CPNP-AC Exam 2026/2027 | Questions with
Verified Answers & Detailed Rationales |
PNCB Acute Care Pediatric NP Certification |
A+ Graded
Section 1: Assessment (Questions 1-50)
Health History & Risk Evaluation
1. A CPNP-AC is obtaining a health history for a 4-year-old child with severe asthma.
Which factor is MOST important to assess when evaluating the child's health risks?
A) The family's religious affiliation
B) The child's immunization status
C) Environmental exposures including secondhand smoke and allergens
D) The parents' marital status
Correct Answer: C
Rationale: Environmental exposures such as secondhand smoke, dust mites, mold, and pet
dander are critical triggers for asthma exacerbations and directly impact disease
management. While immunization status and social factors are important, environmental
triggers are the most directly relevant to acute asthma risk assessment. The CPNP-AC
, must evaluate physiologic, psychosocial, and environmental risks as part of comprehensive
assessment .
2. A 7-year-old child is brought to the emergency department with a suspected
foreign body aspiration. Which assessment finding is MOST concerning?
A) Coughing and gagging
B) Stridor with diminished breath sounds on one side
C) Mild tachypnea
D) Wheezing throughout all lung fields
Correct Answer: B
Rationale: Unilateral diminished breath sounds with stridor suggest a foreign body lodged in
a mainstem bronchus, causing partial airway obstruction. This is a life-threatening
emergency requiring immediate bronchoscopy. Bilateral wheezing suggests a different
pathophysiology. Coughing and gagging may occur initially but do not indicate the severity
of obstruction .
3. The CPNP-AC is evaluating a 2-week-old neonate with poor feeding and lethargy.
Which finding would be MOST concerning for a life-threatening condition?
A) Temperature of 97.5°F (36.4°C)
B) Respiratory rate of 50 breaths/min
C) Bulging anterior fontanelle
, D) Heart rate of 140 bpm
Correct Answer: C
Rationale: A bulging fontanelle in a neonate indicates increased intracranial pressure, which
may result from meningitis, encephalitis, or hydrocephalus. This is a life-threatening
condition requiring immediate evaluation with CT imaging before lumbar puncture. The
other findings may be normal variants or less immediately dangerous .
4. A 10-year-old child with type 1 diabetes presents with abdominal pain, nausea, and
Kussmaul respirations. Which laboratory finding would be MOST consistent with
diabetic ketoacidosis (DKA)?
A) pH 7.45, HCO3 28, glucose 200
B) pH 7.25, HCO3 12, glucose 450
C) pH 7.35, HCO3 24, glucose 150
D) pH 7.50, HCO3 30, glucose 100
Correct Answer: B
Rationale: DKA is characterized by metabolic acidosis (pH <7.30), low bicarbonate (<18
mEq/L), and hyperglycemia (>250 mg/dL). The combination of pH 7.25, HCO3 12, and
glucose 450 is diagnostic. The other options represent normal or alkalotic states .
, 5. A 5-year-old child presents with a petechial rash, fever, and neck stiffness. Which
diagnostic test is the PRIORITY before initiating antibiotics?
A) Complete blood count
B) Blood culture
C) Lumbar puncture
D) CT scan of the head
Correct Answer: B
Rationale: Blood cultures should be obtained BEFORE initiating antibiotics to identify the
causative organism. While lumbar puncture is important for meningitis diagnosis, if the child
is unstable or has signs of increased ICP, it may be deferred. Blood cultures can be
obtained rapidly without delaying treatment .
6. A 3-month-old infant presents with fever, irritability, and a bulging fontanelle.
Which diagnostic procedure is CONTRAINDICATED before CT imaging?
A) Blood culture
B) Lumbar puncture
C) Complete blood count
D) Urinalysis
Correct Answer: B
Rationale: Lumbar puncture is contraindicated before CT imaging when there are signs of
increased intracranial pressure (bulging fontanelle) because of the risk of herniation. CT
should be performed first to rule out space-occupying lesions .
