PEDIATRIC ACUTE CARE NURSE PNP-AC EXAM – PRACTICE QUESTIONS AND
CORRECT ANSWERS (VERIFIED ANSWERS) PLUS RATIONALES 2026 Q&A |
INSTANT DOWNLOAD PDF.
Core Domains
Assessment and Diagnosis
Plan of Care and Management
Pathophysiology and Pharmacology
Professional Practice and Ethics
Healthcare Systems and Regulatory Compliance
Emergency and Critical Care Interventions
Multidisciplinary Collaboration and Leadership
Introduction
This comprehensive assessment is designed to evaluate the competency and clinical
readiness of candidates preparing for the Pediatric Nurse Practitioner-Acute Care
certification. The exam focuses on the high-acuity, complex, and specialized needs of the
pediatric population across diverse acute care settings. Candidates are assessed on their
ability to integrate advanced pathophysiology, pharmacology, and diagnostic reasoning
into the management of critically ill children. The exam utilizes a mix of multiple-choice
and scenario-based questions to mirror real-world clinical decision-making. Emphasis is
placed on evidence-based practice, safety, and the ethical considerations inherent in the
management of pediatric emergencies and chronic health crises.
SECTION ONE: QUESTIONS 1–100
, 1. A 4-year-old male presents with a sudden onset of high fever, drooling, and
inspiratory stridor. He is sitting in a "tripod" position. Which of the following is
the most appropriate initial management step?
A. Perform a thorough oral examination to visualize the airway.
B. Obtain a lateral neck X-ray to confirm the "steeple sign."
C. Keep the patient calm and prepare for emergent intubation in the OR.
D. Administer nebulized racemic epinephrine and corticosteroids.
🟢 C. Keep the patient calm and prepare for emergent intubation in the OR.
🔴 RATIONALE: This presentation is classic for epiglottitis. Any agitation or invasive
examination of the throat can trigger complete airway obstruction. Management
focuses on securing the airway in a controlled environment with anesthesia and ENT
present.
2. A 10-year-old patient in the PICU post-Fontan procedure develops sudden
hypotension and muffled heart sounds. The nurse practitioner suspects cardiac
tamponade. Which diagnostic finding is most supportive?
A. Increased pulmonary capillary wedge pressure.
B. Pulsus paradoxus.
C. Widened pulse pressure.
D. Hypertension with bradycardia.
🟢 B. Pulsus paradoxus.
🔴 RATIONALE: Pulsus paradoxus, defined as a drop in systolic blood pressure of
more than 10 mmHg during inspiration, is a hallmark sign of cardiac tamponade as the
,fluid in the pericardial sac restricts ventricular filling.
3. Which of the following lab abnormalities is most characteristic of Tumor Lysis
Syndrome (TLS) in a pediatric patient undergoing chemotherapy?
A. Hypouricemia.
B. Hypercalcemia.
C. Hyperphosphatemia.
D. Hypokalemia.
🟢 C. Hyperphosphatemia.
🔴 RATIONALE: Tumor Lysis Syndrome results from the rapid breakdown of malignant
cells, leading to the release of intracellular contents. This typically causes
hyperuricemia, hyperkalemia, hyperphosphatemia, and secondary hypocalcemia.
4. A 2-week-old infant presents with projectile non-bilious vomiting and a palpable
"olive-shaped" mass in the epigastrium. What is the initial priority in the
management of this patient?
A. Immediate surgical consultation for pyloromyotomy.
B. Administration of oral rehydration solution.
C. Correction of hypochloremic metabolic alkalosis.
D. Upper GI series to confirm the diagnosis.
🟢 C. Correction of hypochloremic metabolic alkalosis.
🔴 RATIONALE: While pyloric stenosis is a surgical condition, it is not a surgical
emergency. The priority is stabilizing the metabolic and electrolyte imbalances
, (specifically hypochloremia, hypokalemia, and alkalosis) caused by vomiting before
anesthesia.
5. A 14-year-old female with Type 1 Diabetes presents with abdominal pain,
Kussmaul respirations, and a blood glucose of 450 mg/dL. Her pH is 7.15. Which
electrolyte must be closely monitored and often replaced even if initial levels
appear normal?
A. Sodium.
B. Potassium.
C. Magnesium.
D. Bicarbonate.
🟢 B. Potassium.
🔴 RATIONALE: In Diabetic Ketoacidosis (DKA), total body potassium is depleted due
to osmotic diuresis. However, serum levels may appear normal or high due to the shift
of potassium out of cells in an acidic environment. Starting insulin will shift potassium
back into cells, potentially causing severe hypokalemia.
6. Under the Emergency Medical Treatment and Labor Act (EMTALA), what is the
primary obligation of an acute care facility when a pediatric patient presents to
the emergency department?
