Free AACN ACCNS-P exam (Pediatric Clinical Nurse Specialist) Practice Questions

Sample Practice Questions

Try these 10 sample questions from the AACN ACCNS-P exam (Pediatric Clinical Nurse Specialist) practice bank. Each includes the answer and explanation. Continue with the interactive practice above to review the full question set.

1. 1A 4-month-old abruptly becomes irritable. ECG shows a narrow-complex rhythm at 260/min, a fixed R–R interval, and no visible P waves. Which rhythm best explains these findings?

   1. A.Sinus tachycardia
   2. B.Supraventricular tachycardiaCorrect answer: B
   3. C.Atrial flutter
   4. D.Ventricular tachycardia

   Explanation: The guideline describes SVT as a "fixed rate" with abrupt onset and P waves absent or after QRS. The fixed, narrow-complex tachycardia favors SVT over variable sinus tachycardia; flutter has flutter waves, and ventricular tachycardia is generally broad-complex.

   Reference: RCH Clinical Practice Guideline: Supraventricular Tachycardia — Background, characteristic rhythm

2. 2In an HHS-regulated study, the IRB requires assent from a capable 11-year-old. A parent gives permission, but the child remains silent while staff describe participation. Which finding would establish the child's assent?

   1. A.The child remains in the room without protesting
   2. B.The child follows the parent's directions quietly
   3. C.The child accepts the study information sheet
   4. D.The child affirmatively agrees to participateCorrect answer: D

   Explanation: OHRP states, "Mere failure to object should not, absent affirmative agreement, be construed as assent." Silence, passive cooperation, or taking a sheet does not replace affirmative agreement when assent is required.

   Reference: HHS OHRP: Research with Children FAQs — What is child assent, and how do the requirements vary with the age of the research subjects?

3. 3A school-aged child has confirmed SVT, normal blood pressure, warm extremities, and normal mentation. No reversion attempt has been made. Which initial intervention is appropriate while cardiac monitoring continues?

   1. A.Give an intravenous adenosine bolus
   2. B.Perform synchronized electrical cardioversion
   3. C.Coach a monitored Valsalva maneuverCorrect answer: C
   4. D.Begin an intravenous amiodarone infusion

   Explanation: For a stable child, the guideline recommends "Vagal manoeuvres". A monitored Valsalva maneuver is an appropriate first reversion attempt. Adenosine follows unsuccessful vagal treatment; cardioversion and antiarrhythmic infusion are not the initial choice for this stable presentation.

   Reference: RCH Clinical Practice Guideline: Supraventricular Tachycardia — Treatment, Vagal manoeuvres

4. 4A mature adolescent understands a proposed treatment's risks and benefits and clearly expresses a preference. The CNS advocates including the adolescent in the decision with the parents. Which ethical principle most directly supports this action?

   1. A.Distributive justice
   2. B.Respect for autonomyCorrect answer: B
   3. C.Nonmaleficence
   4. D.Fidelity

   Explanation: AMA guidance calls for parents to "nurture their children’s developing personhood and autonomy". Including a mature adolescent's informed preferences respects developing autonomy. Justice concerns fairness, nonmaleficence concerns avoiding harm, and fidelity concerns commitments; none as directly describes participation in one's own decisions.

   Reference: AMA Code of Medical Ethics: Pediatric Decision Making — Opinion 2.2.1, developing autonomy

5. 5During treatment of a child's reentrant SVT, adenosine produces a brief pause before sinus rhythm returns. Which mechanism accounts for this therapeutic effect?

   1. A.Transient blockade of atrioventricular nodal conductionCorrect answer: A
   2. B.Sustained blockade of ventricular fast sodium channels
   3. C.Competitive blockade of myocardial beta receptors
   4. D.Blockade of myocardial potassium channels to prolong repolarization

   Explanation: Adenosine acts by "briefly blocking AV node conduction". Interrupting AV nodal conduction can terminate an AV-node-dependent reentry circuit. The other mechanisms describe different antiarrhythmic drug actions.

   Reference: RCH Clinical Practice Guideline: Supraventricular Tachycardia — Treatment, Adenosine

6. 6A CNS identifies a serious medication mismatch and voices the concern, but the clinician preparing to administer it does not respond. Under the Two-Challenge Rule, what is the next action?

   1. A.Restate the safety concern to obtain acknowledgmentCorrect answer: A
   2. B.Wait until the dose is documented before speaking again
   3. C.Record the concern in the chart without another challenge
   4. D.Ask another nurse to observe while administration proceeds

   Explanation: AHRQ states, "Rule requires team members to state their observation at least twice to ensure that their interests and observations are being addressed." An ignored assertion requires another clear challenge, not silent observation, delayed reporting, or charting alone.

   Reference: AHRQ: Implement Teamwork and Communication — Slide 26, Two-Challenge Rule

7. 7A child is diagnosed with acute Kawasaki disease. Which infusion is the standard initial therapy across risk groups to reduce coronary artery aneurysm risk?

   1. A.Intravenous methylprednisolone
   2. B.Intravenous infliximab
   3. C.Intravenous cyclophosphamide
   4. D.Intravenous immunoglobulinCorrect answer: D

   Explanation: The guideline emphasizes timely treatment with "IVIg" to reduce coronary artery aneurysm risk. IV immunoglobulin is standard initial therapy. Corticosteroids and infliximab may be added for selected risks or resistance; they do not replace this standard first-line infusion.

   Reference: RCH Clinical Practice Guideline: Kawasaki disease — Key points, primary treatment

8. 8An unconscious child needs immediate lifesaving treatment. No legally authorized surrogate is available, and delaying treatment would be dangerous. Which approach is consistent with emergency consent ethics?

   1. A.Wait for a surrogate before initiating lifesaving treatment
   2. B.Ask a staff member to sign as the child's surrogate
   3. C.Provide emergency treatment and inform the surrogate as soon as possibleCorrect answer: C
   4. D.Obtain an administrator's signature as substitute parental permission

   Explanation: AMA guidance permits treatment when an urgent decision is necessary, the patient cannot participate, and a surrogate is unavailable: "physicians may initiate treatment without prior informed consent." The team should inform the surrogate promptly and obtain consent for ongoing treatment; unrelated staff cannot simply replace the surrogate.

   Reference: AMA Code of Medical Ethics: Informed Consent — Opinion 2.1.1, emergencies

9. 9A child has persistent fever and clinical findings strongly suggestive of Kawasaki disease. The initial echocardiogram is normal. How should the CNS interpret this result?

   1. A.It excludes coronary involvement throughout the illness
   2. B.It does not exclude Kawasaki disease early in its courseCorrect answer: B
   3. C.It confirms that the illness has entered convalescence
   4. D.It establishes a viral cause for the inflammatory findings

   Explanation: An early echocardiogram "does not exclude a diagnosis of KD". The result must be interpreted with the clinical course; it does not establish another cause or eliminate the need for treatment and follow-up.

   Reference: RCH Clinical Practice Guideline: Kawasaki disease — Management, Echocardiogram

10. 10A cooperative 4-year-old needs venipuncture and wants contact with a parent. Which position best supports comfort while allowing safe access to the arm?

    1. A.Lying supine while staff hold both shoulders
    2. B.Lying prone across the parent's lap
    3. C.Lying flat while a parent holds both wrists
    4. D.Sitting upright in a supportive parental holdCorrect answer: D

    Explanation: The procedural guideline states, "Procedural holding or ‘Positioning for comfort’ promotes the use of upright positioning and close contact to the parent/guardian." A supportive upright hold preserves comfort and safe access; routine forced recumbent restraint does not serve those aims.

    Reference: RCH: Procedure Management Guideline — During the procedure, Procedural holding