Lippincott ACPNP Self
Assessment #1 Comprehensive
Questions (Frequently Tested)
with Verified Answers Graded
A+
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 - Answer: 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.
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. - Answer: 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.
An 8-year-old with cystic fibrosis (CF) is being treated for Pseudomonas aeruginosa 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. - Answer: 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 effects 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.
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. - Answer: c. Obtaining an inspiratory/expiratory chest radiograph
assists in evaluating lung deflation on exhalation and presence of unilateral air trapping. Pleural
effusions 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.
A 4-month-old infant was found gasping for breath in his crib. He was supported 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:
a. Pneumonia.
b. Meningitis.
c. Reactive airway disease.
d. Pulmonary edema. - Answer: d. The clinical presentation of a child with suspected pulmonary
edema can include tachypnea, dyspnea, tachycardia, hypoxia, and wheezing. Cough with frothy
sputum (often pink), diaphoresis, orthopnea, and paroxysmal nocturnal dyspnea with increased
work of breathing are other clinical findings. On auscultation, crackles may be heard along with
a third heart tone or gallop, which is indicative of cardiogenic pulmonary edema.
A child in cardiogenic shock is being treated with dobutamine. What is the mechanism of action
of this medication?
a. Increasing contractility and promoting peripheral vasodilation.
b. Increasing contractility and increasing peripheral vasoconstriction.
c. Increasing heart rate and increasing renal perfusion.
d. Decreasing heart rate and decreasing systemic vascular resistance. - Answer: A. Dobutamine
is used to treat cardiogenic shock and works by increasing contractility and promoting
peripheral vasodilation. It will also increase renal perfusion and urine output.
A teenager presents with cardiac tamponade following involvement in a motor vehicle crash at
high speed. Clinical findings will include:
a. Hypotension, distended jugular veins, and distant heart sounds.
b. Hypertension, distant heart sounds, and widened pulse pressure.
, c. Distended jugular veins, hypertension, and bradycardia.
d. Hypotension, widened pulse pressure, and bradycardia. - Answer: A. Cardiac tamponade
occurs as a result of several mechanisms including trauma. Clinical presentation includes Beck
triad: hypotension—from low cardiac output; distended neck (jugular) veins—from heart
compression; and muffled (distant) heart sounds—from fluid in pericardial space. Patients often
have pulsus paradoxus with a narrow pulse pressure, altered neurologic status, audible
pericardial rub, and shock with tachycardia and tachypnea.
A teenager with confirmed HIV infection presents with a persistent nonproductive cough for the
past 3 weeks. The patient has been routinely taking his antiviral therapy, but states that school
has been so busy that he sometimes forgets to take some of his medications. He appears stable
but has a respiratory rate of 32 breaths/minute and a pulse oximeter reading of 88% on room
air. Breath sounds are clear. A chest radiograph demonstrates "diffuse haziness in both lung
fields but no focal consolidation." Which diagnosis is highest on the differential list?
a. Streptococcus pneumoniae pneumonia.
b. Viral respiratory tract infection.
c. Pneumocystis jirovecii.
d. Tuberculosis. - Answer: c. Bacterial pneumonia, while overall much more common than
Pneumocystis, usually has a focal finding on chest radiograph and typically causes fever. Viral
infections are usually associated with other symptoms such as rhinorrhea and cough.
Tuberculosis is a reasonable concern, but usually does not cause persistent tachypnea or oxygen
desaturations. Hilar adenopathy on chest radiograph would make the diagnosis more likely.
Pneumocystis jirovecii is likely as it is common in immunocompromised patients, and without
prophylaxis, it would be highest on the differential diagnosis.
The most common pathogens causing meningitis in infants between the ages of 1 and 3 months
include which of the following?
a. Haemophilus influenzae type b, Streptococcus pneumoniae, Neisseria meningitidis.
b. Listeria monocytogenes, Streptococcus pneumoniae, Neisseria meningitidis.
c. Haemophilus influenzae type b, Chlamydia trachomatis, Escherichia coli.
d. Escherichia coli, Listeria monocytogenes, Chlamydia trachomatis. - Answer: a. There are a
variety of organisms that are responsible for causing meningitis in the newborn period, but
Assessment #1 Comprehensive
Questions (Frequently Tested)
with Verified Answers Graded
A+
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 - Answer: 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.
