PNCB CPNP-AC Acute Care Final Competency
Certification Study Guide Exam Questions
with Certified for Accuracy Answers
2024/2025
Prior to a child with trisomy 21 participating in contact sports,
an evaluation should be completed for which of the following
musculoskeletal abnormalities?
A. Atlantoaxial instability
B. Hip subluxation
C. Osteoporosis
D. Patellar instability - correct answer A. Atlantoaxial instability
Typical physical exam findings include hypotonia, broad nasal
bridge, epicanthal folds, low-set ears, macroglossia, and simian
creases. Cardiac defects, including endocardial cushion, septal
defects, and tetralogy of Fallot. Extracardiac manifestations
include gastrointestinal abnormalities such as duodenal atresia,
tracheoesophageal fistula, and Hirschsprung disease.
Musculoskeletal abnormalities associated with Down syndrome
are typically attributable to collagen abnormalities, which results
in increased laxity of ligaments connecting bones to muscle or to
other bones. The major spinal abnormality being atlantoaxial
instability.
A previously healthy child presents with polyuria and recent
weight loss. Pertinent laboratory results include pH 7.12, HCO3
9 mEq/L, Glucose 567 & positive ketones.
Initial management strategies include:
,A. Infusing NS at maintenance & initiate insulin infusion
B. Administering 1 mEq/kg of sodium barcarbonate & insulin
bolus of 1 unit/kg
C. Infusing NS fluid bolus 20 mg/kg & initiating an insulin
infusion
D. Administering 1 mEg/kg of potassium chloride & initiating
long acting insulin therapy - correct answer C. Infusing NS fluid
bolus 20 mg/kg & initiating an insulin infusion
Diagnosis is new onset diabetes. Diagnosis of DKA is confirmed
by hyperglycemia, ketonemia, ketonuria, and metabolic acidosis
(pH < 7.30, bicarbonate <15mEq/L).
Initial management of DKA include fluid resuscitation with
normal saline boluses, insulin infusion starting at 0.1units/kg/hr,
hourly blood glucose checks, and frequent venous blood gas and
electrolyte monitoring.
Bicarbonate administration is contraindicated due to the risk of
developing cerebral edema. Acidosis will correct over time with
fluid resuscitation and insulin therapy. Bolus insulin causes the
glucose level to drop too rapidly, which also increases the risk of
cerebral edema.
An otherwise healthy child presents with upper extremity
weakness and the inability to stand following a one-week history
of progressive ataxia. The caregiver reports that the child had an
upper respiratory infection 2 weeks ago. On physical exam,
ascending motor weakness and areflexia are noted. Which of the
following is the MOST anticipated treatment?
A. Antibiotics
B. Antitoxin
C. Corticosteroids
,D. IVIG - correct answer D. IVIG
With these progressive symptoms after a recent viral infection,
Guillain-Barré Syndrome (GBS) is the most likely among those in
the differential list. GBS is associated with ascending weakness
and areflexia. IVIG is the preferred treatment given its ease of
administration and equivalency to plasmapheresis. It is given
daily for 5 days at a dose of 0.4gm/kg/day.
Which method provides the BEST estimate of energy
requirements for enteral feeding of a school-age child who is
mechanically ventilated for respiratory failure?
A. Holiday Segar Method
B. Indirect Calorimetry Measurement
C. Schofield Equation
D. World Health Organization Equation - correct answer B.
Indirect Calorimetry Measurement
Indirect calorimetry most accurately predicts energy expenditure
through measuring oxygen consumption and carbon dioxide
production, which is then used to calculate resting energy via the
Weir equation. Measurements are taken via a continuous
metabolic monitor and 15-minute measurements can provide 24-
hour energy expenditure. Contraindications to indirect
calorimetry include hemodialysis, continuous renal replacement
therapy, FiO2 >60%, or significant endotracheal tube air leak.
The use of predictive equations such as the World Health
Organization Equation and Schofield Equations are unreliable.
The Holliday Segar Method is used to calculate maintenance
fluid requirements, not energy requirements.
, The administration of succinylcholine is CONTRAINDICATED for
a male toddler with a family history of:
A. Diabetes mellitus
B. Duchenne muscular dystrophy
C. Sudden cardiac death
D. Tachyarrhythmia - correct answer B. Duchenne muscular
dystrophy
Rhabdomyolysis may occur when succinylcholine is administered
to a patient with an undiagnosed myopathy, leading to life-
threatening hyperkalemia. Males, especially toddlers, with a
family history of Duchenne's muscular dystrophy may be yet
undiagnosed; thus, succinylcholine administration should be
avoided.
Diabetes mellitus has an antagonizing effect when cisatracurium
(Nimbex) is used, and the diagnosis itself is not a strict
contraindication to the use of succinylcholine. Pancuronium can
cause tachycardia and should be used with caution in patients at
risk for tachyarrhythmias. A family history of sudden cardiac
death should prompt the provider to investigate possible causes
(e.g., long QT syndrome, cardiomyopathy) and avoid medications
contraindicated with those conditions.
A toddler is being evaluated after failing to meet developmental
milestones. Assessment reveals lack of protective reflexes,
increased deep tendon reflexes, peripheral hypertonia,
weakness, and cognitive impairment. The MOST likely diagnosis
is:
A. Cerebral palsy
B. Guillain-Barre syndrome
C. Muscular dystrophy
