PEDIATRIC NURSING CERTIFICATION BOARD {PNCB}Acute
Care ACTUAL EXAM 2025-2026 LATEST VERSION WITH 180
QUESTIONS AND CORRECT ANSWERS GRADED WITH EXPERT
EXPLANATIONS A+ all you need to pass PNCB exam
A 13-month-old female with a history of developmental delay and hypotonia presents with new
onset seizures, with the following measurements obtained during assessment: weight 18.7 lb (8.5
kg), length 28.3 inches (72 cm) - both in 25 %ile for age , head circumference 14.75 inches (40 cm).
Her head circumference is below the 2 %ile
After achieving control of seizures, which diagnostic testing should be performed FIRST?
A. Brain MRI
B. Head CT
C. Skeletal survey
D. Skull series - CORRECT ANSWER-A. Brain MRI
Imaging by MRI for microcephaly provides more structural information than CT without the radiation
exposure, and identifies abnormalities including lissencephaly, pachygyria, and polymicrogyria. CT is
most useful in evaluating for presence of calcifications, which are associated with congenital viral
infections, Sturge-Weber syndrome, tuberous sclerosis, and intracranial lipoma in newborns, and
with some vascular and neoplastic conditions in older children.
A toddler's complete blood count (CBC) reveals the following results: WBC 11, RBC 33, Hct 28%, Hgb
9, MCV 60, Plt 200, RDW 18%, Reticulocytes <0.1
Which type of anemia is the MOST likely?
A. Aplastic anemia
B. Diamond-Blackfan anemia
C. Glucose-6-phosphate dehydrogenase (G6PD) deficiency
D. Iron-deficiency anemia - CORRECT ANSWER-D. Iron-deficiency anemia
In a toddler, anemia is defined as a hemoglobin <12.0 g/dl. Types of anemia are classified and
diagnosed by reticulocyte count and size of red blood cells (microcytic, normocytic, and macrocytic).
Iron-deficiency anemia is defined as microcytic anemia with a low reticulocyte count and an elevated
red cell distribution width.
Diamond-Blackfan anemia is a rare congenital form of hypoplastic anemia. It causes constitutional
bone marrow suppression with resultant severe normochromic macrocytic anemia, leukopenia, and
thrombocytopenia.
,Aplastic anemia is a life-threatening disease of bone marrow failure with CBC revealing
pancytopenia.
Glucose-6-phosphate dehydrogenase (G6PD) deficiency is a hemolytic anemia, characterized by
severe anemia (hemoglobin less than 2.5), leukocytosis, reticulocyte count greater than 30%, and
large red cell distribution width (RDW).
Within 2-3 days of initiating parenteral nutrition, which of the following laboratory assessments
should be monitored to direct adjustment of the formulation?
A. Complete blood count
B. Prealbumin
C. Trace elements
D. Triglycerides - CORRECT ANSWER-D. Triglycerides
The following levels should be monitored and adjusted in the PN formulation as indicated:
electrolytes and glucose should be checked daily until stable, BUN, creatinine, magnesium, calcium,
and phosphorus should be checked twice a week, albumin, prealbumin, hepatic function, and CBC
should be monitored weekly, triglycerides should be checked each time fat content is increased in
the parenteral nutrition
Triglyceride level can increase rapidly in the first several days after initiation of parenteral nutrition,
therefore, a level should be checked 48-72 hours after initiation and the formulation of parenteral
nutrition should be adjusted if the level is too high. Prealbumin, height, and weight are all important
indicators of adequate nutritional status when on parenteral nutrition; however, changes in these
parameters is slower to occur and would not warrant immediate change in formulation 2-3 days
after initiation.
A toddler presents with a cough and fever greater than 102° F (38.8° C) for 3 days. On physical exam,
decreased breath sounds and intermittent rales are auscultated over the left lower lobe. The MOST
likely diagnosis is:
A. Foreign body aspiration
B. Laryngotracheobronchitis
C. Pneumonia
D. Tracheitis - CORRECT ANSWER-C. Pneumonia
Fever & cough are the most common presenting symptoms of pneumonia. Physical exam findings
include tachypnea, hypoxia, rales (crackles), rhonchi, retractions, and nasal flaring.
Laryngotracheobronchitis (or croup) typically presents with hoarseness, a barking cough, and stridor
and is almost always viral in origin. Lower airway adventitious breath sounds are not typically noted
as this disease occurs in the upper airway.
,Foreign body aspiration may or may not present with a known history of the toddler having
swallowed something. Clinical symptoms are often non-specific with foreign body aspiration. In
smaller children, left-sided aspirations are more common than right-sided due to the bronchial
anatomy, which may cause decreased or absent breath sounds over the left lung.