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. - Answer: 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.
An 8-year-old with cystic fibrosis (CF) is being treated for Pseudomonas aeruginosa 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. - Answer: 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 effects 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.
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. - Answer: c. Obtaining an inspiratory/expiratory chest radiograph
assists in evaluating lung deflation on exhalation and presence of unilateral air trapping. Pleural
effusions 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.
A 4-month-old infant was found gasping for breath in his crib. He was supported 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:
a. Pneumonia.
b. Meningitis.
c. Reactive airway disease.
d. Pulmonary edema. - Answer: d. The clinical presentation of a child with suspected pulmonary
edema can include tachypnea, dyspnea, tachycardia, hypoxia, and wheezing. Cough with frothy
sputum (often pink), diaphoresis, orthopnea, and paroxysmal nocturnal dyspnea with increased
work of breathing are other clinical findings. On auscultation, crackles may be heard along with
a third heart tone or gallop, which is indicative of cardiogenic pulmonary edema.
A child in cardiogenic shock is being treated with dobutamine. What is the mechanism of action
of this medication?
a. Increasing contractility and promoting peripheral vasodilation.
b. Increasing contractility and increasing peripheral vasoconstriction.
c. Increasing heart rate and increasing renal perfusion.
d. Decreasing heart rate and decreasing systemic vascular resistance. - Answer: A. Dobutamine
is used to treat cardiogenic shock and works by increasing contractility and promoting
peripheral vasodilation. It will also increase renal perfusion and urine output.
A teenager presents with cardiac tamponade following involvement in a motor vehicle crash at
high speed. Clinical findings will include:
a. Hypotension, distended jugular veins, and distant heart sounds.
b. Hypertension, distant heart sounds, and widened pulse pressure.
, c. Distended jugular veins, hypertension, and bradycardia.
d. Hypotension, widened pulse pressure, and bradycardia. - Answer: A. Cardiac tamponade
occurs as a result of several mechanisms including trauma. Clinical presentation includes Beck
triad: hypotension—from low cardiac output; distended neck (jugular) veins—from heart
compression; and muffled (distant) heart sounds—from fluid in pericardial space. Patients often
have pulsus paradoxus with a narrow pulse pressure, altered neurologic status, audible
pericardial rub, and shock with tachycardia and tachypnea.
A teenager with confirmed HIV infection presents with a persistent nonproductive cough for the
past 3 weeks. The patient has been routinely taking his antiviral therapy, but states that school
has been so busy that he sometimes forgets to take some of his medications. He appears stable
but has a respiratory rate of 32 breaths/minute and a pulse oximeter reading of 88% on room
air. Breath sounds are clear. A chest radiograph demonstrates "diffuse haziness in both lung
fields but no focal consolidation." Which diagnosis is highest on the differential list?
a. Streptococcus pneumoniae pneumonia.
b. Viral respiratory tract infection.
c. Pneumocystis jirovecii.
d. Tuberculosis. - Answer: c. Bacterial pneumonia, while overall much more common than
Pneumocystis, usually has a focal finding on chest radiograph and typically causes fever. Viral
infections are usually associated with other symptoms such as rhinorrhea and cough.
Tuberculosis is a reasonable concern, but usually does not cause persistent tachypnea or oxygen
desaturations. Hilar adenopathy on chest radiograph would make the diagnosis more likely.
Pneumocystis jirovecii is likely as it is common in immunocompromised patients, and without
prophylaxis, it would be highest on the differential diagnosis.
The most common pathogens causing meningitis in infants between the ages of 1 and 3 months
include which of the following?
a. Haemophilus influenzae type b, Streptococcus pneumoniae, Neisseria meningitidis.
b. Listeria monocytogenes, Streptococcus pneumoniae, Neisseria meningitidis.
c. Haemophilus influenzae type b, Chlamydia trachomatis, Escherichia coli.
d. Escherichia coli, Listeria monocytogenes, Chlamydia trachomatis. - Answer: a. There are a
variety of organisms that are responsible for causing meningitis in the newborn period, but
