pdf
Peds CCRN Review Questions (From AACN)
With 100% Correct Answers Grade A
Certified 2025/26
PEEP is intended to do which of the following?
A. Improve ventilation/perfusion matching
B. Decrease functional residual capacity
C. Increased venous return to the heart
D. Increased cardiac output - correct answersA. Improve ventilation/perfusion matching
- PEEP increases alveolar volume, thereby improving ventilation/perfusion matching and
increasing functional residual capacity.
- A detrimental effect of PEEP (especially at high levels) is a decrease in venous return to the
heart and a subsequent decrease in cardiac output.
In an infant with sepsis, factors that impair the release of oxygen by negatively
affecting oxyhemoglobin dissociation include:
A. Hyperthermia
B. Metabolic acidosis
C. Respiratory acidosis
D. Hypothermia - correct answersD. Hypothermia
- To answer this question, you must consider the factors that would cause a left shift of the
oxyhemoglobin curve.
- Hypothermia, decreased CO2, and increased pH (alkalosis) would all cause a left shift.
- Hyperthermia and acidosis would cause a right shift of the curve
In which condition might you observe a decreased V/Q ratio (<0.8)?
A. Status asthmaticus
B. Sepsis
C. Pulmonary emboli
D. Tricuspid atresia - correct answersA. Status asthmaticus
- A V/Q ratio of <0.8 is indicative of perfusion exceeding ventilation. Air trapping from diseases
such as asthma is a common cause of this scenario
Factors such as small nostrils, larger tongue, and narrower airways in an infant....
A. Decrease airway resistance
B. Make intubation easier
,pdf
C. Increase airway resistance
D. Improve airway obstruction - correct answersC. Increase airway resistance
- There are a number of factors that increase airway resistance and obstruction in young infants,
including their larger heads and tongues, smaller nostrils, decreased muscle tone, and narrower
airways.
- Intubation is more difficult because of an
anterior larynx and narrow cricoid ring.
Indications that a patient is ready to wean from mechanical ventilation include:
A. Hemodynamic instability
B. Adequate cough and gag reflexes
C. Persistent coma
D. PEEP > 8 - correct answersB. Adequate cough and gag reflexes
- Before being extubated, a child needs to have an adequate level of consciousness to protect his
or her airway. This includes having an adequate cough and gag; hemodynamic stability (not
instability); and a PEEP <5, with an oxygen requirement generally
less than an FiO2 of 0.4.
A toddler who was found unresponsive in a swimming pool is in respiratory distress. On chest x-
ray you see bilateral infiltrates and the PaO2/FiO2 ratio is 190.
These findings suggest:
A. Aspiration pneumonia
B. Viral pneumonia
C. Acute respiratory distress syndrome
D. Pneumothorax - correct answersC. Acute respiratory distress syndrome
- This child has signs of acute respiratory distress syndrome (ARDS), which include bilateral
infiltrates on chest x-ray, PaO2/FiO2 ratio <200, and pulmonary edema, among other things.
- Both aspiration and viral pneumonia may lead to ARDS, but that's not the correct answer for
this question.
- The symptoms described are not
consistent with a pneumothorax.
An infant with bronchiolitis is intubated due to an acute respiratory failure. Post-intubation ABG
results demonstrate:
pH 7.22
PaCO2 62
PaO2 75
HCO3 22
O2 sat 90%
,pdf
This blood gas reflects:
A. Metabolic acidosis
B. Respiratory acidosis
C. Metabolic alkalosis
D. Respiratory alkalosis - correct answersB. Respiratory acidosis
This child's blood gas results include a decreased pH and an increase in PaCO2 — both of which
indicate a state of respiratory acidosis.
An intubated, mechanically ventilated patient has a sudden decrease in SpO2 from 95% to 78%,
and the ventilator is alarming high peak pressures. Your first intervention is to:
A. Increase the FiO2 and ventilator rate
B. Assess the patency of the endotracheal tube
C. Administer a neuromuscular blocking agent
D. Prepare to reposition the endotracheal tube - correct answersB. Assess the patency of the
endotracheal tube
- Your first priority is assessing the patency of the ETT.
- Once you have confirmed whether the tube is or is not patent, that will help to direct your next
interventions.
- The alarms for high peak pressure may indicate that the ETT is kinked or blocked with
secretions.
The most important intervention when caring for the patient with epiglottitis and who is in
significant respiratory distress is to:
A. Keep the child quiet and comfortable
B. Administer racemic epinephrine
C. Place the child in a supine position
D. Administer antibiotics - correct answersA. Keep the child quiet and comfortable
- The goal is to keep the child quiet, comfortable, and in whatever position that allows them to
maintain their own airway until a skilled provider who can control the airway is present and
ready to do so.
