AC PEDIATRIC NURSE PRACTITIONER (PNP) –
ACUTE CARE MELNIC EXAM NEWEST EXAM
WITH COMPLETE
QUESTIONS AND DETAILED VERIFIED
ANSWERS
A patient has a wide QRS noted intermittently on telemetry. After assessing that he has a stable
cardiac output, what is your next order?
A. Have the patient perform vagal maneuvers and order Adenosine, then consult EP services
D
B. Lidocaine, Amiodarone, synchronized cardioversion, then investigate cause
O
C. Begin CPR and defibrillate then investigate cause
N
O
D. Atropine and Isoproterenol to the bedside then consult EP services - ✔✔✔ Correct Answer >
Explanation: Answer A. A wide QRS can be aberrant SVT, Ventricular tachycardia or
T
Ventricular fibrillation. In the stable patient (verified by checking cardiac output), the
C
sequence is to give Lidocaine 1mg/kg Iv, followed by lidocaine drip 25-50 mcg/kg/min
continuous IV infusion, Amiodarone 5mg/kg/dose IV bolus. You can also consider
O
procainamide 15 mg/kg. Synchronized cardioversion may be necessary
PY
Answer B. CPR and defibrillation would be done if the patient had no cardiac output
Answer C. Vagal maneuvers and Adenosine treat SVT
Answer D. Atropine and Isproterenol are used for symptomatic 3rd degree AV block
You receive a consult from a Pediatrician who states he has a 7 month old in his office who has
"fallen off her growth curve." He also describes a IV/VI systolic ejection murmur heard best
along her left sternal border. He wants to send her to the Cardiology clinic today. Upon arrival,
you note a petite 7 month old female in no acute distress. Palpation of her chest is positive for a
thrill. She also has hepatomegaly. You order an echocardiogram which diagnoses a large PDA.
Before you can schedule this child for surgery, you need to:
,A. Inform the parents their child needs to undergo cardiac catheterization to better define the
defect
B. Inform the parents that their child has symptoms of congestive heart failure and needs to be
started on some medications for this
C. Inform the parents how to direct donate blood for their child
D. Inform the parents that their child is gravely ill - ✔✔✔ Correct Answer > Explanation:
Answer C. Symptoms of congestive heart failure (CHF) develop from pulmonary over
circulation and are exhibited by the patient's increased work of breathing, hepatomegaly, poor
feeding and growth failure. Treatment may include:
Digoxin for inotropy
Lasix for diuretic effect
D
After load reduction using ACE inhibitors (Enalapril, etc).
O
Answer A. If the patient needs surgery, you may offer information on direct blood donation
N
Answer B. Educate the parents on CHF and probable cause, however reassure them this can be
O
reversed once the PDA is closed
T
Answer D. Educate the parents cardiac catheterization will only be necessary if the patient
qualifies for transcatheter device closure of her PDA
C
O
A 4 day old female infant presents to your ED in cardiogenic shock. She is afebrile, pale and
PY
unresponsive. She is placed on oxygen without any change in her saturations. CXR shows altered
pulmonary vasculature and cardiomegaly. What drug might you start initially?
A.Normal Saline
B. Prostaglandin E1
C. Dopamine
D. Versed - ✔✔✔ Correct Answer > Explanation: Answer C. Congenital heart defects that result
in ↓ blood flow to the lungs or ↓ systemic blood flow are dependent on the pulmonary
systemic shunt from the patent ductus arteriosus to maintain pulmonary and systemic blood
flow.
,Closure of the ductus arteriosus leads to worsening of obstruction to pulmonary blood flow with
right to left shunt and cyanosis in right sided lesions and decreased systemic blood flow in left-
sided obstructive lesions. Until CHD is ruled out PGE should be started.
Answer A. Normal saline can be used for volume if needed
Answer B. Dopamine can be used to help with contractility but will not be of use if PDA is
necessary to provide systemic or pulmonary blood flow
Answer D. Versed is a benzodiazepine and will not help with opening a ductus arteriosus.
