CPNP-AC sample questions

Question 1

A 2-month-old infant with a known history of an unrepaired large ventricular septal defect (VSD) is brought to the pediatric emergency department with acute respiratory distress, tachypnea, and diaphoresis during feeding. The infant was born at 38 weeks' gestation and had previously been tracking at the 25th percentile for weight, but has fallen below the 3rd percentile over the past 3 weeks.

The caregiver reports that over the past 24 hours, the infant has had frequent coughing episodes, takes nearly 45 minutes to finish a 2-ounce bottle, and develops profound perioral duskiness and irritability with crying. The infant has had no recorded fever, vomiting, diarrhea, or rash, but has required increasing layers of swaddling to remain comfortable.

On physical examination, the infant is tachypneic with subcostal retractions, has a holosystolic murmur at the left lower sternal border, hepatomegaly palpated 3.5 cm below the right costal margin, and cool peripheral extremities.

Which historical detail elicited during the health history provides the STRONGEST clinical indication that this infant has transitioned from compensated congestive heart failure to acute pulmonary overcirculation and physiological decompensation?

Accepted Answer

Inability to finish feeding within 20 minutes accompanied by diaphoresis and acute weight trajectory deceleration

Answer

History of full-term gestation without immediate delivery room resuscitation

Answer

Absence of fever and gastrointestinal symptoms over the preceding 24 hours

Answer

Caregiver report of needing increased swaddling to maintain infant comfort

Question 2

A 15-year-old adolescent admitted to the acute surgical step-down unit following an operative fixation of a pelvic fracture displays fluctuating affect and defensiveness during clinical rounds. The CPNP-AC administers the CRAFFT screening tool to evaluate health risks. The CRAFFT tool is validated specifically to identify which category of risk in adolescents?

Accepted Answer

High-risk alcohol, cannabis, nicotine, and illicit substance misuse behaviors

Answer

Cognitive deficits and post-concussive traumatic brain injury

Answer

Physical abuse and non-accidental trauma in domestic living settings

Answer

Severe clinical depression and active suicidal ideation risk

Question 3

An 8-year-old child with severe static encephalopathy who is non-verbal and non-ambulatory is admitted to the pediatric unit with an acute displaced spiral femur fracture and severe protein-calorie malnutrition. Which TWO clinical and psychosocial findings represent critical health risk indicators that mandate priority reporting and immediate multidisciplinary child protection evaluation? (Select TWO)

Accepted Answer

Caregiver explanation for the injury that is physically inconsistent with the child's motor capabilities

Accepted Answer

Non-ambulatory and non-speaking developmental status with an unexplained major long-bone fracture

Answer

Routine placement in an accredited specialized therapeutic foster home

Answer

Presence of a documented clinical prescription for high-calorie enteral formula

Answer

Underlying neurological impairment and gastrointestinal dysmotility managed with an enteral tube

Question 4

A 3-year-old unimmunized child presents to the emergency department with acute onset of high fever, toxic appearance, muffled 'hot potato' voice, inspiratory stridor at rest, and is sitting in a tripod position with neck extension and spontaneous drooling. Which physical examination maneuver is strictly CONTRAINDICATED due to the immediate risk of precipitating catastrophic airway occlusion?

Accepted Answer

Direct visual inspection of the posterior pharynx using a tongue depressor

Answer

Continuous non-invasive pulse oximetry monitoring on an extremity

Answer

Passive delivery of blow-by humidified oxygen in the caregiver's lap

Answer

Auscultation of breath sounds across peripheral lung fields

Question 5

A 7-year-old child hospitalized with severe pneumonia develops altered responsiveness and progressive tachycardia. On physical examination, the CPNP-AC notes bounding peripheral pulses, brisk capillary refill of less than 1 second ('flash refill'), a widened pulse pressure (blood pressure 94/36 mmHg), and warm, hyperemic extremities. Which underlying hemodynamic state is demonstrated by these clinical findings?

Accepted Answer

Distributive septic shock with reduced systemic vascular resistance ('warm shock')

Answer

Cardiogenic shock characterized by low cardiac output and elevated systemic vascular resistance

Answer

Obstructive shock caused by acute pericardial tamponade and impaired ventricular filling

Answer

Hypovolemic shock resulting in marked peripheral vasoconstriction and narrow pulse pressure

Question 6

An 11-year-old child admitted to the pediatric intensive care unit following a severe traumatic brain injury demonstrates acute neurological deterioration. Over a 30-minute interval, the child's heart rate drops from 94 bpm to 48 bpm, blood pressure shifts from 104/62 mmHg to 152/50 mmHg, and respiratory patterns become irregular and shallow. Which clinical syndrome is demonstrated, and what critical anatomical risk is impending?

```mermaid
flowchart TD
ICP[Rising Intracranial Pressure] --> Hypoperfusion[Decreased Cerebral Perfusion Pressure]
Hypoperfusion --> Sympathetic[Sympathetic Surge: Severe Hypertension]
Sympathetic --> Baroreceptors[Baroreceptor Reflex: Bradycardia]
Baroreceptors --> Brainstem[Brainstem Compression: Irregular Respirations]
Brainstem --> Herniation([Impending Transtentorial Herniation])
```

Accepted Answer

Cushing's triad reflecting severe intracranial hypertension and impending brainstem herniation

Answer

Spinal shock with complete loss of systemic vascular vasomotor tone below the cervical level

Answer

Central diabetes insipidus causing severe hypovolemia and hyperosmolar collapse

Answer

Autonomic dysreflexia secondary to uninhibited sympathetic outflow from visceral distension

Free CPNP-AC sample questions

6 more free samples are waiting