Pediatric CCRN Exam Pediatric CCRN from AACN 5 — Questions and Answers
Question 1: A 7-year-old post-liver transplant develops tacrolimus toxicity. Which finding is MOST expected?
- Hypoglycemia and metabolic acidosis
- Nephrotoxicity with rising creatinine and hypertension (Correct answer)
- Thrombocytosis and hypercoagulability
- Bradycardia and prolonged QT interval
Correct answer: Nephrotoxicity with rising creatinine and hypertension
Tacrolimus (a calcineurin inhibitor) commonly causes nephrotoxicity, presenting with rising creatinine and hypertension, requiring dose adjustment and close monitoring of drug levels.
Question 2: A 5-year-old with suspected non-accidental trauma (child abuse) has multiple bruises in various stages of healing. The nurse's LEGAL obligation is to:
- Discuss suspicions only with the child's primary nurse before acting
- Report the suspicion to child protective services (CPS) and document findings (Correct answer)
- Wait for the physician to make the mandatory report
- Confront the caregivers directly before filing a report
Correct answer: Report the suspicion to child protective services (CPS) and document findings
Nurses are mandatory reporters and are legally obligated to report suspected child abuse to CPS regardless of confirmation; documentation of objective findings is essential.
Question 3: A 12-year-old with acute kidney injury (AKI) has oliguria and a rising BUN/creatinine ratio >20:1. This pattern MOST suggests:
- Intrinsic renal failure from tubular necrosis
- Prerenal azotemia from volume depletion (Correct answer)
- Postrenal obstruction from urinary calculi
- Contrast-induced nephropathy
Correct answer: Prerenal azotemia from volume depletion
A BUN:creatinine ratio >20:1 with oliguria indicates prerenal azotemia, where decreased renal perfusion causes urea retention disproportionate to creatinine.
Question 4: An 8-year-old post-cardiopulmonary bypass develops junctional ectopic tachycardia (JET). Which intervention is MOST appropriate?
- Administer adenosine 0.1 mg/kg rapid IV push
- Apply external pacing at a rate faster than JET rate
- Induce mild hypothermia to 35–36°C and correct electrolytes (Correct answer)
- Perform synchronized cardioversion at 0.5 J/kg
Correct answer: Induce mild hypothermia to 35–36°C and correct electrolytes
JET post-cardiac surgery is managed with cooling to 35–36°C, correcting electrolytes (especially magnesium and potassium), and reducing catecholamines, as adenosine and cardioversion are ineffective.
Question 5: A neonate has SpO2 of 75% in the right hand and 95% in the right foot. This differential saturation pattern MOST suggests:
- Coarctation of the aorta with reverse differential cyanosis
- Transposition of the great arteries with patent ductus arteriosus (Correct answer)
- Tetralogy of Fallot with right-to-left shunting
- Total anomalous pulmonary venous return
Correct answer: Transposition of the great arteries with patent ductus arteriosus
In transposition of great arteries with a PDA, oxygenated pulmonary blood flows right-to-left through the duct to the descending aorta, causing higher SpO2 in the lower body (post-ductal) than in the pre-ductal upper body.
Question 6: A 15-year-old with severe traumatic brain injury (TBI) has a cerebral perfusion pressure (CPP) of 45 mmHg. ICP is 28 mmHg. What MAP is needed to achieve a target CPP of 60 mmHg?
- 60 mmHg
- 75 mmHg
- 88 mmHg (Correct answer)
- 95 mmHg
Correct answer: 88 mmHg
CPP = MAP − ICP; to achieve CPP of 60 with ICP of 28, the MAP must be 60 + 28 = 88 mmHg.
Question 7: A 4-year-old with burns over 40% TBSA on day 2 of hospitalization has brown urine, rising creatinine, and serum CK of 25,000 U/L. The PRIORITY intervention is:
- Administer furosemide to increase urine output
- Aggressively increase IV fluid rate to maintain urine output >1–2 mL/kg/hr (Correct answer)
- Add sodium bicarbonate to IV fluids to alkalinize urine and protect kidneys
- Initiate emergent dialysis for myoglobinuric renal failure
Correct answer: Aggressively increase IV fluid rate to maintain urine output >1–2 mL/kg/hr
Myoglobinuria from rhabdomyolysis requires aggressive IV fluid resuscitation to achieve urine output of 1–2 mL/kg/hr to flush myoglobin from the tubules and prevent acute kidney injury.
Pediatric CCRN Exam Pediatric CCRN from AACN 5
A 7-year-old post-liver transplant develops tacrolimus toxicity.
Which finding is MOST expected?