Pediatric CCRN Exam Pediatric CCRN from AACN 4 — Questions and Answers
Question 1: A 4-year-old on ECMO develops circuit clotting. Which lab value BEST reflects adequate anticoagulation?
- Prothrombin time (PT) within normal limits
- Activated clotting time (ACT) of 180–220 seconds (Correct answer)
- Platelet count >150,000/μL
- Anti-Xa level >1.0 IU/mL
Correct answer: Activated clotting time (ACT) of 180–220 seconds
ACT is the primary monitoring tool for heparin anticoagulation during ECMO, with target ranges typically 180–220 seconds to prevent circuit thrombosis while minimizing bleeding risk.
Question 2: A 16-year-old with anorexia nervosa is admitted to the PICU. During refeeding, which complication is MOST critical to monitor for?
- Hyperphosphatemia and hypercalcemia
- Hypophosphatemia causing cardiac and respiratory failure (Correct answer)
- Hyperglycemia from excessive carbohydrate intake
- Hyperkalemia from protein metabolism
Correct answer: Hypophosphatemia causing cardiac and respiratory failure
Refeeding syndrome causes a precipitous drop in serum phosphate as cells uptake phosphate during anabolism, leading to life-threatening cardiac arrhythmias and respiratory failure.
Question 3: A 3-year-old with status epilepticus does not respond to two doses of lorazepam. According to current guidelines, the NEXT medication is:
- Phenobarbital 20 mg/kg IV
- Levetiracetam, fosphenytoin, or valproate IV (Correct answer)
- Midazolam continuous infusion
- Propofol for rapid seizure termination
Correct answer: Levetiracetam, fosphenytoin, or valproate IV
Current pediatric status epilepticus guidelines recommend second-line agents — fosphenytoin, levetiracetam, or valproate — after failure of two benzodiazepine doses.
Question 4: A 6-month-old with bronchiolitis has an SpO2 of 88% on 2L nasal cannula. What is the MOST appropriate next intervention?
- Increase nasal cannula flow to 4L
- Initiate high-flow nasal cannula (HFNC) therapy (Correct answer)
- Place immediately on bilevel positive airway pressure (BiPAP)
- Begin non-invasive positive pressure ventilation (NIPPV)
Correct answer: Initiate high-flow nasal cannula (HFNC) therapy
HFNC is the preferred escalation step for infants with bronchiolitis failing low-flow oxygen, providing heated humidified flow that improves oxygenation and reduces work of breathing.
Question 5: A 10-year-old with tumor lysis syndrome (TLS) has a potassium of 6.8 mEq/L with peaked T-waves on ECG. The PRIORITY intervention is:
- Sodium polystyrene sulfonate (Kayexalate) enema
- IV calcium gluconate to stabilize cardiac membranes (Correct answer)
- Aggressive IV fluid resuscitation
- Emergent hemodialysis
Correct answer: IV calcium gluconate to stabilize cardiac membranes
IV calcium gluconate stabilizes the cardiac membrane immediately to prevent fatal arrhythmias from hyperkalemia, making it the priority before slower potassium-lowering therapies.
Question 6: Which assessment finding MOST suggests increased intracranial pressure in a 2-year-old?
- Sunken anterior fontanelle and tachycardia
- Bulging fontanelle, high-pitched cry, and sunset sign (Correct answer)
- Pinpoint pupils and bradypnea
- Decerebrate posturing and absent gag reflex
Correct answer: Bulging fontanelle, high-pitched cry, and sunset sign
A bulging fontanelle, high-pitched cry, and sunset sign (downward deviation of eyes) are classic early signs of increased ICP in infants with an open fontanelle.
Question 7: A family requests withdrawal of life-sustaining treatment for their critically ill child. The nurse's BEST response is:
- Encourage the family to wait 48 more hours before deciding
- Notify the ethics committee without informing the medical team
- Support the family's decision and facilitate a family meeting with the multidisciplinary team (Correct answer)
- Inform the family that this decision must be made by the attending physician only
Correct answer: Support the family's decision and facilitate a family meeting with the multidisciplinary team
Supporting the family's autonomy and facilitating a multidisciplinary family meeting ensures informed, compassionate end-of-life care consistent with AACN ethical principles.
Pediatric CCRN Exam Pediatric CCRN from AACN 4
A 4-year-old on ECMO develops circuit clotting.
Which lab value BEST reflects adequate anticoagulation?