Free Pediatric CCRN from AACN Questions and Answers — Questions and Answers
Question 1: A newborn with transposed great arteries is hospitalized. 46% is the SpO2 value. Nobody makes a murmur. Which drugs should the nurse anticipate being given as a stopgap measure until a balloon septostomy can be performed?
- Indomethacin (Indocin)
- Alprostadil (PGE1) (Correct answer)
- Digoxin (Lanoxin)
- Tolazoline (Priscoline)
Correct answer: Alprostadil (PGE1)
For a newborn with transposed great arteries and severe hypoxemia (SpO2 46%), Alprostadil (PGE1) is the critical medication. PGE1 keeps the ductus arteriosus open, facilitating the mixing of systemic and pulmonary blood flow. This temporary shunt is vital for maintaining adequate systemic oxygenation until a more permanent solution, such as a balloon septostomy or surgical repair, can be carried out.
Question 2: Esophageal varices that are bleeding may be treated acutely by:
- Administration of octreotide (Sandostatin) (Correct answer)
- Placement of a large NGT to low intermittent suction
- Placement of a central venous line for hyperalimentation (TPN)
- Immediate surgical intervention
Correct answer: Administration of octreotide (Sandostatin)
Acute bleeding from esophageal varices is often treated with octreotide (Sandostatin). Octreotide is a somatostatin analog that causes splanchnic vasoconstriction, reducing blood flow to the portal system and thereby lowering portal pressure. This reduction in pressure helps to decrease bleeding from the varices, making it a key pharmacological intervention in managing this life-threatening condition.
Question 3: Extreme dyspnea is being experienced by a 2-year-old with left-sided ventricular heart failure and pulmonary edema. Which of the following would the nurse advise doing to help the youngster breathe easier and feel less anxious and agitated?
- Furosemide (Lasix)
- Digoxin (Lanoxin)
- Dobutamine (Dobutrex)
- Morphine (Duramorph) (Correct answer)
Correct answer: Morphine (Duramorph)
For a 2-year-old experiencing extreme dyspnea, anxiety, and agitation due to left-sided ventricular heart failure and pulmonary edema, morphine is an appropriate intervention. Morphine reduces anxiety and agitation, decreases venous return (preload) by causing venodilation, and can help to alleviate dyspnea by reducing the work of breathing and altering the perception of shortness of breath.
Question 4: Clinical indicators seen in a kid who has been given the diagnosis of failure to thrive include
- Excessive crying and delayed language development
- Avoidance of eye contact and delayed motor development (Correct answer)
- No interest in surroundings
- Distress when held of left alone
Correct answer: Avoidance of eye contact and delayed motor development
Clinical indicators of failure to thrive (FTT) often include developmental delays, such as delayed motor development, and behavioral signs like avoidance of eye contact. These symptoms reflect the impact of chronic malnutrition and neglect on a child's physical and neurological development, as well as their ability to engage in social interaction and explore their environment.
Question 5: While patients are sleeping, a nursing unit must be able to put patients back on ventilator support as directed. The respiratory therapist is only sometimes present on the unit to put patients on the ventilator because of staffing patterns. The nurse should respond in the following ways:
- Ask the parent to be responsible for this task.
- Place the patient on the ventilator when needed, despite current policy
- Question the current policy that only respiratory therapists can manage the ventilator. (Correct answer)
- Wait for the therapist to intervene.
Correct answer: Question the current policy that only respiratory therapists can manage the ventilator.
In a situation where patients need ventilator support but respiratory therapists are not consistently available, the nurse should question the policy restricting ventilator management to only respiratory therapists. This policy creates a safety risk for patients. Advocating for policy changes, such as training nurses for basic ventilator management, ensures timely and safe patient care, aligning with the nurse's role in patient advocacy and quality improvement.
Question 6: The ICU cares for an end-stage pituitary adenoma patient with diabetes insipidus and aspiration pneumonia. The mother is giving the patient water and soft beverages despite being aware that there is a plan for transpyloric tube feedings and nothing by mouth. What action should the nurse take in this circumstance?
- Notify the social worker that the mother is interfering with the medical plan.
- Ask the resident physician to change the diet order to include oral fluids.
