AC PNP Pediatric Nurse Practitioner - Acute Care
Melnic Questions and Answers 100% Pass A+
Which of the following best describes continuous renal replacement therapy (CCRT)
A. Blood from an artery is circulated to a hemofilter using only arterial pressure and not a blood pump
B. Blood is circulated by hydrostatic pressure through a semipermeable membrane
C. Blood is pumped through a double-lumen venous catheter to a hemofilter
D. A dialysate is used to increase clearance of uremic toxins - ANSWER-CCRT circulates the blood by
hydrostatic pressure through a semipermeable membrane. It is used in critical care units because it
can be instituted quickly.
A. Blood is pumped through a double-lumen venous catheter to a hemofilter is continuous
venovenous hemofiltration (CVVH)
B. Use of a dialysate to increase clearance of uremic toxins is also a description of CVVH
D. Blood from an artery circulated to a hemofilter using only arterial pressure and not a blood pump is
an example of continuous arteriovenous hemofiltration (CAVH)
Complications associated with dialysis include:
A. Peritonitis
B. Dysrhythmias
C. Bleeding especially in females
D. Anorexia - ANSWER-Correct Answer: Dysrhythmias.
Hemodialysis can cause hypotension, muscle cramping and dysrhythmias during treatment
A, B, C are all examples of complications of peritoneal dialysis.
The difference in myocarditis and pericarditis is:
A. Myocarditis is diagnosed by a myocardial biopsy
B. Pericarditis is treated according to the cause and the type and extent of inflammation
C. Pericarditis is caused by endocarditis
D. Myocarditis requires pericardiocentesis - ANSWER-A. Diagnostic procedures for pericarditis are
similar to those for endocarditis and myocarditis. The age, size and condition of the patient with
pericarditis also determine treatment which may include: analgesics, anti-inflammatory drugs,
restriction of activity, corticosteroids, and surgical intervention including percardiocentesis
B. Performing a myocardial biopsy in a patient with suspected myocarditis would allow diagnosis but
the procedure is so high risk due to the friability of the myocardium, it is not recommended
C. Myocarditis may be a complication of endocarditis but is usually triggered by a viral infection such
as influenza, coxsackie and HIV
D. Pericarditis may require surgical intervention such as pericardiocentesis or removing fluid from the
pericardial sac to relieve increasing pressure and diagnose causative agents.
Acute tubular necrosis (ATN) occurs when a hypoxic condition causes renal ischemia that damages
tubular cells of the glomeruli so they are unable to adequately filter the urine, leading to acute renal
failure. Treatment of ATN includes:
A. Loop diuretics
B. Fluid restriction
C. Antibiotics
D. FFP for coagulopathy - ANSWER-Correct Answer: Loop diuretics
,Explanation: A. Adequate fluid balance is necessary to perfuse the kidneys. Identifying and treating
underlying cause is key
C. Antibiotics including sulfonamides and streptomycin can cause ATN. Antibiotics should only be
continued if infection is present
D. Coagulopathy may develop if uremia is present. Uremia leads to destruction of platelets and
bleeding.
In Piaget's formal operational stage, development includes:
A. Egocentrism
B. Flexibility of thought
C. Magical thinking
D. Organization - ANSWER-Correct Answer: Flexibility of thought
D. The formal operational stage of Piaget's theory of cognitive approach to development includes
abstract thought and flexibility of thought. The age range a child begins to exhibit this is 12 years and
older
A. Magical thinking and
B. Egocentrism are in the preoperational thinking stage; ages 2-7 years
C. Organization is found in the concrete operational thinking which is 7-12 years of age
The most common cause of bladder obstruction in the pediatric male patient is:
A. Hypospadius
B. Post urethral valve related issues
C. Undescended testes
D. Single kidney - ANSWER-Explanation: C. Post urethral valve issues are the most common cause of
bladder obstruction in pediatric male patients.
A, B, D. None of these GU or renal abnormalities cause bladder obstruction
When doing Pulmonary Function Tests (PFTs), the NP recalls:
A. Asthma is a form of restrictive lung disease
B. Forced expiration is the best indicator of obstructive airway disease
C. Forced expiration is the best indicator of restrictive airway disease
D. A value is considered abnormal if it is less than 50% of your predicted value - ANSWER-Correct
Answer: Forced expiration is the best indicator of obstructive airway disease
Explanation: A. In PFT's, forced expiration is the best indicator of obstructive airway disease.
Obstructive disease make the lungs contain too much air and take longer to empty. Changes in lung
volumes and capacities are generally consistent with the pattern of impairment. With obstructive lung
disease total lung capacity, functional residual capacity and residual lung volume increase. With
obstructive lung diseases, these decrease.
