PNCB Acute Care Practice Exam
PNCB Acute Care Practice/ pediatrics nurse
Predictor Exam (New)REAL Final Exam
2025/2026 Complete All Verified Questions
And Correct Detailed Answers (Rationales)
|Already Graded A+||Brand New Updated
Version
M
For the past 4 days, a previously healthy infant has had a fever and upper respiratory symptoms. Vital
ED
signs and laboratory values are provided in tables below. Which of the following interventions is the
PRIORITY?
T 38.7
HR 156
RR 32
BP 86/44
ST
SpO2 92%
Sodium 132, K 4.5, Glu 100, WBC 130,000, Hgb 6.1, Plt 10,000
A. administer a fluid bolus and consult oncology
B. obtain blood cultures and administer IV ceftriaxone
U
C. administer IV ceftriaxone and obtain type and cross
D. assess BUN and creatinine levels and obtain type and cross
D
A. administer a fluid bolus and consult oncology
The combination of hyperleukocytosis, thrombocytopenia, and anemia should raise red flags for
Y
leukemia. It is imperative to involve the oncology service early in the treatment plan. The management
goal for symptomatic hyperleukocytosis is the rapid lowering of the white cell count, which can be
achieved through cytoreduction with induction chemotherapy, leukapheresis, exchange transfusion,
and hydroxyurea, although the latter is usually reserved for patients who cannot receive immediate
induction chemotherapy.
An adolescent who is 1-week status-post spinal surgery is evaluated for intermittent episodes of
feeling "out of breath" and midsternal pain during mild exertion. Which of the following studies should
be ordered?
A. antithrombin (AT), protein C (PC), protein S (PS), and Factor V Leiden (FVL)
B. complete blood count, AT, PC, and pulmonary function testing (PFT)
A+ TEST BANK 1
, PNCB Acute Care Practice Exam
C. complete blood count with D-dimer, PT/PTT, and troponin D. homocysteine levels, creatinine,
troponin, and D-dimer
C. complete blood count with D-dimer, PT/PTT, and troponin
Most children diagnosed with pediatric pulmonary embolism or venous thromboembolism have had
recent surgery or have underlying comorbidities such as congenital heart disease or systemic lupus.
Pulmonary embolism frequently presents as shortness of breath or chest pain. In a hemodynamically
stable child, initial laboratory evaluation consists of a complete blood count, PT, PTT, D-dimer, BUN,
Creatinine, BMP, and troponin.
A 2 month old with an infantile hemangioma around the left eye is being evaluated for propranolol
therapy. Which of the following findings would be considered a potential CONTRAINDICATION?
M
A. prematurity B. hypertension C. sinus bradycardia D. family history of diabetes
C. sinus bradycardia
ED
Propranolol is a beta-adrenergic blocker used to treat infantile hemangioma (IH). Previously used as an
off-label therapy, propranolol is FDA-approved for the treatment of proliferating IH in infants at least 5
weeks of age who weigh over two kilograms. The exact mechanism of action for propranolol on IH is
not well understood, but hypothesized mechanisms include vasoconstriction, decreased renin
production, inhibition of angiogenesis, and stimulation of apoptosis. Propranolol has negative
ST
chronotropic and inotropic cardiac effects, resulting in decreased heart rate and blood pressure. Due
to the negative chronotropic effects, children with documented bradycardia are not candidates for
treatment with propranolol.
When preforming a procedure, such as central line insertion, which of the following strategies is MOST
U
effective for promoting safe team communication?
A. confirming steps against a checklist
B. assigning team member roles
D
C. reviewing signed consent
D. using team time outs
D. using team time outs
Y
An infant with unrepaired tetralogy of Fallot is admitted for emesis. Urgent surgical intervention is
warranted for which of the following findings?
A. feeding intolerance
B. hypercyanotic spells
C. polycythemia
D. tachycardia
B. hypercyanotic spells
ToF components
A+ TEST BANK 2
, PNCB Acute Care Practice Exam
VSD
RVOT obstruction
RVH
overriding aorta
Following spinal fusion surgery for scoliosis, an adolescent develops mid-abdominal pain and bilious
emesis. Nonpharmacological therapy to alleviate symptoms includes placing in which of the following
positions?
A. supine or dorsal recumbent
B. prone or knee-chest
C. Trendelenburg's
D. Fowler's
M
B. prone or knee-chest
SMA syndrome
Management of this condition targets relieving the obstruction and maintaining adequate nutrition
ED
and hydration. Symptom relief often occurs by placing the individual in prone, left side-lying, or knee-
chest positioning, which shifts the duodenum away from the SMA and aorta that are causing
obstruction.
SMA syndrome populations commonly seen
post spinal fusion
ST
anorexia nervosa
SMA syndrome definition/pathology
angle between aorta and SMA is decreased, compressing duodenum which is between the two
U
SMA syndrome symptoms
anorexia
D
mid-abdominal pain
bilious emesis
A toddler weighing 15 kg has a tracheostomy and is mechanically ventilated with current ventilator
Y
settings provided below. Assessment reveals moderate retractions, nasal flaring, and hypoxia, with
breath sounds absent in the right lower lobe and rhonchi noted in all other lobes. Ventilator reading
indicates breath volumes of 60 mL. Which of the following actions is the PRIORITY?