You are the PNP seeing a 5 year old female patient who underwent Atrial Septal Defect (ASD)
surgical closure one week ago. She presents for her postoperative appointment and appears
anxious and will not lie flat on the exam table for your exam. Her parents also report fever,
malaise and loss of appetite. Your immediate orders should include:
D
O
A. Chest x-ray
N
O
B. ECHOcardiogram
T
C. CBC/diff
C
D. Viral studies - ✔✔✔ Correct Answer > Explanation: Answer B. Because this patient is
O
refusing to lie flat and appears anxious, a quick look via echo can limit any delay in
PY
treatment that may be necessary. If the diagnosis of pericardial effusion is confirmed by
ECHO you would need to evaluate the size and plan for treatment including hospital
admission and:
NSAIDS/anti-inflammatory actions
Diuretics
Pericardial tube placement
Answer A. CBC/diff may be important but will not help determine why she will not lie flat
Answer C. Viral studies may also be important is she has s/s of respiratory illness, however based
on her recent surgical history and echocardiogram is paramount
Answer D. Chest x-ray would also be important but will only reveal an enlarged cardiac
silhouette and will not show fluid in the pericardial sac.
, In a patient with suspected hemophilus, influenza B (HIB) infection, the antibiotic
choices are? A. Amoxicillin p.o.
B. Nafcillin I.M./I.V.
C. Penicillin
D. Rifampin p.o. - ✔✔✔ Correct Answer > Correct Answer: Nafcillin I.M./I.V.
Explanation: HIB is a bacterial disease that should be treated with an antibiotic. Haemophilus
influenzae produces betalactamases, and is able to modify its penicillin-binding proteins. For this
reason it has gained resistance to the penicillin family of antibiotics. Nafcillin IV/IM contains
side groups that protect drugs from being inactivated by bacterial B lactamases.
D
Answer A. Amoxicillin is inactivated by Beta Lactamases
O
Answer B. Ampicillin IV could be used or Augmentin po in mild cases
N
Answer C. Rifampin is not used for HIB
O
T
In Piaget's formal operational stage, development includes:
C
O
A. Egocentrism
PY
B. Flexibility of thought
C. Magical thinking
D. Organization - ✔✔✔ Correct Answer > Explanation: D. The formal operational stage of
Piaget's theory of cognitive approach to development includes abstract thought and flexibility
of thought. The age range a child begins to exhibit this is 12 years and older
A. Magical thinking and
B. Egocentrism are in the preoperational thinking stage; ages 27 years
C. Organization is found in the concrete operational thinking which is 7-12 years of age
ACUTE CARE MELNIC EXAM NEWEST EXAM
WITH COMPLETE
QUESTIONS AND DETAILED VERIFIED
ANSWERS
A patient has a wide QRS noted intermittently on telemetry. After assessing that he has a stable
cardiac output, what is your next order?
A. Have the patient perform vagal maneuvers and order Adenosine, then consult EP services
D
B. Lidocaine, Amiodarone, synchronized cardioversion, then investigate cause
O
C. Begin CPR and defibrillate then investigate cause
N
O
D. Atropine and Isoproterenol to the bedside then consult EP services - ✔✔✔ Correct Answer >
Explanation: Answer A. A wide QRS can be aberrant SVT, Ventricular tachycardia or
T
Ventricular fibrillation. In the stable patient (verified by checking cardiac output), the
C
sequence is to give Lidocaine 1mg/kg Iv, followed by lidocaine drip 25-50 mcg/kg/min
continuous IV infusion, Amiodarone 5mg/kg/dose IV bolus. You can also consider
O
procainamide 15 mg/kg. Synchronized cardioversion may be necessary
PY
Answer B. CPR and defibrillation would be done if the patient had no cardiac output
Answer C. Vagal maneuvers and Adenosine treat SVT
Answer D. Atropine and Isproterenol are used for symptomatic 3rd degree AV block
You receive a consult from a Pediatrician who states he has a 7 month old in his office who has
"fallen off her growth curve." He also describes a IV/VI systolic ejection murmur heard best
along her left sternal border. He wants to send her to the Cardiology clinic today. Upon arrival,
you note a petite 7 month old female in no acute distress. Palpation of her chest is positive for a
thrill. She also has hepatomegaly. You order an echocardiogram which diagnoses a large PDA.
Before you can schedule this child for surgery, you need to:
,A. Inform the parents their child needs to undergo cardiac catheterization to better define the
defect
B. Inform the parents that their child has symptoms of congestive heart failure and needs to be
started on some medications for this
C. Inform the parents how to direct donate blood for their child
D. Inform the parents that their child is gravely ill - ✔✔✔ Correct Answer > Explanation:
Answer C. Symptoms of congestive heart failure (CHF) develop from pulmonary over
circulation and are exhibited by the patient's increased work of breathing, hepatomegaly, poor
feeding and growth failure. Treatment may include:
Digoxin for inotropy
Lasix for diuretic effect
D
After load reduction using ACE inhibitors (Enalapril, etc).
