ACUTE CARE PNCB UPDATED ACTUAL
QUESTIONS AND CORRECT ANSWERS
EXAM SCRIPT
●● A child with a history of congenital heart disease fell while playing
and presents with a closed fracture of the humerus. Physical exam
reveals mild bradycardia and a moderate pain score.
Which of the following medications would MOST likely explain this
child's bradycardia?
A. Enalapril (Vasotec)
B. Furosemide (Lasix)
C. Levothyroxine (Synthroid)
D. Propranolol (Inderal)
Answer: D. Propranolol (Inderal)
(Decreases heart rate, myocardial contractility, blood pressure, and
myocardial oxygen demand. Adverse effects include bradycardia,
hypotension, and atrioventricular conduction disturbances)
●● Enteral nutrition is initiated in a child with severe malnutrition.
Laboratory values indicative of refeeding syndrome include a
magnesium level of 1.5 mg/dL, and:
A. Phosphate 3.0 ml/dL & potassium 2.8 mEq/L
,B. Phosphate 3.0 ml/dL & potassium 6 mEq/L
C. Phosphate 7.0 ml/dL & potassium 2.8 mEq/L
D. Phosphate 7.0 ml/dL & potassium 6 mEq/L
Answer: A. Phosphate 3.0 ml/dL & potassium 2.8 mEq/L
(Refeeding syndrome occurs when malnourished patients are refed too
aggressively leading. It can occur within 1-3 days after reinstitution of
nutrition.
The major manifestations include fluid overload, hypophosphatemia
(phosphate less than 3.5 mg/dL), hypokalemia (potassium less than 3.5
mEq/L), hypomagnesemia (magnesium less than 1.8 mg/dL), and
thiamine deficiency. Complications include heart failure, dysrhythmias,
respiratory muscle weakness, seizures,
●● When informing a family that a report is being made to Child
Protective Services for suspected abuse, it is MOST important to
A. Focus on the child's well being
B. Identify the suspected perpetrator
C. Identify legal requirements for mandatory reporting
D. Share details with family to avoid misunderstanding
Answer: A. Focus on the child's well being
●● Manifestations of abdominal injuries secondary to a blast mechanism
are typically:
,A. Acute & immediately apparent
B. Observed less than 6 hours after exposure
C. Delayed 8-36 hours after exposure
D. Chronic & slow to develop
Answer: C. Delayed 8-36 hours after exposure
(Blast attack, as seen in explosions, causes extensive compression and
distortion of the gastrointestinal (GI) tract & other air-filled organs.
Manifestations generally delayed, presenting 8-36 hours after exposure.)
●● A previously healthy preschooler who is fully immunized, presents
with a history of fever, URI symptoms, & joint pain over the past several
days. Physical exam reveals petechiae and hepatosplenomegaly. Vital
signs include HR 156, RR 32, temp 101.6 (38.7), BP 86/44 & O2 98%
on RA. Lab results include Na+ 132, K+ 6, Glucose 100, Ca+ 0.95, Phos
6.3, WBC 105,000, Hgb 6.1 & Plt 10,000. Which is the BEST course of
action?
A. Obtain LFTS & type & cross for blood products
B. Administer calcium gluconate & consult nephrology
C. Obtain blood cultures & administer IV Ceftriaxone
D. Administer a fluid bolus & consult oncology
Answer: D. Administer a fluid bolus & consult oncology
, (The combination of leukocytosis, thrombocytopenia, and anemia should
raise red flags for an oncologic process, most likely leukemia. After
initial laboratory values are obtained, the child should receive aggressive
hydration.)
●● An adolescent presents with bilateral knee pain that has occurred for
several months, exacerbated with activities such as climbing stairs and
running. Pain is also worsened by sitting with the knees flexed for an
extended time and is described as a grinding sensation under the
kneecaps. No joint swelling is noted on examination. The MOST likely
diagnosis is:
A. Osgood-Schlatter disease
B. Osteochondritis dissecans
C. Patellofemoral pain syndrome
D. Popliteal cyst (Baker's cyst)
Answer: C. Patellofemoral pain syndrome
(Type of idiopathic anterior knee pain, common in adolescents. This type
of knee pain worsens with activity, especially going up and down stairs,
and when sitting in one position for a prolonged period of time.