A. order a blood gas B. replace the tracheostomy
C. obtain a chest radiograph D. suction the tracheostomy
D. suction the tracheostomy
For the child in the presented scenario, airway patency is the highest priority assessment, confirmed
with breath sounds auscultated in most lobes of the lungs. The absence of breath sounds in one area
of the chest is concerning for obstruction, likely from mucus. Suctioning to attempt removal of the
obstruction is the best initial intervention in addressing this child's respiratory distress. While a chest
A+ TEST BANK 3
, PNCB Acute Care Practice Exam
radiograph may confirm an obstruction preventing aeration in the lobe, it may not be immediately
available. The blood gas may show impaired oxygenation and ventilation but will not treat the cause of
the respiratory distress.
An infant presents after a choking episode during a feeding, followed by cyanosis and a brief period of
hypotonia. One month ago, a previous evaluation following a similar episode revealed laryngomalacia
and reflux, for which a proton-pump inhibitor was prescribed. On physical examination, the infant is
alert with mild stertorous breath sounds. A videofluoroscopic swallowing study (VFSS) demonstrates
intermittent tracheal narrowing and a posterior, pulsatile indentation of the esophagus. Which
differential diagnosis is MOST likely?
A. brief resolved unexplained event (BRUE)
B. esophageal stricture
C. tracheoesophageal fistula
M
D. vascular ring
D. vascular ring
ED
Vascular ring definition
congenital structural/positional abnormalities of aortic arch
malformed vessels encircle/impinge upon trachea or esophagus
signs/symptoms vascular ring
ST
stridor
noisy breathing/wheezing
coughing, choking, color change with feeding
diagnostic tests- vascular ring
U
bronchoscopy or barium esophagogram
can be seen on CXR but is not diagnostic
D
key finding in bronchoscopy for vascular ring diagnosis
pulsatility of affected area in dynamic study
Y
A critically ill adolescent receiving a propofol infusion develops refractory bradycardia. Which of the
following additional clinical findings completes the diagnostic criteria for propofol infusion syndrome?
A. metabolic acidosis
B. worsening coagulopathy
C. new onset seizure activity
D. abrupt onset of hyperthermia
A. metabolic acidosis
signs of propofol infusion syndrome
A+ TEST BANK 4
PNCB Acute Care Practice/ pediatrics nurse
Predictor Exam (New)REAL Final Exam
2025/2026 Complete All Verified Questions
And Correct Detailed Answers (Rationales)
|Already Graded A+||Brand New Updated
Version
M
For the past 4 days, a previously healthy infant has had a fever and upper respiratory symptoms. Vital
ED
signs and laboratory values are provided in tables below. Which of the following interventions is the
PRIORITY?
T 38.7
HR 156
RR 32
BP 86/44
ST
SpO2 92%
Sodium 132, K 4.5, Glu 100, WBC 130,000, Hgb 6.1, Plt 10,000
A. administer a fluid bolus and consult oncology
B. obtain blood cultures and administer IV ceftriaxone
U
C. administer IV ceftriaxone and obtain type and cross
D. assess BUN and creatinine levels and obtain type and cross
D
A. administer a fluid bolus and consult oncology
The combination of hyperleukocytosis, thrombocytopenia, and anemia should raise red flags for
Y
leukemia. It is imperative to involve the oncology service early in the treatment plan. The management
goal for symptomatic hyperleukocytosis is the rapid lowering of the white cell count, which can be
achieved through cytoreduction with induction chemotherapy, leukapheresis, exchange transfusion,
and hydroxyurea, although the latter is usually reserved for patients who cannot receive immediate
induction chemotherapy.
An adolescent who is 1-week status-post spinal surgery is evaluated for intermittent episodes of
feeling "out of breath" and midsternal pain during mild exertion. Which of the following studies should
be ordered?
A. antithrombin (AT), protein C (PC), protein S (PS), and Factor V Leiden (FVL)
B. complete blood count, AT, PC, and pulmonary function testing (PFT)
A+ TEST BANK 1
, PNCB Acute Care Practice Exam
C. complete blood count with D-dimer, PT/PTT, and troponin D. homocysteine levels, creatinine,
troponin, and D-dimer
C. complete blood count with D-dimer, PT/PTT, and troponin
Most children diagnosed with pediatric pulmonary embolism or venous thromboembolism have had
recent surgery or have underlying comorbidities such as congenital heart disease or systemic lupus.
Pulmonary embolism frequently presents as shortness of breath or chest pain. In a hemodynamically
stable child, initial laboratory evaluation consists of a complete blood count, PT, PTT, D-dimer, BUN,
Creatinine, BMP, and troponin.
A 2 month old with an infantile hemangioma around the left eye is being evaluated for propranolol
therapy. Which of the following findings would be considered a potential CONTRAINDICATION?