Tracheitis is typically bacterial in origin, so a high fever may be noted; however, it otherwise
presents with upper airway symptoms such as copious secretions, stridor, and respiratory distress.
As with laryngotracheobronchitis, lower airway adventitious breath sounds are not typically noted as
tracheitis affects the upper airway.
A one month old who presents with severe hypotonia, feeding difficulties, hypogonadism, and
abnormally small hands and feet is determined to be at risk for failure to thrive.
The MOST likely underlying diagnosis is:
A. Fetal alcohol syndrome
B. Fragile X syndrome
C. Noonan syndrome
D. Prader-Willi syndrome - CORRECT ANSWER-D. Prader-Willi syndrome
Findings of Prader-Willi syndrome includes severe hypotonia, feeding difficulties (which causes risk
of FTT), intellectual delays, hypogonadism, abnormally small hands and feet, & dysmorphic features.
Later, children develop hyperphagia and are at risk for morbid obesity.
Noonan syndrome is characterized by short stature, developmental delay, and cardiac defects with
the latter being the most detrimental, usually requiring surgical intervention. Fragile X syndrome is
the most common inherited form of intellectual disability
Fetal alcohol syndrome also causes developmental delay & growth retardation.
None of these other syndromes are as highly associated with FTT, especially in infancy, as Prader-
Willi syndrome.
An infant receiving long term parenteral nutrition for a significant bowel resection is MOST at risk for
which complication?
A. Acute renal failure
B. Cholestatic liver disease
C. Dehydration
D. Refeeding syndrome - CORRECT ANSWER-B. Cholestatic liver disease
Cholestasis is a common complication of parenteral nutrition. Decreased enteral intake leads to
decreased stimulation and emptying of the gallbladder, causing an accumulation of substances in
the hepatocytes and bile ducts that are normally excreted in bile (e.g., bile acids, bile salts, and
cholesterol). Cholestasis is characterized by conjugated hyperbilirubinemia and jaundice. It can lead
to fibrosis and may result in liver failure.
, With the correct calculation of maintenance fluid needs, proper ordering of PN should not lead to
dehydration. Refeeding syndrome is a risk with the reinitiation of parenteral or enteral nutrition in a
child who is malnourished. It is characterized by electrolyte disturbances and fluid overload. Gradual
advancement of caloric intake from carbohydrate, and close monitoring of electrolytes with
repletion as needed, helps prevent refeeding syndrome.
An echocardiogram for a child who underwent patch closure of a ventricular septal defect (VSD)
demonstrates a small residual VSD patch leak. Which of the following statements is the MOST
appropriate education for the child and caregivers regarding this finding?
A. "To reduce the risk of infective endocarditis, antibiotics need to be taken prior to dental care"
B. "To reduce the risk of sudden cardiac death, participation in competitive sports is restricted"
C. "A cardiac catheterization is needed to determine if the residual defect is significant"
D. "Cardiac surgery needs to be scheduled to close the residual defect" - CORRECT ANSWER-A. "To
reduce the risk of infective endocarditis, antibiotics need to be taken prior to dental care"
Over time, the majority of residual defects close spontaneously as endothelialization occurs around
the patch. However, the one requirement for residual VSDs is that all patients with "repaired
congenital heart disease (CHD) with residual defects at the site or adjacent to the site of a prosthetic
patch or prosthetic device" should receive antibiotic prophylaxis prior to any dental procedure due
to the risk of infective endocarditis.
Further intervention or invasive assessment such as a cardiac catheterization is not required as long
as the residual defect is small, there is no hemodynamic significance, and there is no threat or harm
to the patient.
Repaired or unrepaired VSDs are not commonly associated with sudden death during sports. At 3 to
6 months after repair, asymptomatic athletes with no or a small residual defect and no evidence of
pulmonary hypertension, ventricular or atrial tachyarrhythmia, or myocardial dysfunction can
participate in all competitive sports.
A child has recently undergone nephrectomy for resection of a Wilms tumor. Education for the
family should be related to which NEXT expected treatment?
A. Biologic therapy
B. Chemotherapy
C. Immunotherapy
D. Radiation therapy - CORRECT ANSWER-B. Chemotherapy
Chemotherapy is always used in the treatment of a Wilms tumor.
In pediatrics, radiation therapy is primarily used in the treatment of solid tumors. For Wilms tumors
stages 3-5, radiation may be indicated in addition to resection and chemotherapy, but it is not
always part of the treatment for stages 1-2.
