Pediatric CCRN Exam Pediatric CCRN Psychosocial 2 — Questions and Answers
Question 1: A 7-year-old in the PICU becomes increasingly withdrawn and refuses to speak after 3 days of hospitalization. Which nursing intervention is most appropriate to address this child's regression?
- Insist the child verbally communicate needs to prevent further regression
- Provide age-appropriate medical play with syringes and bandages (Correct answer)
- Limit family visitation to structured 1-hour windows to establish routine
- Sedate the child during procedures to prevent psychological trauma
Correct answer: Provide age-appropriate medical play with syringes and bandages
Medical play with safe equipment allows school-age children to process fears, regain a sense of control, and express feelings nonverbally in the PICU setting.
Question 2: Parents of a critically ill toddler display anger and hostility toward the nursing staff. According to crisis theory, this behavior most likely represents:
- Antisocial personality traits requiring psychiatric consultation
- A normal grief response as parents struggle to cope with loss of control (Correct answer)
- Evidence of prior family dysfunction that should be documented
- Displacement of guilt indicating the parents caused the child's illness
Correct answer: A normal grief response as parents struggle to cope with loss of control
Anger and hostility in parents of critically ill children typically represent a normal coping response to loss of control and overwhelming stress rather than pathology.
Question 3: A 16-year-old PICU patient refuses a recommended blood transfusion citing religious beliefs. The parents also refuse consent. What is the nurse's priority action?
- Administer the transfusion immediately since the patient is a minor
- Document the refusal and notify the physician and hospital ethics committee (Correct answer)
- Attempt to convince the adolescent privately without parental knowledge
- Discharge the patient to protect the facility from liability
Correct answer: Document the refusal and notify the physician and hospital ethics committee
When a minor and parents refuse life-sustaining treatment on religious grounds, the nurse must notify the physician and engage the ethics committee, which may seek a court order.
Question 4: Which developmental characteristic of toddlers (1-3 years) makes PICU hospitalization particularly stressful for this age group?
- Fear of bodily mutilation and loss of body integrity
- Separation anxiety and loss of autonomy (Correct answer)
- Loss of peer relationships and social identity
- Abstract thinking about death and permanent disability
Correct answer: Separation anxiety and loss of autonomy
Toddlers are in Erikson's autonomy vs. shame stage and have strong attachment bonds, making separation from caregivers and loss of newly gained independence the primary stressors.
Question 5: A PICU nurse notices a colleague consistently avoids entering the room of a dying child and delegates all care to others. This behavior is BEST described as:
- Appropriate boundary-setting to maintain professional objectivity
- Compassion fatigue manifesting as avoidance behavior (Correct answer)
- Evidence of incompetence requiring mandatory retraining
- Normal behavior that should be encouraged in all staff
Correct answer: Compassion fatigue manifesting as avoidance behavior
Avoidance of emotionally difficult patients is a behavioral manifestation of compassion fatigue, which requires recognition and intervention to protect staff wellbeing and patient care.
Question 6: When communicating a child's poor prognosis to the family, the PICU nurse should:
- Use medical terminology to convey professionalism and accuracy
- Provide all prognostic information in a single, comprehensive session
- Allow silence and sit with the family after delivering difficult news (Correct answer)
- Encourage the family to remain positive to support the child's recovery
Correct answer: Allow silence and sit with the family after delivering difficult news
Sitting in therapeutic silence after delivering bad news allows families to process information and feel supported without the pressure of immediate verbal response.
Question 7: A nurse is caring for a 5-year-old with a new tracheostomy whose parents are from a culture that believes illness is a punishment from God. Which action best demonstrates culturally competent care?
- Educate the parents that illness is not a punishment to correct their misconception
- Ask the parents what their belief means for their child's care and incorporate their values (Correct answer)
- Document the belief as a barrier to care and request social work intervention
- Avoid discussing the topic to prevent conflict during the hospitalization
Correct answer: Ask the parents what their belief means for their child's care and incorporate their values
Culturally competent care requires asking open-ended questions about how cultural beliefs affect care decisions and integrating those values into the care plan respectfully.
Pediatric CCRN Exam Pediatric CCRN Psychosocial 2
A 7-year-old in the PICU becomes increasingly withdrawn and refuses to speak after 3 days of hospitalization.
Which nursing intervention is most appropriate to address this child's regression?