CPNP-AC Acute Care paediatric Nurse Practitioner Certification
Exam 2026: Comprehensive Board Practice Test — paediatric
Emergencies, Critical Care, Acute Illness, Trauma, Diagnostic
Evaluation & Clinical Management — 190 Multiple-Choice Questions
with Answers & Detailed Rationales
SECTION 1: CARDIOVASCULAR SYSTEM (Questions 1-25)
Question 1
A 4-month-old infant with tetralogy of Fallot is brought to the emergency department by
parents who report the infant had a 3-minute episode of deep blue coloring, rapid
breathing, and limpness after crying. The episode resolved spontaneously. Which physiologic
mechanism best explains this event?
A. Increased pulmonary blood flow due to left-to-right shunting
B. Dynamic obstruction of right ventricular outflow tract with increased right-to-left shunting
C. Acute closure of the ductus arteriosus
D. Decreased systemic vascular resistance from vagal stimulation
Correct Answer: B
Explanation: Tet spells result from infundibular spasm worsening right-to-left shunting.
Crying increases pulmonary vascular resistance, exacerbating the obstruction and
hypoxemia.
Question 2
A 6-year-old child with dilated cardiomyopathy is admitted with worsening heart failure. The
NP orders furosemide. Which laboratory value requires closest monitoring after
administration?
,A. Serum sodium
B. Serum potassium
C. Serum calcium
D. Serum magnesium
Correct Answer: B
Explanation: Loop diuretics cause significant potassium wasting, predisposing to
hypokalemia and arrhythmias. Monitor potassium closely and supplement as needed in
heart failure patients.
Question 3
A neonate born at 39 weeks presents with cyanosis unresponsive to supplemental oxygen.
Echocardiography reveals transposition of the great arteries. Which intervention is most
critical to maintain systemic oxygenation while awaiting surgery?
A. Initiation of high-flow nasal cannula
B. Administration of prostaglandin E1 infusion
C. Emergent intubation with 100% oxygen
D. Initiation of inhaled nitric oxide therapy
Correct Answer: B
Explanation: Prostaglandin E1 maintains ductal patency, allowing mixing of oxygenated and
deoxygenated blood. Without mixing, severe hypoxemia persists despite oxygen therapy.
Question 4
,A 12-year-old with a history of Kawasaki disease is now 8 weeks post-diagnosis. Which
finding on follow-up echocardiogram would be most concerning?
A. Mild mitral regurgitation
B. Coronary artery aneurysm measuring 6 mm
C. Pericardial effusion measuring 3 mm
D. Left ventricular ejection fraction of 58%
Correct Answer: B
Explanation: Coronary artery aneurysms, especially large ones (>5 mm), significantly
increase risk for thrombosis and myocardial infarction. These require anticoagulation and
close cardiology follow-up.
Question 5
A 2-day-old infant is noted to have a blood pressure of 58/34 mmHg in the upper extremities
and 38/22 mmHg in the lower extremities. Femoral pulses are weak. What is the most likely
diagnosis?
A. Aortic stenosis
B. Coarctation of the aorta
C. Patent ductus arteriosus
D. Ventricular septal defect
Correct Answer: B
, Explanation: Differential cyanosis and blood pressure discrepancy between upper and lower
extremities are hallmark signs of coarctation. Prostaglandin may be needed to maintain
ductal patency.
Question 6
A 15-year-old athlete collapses during basketball practice. He is resuscitated but remains
unconscious. ECG shows a prolonged QT interval. Which medication should be avoided in
this patient?
A. Amiodarone
B. Lidocaine
C. Adenosine
D. Magnesium sulfate
Correct Answer: A
Explanation: Amiodarone prolongs the QT interval further, increasing risk of torsades de
pointes. In congenital long QT syndrome, avoid QT-prolonging drugs and consider beta-
blockers.
Question 7
A 3-year-old with a ventricular septal defect is being evaluated for surgical repair. Which
finding would indicate the child has developed Eisenmenger syndrome?
