PEDIATRIC CCRN AACN STUDY GUIDE EXAM 2026/2027
QUESTIONS AND SOLUTIONS RATED A+
✔✔A neonate is weaned from conventional mechanical ventilation to HFNC on day of
life 5. On day of life 11, the neonate demonstrates increased respiratory distress that
necessitates intubation. The caregiver questions the nurse regarding the need for
mechanical ventilation given successful tolerance of the HFNC for the past 6 days. The
nurse should:
A. explain the difference between mechanical ventilation and HFNC
B. refer the caregiver to the respiratory therapist
C. ask the provider to speak with the caregiver
D. schedule a multidisciplinary team conference - ✔✔C
✔✔A patient newly diagnosed with acute lymphocytic leukemia presents with a WBC of
60,000/mm3. During induction chemotherapy, the nurse would observe for the following
ECG changes:
A. prominent U waves
B. peaked T waved
C. ST segment depression
D. prolonged QT interval - ✔✔B
✔✔A long term complication for an infant with bronchopulmonary dysplasia (BPD) is:
A. cor pulmonale
B. cardiomyopathy
C. barotrauma
D. subglottic stenosis - ✔✔A
✔✔The nurse is caring for a patient with asthma whose most recent glucose level was
210. Which factors might lead to the patients increased BG level?
A. stress and steroid medications
B. stress and inhaled albuterol
C. lack of sleep and dextrose infusion
D. lack of sleep and Magnesium infusion - ✔✔A
✔✔When a skin surfaces rubs against another surfaces, such as bedsheet, this is
called:
A. shear
B. epidermal stripping
C. friction
D. maceration - ✔✔C
✔✔An African American patient is admitted with angioedema. The patients medication
history includes the use of an ACE inhibitor for hypertension. The patient endorses
taking the medication as prescribed and denies taking any additional doses. Which
should the nurse suspect?
,A. the pharmacist gave the patient the wrong dose of medication
B. the patient needs education on how to take the medication correctly
C. the caregiver is trying to poison the patient by administering additional medication
D. the medication is not being metabolized as intended - ✔✔D
✔✔A child presents to the emergency department with stridor, vomiting, and urticarial
rash. Assessment reveals a capillary refill of 4 seconds and HR 180. The nurse
suspects which type of shock?
A. hypovolemic
B. neurogenic
C. distributive
D. cardiogenic - ✔✔C
✔✔A child is admitted after a near-drowning incident. The patient is being managed
with mechanical ventilation. Assessment reveals decrease bilateral lung sounds,
crackles, and increased frothy secretions. ABG results are as follows:
pH 7.35
pCO2 45
pO2 58
HCO3 24
BE -1
SaO2 89%
Which of the following orders should the nurse anticipate?
A. increased tidal volume to 10 mL/kg
B. increase FiO2 to 100%
C. increase PEEP to 10
D. increase pressure support to 10 - ✔✔C
✔✔A patient is admitted after an episode of emesis during a seizure. Assessment
reveals labored breathing, SaO2 85% in room air, and crackles are auscultated
bilaterally. Which of the following orders should the nurse MOST anticipate?