B. See explanation for A.
C. A value is considered abnormal if it is less than 80% of your predicted value
D. Asthma is a type of obstructive lung disease
A child in the emergency department has point tenderness over the proximal tibia and an appropriate
history of trauma. The radiograph show a fracture through the growth plate that extends in to the
epiphysis and joint space. This type of fracture would be characterized as:
A. Salter - Harris Type I
B. Salter - Harris Type II
C. Salter - Harris Type III
D. Salter - Harris Type IV - ANSWER-Explanation: C. Salter - Harris type III is a fracture through the
growth plate that extends into the epiphysis and into the joint space. They may require open
reduction and fixation.
,A. Salter - Harris type I occur along the growth plate
B. Salter - Harris Type II fractures extend into the metaphysis only
D. Salter - Harris Type IV fractures go through both the metaphysis and epiphysis into the joint space.
Type V fractures result from compression of the growth plate
Which of the following is considered a risk factor for neonatal respiratory distress syndrome?
A. Neonatal sepsis
B. Poorly controlled maternal diabetes
C. Maternal preeclampsia
D. Neural tube defects - ANSWER-Explanation: B. Infants of diabetic mothers, especially those with
poor control, have delayed maturation of surfactant production and are at risk for neonatal
respiratory distress syndrome at any gestational age
A. Infants with neonatal sepsis or pneumonia have normal surfactant production and do not benefit
from surfactant replacement therapy
C. Maternal preeclampsia is associated with acceleration of lung maturation and surfactant
production
D. Patients born full term with neural tube defects have normal lung maturation
Laboratory findings in the diagnosis of diabetic ketoacidosis include:
A. Ketones in urine
B. Hypoglycemia
C. Hypercarbia
D. Decreased BUN - ANSWER-Explanation: C. Diabetic ketoacidosis (DKA) usually exhibits with some
combination of polyuria, polydipsia, fatigue, headache, nausea, emesis and abdominal pain. When
DKA occurs, ketones are formed in the blood and cleared in the urine.
A. Hyperglycemia is usually present, not hypoglycemia
B. Primary metabolic acidosis with secondary respiratory alkalosis is noted (decreased pH and
hypocarbia)
C. Dehydration results in an elevated BUN level. When DKA is present, the patient's total body
potassium is depleted from significant potassium loss in the osmotic diuresis. However, serum
potassium measurements at presentation may appear high, low or normal.
Your 2 year old patient is intubated and ventilated. He suddenly decompensates, dropping his
saturations to 50% and becomes bradycardic to 60 bpm. What is your next course of action?
A. Remove patient from ventilator and hand bag with 100% FiO2
B. Order a chest X-Ray
C. Order a stat blood gas
D. Extubate and re-intubate - ANSWER-Explanation: D. DOPE mnemonic - displaced, obstructed,
placement and equipment. If the patient suddenly decompensates for no apparent reason, TREAT the
Patient by using the DOPE mnemonic to ensure there is not equipment related or something
obstructing the endotracheal tube.
A, B, C may all need to be done, however rule out mechanical causes of decompensation first.
Your are assessing a 5 year old whose parents say she is having "coughing fits" with a difficult time
"catching her breath". She is up to date on her immunizations and has no other significant medical
issues. Based on the parent's description of her cough, your differential diagnosis would include:
A. Mycoplasma pneumonia
B. Pneumocystis pneumonia
C. Croup
D. Strep pneumonia - ANSWER-Explanation: A. A child who is up to date on their immunizations and
present with a paroxysmal type cough (characteristic of pertussis), when treated with a macrolide
antibiotic usually improve in 3-6 weeks.
, B. A child who is not immunocompromised should not contract pneumocystis carinii pneumonia
C. Croup presents with a tight "barky" cough and is caused by a virus
D. Strep pneumoniae - is many time preceded by a URI or OM. Their coughs are usually productive
A patient with a history of hematemesis and melena is reported to have a clear gastric lavage. What
additional diagnostic test should you consider?
A. Meckel's scan
B. Endoscopy
C. Upper GI study
D. KUB - ANSWER-Explanation: B. A history of bloody emesis (hematemesis) and dark tarry stools
(melena) usually indicates recent GI hemorrhage, not a current hemorrhage. Approximately 50 ml of
blood in the stomach can make stools tarry/black. Upper GI hemorrhage (above the Ligament of
Treitz) can be diagnosed with endoscopy.
