CCRN PEDIATRIC AACN FINAL EXAM 2026/2027
QUESTIONS AND SOLUTIONS RATED A+
✔✔A child is admitted with a diagnosis of hemolytic uremic syndrome. In addition to an
increased BUN and creatinine, expected laboratory values should be:
A. Hgb 7.1, Hct 19.5, PLT 58,000, K+ 5.5
B. Hgb 3.1, Hct 36.7, PLT 117,000, K+ 4.5
C. Hgb 14.4, Hct 44.7, PLT 90,000, K+ 3.8
D. Hgb 7.5, Hct 19.8, PLT 200,000, K+ 5.2 - ✔✔A
✔✔An intubated patient is requiring escalating ventilatory support for diffuse pulmonary
edema. The nurse understands that the use of increased levels of PEEP can cause:
A. decreased cardiac output
B. decreased intra-thoracic pressure
C. increased venous return
D. increased pulmonary vascular resistance - ✔✔A
✔✔While performing an exchange transfusion for a patient with sickle cell disease,
which electrolyte abnormality should the nurse anticipate?
A. hypocalcemia
B. hypercalcemia
D. hypomagnesemia
D. hypokalemia - ✔✔A
✔✔A 3 year old is being monitored post-operatively after a kidney transplant. Urinary
output is 0.5 mL/kg/hr and vitals are as follows:
HR 130
RR 22
CVP 4
BP 80/40
The nurse should anticipate which orders?
A. administration of lasix (Furosemide)
B. initiation of dopamine (Inotropin) infusion
C. administration of an isotonic fluid bolus
D. irrigation of the urinary catheter - ✔✔C
✔✔The best explanation for a patient's acute severe esophageal/gastrointestinal
hemorrhage is:
A. Meckel's diverticulum
B. portal hypertension
C. gastric ulcerations
D. bowel obstruction - ✔✔B
,✔✔A patient is intubated due to a sudden deterioration in respiratory status. ABGs post
intubation are as follows:
pH 7.31
pCO2 50
pO2 80
SaO2 95%
The ABGs reflect:
A. respiratory acidosis
B. metabolic acidosis
C. metabolic alkalosis
D. respiratory alkalosis - ✔✔A
✔✔Following repair of coarctation of the aorta in a 3 day old, the following vitals are
obtained: HR 142, RR 51, BP 105/44, SpO2 99%, CVP 3. The nurse should expect
which to be ordered by the provider?
A. fluids at half maintenance
B. nicardipine (Cardene) infusion
C. milrinone (Primacor) infusion
D. furosemide (Lasix) administration - ✔✔B
✔✔A neonate is weaned from conventional mechanical ventilation to HFNC on day of
life 5. On day of life 11, the neonate demonstrates increased respiratory distress that
necessitates intubation. The caregiver questions the nurse regarding the need for
mechanical ventilation given successful tolerance of the HFNC for the past 6 days. The
nurse should:
A. explain the difference between mechanical ventilation and HFNC
B. refer the caregiver to the respiratory therapist
C. ask the provider to speak with the caregiver
D. schedule a multidisciplinary team conference - ✔✔C
✔✔A patient newly diagnosed with acute lymphocytic leukemia presents with a WBC of
60,000/mm3. During induction chemotherapy, the nurse would observe for the following
ECG changes:
A. prominent U waves
B. peaked T waved
C. ST segment depression
D. prolonged QT interval - ✔✔B
✔✔A long term complication for an infant with bronchopulmonary dysplasia (BPD) is:
A. cor pulmonale
B. cardiomyopathy
C. barotrauma
,D. subglottic stenosis - ✔✔A
✔✔The nurse is caring for a patient with asthma whose most recent glucose level was
210. Which factors might lead to the patients increased BG level?
A. stress and steroid medications
B. stress and inhaled albuterol
C. lack of sleep and dextrose infusion
D. lack of sleep and Magnesium infusion - ✔✔A
✔✔When a skin surfaces rubs against another surfaces, such as bedsheet, this is
called:
A. shear
B. epidermal stripping
C. friction
D. maceration - ✔✔C
✔✔An African American patient is admitted with angioedema. The patients medication
history includes the use of an ACE inhibitor for hypertension. The patient endorses
taking the medication as prescribed and denies taking any additional doses. Which
should the nurse suspect?
A. the pharmacist gave the patient the wrong dose of medication
B. the patient needs education on how to take the medication correctly
C. the caregiver is trying to poison the patient by administering additional medication
D. the medication is not being metabolized as intended - ✔✔D
✔✔A child presents to the emergency department with stridor, vomiting, and urticarial
rash. Assessment reveals a capillary refill of 4 seconds and HR 180. The nurse
suspects which type of shock?
A. hypovolemic
B. neurogenic
C. distributive
D. cardiogenic - ✔✔C
✔✔A child is admitted after a near-drowning incident. The patient is being managed
with mechanical ventilation. Assessment reveals decrease bilateral lung sounds,
crackles, and increased frothy secretions. ABG results are as follows:
pH 7.35
pCO2 45
pO2 58
HCO3 24
BE -1
SaO2 89%
Which of the following orders should the nurse anticipate?
, A. increased tidal volume to 10 mL/kg
B. increase FiO2 to 100%
C. increase PEEP to 10
D. increase pressure support to 10 - ✔✔C
✔✔A patient is admitted after an episode of emesis during a seizure. Assessment
reveals labored breathing, SaO2 85% in room air, and crackles are auscultated
bilaterally. Which of the following orders should the nurse MOST anticipate?
A. blood culture and IV maxipime (Cefepime)
B. oxygen to maintain SaO2 between 94-99% and HOB elevated 30-45 degrees
C. albuterol (Proventil) inhaler and IV methylprednisone (Solumedrol)
D. furosemide (Lasix) and 100% FiO2 - ✔✔B
✔✔A patient is admitted with an acute blunt chest trauma. Initial assessment reveals
chest wall bruising, unequal lung sounds, increased dyspnea, and SaO2 91% on 2L
NC. The patient tells the nurse "My chest hurts so much" despite pain medication
administration. The priority intervention the nurse should anticipate would be:
A. chest tube placement
B. non-invasive positive pressure ventilation
C. bronchodilator via nebulizer
D. increasing pain medication - ✔✔A
✔✔A child has been waiting for 2 months for a heart transplant. A family member
angrily tells the nurse "This is hopeless!". The nurse's action should be based on the
knowledge that:
A. maintaining the integrity of the family system is crucial in the transplant process
B. because expressions of hopelessness may be harmful to the patient, the family
member should be encourage to keep these statements out of the patient care area
C. expressions of frustration are normal and usually require no nursing intervention
D. encouraging discussion of negative emotions can impede their resolution - ✔✔A
✔✔A patient with DKA is admitted. To best manage electrolyte imbalances, the nurse
should INITIALLY collaborate with a(n):
A. diabetes educator
B. dietician
C. endocrinologist
D. gastroenterologist - ✔✔B
✔✔A neutropenic patient is admitted showing signs of respiratory infection. Blood and
sputum cultures are obtained. The nurse should anticipate:
A. immediate placement in strict isolation
B. no intervention until causative organism is identified
C. beginning antibiotics immediately
D. transbronchial biopsy - ✔✔C
QUESTIONS AND SOLUTIONS RATED A+
✔✔A child is admitted with a diagnosis of hemolytic uremic syndrome. In addition to an
increased BUN and creatinine, expected laboratory values should be:
A. Hgb 7.1, Hct 19.5, PLT 58,000, K+ 5.5
B. Hgb 3.1, Hct 36.7, PLT 117,000, K+ 4.5
C. Hgb 14.4, Hct 44.7, PLT 90,000, K+ 3.8
D. Hgb 7.5, Hct 19.8, PLT 200,000, K+ 5.2 - ✔✔A
✔✔An intubated patient is requiring escalating ventilatory support for diffuse pulmonary
edema. The nurse understands that the use of increased levels of PEEP can cause:
A. decreased cardiac output
B. decreased intra-thoracic pressure
C. increased venous return
D. increased pulmonary vascular resistance - ✔✔A
✔✔While performing an exchange transfusion for a patient with sickle cell disease,
which electrolyte abnormality should the nurse anticipate?
A. hypocalcemia
B. hypercalcemia
D. hypomagnesemia
D. hypokalemia - ✔✔A
✔✔A 3 year old is being monitored post-operatively after a kidney transplant. Urinary
output is 0.5 mL/kg/hr and vitals are as follows:
HR 130
RR 22
CVP 4
BP 80/40
The nurse should anticipate which orders?
A. administration of lasix (Furosemide)
B. initiation of dopamine (Inotropin) infusion
C. administration of an isotonic fluid bolus
D. irrigation of the urinary catheter - ✔✔C
✔✔The best explanation for a patient's acute severe esophageal/gastrointestinal
hemorrhage is:
A. Meckel's diverticulum
B. portal hypertension
C. gastric ulcerations
D. bowel obstruction - ✔✔B
,✔✔A patient is intubated due to a sudden deterioration in respiratory status. ABGs post
intubation are as follows:
pH 7.31
pCO2 50
pO2 80
SaO2 95%
The ABGs reflect:
A. respiratory acidosis
B. metabolic acidosis
C. metabolic alkalosis
D. respiratory alkalosis - ✔✔A
✔✔Following repair of coarctation of the aorta in a 3 day old, the following vitals are
obtained: HR 142, RR 51, BP 105/44, SpO2 99%, CVP 3. The nurse should expect
which to be ordered by the provider?
