Pediatric Nurse Practitioner (PNP-AC)
Certification Practice Exam 100 Questions And
Correct Answers (Verified Answers) Plus
Rationales 2025/2026 Q&A | Instant Download
Pdf
1. A 4-year-old presents with acute respiratory distress, high fever,
drooling, and tripod positioning. The priority action is:
A. Obtain a throat culture
B. Prepare for immediate intubation
C. Initiate racemic epinephrine
D. Start IV corticosteroids
Answer: B
Rationale: Signs of epiglottitis require emergent airway protection;
throat exam or delays may precipitate obstruction.
2. A child with septic shock remains hypotensive after fluid
resuscitation. The next intervention is:
A. Start dopamine infusion
B. Administer hydrocortisone
C. Begin norepinephrine
D. Give sodium bicarbonate
Answer: C
Rationale: Norepinephrine is first-line vasopressor for fluid-refractory
septic shock.
,3. A 2-year-old with bronchiolitis presents with increasing apnea.
The most appropriate management is:
A. Start high-flow nasal cannula
B. Administer albuterol
C. Trial racemic epinephrine
D. Prepare for intubation
Answer: A
Rationale: HFNC improves ventilation in moderate–severe
bronchiolitis; apnea is an indication for escalation.
4. A 6-month-old in DKA has corrected sodium low and glucose
dropping rapidly. To prevent cerebral edema:
A. Increase insulin infusion
B. Give hypertonic saline
C. Slow IV fluid rate
D. Add bicarbonate
Answer: C
Rationale: Cerebral edema risk increases with rapid osmotic shifts;
slow fluids and glucose decline.
5. In a child with suspected meningococcemia, the first intervention
is:
A. CT head
B. LP
C. Broad-spectrum IV antibiotics
D. Blood cultures
Answer: C
Rationale: Immediate antibiotics reduce mortality; cultures ideally
before but should not delay therapy.
,6. A child with asthma exacerbation has minimal air movement and
silent chest. This indicates:
A. Mild obstruction
B. Impending respiratory failure
C. Normalizing airflow
D. Upper airway obstruction
Answer: B
Rationale: Silent chest is a sign of severe obstruction and impending
failure.
7. Most common cause of pediatric cardiopulmonary arrest:
A. Ventricular fibrillation
B. Respiratory failure
C. Primary cardiac arrhythmia
D. Trauma
Answer: B
Rationale: Arrest in children is typically secondary to hypoxia.
8. A 3-year-old with status epilepticus lasting >5 minutes. First-line
medication:
A. Fosphenytoin
B. Midazolam
C. Levetiracetam
D. Phenobarbital
Answer: B
Rationale: Benzodiazepines (midazolam) are first-line for active
seizures.
, 9. A 10-year-old with fever, petechiae, and hypotension shows cap
refill of 5 seconds. Best initial fluid:
A. D5W
B. NS bolus 20 mL/kg
C. Albumin
D. Lactated Ringer 10 mL/kg
Answer: B
Rationale: Septic shock requires rapid 20 mL/kg crystalloid bolus.
10. Child with pyloric stenosis is at risk for which electrolyte
abnormality?
A. Hyperkalemia
B. Hyperchloremic acidosis
C. Hypochloremic alkalosis
D. Hypernatremia
Answer: C
Rationale: Loss of gastric acid → hypochloremic metabolic alkalosis.
11. A child with sickle cell disease and chest pain, fever, and
infiltrate on CXR likely has:
A. Pneumothorax
B. Acute chest syndrome
C. Asthma exacerbation
D. Viral bronchiolitis
Answer: B
Rationale: Classic triad: chest pain, fever, pulmonary infiltrate.
Certification Practice Exam 100 Questions And
Correct Answers (Verified Answers) Plus
Rationales 2025/2026 Q&A | Instant Download
1. A 4-year-old presents with acute respiratory distress, high fever,
drooling, and tripod positioning. The priority action is:
A. Obtain a throat culture
B. Prepare for immediate intubation
C. Initiate racemic epinephrine
D. Start IV corticosteroids
Answer: B
Rationale: Signs of epiglottitis require emergent airway protection;
throat exam or delays may precipitate obstruction.
2. A child with septic shock remains hypotensive after fluid
resuscitation. The next intervention is:
A. Start dopamine infusion
B. Administer hydrocortisone
C. Begin norepinephrine
D. Give sodium bicarbonate
Answer: C
Rationale: Norepinephrine is first-line vasopressor for fluid-refractory
septic shock.
,3. A 2-year-old with bronchiolitis presents with increasing apnea.
The most appropriate management is:
A. Start high-flow nasal cannula
B. Administer albuterol
C. Trial racemic epinephrine
D. Prepare for intubation
Answer: A
Rationale: HFNC improves ventilation in moderate–severe
bronchiolitis; apnea is an indication for escalation.
4. A 6-month-old in DKA has corrected sodium low and glucose
dropping rapidly. To prevent cerebral edema:
A. Increase insulin infusion
B. Give hypertonic saline
C. Slow IV fluid rate
D. Add bicarbonate
Answer: C
Rationale: Cerebral edema risk increases with rapid osmotic shifts;
slow fluids and glucose decline.
5. In a child with suspected meningococcemia, the first intervention
is:
A. CT head
B. LP
C. Broad-spectrum IV antibiotics
D. Blood cultures
Answer: C
Rationale: Immediate antibiotics reduce mortality; cultures ideally
before but should not delay therapy.
,6. A child with asthma exacerbation has minimal air movement and
silent chest. This indicates:
A. Mild obstruction
B. Impending respiratory failure
C. Normalizing airflow
D. Upper airway obstruction
Answer: B
Rationale: Silent chest is a sign of severe obstruction and impending
failure.
7. Most common cause of pediatric cardiopulmonary arrest:
A. Ventricular fibrillation
B. Respiratory failure
C. Primary cardiac arrhythmia
D. Trauma
Answer: B
Rationale: Arrest in children is typically secondary to hypoxia.
8. A 3-year-old with status epilepticus lasting >5 minutes. First-line
medication:
A. Fosphenytoin
B. Midazolam
C. Levetiracetam
D. Phenobarbital
Answer: B
Rationale: Benzodiazepines (midazolam) are first-line for active
seizures.
, 9. A 10-year-old with fever, petechiae, and hypotension shows cap
refill of 5 seconds. Best initial fluid:
A. D5W
B. NS bolus 20 mL/kg
C. Albumin
D. Lactated Ringer 10 mL/kg
Answer: B
Rationale: Septic shock requires rapid 20 mL/kg crystalloid bolus.
10. Child with pyloric stenosis is at risk for which electrolyte
abnormality?
A. Hyperkalemia
B. Hyperchloremic acidosis
C. Hypochloremic alkalosis
D. Hypernatremia
Answer: C
Rationale: Loss of gastric acid → hypochloremic metabolic alkalosis.
11. A child with sickle cell disease and chest pain, fever, and
infiltrate on CXR likely has:
A. Pneumothorax
B. Acute chest syndrome
C. Asthma exacerbation
D. Viral bronchiolitis
Answer: B
Rationale: Classic triad: chest pain, fever, pulmonary infiltrate.