Care ACTUAL EXAM 2025-2026 LATEST VERSION WITH 180
QUESTIONS AND CORRECT ANSWERS GRADED WITH EXPERT
EXPLANATIONS A+ all you need to pass PNCB exam
A 13-month-old female with a history of developmental delay and hypotonia presents with new
onset seizures, with the following measurements obtained during assessment: weight 18.7 lb (8.5
kg), length 28.3 inches (72 cm) - both in 25 %ile for age , head circumference 14.75 inches (40 cm).
Her head circumference is below the 2 %ile
After achieving control of seizures, which diagnostic testing should be performed FIRST?
A. Brain MRI
B. Head CT
C. Skeletal survey
D. Skull series - CORRECT ANSWER-A. Brain MRI
Imaging by MRI for microcephaly provides more structural information than CT without the radiation
exposure, and identifies abnormalities including lissencephaly, pachygyria, and polymicrogyria. CT is
most useful in evaluating for presence of calcifications, which are associated with congenital viral
infections, Sturge-Weber syndrome, tuberous sclerosis, and intracranial lipoma in newborns, and
with some vascular and neoplastic conditions in older children.
A toddler's complete blood count (CBC) reveals the following results: WBC 11, RBC 33, Hct 28%, Hgb
9, MCV 60, Plt 200, RDW 18%, Reticulocytes <0.1
Which type of anemia is the MOST likely?
A. Aplastic anemia
B. Diamond-Blackfan anemia
C. Glucose-6-phosphate dehydrogenase (G6PD) deficiency
D. Iron-deficiency anemia - CORRECT ANSWER-D. Iron-deficiency anemia
In a toddler, anemia is defined as a hemoglobin <12.0 g/dl. Types of anemia are classified and
diagnosed by reticulocyte count and size of red blood cells (microcytic, normocytic, and macrocytic).
Iron-deficiency anemia is defined as microcytic anemia with a low reticulocyte count and an elevated
red cell distribution width.
Diamond-Blackfan anemia is a rare congenital form of hypoplastic anemia. It causes constitutional
bone marrow suppression with resultant severe normochromic macrocytic anemia, leukopenia, and
thrombocytopenia.
,Aplastic anemia is a life-threatening disease of bone marrow failure with CBC revealing
pancytopenia.
Glucose-6-phosphate dehydrogenase (G6PD) deficiency is a hemolytic anemia, characterized by
severe anemia (hemoglobin less than 2.5), leukocytosis, reticulocyte count greater than 30%, and
large red cell distribution width (RDW).
Within 2-3 days of initiating parenteral nutrition, which of the following laboratory assessments
should be monitored to direct adjustment of the formulation?
A. Complete blood count
B. Prealbumin
C. Trace elements
D. Triglycerides - CORRECT ANSWER-D. Triglycerides
The following levels should be monitored and adjusted in the PN formulation as indicated:
electrolytes and glucose should be checked daily until stable, BUN, creatinine, magnesium, calcium,
and phosphorus should be checked twice a week, albumin, prealbumin, hepatic function, and CBC
should be monitored weekly, triglycerides should be checked each time fat content is increased in
the parenteral nutrition
Triglyceride level can increase rapidly in the first several days after initiation of parenteral nutrition,
therefore, a level should be checked 48-72 hours after initiation and the formulation of parenteral
nutrition should be adjusted if the level is too high. Prealbumin, height, and weight are all important
indicators of adequate nutritional status when on parenteral nutrition; however, changes in these
parameters is slower to occur and would not warrant immediate change in formulation 2-3 days
after initiation.
A toddler presents with a cough and fever greater than 102° F (38.8° C) for 3 days. On physical exam,
decreased breath sounds and intermittent rales are auscultated over the left lower lobe. The MOST
likely diagnosis is:
A. Foreign body aspiration
B. Laryngotracheobronchitis
C. Pneumonia
D. Tracheitis - CORRECT ANSWER-C. Pneumonia
Fever & cough are the most common presenting symptoms of pneumonia. Physical exam findings
include tachypnea, hypoxia, rales (crackles), rhonchi, retractions, and nasal flaring.
Laryngotracheobronchitis (or croup) typically presents with hoarseness, a barking cough, and stridor
and is almost always viral in origin. Lower airway adventitious breath sounds are not typically noted
as this disease occurs in the upper airway.
,Foreign body aspiration may or may not present with a known history of the toddler having
swallowed something. Clinical symptoms are often non-specific with foreign body aspiration. In
smaller children, left-sided aspirations are more common than right-sided due to the bronchial
anatomy, which may cause decreased or absent breath sounds over the left lung.
