Pediatric CCRN Exam Pediatric CCRN Psychosocial 3 — Questions and Answers
Question 1: A 12-year-old PICU patient with a chronic illness tells the nurse, 'I just want to die, I can't do this anymore.' What is the nurse's priority response?
- Reassure the patient that everything will be fine to reduce distress
- Ask directly whether the patient is thinking about ending their life (Correct answer)
- Immediately administer an anxiolytic per standing orders
- Notify the parents and leave the room to give the patient privacy
Correct answer: Ask directly whether the patient is thinking about ending their life
Directly asking about suicidal ideation does not increase risk and is the essential first step to assess safety and guide appropriate intervention.
Question 2: Which of the following is the MOST effective strategy to reduce PICU-related post-traumatic stress disorder (PTSD) in pediatric patients?
- Minimizing all parental involvement to reduce emotional stimulation
- Maintaining consistent staff assignments and providing procedural preparation (Correct answer)
- Keeping the child sedated during all waking hours to prevent memory formation
- Restricting visitation to prevent overstimulation
Correct answer: Maintaining consistent staff assignments and providing procedural preparation
Consistent caregivers and age-appropriate procedural preparation reduce uncertainty and fear, which are primary drivers of PICU-related PTSD in children.
Question 3: A father of a critically ill infant paces continuously, refuses to eat, and states he cannot leave the hospital. The nurse recognizes this as:
- Pathological attachment requiring psychiatric evaluation
- An acute stress response that is an expected parental reaction (Correct answer)
- Evidence of neglecting his own health requiring mandatory reporting
- Anxiety disorder exacerbation requiring pharmacological treatment
Correct answer: An acute stress response that is an expected parental reaction
Hypervigilance, inability to leave, and self-neglect are expected acute stress responses in parents of critically ill children and reflect normal parental protectiveness under extreme stress.
Question 4: When a 9-year-old asks the nurse, 'Am I going to die?' the most therapeutic response is:
- 'No, of course not, you are going to be just fine.'
- 'What makes you ask that question? What are you worried about?' (Correct answer)
- 'That's a question you should ask your parents, not me.'
- 'Let me call the doctor so they can explain your condition.'
Correct answer: 'What makes you ask that question? What are you worried about?'
Reflecting the question back with open-ended inquiry allows the nurse to understand the child's specific fears and provide honest, developmentally appropriate information.
Question 5: Siblings of a critically ill child are exhibiting behavioral regression and somatic complaints at home. The nurse should recommend:
- Keeping siblings completely away from the hospital to protect them from trauma
- Age-appropriate sibling visitation with preparation and a dedicated support person (Correct answer)
- Immediate psychological evaluation for all siblings showing regression
- Telling siblings the ill child has 'gone to sleep' if prognosis is poor
Correct answer: Age-appropriate sibling visitation with preparation and a dedicated support person
Prepared sibling visitation with a dedicated support person reduces siblings' anxiety by replacing frightening imaginings with reality and maintaining family connection.
Question 6: A 14-year-old PICU patient refuses to discuss her care in front of her parents. The nurse's best initial action is to:
- Override the adolescent's preference since parents have legal decision-making authority
- Ask the parents to step out briefly to allow a private conversation with the patient (Correct answer)
- Document the conflict as evidence of family dysfunction
- Refer the adolescent to child psychiatry for oppositional behavior
Correct answer: Ask the parents to step out briefly to allow a private conversation with the patient
Adolescents have a developmental need for privacy and autonomy; providing brief private time acknowledges this need and may reveal important clinical or psychosocial information.
Question 7: A mother who is a nurse insists on performing her 3-year-old's PICU nursing care herself. The care team's best approach is to:
- Prohibit the mother from performing any clinical tasks to maintain professional boundaries
- Collaborate with the mother to define safe, appropriate roles in her child's care (Correct answer)
- Allow the mother to take over all care to reduce her anxiety
- Report the mother to risk management for attempting to practice without hospital privileges
Correct answer: Collaborate with the mother to define safe, appropriate roles in her child's care
A family-centered care approach involves negotiating with parents about appropriate participation, leveraging their skills while maintaining safe boundaries and professional oversight.
Pediatric CCRN Exam Pediatric CCRN Psychosocial 3
A 12-year-old PICU patient with a chronic illness tells the nurse, 'I just want to die, I can't do this anymore.' What is the nurse's priority response?