A. Loud holosystolic murmur at the left lower sternal border
B. Cyanosis with clubbing and polycythemia
C. Bounding peripheral pulses
D. Wide pulse pressure
Exam 2026: Comprehensive Board Practice Test — paediatric
Emergencies, Critical Care, Acute Illness, Trauma, Diagnostic
Evaluation & Clinical Management — 190 Multiple-Choice Questions
with Answers & Detailed Rationales
SECTION 1: CARDIOVASCULAR SYSTEM (Questions 1-25)
Question 1
A 4-month-old infant with tetralogy of Fallot is brought to the emergency department by
parents who report the infant had a 3-minute episode of deep blue coloring, rapid
breathing, and limpness after crying. The episode resolved spontaneously. Which physiologic
mechanism best explains this event?
A. Increased pulmonary blood flow due to left-to-right shunting
B. Dynamic obstruction of right ventricular outflow tract with increased right-to-left shunting
C. Acute closure of the ductus arteriosus
D. Decreased systemic vascular resistance from vagal stimulation
Correct Answer: B
Explanation: Tet spells result from infundibular spasm worsening right-to-left shunting.
Crying increases pulmonary vascular resistance, exacerbating the obstruction and
hypoxemia.
Question 2
A 6-year-old child with dilated cardiomyopathy is admitted with worsening heart failure. The
NP orders furosemide. Which laboratory value requires closest monitoring after
administration?
,A. Serum sodium
B. Serum potassium
C. Serum calcium
D. Serum magnesium
Correct Answer: B
Explanation: Loop diuretics cause significant potassium wasting, predisposing to
hypokalemia and arrhythmias. Monitor potassium closely and supplement as needed in
heart failure patients.
Question 3
A neonate born at 39 weeks presents with cyanosis unresponsive to supplemental oxygen.
Echocardiography reveals transposition of the great arteries. Which intervention is most
critical to maintain systemic oxygenation while awaiting surgery?
A. Initiation of high-flow nasal cannula
B. Administration of prostaglandin E1 infusion
C. Emergent intubation with 100% oxygen
D. Initiation of inhaled nitric oxide therapy
Correct Answer: B
Explanation: Prostaglandin E1 maintains ductal patency, allowing mixing of oxygenated and
deoxygenated blood. Without mixing, severe hypoxemia persists despite oxygen therapy.
Question 4
,A 12-year-old with a history of Kawasaki disease is now 8 weeks post-diagnosis. Which
finding on follow-up echocardiogram would be most concerning?
A. Mild mitral regurgitation
B. Coronary artery aneurysm measuring 6 mm
C. Pericardial effusion measuring 3 mm
D. Left ventricular ejection fraction of 58%
Correct Answer: B
Explanation: Coronary artery aneurysms, especially large ones (>5 mm), significantly
increase risk for thrombosis and myocardial infarction. These require anticoagulation and
close cardiology follow-up.
Question 5
A 2-day-old infant is noted to have a blood pressure of 58/34 mmHg in the upper extremities
and 38/22 mmHg in the lower extremities. Femoral pulses are weak. What is the most likely
diagnosis?
A. Aortic stenosis
B. Coarctation of the aorta
C. Patent ductus arteriosus
D. Ventricular septal defect
Correct Answer: B
, Explanation: Differential cyanosis and blood pressure discrepancy between upper and lower
extremities are hallmark signs of coarctation. Prostaglandin may be needed to maintain
ductal patency.
Question 6
A 15-year-old athlete collapses during basketball practice. He is resuscitated but remains
unconscious. ECG shows a prolonged QT interval. Which medication should be avoided in
this patient?
A. Amiodarone
B. Lidocaine
C. Adenosine
D. Magnesium sulfate
Correct Answer: A
Explanation: Amiodarone prolongs the QT interval further, increasing risk of torsades de
pointes. In congenital long QT syndrome, avoid QT-prolonging drugs and consider beta-
blockers.
Question 7
A 3-year-old with a ventricular septal defect is being evaluated for surgical repair. Which
finding would indicate the child has developed Eisenmenger syndrome?
A. Loud holosystolic murmur at the left lower sternal border
B. Cyanosis with clubbing and polycythemia
C. Bounding peripheral pulses
D. Wide pulse pressure
