Free Pediatric CCRN Sample Question and Answers — Questions and Answers

Question 1: Which of the following electrolyte problems should a nurse monitor when administering an exchange transfusion to a sickle cell patient?

Hypercalcemia
Hypocalcemia (Correct answer)
Hypomagnesemia
Hypokalemia

Correct answer: Hypocalcemia

Exchange transfusions involve replacing the patient's blood with donor blood, which is typically preserved with citrate. Citrate acts as an anticoagulant by binding to calcium. When large amounts of citrated blood are infused rapidly during an exchange transfusion, the citrate can chelate the patient's circulating calcium, leading to a significant drop in serum calcium levels (hypocalcemia). Therefore, monitoring and potentially supplementing calcium are crucial during this procedure.

Question 2: Which of the following does positive end-expiratory pressure (PEEP) aim to accomplish?

Increase venous return to the heart
Increase cardiac output
Decrease functional residual capacity
Increase functional residual capacity (Correct answer)

Correct answer: Increase functional residual capacity

Positive end-expiratory pressure (PEEP) is a ventilatory maneuver that maintains a positive pressure in the airways at the end of exhalation. Its primary goal is to prevent alveolar collapse (atelectasis) and recruit collapsed alveoli, thereby increasing the functional residual capacity (FRC). By keeping alveoli open, PEEP improves oxygenation, reduces the work of breathing, and optimizes gas exchange.

Question 3: What desired outcome is achieved when amrinone lactate (Inocor) is administered?

Phospholipid inhibition
Vasodilation (Correct answer)
Catecholamine antagonism
Decreased myocardial contractility

Correct answer: Vasodilation

Amrinone lactate (Inocor) is a phosphodiesterase inhibitor that increases intracellular cyclic AMP (cAMP) in both cardiac and vascular smooth muscle cells. In the heart, this leads to increased contractility (positive inotropy). In vascular smooth muscle, increased cAMP causes relaxation, resulting in systemic and pulmonary vasodilation, which reduces afterload. This dual action improves cardiac output by both strengthening contractions and reducing the resistance the heart pumps against.

Question 4: After taking prenatal vitamins with iron, a 5-year-old is receiving treatment in the PICU. The nurse assumes all of the following EXCEPT:

Administration of activated charcoal (Correct answer)
Whole bowel irrigation
Administration of ipecac syrup
Gastric lavage

Correct answer: Administration of activated charcoal

The question asks what the nurse assumes *EXCEPT* when treating iron poisoning. Activated charcoal is generally ineffective in binding iron and is therefore not recommended for iron overdose. Iron is poorly adsorbed by charcoal, making it an unsuitable decontamination method. In contrast, whole bowel irrigation, gastric lavage (if early and large ingestion), and sometimes ipecac syrup (though less common now) are methods that might be considered for decontamination in severe iron poisoning, depending on the clinical situation and timing.

Question 5: Which of the following group of children might have a hypertensive crisis as shown by acidosis, hypothermia, and alveolar hypoxia?

Those with sustained increases in afterload
Those with reactive pulmonary vascular bed (Correct answer)
Those with systemic vascular disease.
Those with increases in ventricular afterload.

Correct answer: Those with reactive pulmonary vascular bed

A reactive pulmonary vascular bed is prone to vasoconstriction, leading to increased pulmonary vascular resistance and pulmonary hypertension. This can cause a hypertensive crisis in the pulmonary circulation, resulting in poor gas exchange, alveolar hypoxia, and subsequent metabolic acidosis. Hypothermia can also be a consequence of severe physiological stress and poor perfusion in such critical states.

Question 6: All of the following, except one, are side effects of an external ventricular drain (EVD).

Infection
Subarachnoid hemorrhage
Diabetes insipidus (Correct answer)
Brain herniation

Correct answer: Diabetes insipidus

An External Ventricular Drain (EVD) is a device used to drain cerebrospinal fluid and monitor intracranial pressure. Common side effects include infection, hemorrhage (like subarachnoid), and brain herniation if not managed properly. Diabetes insipidus, however, is typically caused by damage to the hypothalamus or posterior pituitary gland, which is not a direct or common complication of EVD placement itself, but rather related to the underlying brain injury or pathology.

Question 7: Extreme dyspnea is being experienced by a 3-year-old with left-sided ventricular heart failure and pulmonary edema. Which of the following would the nurse advise doing to help the child breathe easier and feel less anxious and agitated?

Morphine (Duramorph) (Correct answer)
Dobutamine (Dobutrex)
Digoxin (Lanoxin)
Furosemide (Lasix)

Correct answer: Morphine (Duramorph)

Morphine is beneficial in acute pulmonary edema due to left-sided heart failure because it acts as a venodilator, reducing preload and afterload on the heart. This decreases pulmonary congestion and improves breathing. Additionally, morphine helps alleviate the severe anxiety and agitation associated with extreme dyspnea, reducing oxygen consumption and making the child more comfortable.

Question 8: Blood in her urine is the main complaint of a young patient. Medical records investigation reveals multiple admissions for the same ailment. No cause has been identified. Only when the mother is there does the patient exhibit symptoms. The nurse anticipates that the diagnosis is going to be:

Physical Abuse
Sexual Abuse
Nonaccidental Trauma
Muchausen syndrome by proxy. (Correct answer)

Correct answer: Muchausen syndrome by proxy.

Munchausen syndrome by proxy (MSP) is a form of child abuse where a caregiver fabricates or induces illness in a child. The classic signs include unexplained, recurrent illnesses with no identified cause, symptoms that only appear in the presence of the caregiver, and multiple hospital admissions. The mother's presence correlating with the child's symptoms strongly suggests MSP.

Question 9: The nurse would anticipate finding _______ of a child whose coarctation of the aorta was suspected.

diminishing cartoid pulses
strong pedal pulses
bounding pulses in the arms (Correct answer)
normal femoral pulses

Correct answer: bounding pulses in the arms

Coarctation of the aorta is a narrowing of the aorta, typically occurring after the arteries branching to the upper body. This narrowing causes increased blood pressure and bounding pulses in the arms and head, as blood flow is obstructed to the lower extremities. Consequently, pulses in the legs (femoral and pedal) would be diminished or absent compared to the strong upper extremity pulses.

Question 10: Which of the following would cause a newborn who had recently undergone cardiac surgery to lose more fluid without being aware of it and develop hypovolemia?

Hypothermia
Radiant warmer use (Correct answer)
Sedation
Decreased activity

Correct answer: Radiant warmer use

Newborns, especially those post-cardiac surgery, are highly susceptible to insensible fluid loss due to their large body surface area relative to mass and immature skin barrier. Radiant warmers, while essential for maintaining body temperature, increase this evaporative fluid loss significantly. This can quickly lead to hypovolemia if fluid intake is not adequately adjusted to compensate for the increased loss.

Question 11: A toddler who suffered a head injury is admitted. The following is the most important aspect of the nurse's ongoing evaluation for early neurological deterioration:

Pupillary response
Cranial nerve assessment
Level of consciousness (Correct answer)
Motor response

Correct answer: Level of consciousness

Level of consciousness (LOC) is the most sensitive and earliest indicator of neurological deterioration following a head injury. Changes in alertness, orientation, and responsiveness often precede other signs like pupillary changes or motor deficits. Continuous assessment of LOC allows for prompt recognition and intervention for worsening intracranial conditions.

Question 12: Which of the following will the asthma patient's chest X-ray most frequently display?

Lobar consolidation
Perihilar infiltrates
Hyperinflation (Correct answer)
An elevated diaphragm

Correct answer: Hyperinflation

Asthma is characterized by bronchoconstriction and inflammation, leading to air trapping in the lungs. This trapped air causes the lungs to become overinflated, which is visible on a chest X-ray as hyperinflation. Signs of hyperinflation include flattened diaphragms, increased retrosternal air space, and widely spaced ribs.

Question 13: A diabetic child who passed out in class is hospitalized. He has tachycardia, short breathing, dilated pupils, and hyperreflexia at admission. The treatment strategy would involve providing:

25% Dextrose IV (Correct answer)
Glucagon IM
Regular insulin SQ
Naloxone (Narcan) IV

Correct answer: 25% Dextrose IV

The child's symptoms of passing out, tachycardia, short breathing, dilated pupils, and hyperreflexia are classic signs of severe hypoglycemia (low blood sugar). In an unconscious or severely symptomatic diabetic child, immediate intravenous administration of 25% Dextrose is crucial to rapidly raise blood glucose levels. This provides immediate glucose to the brain and other tissues, reversing the life-threatening effects of hypoglycemia.

Question 14: The nurse's initial step in treating a patient who has hypovolemic shock as a result of persistent vomiting should be to:

Prepare equipment for intubation
Administer oxygen (Correct answer)
Increase intravenous fluid rate
Prepare the patient for central venous line placement

Correct answer: Administer oxygen

In any shock state, including hypovolemic shock, the initial priority is to ensure adequate oxygenation and ventilation, following the ABCs (Airway, Breathing, Circulation). Administering oxygen helps improve tissue oxygen delivery, which is compromised due to reduced blood volume and perfusion. While fluid resuscitation is critical, ensuring oxygen supply to vital organs is the very first step to mitigate cellular damage.

Question 15: When treating a baby with persistent pulmonary hypertension, the primary objective is to:

Dilate the pulmonary vascular bed (Correct answer)
Maintain fetal pulmonary circulation
Maintain the pH level at less than 7.40
Dilate the systemic vascular bed

Correct answer: Dilate the pulmonary vascular bed

Persistent pulmonary hypertension of the newborn (PPHN) is characterized by high pulmonary vascular resistance, which prevents adequate blood flow to the lungs for oxygenation. The primary objective of treatment is to dilate the pulmonary vascular bed, thereby reducing pulmonary vascular resistance. This allows more blood to flow through the lungs, improving oxygen uptake and systemic oxygenation.

Question 16: Which of the following should be done after desmopressin (DDAVP) has been given to a patient with diabetes insipidus?

Maintain current fluid rate
Increase sodium intake
Decrease IV fluid rate (Correct answer)
Decrease glucose intake

Correct answer: Decrease IV fluid rate

Desmopressin (DDAVP) is an antidiuretic hormone analog that helps the kidneys reabsorb water, significantly reducing urine output in patients with diabetes insipidus. After administering DDAVP, the patient will excrete less fluid, so it is crucial to decrease the IV fluid rate to prevent fluid overload and dilutional hyponatremia. Monitoring fluid balance closely is essential to avoid complications.

Free Pediatric CCRN Sample Question and Answers

Which of the following electrolyte problems should a nurse monitor when administering an exchange transfusion to a sickle cell patient?