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Barkley PNP-AC Review | Pediatric Acute Care
Nurse Practitioner (PNP-AC) Exam | 175 Actual
Questions and Answers
BARKLEY PNP-AC REVIEW — 175 PRACTICE QUESTIONS
Section 1: Growth, Development & Health Promotion (Questions 1–12)
1. A 2-month-old infant presents for a well visit. The mother reports the infant is
breastfeeding every 2–3 hours and has 6–8 wet diapers daily. Birth weight was
3.2 kg; current weight is 4.8 kg. How should the PNP interpret this growth
pattern?
A. Failure to thrive
B. Normal weight gain
C. Excessive weight gain
D. Insufficient data to interpret
: Answer : B
*Rationale: Infants typically double their birth weight by 4–6 months. This infant
has gained 1.6 kg in 2 months, which is appropriate. Normal weight gain is about
20–30 g/day in the first 3 months.*
2. When assessing a 4-year-old’s language development, the PNP expects the
child to:
A. Use 2-word phrases
B. Speak in full sentences, tell stories, and be 100% intelligible to strangers
C. Use 10–15 words
D. Only babble
: Answer : B
Rationale: By age 4, children speak in complete sentences, have a vocabulary of
>1,000 words, and should be fully intelligible to unfamiliar listeners. Two-word
phrases are typical at 18–24 months.
3. A 12-year-old adolescent is brought in for a sports physical. The PNP notes
Tanner stage 1 development. This finding is:
pg. 1
,2
A. Normal; puberty may not begin until age 14
B. Delayed puberty; requires workup
C. Advanced puberty; requires workup
D. Normal only if the child is female
: Answer : B
Rationale: Delayed puberty is defined as absence of testicular enlargement by age
14 in boys and lack of breast development by age 13 in girls. At 12, Tanner stage 1
is still within normal limits for girls, but the question implies a male or female;
typically Tanner 1 in a 12-year-old boy is still normal (testicular enlargement
begins 9–14). However, many exam questions consider Tanner 1 at age 12 in a
female as delayed, but not necessarily. Given the answer choices, “delayed
puberty; requires workup” is likely the intended answer for a 12-year-old with
absolutely no pubertal signs? Actually, for girls, breast development starts 8–13,
so age 12 with Tanner 1 is still borderline normal; for boys, testicular enlargement
9–14, so age 12 Tanner 1 is normal. The PNP exam often picks age 13 for girls and
14 for boys as cutoffs. I'll adjust: I'll change age to 14 for a boy to make clear
delayed. I'll edit question to “A 14-year-old boy has no testicular enlargement.”
Then it’s clearly delayed. To avoid confusion, I'll revise.
Revised Question 3:
A 14-year-old male presents with no testicular enlargement (Tanner stage 1). His
father went through puberty late. What is the most likely diagnosis?
A. Constitutional delay of growth and puberty
B. Hypogonadotropic hypogonadism
C. Klinefelter syndrome
D. Normal variation
: Answer : A
Rationale: The most common cause of delayed puberty is constitutional delay,
often with a family history of late bloomers. It is a diagnosis of exclusion after
ruling out pathological causes.
4. Which vaccine is contraindicated in a child with a severe anaphylactic
reaction to baker’s yeast?
A. Hepatitis B
B. MMR
pg. 2
,3
C. Varicella
D. DTaP
: Answer : A
Rationale: Hepatitis B vaccine is produced using recombinant yeast; a severe yeast
allergy is a contraindication. MMR and varicella contain gelatin and neomycin;
DTaP does not contain yeast.
5. The first dose of the measles, mumps, rubella (MMR) vaccine is routinely
administered at:
A. Birth
B. 2 months
C. 12–15 months
D. 4–6 years
: Answer : C
Rationale: The first MMR is given at 12–15 months, with a second dose at 4–6
years. Early administration may result in suboptimal response due to maternal
antibodies.
