BARKLEY PEDIATRIC ACUTE CARE NURSE PRACTITIONER (PNP-AC) EXAM QUESTIONS AND ANSWERS
ALREADY GRADED A+| 100% VERIFIED SOLUTIONS
Core Domains
Pediatric Acute and Critical Illness Management
Respiratory Failure and Mechanical Ventilation in Children
Pediatric Shock States and Hemodynamic Support
Neurological Emergencies and Neurocritical Care
Pediatric Sepsis and Infectious Disease Emergencies
Fluid, Electrolyte, and Metabolic Management
Trauma and Surgical Emergencies in Children
Sedation, Analgesia, and Pharmacology in Acute Care
Ethical and Legal Issues in Pediatric Acute Care
Family-Centered Care and Crisis Communication
Introduction
This comprehensive examination is designed to rigorously evaluate the advanced clinical knowledge, diagnostic
reasoning, and critical decision-making skills essential for certification as a Barkley Pediatric Acute Care Nurse
Practitioner (PNP-AC). The exam focuses on the specialized competencies required to manage acutely ill, critically
unstable, and injured infants, children, and adolescents in emergency departments, intensive care units, and
,inpatient acute care settings. Candidates will be challenged to integrate developmental physiology,
pathophysiological concepts, and evidence-based guidelines to manage complex pediatric emergencies and life-
threatening conditions. The multiple-choice and scenario-based questions emphasize real-world clinical
application, rapid prioritization, and the unique ethical and family-centered considerations inherent to acute
pediatric care.
SECTION ONE: QUESTIONS 1–100
1. A 4-year-old male is brought to the emergency department with a barking cough, inspiratory stridor, and
respiratory distress. He has a low-grade fever. On examination, you note suprasternal and subcostal
retractions. Which of the following is the most likely diagnosis?
A. Epiglottitis
B. Croup
C. Bacterial tracheitis
D. Foreign body aspiration
🟢B
🔴 RATIONALE: The patient has classic croup (laryngotracheobronchitis), characterized by a barking cough,
inspiratory stridor, and respiratory distress, often following a viral upper respiratory infection. Epiglottitis
,presents with high fever, drooling, and a muffled voice. Bacterial tracheitis presents with high fever and purulent
secretions. Foreign body aspiration typically presents with a sudden onset of choking and wheezing.
2. A 2-year-old female is admitted to the PICU with respiratory syncytial virus (RSV) bronchiolitis. She is on
high-flow nasal cannula (HFNC) with an FiO2 of 0.4. Her work of breathing is increasing, and her PaCO2 on a
capillary blood gas is 55 mmHg. Which of the following is the most appropriate next step in management?
A. Increase the FiO2 to 0.6.
B. Increase the HFNC flow rate.
C. Initiate non-invasive positive pressure ventilation (NIPPV).
D. Intubate and initiate mechanical ventilation.
🟢D
🔴 RATIONALE: The patient is showing signs of impending respiratory failure with increasing work of breathing
and hypercapnia (PaCO2 55 mmHg) despite HFNC. Intubation and mechanical ventilation are indicated when
non-invasive support is failing. Increasing FiO2 would address hypoxemia but not the hypercapnia. Increasing
HFNC flow may be attempted but the patient is already on HFNC and showing signs of deterioration. NIPPV
may be a bridge but intubation is the most definitive next step.
3. A 6-year-old male is admitted with sepsis secondary to pneumonia. He is on a norepinephrine infusion.
His mean arterial pressure (MAP) is 55 mmHg. Which of the following is the most appropriate initial fluid
, resuscitation strategy?
A. Administer a 10 mL/kg bolus of normal saline.
B. Administer a 20 mL/kg bolus of normal saline.
C. Administer a 5 mL/kg bolus of albumin.
D. Administer a 10 mL/kg bolus of packed red blood cells.
🟢B
🔴 RATIONALE: In pediatric septic shock, the initial fluid resuscitation is a 20 mL/kg bolus of isotonic crystalloid
(normal saline or lactated Ringer's). This can be repeated up to 60 mL/kg in the first hour. A 10 mL/kg bolus is
insufficient. Albumin is a second-line colloid and is not the initial fluid of choice. Packed red blood cells are
reserved for hemorrhagic shock or significant anemia.
4. A 10-year-old female is admitted with status epilepticus. She has received two doses of lorazepam and is
now on a continuous infusion of midazolam. Which of the following is the most appropriate next step if
seizures continue?
