Pediatric CCRN Practice Exam Verified Questions,
Correct Answers, and Detailed Explanations for
Students||Already Graded A+
1. A 3-year-old child presents with croup. Which is the most
appropriate initial intervention?
A. Endotracheal intubation
B. Administer nebulized epinephrine
C. Administer IV antibiotics
D. Place the child on mechanical ventilation
Rationale: Nebulized epinephrine reduces airway edema and
improves airway patency in moderate to severe croup. Intubation is
reserved for severe cases with impending respiratory failure.
2. Which electrolyte abnormality is most concerning in a child with
diabetic ketoacidosis (DKA)?
A. Hypernatremia
B. Hypokalemia
C. Hypercalcemia
D. Hypermagnesemia
Rationale: Insulin therapy and fluid resuscitation can precipitate
hypokalemia, which may lead to cardiac arrhythmias. Potassium
should be monitored and replaced appropriately.
3. A 6-month-old infant presents with a heart rate of 220 bpm. The
child is hemodynamically unstable. What is the priority
intervention?
A. Vagal maneuvers
B. Synchronized cardioversion
,C. Administer adenosine
D. Obtain an ECG and observe
Rationale: In unstable supraventricular tachycardia (SVT), immediate
synchronized cardioversion is indicated to restore perfusion and
prevent cardiac arrest.
4. Which of the following is a common cause of acute respiratory
distress syndrome (ARDS) in children?
A. Bronchitis
B. Sepsis
C. Otitis media
D. Urinary tract infection
Rationale: Sepsis is a leading cause of ARDS due to systemic
inflammation leading to alveolar-capillary membrane injury.
5. A 2-year-old with asthma presents with severe wheezing and
hypoxemia. Which intervention is most appropriate?
A. Continuous nebulized albuterol
B. Oral corticosteroids only
C. IV antibiotics
D. Non-invasive ventilation only
Rationale: Continuous nebulized beta-agonists improve
bronchodilation in severe asthma. Corticosteroids are adjunct
therapy.
6. Which hemodynamic parameter is most sensitive for assessing
cardiac output in a child?
A. Heart rate
B. Blood pressure
,C. Capillary refill
D. Central venous pressure
Rationale: Blood pressure alone may be maintained until late shock;
therefore, trends in perfusion and tissue oxygenation are also critical.
7. A 4-year-old is admitted with septic shock. Which vasoactive
agent is first-line if hypotension persists after fluids?
A. Dopamine
B. Epinephrine
C. Nitroglycerin
D. Norepinephrine
Rationale: Epinephrine is recommended as the first-line vasoactive
agent in fluid-refractory pediatric septic shock, particularly in cold
shock presentation.
8. In pediatric patients with traumatic brain injury (TBI), which
parameter is most critical to monitor?
A. Blood glucose
B. Intracranial pressure (ICP)
C. Oxygen saturation
D. Heart rate
Rationale: Elevated ICP can lead to secondary brain injury.
Monitoring ICP and maintaining cerebral perfusion pressure is
essential.
9. Which of the following is the preferred fluid for initial
resuscitation in pediatric septic shock?
A. 5% dextrose
B. Albumin
, C. 0.9% normal saline
D. Lactated Ringer’s at maintenance rate
Rationale: Isotonic saline boluses are recommended for rapid
intravascular volume expansion in pediatric septic shock.
10. A child with cyanotic congenital heart disease is admitted with
hypoxemia. Which action is appropriate first?
A. Increase oxygen only
B. Assess for hypercyanotic “tet” spell and provide supportive care
C. Administer IV diuretics
D. Immediate intubation
Rationale: Hypercyanotic spells can cause sudden hypoxemia; knee-
chest positioning, oxygen, and morphine may help stabilize the child.
11. Which finding is most consistent with impending respiratory
failure in a child?
A. Mild tachypnea
B. Bradycardia with hypoxemia
C. Nasal flaring
D. Retractions
Rationale: Bradycardia is a late and ominous sign of respiratory
failure in children, often preceding arrest.
12. A 7-year-old child with heart failure is prescribed digoxin. Which
electrolyte abnormality increases the risk of digoxin toxicity?
