NEW PNP - AC (PEDIATRIC NURSE PRACTITIONER - ACUTE CARE)
CERTIFICATION FINAL EXAM LATEST COMPLETE ACTUAL TEST
WITH REAL QUESTIONS AND CORRECT ANSWERS (100% CORRECT
VERIFIED SOLUTION) NEWEST UPDATED VERSION |GUARANTEED
PASS.2026-2027
Following resection of a medulloblastoma, a school-age child is noted as
having irritability, a weight gain of 1.5 kg in the absence of edema, urine output of
0.4 mL/kg/hour, and the following laboratory results: Na+ 128, K+ 4.0, Cl- 103, Bicarb
26, BUN 10, Creatinine 0.2, Glucose 102, Ca+ 7.8, Mag 1.8,
Phos 2.9
The MOST likely diagnosis is:
A. Adrenal insufficiency
B. Cerebral salt wasting
C. Diabetes insipidus
D. Syndrome of inappropriate antidiuretic hormone (SIADH)
D. Syndrome of inappropriate antidiuretic hormone (SIADH)
Characterized by hyponatremia & decreased UOP due to excessive release of
ADH.
In SIADH the UOP is low (<1ml/kg/hr), leading to dilutional hyponatremia; whereas
in CSW, UOP is elevated (2-3ml/kg/hr). Electrolyte abnormalities associated with
CSW include an elevated BUN and hyponatremia due to renal losses of sodium.
Children with SIADH have serum hypo-osmolarity. With diabetes insipidus (DI),
there is a deficiency of ADH release, leading to the excretion of large amounts of
dilute urine. An increased UOP of more than 4ml/kg/hr is seen & results in
hypernatremia, increased serum osmolarity, and low urine osmolarity with a low
urine specific gravity (< 1.005).
,In a child who is dependent on mechanical ventilation, findings suggestive of a
tracheal plug include low tidal volumes and:
A. Low RR & high peak inspiratory pressure (PIP)
B. Low RR & low PIP
C. High RR & low PIP
D. High RR & high PIP
D. High RR & high PIP
Tracheal plugging can occur is due to thick mucosal secretions obstructing the
tracheostomy tube. In order to overcome the obstruction, the ventilator will try to
deliver higher pressures (high PIP) but will meet resistance, resulting in low tidal
volumes.
Both the ventilator & patient will try to increase respiratory rate in an attempt to
provide adequate oxygenation and ventilation. The DOPE pneumonic is helpful
in systematically evaluating possible causes for a ventilation problem. "D"
stands for displacement. (Although more typical for an oral endotracheal tube, a
tracheostomy tube can displace outside of the trachea and into the
subcutaneous space.) The "O" stands for obstruction; "P" for pneumothorax;
and "E" for equipment.
,An infant presents with poor feeding and progressive lethargy. A head CT scan
is obtained revealing a hyperdense crescentic mass located along the cerebral
convexities. The MOST appropriate next step is to order a(n):
A. Normal saline bolus
B. Systemic steroid
C. Neurosurgical consult
D. MRI
C. Neurosurgical consult
Dx is acute subdural hematoma. Initial management should focus on medically
managing intracranial hypertension due to the risk for increased intracranial
pressure.
Neurosurgery should be consulted order to initiate urgent evacuation of the
hematoma.
Children with head trauma may require fluid boluses but that will be dependent
on vital sign changes, which is not as imperative as urgent neurosurgical
consultation and management of the increased intracranial pressure. Systemic
steroids are indicated for spinal cord injury but not for closed head injury. The
infant will likely require an MRI in the future for more detailed imaging and
prognostication, although it is not urgent or required at this time.
, An adolescent with a BMI of 30 presents with vague, colicky, right upper quadrant
pain, nausea, and vomiting. Abdominal ultrasound reveals cholecystic
thickening. Which of the following behavioral modifications should be
implemented?
A. Start a strict elimination diet to avoid potential food intolerances
B. Initiate a diet & exercise regimen to promote rapid weight loss
C. Utilize weight loss counseling to reduce weight gradually over time
D. Maintain a food journal to track & encourage fiber & fluid consumption
C. Utilize weight loss counseling to reduce weight gradually over time
Management for acute cholecystitis can either be supportive or surgical via
laparoscopic cholecystectomy. Supportive management includes hospital
admission with gastric decompression, intravenous fluids, and broad-
spectrum antibiotics.
The behavioral modification that should be encouraged to prevent future
episodes of cholecystitis is weight loss. This should be done in a controlled
manner with involvement of nutritionists and weight loss counselors.
Rapid weight loss should be discouraged as it can induce stone formation and
will likely not provide for long term results. An increase in consumption of fiber
and fluids would be helpful in preventing constipation, not cholecystitis.
Tracking food intolerances may be helpful for prevention of abdominal pain
associated with gastroesophageal reflux, food allergies, and other causes of
food intolerance, but will not prevent cholecystitis.