- Ask security to restrict the mother's ability to visit the ICU
- Ask the mother to explain why she is giving fluids to her son (Correct answer)
Correct answer: Ask the mother to explain why she is giving fluids to her son
The nurse's best initial action is to approach the mother non-judgmentally and ask her to explain why she is giving fluids. This allows the nurse to understand the mother's perspective, concerns, or cultural beliefs, which may be influencing her actions. Open communication fosters trust and provides an opportunity for education and collaborative problem-solving, rather than immediately resorting to punitive or restrictive measures.
Question 7: Discharge instruction is the responsibility of respiratory, physical, and occupational therapists and nurses; each profession now keeps track of this information on a separate flow sheet. The following would be the ideal scenario for organizing teaching:
- All disciplines document patient teaching on the same flow sheet. (Correct answer)
- Daily care conferences to review and discuss patient teaching and the flow sheets
- Nurses review the flow sheets of all disciplines during shift change.
- Each discipline distribute copies of its flow sheet to each team member.
Correct answer: All disciplines document patient teaching on the same flow sheet.
The ideal scenario for organizing interdisciplinary patient teaching is for all disciplines to document on the same flow sheet. This centralized approach promotes continuity of care, prevents duplication of teaching efforts, and ensures that all team members are aware of what has been taught and what still needs to be addressed. It facilitates comprehensive communication and a holistic view of the patient's and family's learning progress.
Question 8: A nurse provides medical attention to a little child in the pediatric intensive care unit (PICU) who has had a cardiac catheterization to repair a ventricular septal defect (VSD). What kind of heart arrhythmia is the MOST typical to develop as a side effect of VSD repair?
- Heart Block (Correct answer)
- Atrial fibrillation (A-fib)
- Premature ventricular contractions (PVCs)
- Supraventricular tachycardia (SVT)
Correct answer: Heart Block
Heart block is the most typical heart arrhythmia to develop as a side effect of ventricular septal defect (VSD) repair. The VSD is located in close proximity to the heart's conduction system, particularly the bundle of His. Surgical closure of the defect carries a risk of trauma or damage to these delicate conduction pathways, which can result in varying degrees of heart block.
Question 9: Which disease is frequently linked to pulmonary hypertension (PH) in most pediatric patients?
- Asthma
- Congenital heart disease (CHD) (Correct answer)
- Thoracic trauma
- Bronchopulmonary dysplasia (BPD)
Correct answer: Congenital heart disease (CHD)
Congenital heart disease (CHD) is frequently linked to pulmonary hypertension (PH) in pediatric patients, especially those with left-to-right shunts like VSDs or PDAs. The increased blood flow and pressure to the pulmonary arteries over time cause structural changes and remodeling of the pulmonary vasculature. This leads to elevated pulmonary vascular resistance and the development of pulmonary hypertension.
Question 10: A juvenile patient who has third-degree burns from an apartment fire and is in septic shock is being admitted by a nurse to the PICU. Which of the following treatments is the nurse planning to administer first?
- Normal saline (NS) bolus (Correct answer)
- Intravenous (IV) antibiotics
- Intravenous (IV) vasopressors
- Intravenous (IV) corticosteroids
Correct answer: Normal saline (NS) bolus
In a patient with septic shock, the immediate priority is to restore circulating blood volume and improve tissue perfusion. Septic shock causes widespread vasodilation and increased capillary permeability, leading to severe hypovolemia. Administering a normal saline (NS) bolus rapidly expands the intravascular volume, which is crucial to stabilize blood pressure and deliver oxygen to vital organs before other treatments can take effect.
Question 11: During the postictal phase of a tonic-clonic seizure characterized by uncontrollable limb jerking and loss of consciousness, a nurse is providing postictal care for a 7-year-old male patient in the PICU. What results can be anticipated from this phase?
- Aura, loss of appetite, insomnia
- Immediate return to baseline behavior
- Drowsiness, headache, nausea (Correct answer)
- Crying, "pins-and-needles" sensation, tachycardia
Correct answer: Drowsiness, headache, nausea
The postictal phase is the recovery period immediately following a seizure. During this time, the brain is recovering from intense electrical activity, leading to common symptoms such as drowsiness, confusion, and fatigue. Patients may also experience headaches, muscle soreness, and sometimes nausea or vomiting as their body recovers from the physiological stress of the seizure.