A. UGI - is used to administer contrast medium and observe for reflux, not hemorrhage
C. Meckels scan is a study unique to pediatrics used to diagnose Meckels diverticulum. It is the most
common abnormality of the GI tract due to the vestigial remnant of the omphalomesenteric duct. It
presents with painless bright red stools
D. KUB (kidney, ureter and bladder) abdominal x-ray will not reveal active upper or lower GI bleeding.
A known Cystic Fibrosis patient may need which of the following medications for control of known
Pseudomonas infection.
A. Antibiotics
B. Inhaled Tobramycin
C. Recombinant human deoxyribonuclease nebulized
D. Physical therapy and vigorous vibration exercises - ANSWER-Correct Answer: Inhaled Tobramycin
Explanation: A. Alternating months of regular inhaled tobramycin may be indicated for patients
infected with Pseudomonas
B. Nebulized recombinant human deoxyribonuclease breaks down thick DNA complexes present in
mucus as a result of cell destruction and bacterial colonization
C. Physical therapy and vigorous vibration exercises are the most fundamental therapies used in CF
therapy. These are helpful in mobilizing secretions
D. Antibiotics decrease the production of bacterial toxins, reduce inflammation and curb tissue
destruction. Azithromycin has recently been added as a possible immune modifier
Which of the following patients is at greatest risk for developing sepsis?
Incorrect
A. 5 year old requiring PICC for TPN secondary to ruptured appendix
B. 2 year old with a PICC placed 24 days ago
C. 5 year old patient with PIV placed for dehydration 72 hours ago
D. 2 month old with central line placed < 2 weeks ago - ANSWER-Explanation: B. PICC's placed in a
patient admitted to a PICU for greater than 21 days are at higher risk for developing a hospital
acquired infection. The prolonged catheter dwell time can lead to catheter colonization and biofilm
formation.
A. Although PIV's pose a risk for infection, short term use is not highly likely to lead to sepsis
C. Infants with central line placed less than 2 weeks are at risk for infection but not as high risk as
patients admitted to PICU with PICC line in place greater than 21 days
D. Adolescents with ruptured appendix who need a central line (short term) for nutrition purposes are
at risk but lower risk than a patient admitted to a PICU with a PICC in place for greater than 21 days
Two month old male presents with fever of 102F and fussiness. He has decreased urine output, but
mild symptoms of dehydration. A full sepsis workup is completed and he needs to be started on
antibiotics. Your orders include Ampicillin and Gentamycin. The following morning his urine culture
Melnic Questions and Answers 100% Pass A+
Which of the following best describes continuous renal replacement therapy (CCRT)
A. Blood from an artery is circulated to a hemofilter using only arterial pressure and not a blood pump
B. Blood is circulated by hydrostatic pressure through a semipermeable membrane
C. Blood is pumped through a double-lumen venous catheter to a hemofilter
D. A dialysate is used to increase clearance of uremic toxins - ANSWER-CCRT circulates the blood by
hydrostatic pressure through a semipermeable membrane. It is used in critical care units because it
can be instituted quickly.
A. Blood is pumped through a double-lumen venous catheter to a hemofilter is continuous
venovenous hemofiltration (CVVH)
B. Use of a dialysate to increase clearance of uremic toxins is also a description of CVVH
D. Blood from an artery circulated to a hemofilter using only arterial pressure and not a blood pump is
an example of continuous arteriovenous hemofiltration (CAVH)
Complications associated with dialysis include:
A. Peritonitis
B. Dysrhythmias
C. Bleeding especially in females
D. Anorexia - ANSWER-Correct Answer: Dysrhythmias.
Hemodialysis can cause hypotension, muscle cramping and dysrhythmias during treatment
A, B, C are all examples of complications of peritoneal dialysis.
The difference in myocarditis and pericarditis is:
A. Myocarditis is diagnosed by a myocardial biopsy
B. Pericarditis is treated according to the cause and the type and extent of inflammation
C. Pericarditis is caused by endocarditis
D. Myocarditis requires pericardiocentesis - ANSWER-A. Diagnostic procedures for pericarditis are
similar to those for endocarditis and myocarditis. The age, size and condition of the patient with
pericarditis also determine treatment which may include: analgesics, anti-inflammatory drugs,
restriction of activity, corticosteroids, and surgical intervention including percardiocentesis
B. Performing a myocardial biopsy in a patient with suspected myocarditis would allow diagnosis but
the procedure is so high risk due to the friability of the myocardium, it is not recommended
C. Myocarditis may be a complication of endocarditis but is usually triggered by a viral infection such
as influenza, coxsackie and HIV
D. Pericarditis may require surgical intervention such as pericardiocentesis or removing fluid from the
pericardial sac to relieve increasing pressure and diagnose causative agents.