O
Answer A. If the patient needs surgery, you may offer information on direct blood donation
N
Answer B. Educate the parents on CHF and probable cause, however reassure them this can be
O
reversed once the PDA is closed
T
Answer D. Educate the parents cardiac catheterization will only be necessary if the patient
qualifies for transcatheter device closure of her PDA
C
O
A 4 day old female infant presents to your ED in cardiogenic shock. She is afebrile, pale and
PY
unresponsive. She is placed on oxygen without any change in her saturations. CXR shows altered
pulmonary vasculature and cardiomegaly. What drug might you start initially?
A.Normal Saline
B. Prostaglandin E1
C. Dopamine
D. Versed - ✔✔✔ Correct Answer > Explanation: Answer C. Congenital heart defects that result
in ↓ blood flow to the lungs or ↓ systemic blood flow are dependent on the pulmonary
systemic shunt from the patent ductus arteriosus to maintain pulmonary and systemic blood
flow.
,Closure of the ductus arteriosus leads to worsening of obstruction to pulmonary blood flow with
right to left shunt and cyanosis in right sided lesions and decreased systemic blood flow in left-
sided obstructive lesions. Until CHD is ruled out PGE should be started.
Answer A. Normal saline can be used for volume if needed
Answer B. Dopamine can be used to help with contractility but will not be of use if PDA is
necessary to provide systemic or pulmonary blood flow
Answer D. Versed is a benzodiazepine and will not help with opening a ductus arteriosus.
You are the PNP seeing a 5 year old female patient who underwent Atrial Septal Defect (ASD)
surgical closure one week ago. She presents for her postoperative appointment and appears
anxious and will not lie flat on the exam table for your exam. Her parents also report fever,
malaise and loss of appetite. Your immediate orders should include:
D
O
A. Chest x-ray
N
O
B. ECHOcardiogram
T
C. CBC/diff
C
D. Viral studies - ✔✔✔ Correct Answer > Explanation: Answer B. Because this patient is
O
refusing to lie flat and appears anxious, a quick look via echo can limit any delay in
PY
treatment that may be necessary. If the diagnosis of pericardial effusion is confirmed by
ECHO you would need to evaluate the size and plan for treatment including hospital
admission and:
NSAIDS/anti-inflammatory actions
Diuretics
Pericardial tube placement
Answer A. CBC/diff may be important but will not help determine why she will not lie flat
Answer C. Viral studies may also be important is she has s/s of respiratory illness, however based
on her recent surgical history and echocardiogram is paramount
Answer D. Chest x-ray would also be important but will only reveal an enlarged cardiac
silhouette and will not show fluid in the pericardial sac.
, In a patient with suspected hemophilus, influenza B (HIB) infection, the antibiotic
choices are? A. Amoxicillin p.o.
B. Nafcillin I.M./I.V.
C. Penicillin
D. Rifampin p.o. - ✔✔✔ Correct Answer > Correct Answer: Nafcillin I.M./I.V.
Explanation: HIB is a bacterial disease that should be treated with an antibiotic. Haemophilus
influenzae produces betalactamases, and is able to modify its penicillin-binding proteins. For this
reason it has gained resistance to the penicillin family of antibiotics. Nafcillin IV/IM contains
side groups that protect drugs from being inactivated by bacterial B lactamases.
D
Answer A. Amoxicillin is inactivated by Beta Lactamases
O
Answer B. Ampicillin IV could be used or Augmentin po in mild cases
N
Answer C. Rifampin is not used for HIB
O
T
In Piaget's formal operational stage, development includes:
C
O
A. Egocentrism
PY
B. Flexibility of thought
C. Magical thinking
D. Organization - ✔✔✔ Correct Answer > Explanation: D. The formal operational stage of
Piaget's theory of cognitive approach to development includes abstract thought and flexibility
of thought. The age range a child begins to exhibit this is 12 years and older
A. Magical thinking and
B. Egocentrism are in the preoperational thinking stage; ages 27 years
C. Organization is found in the concrete operational thinking which is 7-12 years of age
