PNP-AC CERTIFICATION Exam| YEAR
2026–2027 | Comprehensive 150-Question
Practice Test with Answers & Rationales|
Pdf Access ALREADY GRADED A+.
SECTION 1: RESPIRATORY (Questions 1–15)
Q1. A 3-year-old presents with drooling, stridor, tripod positioning, and fever of 39.2°C. The
child appears toxic. Which is the MOST appropriate initial action?
A. Obtain a throat culture
B. Perform a lateral neck X-ray
C. Prepare for controlled intubation in the operating room
D. Administer nebulized racemic epinephrine
Answer: C
Rationale: This presentation is classic for epiglottitis (supraglottitis), a life-threatening airway
emergency. Any manipulation of the throat or positioning for X-ray can precipitate complete
airway obstruction. The priority is maintaining the child in a comfortable position and preparing
for controlled intubation in the operating room with anesthesia and ENT present. Throat
cultures are contraindicated. Racemic epinephrine is for croup, not epiglottitis.
Q2. A 6-month-old infant presents with copious nasal discharge, low-grade fever, tachypnea,
and diffuse wheezing. RSV testing is positive. Which intervention is evidence-based?
A. Routine nebulized albuterol
B. Systemic corticosteroids
C. Supportive care with oxygen, suctioning, and hydration
D. Prophylactic antibiotics
Answer: C
Rationale: RSV bronchiolitis management is supportive. Oxygen for SpO2 <90%, nasal
suctioning, and hydration are the mainstays. Bronchodilators, corticosteroids, and antibiotics
,are NOT routinely recommended unless there is a confirmed secondary bacterial infection or
underlying reactive airway disease.
Q3. A 10-year-old with asthma has a peak expiratory flow rate (PEFR) of 45% of personal best,
speaks in partial sentences, and has moderate retractions. Classification?
A. Mild exacerbation
B. Moderate exacerbation
C. Severe exacerbation
D. Life-threatening exacerbation
Answer: B
Rationale: Moderate exacerbation: PEFR 40–69% of personal best, partial sentences, moderate
retractions, audible wheezing. Severe: PEFR <40%, speaks in single words, severe retractions,
silent chest. Life-threatening: altered consciousness, cyanosis, bradycardia.
Q4. A 2-year-old with croup receives nebulized racemic epinephrine. Which parameter requires
closest monitoring post-treatment?
A. Respiratory rate
B. Heart rate
C. Temperature
D. Oxygen saturation
Answer: B
Rationale: Racemic epinephrine is a sympathomimetic that causes tachycardia and
hypertension. Heart rate should be continuously monitored during and after administration.
Rebound stridor may occur 2–4 hours post-treatment, so observation is required.
Q5. An 8-year-old with status asthmaticus has received continuous albuterol, IV corticosteroids,
and ipratropium but remains in severe distress. Which is the next appropriate pharmacologic
intervention?
A. IV magnesium sulfate
B. Subcutaneous epinephrine
C. IV aminophylline
D. Oral montelukast
,Answer: A
Rationale: IV magnesium sulfate is the next step for severe asthma exacerbation refractory to
standard therapy. It acts as a smooth muscle relaxant and bronchodilator. Subcutaneous
epinephrine is for anaphylaxis. Aminophylline is rarely used due to toxicity. Montelukast is a
controller medication, not acute rescue.
Q6. A 4-year-old develops stridor, barky cough, and hoarseness following 2 days of URI
symptoms. Symptoms worsen at night. What is the most likely diagnosis?
A. Epiglottitis
B. Croup (laryngotracheobronchitis)
C. Bacterial tracheitis
D. Foreign body aspiration
Answer: B
Rationale: Croup presents with the classic triad: barky cough, stridor, and hoarseness, often
following a viral URI. Symptoms worsen at night. Epiglottitis has rapid onset with drooling and
toxic appearance. Bacterial tracheitis has high fever and toxic appearance. Foreign body has
sudden onset without fever.
Q7. A 12-year-old with asthma has a silent chest, bradycardia, and altered mental status. What
is the priority intervention?
