A 4-year-old child is brought to the emergency department with respiratory distress. Which assessment finding would be most concerning for impending respiratory failure?
Cpnp Ac Assessment
Question · Easy
When assessing a child with suspected sepsis, which vital sign change would be most concerning in a previously healthy 3-year-old?
Chapter 1: Introduction, CPNP-AC Exam Architecture & Acute Triage
1.1 CPNP-AC Exam Structure, Scoring & Blueprint Architecture
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A 6-month-old infant presents with bilious vomiting and abdominal distension. Which assessment finding would suggest midgut volvulus?
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During the assessment of a child with diabetic ketoacidosis (DKA), which finding indicates severe dehydration?
A 2-year-old child presents with fever and a purpuric rash. Which assessment finding would be most concerning for meningococcemia?
When performing a neurologic assessment on a child with suspected increased intracranial pressure (ICP), which finding would be most significant?
1.2 APRN Scope of Practice & Acute Care Pediatric Population Parameters
A 5-year-old presents with sudden onset of drooling, dysphagia, and a muffled "hot potato" voice. The child appears toxic and is sitting in the tripod position. What is the most likely diagnosis?
Cpnp Ac Diagnosis
A 3-month-old infant presents with paroxysmal coughing, post-tussive vomiting, and apnea episodes. The infant has not received any immunizations. Which diagnosis is most likely?
A 10-year-old with sickle cell disease presents with fever, chest pain, cough, and new infiltrate on chest X-ray. Which complication is most likely?
A child in status epilepticus has received two doses of lorazepam without cessation of seizure activity. What is the next appropriate medication?
Cpnp Ac Management
1.3 Advanced Pediatric Triage, Acuity Stratification & Rapid Response Systems
A child presents with anaphylaxis after eating peanuts. The child has wheezing and hypotension. What is the first-line treatment?
During resuscitation of a child in septic shock, what is the initial fluid bolus recommendation?
A child with severe asthma exacerbation has persistent hypoxemia despite supplemental oxygen. Which intervention is most appropriate?
A child with DKA has a serum glucose of 650 mg/dL and is receiving IV fluids and insulin. At what glucose level should dextrose be added to the fluids?
Chapter 2: Pediatric Shock States & Hemodynamic Instability
2.1 Hypovolemic & Distributive Shock: Recognition, Pathophysiology & Fluid Resuscitation
A child with suspected bacterial meningitis is being evaluated. What is the priority nursing action?
A 7-year-old with bronchiolitis has the following findings: respiratory rate 55/min, oxygen saturation 88% on room air, moderate retractions, and lethargy. What is the most appropriate next step?
Question · Medium
A 12-year-old with chest trauma has a blood pressure of 82/50 mmHg, heart rate 125 bpm, and distended neck veins. Breath sounds are equal bilaterally. What is the most likely diagnosis?
A 5-year-old with suspected appendicitis has localized tenderness at McBurney's point, guarding, and rebound tenderness. What additional finding would indicate perforated appendicitis?
2.2 Cardiogenic & Obstructive Shock: Recognition, Tamponade, PE & Tension Pneumothorax
A child with status asthmaticus has been intubated. On initial ventilator settings, the peak inspiratory pressure is 45 cm H2O and plateau pressure is 30 cm H2O. What does this pressure difference suggest?
An infant with suspected intussusception has the following abdominal ultrasound findings: "target sign" or "doughnut sign" with alternating hyperechoic and hypoechoic rings. What does this indicate?
A 15-year-old presents with altered mental status. Laboratory studies show: pH 7.25, PaCO2 25 mmHg, HCO3 12 mEq/L, glucose 850 mg/dL, ketones positive. What acid-base disturbance is present?
A child with severe traumatic brain injury has an ICP monitor in place. The monitor shows ICP of 25 mmHg. Which additional finding would be most concerning?
2.3 Hemodynamic Monitoring & Advanced Vascular Access (CVP, Arterial Lines, ScvO2)
A 4-year-old with leukemia presents with fever, neutropenia (ANC <500/uL), and hypotension. Blood cultures are pending. What is the most appropriate immediate action?
A newborn presents with bilious vomiting and abdominal distension. An abdominal X-ray shows multiple dilated loops of bowel with air-fluid levels and a "double bubble" sign. What is the most likely diagnosis?
An 8-month-old presents with fever, irritability, and a bulging fontanelle. Lumbar puncture reveals cloudy CSF with 2,000 WBC/μL (predominantly neutrophils), low glucose (<40 mg/dL), and elevated protein. What is the most likely causative organism?
A 6-year-old with pneumonia develops worsening respiratory distress. Chest X-ray shows a large pleural effusion with mediastinal shift. Thoracentesis reveals purulent fluid with pH <7.2, glucose <40 mg/dL, and LDH >1,000 U/L. What is the diagnosis?
Chapter 3: Congenital Heart Defects & Post-Operative Cardiac Intensive Care
3.1 Acyanotic & Obstructive Heart Lesions (VSD, ASD, PDA, Coarctation, AS)
A 2-year-old presents with pallor, irritability, and tachypnea. Laboratory studies show: Hemoglobin 4.8 g/dL, MCV 78 fL, RDW 18%, platelets 450,000/μL, and reticulocyte count 1.5%. What is the most likely diagnosis?
A 14-year-old presents with polyuria, polydipsia, and weight loss. Laboratory studies show: glucose 380 mg/dL, bicarbonate 16 mEq/L, anion gap 22, and moderate ketonuria. Which classification of diabetes is most likely?
A child presents with headache, vomiting, and ataxia. MRI shows a posterior fossa mass with hydrocephalus. Which additional finding would suggest herniation?
A 5-year-old with sickle cell disease presents with sudden severe abdominal pain, bilirubin 8 mg/dL, and falling hemoglobin. Peripheral smear shows nucleated red blood cells. What is the diagnosis?
3.2 Cyanotic & Ductal-Dependent Defects (TOF, TGA, HLHS, PGE1 Infusion)
A child presents with fever, arthritis of the knee, and a new heart murmur. Echocardiogram shows valvular vegetations. Blood cultures are positive for Streptococcus viridans. What is the diagnosis?
A child with severe traumatic brain injury has an ICP of 30 mmHg despite head elevation and sedation. Which intervention should be implemented next?
A 3-year-old with moderate dehydration from gastroenteritis requires fluid resuscitation. Weight is 15 kg. What is the appropriate fluid management for the first 4 hours?
A child with a 15% total body surface area (TBSA) partial-thickness burn requires fluid resuscitation using the Parkland formula. The child weighs 25 kg. What is the total fluid requirement for the first 24 hours?
3.3 Post-Operative Cardiac Surgical Management & Low Cardiac Output Syndrome (LCOS)
A child with status epilepticus has failed first-line (benzodiazepine) and second-line (phenytoin) therapy. Which medication is most appropriate as third-line therapy?
A 12-year-old presents with testicular pain of 6 hours duration. Physical examination reveals a high-riding testis with absent cremasteric reflex. What is the priority intervention?
A child with a supracondylar fracture has decreased pulses and a cool, pale hand. What is the immediate management?
Question · Hard
A child with ventilator-associated pneumonia has been treated with appropriate antibiotics for 7 days and is clinically improving. What is the most appropriate next step?
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