Acute tubular necrosis (ATN) occurs when a hypoxic condition causes renal ischemia that damages
tubular cells of the glomeruli so they are unable to adequately filter the urine, leading to acute renal
failure. Treatment of ATN includes:
A. Loop diuretics
B. Fluid restriction
C. Antibiotics
D. FFP for coagulopathy - ANSWER-Correct Answer: Loop diuretics
,Explanation: A. Adequate fluid balance is necessary to perfuse the kidneys. Identifying and treating
underlying cause is key
C. Antibiotics including sulfonamides and streptomycin can cause ATN. Antibiotics should only be
continued if infection is present
D. Coagulopathy may develop if uremia is present. Uremia leads to destruction of platelets and
bleeding.
In Piaget's formal operational stage, development includes:
A. Egocentrism
B. Flexibility of thought
C. Magical thinking
D. Organization - ANSWER-Correct Answer: Flexibility of thought
D. The formal operational stage of Piaget's theory of cognitive approach to development includes
abstract thought and flexibility of thought. The age range a child begins to exhibit this is 12 years and
older
A. Magical thinking and
B. Egocentrism are in the preoperational thinking stage; ages 2-7 years
C. Organization is found in the concrete operational thinking which is 7-12 years of age
The most common cause of bladder obstruction in the pediatric male patient is:
A. Hypospadius
B. Post urethral valve related issues
C. Undescended testes
D. Single kidney - ANSWER-Explanation: C. Post urethral valve issues are the most common cause of
bladder obstruction in pediatric male patients.
A, B, D. None of these GU or renal abnormalities cause bladder obstruction
When doing Pulmonary Function Tests (PFTs), the NP recalls:
A. Asthma is a form of restrictive lung disease
B. Forced expiration is the best indicator of obstructive airway disease
C. Forced expiration is the best indicator of restrictive airway disease
D. A value is considered abnormal if it is less than 50% of your predicted value - ANSWER-Correct
Answer: Forced expiration is the best indicator of obstructive airway disease
Explanation: A. In PFT's, forced expiration is the best indicator of obstructive airway disease.
Obstructive disease make the lungs contain too much air and take longer to empty. Changes in lung
volumes and capacities are generally consistent with the pattern of impairment. With obstructive lung
disease total lung capacity, functional residual capacity and residual lung volume increase. With
obstructive lung diseases, these decrease.
B. See explanation for A.
C. A value is considered abnormal if it is less than 80% of your predicted value
D. Asthma is a type of obstructive lung disease
A child in the emergency department has point tenderness over the proximal tibia and an appropriate
history of trauma. The radiograph show a fracture through the growth plate that extends in to the
epiphysis and joint space. This type of fracture would be characterized as:
A. Salter - Harris Type I
B. Salter - Harris Type II
C. Salter - Harris Type III
D. Salter - Harris Type IV - ANSWER-Explanation: C. Salter - Harris type III is a fracture through the
growth plate that extends into the epiphysis and into the joint space. They may require open
reduction and fixation.
,A. Salter - Harris type I occur along the growth plate
B. Salter - Harris Type II fractures extend into the metaphysis only
D. Salter - Harris Type IV fractures go through both the metaphysis and epiphysis into the joint space.
Type V fractures result from compression of the growth plate
Which of the following is considered a risk factor for neonatal respiratory distress syndrome?
A. Neonatal sepsis
B. Poorly controlled maternal diabetes
C. Maternal preeclampsia
D. Neural tube defects - ANSWER-Explanation: B. Infants of diabetic mothers, especially those with
poor control, have delayed maturation of surfactant production and are at risk for neonatal
respiratory distress syndrome at any gestational age
A. Infants with neonatal sepsis or pneumonia have normal surfactant production and do not benefit
from surfactant replacement therapy
C. Maternal preeclampsia is associated with acceleration of lung maturation and surfactant
production
D. Patients born full term with neural tube defects have normal lung maturation
Laboratory findings in the diagnosis of diabetic ketoacidosis include:
A. Ketones in urine
B. Hypoglycemia
C. Hypercarbia
D. Decreased BUN - ANSWER-Explanation: C. Diabetic ketoacidosis (DKA) usually exhibits with some
combination of polyuria, polydipsia, fatigue, headache, nausea, emesis and abdominal pain. When
DKA occurs, ketones are formed in the blood and cleared in the urine.
A. Hyperglycemia is usually present, not hypoglycemia
B. Primary metabolic acidosis with secondary respiratory alkalosis is noted (decreased pH and
hypocarbia)
C. Dehydration results in an elevated BUN level. When DKA is present, the patient's total body
potassium is depleted from significant potassium loss in the osmotic diuresis. However, serum
potassium measurements at presentation may appear high, low or normal.
