PNCB CPNP-ACFree Pediatric Nurse Practitioner Acute Care practice test

Correct answer: C. "Have you been exposed to any new allergens or irritants?"

Because allergens and irritants are among the most frequent precipitants of asthma symptoms, pinpointing recent exposures lets the provider adjust the plan to limit contact and control flares. Reviewing whether he takes his medications correctly matters, yet it is less specific to this presentation than uncovering a new exposure. How often he reaches for the inhaler signals worsening disease but does not reveal what set it off. A family respiratory history is useful background but does nothing to address the immediate search for a trigger.

Correct answer: D. Throat culture and sensitivity testing

These findings point toward a peritonsillar abscess of bacterial origin; culturing the throat most reliably isolates the responsible organism and directs antibiotic selection. A CBC might demonstrate leukocytosis to signal infection, but it neither confirms nor pinpoints the source. Neck ultrasound can separate an abscess from cellulitis, though it is seldom required when the exam already strongly indicates an abscess. A rapid strep antigen test flags Group A streptococcal pharyngitis without establishing a peritonsillar abscess.

Correct answer: C. Urinalysis with microscopy

The picture fits post-streptococcal glomerulonephritis. Urinalysis is essential because it reveals the characteristic hematuria, proteinuria, and red-cell casts. Serum creatinine and BUN gauge kidney function but do not establish glomerulonephritis specifically. An ASO titer documents a preceding streptococcal infection yet is not diagnostic of the glomerular disease itself. Renal ultrasound assesses anatomy but cannot detect glomerular pathology.

Correct answer: A. Chest radiograph

Diminished breath sounds on one side following blunt trauma make a traumatic pneumothorax the leading concern. Plain chest radiography serves as the initial study, revealing free air in the pleural cavity along with any associated collapse of the lung. Measuring arterial blood gases might uncover low oxygen levels, yet it says nothing about the mechanical problem behind them. Spirometry offers no help and is actually hazardous while a child is in acute pain and struggling to breathe. An electrocardiogram interrogates the heart and therefore would overlook this pleural injury.

Correct answer: A. "What was the last blood glucose reading and insulin dose given?"

The most valuable information is her most recent glucose value and last insulin dose, because these help detect hyperglycemia or diabetic ketoacidosis (DKA) — a dangerous complication demanding rapid treatment. DKA classically produces GI complaints like nausea, vomiting, and abdominal pain and reflects problems with glucose and insulin balance, so recognizing it early prevents deterioration. Asking whether she can tolerate food speaks to hydration but not glucose control. Inquiring about prior similar episodes may help but rarely reveals the current trigger. Asking about sick household members fits an infectious workup but is less relevant here.

Correct answer: A. Arterial blood gas to evaluate for metabolic acidosis

Such findings are classic for diabetic ketoacidosis (DKA) — a state marked by acidemia, elevated blood sugar, and circulating ketones. An arterial blood gas verifies the acid-base derangement and lets the clinician gauge how severe it is. A fingerstick glucose confirms that sugars are high but cannot, on its own, establish DKA. Checking the urine shows ketones yet gives no reading of acid-base balance. Serum osmolality is useful for estimating fluid deficits but will not clinch the DKA diagnosis.

Correct answer: D. "Can you describe exactly where the pain is located and if it has moved since it began?"

Pinning down exactly where the pain lies and whether it has traveled gives the provider the most valuable diagnostic clues, because disorders like appendicitis tend to follow predictable patterns. When discomfort begins near the navel and later concentrates in the lower right abdomen, appendicitis climbs the differential, while pain that never relocates leans more toward something like gastroenteritis — so mapping the site and any shift points the evaluation toward problems that may need urgent care. What the child last consumed can contribute to belly pain but carries far less diagnostic weight than the location and evolution of the pain. Fever often accompanies infection, yet on its own — without knowing where the pain is — it is a poor guide to urgency or cause. Allergy information is important for the broader history and for prescribing safely, but it does little to reveal what is driving this acute pain.

Correct answer: C. Lumbar puncture with cerebrospinal fluid (CSF) analysis

These findings make bacterial meningitis the primary concern, and sampling the cerebrospinal fluid by lumbar puncture is the definitive step — it recovers the responsible pathogen and yields the crucial CSF measurements of leukocytes, glucose, and protein. A head CT precedes the tap only when clues suggest elevated intracranial pressure or focal neurologic deficits. Blood cultures can flag bacteremia and help select antibiotics, but they cannot themselves diagnose meningitis. An EEG confirms no infection and has no role unless seizures predominate; obtaining one would only postpone the essential spinal tap needed to confirm the disease and begin directed treatment.

Correct answer: A. Evaluate for underlying conditions such as vocal cord dysfunction

On the surface this resembles poorly controlled asthma, but the lack of response to bronchodilators alongside a preserved diffusion capacity should raise the possibility of a different problem — for instance, vocal cord dysfunction — so the real diagnosis must be nailed down before therapy is altered. Systemic steroids help in true asthma flares yet accomplish little if some other condition is responsible. Simply using the beta-agonist more often, without knowing the cause, invites more adverse effects. A leukotriene receptor antagonist is a maintenance agent and has no place in this particular scenario.

Correct answer: D. "Has she had any drainage from her ears or changes in her balance?"

Focusing on ear drainage and shifts in balance targets the dangerous sequelae of repeated middle-ear disease: fluid draining from the ear can mean the eardrum has ruptured, and new balance trouble can reflect inner-ear involvement. Such signs may warn of serious problems — a persistent effusion behind the drum, mastoiditis, or damage to hearing and balance — and catching them early prevents lasting consequences like delayed speech or permanent hearing loss. Loud sound can injure hearing, but it is beside the point in a child with recurring infections and does not explain the irritability, ear-tugging, or reduced alertness seen here. Allergies during allergy season may block the middle ear and set the stage for otitis media, yet they would not produce a picture that looks like an active complication. Learning whether antibiotics were taken for the prior infection supplies past-treatment details but reveals nothing about complications happening now.