Free practice quiz
CPNP-AC Prep Course (CPNP-AC): free quiz
10 questions from the program. See your score right away, then unlock the explanation of every answer.
- Question 1 of 10
An 8-month-old admitted with bronchiolitis is increasingly sleepy and difficult to console. Vital signs: T 38.2°C, HR 178/min, RR 68/min, SpO2 91% on room air. Exam shows nasal flaring, intercostal retractions, mottled extremities, capillary refill 4 seconds, and one wet diaper in 10 hours. Which action has the highest priority?
C is correct: ABCs and circulation come first; age-adjusted tachycardia, respiratory distress, altered mental status, poor perfusion, and oliguria are decompensation red flags requiring stabilization and escalation. D is tempting because fever can raise HR, but it does not explain poor perfusion and lethargy. B addresses dehydration, but oral fluids are unsafe with respiratory distress and altered mental status. A may help later, but diagnostics must not delay oxygenation, monitoring, access, and urgent team notification.
- Question 2 of 10
A 7-year-old arrives from school with abrupt headache, repeated emesis, slurred speech, and new right-sided weakness. Airway is patent, SpO2 is 98% on room air, perfusion is adequate, and bedside glucose is 94 mg/dL. The child has no fever or trauma history. As the acute care PNP, which action best applies a pediatric differential diagnosis framework after initial stabilization?
Best answer: D. ABCs and glucose are stable; the priority is a can’t-miss neurologic emergency such as pediatric stroke, hemorrhage, mass effect, or CNS infection mimic. A is a real intervention, but treating vomiting first delays time-sensitive neurologic evaluation. D correctly escalates for urgent imaging and specialty input after stabilization. B is tempting because migraine can cause vomiting and neurologic symptoms, but focal weakness is a red flag. C is useful later, but history expansion must not precede emergency evaluation when acute focal deficits are present. Pediatric presentations differ from adult patterns; sudden focal deficit warrants rapid escalation. Local protocols vary; confirm with your institution.
- Question 3 of 10
A 6-year-old admitted with suspected pyelonephritis weighs 18.2 kg on the ED bed scale; a clinic note from 1 month ago lists 48 lb. Serum creatinine is 0.9 mg/dL, increased from a prior 0.4 mg/dL. The PNP is preparing a weight-based aminoglycoside medication order. Which action is the priority before the medication is sent to the pharmacy?
Best answer: C. Pediatric medication safety prioritizes a current kilogram weight, renal function review for aminoglycoside adjustment, and concentration/max-dose verification. B is unsafe because pound-based or outdated weights increase dosing error risk. A addresses decimal safety, but rounding before verifying the correct weight, renal status, and concentration can still create an overdose. D is tempting because circulation support matters, but suspected serious infection requires timely therapy; dosing verification should occur promptly and in parallel with stabilization. Escalate to the attending and pharmacist for impaired renal function or unclear dosing limits.
- Question 4 of 10
A 4-year-old arrives with abrupt fever, muffled voice, drooling, tripod posture, and inspiratory stridor. Oxygen saturation is 91% on room air. The child becomes more distressed when staff approach with equipment. As the pediatric acute care NP, which immediate action is the priority?
A is correct: ABCs drive priority. Toxic appearance, drooling, tripod posture, and stridor suggest critical upper airway obstruction; minimize agitation, support oxygenation, and escalate for a controlled airway. B is incorrect: throat inspection can precipitate complete obstruction. D is incorrect: IV access and cultures are appropriate later but may agitate the child before airway stabilization. C is incorrect: fever care is lower priority than airway threat. Pediatric pearl: suspected epiglottitis requires calm positioning and immediate specialty airway support; local protocols vary, so confirm with your institution.
- Question 5 of 10
A 6-year-old hospitalized with community-acquired pneumonia has received 36 hours of IV ampicillin. Now she has temperature 39.4°C, heart rate 148/min, respiratory rate 42/min, SpO2 89% on 2 L/min nasal cannula, and increasing right pleuritic pain. Breath sounds are markedly decreased at the right base. Chest radiograph shows a new moderate right pleural effusion. As the pediatric acute care NP, what is the priority next action?
B is correct: ABCs and safety come first; hypoxemia, worsening distress, pleuritic pain, and new effusion suggest complicated pneumonia/parapneumonic effusion needing escalation, imaging, broader management, and consultation. C delays care despite deterioration after therapy. A is unsafe because discharge requires clinical improvement and adequate oxygenation. D may be reasonable if bronchospasm is present, but it does not address suspected effusion, sepsis risk, or respiratory failure. Local protocols vary; confirm with your institution.