- Racemic epinephrine might be helpful for the patient with croup
- Although the patient with epiglottitis needs antibiotics, that's not the priority intervention until
the airway is secure.
Which of the following is the first action to take in the case of a patient with a
suspected tension pneumothorax?
A. Assess blood pressure
B. Prepare for intubation
C. Obtain a chest radiograph
, pdf
D. Prepare for needle thoracostomy - correct answersD. Prepare for needle thoracostomy
Tension pneumothorax is an emergency requiring needle decompression. The child will require
monitoring of vital signs during the procedure and an x-ray post-procedure. The need for
intubation will be determined based on the child's clinical exam
following evacuation of the tension pneumothorax.
For a patient with status asthmaticus, chest x-ray will reveal:
A. Perihilar infiltration
B. Hyperinflation
C. Foreign body aspiration
D. An elevated diaphragm - correct answersB. Hyperinflation
Remembering that air "trapping" is a common phenomenon in status asthmatics, you would
anticipate seeing hyperinflation on this x-ray.
A term newborn develops difficulty breathing and cyanosis. The nurse has difficulty hearing
breath sounds and notes the baby has a scaphoid abdomen.
Which should the nurse suspect?
A. Tracheoesophageal fistula
B. Diaphragmatic hernia
C. Pneumothorax
D. Congenital heart defect - correct answersB. Diaphragmatic hernia
A baby with diaphragmatic hernia will appear to have a scaphoid abdomen because the
abdominal contents have shifted up into the thorax. The lungs are hypoplastic and the heart may
be shifted to the right.
Intubation and positive pressure ventilation are high-risk therapies in the pediatric asthmatic
patient due to possible:
A. Infection
B. Oxygen toxicity
C. Pneumothorax
D. Ventilator dependence - correct answersC. Pneumothorax
These patients typically have thick secretions, mucosal edema, and bronchoconstriction, all of
which put them at risk for increased airway resistance and air trapping. This, in turn, places them
at higher risk for the development of pneumothoraces associated with positive pressure
ventilation.
A patient with status asthmatics is increasingly somnolent and only able to speak one word
between breaths. The priority intervention is:
Peds CCRN Review Questions (From AACN)
With 100% Correct Answers Grade A
Certified 2025/26
PEEP is intended to do which of the following?
A. Improve ventilation/perfusion matching
B. Decrease functional residual capacity
C. Increased venous return to the heart
D. Increased cardiac output - correct answersA. Improve ventilation/perfusion matching
- PEEP increases alveolar volume, thereby improving ventilation/perfusion matching and
increasing functional residual capacity.
- A detrimental effect of PEEP (especially at high levels) is a decrease in venous return to the
heart and a subsequent decrease in cardiac output.
In an infant with sepsis, factors that impair the release of oxygen by negatively
affecting oxyhemoglobin dissociation include:
A. Hyperthermia
B. Metabolic acidosis
C. Respiratory acidosis
D. Hypothermia - correct answersD. Hypothermia
- To answer this question, you must consider the factors that would cause a left shift of the
oxyhemoglobin curve.
- Hypothermia, decreased CO2, and increased pH (alkalosis) would all cause a left shift.
- Hyperthermia and acidosis would cause a right shift of the curve
In which condition might you observe a decreased V/Q ratio (<0.8)?
A. Status asthmaticus
B. Sepsis
C. Pulmonary emboli
D. Tricuspid atresia - correct answersA. Status asthmaticus
- A V/Q ratio of <0.8 is indicative of perfusion exceeding ventilation. Air trapping from diseases
such as asthma is a common cause of this scenario
Factors such as small nostrils, larger tongue, and narrower airways in an infant....
A. Decrease airway resistance
B. Make intubation easier
C. Increase airway resistance
D. Improve airway obstruction - correct answersC. Increase airway resistance
- There are a number of factors that increase airway resistance and obstruction in young infants,
including their larger heads and tongues, smaller nostrils, decreased muscle tone, and narrower
airways.
- Intubation is more difficult because of an
anterior larynx and narrow cricoid ring.
Indications that a patient is ready to wean from mechanical ventilation include:
A. Hemodynamic instability
B. Adequate cough and gag reflexes
C. Persistent coma
D. PEEP > 8 - correct answersB. Adequate cough and gag reflexes
- Before being extubated, a child needs to have an adequate level of consciousness to protect his
or her airway. This includes having an adequate cough and gag; hemodynamic stability (not
instability); and a PEEP <5, with an oxygen requirement generally
less than an FiO2 of 0.4.