Tracheitis is typically bacterial in origin, so a high fever may be noted; however, it otherwise
presents with upper airway symptoms such as copious secretions, stridor, and respiratory distress.
As with laryngotracheobronchitis, lower airway adventitious breath sounds are not typically noted as
tracheitis affects the upper airway.
A one month old who presents with severe hypotonia, feeding difficulties, hypogonadism, and
abnormally small hands and feet is determined to be at risk for failure to thrive.
The MOST likely underlying diagnosis is:
A. Fetal alcohol syndrome
B. Fragile X syndrome
C. Noonan syndrome
D. Prader-Willi syndrome - CORRECT ANSWER-D. Prader-Willi syndrome
Findings of Prader-Willi syndrome includes severe hypotonia, feeding difficulties (which causes risk
of FTT), intellectual delays, hypogonadism, abnormally small hands and feet, & dysmorphic features.
Later, children develop hyperphagia and are at risk for morbid obesity.
Noonan syndrome is characterized by short stature, developmental delay, and cardiac defects with
the latter being the most detrimental, usually requiring surgical intervention. Fragile X syndrome is
the most common inherited form of intellectual disability
Fetal alcohol syndrome also causes developmental delay & growth retardation.
None of these other syndromes are as highly associated with FTT, especially in infancy, as Prader-
Willi syndrome.
An infant receiving long term parenteral nutrition for a significant bowel resection is MOST at risk for
which complication?
A. Acute renal failure
B. Cholestatic liver disease
C. Dehydration
D. Refeeding syndrome - CORRECT ANSWER-B. Cholestatic liver disease
Cholestasis is a common complication of parenteral nutrition. Decreased enteral intake leads to
decreased stimulation and emptying of the gallbladder, causing an accumulation of substances in
the hepatocytes and bile ducts that are normally excreted in bile (e.g., bile acids, bile salts, and
cholesterol). Cholestasis is characterized by conjugated hyperbilirubinemia and jaundice. It can lead
to fibrosis and may result in liver failure.
, With the correct calculation of maintenance fluid needs, proper ordering of PN should not lead to
dehydration. Refeeding syndrome is a risk with the reinitiation of parenteral or enteral nutrition in a
child who is malnourished. It is characterized by electrolyte disturbances and fluid overload. Gradual
advancement of caloric intake from carbohydrate, and close monitoring of electrolytes with
repletion as needed, helps prevent refeeding syndrome.
An echocardiogram for a child who underwent patch closure of a ventricular septal defect (VSD)
demonstrates a small residual VSD patch leak. Which of the following statements is the MOST
appropriate education for the child and caregivers regarding this finding?
A. "To reduce the risk of infective endocarditis, antibiotics need to be taken prior to dental care"
B. "To reduce the risk of sudden cardiac death, participation in competitive sports is restricted"
C. "A cardiac catheterization is needed to determine if the residual defect is significant"
D. "Cardiac surgery needs to be scheduled to close the residual defect" - CORRECT ANSWER-A. "To
reduce the risk of infective endocarditis, antibiotics need to be taken prior to dental care"
Over time, the majority of residual defects close spontaneously as endothelialization occurs around
the patch. However, the one requirement for residual VSDs is that all patients with "repaired
congenital heart disease (CHD) with residual defects at the site or adjacent to the site of a prosthetic
patch or prosthetic device" should receive antibiotic prophylaxis prior to any dental procedure due
to the risk of infective endocarditis.
Further intervention or invasive assessment such as a cardiac catheterization is not required as long
as the residual defect is small, there is no hemodynamic significance, and there is no threat or harm
to the patient.
Repaired or unrepaired VSDs are not commonly associated with sudden death during sports. At 3 to
6 months after repair, asymptomatic athletes with no or a small residual defect and no evidence of
pulmonary hypertension, ventricular or atrial tachyarrhythmia, or myocardial dysfunction can
participate in all competitive sports.
A child has recently undergone nephrectomy for resection of a Wilms tumor. Education for the
family should be related to which NEXT expected treatment?
A. Biologic therapy
B. Chemotherapy
C. Immunotherapy
D. Radiation therapy - CORRECT ANSWER-B. Chemotherapy
Chemotherapy is always used in the treatment of a Wilms tumor.
In pediatrics, radiation therapy is primarily used in the treatment of solid tumors. For Wilms tumors
stages 3-5, radiation may be indicated in addition to resection and chemotherapy, but it is not
always part of the treatment for stages 1-2.
