PEDIATRIC CCRN CERTIFICATION EVALUATION
EXAMS 2026 QUESTIONS WITH ANSWERS
◉In an infant with sepsis, factors that may impair the release of oxygen
by negatively affecting oxyhemoglobin dissociation include:
A. Hyperthermia
B. Metabolic acidosis
C. Respiratory acidosis
D. Hypothermia . Answer: D. Hypothermia
To answer this question you must consider the factor that would cause a
left shift of the oxyhemoglobin curve. Hypothermia, hypocarbia, and
alkalosis would all cause a left shift.
◉In which condition might you observe a decreased V/Q ratio (<0.8)?
A. Status asthmaticus
B. Sepsis
C. Pulmonary emboli
D. Tricuspid atresia . Answer: A. Status asthmaticus
A V/Q ratio of <0.8 is indicative of perfusion > ventilation. Air trapping
from diseases such as asthma is a common cause of this scenario.
,◉Factors such as smaller 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 . Answer: C. Increase airway resistance
There are a number of factors that increase airway resistance and
obstruction in young infants, including their larger heads an tongues,
smaller nostrils, decreased muscle tone, and narrower airways.
Intubation is more difficult because of an anterior larynx and narrow
cricoid ring.
◉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 . Answer: B. Respiratory acidosis
,This childs blood gas results include a decreased pH and an increased
PaCO2, both of which indicate a state of respiratory acidosis
◉A toddler who was found unresponsive in a swimming pool is in
respiratory distress. On a CXR, 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 (ARDS)
D. Pneumothorax . Answer: C. Acute respiratory distress syndrome
This child has signs of ARDS which include bilateral infiltrates on CXR,
PaO2/FiO2 ratio <200, and pulmonary edema.
◉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 . Answer: B. Adequate cough and gag reflexes
Before being extubated the child needs to have adequate LOC to protect
their airway, hemodynamic stability, PEEP <5 with an oxygen
requirement generally less than FiO2 of 40%
, ◉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 FiO2 and ventilator rate
B. Assess patency of the ETT
C. Administer a NMBA
D. Prepare to reposition the ETT . Answer: B. Assess patency off the
ETT
Your first priority is assessing the patency of the ETT. Once you have
confirmed the tube is/is not patent, that will help to direct your next
interventions. The alarm 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 epi
C. Place the child in a supine position
D. Administer antibiotics . Answer: A. Keep the child quiet and
comfortable
EXAMS 2026 QUESTIONS WITH ANSWERS
◉In an infant with sepsis, factors that may impair the release of oxygen
by negatively affecting oxyhemoglobin dissociation include:
A. Hyperthermia
B. Metabolic acidosis
C. Respiratory acidosis
D. Hypothermia . Answer: D. Hypothermia
To answer this question you must consider the factor that would cause a
left shift of the oxyhemoglobin curve. Hypothermia, hypocarbia, and
alkalosis would all cause a left shift.
◉In which condition might you observe a decreased V/Q ratio (<0.8)?
A. Status asthmaticus
B. Sepsis
C. Pulmonary emboli
D. Tricuspid atresia . Answer: A. Status asthmaticus
A V/Q ratio of <0.8 is indicative of perfusion > ventilation. Air trapping
from diseases such as asthma is a common cause of this scenario.
,◉Factors such as smaller 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 . Answer: C. Increase airway resistance
There are a number of factors that increase airway resistance and
obstruction in young infants, including their larger heads an tongues,
smaller nostrils, decreased muscle tone, and narrower airways.
Intubation is more difficult because of an anterior larynx and narrow
cricoid ring.
◉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 . Answer: B. Respiratory acidosis
,This childs blood gas results include a decreased pH and an increased
PaCO2, both of which indicate a state of respiratory acidosis
◉A toddler who was found unresponsive in a swimming pool is in
respiratory distress. On a CXR, 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 (ARDS)
D. Pneumothorax . Answer: C. Acute respiratory distress syndrome
This child has signs of ARDS which include bilateral infiltrates on CXR,
PaO2/FiO2 ratio <200, and pulmonary edema.
◉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 . Answer: B. Adequate cough and gag reflexes
Before being extubated the child needs to have adequate LOC to protect
their airway, hemodynamic stability, PEEP <5 with an oxygen
requirement generally less than FiO2 of 40%
, ◉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 FiO2 and ventilator rate
B. Assess patency of the ETT
C. Administer a NMBA
D. Prepare to reposition the ETT . Answer: B. Assess patency off the
ETT
Your first priority is assessing the patency of the ETT. Once you have
confirmed the tube is/is not patent, that will help to direct your next
interventions. The alarm 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 epi
C. Place the child in a supine position
D. Administer antibiotics . Answer: A. Keep the child quiet and
comfortable
