LIPPINCOTT ACPNP SELF ASSESSMENT #1 STUDY GUIDE|
200 ACTUAL QUESTIONS & CORRECT VERIFIED ANSWERS
LATEST UPDATE 2025
1. A neonate presents with seizures at age 1 week. In the newborn period, he
was noted to be hypotonic, with low-set ears and a cleft palate. Which of the
following diagnoses is highest on the differential list?
a. Angle-man syndrome
b. Alagille Syndrome
c. Digeorge Syndrome
d. Treacher Collin Syndrome CORRECT ANS >> c. DiGeorge syndrome results in absence or hypoplasia of
the parathyroid gland which can lead to hypocalcemia resulting in seizures. Dysmorphic facial features
characteristic of DiGeorge syndrome include low-set ears, micrognathia, and hypertelorism. Cleft palate is present
70% to 80% of the time in this syndrome. Hypotonia is common in infancy in those with the syndrome.
2. A 3-year-old is in the pediatric acute care unit after having a subclavian central
line placed in the operating room. He is stable on 2-L nasal cannula and playful
until a few minutes later when he starts crying and his SaO2 decreases to 85%.
He is notably tachypneic and tachycardic and his breath sounds are unequal.
What is the most likely explanation for this acute change in the patient's
condition?
a. Bronchospasm.
,b. Pneumothorax.
c. Postoperative pain.
d. Foreign body aspiration CORRECT ANS >> b. Pneumothorax is a known potential complication of central
line placement. Unequal breath sounds with impaired oxygenation are hallmark signs. Foreign body aspiration
could have a similar presentation but is less likely in a supervised environment.
3. An 8-year-old with cystic fibrosis (CF) is being treated for Pseudomonas aerug-
inosa infection in the respiratory tract. Serum tobramycin levels have been
below the therapeutic range, despite being on appropriate dosing for her age
(7.5 mg/kg/24 hours). What is the rationale and next best step in this child's
plan?
a. Tobramycin can cause nephrotoxicity and ototoxicity, so the dose should
remain the same, despite low serum levels.
b. Patients with CF metabolize antibiotics rapidly; therefore, it is safe to increase
the dose until desired therapeutic blood levels are achieved.
c. Patients with CF metabolize many antibiotics rapidly; therefore, it is safe to
,increase her dose to 10 mg/kg/24 hours.
d. Tobramycin can cause renal failure if the levels remain elevated, so the child
should remain on the same dose CORRECT ANS >> C. The recommended range for dosing of
tobramycin in patients with CF is 7.5 to 10 mg/kg/24 hours. The risk of toxic side ettects is real, but the dose
should be increased to try to achieve therapeutic target, but not above the upper limit to minimize risk of toxicity.
4. When evaluating a toddler suspected of a foreign body aspiration, obtaining
an inspiratory/expiratory chest radiograph is used to determine presence of
which of the following?
a. Pleural effusion.
b. Object on the horizontal plane.
c. Lung deflation on exhalation.
d. Bilateral hyperinflation CORRECT ANS >> c. Obtaining an inspiratory/expiratory chest radiograph
assists in evaluating lung deflation on exhalation and presence of unilateral air trapping. Pleural ettusions are
generally not associated with foreign body aspiration. Objects most commonly position themselves on the vertical
plane. Bilateral hyperinflation is common in asthma/status asthmaticus.
5. A 4-month-old infant was found gasping for breath in his crib. He was sup-
ported with positive-pressure bag-mask ventilation and transported to the
hospital by the local emergency medical services. On arrival to the hospital,
the child was lethargic, tachypneic, tachycardic, and wheezing. He was noted
to have pink, frothy sputum when suctioned. The most likely reason for this
presentation is CORRECT ANS >>
a. Pneumonia.
3 m/
, b. Meningitis.
c. Reactive airway disease. m m
d. Pulmonary edema CORRECT ANS >> d. The clinical presentation of a child with suspected
m m m m m m m m m m m m m
pulmonary edema can include tachypnea, dyspnea, tachycardia, hypoxia, and wheezing. Cough with frothy sputum
m m m m m m m m m m m m m m
m(often pink), diaphoresis, orthop- nea, and paroxysmal nocturnal dyspnea with increased work of breathing
m m m m m m m m m m m m m
mare other clinical findings. On auscultation, crackles may be heard along with a third heart tone or gallop,
m m m m m m m m m m m m m m m m m
mwhich is indicative of cardiogenic pulmonary edema.
m m m m m m
6. A child in cardiogenic shock is being treated with dobutamine. What
m m m m m m m m m m
m is the mechanism of action of this medication?
m m m m m m m
a. Increasing contractility and promoting peripheral vasodilation.
m m m m m
b. Increasing contractility and increasing peripheral vasoconstriction.