A. blood culture and IV maxipime (Cefepime)
B. oxygen to maintain SaO2 between 94-99% and HOB elevated 30-45 degrees
C. albuterol (Proventil) inhaler and IV methylprednisone (Solumedrol)
D. furosemide (Lasix) and 100% FiO2 - ✔✔B
✔✔A patient is admitted with an acute blunt chest trauma. Initial assessment reveals
chest wall bruising, unequal lung sounds, increased dyspnea, and SaO2 91% on 2L
NC. The patient tells the nurse "My chest hurts so much" despite pain medication
administration. The priority intervention the nurse should anticipate would be:
A. chest tube placement
B. non-invasive positive pressure ventilation
C. bronchodilator via nebulizer
,D. increasing pain medication - ✔✔A
✔✔A child has been waiting for 2 months for a heart transplant. A family member
angrily tells the nurse "This is hopeless!". The nurse's action should be based on the
knowledge that:
A. maintaining the integrity of the family system is crucial in the transplant process
B. because expressions of hopelessness may be harmful to the patient, the family
member should be encourage to keep these statements out of the patient care area
C. expressions of frustration are normal and usually require no nursing intervention
D. encouraging discussion of negative emotions can impede their resolution - ✔✔A
✔✔A patient with DKA is admitted. To best manage electrolyte imbalances, the nurse
should INITIALLY collaborate with a(n):
A. diabetes educator
B. dietician
C. endocrinologist
D. gastroenterologist - ✔✔B
✔✔A neutropenic patient is admitted showing signs of respiratory infection. Blood and
sputum cultures are obtained. The nurse should anticipate:
A. immediate placement in strict isolation
B. no intervention until causative organism is identified
C. beginning antibiotics immediately
D. transbronchial biopsy - ✔✔C
✔✔A patient is receiving IV decadron (Dexamethasone) and epinephrine (Adrenaline)
infusion at 0.03 mcg/kg/min. What lab result should the nurse anticipate?
A. decreased sodium
B. decreased calcium
C. elevated BG
D. elevated potassium - ✔✔C
✔✔A patient is receiving continuous nasogastric feedings. The nurse discovers that the
feeding tube has been dislodged and has been infusing into the esophagus. What is the
nurse's FIRST priority?
A. stop the continuous feeds and remove the feeding tube
B. suction the patient and advance the feeding tube back into the stomach
C. inform the provider and obtain and order for a chest x-ray
D. replace the feeding tube and flush with sterile water - ✔✔A
✔✔When placing a dietary order for a patient with Type 2 diabetes, the nurse knows
that the diet ordered should:
A. not contain any carbs
B. be low in sodium
C. include a carb count
, D. should only contain low-calorie drinks - ✔✔C
✔✔A full-term neonate is delivered emergently after the mother was involved in a MVC.
After testing in the unit, brain death of the neonate is determined and the father asks
about organ donation. In response to the father's request, the nurse's BEST response
would be to:
A. notify the medical examiner's office of a neonatal death
B. convene a multidisciplinary care conference with all available family
C. tell the father that newborns do not meet criteria for organ and tissue donation
D. contact the hospital's organ procurement agency representative - ✔✔D
✔✔A child is admitted following a MVC. During the initial evaluation, the nurse notes the
chest wall of the left is drawn inward during spontaneous respiration and outward during
exhalation. The injury MOST commonly associated with this phenomenon is:
A. pulmonary contusion
B. pneumothorax
C. hemothorax
D. cardiac tamponade - ✔✔A
✔✔An infant with respiratory distress syndrome (RDS) requiring mechanical ventilation
(PIP 34, PEEP 10) suddenly desaturates and becomes bradycardic. The MOST likely
explanation is which of the following?
A. hemothorax
B. mucous plug
C. pneumomediastinum
D. pneumothorax - ✔✔D
✔✔A toddler presents with sever pain in the shoulders, lower back, thighs, and calves.
The child's parents report that the diaper had reddish brown colored urine. Which lab
tests are MOST helpful in identifying the probable cause of the child's symptoms?
A creatinine kinase, urine culture, CBC
B. electrolytes, C reactive protein, blood culture
C. urine analysis, electrolytes, creatinine kinase
D. cardiac enzymes, CBC, urine analysis - ✔✔C
✔✔A patient tells a nurse "I don't know how I'm going to pay for this hospitalization."