Question 12: Which condition is caused by the presence of a large, isolated patent ductus arteriosus (PDA) where the ductus fails to close normally?
- Low systolic pressure
- High systolic pressure
- High diastolic pressure
- Low diastolic pressure (Correct answer)
Correct answer: Low diastolic pressure
A large patent ductus arteriosus (PDA) allows blood to continuously shunt from the high-pressure aorta to the lower-pressure pulmonary artery throughout both systole and diastole. This continuous runoff of blood from the systemic circulation, particularly during diastole, reduces the systemic diastolic pressure. Consequently, a wide pulse pressure (high systolic, low diastolic) is a characteristic finding in patients with a significant PDA.
Question 13: Which of the following graft types is frequently derived from cadaver skin and is frequently utilized in the treatment of pediatric burn wounds?
- Xenograft
- Heterograft
- Allograft (Correct answer)
- Autograft
Correct answer: Allograft
An allograft, also known as a homograft, is a tissue graft taken from a donor of the same species but a different genetic makeup. In pediatric burn care, cadaver skin is frequently used as an allograft. These grafts serve as temporary biological dressings to cover extensive burn wounds, providing a protective barrier against infection and fluid loss while promoting healing until the patient's own skin (autograft) can be harvested.
Question 14: When patient attributes and nursing competencies are aligned, optimal outcomes in terms of the AACN Synergy Model for Patient Care occur. From the standpoint of the patient and family, outcomes should contain everything listed below, EXCEPT:
- Functional changes
- Quality of life
- Behavioral changes
- Physiologic changes (Correct answer)
Correct answer: Physiologic changes
The AACN Synergy Model for Patient Care emphasizes that optimal outcomes occur when patient needs align with nursing competencies. From the perspective of the patient and family, outcomes are typically described in terms of their lived experience, such as improvements in functional abilities, quality of life, and behavioral adaptations. While nurses certainly influence physiological changes, these are often considered more objective, medical-centric measures rather than the subjective, holistic outcomes prioritized by the patient and family within this model.
Question 15: EMS reportedly transported a 4-year-old boy to the ER after he reportedly ingested some of his mother's prescribed diazepam (Valium). Which of the following is employed as a countermeasure to the drug's probable toxicity?
- N-acetylcysteine
- Naloxone
- Flumazenil (Correct answer)
- Activated charcoal
Correct answer: Flumazenil
Diazepam (Valium) is a benzodiazepine, and its overdose can lead to severe central nervous system depression, including respiratory depression. Flumazenil is a specific benzodiazepine receptor antagonist that competitively blocks the effects of benzodiazepines. Administering flumazenil can rapidly reverse the sedative and respiratory depressant effects, making it the appropriate countermeasure for diazepam toxicity.
Question 16: A nurse is gathering materials to start intravenous (IV) fluid resuscitation and a blood transfusion using packed red blood cells (PRBCs) as she gets ready to admit a child with a new diagnosis of sickle cell disease (SCD). Why is it necessary to use these interventions?
- To reduce pain caused by sickling
- To treat dehydration and anemia (Correct answer)
- To reverse hypovolemic shock
- To reduce kidney damage and correct acidosis
Correct answer: To treat dehydration and anemia
Children with sickle cell disease (SCD) are prone to dehydration, which can trigger painful vaso-occlusive crises, and chronic anemia due to the premature destruction of sickled red blood cells. Intravenous (IV) fluid resuscitation is crucial to correct dehydration and improve blood flow. Blood transfusions with packed red blood cells (PRBCs) are administered to treat severe anemia, increase oxygen-carrying capacity, and dilute the concentration of sickled cells, thereby reducing the risk of further complications.
Free Pediatric CCRN from AACN Questions and Answers
A newborn with transposed great arteries is hospitalized. 46% is the SpO2 value.
Nobody makes a murmur.
Which drugs should the nurse anticipate being given as a stopgap measure until a balloon septostomy can be performed?