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ACNP Exam: Pediatric – Questions & Accurate Solutions With Complete Rationales
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ACNP Exam: Pediatric – Questions & Accurate Solutions With Complete Rationales
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ACNP Exam: Pediatric – Questions & Accurate SolutionsWith Complete Rationales
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. Right Ans - 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. Right
Ans - 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. Right Ans - 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. Right Ans - 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.
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. Angelman syndrome.
B. Alagille syndrome.
C. DiGeorge syndrome.
D. Treacher Collins syndrome. Right Ans - D. 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 Right Ans - 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. Right Ans - 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. Right Ans - 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.
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. Right
Ans - A. There are a variety of organisms that are responsible for causing
meningitis in the newborn period, but these organisms change at 1 month of
age and then again between 3 months and 2 years of age. Recognizing the
potential etiology assists in providing appropriate treatment. The organisms
that typically cause meningitis in infants beyond the neonatal period are
Haemophilus influenzae type b, Streptococcus pneumoniae, Neisseria
meningitidis, late-onset group B streptococcus and Bordetella pertussis.
A toddler with a diagnosis of spinal muscle atrophy (SMA) type I has been
hospitalized multiple times for respiratory failure requiring mechanical
ventilation. She is currently on bilevel positive airway pressure (BiPAP) at
night time at home. Decisions for determining the next steps in care are based
on which of the following statements?
A. Children with SMA type I have poor prognosis and there is no specific
therapy or cure.
B. With targeted therapy, children with SMA type I can live into adolescence,
so aggressive therapy is indicated.
C. Children with SMA type I may need support walking later in their life, but
are expected to live a normal lifespan.
D. Optimal nutrition and intravenous immunoglobulin treatment can assist in
managing respiratory symptoms. Right Ans - A. There are three specific
types of SMA, with the first one (type I) typically diagnosed early in infancy
with symptoms of hypotonia with generalized weakness, poor head control,
lack of meeting milestones, paradoxical breathing, and areflexia. Once genetic
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