- Question 6 of 10
A 9-month-old with bronchiolitis is on 2 L/min nasal cannula. Assessment shows SpO2 88%, respiratory rate 64/min, moderate intercostal retractions, nasal flaring, and fatigue with feeding. Breath sounds are diffuse wheezes and crackles. The infant is awake but tiring. As the acute care PNP coordinating care with respiratory therapy, what is the priority oxygen-delivery escalation?
B is correct: ABCs prioritize breathing; persistent hypoxemia plus increased work of breathing and fatigue warrant escalation to heated humidified high-flow support with close reassessment. D is tempting but delays escalation and feeding increases respiratory demand. A may raise FiO2 but is poorly tolerated in infants and does not reduce work of breathing as effectively. C may be appropriate later, but diagnostics should not delay oxygenation support. If mental status worsens, apnea develops, or hypoxemia persists, escalate urgently to critical care/attending support; local protocols vary.
- Question 7 of 10
A 5-year-old hospitalized with pneumonia has new irritability. Assessment: temperature 39.2°C, heart rate 168/min, respiratory rate 34/min, blood pressure 94/58 mm Hg, capillary refill 5 seconds, weak peripheral pulses, cool mottled feet, urine output 0.4 mL/kg/hr, and lactate 4.2 mmol/L. As the acute care PNP, which action has the highest priority?
A is correct: ABCs/circulation priority: tachycardia, delayed refill, weak pulses, cool extremities, oliguria, mental-status change, and elevated lactate indicate compensated shock despite preserved blood pressure; activate escalation and begin protocolized resuscitation. D: lactate trending is useful but cannot replace bedside perfusion assessment. B: nutrition assessment may be appropriate later but does not address acute circulatory compromise. C: children can maintain blood pressure until late shock, so normal blood pressure is falsely reassuring. Local protocols vary; confirm with your institution.
- Question 8 of 10
A 12-year-old admitted for gastroenteritis reports palpitations after receiving ondansetron. Assessment: alert, BP 104/62 mm Hg, HR 118/min, capillary refill 2 seconds. ECG shows sinus rhythm with QTc 530 ms; potassium is 2.8 mEq/L and magnesium is 1.5 mg/dL. As the acute care PNP, which action has the highest priority?
C is correct: ABC/safety priority is preventing torsades in acquired long-QT from hypokalemia, hypomagnesemia, and ondansetron exposure. Continuous monitoring and electrolyte correction are urgent; local protocols vary. A is useful evaluation but delays intervention. D is unsafe because symptomatic QTc prolongation with abnormal electrolytes requires inpatient management. B treats unstable SVT, not sinus rhythm with prolonged repolarization, and may distract from correcting the cause. Escalate immediately for syncope, ventricular ectopy, torsades, hypotension, or worsening mental status.
- Question 9 of 10
A 10-day-old term newborn in the emergency department has poor feeding, tachypnea, central cyanosis, weak femoral pulses, and a harsh systolic murmur. Oxygen saturation is 76% on room air and 79% after several minutes of 100% oxygen. Glucose is 72 mg/dL. The infant is irritable but arousable. As the pediatric acute care NP, which action is the priority?
D is correct. Cyanosis with minimal response to 100% oxygen suggests cyanotic congenital heart disease; weak femoral pulses raise concern for ductal-dependent systemic flow. ABCs and circulation require urgent escalation and prostaglandin E1 per local protocol; monitor for apnea and hypotension. A provides useful data but delays stabilization. C may help hypercyanotic tet spells, but this presentation suggests ductal dependence and shock risk. B may temporarily support preload but does not reopen/maintain the ductus and is incomplete as priority care. Local protocols vary; confirm with your institution.
- Question 10 of 10
A 6-year-old admitted for pneumonia becomes difficult to arouse. Assessment shows T 38.4°C, HR 58/min, BP 132/86 mm Hg, RR 10/min with irregular pauses, SpO2 93% on oxygen. Pupils are 5 mm and sluggish; right arm withdraws less than left. The bedside nurse calls the pediatric acute care NP to evaluate. Which action takes priority?
Best answer: C. ABCs come first in altered mental status, and hypoglycemia is a rapidly reversible cause. A is appropriate if seizure activity occurs, but it does not address immediate ventilation or glucose. D helps trend neurologic status, but a full exam must not delay stabilization. B may be needed because bradycardia, hypertension, irregular respirations, sluggish pupils, and motor asymmetry suggest possible rising intracranial pressure; escalate promptly after immediate stabilization. Local protocols vary; confirm with your institution.
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