A. Albuterol nebulization
B. Immediate intubation and mechanical ventilation
C. Oral prednisone
D. Chest physiotherapy
Answer: B
Rationale: Silent chest, bradycardia, and altered mental status indicate impending respiratory
failure and life-threatening asthma. Immediate airway management with intubation and
mechanical ventilation is required. Albuterol and steroids are adjuncts but will not address the
immediate need for ventilatory support.
Q8. A 7-month-old with bronchiolitis has apneic episodes. Which is the strongest risk factor for
apnea in bronchiolitis?
, A. Age <2 months
B. Prematurity
C. History of eczema
D. Formula feeding
Answer: B
Rationale: Prematurity is the strongest risk factor for apnea in bronchiolitis, along with age <2
months, congenital heart disease, and chronic lung disease. These infants require continuous
monitoring and may need ICU admission.
Q9. A 5-year-old aspirates a peanut. Which physical finding is most likely?
A. Bilateral diffuse wheezing
B. Unilateral decreased breath sounds on the right
C. Pleural friction rub
D. Inspiratory stridor
Answer: B
Rationale: Foreign body aspiration most commonly lodges in the right mainstem bronchus due
to its more vertical angle. Unilateral decreased breath sounds on the affected side is the classic
finding. Bilateral wheezing suggests asthma. Stridor suggests upper airway obstruction.
Q10. A 3-week-old presents with projectile vomiting after feeds, is constantly hungry, and has a
palpable olive-shaped mass in the RUQ. Which lab abnormality is expected?
A. Hyperchloremic metabolic acidosis
B. Hypochloremic hypokalemic metabolic alkalosis
C. Hypernatremia
D. Hypoglycemia
Answer: B
Rationale: Pyloric stenosis causes loss of gastric HCl, leading to hypochloremia, hypokalemia,
and metabolic alkalosis. The olive-shaped mass is the hypertrophied pylorus. Correct with IV
fluids and electrolytes before surgery.
Q11. A 6-year-old with pneumonia has increased work of breathing, fever, and decreased
breath sounds on the right. Chest X-ray shows a large pleural effusion. What is the most
appropriate next step?
2026–2027 | Comprehensive 150-Question
Practice Test with Answers & Rationales|
Pdf Access ALREADY GRADED A+.
SECTION 1: RESPIRATORY (Questions 1–15)
Q1. A 3-year-old presents with drooling, stridor, tripod positioning, and fever of 39.2°C. The
child appears toxic. Which is the MOST appropriate initial action?
A. Obtain a throat culture
B. Perform a lateral neck X-ray
C. Prepare for controlled intubation in the operating room
D. Administer nebulized racemic epinephrine
Answer: C
Rationale: This presentation is classic for epiglottitis (supraglottitis), a life-threatening airway
emergency. Any manipulation of the throat or positioning for X-ray can precipitate complete
airway obstruction. The priority is maintaining the child in a comfortable position and preparing
for controlled intubation in the operating room with anesthesia and ENT present. Throat
cultures are contraindicated. Racemic epinephrine is for croup, not epiglottitis.
Q2. A 6-month-old infant presents with copious nasal discharge, low-grade fever, tachypnea,
and diffuse wheezing. RSV testing is positive. Which intervention is evidence-based?
A. Routine nebulized albuterol
B. Systemic corticosteroids
C. Supportive care with oxygen, suctioning, and hydration
D. Prophylactic antibiotics
Answer: C
Rationale: RSV bronchiolitis management is supportive. Oxygen for SpO2 <90%, nasal
suctioning, and hydration are the mainstays. Bronchodilators, corticosteroids, and antibiotics
,are NOT routinely recommended unless there is a confirmed secondary bacterial infection or
underlying reactive airway disease.
Q3. A 10-year-old with asthma has a peak expiratory flow rate (PEFR) of 45% of personal best,
speaks in partial sentences, and has moderate retractions. Classification?
A. Mild exacerbation
B. Moderate exacerbation
C. Severe exacerbation
D. Life-threatening exacerbation
Answer: B
Rationale: Moderate exacerbation: PEFR 40–69% of personal best, partial sentences, moderate
retractions, audible wheezing. Severe: PEFR <40%, speaks in single words, severe retractions,
silent chest. Life-threatening: altered consciousness, cyanosis, bradycardia.