A. Increase the midazolam infusion rate.
B. Administer a loading dose of phenytoin.
C. Administer a loading dose of levetiracetam.
D. Initiate pentobarbital coma.
🟢B
ALREADY GRADED A+| 100% VERIFIED SOLUTIONS
Core Domains
Pediatric Acute and Critical Illness Management
Respiratory Failure and Mechanical Ventilation in Children
Pediatric Shock States and Hemodynamic Support
Neurological Emergencies and Neurocritical Care
Pediatric Sepsis and Infectious Disease Emergencies
Fluid, Electrolyte, and Metabolic Management
Trauma and Surgical Emergencies in Children
Sedation, Analgesia, and Pharmacology in Acute Care
Ethical and Legal Issues in Pediatric Acute Care
Family-Centered Care and Crisis Communication
Introduction
This comprehensive examination is designed to rigorously evaluate the advanced clinical knowledge, diagnostic
reasoning, and critical decision-making skills essential for certification as a Barkley Pediatric Acute Care Nurse
Practitioner (PNP-AC). The exam focuses on the specialized competencies required to manage acutely ill, critically
unstable, and injured infants, children, and adolescents in emergency departments, intensive care units, and
,inpatient acute care settings. Candidates will be challenged to integrate developmental physiology,
pathophysiological concepts, and evidence-based guidelines to manage complex pediatric emergencies and life-
threatening conditions. The multiple-choice and scenario-based questions emphasize real-world clinical
application, rapid prioritization, and the unique ethical and family-centered considerations inherent to acute
pediatric care.
SECTION ONE: QUESTIONS 1–100
1. A 4-year-old male is brought to the emergency department with a barking cough, inspiratory stridor, and
respiratory distress. He has a low-grade fever. On examination, you note suprasternal and subcostal
retractions. Which of the following is the most likely diagnosis?
A. Epiglottitis
B. Croup
C. Bacterial tracheitis
D. Foreign body aspiration
🟢B
🔴 RATIONALE: The patient has classic croup (laryngotracheobronchitis), characterized by a barking cough,
inspiratory stridor, and respiratory distress, often following a viral upper respiratory infection. Epiglottitis
,presents with high fever, drooling, and a muffled voice. Bacterial tracheitis presents with high fever and purulent
secretions. Foreign body aspiration typically presents with a sudden onset of choking and wheezing.
2. A 2-year-old female is admitted to the PICU with respiratory syncytial virus (RSV) bronchiolitis. She is on
high-flow nasal cannula (HFNC) with an FiO2 of 0.4. Her work of breathing is increasing, and her PaCO2 on a
capillary blood gas is 55 mmHg. Which of the following is the most appropriate next step in management?
A. Increase the FiO2 to 0.6.
B. Increase the HFNC flow rate.
C. Initiate non-invasive positive pressure ventilation (NIPPV).
D. Intubate and initiate mechanical ventilation.
🟢D
🔴 RATIONALE: The patient is showing signs of impending respiratory failure with increasing work of breathing
and hypercapnia (PaCO2 55 mmHg) despite HFNC. Intubation and mechanical ventilation are indicated when
non-invasive support is failing. Increasing FiO2 would address hypoxemia but not the hypercapnia. Increasing
HFNC flow may be attempted but the patient is already on HFNC and showing signs of deterioration. NIPPV
may be a bridge but intubation is the most definitive next step.
3. A 6-year-old male is admitted with sepsis secondary to pneumonia. He is on a norepinephrine infusion.
His mean arterial pressure (MAP) is 55 mmHg. Which of the following is the most appropriate initial fluid
, resuscitation strategy?
A. Administer a 10 mL/kg bolus of normal saline.
B. Administer a 20 mL/kg bolus of normal saline.
C. Administer a 5 mL/kg bolus of albumin.
D. Administer a 10 mL/kg bolus of packed red blood cells.
🟢B
🔴 RATIONALE: In pediatric septic shock, the initial fluid resuscitation is a 20 mL/kg bolus of isotonic crystalloid
(normal saline or lactated Ringer's). This can be repeated up to 60 mL/kg in the first hour. A 10 mL/kg bolus is
insufficient. Albumin is a second-line colloid and is not the initial fluid of choice. Packed red blood cells are
reserved for hemorrhagic shock or significant anemia.
4. A 10-year-old female is admitted with status epilepticus. She has received two doses of lorazepam and is
now on a continuous infusion of midazolam. Which of the following is the most appropriate next step if
seizures continue?
A. Increase the midazolam infusion rate.
B. Administer a loading dose of phenytoin.
C. Administer a loading dose of levetiracetam.
D. Initiate pentobarbital coma.
🟢B