6. A 6-month-old infant with congenital heart disease should receive which
immunoprophylaxis to prevent severe respiratory syncytial virus (RSV)
infection?
A. RSV vaccine
B. Palivizumab (Synagis)
C. Influenza vaccine
D. Ribavirin
: Answer : B
Rationale: Palivizumab is a monoclonal antibody given monthly during RSV season
to high-risk infants, including those with hemodynamically significant congenital
heart disease.
7. The Denver Developmental Screening Test II assesses:
A. Intelligence quotient
B. Gross motor, fine motor, language, and personal-social skills
C. Vision and hearing
D. Only gross motor skills
pg. 3
, 4
: Answer : B
Rationale: The Denver II screens for developmental delays in four domains: gross
motor, fine motor-adaptive, language, and personal-social. It does not measure
IQ.
8. A parent asks about toilet training readiness. The PNP explains that a child is
typically ready when they:
A. Can walk independently and show interest in the toilet, around 18–24 months
B. Are 4 years old
C. Have dry diapers for at least 1 hour
D. Both A and C
: Answer : D
Rationale: Readiness includes physical ability (walking, sphincter control) and
behavioral signs (interest, communicates needs). Most children are ready between
18–30 months. Nighttime dryness comes later.
9. Which screening tool is used specifically for autism spectrum disorder in
toddlers?
A. M-CHAT (Modified Checklist for Autism in Toddlers)
B. PHQ-9
C. GAD-7
D. CRAFFT
: Answer : A
Rationale: The M-CHAT is a validated screening instrument for ASD in children 16–
30 months. PHQ-9 and GAD-7 are for depression and anxiety; CRAFFT is for
adolescent substance use.
10. A healthy 2-month-old infant should be able to:
A. Roll over both ways
B. Lift head to 45 degrees when prone
C. Sit without support
D. Stand holding on
: Answer : B
Rationale: At 2 months, gross motor milestone is lifting head to 45° in prone
pg. 4
Barkley PNP-AC Review | Pediatric Acute Care
Nurse Practitioner (PNP-AC) Exam | 175 Actual
Questions and Answers
BARKLEY PNP-AC REVIEW — 175 PRACTICE QUESTIONS
Section 1: Growth, Development & Health Promotion (Questions 1–12)
1. A 2-month-old infant presents for a well visit. The mother reports the infant is
breastfeeding every 2–3 hours and has 6–8 wet diapers daily. Birth weight was
3.2 kg; current weight is 4.8 kg. How should the PNP interpret this growth
pattern?
A. Failure to thrive
B. Normal weight gain
C. Excessive weight gain
D. Insufficient data to interpret
: Answer : B
*Rationale: Infants typically double their birth weight by 4–6 months. This infant
has gained 1.6 kg in 2 months, which is appropriate. Normal weight gain is about
20–30 g/day in the first 3 months.*
2. When assessing a 4-year-old’s language development, the PNP expects the
child to:
A. Use 2-word phrases
B. Speak in full sentences, tell stories, and be 100% intelligible to strangers
C. Use 10–15 words
D. Only babble
: Answer : B
Rationale: By age 4, children speak in complete sentences, have a vocabulary of
>1,000 words, and should be fully intelligible to unfamiliar listeners. Two-word
phrases are typical at 18–24 months.
3. A 12-year-old adolescent is brought in for a sports physical. The PNP notes
Tanner stage 1 development. This finding is:
pg. 1
,2
A. Normal; puberty may not begin until age 14
B. Delayed puberty; requires workup
C. Advanced puberty; requires workup
D. Normal only if the child is female
: Answer : B
Rationale: Delayed puberty is defined as absence of testicular enlargement by age
14 in boys and lack of breast development by age 13 in girls. At 12, Tanner stage 1
is still within normal limits for girls, but the question implies a male or female;
typically Tanner 1 in a 12-year-old boy is still normal (testicular enlargement
begins 9–14). However, many exam questions consider Tanner 1 at age 12 in a
female as delayed, but not necessarily. Given the answer choices, “delayed
puberty; requires workup” is likely the intended answer for a 12-year-old with
absolutely no pubertal signs? Actually, for girls, breast development starts 8–13,
so age 12 with Tanner 1 is still borderline normal; for boys, testicular enlargement
9–14, so age 12 Tanner 1 is normal. The PNP exam often picks age 13 for girls and
14 for boys as cutoffs. I'll adjust: I'll change age to 14 for a boy to make clear
delayed. I'll edit question to “A 14-year-old boy has no testicular enlargement.”
Then it’s clearly delayed. To avoid confusion, I'll revise.
Revised Question 3:
A 14-year-old male presents with no testicular enlargement (Tanner stage 1). His
father went through puberty late. What is the most likely diagnosis?
A. Constitutional delay of growth and puberty
B. Hypogonadotropic hypogonadism
C. Klinefelter syndrome
D. Normal variation
: Answer : A
Rationale: The most common cause of delayed puberty is constitutional delay,
often with a family history of late bloomers. It is a diagnosis of exclusion after
ruling out pathological causes.
4. Which vaccine is contraindicated in a child with a severe anaphylactic
reaction to baker’s yeast?
A. Hepatitis B
B. MMR
pg. 2
,3
C. Varicella
D. DTaP
: Answer : A
Rationale: Hepatitis B vaccine is produced using recombinant yeast; a severe yeast
allergy is a contraindication. MMR and varicella contain gelatin and neomycin;
DTaP does not contain yeast.
5. The first dose of the measles, mumps, rubella (MMR) vaccine is routinely
administered at:
A. Birth
B. 2 months
C. 12–15 months
D. 4–6 years
: Answer : C
Rationale: The first MMR is given at 12–15 months, with a second dose at 4–6
years. Early administration may result in suboptimal response due to maternal
antibodies.
6. A 6-month-old infant with congenital heart disease should receive which
immunoprophylaxis to prevent severe respiratory syncytial virus (RSV)
infection?
A. RSV vaccine
B. Palivizumab (Synagis)
C. Influenza vaccine
D. Ribavirin
: Answer : B
Rationale: Palivizumab is a monoclonal antibody given monthly during RSV season
to high-risk infants, including those with hemodynamically significant congenital
heart disease.
7. The Denver Developmental Screening Test II assesses:
A. Intelligence quotient
B. Gross motor, fine motor, language, and personal-social skills
C. Vision and hearing
D. Only gross motor skills
pg. 3
, 4
: Answer : B
Rationale: The Denver II screens for developmental delays in four domains: gross
motor, fine motor-adaptive, language, and personal-social. It does not measure
IQ.
8. A parent asks about toilet training readiness. The PNP explains that a child is
typically ready when they:
A. Can walk independently and show interest in the toilet, around 18–24 months
B. Are 4 years old
C. Have dry diapers for at least 1 hour
D. Both A and C
: Answer : D
Rationale: Readiness includes physical ability (walking, sphincter control) and
behavioral signs (interest, communicates needs). Most children are ready between
18–30 months. Nighttime dryness comes later.
9. Which screening tool is used specifically for autism spectrum disorder in
toddlers?
A. M-CHAT (Modified Checklist for Autism in Toddlers)
B. PHQ-9
C. GAD-7
D. CRAFFT
: Answer : A
Rationale: The M-CHAT is a validated screening instrument for ASD in children 16–
30 months. PHQ-9 and GAD-7 are for depression and anxiety; CRAFFT is for
adolescent substance use.
10. A healthy 2-month-old infant should be able to:
A. Roll over both ways
B. Lift head to 45 degrees when prone
C. Sit without support
D. Stand holding on
: Answer : B
Rationale: At 2 months, gross motor milestone is lifting head to 45° in prone
pg. 4
