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AACN CCRN-Pediatric Exam is open to registered nurses and advanced practice registered nurses (APRNs) with at least two years of experience in pediatric critical care. Candidates must hold a current and unrestricted RN or APRN license to be eligible to take the exam. Additionally, they must meet specific clinical practice hour requirements and achieve a predetermined continuing education level. Once candidates pass the exam, they will be recognized as having the certification in pediatric critical care nursing demonstrating their expertise in critical care nursing.
The American Association of Critical-Care Nurses (AACN) Certification Corporation offers certifications in various nursing specialties, and one of their most prestigious certifications is the CCRN-Pediatric exam. Critical Care Nursing Exam certification is specifically designed for nurses who work in pediatric critical care settings, such as intensive care units, cardiac care units, and emergency departments. Nurses who pass the CCRN-Pediatric exam demonstrate their expertise in providing care for critically ill pediatric patients.
NEW QUESTION # 46
A student nurse is caring for a 4-year old child diagnosed with croup and the clinical instructor asks the student about the clinical manifestations associated with the illness. Which statement by the student indicates a need for further research:
- A. symptoms usually worsen at night and are better during the day
- B. symptoms usually worsen during the day and are relieved during sleep
- C. inspiratory stridor and a low-grad fever may be present
- D. cough is harsh and brassy
Answer: B
Explanation:
Explanation: Croup often begins at night and may be preceded by several days of upper respiratory infection symptoms. Croup is characterized by a sudden onset of a harsh, brassy cough, sore throat, and inspiratory stridor. Symptoms usually worsen at night and are better in the day. Croup usually is accompanied by a low-grade fever.
NEW QUESTION # 47
Following resuscitation of a 2-year-old near-drowning patient, which of the following changes is indicative of a poor neurologic outcome?
- A. Absent Babinski's reflex
- B. Absent Cushing's reflex
- C. Flaccid paralysis
- D. Pupil constriction
Answer: C
Explanation:
In the post-resuscitation period of a near-drowning event, neurologic status is the primary determinant of prognosis. Flaccid paralysis is a sign ofsevere hypoxic-ischemic brain injury, reflectingglobal neuronal dysfunctionandpoor cerebral perfusion recovery.
FromCCRN (Pediatric) - Direct Care (Neurology Section):
"Signs of poor neurological outcome post-resuscitation include lack of purposeful movement, flaccidity, absence of motor responses to pain, and abnormal or absent brainstem reflexes. Flaccid paralysis, particularly when persistent after resuscitative efforts, strongly correlates with a poor neurologic prognosis in pediatric patients." In contrast:
* Pupil constrictionmay be benign or related to medication or light stimulus.
* Absent Babinski's reflexis not considered abnormal at 2 years.
* Absent Cushing's reflexis non-specific and may not manifest in all children with brain injury.
NEW QUESTION # 48
Charlie, an 8-month-old infant, had a clubfoot. A boot cast was applied to correct the problem. Which of the following assessment could not be determined while the boot cast is in place:
- A. warmth
- B. Pedal pulse
- C. color
- D. blanching
Answer: B
Explanation:
Explanation: Pedal pulse is obviously not measurable while the boot cast is in place.
NEW QUESTION # 49
Upon assessing the mouth of a 4 year-old child, the nurse noted that the teeth have chalky white-to- yellowish staining with pitting of the enamel. Which of the following conditions would most likely explain these findings?
- A. Tetracycline ingestion
- B. Oral iron therapy
- C. Excessive fluoride intake
- D. Poor oral hygiene
Answer: C
Explanation:
Explanation: The findings are indicative of Fluorosis, a condition characterized by an increase in the extent and degree of the enamel''s porosity. This problem is associated with repeated swallowing of toothpaste with fluoride and or drinking water with high levels of fluoride.
NEW QUESTION # 50
A 12-year-old patient with severe developmental delay underwent a video-assisted thoracentesis and chest tube placement for an empyema. The patient remained intubated after the procedure. The nurse is assessing for postoperative pain. Which of the following pain assessment tools should the nurse select?
- A. FLACC pain scale
- B. Numeric scale
- C. Visual analog scale
- D. Faces pain rating scale
Answer: A
Explanation:
TheFLACC scale(Face, Legs, Activity, Cry, Consolability) is abehavioral pain assessment tool validated for use in non-verbal or cognitively impaired children, as well as those who are intubated or developmentally delayed.
"For non-verbal children or those with developmental delay, the FLACC scale is most appropriate. It assesses behavioral cues and is validated for use in ICU and post-op settings." (Referenced from CCRN Pediatric - Direct Care: Neurological, Pain and Sedation Assessment Tools)
NEW QUESTION # 51
One day after a spinal fusion, a child is tachycardic and febrile with decreased bilateral breath sounds.
SaO# is 92% on 2 L/min and FVC is 10 mL/kg. These symptoms most likely indicate:
- A. Aspiration pneumonia
- B. Pneumothorax
- C. Pulmonary embolism
- D. Atelectasis
Answer: D
Explanation:
Atelectasisis common postoperatively, especially after spinal surgery due toimmobility, poor inspiratory effort, andsedation. Thedecreased breath sounds, fever, and low FVC (<15 mL/kg)strongly support this diagnosis.
"Postoperative patients, particularly those with thoracoabdominal or spinal surgery, are at high risk for atelectasis. Low FVC, diminished breath sounds, and hypoxemia are hallmark signs." (Referenced from CCRN Pediatric - Direct Care: Pulmonary, Postoperative Respiratory Complications)
NEW QUESTION # 52
A teenage patient has an abrasion on her right forearm after a fall from a bicycle 3 days ago. The arm is cool, pale, and tight, capillary refill is greater than 5 seconds, and movement of her fingers is limited.
Which of the following should a nurse anticipate as the initial treatment?
- A. Incisional fasciotomy
- B. Fluid bolus and antibiotic administration
- C. X-ray of the right forearm
- D. Application of an immobilizing device
Answer: A
Explanation:
This clinical picture is classic forcompartment syndrome: a surgical emergency. Symptoms includecool extremity, prolonged capillary refill, pain, paresthesia, and loss of motor function.Fasciotomyis the definitive treatment torelieve pressure and prevent permanent damage.
"Compartment syndrome requires immediate fasciotomy. Delay in intervention may lead to muscle necrosis and permanent disability." (Referenced from CCRN Pediatric - Direct Care: Musculoskeletal, Orthopedic Trauma and Emergencies)
NEW QUESTION # 53
A stat abdominal x-ray reveals free air and a large loculated fluid collection presumed to be blood. The priority of care should be:
- A. Platelet transfusion
- B. Nasogastric tube placement
- C. Surgical intervention
- D. Vasopressin (Pitressin) therapy
Answer: C
Explanation:
Free air on abdominal x-rayindicatesbowel perforation, andloculated fluidsuggests hemoperitoneum or intra-abdominal bleeding. This is asurgical emergency, and the child requiresimmediate operative interventionto prevent further deterioration.
"Free intraperitoneal air and fluid suggest perforation and hemorrhage, which require emergent surgical exploration and correction to prevent peritonitis and shock." (Referenced from CCRN Pediatric - Direct Care: Gastrointestinal, Surgical Emergencies and Acute Abdomen)
NEW QUESTION # 54
A mother tells the nurse "the doctor said that my child has pulmonic stenosis. What does it mean?" The nurse's best response should be:
- A. "Let me call your doctor so that your questions will be answered correctly"
- B. "You seemed very concerned. Your baby has a great doctor anyway"
- C. "It means that the baby has a heart failure"
- D. "What else did the doctor say about the disease"
Answer: D
Explanation:
Explanation: The nurse needs to know how much information the mother has before giving any information. We know that the disease is narrowing at the entrance to the pulmonary artery and may vary in severity and treatment. Calling the doctor at this point abdicates the role of the nurse.
NEW QUESTION # 55
The nurse notes that a 10-month-old infant had a fever, runny nose, cough, and white spots in the mouth for almost 3 days. Rash started on his face and spread to the whole body. The nurse suspected a case of:
- A. Varicella
- B. Herpes
- C. Rubella
- D. Rubella
Answer: D
Explanation:
Explanation: Signs and symptoms of Rubella include Koplik's spots and rash accompanied by coryza.
NEW QUESTION # 56
A nurse preceptor and new nurse are caring for a 16-year-old patient following a crush injury. The lab report is significant for a creatine kinase (CK) level of 150 U/L and the patient's urine is dark yellow.
Vital signs are:
* BP: 95/60
* HR: 115
* RR: 22
* Temp: 100.5°F (38.1°C)
Which of the following statements by the new nurse is most correct?
- A. "The clinical presentation looks like rhabdomyolysis."
- B. "This is indicative of decompensated septic shock."
- C. "The patient is demonstrating signs of MODS."
- D. "This is the result of an inflammatory response."
Answer: A
Explanation:
Rhabdomyolysisis characterized byelevated CK levels,tea-colored urine, and signs ofmyoglobinuriaafter muscle injury (such as crush injuries). This condition can lead toacute kidney injuryand electrolyte disturbances.
"Crush injuries can lead to rhabdomyolysis, evidenced by muscle pain, elevated creatine kinase,and dark urine due to myoglobin. Early identification and hydration are critical to prevent renal complications." (Referenced from CCRN Pediatric - Direct Care: Multisystem, Trauma and Rhabdomyolysis)
NEW QUESTION # 57
A 15-year-old boy comes to a clinic with complaint of thick urethral discharge. For gonorrhea to be ruled out the nurse should:
- A. obtain blood sample for VDRL
- B. obtain sexual history
- C. collect urine sample
- D. obtain urethral specimen
Answer: D
Explanation:
Explanation: If the causative agent/organism is present in the genitourinary tract of the client, a culture of the urethral exudates would provide a definitive diagnosis.
NEW QUESTION # 58
A mother asks the school nurse as her school age child has Encopresis. The nurse advised the mother to:
- A. Not let a child wear clothes with elastic bandages
- B. Give as much attention as you can to the bowel habits
- C. Have the child wear buttoned pants
- D. Have her child clean his soiled pants
Answer: D
Explanation:
Explanation: Let the child over six take responsibility for cleaning their soiled pants. It is not a punishment, but a way to help a child learn to take responsibility for his actions and motivate him to listen to his body signals.
NEW QUESTION # 59
A patient with restrictive cardiomyopathy is ambulating and begins to complain of fatigue and chest pain. A nurse should expect initial treatment to be aimed at:
- A. Decreasing the preload
- B. Decreasing cardiac workload
- C. Increasing systemic vascular resistance
- D. Increasing the force of contraction
Answer: B
Explanation:
Restrictive cardiomyopathyis characterized byimpaired ventricular fillingdue to stiff ventricular walls.
The primary issue isdiastolic dysfunction, not contractility. As a result, the focus is onreducing myocardial oxygen demand and workload, often with activity restriction, beta blockers, and afterload reduction.
"Management of restrictive cardiomyopathy centers on decreasing cardiac workload and optimizing preload, as the heart cannot relax properly. Inotropic agents are not typically effective." (Referenced from CCRN Pediatric - Direct Care: Cardiovascular, Cardiomyopathies)
NEW QUESTION # 60
A 15-year-old patient with a history of anxiety is experiencing palpitations, dizziness, nausea, diaphoresis, and tachypnea. This is most likely:
- A. An asthma exacerbation
- B. Due to caffeine consumption
- C. Supraventricular tachycardia
- D. A panic attack
Answer: D
Explanation:
Panic attacksare common in adolescents and present withsympathetic overdrivesymptoms-palpitations, dyspnea, dizziness, chest discomfort, nausea, and diaphoresis. A history of anxiety strongly supports this diagnosis, especially in the absence of objective cardiac or respiratory findings.
"Panic attacks in adolescents can mimic cardiopulmonary emergencies. The presence of a prior anxiety disorder and resolution of symptoms without intervention support the diagnosis." (Referenced from CCRN Pediatric - Direct Care: Psychosocial, Mental Health Emergencies)
NEW QUESTION # 61
When assessing a newborn with cleft lip, the nurse would be alert which of the following will most likely be compromised:
- A. Locomotion
- B. GI function
- C. Respiratory status
- D. Sucking ability
Answer: D
Explanation:
Explanation: Because of the defect, the child will be unable to form the mouth adequately around the nipple thereby requiring special devices to allow feeding and sucking gratification. Respiratory status may be compromised when the child is fed improperly or during post op period.
NEW QUESTION # 62
A 7 year-old child was rushed at the ER after a sudden onset of findings that include irritability, thick muffled voice, croaking on inspiration, fever, leaning forward while in a sitting position, protruding tongue, salivation and suprasternal retractions. What should the nurse do first?
- A. have the sputum sent to laboratory for testing
- B. Have the child undergo an upper airway x-ray
- C. notify the doctor about the current status
- D. assess the throat
Answer: C
Explanation:
Explanation: These findings suggest a medical emergency and may be due to epiglottises. Any child with an acute onset of an inflammatory response in the mouth and throat should receive immediate medical attention in a hospital equipped with Intubation or a Tracheostomy in the event of further or complete obstruction.
NEW QUESTION # 63
The family member of a patient who is receiving mechanical ventilation is to be taught suctioning.
When developing a teaching plan, the nurse should first:
- A. Identify the areas in which the family member needs information and skills
- B. Determine a schedule for demonstrating the technique
- C. Obtain written information about the procedure
- D. Encourage the family member to observe the procedure on other patients
Answer: A
Explanation:
Assessment of learner needsis the foundational step in developing a teaching plan. Understanding what the caregiver knows or is anxious about allows for a tailored, effective education approach.
"Before implementing education, the nurse should assess the family member's baseline knowledge and learning needs to guide teaching and ensure competence in complex care procedures." (Referenced from CCRN Pediatric - Professional Caring and Ethical Practice: Family-Centered Teaching and Learning)
NEW QUESTION # 64
A nursing practice council is reviewing a protocol for flushing unused IV lines. A team member questions the use of saline vs. dextrose. What should the council do first?
- A. Plan interventions
- B. Develop research methods
- C. Determine the problem
- D. Identify the outcomes
Answer: C
Explanation:
The first step in any evidence-based practice (EBP) or quality improvement (QI) process is toclearly define the clinical problem or question. Before outcomes or interventions are addressed, the council must determine the exact issue to be studied.
"In quality improvement and evidence-based practice, step one is always problem identification. A well- defined problem leads to targeted and effective research." (Referenced from CCRN Pediatric - Professional Caring and Ethical Practice: Evidence-Based Practice and QI Models)
NEW QUESTION # 65
A 10-year-old child presents with peri-umbilical pain, rebound tenderness, nausea, and fever up to 102° F (38.9°C). The pain prevents him from standing up straight. Which of the following should a nurse anticipate first?
- A. Insert a nasogastric tube
- B. Administer antiemetics
- C. Initiate oral rehydration
- D. Consult pediatric surgery
Answer: D
Explanation:
This child presents with classic signs ofacute appendicitispotentially progressing toperitonitis or perforation. The priority is toconsult pediatric surgery immediately, asdelaying surgical evaluation can lead to worsening complications, including sepsis.
"Clinical presentation of acute appendicitis includes right lower quadrant or peri-umbilical pain, nausea, fever, and rebound tenderness. Surgical consultation is the priority in suspected appendicitis." (Referenced from CCRN Pediatric - Direct Care: Gastrointestinal, Acute Abdomen and Surgical Emergencies)
NEW QUESTION # 66
A nurse is assessing an 18-month-old child. The nurse would expect the child to do which of the following actions?
- A. Climbs the stairs alone, with both feet on the same step at the same time
- B. Open doors by turning doorknobs
- C. Run and jump in place
- D. Stack 2 blocks
Answer: C
Explanation:
Explanation: A child at 18 months should be able to run and jump in place. Stacking 2 blocks should be seen at 15 months, opening doors by turning doorknobs at 36 months, and climbing stairs alone with both feet on the same step at the same time at 24 months.
NEW QUESTION # 67
What would be the most important discharge teaching for a mother of a child who has just completed a series of Chemotherapy?
- A. Giving enough fluids
- B. Consider proper handwashing
- C. Buying a wig
- D. Providing adequate rest
Answer: B
Explanation:
Explanation: Effective and proper handwashing helps prevent infection. This is the most important way in caring for a child with suppressed immune system.
NEW QUESTION # 68
Fluid restriction of 800 ml in 24 hours was ordered for a 5-year-old child with acute glomerulonephritis.
To best assist the client to cope with these limitations, the nurse should:
- A. hold the fluids from 8am to 8pm
- B. give fluids in 1-ounce calibrated cup throughout the waking hours.
- C. equally divide the intake per shift
- D. allow fluid as desired until 800 ml is reached.
Answer: B
Explanation:
Explanation: It allows the child to take full 1-ounce cup of fluid without long waits; a full cup, though it is small cup creates an illusion that he is receiving more. A child can't tolerate long hours of waiting for a fluid.
NEW QUESTION # 69
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