Your 2 year old patient is intubated and ventilated. He suddenly decompensates, dropping his
saturations to 50% and becomes bradycardic to 60 bpm. What is your next course of action?
A. Remove patient from ventilator and hand bag with 100% FiO2
B. Order a chest X-Ray
C. Order a stat blood gas
D. Extubate and re-intubate - ANSWER-Explanation: D. DOPE mnemonic - displaced, obstructed,
placement and equipment. If the patient suddenly decompensates for no apparent reason, TREAT the
Patient by using the DOPE mnemonic to ensure there is not equipment related or something
obstructing the endotracheal tube.
A, B, C may all need to be done, however rule out mechanical causes of decompensation first.
Your are assessing a 5 year old whose parents say she is having "coughing fits" with a difficult time
"catching her breath". She is up to date on her immunizations and has no other significant medical
issues. Based on the parent's description of her cough, your differential diagnosis would include:
A. Mycoplasma pneumonia
B. Pneumocystis pneumonia
C. Croup
D. Strep pneumonia - ANSWER-Explanation: A. A child who is up to date on their immunizations and
present with a paroxysmal type cough (characteristic of pertussis), when treated with a macrolide
antibiotic usually improve in 3-6 weeks.
, B. A child who is not immunocompromised should not contract pneumocystis carinii pneumonia
C. Croup presents with a tight "barky" cough and is caused by a virus
D. Strep pneumoniae - is many time preceded by a URI or OM. Their coughs are usually productive
A patient with a history of hematemesis and melena is reported to have a clear gastric lavage. What
additional diagnostic test should you consider?
A. Meckel's scan
B. Endoscopy
C. Upper GI study
D. KUB - ANSWER-Explanation: B. A history of bloody emesis (hematemesis) and dark tarry stools
(melena) usually indicates recent GI hemorrhage, not a current hemorrhage. Approximately 50 ml of
blood in the stomach can make stools tarry/black. Upper GI hemorrhage (above the Ligament of
Treitz) can be diagnosed with endoscopy.
A. UGI - is used to administer contrast medium and observe for reflux, not hemorrhage
C. Meckels scan is a study unique to pediatrics used to diagnose Meckels diverticulum. It is the most
common abnormality of the GI tract due to the vestigial remnant of the omphalomesenteric duct. It
presents with painless bright red stools
D. KUB (kidney, ureter and bladder) abdominal x-ray will not reveal active upper or lower GI bleeding.
A known Cystic Fibrosis patient may need which of the following medications for control of known
Pseudomonas infection.
A. Antibiotics
B. Inhaled Tobramycin
C. Recombinant human deoxyribonuclease nebulized
D. Physical therapy and vigorous vibration exercises - ANSWER-Correct Answer: Inhaled Tobramycin
Explanation: A. Alternating months of regular inhaled tobramycin may be indicated for patients
infected with Pseudomonas
B. Nebulized recombinant human deoxyribonuclease breaks down thick DNA complexes present in
mucus as a result of cell destruction and bacterial colonization
C. Physical therapy and vigorous vibration exercises are the most fundamental therapies used in CF
therapy. These are helpful in mobilizing secretions
D. Antibiotics decrease the production of bacterial toxins, reduce inflammation and curb tissue
destruction. Azithromycin has recently been added as a possible immune modifier
Which of the following patients is at greatest risk for developing sepsis?
Incorrect
A. 5 year old requiring PICC for TPN secondary to ruptured appendix
B. 2 year old with a PICC placed 24 days ago
C. 5 year old patient with PIV placed for dehydration 72 hours ago
D. 2 month old with central line placed < 2 weeks ago - ANSWER-Explanation: B. PICC's placed in a
patient admitted to a PICU for greater than 21 days are at higher risk for developing a hospital
acquired infection. The prolonged catheter dwell time can lead to catheter colonization and biofilm
formation.
A. Although PIV's pose a risk for infection, short term use is not highly likely to lead to sepsis
C. Infants with central line placed less than 2 weeks are at risk for infection but not as high risk as
patients admitted to PICU with PICC line in place greater than 21 days
D. Adolescents with ruptured appendix who need a central line (short term) for nutrition purposes are
at risk but lower risk than a patient admitted to a PICU with a PICC in place for greater than 21 days
Two month old male presents with fever of 102F and fussiness. He has decreased urine output, but
mild symptoms of dehydration. A full sepsis workup is completed and he needs to be started on
antibiotics. Your orders include Ampicillin and Gentamycin. The following morning his urine culture