The nurse should:
A. notify the business office so a payment plan can be designed
B. redirect the patient toward meeting physiological needs
C. give the patient applications for public assistance medical coverage
D. arrange a meeting with the hospital social services staff - ✔✔D
✔✔A 2 month old is admitted following a cardiac catheterization. The nurse notes an
access through the R femoral artery and vein. Further assessment reveals a non-
palpable R pedal pulse. Pulses in all other extremities are 2+. VS are as follows:
QUESTIONS AND SOLUTIONS RATED A+
✔✔A neonate is weaned from conventional mechanical ventilation to HFNC on day of
life 5. On day of life 11, the neonate demonstrates increased respiratory distress that
necessitates intubation. The caregiver questions the nurse regarding the need for
mechanical ventilation given successful tolerance of the HFNC for the past 6 days. The
nurse should:
A. explain the difference between mechanical ventilation and HFNC
B. refer the caregiver to the respiratory therapist
C. ask the provider to speak with the caregiver
D. schedule a multidisciplinary team conference - ✔✔C
✔✔A patient newly diagnosed with acute lymphocytic leukemia presents with a WBC of
60,000/mm3. During induction chemotherapy, the nurse would observe for the following
ECG changes:
A. prominent U waves
B. peaked T waved
C. ST segment depression
D. prolonged QT interval - ✔✔B
✔✔A long term complication for an infant with bronchopulmonary dysplasia (BPD) is:
A. cor pulmonale
B. cardiomyopathy
C. barotrauma
D. subglottic stenosis - ✔✔A
✔✔The nurse is caring for a patient with asthma whose most recent glucose level was
210. Which factors might lead to the patients increased BG level?
A. stress and steroid medications
B. stress and inhaled albuterol
C. lack of sleep and dextrose infusion
D. lack of sleep and Magnesium infusion - ✔✔A
✔✔When a skin surfaces rubs against another surfaces, such as bedsheet, this is
called:
A. shear
B. epidermal stripping
C. friction
D. maceration - ✔✔C
✔✔An African American patient is admitted with angioedema. The patients medication
history includes the use of an ACE inhibitor for hypertension. The patient endorses
taking the medication as prescribed and denies taking any additional doses. Which
should the nurse suspect?
,A. the pharmacist gave the patient the wrong dose of medication
B. the patient needs education on how to take the medication correctly
C. the caregiver is trying to poison the patient by administering additional medication
D. the medication is not being metabolized as intended - ✔✔D
✔✔A child presents to the emergency department with stridor, vomiting, and urticarial
rash. Assessment reveals a capillary refill of 4 seconds and HR 180. The nurse
suspects which type of shock?
A. hypovolemic
B. neurogenic
C. distributive
D. cardiogenic - ✔✔C
✔✔A child is admitted after a near-drowning incident. The patient is being managed
with mechanical ventilation. Assessment reveals decrease bilateral lung sounds,
crackles, and increased frothy secretions. ABG results are as follows:
pH 7.35
pCO2 45
pO2 58
HCO3 24
BE -1
SaO2 89%
Which of the following orders should the nurse anticipate?
A. increased tidal volume to 10 mL/kg
B. increase FiO2 to 100%
C. increase PEEP to 10
D. increase pressure support to 10 - ✔✔C
✔✔A patient is admitted after an episode of emesis during a seizure. Assessment
reveals labored breathing, SaO2 85% in room air, and crackles are auscultated
bilaterally. Which of the following orders should the nurse MOST anticipate?