A. To ensure the patient has insurance before treatment.
B. To provide a medical screening exam to determine if an emergency exists.
C. To transfer the patient to a pediatric specialty center immediately.
D. To contact the primary care provider for authorization.
CORRECT ANSWERS (VERIFIED ANSWERS) PLUS RATIONALES 2026 Q&A |
INSTANT DOWNLOAD PDF.
Core Domains
Assessment and Diagnosis
Plan of Care and Management
Pathophysiology and Pharmacology
Professional Practice and Ethics
Healthcare Systems and Regulatory Compliance
Emergency and Critical Care Interventions
Multidisciplinary Collaboration and Leadership
Introduction
This comprehensive assessment is designed to evaluate the competency and clinical
readiness of candidates preparing for the Pediatric Nurse Practitioner-Acute Care
certification. The exam focuses on the high-acuity, complex, and specialized needs of the
pediatric population across diverse acute care settings. Candidates are assessed on their
ability to integrate advanced pathophysiology, pharmacology, and diagnostic reasoning
into the management of critically ill children. The exam utilizes a mix of multiple-choice
and scenario-based questions to mirror real-world clinical decision-making. Emphasis is
placed on evidence-based practice, safety, and the ethical considerations inherent in the
management of pediatric emergencies and chronic health crises.
SECTION ONE: QUESTIONS 1–100
, 1. A 4-year-old male presents with a sudden onset of high fever, drooling, and
inspiratory stridor. He is sitting in a "tripod" position. Which of the following is
the most appropriate initial management step?
A. Perform a thorough oral examination to visualize the airway.
B. Obtain a lateral neck X-ray to confirm the "steeple sign."
C. Keep the patient calm and prepare for emergent intubation in the OR.
D. Administer nebulized racemic epinephrine and corticosteroids.
🟢 C. Keep the patient calm and prepare for emergent intubation in the OR.
🔴 RATIONALE: This presentation is classic for epiglottitis. Any agitation or invasive
examination of the throat can trigger complete airway obstruction. Management
focuses on securing the airway in a controlled environment with anesthesia and ENT
present.
2. A 10-year-old patient in the PICU post-Fontan procedure develops sudden
hypotension and muffled heart sounds. The nurse practitioner suspects cardiac
tamponade. Which diagnostic finding is most supportive?
A. Increased pulmonary capillary wedge pressure.
B. Pulsus paradoxus.
C. Widened pulse pressure.
D. Hypertension with bradycardia.
🟢 B. Pulsus paradoxus.
🔴 RATIONALE: Pulsus paradoxus, defined as a drop in systolic blood pressure of
more than 10 mmHg during inspiration, is a hallmark sign of cardiac tamponade as the
,fluid in the pericardial sac restricts ventricular filling.
3. Which of the following lab abnormalities is most characteristic of Tumor Lysis
Syndrome (TLS) in a pediatric patient undergoing chemotherapy?
A. Hypouricemia.
B. Hypercalcemia.
C. Hyperphosphatemia.
D. Hypokalemia.
🟢 C. Hyperphosphatemia.
🔴 RATIONALE: Tumor Lysis Syndrome results from the rapid breakdown of malignant
cells, leading to the release of intracellular contents. This typically causes
hyperuricemia, hyperkalemia, hyperphosphatemia, and secondary hypocalcemia.
4. A 2-week-old infant presents with projectile non-bilious vomiting and a palpable
"olive-shaped" mass in the epigastrium. What is the initial priority in the
management of this patient?
A. Immediate surgical consultation for pyloromyotomy.
B. Administration of oral rehydration solution.
C. Correction of hypochloremic metabolic alkalosis.
D. Upper GI series to confirm the diagnosis.
🟢 C. Correction of hypochloremic metabolic alkalosis.
🔴 RATIONALE: While pyloric stenosis is a surgical condition, it is not a surgical
emergency. The priority is stabilizing the metabolic and electrolyte imbalances
, (specifically hypochloremia, hypokalemia, and alkalosis) caused by vomiting before
anesthesia.
5. A 14-year-old female with Type 1 Diabetes presents with abdominal pain,
Kussmaul respirations, and a blood glucose of 450 mg/dL. Her pH is 7.15. Which
electrolyte must be closely monitored and often replaced even if initial levels
appear normal?
A. Sodium.
B. Potassium.
C. Magnesium.
D. Bicarbonate.
🟢 B. Potassium.
🔴 RATIONALE: In Diabetic Ketoacidosis (DKA), total body potassium is depleted due
to osmotic diuresis. However, serum levels may appear normal or high due to the shift
of potassium out of cells in an acidic environment. Starting insulin will shift potassium
back into cells, potentially causing severe hypokalemia.
6. Under the Emergency Medical Treatment and Labor Act (EMTALA), what is the
primary obligation of an acute care facility when a pediatric patient presents to
the emergency department?
A. To ensure the patient has insurance before treatment.
B. To provide a medical screening exam to determine if an emergency exists.
C. To transfer the patient to a pediatric specialty center immediately.
D. To contact the primary care provider for authorization.