Q4. A 2-year-old with croup receives nebulized racemic epinephrine. Which parameter requires
closest monitoring post-treatment?
A. Respiratory rate
B. Heart rate
C. Temperature
D. Oxygen saturation
Answer: B
Rationale: Racemic epinephrine is a sympathomimetic that causes tachycardia and
hypertension. Heart rate should be continuously monitored during and after administration.
Rebound stridor may occur 2–4 hours post-treatment, so observation is required.
Q5. An 8-year-old with status asthmaticus has received continuous albuterol, IV corticosteroids,
and ipratropium but remains in severe distress. Which is the next appropriate pharmacologic
intervention?
A. IV magnesium sulfate
B. Subcutaneous epinephrine
C. IV aminophylline
D. Oral montelukast
,Answer: A
Rationale: IV magnesium sulfate is the next step for severe asthma exacerbation refractory to
standard therapy. It acts as a smooth muscle relaxant and bronchodilator. Subcutaneous
epinephrine is for anaphylaxis. Aminophylline is rarely used due to toxicity. Montelukast is a
controller medication, not acute rescue.
Q6. A 4-year-old develops stridor, barky cough, and hoarseness following 2 days of URI
symptoms. Symptoms worsen at night. What is the most likely diagnosis?
A. Epiglottitis
B. Croup (laryngotracheobronchitis)
C. Bacterial tracheitis
D. Foreign body aspiration
Answer: B
Rationale: Croup presents with the classic triad: barky cough, stridor, and hoarseness, often
following a viral URI. Symptoms worsen at night. Epiglottitis has rapid onset with drooling and
toxic appearance. Bacterial tracheitis has high fever and toxic appearance. Foreign body has
sudden onset without fever.
Q7. A 12-year-old with asthma has a silent chest, bradycardia, and altered mental status. What
is the priority intervention?
A. Albuterol nebulization
B. Immediate intubation and mechanical ventilation
C. Oral prednisone
D. Chest physiotherapy
Answer: B
Rationale: Silent chest, bradycardia, and altered mental status indicate impending respiratory
failure and life-threatening asthma. Immediate airway management with intubation and
mechanical ventilation is required. Albuterol and steroids are adjuncts but will not address the
immediate need for ventilatory support.
Q8. A 7-month-old with bronchiolitis has apneic episodes. Which is the strongest risk factor for
apnea in bronchiolitis?
, A. Age <2 months
B. Prematurity
C. History of eczema
D. Formula feeding
Answer: B
Rationale: Prematurity is the strongest risk factor for apnea in bronchiolitis, along with age <2
months, congenital heart disease, and chronic lung disease. These infants require continuous
monitoring and may need ICU admission.
Q9. A 5-year-old aspirates a peanut. Which physical finding is most likely?
A. Bilateral diffuse wheezing
B. Unilateral decreased breath sounds on the right
C. Pleural friction rub
D. Inspiratory stridor
Answer: B
Rationale: Foreign body aspiration most commonly lodges in the right mainstem bronchus due
to its more vertical angle. Unilateral decreased breath sounds on the affected side is the classic
finding. Bilateral wheezing suggests asthma. Stridor suggests upper airway obstruction.
Q10. A 3-week-old presents with projectile vomiting after feeds, is constantly hungry, and has a
palpable olive-shaped mass in the RUQ. Which lab abnormality is expected?
A. Hyperchloremic metabolic acidosis
B. Hypochloremic hypokalemic metabolic alkalosis
C. Hypernatremia
D. Hypoglycemia
Answer: B
Rationale: Pyloric stenosis causes loss of gastric HCl, leading to hypochloremia, hypokalemia,
and metabolic alkalosis. The olive-shaped mass is the hypertrophied pylorus. Correct with IV
fluids and electrolytes before surgery.
Q11. A 6-year-old with pneumonia has increased work of breathing, fever, and decreased
breath sounds on the right. Chest X-ray shows a large pleural effusion. What is the most
appropriate next step?
