Pediatric CCRN Practice Exam 100 Multiple-Choice Questions with
Answers and Rationales Pediatric Critical Care Review
Practice Questions
1. A distressed child becomes less responsive with weaker breathing. What
does this suggest?
A. Improvement because retractions lessen
B. Resolution of airway disease
C. Progression toward respiratory failure
D. Normal sleep requiring no assessment
Correct answer: C. Progression toward respiratory failure
Rationale: Falling effort with altered responsiveness can indicate exhaustion.
Immediate airway and ventilation assessment and emergency support are required
rather than reassurance.
2. A child with severe asthma has a nearly silent chest. What is appropriate?
A. Emergency assessment of critically reduced airflow
B. Reassessment after sleep
C. A feeding trial
D. Discharge because wheezing stopped
Correct answer: A. Emergency assessment of critically reduced airflow
Rationale: Minimal airflow may produce little wheeze despite severe obstruction.
Fatigue or altered mentation further increases concern for impending respiratory
failure.
3. A toddler has drooling, stridor, and tripod posture. What is safest?
A. Require flat positioning
B. Keep the child calm and obtain expert airway help
C. Force a tongue-blade examination
D. Offer solid food
Correct answer: B. Keep the child calm and obtain expert airway help
Rationale: A threatened upper airway can worsen with agitation or manipulation.
Avoid unnecessary distress and arrange controlled expert assessment and airway
support.
4. An intubated child suddenly desaturates after turning. What needs
immediate assessment?
A. Only visitor arrangements
B. Only the original diagnosis
C. Tube position, patency, ventilation, and equipment
Pediatric CCRN Practice Exam | Page 1
,D. Only the next feed
Correct answer: C. Tube position, patency, ventilation, and equipment
Rationale: Displacement, obstruction, pulmonary problems, and equipment failure
can cause acute desaturation. Check the patient and airway immediately rather than
relying on historical information.
5. Which postextubation finding is most concerning?
A. Stable respiratory effort
B. Progressive stridor and increasing breathing effort
C. A mild cough with stable oxygenation
D. Comfortable speech
Correct answer: B. Progressive stridor and increasing breathing effort
Rationale: Progressive stridor suggests significant upper-airway narrowing.
Prompt escalation is needed before obstruction worsens; stable mild coughing is
less urgent.
6. A child on noninvasive ventilation vomits and becomes obtunded. What is
appropriate?
A. Offer more fluids
B. Assume the mask prevents aspiration
C. Urgently assess airway protection and obtain help
D. Tighten the mask and continue
Correct answer: C. Urgently assess airway protection and obtain help
Rationale: Vomiting with depressed consciousness threatens airway protection.
Noninvasive support may no longer be safe, requiring immediate reassessment and
possible escalation.
7. What is a principal effect of PEEP?
A. Reduce end-expiratory alveolar collapse
B. Remove all intrathoracic pressure
C. Guarantee ventilation without monitoring
D. Eliminate pneumothorax risk
Correct answer: A. Reduce end-expiratory alveolar collapse
Rationale: PEEP supports alveolar recruitment and oxygenation. Circulatory effects
and lung-injury risks still require monitoring and individualized settings.
8. Hypotension follows a substantial rise in airway pressure. What mechanism
may contribute?
A. Elimination of pulmonary resistance
B. Guaranteed increased preload
Pediatric CCRN Practice Exam | Page 2
, C. Increased blood volume
D. Reduced venous return
Correct answer: D. Reduced venous return
Rationale: Higher intrathoracic pressure can reduce venous return and cardiac
output. Assess the child and other possible causes rather than assuming ventilator
changes affect only gas exchange.
9. Which practice reduces ventilator-associated complications?
A. Maintain deep sedation indefinitely
B. Use the pediatric prevention bundle and reassess sedation appropriately
C. Ignore mouth and device care
D. Disconnect routinely
Correct answer: B. Use the pediatric prevention bundle and reassess sedation
appropriately
Rationale: A coordinated bundle addresses airway, positioning, sedation, and other
risks. Measures are adapted to the child's condition rather than applied without
reassessment.
10. A chest drain stops tidaling and the child becomes distressed. What is
appropriate?
A. Assume recovery
B. Clamp indefinitely
C. Strip forcefully
D. Assess the child and system for complications
Correct answer: D. Assess the child and system for complications
Rationale: A change in drainage must be interpreted with clinical status. Distress
requires urgent evaluation for obstruction, displacement, or another pulmonary
complication.
11. Sudden hypoxemia, hypotension, and unilateral absent breath sounds
occur. What is concerning?
A. Stable anemia alone
B. Tension pneumothorax
C. Mild rhinitis
D. Uncomplicated otitis externa
Correct answer: B. Tension pneumothorax
Rationale: This pattern suggests life-threatening obstructive physiology. Obtain
emergency help; severe instability should not wait for routine confirmatory testing.
