PEDIATRIC CCRN CERTIFICATION EXAM – EXAM-STYLE QUESTIONS AND
ANSWERS | VERIFIED AND WELL DETAILED ANSWERS | PLUS RATIONALES |
GUARANTEED PASS | 2026/27 LATEST UPDATE | EXAM PREP | STUDY GUIDE |
PRACTICE TEST
1. A 4-year-old child is brought to the pediatric intensive care unit (PICU)
following a near-drowning event. The child is intubated and mechanically
ventilated. An arterial blood gas (ABG) reveals a pH of 7.18, PaCO2 of 58
mmHg, and HCO3- of 22 mEq/L. Which of the following is the priority nursing
intervention?
A. Administer sodium bicarbonate intravenously.
B. Increase the respiratory rate on the ventilator.
C. Prepare for emergent needle decompression.
D. Assess for pupillary response and intracranial pressure.
Correct Answer: B. Increase the respiratory rate on the ventilator.
Rationale: The ABG indicates respiratory acidosis (elevated PaCO2 and low pH with
a normal HCO3-). The primary treatment is to improve alveolar ventilation.
Increasing the respiratory rate on the ventilator will help to reduce the PaCO2 and
correct the acidosis. Sodium bicarbonate (A) is not the first-line treatment for
respiratory acidosis and is typically reserved for severe metabolic acidosis. Needle
decompression (C) is indicated for a tension pneumothorax, not respiratory acidosis.
Assessing pupillary response and ICP (D) is important in this patient, but addressing
the life-threatening acid-base imbalance is the priority.
2. A 2-year-old with a history of complex congenital heart disease is post-
operative day one from a Fontan procedure. The child's central venous pressure
,(CVP) is 18 mmHg, and chest tube output has increased from 5 mL/kg/hr to 10
mL/kg/hr over the last hour. The child is tachypneic and hypotensive. Which of
the following should the nurse anticipate first?
A. Infuse a normal saline bolus.
B. Administer furosemide intravenously.
C. Notify the surgeon for possible re-exploration.
D. Increase the rate of the inotropic infusion.
Correct Answer: C. Notify the surgeon for possible re-exploration.
Rationale: This scenario is highly suspicious for cardiac tamponade or mediastinal
bleeding following a Fontan procedure. The combination of elevated CVP, increased
chest tube output, tachypnea, and hypotension suggests a surgical cause that may
require re-exploration to control bleeding or relieve tamponade. Administering a
fluid bolus (A) might temporarily support blood pressure but could worsen
tamponade by further distending the right heart. Furosemide (B) would not address
the acute hemodynamic instability or bleeding. Increasing inotropes (D) may be a
temporizing measure, but it does not address the likely mechanical or surgical
issue.
3. In assessing a 6-month-old infant with bronchiolitis, which of the following
clinical findings would be the most sensitive indicator of impending respiratory
failure?
A. Nasal flaring and grunting.
B. Oxygen saturation of 88% on room air.
C. A respiratory rate of 45 breaths per minute.
D. Capnography showing an ETCO2 of 55 mmHg with a "shark fin" waveform.
,Correct Answer: D. Capnography showing an ETCO2 of 55 mmHg with a "shark
fin" waveform.
Rationale: Capnography provides a real-time assessment of ventilation and
perfusion. An ETCO2 of 55 mmHg is elevated, indicating CO2 retention and
hypoventilation. The "shark fin" waveform indicates air trapping or obstruction,
which is a hallmark of lower airway disease. While nasal flaring/grunting (A),
oxygen saturation (B), and respiratory rate (C) are important signs of respiratory
distress, they are often late or less specific indicators of impending failure compared
to capnography, which can detect hypoventilation before clinical deterioration
becomes profound.
4. A 10-year-old child with status asthmaticus is receiving continuous albuterol
nebulization. The nurse notes a heart rate of 165 bpm and a blood pressure of
95/55 mmHg. Which of the following is the most appropriate nursing action?
A. Discontinue the albuterol immediately.
B. Administer a fluid bolus of 10 mL/kg of normal saline.
C. Obtain a 12-lead electrocardiogram (ECG).
D. Continue albuterol and evaluate for hypovolemia.
Correct Answer: D. Continue albuterol and evaluate for hypovolemia.
