,CCRN Pediatric Exam 2026 | Comprehensive Test Bank | Questions
And Answers
I. CLINICAL JUDGMENT
Cardiovascular
Q1. A 2-month-old with poor feeding, tachypnea, diaphoresis during
feeds, hepatomegaly, and inadequate weight gain has a large
ventricular septal defect. Which physiologic change best explains
the symptoms?
A) Complete obstruction of pulmonary blood flow
B) Excessive pulmonary blood flow from a left-to-right shunt causing heart
failure
C) Fixed right-to-left shunting with decreased pulmonary circulation
D) Isolated systemic venous obstruction
Correct Answer: B) Excessive pulmonary blood flow from a left-to-right shunt
causing heart failure
Rationale: A large ventricular septal defect permits substantial left-to-right
shunting as pulmonary vascular resistance falls after birth. Increased
pulmonary blood flow and ventricular volume load lead to tachypnea,
feeding intolerance, diaphoresis, hepatomegaly, and poor growth.
Q2. A 6-year-old with tetralogy of Fallot becomes acutely cyanotic,
tachypneic, and irritable after crying. Which intervention should the
nurse perform first?
A) Place the child supine with the legs extended
B) Encourage continued crying to increase ventilation
C) Place the child in a knee-chest position and administer oxygen
D) Restrict fluids immediately
Correct Answer: C) Place the child in a knee-chest position and administer
oxygen
Rationale: Knee-chest positioning increases systemic vascular resistance
and reduces right-to-left shunting during a hypercyanotic spell. Oxygen and
calming measures are also useful while additional therapies are prepared if
the episode does not resolve.
Q3. A 4-year-old has had fever for 6 days, bilateral conjunctival
injection, strawberry tongue, cervical lymphadenopathy, rash, and
,swollen hands. Which therapy most directly reduces the risk of
coronary artery aneurysm?
A) Intravenous immune globulin
B) Oral penicillin
C) Digoxin
D) Furosemide
Correct Answer: A) Intravenous immune globulin
Rationale: The findings indicate Kawasaki disease. Timely IV immune
globulin significantly reduces the incidence of coronary artery abnormalities.
Aspirin is also commonly incorporated into treatment, while cardiac
surveillance evaluates coronary involvement.
Q4. A 12-year-old with hypertrophic cardiomyopathy collapses
during exercise. Which physiologic change can worsen dynamic left
ventricular outflow obstruction?
A) Increased preload
B) Increased systemic vascular resistance
C) Reduced myocardial contractility
D) Decreased preload and increased contractility
Correct Answer: D) Decreased preload and increased contractility
Rationale: Hypertrophic obstructive cardiomyopathy worsens when the
ventricular chamber becomes smaller or contraction becomes more vigorous.
Dehydration, vasodilation, or increased contractility can intensify dynamic
obstruction and reduce cardiac output.
Q5. A child with myocarditis develops hypotension, cool extremities,
oliguria, rising lactate, and an ejection fraction of 18%. Which
condition best explains this presentation?
A) Distributive shock
B) Neurogenic shock
C) Cardiogenic shock from severe ventricular dysfunction
D) Uncomplicated dehydration
Correct Answer: C) Cardiogenic shock from severe ventricular dysfunction
Rationale: Severe myocardial inflammation can markedly impair
contractility, producing reduced cardiac output and systemic hypoperfusion.
, Hypotension, cool extremities, oliguria, increasing lactate, and severe
ventricular dysfunction are consistent with cardiogenic shock.
Q6. A child with supraventricular tachycardia has a heart rate of
220/min, blood pressure 62/34 mmHg, altered consciousness, and
delayed capillary refill. What is the priority intervention?
A) Obtain a 24-hour Holter monitor
B) Perform synchronized cardioversion
C) Attempt prolonged observation
D) Schedule an outpatient electrophysiology study
Correct Answer: B) Perform synchronized cardioversion
Rationale: Hemodynamic instability caused by a tachyarrhythmia requires
rapid synchronized cardioversion. Hypotension, altered mental status, and
poor perfusion indicate that slower diagnostic or pharmacologic approaches
may be unsafe.
Q7. A child has a regular narrow-complex tachycardia at 210/min but
remains alert with normal blood pressure and perfusion. Which
intervention is appropriate initially?
A) Immediate unsynchronized defibrillation
B) Permanent pacemaker insertion
C) Chest compressions
D) Attempt age-appropriate vagal maneuvers while preparing further therapy
Correct Answer: D) Attempt age-appropriate vagal maneuvers while
preparing further therapy
Rationale: A stable child with probable SVT may undergo vagal maneuvers
before pharmacologic therapy such as adenosine. Defibrillation and chest
compressions are not indicated when the child has an organized rhythm and
adequate perfusion.
Q8. A child with complete heart block has a ventricular rate of
38/min, hypotension, lethargy, and poor perfusion despite initial
supportive measures. Which intervention should be anticipated?
