NEW PNCB ACUTE CARE ACTUAL EXAM WITH
Q&A NEWLY MODIFIED EXAM 2025/2026 LATEST
A toddler presents with vomiting and altered mental status after an ingestion of a large
amount of aspirin about 45 minutes ago. Prior to the administration of activated charcoal, the
PRIORITY is to:
A. Obtain a urine drug screen
B. Ensure IV access
C. Obtain and EKG
D. Ensure adequate airway protection -- ANSWER--D. Ensure adequate airway protection
Which of the following children is MOST at risk for opiate withdrawal?
A. Infant intubated for respiratory failure receiving Dexmedetomidine (Precedex) infusion for
5 days
B. Infant intubated for respiratory failure receiving a morphine infusion for 6 days
C. Adolescent post-posterior spinal fusion receiving hydromorphone via PCA for 3 days
D. Adolescent post-cardiac surgery receiving PO oxycodone PRN for 2 days -- ANSWER--
B. Infant intubated for respiratory failure receiving a morphine infusion for 6 days
(Opiate withdrawal should be suspected in any child who has received opioids for a minimum
of 3 days. After 5 days, approximately 50% of children are expected to experience some
withdrawal symptoms. When opiates are administered for >10 days, withdrawal should be
expected in 100% of patients)
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,Following an episode of gastroenteritis, a child is diagnosed with reactive inflammatory
arthritis that is affecting joints in the lower extremities. To maximize return to the previous
level of mobility, the treatment plan should include:
A. Weight-bearing exercise plan
B. Administration of corticosteroids
C. PT & OT
D. Calcium & vitamin D supplementation -- ANSWER--C. PT & OT
(Maintain joint range of motion and strength of associated muscle groups, to decrease pain,
and to prevent contractures and deformities, all of which maximize the potential to return to
the previous level of activity).
Which of the following is the MOST likely presentation of behavioral and psychiatric
disorders in a preschooler?
A. Fear of the dark
B. Issues with identity formation
C. Learning disabilities
D. Frequent temper tantrums -- ANSWER--D. Frequent temper tantrums
Routine preventive healthcare for an infant with sickle cell disease includes
A. The MMR vaccine at 6 months of age
B. Penicillin prophylaxis until 5 years of age
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,C. Pneumococcal polysaccharide vaccine at 6 months of age
D. Sulfamethoxazole-trimethoprim prophylaxis until 5 years of age -- ANSWER--B.
Penicillin prophylaxis until 5 years of age
Enteral nutrition is initiated in a child with severe malnutrition. Laboratory values indicative
of refeeding syndrome include a magnesium level of 1.5 mg/dL, and:
A. Phosphate 3.0 ml/dL & potassium 2.8 mEq/L
B. Phosphate 3.0 ml/dL & potassium 6 mEq/L
C. Phosphate 7.0 ml/dL & potassium 2.8 mEq/L
D. Phosphate 7.0 ml/dL & potassium 6 mEq/L -- ANSWER--A. Phosphate 3.0 ml/dL &
potassium 2.8 mEq/L
(Refeeding syndrome occurs when malnourished patients are refed too aggressively leading.
It can occur within 1-3 days after reinstitution of nutrition.
The major manifestations include fluid overload, hypophosphatemia (phosphate less than 3.5
mg/dL), hypokalemia (potassium less than 3.5 mEq/L), hypomagnesemia (magnesium less
than 1.8 mg/dL), and thiamine deficiency. Complications include heart failure, dysrhythmias,
respiratory muscle weakness, seizures,
When informing a family that a report is being made to Child Protective Services for
suspected abuse, it is MOST important to
A. Focus on the child's well being
B. Identify the suspected perpetrator
C. Identify legal requirements for mandatory reporting
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, D. Share details with family to avoid misunderstanding -- ANSWER--A. Focus on the child's
well being
Manifestations of abdominal injuries secondary to a blast mechanism are typically:
A. Acute & immediately apparent
B. Observed less than 6 hours after exposure
C. Delayed 8-36 hours after exposure
D. Chronic & slow to develop -- ANSWER--C. Delayed 8-36 hours after exposure
(Blast attack, as seen in explosions, causes extensive compression and distortion of the
gastrointestinal (GI) tract & other air-filled organs. Manifestations generally delayed,
presenting 8-36 hours after exposure.)
In a child with myasthenia gravis, which of the following symptoms would be MOST
indicative of a myasthenic crisis?