A toddler who was found unresponsive in a swimming pool is in respiratory distress. On chest x-
ray you see bilateral infiltrates and the PaO2/FiO2 ratio is 190.
These findings suggest:
A. Aspiration pneumonia
B. Viral pneumonia
C. Acute respiratory distress syndrome
D. Pneumothorax - correct answersC. Acute respiratory distress syndrome
- This child has signs of acute respiratory distress syndrome (ARDS), which include bilateral
infiltrates on chest x-ray, PaO2/FiO2 ratio <200, and pulmonary edema, among other things.
- Both aspiration and viral pneumonia may lead to ARDS, but that's not the correct answer for
this question.
- The symptoms described are not
consistent with a pneumothorax.
An infant with bronchiolitis is intubated due to an acute respiratory failure. Post-intubation ABG
results demonstrate:
pH 7.22
PaCO2 62
PaO2 75
HCO3 22
O2 sat 90%
This blood gas reflects:
A. Metabolic acidosis
B. Respiratory acidosis
C. Metabolic alkalosis
D. Respiratory alkalosis - correct answersB. Respiratory acidosis
This child's blood gas results include a decreased pH and an increase in PaCO2 — both of which
indicate a state of respiratory acidosis.
An intubated, mechanically ventilated patient has a sudden decrease in SpO2 from 95% to 78%,
and the ventilator is alarming high peak pressures. Your first intervention is to:
A. Increase the FiO2 and ventilator rate
B. Assess the patency of the endotracheal tube
C. Administer a neuromuscular blocking agent
D. Prepare to reposition the endotracheal tube - correct answersB. Assess the patency of the
endotracheal tube
- Your first priority is assessing the patency of the ETT.
- Once you have confirmed whether the tube is or is not patent, that will help to direct your next
interventions.
- The alarms for high peak pressure may indicate that the ETT is kinked or blocked with
secretions.
The most important intervention when caring for the patient with epiglottitis and who is in
significant respiratory distress is to:
A. Keep the child quiet and comfortable
B. Administer racemic epinephrine
C. Place the child in a supine position
D. Administer antibiotics - correct answersA. Keep the child quiet and comfortable
- The goal is to keep the child quiet, comfortable, and in whatever position that allows them to
maintain their own airway until a skilled provider who can control the airway is present and
ready to do so.
- Racemic epinephrine might be helpful for the patient with croup
- Although the patient with epiglottitis needs antibiotics, that's not the priority intervention until
the airway is secure.
Which of the following is the first action to take in the case of a patient with a
suspected tension pneumothorax?
A. Assess blood pressure
B. Prepare for intubation
C. Obtain a chest radiograph
D. Prepare for needle thoracostomy - correct answersD. Prepare for needle thoracostomy
Tension pneumothorax is an emergency requiring needle decompression. The child will require
monitoring of vital signs during the procedure and an x-ray post-procedure. The need for
intubation will be determined based on the child's clinical exam
following evacuation of the tension pneumothorax.
For a patient with status asthmaticus, chest x-ray will reveal:
A. Perihilar infiltration
B. Hyperinflation
C. Foreign body aspiration
D. An elevated diaphragm - correct answersB. Hyperinflation
Remembering that air "trapping" is a common phenomenon in status asthmatics, you would
anticipate seeing hyperinflation on this x-ray.
A term newborn develops difficulty breathing and cyanosis. The nurse has difficulty hearing
breath sounds and notes the baby has a scaphoid abdomen.
Which should the nurse suspect?
A. Tracheoesophageal fistula
B. Diaphragmatic hernia
C. Pneumothorax
D. Congenital heart defect - correct answersB. Diaphragmatic hernia
A baby with diaphragmatic hernia will appear to have a scaphoid abdomen because the
abdominal contents have shifted up into the thorax. The lungs are hypoplastic and the heart may
be shifted to the right.
Intubation and positive pressure ventilation are high-risk therapies in the pediatric asthmatic
patient due to possible:
A. Infection
B. Oxygen toxicity
C. Pneumothorax
D. Ventilator dependence - correct answersC. Pneumothorax
These patients typically have thick secretions, mucosal edema, and bronchoconstriction, all of
which put them at risk for increased airway resistance and air trapping. This, in turn, places them
at higher risk for the development of pneumothoraces associated with positive pressure
ventilation.
A patient with status asthmatics is increasingly somnolent and only able to speak one word
between breaths. The priority intervention is:
