CCRN PEDIATRIC AACN EXAMS SCRIPT 2026/2027
QUESTIONS AND SOLUTIONS RATED A+
✔✔An infant is admitted two days ago after being in a MVC with a L femur fracture.
Initial assessment reveals a unilateral hip spica cast. The nurse notes the following on
the infant's LLE: 3+ pitting edema, pallor, pulselessness, paresthesia, and some
paralysis. Data are:
BP 104/65
HR 190
RR 58
T 37.2C
SpO2 90%
The BEST action for the nurse would be to:
A. call the provider immediately for a new pain medication order
B. ice and elevate the extremity
C. conduct a bedside Doppler ultrasound exam
D. call the provider immediately with the findings - ✔✔D
✔✔A newborn with hypothermia and hypoglycemia has an absolute neutrophil count
and an immature/total neutrophil count ration of 0.30. Based on the findings the nurse
prepares to:
A. administer IV fluids
B. obtain a blood culture
C. administer antibiotics
D. repeat a CBC in 4 hours - ✔✔C
✔✔A nurse notices that there seems to be an increase in medication errors when
medication infusions are started. The nurse's BEST course of action would be to:
A. keep a list of all nurses who have made errors, and give to the nurse manager
B. be more careful when hanging and checking medication infusions
C. ask the nurse manager to remind all staff to be careful when hanging and checking
medication infusions
D. review the medication error rate, then offer to help revise the unit policy for checking
medication drips - ✔✔D
✔✔A 9 month old born at 26 weeks has grunting, tachypnea and cool extremities. The
following ABG findings are obtained on room air:
pH 7.07, pCO2 80, pO2 50, HCO3 7.
These ABG results indicate:
A. compensated metabolic acidosis
B. alveolar hypoventilation
C. uncompensated respiratory acidosis
D. alveolar hyperventilation - ✔✔B
,✔✔A patient presents with a temperature of 40.9C and nuchal rigidity. A nurse obtains
blood cultures and administers antibiotics. The patient remains febrile, and the family
questions the adequacy of the interventions. The nurse's BEST response should be to:
A. arrange a social services consult
B. suggest that the family discuss their concerns with the provider
C. acknowledge the family's concerns with while explaining the rationale for the
interventions
D. assure the family that everything will be explained later - ✔✔C
✔✔A patient with a urinary catheter develops a temperature of 102.3F (39C), is agitated
and states that their back is hurting. What orders should the nurse expect FIRST?
A. remove the urinary catheter
B. begin antibiotics as ordered
C. flush the urinary catheter
D. obtain urinalysis and urine cultures - ✔✔D
✔✔A 12 year old patient was admitted 4 days ago following an attempt to harm self.
The patient tells the nurse about having multiple sexual encounters and is currently
living with an uncle. The nurse is concerned that the patient may be a sex trafficking
victim. Which is a nursing PRIORITY?
A. contact the forensic nurse examiner
B. contact the provider on call
C. contact the social worker on call
D. contact the local child protection agency - ✔✔D
✔✔A patient is scheduled for surgery. During the pre-operative assessment, the nurse
notes a history of poor weight gain, fatigue, muscle weakness, and hyperpigmentation
of the face. Lab values include a serum sodium of 130 mEq/L. The nurse should
anticipate an:
A. increased desmopressin (DDVAP) dose
B. increased levothyroxine (Synthroid) dose
C. increased calcium dose
D. increased hydrocortisone (SoluCortef) dose - ✔✔D
✔✔In the patient with early distributive shock and low SVR, the nurse would expect
which EARLY physical finding?
A. warm skin, flushed extremities, brisk capillary refill, hypotension
B. decreased UOP, hypotension, decreased level of consciousness, prolonged capillary
refill
C. hypotension, hyperthermia, respiratory distress, hypoxemia
D. brisk capillary refill, increased UOP, hypoxemia, hyperthermia - ✔✔A
✔✔A 10 year old diagnosed with myocarditis presents with dyspnea, crackles
bilaterally, and thready peripheral pulses. CVP 15 mmHg, HR 130, RR 32. Which of the
following orders should the nurse anticipate?
,A. spironolactone (Aldactone) and epinephrine (adrenalin) infusion
B. IV furosemide (Lasix) and milrinone (Primacor) infusion
C. metolazone (Zaroxolyn) and nitroprusside (Nipride) infusion
D. hydrochlorothiazide (HCTZ) and dobutamine (Dobutrex) infusion - ✔✔B
✔✔An intubated patient has the following ventilator settings:
PIP 20
PEEP 5
FiO2 0.5
Rate 15
EtCO2 55
SaO2 92%
ABG results are:
pH 7.2
paCO2 57
paO2 90
HCO3 25
Which change in settings with BEST improve the patient's ventilation?
A. increase PIP
B. increase PEEP
C. increase rate
D. increase FiO2 - ✔✔B
✔✔The nurse is admitting a child with a significant developmental delay. Which of the
following statements indicates use of the mutual participation model?
