PNP-AC (Pediatric Nurse Practitioner
Acute Care) practice exam CORRECT
ACTUAL QUESTIONS AND CORRECTLY
WELL DEFINED ANSWERS LATEST
ALREADY GRADED A+ (2025/2026).,
1. A 6-year-old with a history of asthma presents to the emergency department with
respiratory distress, retractions, and oxygen saturation 88% on room air. He is speaking
in 2-3 word sentences. Which is the most appropriate initial intervention?
A) Oral prednisone
B) Nebulized albuterol and ipratropium bromide, plus systemic corticosteroids
C) Intubation and mechanical ventilation
D) Heliox therapy
Correct ,,,,Answer,,,,: B – Nebulized albuterol/ipratropium + systemic corticosteroids
(moderate-severe exacerbation)
Rationale: Acute asthma exacerbation: first-line is rapid-acting bronchodilators and
systemic steroids. Intubation if impending failure.
2. A 2-month-old presents with fever (38.5°C), irritability, and poor feeding. The infant
appears well otherwise. According to guidelines, which evaluation is required?
A) Complete blood count and blood culture only
,B) Full septic workup (blood, urine, CSF) and empirical antibiotics
C) Observation without testing
D) Urinalysis only
Correct ,,,,Answer,,,,: B – Full septic workup (fever in infant ≤60 days)
Rationale: Infants ≤60 days with fever require blood, urine (catheter), and CSF studies;
admit for IV antibiotics pending cultures.
3. A 5-year-old with repaired tetralogy of Fallot presents with sudden-onset dyspnea
and syncope. ECG shows a wide complex tachycardia. Which arrhythmia is most likely?
A) Atrial flutter
B) Ventricular tachycardia (due to prior right ventriculotomy scar)
C) Supraventricular tachycardia
D) Sinus tachycardia
Correct ,,,,Answer,,,,: B – Ventricular tachycardia (post-repair ventricular scarring)
Rationale: Patients with tetralogy of Fallot repair are at risk for re-entrant ventricular
tachycardia. Emergent cardiology consultation.
4. A 10-year-old with acute appendicitis undergoes laparoscopic appendectomy.
Postoperatively, she reports persistent right lower quadrant pain and has a fever of
39°C. WBC is 18,000/mm³. Which complication is most likely?
A) Ileus
B) Intra-abdominal abscess
C) Wound infection
D) Perforated viscus
,Correct ,,,,Answer,,,,: B – Intra-abdominal abscess (post-appendectomy fever, pain,
leukocytosis)
Rationale: CT abdomen to confirm; percutaneous drainage and antibiotics.
5. A 4-week-old with projectile vomiting after feeds is hungry and has visible
peristalsis. A palpable olive-shaped mass is felt in the right upper quadrant. Which
metabolic abnormality is expected?
A) Hypochloremic metabolic alkalosis
B) Hyperchloremic metabolic acidosis
C) Hypernatremia
D) Hypoglycemia
Correct ,,,,Answer,,,,: A – Hypochloremic metabolic alkalosis (pyloric stenosis)
Rationale: Loss of gastric acid (HCl) causes hypochloremia, hypokalemia, and metabolic
alkalosis. Correct with saline and potassium before surgery.
6. A 7-year-old with newly diagnosed type 1 diabetes presents with nausea, vomiting,
abdominal pain, and Kussmaul breathing. Capillary glucose is 550 mg/dL. Which lab
finding is most consistent with diabetic ketoacidosis (DKA)?
A) pH 7.35, HCO₃ 22 mEq/L
B) pH 7.20, HCO₃ 12 mEq/L, elevated beta-hydroxybutyrate
C) pH 7.45, HCO₃ 28 mEq/L
D) pH 7.30, HCO₃ 18 mEq/L, normal ketones
Correct ,,,,Answer,,,,: B – Metabolic acidosis with ketonemia (DKA)
Rationale: DKA: pH <7.3, HCO₃ <18, elevated ketones. Treatment: IV fluids, insulin infusion,
monitor potassium.
, 7. A 16-year-old with sickle cell disease presents with chest pain, fever, and
hypoxemia. Chest X-ray shows a new infiltrate. Which condition is the most likely
cause?
A) Pneumonia
B) Pulmonary embolism
C) Acute chest syndrome
D) Asthma exacerbation
Correct ,,,,Answer,,,,: C – Acute chest syndrome (sickle cell complication)
Rationale: Acute chest syndrome: fever, respiratory symptoms, new pulmonary
infiltrate. Treat with oxygen, IV fluids, pain control, antibiotics, and exchange
transfusion if severe.
8. A 3-year-old presents with stridor, drooling, and tripod positioning. He has a fever of
104°F and is toxic-appearing. Which intervention is most appropriate?
A) Lateral neck X-ray
B) Direct pharyngeal examination with tongue depressor
C) Emergent intubation in a controlled setting (OR/ICU)
D) Nebulized racemic epinephrine
Correct ,,,,Answer,,,,: C – Controlled intubation (suspected epiglottitis)
Rationale: Do not agitate child; do not examine throat. Immediate airway management
by anesthesia/ENT.