M
A. prematurity B. hypertension C. sinus bradycardia D. family history of diabetes
C. sinus bradycardia
ED
Propranolol is a beta-adrenergic blocker used to treat infantile hemangioma (IH). Previously used as an
off-label therapy, propranolol is FDA-approved for the treatment of proliferating IH in infants at least 5
weeks of age who weigh over two kilograms. The exact mechanism of action for propranolol on IH is
not well understood, but hypothesized mechanisms include vasoconstriction, decreased renin
production, inhibition of angiogenesis, and stimulation of apoptosis. Propranolol has negative
ST
chronotropic and inotropic cardiac effects, resulting in decreased heart rate and blood pressure. Due
to the negative chronotropic effects, children with documented bradycardia are not candidates for
treatment with propranolol.
When preforming a procedure, such as central line insertion, which of the following strategies is MOST
U
effective for promoting safe team communication?
A. confirming steps against a checklist
B. assigning team member roles
D
C. reviewing signed consent
D. using team time outs
D. using team time outs
Y
An infant with unrepaired tetralogy of Fallot is admitted for emesis. Urgent surgical intervention is
warranted for which of the following findings?
A. feeding intolerance
B. hypercyanotic spells
C. polycythemia
D. tachycardia
B. hypercyanotic spells
ToF components
A+ TEST BANK 2
, PNCB Acute Care Practice Exam
VSD
RVOT obstruction
RVH
overriding aorta
Following spinal fusion surgery for scoliosis, an adolescent develops mid-abdominal pain and bilious
emesis. Nonpharmacological therapy to alleviate symptoms includes placing in which of the following
positions?
A. supine or dorsal recumbent
B. prone or knee-chest
C. Trendelenburg's
D. Fowler's
M
B. prone or knee-chest
SMA syndrome
Management of this condition targets relieving the obstruction and maintaining adequate nutrition
ED
and hydration. Symptom relief often occurs by placing the individual in prone, left side-lying, or knee-
chest positioning, which shifts the duodenum away from the SMA and aorta that are causing
obstruction.
SMA syndrome populations commonly seen
post spinal fusion
ST
anorexia nervosa
SMA syndrome definition/pathology
angle between aorta and SMA is decreased, compressing duodenum which is between the two
U
SMA syndrome symptoms
anorexia
D
mid-abdominal pain
bilious emesis
A toddler weighing 15 kg has a tracheostomy and is mechanically ventilated with current ventilator
Y
settings provided below. Assessment reveals moderate retractions, nasal flaring, and hypoxia, with
breath sounds absent in the right lower lobe and rhonchi noted in all other lobes. Ventilator reading
indicates breath volumes of 60 mL. Which of the following actions is the PRIORITY?
A. order a blood gas B. replace the tracheostomy
C. obtain a chest radiograph D. suction the tracheostomy
D. suction the tracheostomy
For the child in the presented scenario, airway patency is the highest priority assessment, confirmed
with breath sounds auscultated in most lobes of the lungs. The absence of breath sounds in one area
of the chest is concerning for obstruction, likely from mucus. Suctioning to attempt removal of the
obstruction is the best initial intervention in addressing this child's respiratory distress. While a chest
A+ TEST BANK 3
, PNCB Acute Care Practice Exam
radiograph may confirm an obstruction preventing aeration in the lobe, it may not be immediately
available. The blood gas may show impaired oxygenation and ventilation but will not treat the cause of
the respiratory distress.
An infant presents after a choking episode during a feeding, followed by cyanosis and a brief period of
hypotonia. One month ago, a previous evaluation following a similar episode revealed laryngomalacia
and reflux, for which a proton-pump inhibitor was prescribed. On physical examination, the infant is
alert with mild stertorous breath sounds. A videofluoroscopic swallowing study (VFSS) demonstrates
intermittent tracheal narrowing and a posterior, pulsatile indentation of the esophagus. Which
differential diagnosis is MOST likely?
A. brief resolved unexplained event (BRUE)
B. esophageal stricture
C. tracheoesophageal fistula
M
D. vascular ring
D. vascular ring
ED
Vascular ring definition
congenital structural/positional abnormalities of aortic arch
malformed vessels encircle/impinge upon trachea or esophagus
signs/symptoms vascular ring
ST
stridor
noisy breathing/wheezing
coughing, choking, color change with feeding
diagnostic tests- vascular ring
U
bronchoscopy or barium esophagogram
can be seen on CXR but is not diagnostic
D
key finding in bronchoscopy for vascular ring diagnosis
pulsatility of affected area in dynamic study
Y
A critically ill adolescent receiving a propofol infusion develops refractory bradycardia. Which of the
following additional clinical findings completes the diagnostic criteria for propofol infusion syndrome?
A. metabolic acidosis
B. worsening coagulopathy
C. new onset seizure activity
D. abrupt onset of hyperthermia
A. metabolic acidosis
signs of propofol infusion syndrome
A+ TEST BANK 4
