PNCB Acute Care questions
PNCB Acute Care Exam Questions &
Answers Latest
Question 1
In a child with myasthenia gravis, which of the following symptoms would be MOST
indicative of a myasthenic crisis?
A. Eye drooling
B. Respiratory distress
C. Excessive salivation
D. Muscle fasciculation
Correct Answer
B. Respiratory distress
(Characterized by weakness and fatigue of skeletal muscle tissue that results from
autoimmune destruction of acetylcholine receptors (AchR). A crisis event, or
myasthenic crisis, is an acute exacerbation of the disease process that results in
severe weakness from dysfunction of the neuromuscular junctions. It is
characterized by respiratory failure due to weakness of the airway or respiratory
muscles.
A cholinergic crisis, is a severe weakness caused by overtreatment with cholinergic
medications used to treat MG & crisis present with excessive salivation, excessive
lacrimation, diarrhea, sweating, pupillary constriction, and muscle fasciculation.
Page 1 of 128
, PNCB Acute Care questions
Question 2
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)
Correct Answer
D. Propranolol (Inderal)
(Decreases heart rate, myocardial contractility, blood pressure, and myocardial
oxygen demand. Adverse effects include bradycardia, hypotension, and
atrioventricular conduction disturbances)
Question 3
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
Correct 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,
Page 2 of 128
, PNCB Acute Care questions
Question 4
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
Correct Answer
A. Focus on the child's well being
Question 5
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
Correct 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.)
Page 3 of 128
, PNCB Acute Care questions
Question 6
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
Correct 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.)
Question 7
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)
Correct 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)
Page 4 of 128
PNCB Acute Care Exam Questions &
Answers Latest
Question 1
In a child with myasthenia gravis, which of the following symptoms would be MOST
indicative of a myasthenic crisis?
A. Eye drooling
B. Respiratory distress
C. Excessive salivation
D. Muscle fasciculation
Correct Answer
B. Respiratory distress
(Characterized by weakness and fatigue of skeletal muscle tissue that results from
autoimmune destruction of acetylcholine receptors (AchR). A crisis event, or
myasthenic crisis, is an acute exacerbation of the disease process that results in
severe weakness from dysfunction of the neuromuscular junctions. It is
characterized by respiratory failure due to weakness of the airway or respiratory
muscles.
A cholinergic crisis, is a severe weakness caused by overtreatment with cholinergic
medications used to treat MG & crisis present with excessive salivation, excessive
lacrimation, diarrhea, sweating, pupillary constriction, and muscle fasciculation.
Page 1 of 128
, PNCB Acute Care questions
Question 2
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)
Correct Answer
D. Propranolol (Inderal)
(Decreases heart rate, myocardial contractility, blood pressure, and myocardial
oxygen demand. Adverse effects include bradycardia, hypotension, and
atrioventricular conduction disturbances)
Question 3
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
Correct 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,
Page 2 of 128
, PNCB Acute Care questions
Question 4
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
Correct Answer
A. Focus on the child's well being
Question 5
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
Correct 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.)
Page 3 of 128
, PNCB Acute Care questions
Question 6
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
Correct 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.)
Question 7
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)
Correct 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)
Page 4 of 128