CERTIFICATION FINAL EXAM LATEST COMPLETE ACTUAL TEST
WITH REAL QUESTIONS AND CORRECT ANSWERS (100% CORRECT
VERIFIED SOLUTION) NEWEST UPDATED VERSION |GUARANTEED
PASS.2026-2027
Following resection of a medulloblastoma, a school-age child is noted as
having irritability, a weight gain of 1.5 kg in the absence of edema, urine output of
0.4 mL/kg/hour, and the following laboratory results: Na+ 128, K+ 4.0, Cl- 103, Bicarb
26, BUN 10, Creatinine 0.2, Glucose 102, Ca+ 7.8, Mag 1.8,
Phos 2.9
The MOST likely diagnosis is:
A. Adrenal insufficiency
B. Cerebral salt wasting
C. Diabetes insipidus
D. Syndrome of inappropriate antidiuretic hormone (SIADH)
D. Syndrome of inappropriate antidiuretic hormone (SIADH)
Characterized by hyponatremia & decreased UOP due to excessive release of
ADH.
In SIADH the UOP is low (<1ml/kg/hr), leading to dilutional hyponatremia; whereas
in CSW, UOP is elevated (2-3ml/kg/hr). Electrolyte abnormalities associated with
CSW include an elevated BUN and hyponatremia due to renal losses of sodium.
Children with SIADH have serum hypo-osmolarity. With diabetes insipidus (DI),
there is a deficiency of ADH release, leading to the excretion of large amounts of
dilute urine. An increased UOP of more than 4ml/kg/hr is seen & results in
hypernatremia, increased serum osmolarity, and low urine osmolarity with a low
urine specific gravity (< 1.005).
,In a child who is dependent on mechanical ventilation, findings suggestive of a
tracheal plug include low tidal volumes and:
A. Low RR & high peak inspiratory pressure (PIP)
B. Low RR & low PIP
C. High RR & low PIP
D. High RR & high PIP
D. High RR & high PIP
Tracheal plugging can occur is due to thick mucosal secretions obstructing the
tracheostomy tube. In order to overcome the obstruction, the ventilator will try to
deliver higher pressures (high PIP) but will meet resistance, resulting in low tidal
volumes.
Both the ventilator & patient will try to increase respiratory rate in an attempt to
provide adequate oxygenation and ventilation. The DOPE pneumonic is helpful
in systematically evaluating possible causes for a ventilation problem. "D"
stands for displacement. (Although more typical for an oral endotracheal tube, a
tracheostomy tube can displace outside of the trachea and into the
subcutaneous space.) The "O" stands for obstruction; "P" for pneumothorax;
and "E" for equipment.
,An infant presents with poor feeding and progressive lethargy. A head CT scan
is obtained revealing a hyperdense crescentic mass located along the cerebral
convexities. The MOST appropriate next step is to order a(n):
A. Normal saline bolus
B. Systemic steroid
C. Neurosurgical consult
D. MRI
C. Neurosurgical consult
Dx is acute subdural hematoma. Initial management should focus on medically
managing intracranial hypertension due to the risk for increased intracranial
pressure.
Neurosurgery should be consulted order to initiate urgent evacuation of the
hematoma.
Children with head trauma may require fluid boluses but that will be dependent
on vital sign changes, which is not as imperative as urgent neurosurgical
consultation and management of the increased intracranial pressure. Systemic
steroids are indicated for spinal cord injury but not for closed head injury. The
infant will likely require an MRI in the future for more detailed imaging and
prognostication, although it is not urgent or required at this time.
, An adolescent with a BMI of 30 presents with vague, colicky, right upper quadrant
pain, nausea, and vomiting. Abdominal ultrasound reveals cholecystic
thickening. Which of the following behavioral modifications should be
implemented?
A. Start a strict elimination diet to avoid potential food intolerances
B. Initiate a diet & exercise regimen to promote rapid weight loss
C. Utilize weight loss counseling to reduce weight gradually over time
D. Maintain a food journal to track & encourage fiber & fluid consumption
C. Utilize weight loss counseling to reduce weight gradually over time
Management for acute cholecystitis can either be supportive or surgical via
laparoscopic cholecystectomy. Supportive management includes hospital
admission with gastric decompression, intravenous fluids, and broad-
spectrum antibiotics.
The behavioral modification that should be encouraged to prevent future
episodes of cholecystitis is weight loss. This should be done in a controlled
manner with involvement of nutritionists and weight loss counselors.
Rapid weight loss should be discouraged as it can induce stone formation and
will likely not provide for long term results. An increase in consumption of fiber
and fluids would be helpful in preventing constipation, not cholecystitis.
Tracking food intolerances may be helpful for prevention of abdominal pain
associated with gastroesophageal reflux, food allergies, and other causes of
food intolerance, but will not prevent cholecystitis.
