,Barkley CPNP-AC Exam Practice Questions 2026–2027
250 Questions with Answers & Detailed Rationales
Graded A+ | 2026 Update | 100% Correct
Content Areas Covered:
• Fluid, Electrolytes & Nutrition
• Respiratory Disorders & Mechanical Ventilation
• Cardiovascular Disorders
• Neurological Disorders
• Infectious Diseases
• Renal & Genitourinary Disorders
• Gastrointestinal Disorders
• Endocrine & Metabolic Disorders
• Hematology & Oncology
• Trauma & Emergency Management
• Pharmacology
• Professional Practice & Ethics
SECTION 1: FLUID, ELECTROLYTES & NUTRITION (Questions
1–25)
Question 1
,A 6-year-old child with severe malnutrition is started on enteral nutrition after a period
of starvation. Which laboratory finding is most concerning for refeeding syndrome?
A. Phosphate 3.0 mg/dL
B. Potassium 2.8 mEq/L
C. Magnesium 1.8 mg/dL
D. Both A and B
Answer: D. Both A and B
Rationale: Refeeding syndrome is characterized by hypophosphatemia, hypokalemia,
and hypomagnesemia. Laboratory values indicative of refeeding syndrome include
phosphate < 3.5 mg/dL and potassium < 3.5 mEq/L. Thiamine deficiency is also a
concern. Close monitoring of electrolytes is essential during refeeding.
Question 2
A 4-year-old child with pneumonia and adequate urine output requires maintenance IV
fluids. Which fluid is most appropriate?
A. 0.9% normal saline
B. D5 normal saline + potassium chloride 20 mEq/L
C. 0.45% normal saline
D. Lactated Ringer's
Answer: B. D5 normal saline + potassium chloride 20 mEq/L
Rationale: Maintenance fluids for a child with pneumonia and adequate urine output
should include dextrose to prevent hypoglycemia and potassium to maintain electrolyte
balance.
, Question 3
Which diagnostic method provides the BEST estimate of energy requirements for a
mechanically ventilated child?
A. Harris-Benedict equation
B. Indirect calorimetry
C. Weight-based calculation
D. Schofield equation
Answer: B. Indirect calorimetry
Rationale: Indirect calorimetry is considered the gold standard for estimating energy
requirements in mechanically ventilated children as it measures actual oxygen
consumption and carbon dioxide production.
Question 4
A child on long-term parenteral nutrition develops cholestatic liver disease. This
complication is primarily caused by:
A. Excess glucose administration
B. Lipid emulsion toxicity
C. Lack of enteral stimulation
D. Amino acid imbalance
Answer: C. Lack of enteral stimulation
250 Questions with Answers & Detailed Rationales
Graded A+ | 2026 Update | 100% Correct
Content Areas Covered:
• Fluid, Electrolytes & Nutrition
• Respiratory Disorders & Mechanical Ventilation
• Cardiovascular Disorders
• Neurological Disorders
• Infectious Diseases
• Renal & Genitourinary Disorders
• Gastrointestinal Disorders
• Endocrine & Metabolic Disorders
• Hematology & Oncology
• Trauma & Emergency Management
• Pharmacology
• Professional Practice & Ethics
SECTION 1: FLUID, ELECTROLYTES & NUTRITION (Questions
1–25)
Question 1
,A 6-year-old child with severe malnutrition is started on enteral nutrition after a period
of starvation. Which laboratory finding is most concerning for refeeding syndrome?
A. Phosphate 3.0 mg/dL
B. Potassium 2.8 mEq/L
C. Magnesium 1.8 mg/dL
D. Both A and B
Answer: D. Both A and B
Rationale: Refeeding syndrome is characterized by hypophosphatemia, hypokalemia,
and hypomagnesemia. Laboratory values indicative of refeeding syndrome include
phosphate < 3.5 mg/dL and potassium < 3.5 mEq/L. Thiamine deficiency is also a
concern. Close monitoring of electrolytes is essential during refeeding.
Question 2
A 4-year-old child with pneumonia and adequate urine output requires maintenance IV
fluids. Which fluid is most appropriate?
A. 0.9% normal saline
B. D5 normal saline + potassium chloride 20 mEq/L
C. 0.45% normal saline
D. Lactated Ringer's
Answer: B. D5 normal saline + potassium chloride 20 mEq/L
Rationale: Maintenance fluids for a child with pneumonia and adequate urine output
should include dextrose to prevent hypoglycemia and potassium to maintain electrolyte
balance.
, Question 3
Which diagnostic method provides the BEST estimate of energy requirements for a
mechanically ventilated child?
A. Harris-Benedict equation
B. Indirect calorimetry
C. Weight-based calculation
D. Schofield equation
Answer: B. Indirect calorimetry
Rationale: Indirect calorimetry is considered the gold standard for estimating energy
requirements in mechanically ventilated children as it measures actual oxygen
consumption and carbon dioxide production.
Question 4
A child on long-term parenteral nutrition develops cholestatic liver disease. This
complication is primarily caused by:
A. Excess glucose administration
B. Lipid emulsion toxicity
C. Lack of enteral stimulation
D. Amino acid imbalance
Answer: C. Lack of enteral stimulation