m m m m m
4 m/
200 ACTUAL QUESTIONS & CORRECT VERIFIED ANSWERS
LATEST UPDATE 2025
1. A neonate presents with seizures at age 1 week. In the newborn period, he
was noted to be hypotonic, with low-set ears and a cleft palate. Which of the
following diagnoses is highest on the differential list?
a. Angle-man syndrome
b. Alagille Syndrome
c. Digeorge Syndrome
d. Treacher Collin Syndrome CORRECT ANS >> c. DiGeorge syndrome results in absence or hypoplasia of
the parathyroid gland which can lead to hypocalcemia resulting in seizures. Dysmorphic facial features
characteristic of DiGeorge syndrome include low-set ears, micrognathia, and hypertelorism. Cleft palate is present
70% to 80% of the time in this syndrome. Hypotonia is common in infancy in those with the syndrome.
2. A 3-year-old is in the pediatric acute care unit after having a subclavian central
line placed in the operating room. He is stable on 2-L nasal cannula and playful
until a few minutes later when he starts crying and his SaO2 decreases to 85%.
He is notably tachypneic and tachycardic and his breath sounds are unequal.
What is the most likely explanation for this acute change in the patient's
condition?
a. Bronchospasm.
,b. Pneumothorax.
c. Postoperative pain.
d. Foreign body aspiration CORRECT ANS >> b. Pneumothorax is a known potential complication of central
line placement. Unequal breath sounds with impaired oxygenation are hallmark signs. Foreign body aspiration
could have a similar presentation but is less likely in a supervised environment.
3. An 8-year-old with cystic fibrosis (CF) is being treated for Pseudomonas aerug-
inosa infection in the respiratory tract. Serum tobramycin levels have been
below the therapeutic range, despite being on appropriate dosing for her age
(7.5 mg/kg/24 hours). What is the rationale and next best step in this child's
plan?
a. Tobramycin can cause nephrotoxicity and ototoxicity, so the dose should
remain the same, despite low serum levels.
b. Patients with CF metabolize antibiotics rapidly; therefore, it is safe to increase
the dose until desired therapeutic blood levels are achieved.
c. Patients with CF metabolize many antibiotics rapidly; therefore, it is safe to
,increase her dose to 10 mg/kg/24 hours.
d. Tobramycin can cause renal failure if the levels remain elevated, so the child
should remain on the same dose CORRECT ANS >> C. The recommended range for dosing of
tobramycin in patients with CF is 7.5 to 10 mg/kg/24 hours. The risk of toxic side ettects is real, but the dose
should be increased to try to achieve therapeutic target, but not above the upper limit to minimize risk of toxicity.
4. When evaluating a toddler suspected of a foreign body aspiration, obtaining
an inspiratory/expiratory chest radiograph is used to determine presence of
which of the following?
a. Pleural effusion.
b. Object on the horizontal plane.
c. Lung deflation on exhalation.
d. Bilateral hyperinflation CORRECT ANS >> c. Obtaining an inspiratory/expiratory chest radiograph
assists in evaluating lung deflation on exhalation and presence of unilateral air trapping. Pleural ettusions are
generally not associated with foreign body aspiration. Objects most commonly position themselves on the vertical
plane. Bilateral hyperinflation is common in asthma/status asthmaticus.
5. A 4-month-old infant was found gasping for breath in his crib. He was sup-
ported with positive-pressure bag-mask ventilation and transported to the
hospital by the local emergency medical services. On arrival to the hospital,
the child was lethargic, tachypneic, tachycardic, and wheezing. He was noted
to have pink, frothy sputum when suctioned. The most likely reason for this
presentation is CORRECT ANS >>
a. Pneumonia.
3 m/
, b. Meningitis.
c. Reactive airway disease. m m
d. Pulmonary edema CORRECT ANS >> d. The clinical presentation of a child with suspected
m m m m m m m m m m m m m
pulmonary edema can include tachypnea, dyspnea, tachycardia, hypoxia, and wheezing. Cough with frothy sputum
m m m m m m m m m m m m m m
m(often pink), diaphoresis, orthop- nea, and paroxysmal nocturnal dyspnea with increased work of breathing
m m m m m m m m m m m m m
mare other clinical findings. On auscultation, crackles may be heard along with a third heart tone or gallop,
m m m m m m m m m m m m m m m m m
mwhich is indicative of cardiogenic pulmonary edema.
m m m m m m
6. A child in cardiogenic shock is being treated with dobutamine. What
m m m m m m m m m m
m is the mechanism of action of this medication?
m m m m m m m
a. Increasing contractility and promoting peripheral vasodilation.
m m m m m
b. Increasing contractility and increasing peripheral vasoconstriction.
m m m m m
4 m/
