Pediatric CCRN Exam Pediatric CCRN from AACN 4

Question 1

A 4-year-old on ECMO develops circuit clotting. Which lab value BEST reflects adequate anticoagulation?

Accepted Answer

Activated clotting time (ACT) of 180–220 seconds

Answer

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?

Accepted Answer

Hypophosphatemia causing cardiac and respiratory failure

Answer

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:

Accepted Answer

Levetiracetam, fosphenytoin, or valproate IV

Answer

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?

Accepted Answer

Initiate high-flow nasal cannula (HFNC) therapy

Answer

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:

Accepted Answer

IV calcium gluconate to stabilize cardiac membranes

Answer

IV calcium gluconate stabilizes the cardiac membrane immediately to prevent fatal arrhythmias from hyperkalemia, making it the priority before slower potassium-lowering therapies.

Pediatric CCRN Exam Practice Test

Pediatric CCRN Exam Practice Test

Pediatric CCRN Exam Pediatric CCRN from AACN 4