A. blood culture and IV maxipime (Cefepime)
B. oxygen to maintain SaO2 between 94-99% and HOB elevated 30-45 degrees
C. albuterol (Proventil) inhaler and IV methylprednisone (Solumedrol)
D. furosemide (Lasix) and 100% FiO2 - ✔✔B
✔✔A patient is admitted with an acute blunt chest trauma. Initial assessment reveals
chest wall bruising, unequal lung sounds, increased dyspnea, and SaO2 91% on 2L
NC. The patient tells the nurse "My chest hurts so much" despite pain medication
administration. The priority intervention the nurse should anticipate would be:
A. chest tube placement
B. non-invasive positive pressure ventilation
C. bronchodilator via nebulizer
,D. increasing pain medication - ✔✔A
✔✔A child has been waiting for 2 months for a heart transplant. A family member
angrily tells the nurse "This is hopeless!". The nurse's action should be based on the
knowledge that:
A. maintaining the integrity of the family system is crucial in the transplant process
B. because expressions of hopelessness may be harmful to the patient, the family
member should be encourage to keep these statements out of the patient care area
C. expressions of frustration are normal and usually require no nursing intervention
D. encouraging discussion of negative emotions can impede their resolution - ✔✔A
✔✔A patient with DKA is admitted. To best manage electrolyte imbalances, the nurse
should INITIALLY collaborate with a(n):
A. diabetes educator
B. dietician
C. endocrinologist
D. gastroenterologist - ✔✔B
✔✔A neutropenic patient is admitted showing signs of respiratory infection. Blood and
sputum cultures are obtained. The nurse should anticipate:
A. immediate placement in strict isolation
B. no intervention until causative organism is identified
C. beginning antibiotics immediately
D. transbronchial biopsy - ✔✔C
✔✔A patient is receiving IV decadron (Dexamethasone) and epinephrine (Adrenaline)
infusion at 0.03 mcg/kg/min. What lab result should the nurse anticipate?
A. decreased sodium
B. decreased calcium
C. elevated BG
D. elevated potassium - ✔✔C
✔✔A patient is receiving continuous nasogastric feedings. The nurse discovers that the
feeding tube has been dislodged and has been infusing into the esophagus. What is the
nurse's FIRST priority?
A. stop the continuous feeds and remove the feeding tube
B. suction the patient and advance the feeding tube back into the stomach
C. inform the provider and obtain and order for a chest x-ray
D. replace the feeding tube and flush with sterile water - ✔✔A
✔✔When placing a dietary order for a patient with Type 2 diabetes, the nurse knows
that the diet ordered should:
A. not contain any carbs
B. be low in sodium
C. include a carb count
, D. should only contain low-calorie drinks - ✔✔C
✔✔A full-term neonate is delivered emergently after the mother was involved in a MVC.
After testing in the unit, brain death of the neonate is determined and the father asks
about organ donation. In response to the father's request, the nurse's BEST response
would be to:
A. notify the medical examiner's office of a neonatal death
B. convene a multidisciplinary care conference with all available family
C. tell the father that newborns do not meet criteria for organ and tissue donation
D. contact the hospital's organ procurement agency representative - ✔✔D
✔✔A child is admitted following a MVC. During the initial evaluation, the nurse notes the
chest wall of the left is drawn inward during spontaneous respiration and outward during
exhalation. The injury MOST commonly associated with this phenomenon is:
A. pulmonary contusion
B. pneumothorax
C. hemothorax
D. cardiac tamponade - ✔✔A
✔✔An infant with respiratory distress syndrome (RDS) requiring mechanical ventilation
(PIP 34, PEEP 10) suddenly desaturates and becomes bradycardic. The MOST likely
explanation is which of the following?
A. hemothorax
B. mucous plug
C. pneumomediastinum
D. pneumothorax - ✔✔D
✔✔A toddler presents with sever pain in the shoulders, lower back, thighs, and calves.
The child's parents report that the diaper had reddish brown colored urine. Which lab
tests are MOST helpful in identifying the probable cause of the child's symptoms?
A creatinine kinase, urine culture, CBC
B. electrolytes, C reactive protein, blood culture
C. urine analysis, electrolytes, creatinine kinase
D. cardiac enzymes, CBC, urine analysis - ✔✔C
✔✔A patient tells a nurse "I don't know how I'm going to pay for this hospitalization."
The nurse should:
A. notify the business office so a payment plan can be designed
B. redirect the patient toward meeting physiological needs
C. give the patient applications for public assistance medical coverage
D. arrange a meeting with the hospital social services staff - ✔✔D
✔✔A 2 month old is admitted following a cardiac catheterization. The nurse notes an
access through the R femoral artery and vein. Further assessment reveals a non-
palpable R pedal pulse. Pulses in all other extremities are 2+. VS are as follows:
