CCRN Pediatric Practice Exam
Questions from AACN
A 1-month antique toddler provides with failure to thrive, common vomiting and irritability for
the reason that delivery. The mom reviews having another toddler with the equal signs who
died at 2 months of age. Which extra assessment locating could cause the nurse to suspect
an inborn mistakes of metabolism?
A) Micrognathia
B) Microglossia
C) Petite Facial Features
D) Musty Urine Odor - ANS-Answer: D) Musty urine odor: This is a common indicator of a
metabolic disease, specially with a own family records of siblings demise early
A) Micrognathia: This is not associated with an inborn errors of metabolism
B) Microglossia: This isn't always associated with an inborn mistakes of metabolism
C) Petite Facial Features: This isn't related to an inborn errors of metabolism
A 1-12 months-vintage who is ventilator established has been hospitalized due to the fact
that birth. The doctor has indicated that the patient can be discharged home with a
tracheostomy and a gastrostomy in one week. In order to decide the release wishes of the
patient, the nurse need to set up for:
A) Home nursing take care of the primary few days following discharge
B) A social employee to meet with the family and determine adequacy of the house
surroundings
C) An outreach educator to decide the gaining knowledge of wishes of the family
D) A multidisciplinary care convention earlier than discharge - ANS-Answer: B) A social
worker to satisfy with the family and examine adequacy of the home environment: The first
predischarge priority for a generation-dependent baby is to evaluate the adequacy of the
house environemtn. Further discharge planning is then primarily based at the needs of the
affected person and own family.
A) Home nursing care for the primary few days following discharge: While domestic nursing
care can be wished after discharge, the primary predischarge priority in this situation is to
assess the house surroundings. From there, a willpower can be made approximately nursing
care so one can be wished at domestic. The home might not be adequate for a safe
transition for the little one.
C) An outreach educator to decide the getting to know wishes of the circle of relatives:
Education may be necessary earlier than discharging a era-dependent baby, however that
cannot be decided without similarly information approximately the patient's domestic
environment and circle of relatives desires.
D) A multidisciplinary care convention earlier than discharge: This isn't always constant with
Systems Thinking. Waiting until discharge for a multidisciplinary conference will not permit
the family ok time to put together to fulfill the complicated needs of the kid at home.
A 10-day-vintage infant is admitted with a suspected congenital coronary heart disorder, due
to a records of negative feeding and sudden onsent of respiration distress and cyanosis.
Initial evaluation shows:
,HR: a hundred and eighty
pH: 7.28
RR: seventy two
pCO2: 30
BP: forty eight/ Doppler
pO2: forty eight
CRT: extra than five sec
HCO3: sixteen
The affected person is intubated and positioned on mechanical air flow. Settings are as
follows: rate of 20, PIP/PEEP: 24/4 cmH20, Fio2: a hundred%.
Subsequent ABG effects show:
pH: 7.27
pCO2: 28
pO2: 50
HCO3: 15
The most probable etiology off the affected person's cardiopulmonary status is which of the
subsequent?
A) Tetrology of Fallot
B) Hypoplasia
C) Coarctation of aorta
D) Transposition of the awesome arteries - ANS-Answer: B) Hypoplasia: Ten days after
beginning, the ductus arteriosus has closed, growing pulmonary blood float, and aortic go
with the flow and ysstemic perfusion decreasing. This reasons intense deterioration,
consisting of excessive cyanosis, hypoxemia, acidosis, and low cardiac output. The
hypoxemia does no longer enhance with oxygen management or mechanical ventilation.
A) Tetralogy of Fallot: an toddler with tetralogy of fallot could have hypercapnia for the
duration of a hypoxemic spell ("tet" spell). This affected person has decrease than regular
pCO2.
C) Coarctation of the Aorta: Patients with coarctation of the aorta present with poor feeding,
tachypnea, pallow, listlessness, acidosis, and weak or absent decrease extremity pulses,
however not sudden onset of breathing distress.