12. Which assessment addresses ventilation specifically?
Pediatric CCRN Practice Exam | Page 3
Answers and Rationales Pediatric Critical Care Review
Practice Questions
1. A distressed child becomes less responsive with weaker breathing. What
does this suggest?
A. Improvement because retractions lessen
B. Resolution of airway disease
C. Progression toward respiratory failure
D. Normal sleep requiring no assessment
Correct answer: C. Progression toward respiratory failure
Rationale: Falling effort with altered responsiveness can indicate exhaustion.
Immediate airway and ventilation assessment and emergency support are required
rather than reassurance.
2. A child with severe asthma has a nearly silent chest. What is appropriate?
A. Emergency assessment of critically reduced airflow
B. Reassessment after sleep
C. A feeding trial
D. Discharge because wheezing stopped
Correct answer: A. Emergency assessment of critically reduced airflow
Rationale: Minimal airflow may produce little wheeze despite severe obstruction.
Fatigue or altered mentation further increases concern for impending respiratory
failure.
3. A toddler has drooling, stridor, and tripod posture. What is safest?
A. Require flat positioning
B. Keep the child calm and obtain expert airway help
C. Force a tongue-blade examination
D. Offer solid food
Correct answer: B. Keep the child calm and obtain expert airway help
Rationale: A threatened upper airway can worsen with agitation or manipulation.
Avoid unnecessary distress and arrange controlled expert assessment and airway
support.
4. An intubated child suddenly desaturates after turning. What needs
immediate assessment?
A. Only visitor arrangements
B. Only the original diagnosis
C. Tube position, patency, ventilation, and equipment
Pediatric CCRN Practice Exam | Page 1
,D. Only the next feed
Correct answer: C. Tube position, patency, ventilation, and equipment
Rationale: Displacement, obstruction, pulmonary problems, and equipment failure
can cause acute desaturation. Check the patient and airway immediately rather than
relying on historical information.
5. Which postextubation finding is most concerning?
A. Stable respiratory effort
B. Progressive stridor and increasing breathing effort
C. A mild cough with stable oxygenation
D. Comfortable speech
Correct answer: B. Progressive stridor and increasing breathing effort
Rationale: Progressive stridor suggests significant upper-airway narrowing.
Prompt escalation is needed before obstruction worsens; stable mild coughing is
less urgent.
6. A child on noninvasive ventilation vomits and becomes obtunded. What is
appropriate?
A. Offer more fluids
B. Assume the mask prevents aspiration
C. Urgently assess airway protection and obtain help
D. Tighten the mask and continue
Correct answer: C. Urgently assess airway protection and obtain help
Rationale: Vomiting with depressed consciousness threatens airway protection.
Noninvasive support may no longer be safe, requiring immediate reassessment and
possible escalation.
7. What is a principal effect of PEEP?
A. Reduce end-expiratory alveolar collapse
B. Remove all intrathoracic pressure
C. Guarantee ventilation without monitoring
D. Eliminate pneumothorax risk
Correct answer: A. Reduce end-expiratory alveolar collapse
Rationale: PEEP supports alveolar recruitment and oxygenation. Circulatory effects
and lung-injury risks still require monitoring and individualized settings.
8. Hypotension follows a substantial rise in airway pressure. What mechanism
may contribute?
A. Elimination of pulmonary resistance
B. Guaranteed increased preload
Pediatric CCRN Practice Exam | Page 2
, C. Increased blood volume
D. Reduced venous return
Correct answer: D. Reduced venous return
Rationale: Higher intrathoracic pressure can reduce venous return and cardiac
output. Assess the child and other possible causes rather than assuming ventilator
changes affect only gas exchange.
9. Which practice reduces ventilator-associated complications?
A. Maintain deep sedation indefinitely
B. Use the pediatric prevention bundle and reassess sedation appropriately
C. Ignore mouth and device care
D. Disconnect routinely
Correct answer: B. Use the pediatric prevention bundle and reassess sedation
appropriately
Rationale: A coordinated bundle addresses airway, positioning, sedation, and other
risks. Measures are adapted to the child's condition rather than applied without
reassessment.
10. A chest drain stops tidaling and the child becomes distressed. What is
appropriate?
A. Assume recovery
B. Clamp indefinitely
C. Strip forcefully
D. Assess the child and system for complications
Correct answer: D. Assess the child and system for complications
Rationale: A change in drainage must be interpreted with clinical status. Distress
requires urgent evaluation for obstruction, displacement, or another pulmonary
complication.
11. Sudden hypoxemia, hypotension, and unilateral absent breath sounds
occur. What is concerning?
A. Stable anemia alone
B. Tension pneumothorax
C. Mild rhinitis
D. Uncomplicated otitis externa
Correct answer: B. Tension pneumothorax
Rationale: This pattern suggests life-threatening obstructive physiology. Obtain
emergency help; severe instability should not wait for routine confirmatory testing.
12. Which assessment addresses ventilation specifically?
Pediatric CCRN Practice Exam | Page 3