Treatment involves an exercise program focusing on hip girdle and
vastus medialis strengthening with lower extremity flexibility)
●● A toddler presents with vomiting and altered mental status after an
ingestion of a large amount of aspirin about 45 minutes ago. Prior to the
administration of activated charcoal, the PRIORITY is to:
QUESTIONS AND CORRECT ANSWERS
EXAM SCRIPT
●● A child with a history of congenital heart disease fell while playing
and presents with a closed fracture of the humerus. Physical exam
reveals mild bradycardia and a moderate pain score.
Which of the following medications would MOST likely explain this
child's bradycardia?
A. Enalapril (Vasotec)
B. Furosemide (Lasix)
C. Levothyroxine (Synthroid)
D. Propranolol (Inderal)
Answer: D. Propranolol (Inderal)
(Decreases heart rate, myocardial contractility, blood pressure, and
myocardial oxygen demand. Adverse effects include bradycardia,
hypotension, and atrioventricular conduction disturbances)
●● Enteral nutrition is initiated in a child with severe malnutrition.
Laboratory values indicative of refeeding syndrome include a
magnesium level of 1.5 mg/dL, and:
A. Phosphate 3.0 ml/dL & potassium 2.8 mEq/L
,B. Phosphate 3.0 ml/dL & potassium 6 mEq/L
C. Phosphate 7.0 ml/dL & potassium 2.8 mEq/L
D. Phosphate 7.0 ml/dL & potassium 6 mEq/L
Answer: A. Phosphate 3.0 ml/dL & potassium 2.8 mEq/L
(Refeeding syndrome occurs when malnourished patients are refed too
aggressively leading. It can occur within 1-3 days after reinstitution of
nutrition.
The major manifestations include fluid overload, hypophosphatemia
(phosphate less than 3.5 mg/dL), hypokalemia (potassium less than 3.5
mEq/L), hypomagnesemia (magnesium less than 1.8 mg/dL), and
thiamine deficiency. Complications include heart failure, dysrhythmias,
respiratory muscle weakness, seizures,
●● When informing a family that a report is being made to Child
Protective Services for suspected abuse, it is MOST important to
A. Focus on the child's well being
B. Identify the suspected perpetrator
C. Identify legal requirements for mandatory reporting
D. Share details with family to avoid misunderstanding
Answer: A. Focus on the child's well being
●● Manifestations of abdominal injuries secondary to a blast mechanism
are typically:
,A. Acute & immediately apparent
B. Observed less than 6 hours after exposure
C. Delayed 8-36 hours after exposure
D. Chronic & slow to develop
Answer: C. Delayed 8-36 hours after exposure
(Blast attack, as seen in explosions, causes extensive compression and
distortion of the gastrointestinal (GI) tract & other air-filled organs.
Manifestations generally delayed, presenting 8-36 hours after exposure.)
●● A previously healthy preschooler who is fully immunized, presents
with a history of fever, URI symptoms, & joint pain over the past several
days. Physical exam reveals petechiae and hepatosplenomegaly. Vital
signs include HR 156, RR 32, temp 101.6 (38.7), BP 86/44 & O2 98%
on RA. Lab results include Na+ 132, K+ 6, Glucose 100, Ca+ 0.95, Phos
6.3, WBC 105,000, Hgb 6.1 & Plt 10,000. Which is the BEST course of
action?
A. Obtain LFTS & type & cross for blood products
B. Administer calcium gluconate & consult nephrology
C. Obtain blood cultures & administer IV Ceftriaxone
D. Administer a fluid bolus & consult oncology
Answer: D. Administer a fluid bolus & consult oncology
, (The combination of leukocytosis, thrombocytopenia, and anemia should
raise red flags for an oncologic process, most likely leukemia. After
initial laboratory values are obtained, the child should receive aggressive
hydration.)
●● An adolescent presents with bilateral knee pain that has occurred for
several months, exacerbated with activities such as climbing stairs and
running. Pain is also worsened by sitting with the knees flexed for an
extended time and is described as a grinding sensation under the
kneecaps. No joint swelling is noted on examination. The MOST likely
diagnosis is:
A. Osgood-Schlatter disease
B. Osteochondritis dissecans
C. Patellofemoral pain syndrome
D. Popliteal cyst (Baker's cyst)
Answer: C. Patellofemoral pain syndrome
(Type of idiopathic anterior knee pain, common in adolescents. This type
of knee pain worsens with activity, especially going up and down stairs,
and when sitting in one position for a prolonged period of time.
Treatment involves an exercise program focusing on hip girdle and
vastus medialis strengthening with lower extremity flexibility)
●● A toddler presents with vomiting and altered mental status after an
ingestion of a large amount of aspirin about 45 minutes ago. Prior to the
administration of activated charcoal, the PRIORITY is to:
