10 exam-style questions with answers and explanations, straight from our 1,030-question bank. Tap an answer to check yourself. When you're ready, take the scored version in the free practice test.
The BCPPS exam has 150 questions and runs 3 hours 45 minutes.
These 10 free BCPPS questions are organized by exam domain, so you can see how each part of the Board-Certified Pediatric Pharmacy Specialist blueprint is tested. Reveal the answer and explanation under each question.
For a very premature infant, an appropriate gentamicin regimen may pair a substantial dose per kilogram with a long interval between doses. Which developmental pairing explains this dosing pattern?
Correct answer: D - Larger extracellular distribution volume and immature renal clearance.
At a 14-month well-child visit, the vaccination record shows one MMR dose given at 9 months before international travel and no subsequent MMR doses. The child has mild rhinorrhea, a temperature of 37.1°C, and normal activity. There is no immunosuppression or recent blood-product exposure. What belongs in today's vaccination plan?
Correct answer: C - Give MMR today; the travel dose does not count toward the routine series.
After an episode of hypoglycemia is corrected, a 3-kg postoperative neonate needs a continuous glucose infusion rate of 8 mg/kg/min. Central venous access is confirmed. Because of fluid overload, no more than 10 mL/hour can be allocated to the dextrose infusion; all other fluid sources have already been accounted for. Which order meets the glucose requirement without exceeding the fluid allowance?
Correct answer: B - 20% dextrose at 7.2 mL/hour.
A 9-year-old receiving IV vancomycin for MRSA osteomyelitis with bacteremia is improving after drainage of an associated abscess. Repeat blood cultures are negative, and renal function is unchanged. A pediatric Bayesian model, using two correctly timed concentrations, estimates an AUC24 of 515 mg·h/L. The trough is 9.2 mg/L, and the isolate's broth-microdilution MIC is 1 mg/L. How should the pharmacist respond to a request to raise the trough to 15-20 mg/L?
Correct answer: B - Continue the regimen, following clinical response, vancomycin exposure, and renal function.
Paramedics give a 20-kg child intranasal midazolam 4 mg for an ongoing generalized convulsion. In the emergency department, IV lorazepam 2 mg is administered five minutes later. Six minutes after lorazepam, convulsions continue. Glucose is 104 mg/dL; oxygenation, ventilation, and blood pressure remain adequate with supportive care. Which order best advances seizure treatment now?
Correct answer: A - Levetiracetam 60 mg/kg IV as a single loading dose.
During treatment of diabetic ketoacidosis, a 13-year-old is receiving IV insulin at 0.05 units/kg/hour and dextrose-containing replacement fluids. Glucose has fallen to 180 mg/dL and continues to decline, but beta-hydroxybutyrate is 4.2 mmol/L and bicarbonate is 11 mmol/L. Potassium is 4.1 mmol/L, urine output is adequate, and the neurologic examination is unchanged. The nurse asks whether insulin can now be stopped. The pharmacist should recommend:
Correct answer: A - Increasing dextrose delivery while continuing IV insulin to clear the remaining ketosis.
After eight days of mechanical ventilation, a developmentally typical 7-year-old is extubated while fentanyl and midazolam are being tapered. The child is awake but unusually quiet, inconsistently recognizes familiar people, and has fluctuating attention without agitation. The Cornell Assessment of Pediatric Delirium (CAPD) score is 14; the Withdrawal Assessment Tool-1 (WAT-1) score is 1. Pain is rated 0/10, and oxygenation and glucose are normal. These findings are best interpreted as:
Correct answer: D - A positive delirium screen requiring assessment of reversible causes of the child's hypoactive behavior.
Before a child with acute lymphoblastic leukemia starts mercaptopurine-containing maintenance therapy, pharmacogenomic testing identifies normal TPMT metabolism but poor NUDT15 metabolism. Baseline blood counts meet the oncology protocol's treatment criteria. What change should the pharmacist seek before the first mercaptopurine dose?
Correct answer: C - Use a markedly reduced, protocol-directed mercaptopurine regimen with serial blood-count monitoring.
A formulary committee reviews a randomized trial comparing 5 versus 10 days of an antibiotic for uncomplicated pediatric pneumonia. The prespecified noninferiority margin is an absolute increase of 5 percentage points in treatment failure by day 30. The risk difference, defined as 5-day minus 10-day treatment, is +2 percentage points, with a 95% confidence interval of −2 to +6. The authors note that the superiority comparison is not statistically significant. Which conclusion is supported?
Correct answer: C - Noninferiority is not established because the confidence interval extends beyond the prespecified margin.
A pediatric oncology service administers IV vincristine and intrathecal methotrexate on the same treatment days. Vincristine is currently dispensed in syringes with prominent IV-only labels. After a wrong-route near miss, pharmacy is asked to select a dispensing redesign that reduces dependence on reading and remembering the warning. Which change offers the strongest protection against intrathecal vincristine administration?
Correct answer: A - Dispense vincristine diluted in a compatible IV minibag, rather than a syringe.
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