Viral croup (Laryngotracheobronchitis)
B. Bacterial tracheitis
C. Epiglottitis [CORRECT]
D. Peritonsillar abscess
Correct Answer: C
Rationale: Epiglottitis is characterized by the abrupt onset of high fever, toxic appearance,
drooling, and inspiratory stridor, with the child preferring to sit in the tripod or sniffing position
to optimize the airway. Croup (Option A) typically has a barking cough and lacks drooling.
Tracheitis (Option B) often presents similarly but with a productive cough. Peritonsillar abscess
(Option D) causes trismus and a "hot potato" voice but rarely stridor.
Q7: Which of the following is a component of the "Disability" assessment in the primary survey
(ABCDE)?
A. Blood glucose level
B. Glasgow Coma Scale (GCS) score [CORRECT]
, 4
C. Pupillary response to light
D. Serum electrolytes
Correct Answer: B
Rationale: Disability in the primary survey involves a rapid assessment of neurologic status,
primarily using AVPU (Alert, Verbal, Pain, Unresponsive) or the Glasgow Coma Scale (GCS).
While blood glucose (Option A) and pupils (Option C) are critical, the GCS/AVPU is the
defining metric for 'D'. Serum electrolytes (Option D) are part of the secondary survey or labs.
Q8: (Pediatric Resuscitation) A 4-year-old child is in pulseless ventricular tachycardia (pVT).
After the first dose of epinephrine, what is the next appropriate antiarrhythmic medication?
A. Lidocaine
B. Amiodarone [CORRECT]
C. Adenosine
D. Procainamide
Correct Answer: B
Rationale: In the PALS algorithm for pVT/VF, amiodarone (5 mg/kg) is the antiarrhythmic of
choice. Lidocaine (Option A) is an alternative but not the first-line antiarrhythmic in the current
algorithm. Adenosine (Option C) is used for SVT. Procainamide (Option D) is used for stable
VT, not pulseless arrest.
Q9: When assessing pain in a non-verbal, cognitively impaired child, which tool is most
appropriate?
A. The Numeric Rating Scale (NRS)
B. The Wong-Baker FACES Scale
C. The FLACC scale [CORRECT]
D. Visual Analog Scale (VAS)
Correct Answer: C
