PEDIATRIC NURSE PRACTITIONER (PNP AC) EXAM
|ACTUAL QUESTIONS AND VERIFIED
ANSWERS|BRAND NEW 2026-2027
UPDATE|GRADED A+
Question 1
A 13 m/o, weighs 11 kg, has stridor & LG fever after 5 days of cough & cold s/s. Humidified
air & tylenol have not helped & his work of breathing increased. O2 sat on room sir is 94%.
what Is the next rec strep of tx?
a) Dex 22 mg PO/IM
b) Dex 6.6 mg PO/IM
c) neb albuterol
d) consult END
CORRECT ANSWER
B - 0.6mg/kg, presentation consistent w/croup. albuterol is not appropriate with
w/upper airway obstruction
Question 2
Which of the following are the most likely pathogen in an 8 m/o infant w/3 days of URI, LG
fever, now presenting w/harsh cough & stridor, worse at nighttime
a) RSV & adeno
b) Human metapneumovirus & flu
c) parainfluenza type 1 & 2
d) rhino & parainfluenza type 3
CORRECT ANSWER
c - likely cause of croup (RSV & adeno are 2nd), croup is worse at night
1
,Question 3
a 2 y/o w/cold s/s X 1 week, now has sig stridor w/orthopnea & neck stiffness. what would
be an expected finding on the neck radiograph?
a) steeple sign
b) thumbprint sign
c) brudzinski sign
d) wide retropharyngeal space
CORRECT ANSWER
d - retropharyngeal abscess, preceeding infxn, URI, neck stiffness
Question 4
a 7 y/o w/a hx of asthma presents w/wheezing & hypoxia. after 2 hrs, he continues to
have sig difficulty breathing, despite multiple albuterol nebs, PO steroids & O2
supplementation.
What are differential dx?
What is the next step in tx?
CORRECT ANSWER
- status asthmaticus, pneumonia, foreign body, viral or bacterial infxn
- mag, high flow, hospitalize, non-invasive ventilation,
Question 5
What are the findings?
CORRECT ANSWER
patchy infiltrates on right mid/lower lobe
2
,Question 6
what are the findings?
CORRECT ANSWER
LLL opacification - effusion vs infiltration (blunting may suggest effusion)
Question 7
when is this xray indicated (lateral decubitus)? benefits of x-ray vs US?
CORRECT ANSWER
indicated when have concerns of effusion, may see air levels, in L lung well aerated, R
lung not well aerated, can see fluid on R side. pleural effusion on R side.
benefit - easy and simple to perform. hard if have complex fluid collection
US can better ID & characterize fluid in there (simple vs complex) - look for lung
abscesses, necrosis etc.
Question 8
an obese 14 yr old presents w/acute hip pain & inability to walk even w/support of
crutches. he has recently complained of hip pain & doesnt remember an injury. The MOST
likely dx is:
a) legg calve perthes dse
b) femur fx
c) SCFE
d) osteomyelitis
CORRECT ANSWER
3
, Question 9
11 yr old w/hx of asthma presents w/LG fever, SOB, hypoxia & +COVID-19
-diff dx?
-is this x-ray atelectasis vs an effusion or pneumonia?
CORRECT ANSWER
- ARDS, pneumonia, atelectasis, effusion/empyema
-volume loss or volume gained, might see cardiac silhouette move w/loss, w/a gain see
additional volume added to R chest, may see shifting in the opposite direction - looks
more like infiltration bc able to see CV silhouette
Question 10
Infant w/resp distress on HFNC at 10L & 40% O2: interpret this art BG
pH 7.23
-PaCO2 65
-paO2 86
-HCO3 25
-Base excess +4
a) resp acidosis w/metabolic compensation
b) respiratory acidosis w/out metabolic compensation
c) respiratory alkalosis
CORRECT ANSWER
b - low pH (if compensated more normal), high CO2, normal bicarb
Question 11
4
|ACTUAL QUESTIONS AND VERIFIED
ANSWERS|BRAND NEW 2026-2027
UPDATE|GRADED A+
Question 1
A 13 m/o, weighs 11 kg, has stridor & LG fever after 5 days of cough & cold s/s. Humidified
air & tylenol have not helped & his work of breathing increased. O2 sat on room sir is 94%.
what Is the next rec strep of tx?
a) Dex 22 mg PO/IM
b) Dex 6.6 mg PO/IM
c) neb albuterol
d) consult END
CORRECT ANSWER
B - 0.6mg/kg, presentation consistent w/croup. albuterol is not appropriate with
w/upper airway obstruction
Question 2
Which of the following are the most likely pathogen in an 8 m/o infant w/3 days of URI, LG
fever, now presenting w/harsh cough & stridor, worse at nighttime
a) RSV & adeno
b) Human metapneumovirus & flu
c) parainfluenza type 1 & 2
d) rhino & parainfluenza type 3
CORRECT ANSWER
c - likely cause of croup (RSV & adeno are 2nd), croup is worse at night
1
,Question 3
a 2 y/o w/cold s/s X 1 week, now has sig stridor w/orthopnea & neck stiffness. what would
be an expected finding on the neck radiograph?
a) steeple sign
b) thumbprint sign
c) brudzinski sign
d) wide retropharyngeal space
CORRECT ANSWER
d - retropharyngeal abscess, preceeding infxn, URI, neck stiffness
Question 4
a 7 y/o w/a hx of asthma presents w/wheezing & hypoxia. after 2 hrs, he continues to
have sig difficulty breathing, despite multiple albuterol nebs, PO steroids & O2
supplementation.
What are differential dx?
What is the next step in tx?
CORRECT ANSWER
- status asthmaticus, pneumonia, foreign body, viral or bacterial infxn
- mag, high flow, hospitalize, non-invasive ventilation,
Question 5
What are the findings?
CORRECT ANSWER
patchy infiltrates on right mid/lower lobe
2
,Question 6
what are the findings?
CORRECT ANSWER
LLL opacification - effusion vs infiltration (blunting may suggest effusion)
Question 7
when is this xray indicated (lateral decubitus)? benefits of x-ray vs US?
CORRECT ANSWER
indicated when have concerns of effusion, may see air levels, in L lung well aerated, R
lung not well aerated, can see fluid on R side. pleural effusion on R side.
benefit - easy and simple to perform. hard if have complex fluid collection
US can better ID & characterize fluid in there (simple vs complex) - look for lung
abscesses, necrosis etc.
Question 8
an obese 14 yr old presents w/acute hip pain & inability to walk even w/support of
crutches. he has recently complained of hip pain & doesnt remember an injury. The MOST
likely dx is:
a) legg calve perthes dse
b) femur fx
c) SCFE
d) osteomyelitis
CORRECT ANSWER
3
, Question 9
11 yr old w/hx of asthma presents w/LG fever, SOB, hypoxia & +COVID-19
-diff dx?
-is this x-ray atelectasis vs an effusion or pneumonia?
CORRECT ANSWER
- ARDS, pneumonia, atelectasis, effusion/empyema
-volume loss or volume gained, might see cardiac silhouette move w/loss, w/a gain see
additional volume added to R chest, may see shifting in the opposite direction - looks
more like infiltration bc able to see CV silhouette
Question 10
Infant w/resp distress on HFNC at 10L & 40% O2: interpret this art BG
pH 7.23
-PaCO2 65
-paO2 86
-HCO3 25
-Base excess +4
a) resp acidosis w/metabolic compensation
b) respiratory acidosis w/out metabolic compensation
c) respiratory alkalosis
CORRECT ANSWER
b - low pH (if compensated more normal), high CO2, normal bicarb
Question 11
4