Verified Answers & Detailed Rationales |
PNCB Acute Care Pediatric NP Certification |
A+ Graded
Section 1: Assessment (Questions 1-50)
Health History & Risk Evaluation
1. A CPNP-AC is obtaining a health history for a 4-year-old child with severe asthma.
Which factor is MOST important to assess when evaluating the child's health risks?
A) The family's religious affiliation
B) The child's immunization status
C) Environmental exposures including secondhand smoke and allergens
D) The parents' marital status
Correct Answer: C
Rationale: Environmental exposures such as secondhand smoke, dust mites, mold, and pet
dander are critical triggers for asthma exacerbations and directly impact disease
management. While immunization status and social factors are important, environmental
triggers are the most directly relevant to acute asthma risk assessment. The CPNP-AC
, must evaluate physiologic, psychosocial, and environmental risks as part of comprehensive
assessment .
2. A 7-year-old child is brought to the emergency department with a suspected
foreign body aspiration. Which assessment finding is MOST concerning?
A) Coughing and gagging
B) Stridor with diminished breath sounds on one side
C) Mild tachypnea
D) Wheezing throughout all lung fields
Correct Answer: B
Rationale: Unilateral diminished breath sounds with stridor suggest a foreign body lodged in
a mainstem bronchus, causing partial airway obstruction. This is a life-threatening
emergency requiring immediate bronchoscopy. Bilateral wheezing suggests a different
pathophysiology. Coughing and gagging may occur initially but do not indicate the severity
of obstruction .
3. The CPNP-AC is evaluating a 2-week-old neonate with poor feeding and lethargy.
Which finding would be MOST concerning for a life-threatening condition?
A) Temperature of 97.5°F (36.4°C)
B) Respiratory rate of 50 breaths/min
C) Bulging anterior fontanelle
, D) Heart rate of 140 bpm
Correct Answer: C
Rationale: A bulging fontanelle in a neonate indicates increased intracranial pressure, which
may result from meningitis, encephalitis, or hydrocephalus. This is a life-threatening
condition requiring immediate evaluation with CT imaging before lumbar puncture. The
other findings may be normal variants or less immediately dangerous .
4. A 10-year-old child with type 1 diabetes presents with abdominal pain, nausea, and
Kussmaul respirations. Which laboratory finding would be MOST consistent with
diabetic ketoacidosis (DKA)?
A) pH 7.45, HCO3 28, glucose 200
B) pH 7.25, HCO3 12, glucose 450
C) pH 7.35, HCO3 24, glucose 150
D) pH 7.50, HCO3 30, glucose 100
Correct Answer: B
Rationale: DKA is characterized by metabolic acidosis (pH <7.30), low bicarbonate (<18
mEq/L), and hyperglycemia (>250 mg/dL). The combination of pH 7.25, HCO3 12, and
glucose 450 is diagnostic. The other options represent normal or alkalotic states .
, 5. A 5-year-old child presents with a petechial rash, fever, and neck stiffness. Which
diagnostic test is the PRIORITY before initiating antibiotics?
A) Complete blood count
B) Blood culture
C) Lumbar puncture
D) CT scan of the head
Correct Answer: B
Rationale: Blood cultures should be obtained BEFORE initiating antibiotics to identify the
causative organism. While lumbar puncture is important for meningitis diagnosis, if the child
is unstable or has signs of increased ICP, it may be deferred. Blood cultures can be
obtained rapidly without delaying treatment .
6. A 3-month-old infant presents with fever, irritability, and a bulging fontanelle.
Which diagnostic procedure is CONTRAINDICATED before CT imaging?
A) Blood culture
B) Lumbar puncture
C) Complete blood count
D) Urinalysis
Correct Answer: B
Rationale: Lumbar puncture is contraindicated before CT imaging when there are signs of
increased intracranial pressure (bulging fontanelle) because of the risk of herniation. CT
should be performed first to rule out space-occupying lesions .
