PNCB ACUTE CARE CERTIFICATION PRACTICE
TEST 2025/2026 ACTUAL REAL EXAM WITH
COMPLETE QUESTIONS WITH DETAILED
Page | 1
CORRECT ANSWERS WITH RATIONALE EXPERT
VERIFIED FOR GUARANTEED PASS|
TOP RATED A+.
PNCB
Pass the PNCB Acute Care Certification Exam 2025/2026 with confidence.
This exam features questions in areas like: acute and chronic pediatric
conditions, diagnostic reasoning, pharmacology, emergency interventions,
and family-centered care. Best ideal to pediatric nurse practitioners (PNPs)
seeking board certification in acute care through the Pediatric Nursing
Certification Board (PNCB).
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
Rationale: (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 dysfunction of the
, neuromuscular junctions. It is characterized by respiratory failure due to
weakness of the airway or respiratory muscles.
A cholinergic crisis, is a severe weakness caused by overtreatment with
Page | 2 cholinergic medications used to treat MG & crisis present with excessive
salivation, excessive lacrimation, diarrhea, sweating, pupillary
constriction, and muscle fasciculation.
A child with a history of congenital heart disease fell while playing and
presents with a closed fracture of the humerus. Physical exam reveals
mild bradycardia and a moderate pain score.
Which of the following medications would MOST likely explain this
child's bradycardia?
A. Enalapril (Vasotec)
B. Furosemide (Lasix)
C. Levothyroxine (Synthroid)
D. Propranolol (Inderal) ..... ANSWER ....... D. Propranolol (Inderal)
Rationale: (Decreases heart rate, myocardial contractility, blood pressure,
and myocardial oxygen demand. Adverse effects include bradycardia,
hypotension, and atrioventricular conduction disturbances)
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
Page | 3
Rationale: (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
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
Page | 4
Rationale: (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.)
A previously healthy preschooler who is fully immunized, presents with a
history of fever, URI symptoms, & joint pain over the past several days.
Physical exam reveals petechiae and hepatosplenomegaly. Vital signs
include HR 156, RR 32, temp 101.6 (38.7), BP 86/44 & O2 98% on RA.
Lab results include Na+ 132, K+ 6, Glucose 100, Ca+ 0.95, Phos 6.3,
WBC 105,000, Hgb 6.1 & Plt 10,000. Which is the BEST course of
action?
A. Obtain LFTS & type & cross for blood products
B. Administer calcium gluconate & consult nephrology
C. Obtain blood cultures & administer IV Ceftriaxone
D. Administer a fluid bolus & consult oncology ..... ANSWER .......
D. Administer a fluid bolus & consult oncology
Rationale: (The combination of leukocytosis, thrombocytopenia, and
anemia should raise red flags for an oncologic process, most likely
leukemia. After initial laboratory values are obtained, the child should
receive aggressive hydration.)
TEST 2025/2026 ACTUAL REAL EXAM WITH
COMPLETE QUESTIONS WITH DETAILED
Page | 1
CORRECT ANSWERS WITH RATIONALE EXPERT
VERIFIED FOR GUARANTEED PASS|
TOP RATED A+.
PNCB
Pass the PNCB Acute Care Certification Exam 2025/2026 with confidence.
This exam features questions in areas like: acute and chronic pediatric
conditions, diagnostic reasoning, pharmacology, emergency interventions,
and family-centered care. Best ideal to pediatric nurse practitioners (PNPs)
seeking board certification in acute care through the Pediatric Nursing
Certification Board (PNCB).
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
Rationale: (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 dysfunction of the
, neuromuscular junctions. It is characterized by respiratory failure due to
weakness of the airway or respiratory muscles.
A cholinergic crisis, is a severe weakness caused by overtreatment with
Page | 2 cholinergic medications used to treat MG & crisis present with excessive
salivation, excessive lacrimation, diarrhea, sweating, pupillary
constriction, and muscle fasciculation.
A child with a history of congenital heart disease fell while playing and
presents with a closed fracture of the humerus. Physical exam reveals
mild bradycardia and a moderate pain score.
Which of the following medications would MOST likely explain this
child's bradycardia?
A. Enalapril (Vasotec)
B. Furosemide (Lasix)
C. Levothyroxine (Synthroid)
D. Propranolol (Inderal) ..... ANSWER ....... D. Propranolol (Inderal)
Rationale: (Decreases heart rate, myocardial contractility, blood pressure,
and myocardial oxygen demand. Adverse effects include bradycardia,
hypotension, and atrioventricular conduction disturbances)
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
Page | 3
Rationale: (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
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
Page | 4
Rationale: (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.)
A previously healthy preschooler who is fully immunized, presents with a
history of fever, URI symptoms, & joint pain over the past several days.
Physical exam reveals petechiae and hepatosplenomegaly. Vital signs
include HR 156, RR 32, temp 101.6 (38.7), BP 86/44 & O2 98% on RA.
Lab results include Na+ 132, K+ 6, Glucose 100, Ca+ 0.95, Phos 6.3,
WBC 105,000, Hgb 6.1 & Plt 10,000. Which is the BEST course of
action?
A. Obtain LFTS & type & cross for blood products
B. Administer calcium gluconate & consult nephrology
C. Obtain blood cultures & administer IV Ceftriaxone
D. Administer a fluid bolus & consult oncology ..... ANSWER .......
D. Administer a fluid bolus & consult oncology
Rationale: (The combination of leukocytosis, thrombocytopenia, and
anemia should raise red flags for an oncologic process, most likely
leukemia. After initial laboratory values are obtained, the child should
receive aggressive hydration.)
