PEDIATRIC CCRN AACN TEST PAPER 2026/2027
QUESTIONS AND SOLUTIONS RATED A+
✔✔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
B. increased production of mucous
C. respiratory alkalosis
D. persistent agitation - ✔✔D
✔✔Positive end-expiratory pressure (PEEP) is intended to:
A. increase venous return to the heart
B. increase functional residual capacity
C. decrease functional residual capacity
D. increase cardiac output - ✔✔B
✔✔On the second day following tracheoesophageal fistula repair, an infant develops a
temperature of 102F (39C), RR 75, and frothy chest tube drainage. These
signs/symptoms indicate:
A. chylothorax
B. ventilator-associated pneumonia (VAP)
C. pneumothorax
D. anastomosis site leakage - ✔✔D
✔✔The nurse is placing a diet order for the patient with glomerulonephritis who receives
hemodialysis three times a week. Which items on the menu should be avoided?
A. caffeinated drinks
B. bananas and avocados
C. sugary desserts
D. bread and pasta - ✔✔B
✔✔A patient who is visually impaired is to be transferred to another unit. The nurse
should prepare for the transition by:
A. explaining the physical layout of the receiving unit to the patient
B. advising the staff on the receiving unit to orient the patient
C. providing written materials about the receiving unit to the patient's family
, D. arranging for the patient's family to tour the receiving unit - ✔✔A
✔✔When caring for a patient with an open wound, the nurse implements which
measures to improve healing?
A. compression, keeping the wound moist and cool
B. reducing edema, pressure on wound and avoiding debridement
C. good nutrition, normal BG levels, adequate hydration
D. reducing pain, preventing friction, and encouraging caffeine intake - ✔✔C
✔✔When treating a patient with hypovolemic shock due to prolonged vomiting, the
FIRST action by the nurse should be to:
A. prepare equipment for intubation
B. increase MIVF rate
C. administer oxygen
D. prepare for central venous line placement - ✔✔C
✔✔A patient with no past medical history presents with fever for one day. The nurse
notes hypotension, tachycardia, prolonged capillary refill, clear breath sounds bilaterally,
and a murmur. The nurse suspects:
A. cardiomyopathy
B. congestive heart failure
C. endocarditis
D. sepsis - ✔✔C
✔✔A child is admitted one week after device closure of a ventricular septal defect via
cardiac catheterization. The MOST common dysrhythmia seen after this procedure is:
A. third degree AV block
B. ventricular tachycardia
C. PVCs
D. junctional rhythm - ✔✔A
✔✔A provider discloses to the nurse that a patient received twice the desired dose of
sedation for bronchoscopy. The patient required initiation of vasopressors and insertion
of a central venous catheter as a result. The nurse should INITIALLY:
A. collaborate with risk management
B. encourage the provider to disclose the error to the family
C. call the Ethics Committee for a consult
D. contact the hospital legal counsel - ✔✔B
✔✔A teenage with end stage renal disease (ESRD) is admitted to the unit with a
dialysis catheter in place. Data are:
BUN elevated
Creatinine elevated
K+ 5.9
QUESTIONS AND SOLUTIONS RATED A+
✔✔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
B. increased production of mucous
C. respiratory alkalosis
D. persistent agitation - ✔✔D
✔✔Positive end-expiratory pressure (PEEP) is intended to:
A. increase venous return to the heart
B. increase functional residual capacity
C. decrease functional residual capacity
D. increase cardiac output - ✔✔B
✔✔On the second day following tracheoesophageal fistula repair, an infant develops a
temperature of 102F (39C), RR 75, and frothy chest tube drainage. These
signs/symptoms indicate:
A. chylothorax
B. ventilator-associated pneumonia (VAP)
C. pneumothorax
D. anastomosis site leakage - ✔✔D
✔✔The nurse is placing a diet order for the patient with glomerulonephritis who receives
hemodialysis three times a week. Which items on the menu should be avoided?
A. caffeinated drinks
B. bananas and avocados
C. sugary desserts
D. bread and pasta - ✔✔B
✔✔A patient who is visually impaired is to be transferred to another unit. The nurse
should prepare for the transition by:
A. explaining the physical layout of the receiving unit to the patient
B. advising the staff on the receiving unit to orient the patient
C. providing written materials about the receiving unit to the patient's family
, D. arranging for the patient's family to tour the receiving unit - ✔✔A
✔✔When caring for a patient with an open wound, the nurse implements which
measures to improve healing?
A. compression, keeping the wound moist and cool
B. reducing edema, pressure on wound and avoiding debridement
C. good nutrition, normal BG levels, adequate hydration
D. reducing pain, preventing friction, and encouraging caffeine intake - ✔✔C
✔✔When treating a patient with hypovolemic shock due to prolonged vomiting, the
FIRST action by the nurse should be to:
A. prepare equipment for intubation
B. increase MIVF rate
C. administer oxygen
D. prepare for central venous line placement - ✔✔C
✔✔A patient with no past medical history presents with fever for one day. The nurse
notes hypotension, tachycardia, prolonged capillary refill, clear breath sounds bilaterally,
and a murmur. The nurse suspects:
A. cardiomyopathy
B. congestive heart failure
C. endocarditis
D. sepsis - ✔✔C
✔✔A child is admitted one week after device closure of a ventricular septal defect via
cardiac catheterization. The MOST common dysrhythmia seen after this procedure is:
A. third degree AV block
B. ventricular tachycardia
C. PVCs
D. junctional rhythm - ✔✔A
✔✔A provider discloses to the nurse that a patient received twice the desired dose of
sedation for bronchoscopy. The patient required initiation of vasopressors and insertion
of a central venous catheter as a result. The nurse should INITIALLY:
A. collaborate with risk management
B. encourage the provider to disclose the error to the family
C. call the Ethics Committee for a consult
D. contact the hospital legal counsel - ✔✔B
✔✔A teenage with end stage renal disease (ESRD) is admitted to the unit with a
dialysis catheter in place. Data are:
BUN elevated
Creatinine elevated
K+ 5.9