A. "If you change any diapers, will you please set them aside for me to weigh?"
B. "I know you manage your child's ventilator alarms at home, but please call the nurse
or RRT to help you while you are here"
C. "Because you know your child better than we do, we need you or another family
member to be with your child during the day"
D. "We do baths on this unit at 4am. We will do our best not to wake you" - ✔✔A
✔✔A child is admitted with meningococcemia. Which of the following is associated with
this diagnosis?
A. scalded skin syndrome
B. impetigo contagiosa
C. pyoderma
D. purpura fulminans - ✔✔D
✔✔A toddler with a history of un-repaired Tetralogy of Fallot (TOF) begins to cry while
IV access is attempted. Cyanosis, diaphoresis, and tachypnea are noted. The MOST
APPROPRIATE nursing intervention would be to:
, A. place the child in knee-chest position
B. apply a face mask with oxygen
C. transfuse red blood cells
D. administer a premedication before attempting the IV - ✔✔A
✔✔A child is admitted after sustaining a head injury. The most important aspect of the
nurse's continuing assessment for early neurological deterioration is:
A. motor response
B. pupillary response
C. level of consciousness
D. cranial nerve assessment - ✔✔C
✔✔A patient being discharged is tearful and states "Medication costs are overwhelming
and I have to come back to the hospital when my condition flares up when I have no
medications. The social workers give me phone numbers and websites, but I don't have
a computer or know what to say to those people." This is the patient's third admission.
The provider has written 5 necessary prescriptions for the patient's heart condition. The
NEXT action for the nurse should be to:
A. call the provider and request enough samples to fill the prescription
B. perform medication reconciliation to determine generic equivalents for the
prescriptions
C. help the patient prioritize which medications are really necessary and which can be
omitted
D. review of previously provided information and assist in contacting assistance
programs prior to discharge - ✔✔D
✔✔A patient with ARDS has been on mechanical ventilation and bed rest. The patient
has a Richmond Agitation and Sedation Score (RASS) of 0. Hemodynamic stability has
been achieved at this time. The nurse should INITIALLY collaborate with:
A. a speech pathologist
B. a physiotherapist
C. the social worker
D. the respiratory therapist - ✔✔B
✔✔An infant is nearing discharge from the unit. The parents report that they need a car
seat for their infant but cannot afford it. Which is the BEST ACTION by the nurse?
A. report to the charge nurse that discharge may be delayed due to the lack of car seat
B. notify social services to aid the parents with both the car seat and potential financial
needs
C. refer the parents to a local resources to obtain a car seat
D. offer to give the family a care seat to use personally - ✔✔B
✔✔Which of the following clinical manifestations indicates the need for an artificial
airway in a child with laryngotracheobronchitis?
A. metabolic acidosis
QUESTIONS AND SOLUTIONS RATED A+
✔✔An infant is admitted two days ago after being in a MVC with a L femur fracture.
Initial assessment reveals a unilateral hip spica cast. The nurse notes the following on
the infant's LLE: 3+ pitting edema, pallor, pulselessness, paresthesia, and some
paralysis. Data are:
BP 104/65
HR 190
RR 58
T 37.2C
SpO2 90%
The BEST action for the nurse would be to:
A. call the provider immediately for a new pain medication order
B. ice and elevate the extremity
C. conduct a bedside Doppler ultrasound exam
D. call the provider immediately with the findings - ✔✔D
✔✔A newborn with hypothermia and hypoglycemia has an absolute neutrophil count
and an immature/total neutrophil count ration of 0.30. Based on the findings the nurse
prepares to:
A. administer IV fluids
B. obtain a blood culture
C. administer antibiotics
D. repeat a CBC in 4 hours - ✔✔C
✔✔A nurse notices that there seems to be an increase in medication errors when
medication infusions are started. The nurse's BEST course of action would be to:
A. keep a list of all nurses who have made errors, and give to the nurse manager
B. be more careful when hanging and checking medication infusions
C. ask the nurse manager to remind all staff to be careful when hanging and checking
medication infusions
D. review the medication error rate, then offer to help revise the unit policy for checking
medication drips - ✔✔D
✔✔A 9 month old born at 26 weeks has grunting, tachypnea and cool extremities. The
following ABG findings are obtained on room air:
pH 7.07, pCO2 80, pO2 50, HCO3 7.
These ABG results indicate:
A. compensated metabolic acidosis
B. alveolar hypoventilation
C. uncompensated respiratory acidosis
D. alveolar hyperventilation - ✔✔B
,✔✔A patient presents with a temperature of 40.9C and nuchal rigidity. A nurse obtains
blood cultures and administers antibiotics. The patient remains febrile, and the family
questions the adequacy of the interventions. The nurse's BEST response should be to:
A. arrange a social services consult
B. suggest that the family discuss their concerns with the provider
C. acknowledge the family's concerns with while explaining the rationale for the
interventions
D. assure the family that everything will be explained later - ✔✔C
✔✔A patient with a urinary catheter develops a temperature of 102.3F (39C), is agitated
and states that their back is hurting. What orders should the nurse expect FIRST?
A. remove the urinary catheter
B. begin antibiotics as ordered
C. flush the urinary catheter
D. obtain urinalysis and urine cultures - ✔✔D
✔✔A 12 year old patient was admitted 4 days ago following an attempt to harm self.
The patient tells the nurse about having multiple sexual encounters and is currently
living with an uncle. The nurse is concerned that the patient may be a sex trafficking
victim. Which is a nursing PRIORITY?
A. contact the forensic nurse examiner
B. contact the provider on call
C. contact the social worker on call
D. contact the local child protection agency - ✔✔D
✔✔A patient is scheduled for surgery. During the pre-operative assessment, the nurse
notes a history of poor weight gain, fatigue, muscle weakness, and hyperpigmentation
of the face. Lab values include a serum sodium of 130 mEq/L. The nurse should
anticipate an:
A. increased desmopressin (DDVAP) dose
B. increased levothyroxine (Synthroid) dose
C. increased calcium dose
D. increased hydrocortisone (SoluCortef) dose - ✔✔D
✔✔In the patient with early distributive shock and low SVR, the nurse would expect
which EARLY physical finding?
A. warm skin, flushed extremities, brisk capillary refill, hypotension
B. decreased UOP, hypotension, decreased level of consciousness, prolonged capillary
refill
C. hypotension, hyperthermia, respiratory distress, hypoxemia
D. brisk capillary refill, increased UOP, hypoxemia, hyperthermia - ✔✔A
✔✔A 10 year old diagnosed with myocarditis presents with dyspnea, crackles
bilaterally, and thready peripheral pulses. CVP 15 mmHg, HR 130, RR 32. Which of the
following orders should the nurse anticipate?
,A. spironolactone (Aldactone) and epinephrine (adrenalin) infusion
B. IV furosemide (Lasix) and milrinone (Primacor) infusion
C. metolazone (Zaroxolyn) and nitroprusside (Nipride) infusion
D. hydrochlorothiazide (HCTZ) and dobutamine (Dobutrex) infusion - ✔✔B
✔✔An intubated patient has the following ventilator settings:
PIP 20
PEEP 5
FiO2 0.5
Rate 15
EtCO2 55
SaO2 92%
ABG results are:
pH 7.2
paCO2 57
paO2 90
HCO3 25
Which change in settings with BEST improve the patient's ventilation?
A. increase PIP
B. increase PEEP
C. increase rate
D. increase FiO2 - ✔✔B
✔✔The nurse is admitting a child with a significant developmental delay. Which of the
following statements indicates use of the mutual participation model?
A. "If you change any diapers, will you please set them aside for me to weigh?"
B. "I know you manage your child's ventilator alarms at home, but please call the nurse
or RRT to help you while you are here"
C. "Because you know your child better than we do, we need you or another family
member to be with your child during the day"
D. "We do baths on this unit at 4am. We will do our best not to wake you" - ✔✔A
✔✔A child is admitted with meningococcemia. Which of the following is associated with
this diagnosis?
A. scalded skin syndrome
B. impetigo contagiosa
C. pyoderma
D. purpura fulminans - ✔✔D
✔✔A toddler with a history of un-repaired Tetralogy of Fallot (TOF) begins to cry while
IV access is attempted. Cyanosis, diaphoresis, and tachypnea are noted. The MOST
APPROPRIATE nursing intervention would be to:
, A. place the child in knee-chest position
B. apply a face mask with oxygen
C. transfuse red blood cells
D. administer a premedication before attempting the IV - ✔✔A
✔✔A child is admitted after sustaining a head injury. The most important aspect of the
nurse's continuing assessment for early neurological deterioration is:
A. motor response
B. pupillary response
C. level of consciousness
D. cranial nerve assessment - ✔✔C
✔✔A patient being discharged is tearful and states "Medication costs are overwhelming
and I have to come back to the hospital when my condition flares up when I have no
medications. The social workers give me phone numbers and websites, but I don't have
a computer or know what to say to those people." This is the patient's third admission.
The provider has written 5 necessary prescriptions for the patient's heart condition. The
NEXT action for the nurse should be to:
A. call the provider and request enough samples to fill the prescription
B. perform medication reconciliation to determine generic equivalents for the
prescriptions
C. help the patient prioritize which medications are really necessary and which can be
omitted
D. review of previously provided information and assist in contacting assistance
programs prior to discharge - ✔✔D
✔✔A patient with ARDS has been on mechanical ventilation and bed rest. The patient
has a Richmond Agitation and Sedation Score (RASS) of 0. Hemodynamic stability has
been achieved at this time. The nurse should INITIALLY collaborate with:
A. a speech pathologist
B. a physiotherapist
C. the social worker
D. the respiratory therapist - ✔✔B
✔✔An infant is nearing discharge from the unit. The parents report that they need a car
seat for their infant but cannot afford it. Which is the BEST ACTION by the nurse?
A. report to the charge nurse that discharge may be delayed due to the lack of car seat
B. notify social services to aid the parents with both the car seat and potential financial
needs
C. refer the parents to a local resources to obtain a car seat
D. offer to give the family a care seat to use personally - ✔✔B
✔✔Which of the following clinical manifestations indicates the need for an artificial
airway in a child with laryngotracheobronchitis?
A. metabolic acidosis