Acute Care) practice exam CORRECT
ACTUAL QUESTIONS AND CORRECTLY
WELL DEFINED ANSWERS LATEST
ALREADY GRADED A+ (2025/2026).,
1. A 6-year-old with a history of asthma presents to the emergency department with
respiratory distress, retractions, and oxygen saturation 88% on room air. He is speaking
in 2-3 word sentences. Which is the most appropriate initial intervention?
A) Oral prednisone
B) Nebulized albuterol and ipratropium bromide, plus systemic corticosteroids
C) Intubation and mechanical ventilation
D) Heliox therapy
Correct ,,,,Answer,,,,: B – Nebulized albuterol/ipratropium + systemic corticosteroids
(moderate-severe exacerbation)
Rationale: Acute asthma exacerbation: first-line is rapid-acting bronchodilators and
systemic steroids. Intubation if impending failure.
2. A 2-month-old presents with fever (38.5°C), irritability, and poor feeding. The infant
appears well otherwise. According to guidelines, which evaluation is required?
A) Complete blood count and blood culture only
,B) Full septic workup (blood, urine, CSF) and empirical antibiotics
C) Observation without testing
D) Urinalysis only
Correct ,,,,Answer,,,,: B – Full septic workup (fever in infant ≤60 days)
Rationale: Infants ≤60 days with fever require blood, urine (catheter), and CSF studies;
admit for IV antibiotics pending cultures.
3. A 5-year-old with repaired tetralogy of Fallot presents with sudden-onset dyspnea
and syncope. ECG shows a wide complex tachycardia. Which arrhythmia is most likely?
A) Atrial flutter
B) Ventricular tachycardia (due to prior right ventriculotomy scar)
C) Supraventricular tachycardia
D) Sinus tachycardia
Correct ,,,,Answer,,,,: B – Ventricular tachycardia (post-repair ventricular scarring)
Rationale: Patients with tetralogy of Fallot repair are at risk for re-entrant ventricular
tachycardia. Emergent cardiology consultation.
4. A 10-year-old with acute appendicitis undergoes laparoscopic appendectomy.
Postoperatively, she reports persistent right lower quadrant pain and has a fever of
39°C. WBC is 18,000/mm³. Which complication is most likely?
A) Ileus
B) Intra-abdominal abscess
C) Wound infection
D) Perforated viscus
,Correct ,,,,Answer,,,,: B – Intra-abdominal abscess (post-appendectomy fever, pain,
leukocytosis)
Rationale: CT abdomen to confirm; percutaneous drainage and antibiotics.
5. A 4-week-old with projectile vomiting after feeds is hungry and has visible
peristalsis. A palpable olive-shaped mass is felt in the right upper quadrant. Which
metabolic abnormality is expected?
A) Hypochloremic metabolic alkalosis
B) Hyperchloremic metabolic acidosis
C) Hypernatremia
D) Hypoglycemia
Correct ,,,,Answer,,,,: A – Hypochloremic metabolic alkalosis (pyloric stenosis)
Rationale: Loss of gastric acid (HCl) causes hypochloremia, hypokalemia, and metabolic
alkalosis. Correct with saline and potassium before surgery.
6. A 7-year-old with newly diagnosed type 1 diabetes presents with nausea, vomiting,
abdominal pain, and Kussmaul breathing. Capillary glucose is 550 mg/dL. Which lab
finding is most consistent with diabetic ketoacidosis (DKA)?
A) pH 7.35, HCO₃ 22 mEq/L
B) pH 7.20, HCO₃ 12 mEq/L, elevated beta-hydroxybutyrate
C) pH 7.45, HCO₃ 28 mEq/L
D) pH 7.30, HCO₃ 18 mEq/L, normal ketones
Correct ,,,,Answer,,,,: B – Metabolic acidosis with ketonemia (DKA)
Rationale: DKA: pH <7.3, HCO₃ <18, elevated ketones. Treatment: IV fluids, insulin infusion,
monitor potassium.
, 7. A 16-year-old with sickle cell disease presents with chest pain, fever, and
hypoxemia. Chest X-ray shows a new infiltrate. Which condition is the most likely
cause?
A) Pneumonia
B) Pulmonary embolism
C) Acute chest syndrome
D) Asthma exacerbation
Correct ,,,,Answer,,,,: C – Acute chest syndrome (sickle cell complication)
Rationale: Acute chest syndrome: fever, respiratory symptoms, new pulmonary
infiltrate. Treat with oxygen, IV fluids, pain control, antibiotics, and exchange
transfusion if severe.
8. A 3-year-old presents with stridor, drooling, and tripod positioning. He has a fever of
104°F and is toxic-appearing. Which intervention is most appropriate?
A) Lateral neck X-ray
B) Direct pharyngeal examination with tongue depressor
C) Emergent intubation in a controlled setting (OR/ICU)
D) Nebulized racemic epinephrine
Correct ,,,,Answer,,,,: C – Controlled intubation (suspected epiglottitis)
Rationale: Do not agitate child; do not examine throat. Immediate airway management
by anesthesia/ENT.