D) Transposition of the superb arteries: In patients with transposition of the splendid arteries,
cyanosis will no longer enhance with oxygen administration. But oxygen administration
enables lower pulmonary vascular resistance, leading to elevated pulmonary blood flow,
which improves mixing of systemic and venous blood and improves arterial oxygen
saturation.
A 15 yo affected person underwent a conventional Fontan restore of tricuspid atresia 12
hours in the past. The affected person is cool, diaphoretic, stressed, mottled peripherally,
without a pedal pulses and faint femoral pulses. Vital signs are:
HR: 140
MAP: 60 mmHg
CVP: 20 mmHg
Cardiac Index: 2.Three L/min/m2
SVR: 2000 dynes/sec/cm-5
The nurse should suspect:
, A) A pulmonary embolus
B) Cardiac Tamponade
C) Cardiogenic Shock
D) Hypovolemic Shock - ANS-Answer: C) Cardiogenic Shock: After the Fontan operation,
low cardiac output is the most not unusual and intense complication. It is often due to
inadequate blood circulate the pulmonary stream that results from hypovolemia and
inadequate systemic venous stress, expanded pulmonary vascular resistance, obstruction
on the surgical site, or pump failure.
A) A pulmonary embolus: A pulmonary embolus (PE) is most normally associated with a
deep vein thrombus. Other chance factors bacterial endocarditis, sepsis, and
hematologic/oncologic pathology. There isn't any point out of court cases of chest pain or
dyspnea, which can be primary signs of a PE.
B) Cardiac Tamponade: This is a unexpected accumulation of fluid within the pericardial sac.
Signs and signs are similar to shock, hypotension, tachycardia, high CVP, narrowing of pulse
strain and deteriorating systemic perfusion.
D) Hypovolemic Shock: Although some of the classic signs of hypovolemic shock are
present (cool, restless, reduced pulses, tachycardia) diaphoresis and increased CVP might
now not be seen with hypovolemic shock.
A 2-yr-old with left-sided ventricular coronary heart failure and pulmonary edema is
experiencing intense dyspnea. Which of the following could the nurse propose to enhance
the work of respiration and decrease the kid's anxiety and agitation?
A) Digoxin (Lanoxin)
B) Morphine (Duramorph)
C) Furosemide (Lasix)
D) Dobutamine (Dobutrex) - ANS-Answer: B) Morphine (Duramorph): Morphine relaxes the
smooth muscle groups within the bronchial tubes, making the work of breathing less
complicated, and it allows to govern associated anxiety and agitation.
A) Digoxin (Lanoxin): Digoin is a cardiac glycoside, which improves cardiac contractility and
may be indicated for this affected person. However, digoxin isn't particularly used to treat
dyspnea or anxiety/agitation.
C) Furosemide (Lasix): Furosemide, a diuretic that blocks reabsorption of sodium and water,
may be indicated for this affected person, but is not in particular used to deal with dyspnea
or tension/agitation.
D) Dobutamine (Dobutrex): Dobutamine has selective beta-adrenergic effects, which growth
cardiac contractility. Dobutamine can be indicated for this patient but is not mainly used to
deal with dyspnea or anxiety/agitation.
A five-year-old with a history of congenital hydrocephalus and VP shunt placement at 4
weeks of age is admitted with accelerated somnolence, reduced appetite, and multiplied
lawsuits of headache. This morning the kid vomited twice. The nurse must anticipate:
A) The health practitioner ordering lumbar puncture and blood and urine cultures
B) the affected person having a CT scan followed via possible shunt revision
C) Administering mannitol or hypertonic saline
D) Administering phenytoin (Dilantin) or fosphenytoin (Cerebyx) - ANS-Answer: B) The
patient having a CT scan followed through possible shunt revision: This affected person is
demonstrating symptoms of expanded intracranial strain. The most likely etiology is
malfunction of the VP shunt because of blockage or disconnection, which is especially
possibly through the years as the kid grows. The definitive prognosis is made by way of a CT
test and a shunt series. Surgical intervention for a shunt revision would be indicated.