A. Eye drooling
B. Respiratory distress
C. Excessive salivation
D. Muscle fasciculation -- ANSWER--B. Respiratory distress
(Characterized by weakness and fatigue of skeletal muscle tissue that results from
autoimmune destruction of acetylcholine receptors (AchR). A crisis event, or myasthenic
crisis, is an acute exacerbation of the disease process that results in severe weakness from
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Q&A NEWLY MODIFIED EXAM 2025/2026 LATEST
A toddler presents with vomiting and altered mental status after an ingestion of a large
amount of aspirin about 45 minutes ago. Prior to the administration of activated charcoal, the
PRIORITY is to:
A. Obtain a urine drug screen
B. Ensure IV access
C. Obtain and EKG
D. Ensure adequate airway protection -- ANSWER--D. Ensure adequate airway protection
Which of the following children is MOST at risk for opiate withdrawal?
A. Infant intubated for respiratory failure receiving Dexmedetomidine (Precedex) infusion for
5 days
B. Infant intubated for respiratory failure receiving a morphine infusion for 6 days
C. Adolescent post-posterior spinal fusion receiving hydromorphone via PCA for 3 days
D. Adolescent post-cardiac surgery receiving PO oxycodone PRN for 2 days -- ANSWER--
B. Infant intubated for respiratory failure receiving a morphine infusion for 6 days
(Opiate withdrawal should be suspected in any child who has received opioids for a minimum
of 3 days. After 5 days, approximately 50% of children are expected to experience some
withdrawal symptoms. When opiates are administered for >10 days, withdrawal should be
expected in 100% of patients)
Page 1 of 113
,Following an episode of gastroenteritis, a child is diagnosed with reactive inflammatory
arthritis that is affecting joints in the lower extremities. To maximize return to the previous
level of mobility, the treatment plan should include:
A. Weight-bearing exercise plan
B. Administration of corticosteroids
C. PT & OT
D. Calcium & vitamin D supplementation -- ANSWER--C. PT & OT
(Maintain joint range of motion and strength of associated muscle groups, to decrease pain,
and to prevent contractures and deformities, all of which maximize the potential to return to
the previous level of activity).
Which of the following is the MOST likely presentation of behavioral and psychiatric
disorders in a preschooler?
A. Fear of the dark
B. Issues with identity formation
C. Learning disabilities
D. Frequent temper tantrums -- ANSWER--D. Frequent temper tantrums
Routine preventive healthcare for an infant with sickle cell disease includes
A. The MMR vaccine at 6 months of age
B. Penicillin prophylaxis until 5 years of age
Page 2 of 113
,C. Pneumococcal polysaccharide vaccine at 6 months of age
D. Sulfamethoxazole-trimethoprim prophylaxis until 5 years of age -- ANSWER--B.
Penicillin prophylaxis until 5 years of age
Enteral nutrition is initiated in a child with severe malnutrition. Laboratory values indicative
of refeeding syndrome include a magnesium level of 1.5 mg/dL, and:
A. Phosphate 3.0 ml/dL & potassium 2.8 mEq/L
B. Phosphate 3.0 ml/dL & potassium 6 mEq/L
C. Phosphate 7.0 ml/dL & potassium 2.8 mEq/L
D. Phosphate 7.0 ml/dL & potassium 6 mEq/L -- ANSWER--A. Phosphate 3.0 ml/dL &
potassium 2.8 mEq/L
(Refeeding syndrome occurs when malnourished patients are refed too aggressively leading.
It can occur within 1-3 days after reinstitution of nutrition.
The major manifestations include fluid overload, hypophosphatemia (phosphate less than 3.5
mg/dL), hypokalemia (potassium less than 3.5 mEq/L), hypomagnesemia (magnesium less
than 1.8 mg/dL), and thiamine deficiency. Complications include heart failure, dysrhythmias,
respiratory muscle weakness, seizures,
When informing a family that a report is being made to Child Protective Services for
suspected abuse, it is MOST important to
A. Focus on the child's well being
B. Identify the suspected perpetrator
C. Identify legal requirements for mandatory reporting
Page 3 of 113
, D. Share details with family to avoid misunderstanding -- ANSWER--A. Focus on the child's
well being
Manifestations of abdominal injuries secondary to a blast mechanism are typically:
A. Acute & immediately apparent
B. Observed less than 6 hours after exposure
C. Delayed 8-36 hours after exposure
D. Chronic & slow to develop -- ANSWER--C. Delayed 8-36 hours after exposure
(Blast attack, as seen in explosions, causes extensive compression and distortion of the
gastrointestinal (GI) tract & other air-filled organs. Manifestations generally delayed,
presenting 8-36 hours after exposure.)
In a child with myasthenia gravis, which of the following symptoms would be MOST
indicative of a myasthenic crisis?
A. Eye drooling
B. Respiratory distress
C. Excessive salivation
D. Muscle fasciculation -- ANSWER--B. Respiratory distress
(Characterized by weakness and fatigue of skeletal muscle tissue that results from
autoimmune destruction of acetylcholine receptors (AchR). A crisis event, or myasthenic
crisis, is an acute exacerbation of the disease process that results in severe weakness from
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