A) Temporary pacing
B) Vagal stimulation
C) Synchronized cardioversion for tachycardia
D) Fluid restriction
And Answers
I. CLINICAL JUDGMENT
Cardiovascular
Q1. A 2-month-old with poor feeding, tachypnea, diaphoresis during
feeds, hepatomegaly, and inadequate weight gain has a large
ventricular septal defect. Which physiologic change best explains
the symptoms?
A) Complete obstruction of pulmonary blood flow
B) Excessive pulmonary blood flow from a left-to-right shunt causing heart
failure
C) Fixed right-to-left shunting with decreased pulmonary circulation
D) Isolated systemic venous obstruction
Correct Answer: B) Excessive pulmonary blood flow from a left-to-right shunt
causing heart failure
Rationale: A large ventricular septal defect permits substantial left-to-right
shunting as pulmonary vascular resistance falls after birth. Increased
pulmonary blood flow and ventricular volume load lead to tachypnea,
feeding intolerance, diaphoresis, hepatomegaly, and poor growth.
Q2. A 6-year-old with tetralogy of Fallot becomes acutely cyanotic,
tachypneic, and irritable after crying. Which intervention should the
nurse perform first?
A) Place the child supine with the legs extended
B) Encourage continued crying to increase ventilation
C) Place the child in a knee-chest position and administer oxygen
D) Restrict fluids immediately
Correct Answer: C) Place the child in a knee-chest position and administer
oxygen
Rationale: Knee-chest positioning increases systemic vascular resistance
and reduces right-to-left shunting during a hypercyanotic spell. Oxygen and
calming measures are also useful while additional therapies are prepared if
the episode does not resolve.
Q3. A 4-year-old has had fever for 6 days, bilateral conjunctival
injection, strawberry tongue, cervical lymphadenopathy, rash, and
,swollen hands. Which therapy most directly reduces the risk of
coronary artery aneurysm?
A) Intravenous immune globulin
B) Oral penicillin
C) Digoxin
D) Furosemide
Correct Answer: A) Intravenous immune globulin
Rationale: The findings indicate Kawasaki disease. Timely IV immune
globulin significantly reduces the incidence of coronary artery abnormalities.
Aspirin is also commonly incorporated into treatment, while cardiac
surveillance evaluates coronary involvement.
Q4. A 12-year-old with hypertrophic cardiomyopathy collapses
during exercise. Which physiologic change can worsen dynamic left
ventricular outflow obstruction?
A) Increased preload
B) Increased systemic vascular resistance
C) Reduced myocardial contractility
D) Decreased preload and increased contractility
Correct Answer: D) Decreased preload and increased contractility
Rationale: Hypertrophic obstructive cardiomyopathy worsens when the
ventricular chamber becomes smaller or contraction becomes more vigorous.
Dehydration, vasodilation, or increased contractility can intensify dynamic
obstruction and reduce cardiac output.
Q5. A child with myocarditis develops hypotension, cool extremities,
oliguria, rising lactate, and an ejection fraction of 18%. Which
condition best explains this presentation?
A) Distributive shock
B) Neurogenic shock
C) Cardiogenic shock from severe ventricular dysfunction
D) Uncomplicated dehydration
Correct Answer: C) Cardiogenic shock from severe ventricular dysfunction
Rationale: Severe myocardial inflammation can markedly impair
contractility, producing reduced cardiac output and systemic hypoperfusion.
, Hypotension, cool extremities, oliguria, increasing lactate, and severe
ventricular dysfunction are consistent with cardiogenic shock.
Q6. A child with supraventricular tachycardia has a heart rate of
220/min, blood pressure 62/34 mmHg, altered consciousness, and
delayed capillary refill. What is the priority intervention?
A) Obtain a 24-hour Holter monitor
B) Perform synchronized cardioversion
C) Attempt prolonged observation
D) Schedule an outpatient electrophysiology study
Correct Answer: B) Perform synchronized cardioversion
Rationale: Hemodynamic instability caused by a tachyarrhythmia requires
rapid synchronized cardioversion. Hypotension, altered mental status, and
poor perfusion indicate that slower diagnostic or pharmacologic approaches
may be unsafe.
Q7. A child has a regular narrow-complex tachycardia at 210/min but
remains alert with normal blood pressure and perfusion. Which
intervention is appropriate initially?
A) Immediate unsynchronized defibrillation
B) Permanent pacemaker insertion
C) Chest compressions
D) Attempt age-appropriate vagal maneuvers while preparing further therapy
Correct Answer: D) Attempt age-appropriate vagal maneuvers while
preparing further therapy
Rationale: A stable child with probable SVT may undergo vagal maneuvers
before pharmacologic therapy such as adenosine. Defibrillation and chest
compressions are not indicated when the child has an organized rhythm and
adequate perfusion.
Q8. A child with complete heart block has a ventricular rate of
38/min, hypotension, lethargy, and poor perfusion despite initial
supportive measures. Which intervention should be anticipated?
A) Temporary pacing
B) Vagal stimulation
C) Synchronized cardioversion for tachycardia
D) Fluid restriction