Questions from AACN
A 1-month antique toddler provides with failure to thrive, common vomiting and irritability for
the reason that delivery. The mom reviews having another toddler with the equal signs who
died at 2 months of age. Which extra assessment locating could cause the nurse to suspect
an inborn mistakes of metabolism?
A) Micrognathia
B) Microglossia
C) Petite Facial Features
D) Musty Urine Odor - ANS-Answer: D) Musty urine odor: This is a common indicator of a
metabolic disease, specially with a own family records of siblings demise early
A) Micrognathia: This is not associated with an inborn errors of metabolism
B) Microglossia: This isn't always associated with an inborn mistakes of metabolism
C) Petite Facial Features: This isn't related to an inborn errors of metabolism
A 1-12 months-vintage who is ventilator established has been hospitalized due to the fact
that birth. The doctor has indicated that the patient can be discharged home with a
tracheostomy and a gastrostomy in one week. In order to decide the release wishes of the
patient, the nurse need to set up for:
A) Home nursing take care of the primary few days following discharge
B) A social employee to meet with the family and determine adequacy of the house
surroundings
C) An outreach educator to decide the gaining knowledge of wishes of the family
D) A multidisciplinary care convention earlier than discharge - ANS-Answer: B) A social
worker to satisfy with the family and examine adequacy of the home environment: The first
predischarge priority for a generation-dependent baby is to evaluate the adequacy of the
house environemtn. Further discharge planning is then primarily based at the needs of the
affected person and own family.
A) Home nursing care for the primary few days following discharge: While domestic nursing
care can be wished after discharge, the primary predischarge priority in this situation is to
assess the house surroundings. From there, a willpower can be made approximately nursing
care so one can be wished at domestic. The home might not be adequate for a safe
transition for the little one.
C) An outreach educator to decide the getting to know wishes of the circle of relatives:
Education may be necessary earlier than discharging a era-dependent baby, however that
cannot be decided without similarly information approximately the patient's domestic
environment and circle of relatives desires.
D) A multidisciplinary care convention earlier than discharge: This isn't always constant with
Systems Thinking. Waiting until discharge for a multidisciplinary conference will not permit
the family ok time to put together to fulfill the complicated needs of the kid at home.
A 10-day-vintage infant is admitted with a suspected congenital coronary heart disorder, due
to a records of negative feeding and sudden onsent of respiration distress and cyanosis.
Initial evaluation shows:
,HR: a hundred and eighty
pH: 7.28
RR: seventy two
pCO2: 30
BP: forty eight/ Doppler
pO2: forty eight
CRT: extra than five sec
HCO3: sixteen
The affected person is intubated and positioned on mechanical air flow. Settings are as
follows: rate of 20, PIP/PEEP: 24/4 cmH20, Fio2: a hundred%.
Subsequent ABG effects show:
pH: 7.27
pCO2: 28
pO2: 50
HCO3: 15
The most probable etiology off the affected person's cardiopulmonary status is which of the
subsequent?
A) Tetrology of Fallot
B) Hypoplasia
C) Coarctation of aorta
D) Transposition of the awesome arteries - ANS-Answer: B) Hypoplasia: Ten days after
beginning, the ductus arteriosus has closed, growing pulmonary blood float, and aortic go
with the flow and ysstemic perfusion decreasing. This reasons intense deterioration,
consisting of excessive cyanosis, hypoxemia, acidosis, and low cardiac output. The
hypoxemia does no longer enhance with oxygen management or mechanical ventilation.
A) Tetralogy of Fallot: an toddler with tetralogy of fallot could have hypercapnia for the
duration of a hypoxemic spell ("tet" spell). This affected person has decrease than regular
pCO2.
C) Coarctation of the Aorta: Patients with coarctation of the aorta present with poor feeding,
tachypnea, pallow, listlessness, acidosis, and weak or absent decrease extremity pulses,
however not sudden onset of breathing distress.
D) Transposition of the superb arteries: In patients with transposition of the splendid arteries,
cyanosis will no longer enhance with oxygen administration. But oxygen administration
enables lower pulmonary vascular resistance, leading to elevated pulmonary blood flow,
which improves mixing of systemic and venous blood and improves arterial oxygen
saturation.
A 15 yo affected person underwent a conventional Fontan restore of tricuspid atresia 12
hours in the past. The affected person is cool, diaphoretic, stressed, mottled peripherally,
without a pedal pulses and faint femoral pulses. Vital signs are:
HR: 140
MAP: 60 mmHg
CVP: 20 mmHg
Cardiac Index: 2.Three L/min/m2
SVR: 2000 dynes/sec/cm-5
The nurse should suspect:
, A) A pulmonary embolus
B) Cardiac Tamponade
C) Cardiogenic Shock
D) Hypovolemic Shock - ANS-Answer: C) Cardiogenic Shock: After the Fontan operation,
low cardiac output is the most not unusual and intense complication. It is often due to
inadequate blood circulate the pulmonary stream that results from hypovolemia and
inadequate systemic venous stress, expanded pulmonary vascular resistance, obstruction
on the surgical site, or pump failure.
A) A pulmonary embolus: A pulmonary embolus (PE) is most normally associated with a
deep vein thrombus. Other chance factors bacterial endocarditis, sepsis, and
hematologic/oncologic pathology. There isn't any point out of court cases of chest pain or
dyspnea, which can be primary signs of a PE.
B) Cardiac Tamponade: This is a unexpected accumulation of fluid within the pericardial sac.
Signs and signs are similar to shock, hypotension, tachycardia, high CVP, narrowing of pulse
strain and deteriorating systemic perfusion.
D) Hypovolemic Shock: Although some of the classic signs of hypovolemic shock are
present (cool, restless, reduced pulses, tachycardia) diaphoresis and increased CVP might
now not be seen with hypovolemic shock.
A 2-yr-old with left-sided ventricular coronary heart failure and pulmonary edema is
experiencing intense dyspnea. Which of the following could the nurse propose to enhance
the work of respiration and decrease the kid's anxiety and agitation?
A) Digoxin (Lanoxin)
B) Morphine (Duramorph)
C) Furosemide (Lasix)
D) Dobutamine (Dobutrex) - ANS-Answer: B) Morphine (Duramorph): Morphine relaxes the
smooth muscle groups within the bronchial tubes, making the work of breathing less
complicated, and it allows to govern associated anxiety and agitation.
A) Digoxin (Lanoxin): Digoin is a cardiac glycoside, which improves cardiac contractility and
may be indicated for this affected person. However, digoxin isn't particularly used to treat
dyspnea or anxiety/agitation.
C) Furosemide (Lasix): Furosemide, a diuretic that blocks reabsorption of sodium and water,
may be indicated for this affected person, but is not in particular used to deal with dyspnea
or tension/agitation.
D) Dobutamine (Dobutrex): Dobutamine has selective beta-adrenergic effects, which growth
cardiac contractility. Dobutamine can be indicated for this patient but is not mainly used to
deal with dyspnea or anxiety/agitation.
A five-year-old with a history of congenital hydrocephalus and VP shunt placement at 4
weeks of age is admitted with accelerated somnolence, reduced appetite, and multiplied
lawsuits of headache. This morning the kid vomited twice. The nurse must anticipate:
A) The health practitioner ordering lumbar puncture and blood and urine cultures
B) the affected person having a CT scan followed via possible shunt revision
C) Administering mannitol or hypertonic saline
D) Administering phenytoin (Dilantin) or fosphenytoin (Cerebyx) - ANS-Answer: B) The
patient having a CT scan followed through possible shunt revision: This affected person is
demonstrating symptoms of expanded intracranial strain. The most likely etiology is
malfunction of the VP shunt because of blockage or disconnection, which is especially
possibly through the years as the kid grows. The definitive prognosis is made by way of a CT
test and a shunt series. Surgical intervention for a shunt revision would be indicated.
