CCRN Pediatric Practice Exam
Questions with Answers and Rationales
EXAM REVIEWS 2025-2026 QUESTIONS
AND CORRECT VERIFIED ANSWERS/
ALREADY GRADED A+ (MOST RECENT!!)
Question 1
A 4-year-old child admitted with septic shock remains hypotensive
despite receiving 60 mL/kg of isotonic crystalloid. Which intervention
should the nurse anticipate next?
A. Administer sodium bicarbonate
B. Begin dopamine infusion
C. Initiate norepinephrine infusion
D. Administer additional maintenance fluids
Answer: B. Begin dopamine infusion
Rationale: Persistent hypotension after adequate fluid resuscitation
requires vasoactive support. Dopamine is commonly used as an initial
vasoactive medication in pediatric septic shock, although epinephrine
or norepinephrine may also be appropriate depending on the
hemodynamic profile.
Question 2
Which assessment finding is the earliest indicator of increased
intracranial pressure (ICP) in an infant?
A. Bradycardia
,B. Bulging fontanel
C. Dilated pupils
D. Decerebrate posturing
Answer: B. Bulging fontanel
Rationale: A bulging anterior fontanel is an early sign of elevated ICP
in infants. Bradycardia, abnormal posturing, and pupillary changes
are later findings.
Question 3
A child with tetralogy of Fallot suddenly becomes cyanotic and
dyspneic. What is the nurse's priority intervention?
A. Place the child in the knee-chest position
B. Administer IV furosemide
C. Restrict fluids
D. Lower the head of the bed
Answer: A. Place the child in the knee-chest position
Rationale: The knee-chest position increases systemic vascular
resistance, decreases right-to-left shunting, and improves pulmonary
blood flow during a hypercyanotic ("Tet") spell.
Question 4
A pediatric patient receiving mechanical ventilation suddenly
develops high peak airway pressures and absent breath sounds on
the right side. Which complication is most likely?
A. Atelectasis
B. Pulmonary edema
,C. Right tension pneumothorax
D. Aspiration
Answer: C. Right tension pneumothorax
Rationale: Unilateral absent breath sounds combined with elevated
airway pressures strongly suggests tension pneumothorax requiring
immediate intervention.
Question 5
Which laboratory value best indicates adequate tissue perfusion
during resuscitation of septic shock?
A. Hemoglobin
B. Serum sodium
C. Lactate level
D. Platelet count
Answer: C. Lactate level
Rationale: Decreasing serum lactate reflects improved tissue oxygen
delivery and perfusion during resuscitation.
Question 6
A child develops ventricular tachycardia without a pulse. What is the
priority intervention?
A. Administer atropine
B. Begin synchronized cardioversion
C. Begin CPR and defibrillate
D. Give adenosine
, Answer: C. Begin CPR and defibrillate
Rationale: Pulseless ventricular tachycardia is treated as ventricular
fibrillation with immediate CPR and unsynchronized defibrillation.
Question 7
Which electrolyte abnormality is expected in diabetic ketoacidosis
before treatment?
A. Severe hypocalcemia
B. Hyperkalemia
C. Hypermagnesemia
D. Hypernatremia
Answer: B. Hyperkalemia
Rationale: Although total body potassium is depleted, serum
potassium is often elevated initially because of acidosis and insulin
deficiency.
Question 8
A child with status asthmaticus has a PaCO₂ that changes from 30
mmHg to 48 mmHg. What does this indicate?
A. Clinical improvement
B. Respiratory fatigue
C. Hyperventilation
D. Anxiety
Answer: B. Respiratory fatigue
Questions with Answers and Rationales
EXAM REVIEWS 2025-2026 QUESTIONS
AND CORRECT VERIFIED ANSWERS/
ALREADY GRADED A+ (MOST RECENT!!)
Question 1
A 4-year-old child admitted with septic shock remains hypotensive
despite receiving 60 mL/kg of isotonic crystalloid. Which intervention
should the nurse anticipate next?
A. Administer sodium bicarbonate
B. Begin dopamine infusion
C. Initiate norepinephrine infusion
D. Administer additional maintenance fluids
Answer: B. Begin dopamine infusion
Rationale: Persistent hypotension after adequate fluid resuscitation
requires vasoactive support. Dopamine is commonly used as an initial
vasoactive medication in pediatric septic shock, although epinephrine
or norepinephrine may also be appropriate depending on the
hemodynamic profile.
Question 2
Which assessment finding is the earliest indicator of increased
intracranial pressure (ICP) in an infant?
A. Bradycardia
,B. Bulging fontanel
C. Dilated pupils
D. Decerebrate posturing
Answer: B. Bulging fontanel
Rationale: A bulging anterior fontanel is an early sign of elevated ICP
in infants. Bradycardia, abnormal posturing, and pupillary changes
are later findings.
Question 3
A child with tetralogy of Fallot suddenly becomes cyanotic and
dyspneic. What is the nurse's priority intervention?
A. Place the child in the knee-chest position
B. Administer IV furosemide
C. Restrict fluids
D. Lower the head of the bed
Answer: A. Place the child in the knee-chest position
Rationale: The knee-chest position increases systemic vascular
resistance, decreases right-to-left shunting, and improves pulmonary
blood flow during a hypercyanotic ("Tet") spell.
Question 4
A pediatric patient receiving mechanical ventilation suddenly
develops high peak airway pressures and absent breath sounds on
the right side. Which complication is most likely?
A. Atelectasis
B. Pulmonary edema
,C. Right tension pneumothorax
D. Aspiration
Answer: C. Right tension pneumothorax
Rationale: Unilateral absent breath sounds combined with elevated
airway pressures strongly suggests tension pneumothorax requiring
immediate intervention.
Question 5
Which laboratory value best indicates adequate tissue perfusion
during resuscitation of septic shock?
A. Hemoglobin
B. Serum sodium
C. Lactate level
D. Platelet count
Answer: C. Lactate level
Rationale: Decreasing serum lactate reflects improved tissue oxygen
delivery and perfusion during resuscitation.
Question 6
A child develops ventricular tachycardia without a pulse. What is the
priority intervention?
A. Administer atropine
B. Begin synchronized cardioversion
C. Begin CPR and defibrillate
D. Give adenosine
, Answer: C. Begin CPR and defibrillate
Rationale: Pulseless ventricular tachycardia is treated as ventricular
fibrillation with immediate CPR and unsynchronized defibrillation.
Question 7
Which electrolyte abnormality is expected in diabetic ketoacidosis
before treatment?
A. Severe hypocalcemia
B. Hyperkalemia
C. Hypermagnesemia
D. Hypernatremia
Answer: B. Hyperkalemia
Rationale: Although total body potassium is depleted, serum
potassium is often elevated initially because of acidosis and insulin
deficiency.
Question 8
A child with status asthmaticus has a PaCO₂ that changes from 30
mmHg to 48 mmHg. What does this indicate?
A. Clinical improvement
B. Respiratory fatigue
C. Hyperventilation
D. Anxiety
Answer: B. Respiratory fatigue
