Pediatric CCRN Exam Pediatric CCRN from AACN 3 — Questions and Answers
Question 1: A 5-year-old with bacterial meningitis develops sudden hypotension, diffuse petechiae, and purpura. These findings are MOST consistent with:
- Hemolytic uremic syndrome
- Disseminated intravascular coagulation (DIC) (Correct answer)
- Thrombotic thrombocytopenic purpura
- Idiopathic thrombocytopenic purpura
Correct answer: Disseminated intravascular coagulation (DIC)
DIC is a life-threatening complication of sepsis/meningitis characterized by simultaneous clotting and bleeding, causing diffuse petechiae, purpura, and organ dysfunction.
Question 2: A pediatric CCRN nurse is caring for a child with increased intracranial pressure (ICP). Which positioning is MOST appropriate?
- Trendelenburg position to increase cerebral perfusion
- Head of bed at 30–45° with head midline (Correct answer)
- Prone positioning to decrease ICP
- Supine flat position to maximize venous return
Correct answer: Head of bed at 30–45° with head midline
Elevating the head of the bed 30–45° with the head in a neutral midline position promotes venous drainage and reduces ICP without compromising CPP.
Question 3: Which finding BEST indicates adequate cardiac output in a pediatric patient post-cardiac surgery?
- Mean arterial pressure >65 mmHg
- Mixed venous oxygen saturation (SvO2) of 70–75% (Correct answer)
- Heart rate within 10% of baseline
- Urine output >0.5 mL/kg/hr
Correct answer: Mixed venous oxygen saturation (SvO2) of 70–75%
SvO2 of 70–75% reflects a balance between oxygen delivery and consumption, serving as a global indicator of adequate cardiac output and tissue perfusion.
Question 4: A 2-year-old ingests a button battery. After endoscopic removal, the PRIORITY assessment is for:
- Stricture formation over the next 6 months
- Esophageal perforation or tracheoesophageal fistula (Correct answer)
- Chemical burn to the oral mucosa
- Aspiration of battery contents into the lungs
Correct answer: Esophageal perforation or tracheoesophageal fistula
Button batteries generate an electrical current that causes rapid liquefactive necrosis, risking esophageal perforation and life-threatening tracheoesophageal fistula within hours.
Question 5: A 9-year-old with sickle cell disease presents in vaso-occlusive crisis with acute chest syndrome. Which intervention is MOST indicated?
- High-flow oxygen via non-rebreather mask and IV fluids only
- Incentive spirometry, analgesics, oxygen, and exchange transfusion if severe (Correct answer)
- Immediate hydroxyurea administration
- Emergent splenectomy
Correct answer: Incentive spirometry, analgesics, oxygen, and exchange transfusion if severe
Acute chest syndrome management includes analgesia, incentive spirometry to prevent atelectasis, supplemental oxygen, antibiotics, and exchange transfusion in severe cases to reduce HbS levels.
Question 6: A 6-year-old on high-frequency oscillatory ventilation (HFOV) has worsening oxygenation. Which parameter should be adjusted to improve oxygenation?
- Increase oscillatory frequency (Hz)
- Increase mean airway pressure (MAP) (Correct answer)
- Decrease amplitude (ΔP)
- Decrease inspired oxygen concentration (FiO2)
Correct answer: Increase mean airway pressure (MAP)
In HFOV, oxygenation is primarily controlled by mean airway pressure and FiO2; increasing MAP recruits alveoli and improves oxygenation.
Question 7: The nurse notes that a 12-year-old post-cardiac catheterization has a cool, pulseless extremity distal to the access site. The FIRST action is:
- Apply warm compresses to the extremity
- Notify the physician immediately (Correct answer)
- Administer heparin 100 units/kg IV
- Document and continue monitoring every 30 minutes
Correct answer: Notify the physician immediately
A pulseless, cool extremity post-catheterization indicates arterial occlusion requiring immediate physician notification for potential thrombectomy or thrombolysis.
Pediatric CCRN Exam Pediatric CCRN from AACN 3
A 5-year-old with bacterial meningitis develops sudden hypotension, diffuse petechiae, and purpura.
These findings are MOST consistent with: