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AACN CCRN-PEDIATRIC AMERICAN ASSOCIATION OF
CRITICAL CARE NURSES PEDIATRIC CRITICAL CARE
QUESTIONS AND CORRECT ANSWERS WITH RATIONALES
2026 JUST RELEASED INSTANT DOWNLOAD PDF
Overview
The AACN CCRN-Pediatric (Pediatric Critical Care) Exam is a certification exam for nurses
specializing in the care of critically ill pediatric patients. The exam evaluates advanced
knowledge, clinical reasoning, and critical decision-making in pediatric critical care nursing.
Key Areas Tested:
1. Cardiovascular: Management of congenital heart defects, arrhythmias, shock, and
cardiac monitoring.
2. Respiratory: Pediatric airway management, mechanical ventilation, and acute
respiratory distress syndrome.
3. Neurological: Pediatric neuro assessment, seizure management, traumatic brain injury,
and intracranial pressure.
4. Endocrine/Metabolic: Diabetes management, electrolyte imbalances, and fluid therapy.
5. Hematology/Immunology: Management of anemia, coagulopathies, sepsis, and
immune deficiencies.
6. Gastrointestinal/Renal: Acute kidney injury, fluid/electrolyte balance, and liver failure.
7. Multisystem/Complex Cases: Trauma, shock, multi-organ dysfunction, and critical care
pharmacology.
8. Professional Practice: Ethics, patient safety, quality improvement, and pediatric nursing
principles.
Candidates should:
• Have hands-on experience in pediatric critical care
• Be proficient in pediatric assessment, interventions, and monitoring
• Understand pharmacologic and procedural considerations unique to children
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Question 1:
A 6-year-old patient with congenital heart disease presents with
tachycardia, hypotension, and cool extremities. Which
intervention should the nurse prioritize?
A) Administer antipyretics
B) Initiate rapid fluid resuscitation with isotonic saline
C) Prepare for immediate intubation
D) Obtain blood cultures and start antibiotics
Answer: B) Initiate rapid fluid resuscitation with isotonic saline
Rationale:
The patient demonstrates shock (cold, hypoperfused). Rapid
isotonic fluid resuscitation is the first-line intervention in
hypovolemic or distributive shock to restore perfusion.
Assessment for underlying cause (infection, cardiac output) is
important afterward.
Question 2:
A child with severe asthma is admitted to the PICU with
respiratory distress. Which ABG pattern indicates respiratory
failure?
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A) pH 7.50, PaCO₂ 30 mmHg, PaO₂ 80 mmHg
B) pH 7.25, PaCO₂ 55 mmHg, PaO₂ 60 mmHg
C) pH 7.40, PaCO₂ 40 mmHg, PaO₂ 90 mmHg
D) pH 7.48, PaCO₂ 35 mmHg, PaO₂ 95 mmHg
Answer: B) pH 7.25, PaCO₂ 55 mmHg, PaO₂ 60 mmHg
Rationale:
Respiratory failure is indicated by hypercapnia (PaCO₂ >45
mmHg) and hypoxemia (PaO₂ <60 mmHg) with acidosis. This
reflects inadequate ventilation and oxygenation in severe
asthma.
Question 3:
A 2-year-old post-cardiac surgery patient develops sudden chest
tube drainage of 100 mL bright red blood. What is the nurse’s
first action?
A) Notify the physician immediately
B) Increase the IV fluid rate
C) Encourage the child to cough
D) Administer pain medication
Answer: A) Notify the physician immediately
Rationale:
Sudden bright red chest tube output post-cardiac surgery may
indicate hemorrhage, which is a life-threatening emergency.
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Immediate notification and preparation for resuscitation are
required.
Question 4:
Which assessment finding is most concerning in a pediatric
patient with increased intracranial pressure (ICP)?
A) Irritability and mild headache
B) Bradycardia, hypertension, and irregular respirations
C) Slightly dilated pupils reactive to light
D) Mild nausea
Answer: B) Bradycardia, hypertension, and irregular
respirations
Rationale:
This triad is known as Cushing’s triad, indicative of severe or
impending increased ICP, and requires immediate intervention
to prevent brain herniation.
Question 5:
A 10-year-old with diabetic ketoacidosis (DKA) is started on IV
insulin. Which electrolyte must be closely monitored and
supplemented as needed?
AACN CCRN-PEDIATRIC AMERICAN ASSOCIATION OF
CRITICAL CARE NURSES PEDIATRIC CRITICAL CARE
QUESTIONS AND CORRECT ANSWERS WITH RATIONALES
2026 JUST RELEASED INSTANT DOWNLOAD PDF
Overview
The AACN CCRN-Pediatric (Pediatric Critical Care) Exam is a certification exam for nurses
specializing in the care of critically ill pediatric patients. The exam evaluates advanced
knowledge, clinical reasoning, and critical decision-making in pediatric critical care nursing.
Key Areas Tested:
1. Cardiovascular: Management of congenital heart defects, arrhythmias, shock, and
cardiac monitoring.
2. Respiratory: Pediatric airway management, mechanical ventilation, and acute
respiratory distress syndrome.
3. Neurological: Pediatric neuro assessment, seizure management, traumatic brain injury,
and intracranial pressure.
4. Endocrine/Metabolic: Diabetes management, electrolyte imbalances, and fluid therapy.
5. Hematology/Immunology: Management of anemia, coagulopathies, sepsis, and
immune deficiencies.
6. Gastrointestinal/Renal: Acute kidney injury, fluid/electrolyte balance, and liver failure.
7. Multisystem/Complex Cases: Trauma, shock, multi-organ dysfunction, and critical care
pharmacology.
8. Professional Practice: Ethics, patient safety, quality improvement, and pediatric nursing
principles.
Candidates should:
• Have hands-on experience in pediatric critical care
• Be proficient in pediatric assessment, interventions, and monitoring
• Understand pharmacologic and procedural considerations unique to children
,2
Question 1:
A 6-year-old patient with congenital heart disease presents with
tachycardia, hypotension, and cool extremities. Which
intervention should the nurse prioritize?
A) Administer antipyretics
B) Initiate rapid fluid resuscitation with isotonic saline
C) Prepare for immediate intubation
D) Obtain blood cultures and start antibiotics
Answer: B) Initiate rapid fluid resuscitation with isotonic saline
Rationale:
The patient demonstrates shock (cold, hypoperfused). Rapid
isotonic fluid resuscitation is the first-line intervention in
hypovolemic or distributive shock to restore perfusion.
Assessment for underlying cause (infection, cardiac output) is
important afterward.
Question 2:
A child with severe asthma is admitted to the PICU with
respiratory distress. Which ABG pattern indicates respiratory
failure?
,3
A) pH 7.50, PaCO₂ 30 mmHg, PaO₂ 80 mmHg
B) pH 7.25, PaCO₂ 55 mmHg, PaO₂ 60 mmHg
C) pH 7.40, PaCO₂ 40 mmHg, PaO₂ 90 mmHg
D) pH 7.48, PaCO₂ 35 mmHg, PaO₂ 95 mmHg
Answer: B) pH 7.25, PaCO₂ 55 mmHg, PaO₂ 60 mmHg
Rationale:
Respiratory failure is indicated by hypercapnia (PaCO₂ >45
mmHg) and hypoxemia (PaO₂ <60 mmHg) with acidosis. This
reflects inadequate ventilation and oxygenation in severe
asthma.
Question 3:
A 2-year-old post-cardiac surgery patient develops sudden chest
tube drainage of 100 mL bright red blood. What is the nurse’s
first action?
A) Notify the physician immediately
B) Increase the IV fluid rate
C) Encourage the child to cough
D) Administer pain medication
Answer: A) Notify the physician immediately
Rationale:
Sudden bright red chest tube output post-cardiac surgery may
indicate hemorrhage, which is a life-threatening emergency.
, 4
Immediate notification and preparation for resuscitation are
required.
Question 4:
Which assessment finding is most concerning in a pediatric
patient with increased intracranial pressure (ICP)?
A) Irritability and mild headache
B) Bradycardia, hypertension, and irregular respirations
C) Slightly dilated pupils reactive to light
D) Mild nausea
Answer: B) Bradycardia, hypertension, and irregular
respirations
Rationale:
This triad is known as Cushing’s triad, indicative of severe or
impending increased ICP, and requires immediate intervention
to prevent brain herniation.
Question 5:
A 10-year-old with diabetic ketoacidosis (DKA) is started on IV
insulin. Which electrolyte must be closely monitored and
supplemented as needed?