A. Hypernatremia
B. Hypokalemia
C. Hypercalcemia
D. Hypomagnesemia
Correct Answers, and Detailed Explanations for
Students||Already Graded A+
1. A 3-year-old child presents with croup. Which is the most
appropriate initial intervention?
A. Endotracheal intubation
B. Administer nebulized epinephrine
C. Administer IV antibiotics
D. Place the child on mechanical ventilation
Rationale: Nebulized epinephrine reduces airway edema and
improves airway patency in moderate to severe croup. Intubation is
reserved for severe cases with impending respiratory failure.
2. Which electrolyte abnormality is most concerning in a child with
diabetic ketoacidosis (DKA)?
A. Hypernatremia
B. Hypokalemia
C. Hypercalcemia
D. Hypermagnesemia
Rationale: Insulin therapy and fluid resuscitation can precipitate
hypokalemia, which may lead to cardiac arrhythmias. Potassium
should be monitored and replaced appropriately.
3. A 6-month-old infant presents with a heart rate of 220 bpm. The
child is hemodynamically unstable. What is the priority
intervention?
A. Vagal maneuvers
B. Synchronized cardioversion
,C. Administer adenosine
D. Obtain an ECG and observe
Rationale: In unstable supraventricular tachycardia (SVT), immediate
synchronized cardioversion is indicated to restore perfusion and
prevent cardiac arrest.
4. Which of the following is a common cause of acute respiratory
distress syndrome (ARDS) in children?
A. Bronchitis
B. Sepsis
C. Otitis media
D. Urinary tract infection
Rationale: Sepsis is a leading cause of ARDS due to systemic
inflammation leading to alveolar-capillary membrane injury.
5. A 2-year-old with asthma presents with severe wheezing and
hypoxemia. Which intervention is most appropriate?
A. Continuous nebulized albuterol
B. Oral corticosteroids only
C. IV antibiotics
D. Non-invasive ventilation only
Rationale: Continuous nebulized beta-agonists improve
bronchodilation in severe asthma. Corticosteroids are adjunct
therapy.
6. Which hemodynamic parameter is most sensitive for assessing
cardiac output in a child?
A. Heart rate
B. Blood pressure
,C. Capillary refill
D. Central venous pressure
Rationale: Blood pressure alone may be maintained until late shock;
therefore, trends in perfusion and tissue oxygenation are also critical.
7. A 4-year-old is admitted with septic shock. Which vasoactive
agent is first-line if hypotension persists after fluids?
A. Dopamine
B. Epinephrine
C. Nitroglycerin
D. Norepinephrine
Rationale: Epinephrine is recommended as the first-line vasoactive
agent in fluid-refractory pediatric septic shock, particularly in cold
shock presentation.
8. In pediatric patients with traumatic brain injury (TBI), which
parameter is most critical to monitor?
A. Blood glucose
B. Intracranial pressure (ICP)
C. Oxygen saturation
D. Heart rate
Rationale: Elevated ICP can lead to secondary brain injury.
Monitoring ICP and maintaining cerebral perfusion pressure is
essential.
9. Which of the following is the preferred fluid for initial
resuscitation in pediatric septic shock?
A. 5% dextrose
B. Albumin
, C. 0.9% normal saline
D. Lactated Ringer’s at maintenance rate
Rationale: Isotonic saline boluses are recommended for rapid
intravascular volume expansion in pediatric septic shock.
10. A child with cyanotic congenital heart disease is admitted with
hypoxemia. Which action is appropriate first?
A. Increase oxygen only
B. Assess for hypercyanotic “tet” spell and provide supportive care
C. Administer IV diuretics
D. Immediate intubation
Rationale: Hypercyanotic spells can cause sudden hypoxemia; knee-
chest positioning, oxygen, and morphine may help stabilize the child.
11. Which finding is most consistent with impending respiratory
failure in a child?
A. Mild tachypnea
B. Bradycardia with hypoxemia
C. Nasal flaring
D. Retractions
Rationale: Bradycardia is a late and ominous sign of respiratory
failure in children, often preceding arrest.
12. A 7-year-old child with heart failure is prescribed digoxin. Which
electrolyte abnormality increases the risk of digoxin toxicity?
A. Hypernatremia
B. Hypokalemia
C. Hypercalcemia
D. Hypomagnesemia