Rationale: Tachycardia and a narrowed pulse pressure are common side effects of
beta-agonist therapy (albuterol) due to vasodilation and increased cardiac
contractility. In a child with status asthmaticus, maintaining bronchodilation is
paramount. The hypotension is likely relative, from vasodilation, and may be
compounded by dehydration from tachypnea. Discontinuing albuterol (A) would
worsen the bronchospasm. A fluid bolus (B) may be appropriate if there is evidence
of true hypovolemia, but the first step is to evaluate and not discontinue the life-
, saving bronchodilator. An ECG (C) is not the priority; the tachycardia is an expected
side effect.
5. A 3-year-old child is post-operative following a craniopharyngioma
resection. The nurse is monitoring for diabetes insipidus (DI). Which of the
following assessment findings is most consistent with this complication?
A. Serum sodium of 135 mEq/L and urine output of 2 mL/kg/hr.
B. Serum sodium of 150 mEq/L and urine specific gravity of 1.005.
C. Serum sodium of 128 mEq/L and weight gain of 200 grams.
D. Serum sodium of 138 mEq/L and urine output of 1 mL/kg/hr.
Correct Answer: B. Serum sodium of 150 mEq/L and urine specific gravity of
1.005.
Rationale: Diabetes insipidus is a complication of pituitary surgery characterized by
a deficiency of antidiuretic hormone (ADH). This leads to large volumes of dilute
urine and subsequent hypernatremia. A serum sodium of 150 mEq/L is elevated,
and a urine specific gravity of 1.005 is very dilute, which is the hallmark of DI.
Option A has a normal sodium and urine output. Option C (low sodium and weight
gain) is consistent with SIADH (Syndrome of Inappropriate Antidiuretic Hormone).
Option D is within normal limits.
6. Which of the following developmental milestones is most appropriate for
the nurse to expect in a normally developing 9-month-old infant?
A. Walks independently and says two to three words.
B. Sits without support and transfers objects from one hand to the other.
C. Holds head up and follows objects past the midline.
D. Walks up stairs with assistance and uses a cup.
ANSWERS | VERIFIED AND WELL DETAILED ANSWERS | PLUS RATIONALES |
GUARANTEED PASS | 2026/27 LATEST UPDATE | EXAM PREP | STUDY GUIDE |
PRACTICE TEST
1. A 4-year-old child is brought to the pediatric intensive care unit (PICU)
following a near-drowning event. The child is intubated and mechanically
ventilated. An arterial blood gas (ABG) reveals a pH of 7.18, PaCO2 of 58
mmHg, and HCO3- of 22 mEq/L. Which of the following is the priority nursing
intervention?
A. Administer sodium bicarbonate intravenously.
B. Increase the respiratory rate on the ventilator.
C. Prepare for emergent needle decompression.
D. Assess for pupillary response and intracranial pressure.
Correct Answer: B. Increase the respiratory rate on the ventilator.
Rationale: The ABG indicates respiratory acidosis (elevated PaCO2 and low pH with
a normal HCO3-). The primary treatment is to improve alveolar ventilation.
Increasing the respiratory rate on the ventilator will help to reduce the PaCO2 and
correct the acidosis. Sodium bicarbonate (A) is not the first-line treatment for
respiratory acidosis and is typically reserved for severe metabolic acidosis. Needle
decompression (C) is indicated for a tension pneumothorax, not respiratory acidosis.
Assessing pupillary response and ICP (D) is important in this patient, but addressing
the life-threatening acid-base imbalance is the priority.
2. A 2-year-old with a history of complex congenital heart disease is post-
operative day one from a Fontan procedure. The child's central venous pressure
,(CVP) is 18 mmHg, and chest tube output has increased from 5 mL/kg/hr to 10
mL/kg/hr over the last hour. The child is tachypneic and hypotensive. Which of
the following should the nurse anticipate first?
A. Infuse a normal saline bolus.
B. Administer furosemide intravenously.
C. Notify the surgeon for possible re-exploration.
D. Increase the rate of the inotropic infusion.
Correct Answer: C. Notify the surgeon for possible re-exploration.