A. fluids at half maintenance
B. nicardipine (Cardene) infusion
C. milrinone (Primacor) infusion
D. furosemide (Lasix) administration - ✔✔B
✔✔A neonate is weaned from conventional mechanical ventilation to HFNC on day of
life 5. On day of life 11, the neonate demonstrates increased respiratory distress that
necessitates intubation. The caregiver questions the nurse regarding the need for
mechanical ventilation given successful tolerance of the HFNC for the past 6 days. The
nurse should:
A. explain the difference between mechanical ventilation and HFNC
B. refer the caregiver to the respiratory therapist
C. ask the provider to speak with the caregiver
D. schedule a multidisciplinary team conference - ✔✔C
✔✔A patient newly diagnosed with acute lymphocytic leukemia presents with a WBC of
60,000/mm3. During induction chemotherapy, the nurse would observe for the following
ECG changes:
A. prominent U waves
B. peaked T waved
C. ST segment depression
D. prolonged QT interval - ✔✔B
✔✔A long term complication for an infant with bronchopulmonary dysplasia (BPD) is:
A. cor pulmonale
B. cardiomyopathy
C. barotrauma
,D. subglottic stenosis - ✔✔A
✔✔The nurse is caring for a patient with asthma whose most recent glucose level was
210. Which factors might lead to the patients increased BG level?
A. stress and steroid medications
B. stress and inhaled albuterol
C. lack of sleep and dextrose infusion
D. lack of sleep and Magnesium infusion - ✔✔A
✔✔When a skin surfaces rubs against another surfaces, such as bedsheet, this is
called:
A. shear
B. epidermal stripping
C. friction
D. maceration - ✔✔C
✔✔An African American patient is admitted with angioedema. The patients medication
history includes the use of an ACE inhibitor for hypertension. The patient endorses
taking the medication as prescribed and denies taking any additional doses. Which
should the nurse suspect?
A. the pharmacist gave the patient the wrong dose of medication
B. the patient needs education on how to take the medication correctly
C. the caregiver is trying to poison the patient by administering additional medication
D. the medication is not being metabolized as intended - ✔✔D
✔✔A child presents to the emergency department with stridor, vomiting, and urticarial
rash. Assessment reveals a capillary refill of 4 seconds and HR 180. The nurse
suspects which type of shock?
A. hypovolemic
B. neurogenic
C. distributive
D. cardiogenic - ✔✔C
✔✔A child is admitted after a near-drowning incident. The patient is being managed
with mechanical ventilation. Assessment reveals decrease bilateral lung sounds,
crackles, and increased frothy secretions. ABG results are as follows:
pH 7.35
pCO2 45
pO2 58
HCO3 24
BE -1
SaO2 89%
Which of the following orders should the nurse anticipate?
, A. increased tidal volume to 10 mL/kg
B. increase FiO2 to 100%
C. increase PEEP to 10
D. increase pressure support to 10 - ✔✔C
✔✔A patient is admitted after an episode of emesis during a seizure. Assessment
reveals labored breathing, SaO2 85% in room air, and crackles are auscultated
bilaterally. Which of the following orders should the nurse MOST anticipate?
A. blood culture and IV maxipime (Cefepime)
B. oxygen to maintain SaO2 between 94-99% and HOB elevated 30-45 degrees
C. albuterol (Proventil) inhaler and IV methylprednisone (Solumedrol)
D. furosemide (Lasix) and 100% FiO2 - ✔✔B
✔✔A patient is admitted with an acute blunt chest trauma. Initial assessment reveals
chest wall bruising, unequal lung sounds, increased dyspnea, and SaO2 91% on 2L
NC. The patient tells the nurse "My chest hurts so much" despite pain medication
administration. The priority intervention the nurse should anticipate would be:
A. chest tube placement
B. non-invasive positive pressure ventilation
C. bronchodilator via nebulizer
D. increasing pain medication - ✔✔A
✔✔A child has been waiting for 2 months for a heart transplant. A family member
angrily tells the nurse "This is hopeless!". The nurse's action should be based on the
knowledge that:
A. maintaining the integrity of the family system is crucial in the transplant process
B. because expressions of hopelessness may be harmful to the patient, the family
member should be encourage to keep these statements out of the patient care area
C. expressions of frustration are normal and usually require no nursing intervention
D. encouraging discussion of negative emotions can impede their resolution - ✔✔A
✔✔A patient with DKA is admitted. To best manage electrolyte imbalances, the nurse
should INITIALLY collaborate with a(n):
A. diabetes educator
B. dietician
C. endocrinologist
D. gastroenterologist - ✔✔B
✔✔A neutropenic patient is admitted showing signs of respiratory infection. Blood and
sputum cultures are obtained. The nurse should anticipate:
A. immediate placement in strict isolation
B. no intervention until causative organism is identified
C. beginning antibiotics immediately
D. transbronchial biopsy - ✔✔C