Rationale: This scenario is highly suspicious for cardiac tamponade or mediastinal
bleeding following a Fontan procedure. The combination of elevated CVP, increased
chest tube output, tachypnea, and hypotension suggests a surgical cause that may
require re-exploration to control bleeding or relieve tamponade. Administering a
fluid bolus (A) might temporarily support blood pressure but could worsen
tamponade by further distending the right heart. Furosemide (B) would not address
the acute hemodynamic instability or bleeding. Increasing inotropes (D) may be a
temporizing measure, but it does not address the likely mechanical or surgical
issue.
3. In assessing a 6-month-old infant with bronchiolitis, which of the following
clinical findings would be the most sensitive indicator of impending respiratory
failure?
A. Nasal flaring and grunting.
B. Oxygen saturation of 88% on room air.
C. A respiratory rate of 45 breaths per minute.
D. Capnography showing an ETCO2 of 55 mmHg with a "shark fin" waveform.
,Correct Answer: D. Capnography showing an ETCO2 of 55 mmHg with a "shark
fin" waveform.
Rationale: Capnography provides a real-time assessment of ventilation and
perfusion. An ETCO2 of 55 mmHg is elevated, indicating CO2 retention and
hypoventilation. The "shark fin" waveform indicates air trapping or obstruction,
which is a hallmark of lower airway disease. While nasal flaring/grunting (A),
oxygen saturation (B), and respiratory rate (C) are important signs of respiratory
distress, they are often late or less specific indicators of impending failure compared
to capnography, which can detect hypoventilation before clinical deterioration
becomes profound.
4. A 10-year-old child with status asthmaticus is receiving continuous albuterol
nebulization. The nurse notes a heart rate of 165 bpm and a blood pressure of
95/55 mmHg. Which of the following is the most appropriate nursing action?
A. Discontinue the albuterol immediately.
B. Administer a fluid bolus of 10 mL/kg of normal saline.
C. Obtain a 12-lead electrocardiogram (ECG).
D. Continue albuterol and evaluate for hypovolemia.
Correct Answer: D. Continue albuterol and evaluate for hypovolemia.
Rationale: Tachycardia and a narrowed pulse pressure are common side effects of
beta-agonist therapy (albuterol) due to vasodilation and increased cardiac
contractility. In a child with status asthmaticus, maintaining bronchodilation is
paramount. The hypotension is likely relative, from vasodilation, and may be
compounded by dehydration from tachypnea. Discontinuing albuterol (A) would
worsen the bronchospasm. A fluid bolus (B) may be appropriate if there is evidence
of true hypovolemia, but the first step is to evaluate and not discontinue the life-
, saving bronchodilator. An ECG (C) is not the priority; the tachycardia is an expected
side effect.
5. A 3-year-old child is post-operative following a craniopharyngioma
resection. The nurse is monitoring for diabetes insipidus (DI). Which of the
following assessment findings is most consistent with this complication?
A. Serum sodium of 135 mEq/L and urine output of 2 mL/kg/hr.
B. Serum sodium of 150 mEq/L and urine specific gravity of 1.005.
C. Serum sodium of 128 mEq/L and weight gain of 200 grams.
D. Serum sodium of 138 mEq/L and urine output of 1 mL/kg/hr.
Correct Answer: B. Serum sodium of 150 mEq/L and urine specific gravity of
1.005.
Rationale: Diabetes insipidus is a complication of pituitary surgery characterized by
a deficiency of antidiuretic hormone (ADH). This leads to large volumes of dilute
urine and subsequent hypernatremia. A serum sodium of 150 mEq/L is elevated,
and a urine specific gravity of 1.005 is very dilute, which is the hallmark of DI.
Option A has a normal sodium and urine output. Option C (low sodium and weight
gain) is consistent with SIADH (Syndrome of Inappropriate Antidiuretic Hormone).
Option D is within normal limits.
6. Which of the following developmental milestones is most appropriate for
the nurse to expect in a normally developing 9-month-old infant?
A. Walks independently and says two to three words.
B. Sits without support and transfers objects from one hand to the other.
C. Holds head up and follows objects past the midline.
D. Walks up stairs with assistance and uses a cup.
