CCRN PEDS AACN
1. A 1-month-old infant presents with poor feeding, vomiting and diarrhea since birth. The
infant is lethargic and in mild respiratory distress. The mother reports having another infant
with the same symptoms who died at 2 months of age. Which finding would cause the nurse
to suspect an inborn error of metabolism?
A. micrognathia
B. microglossia
C. petite facial features
D. abnormal urine odor - ANS-abnormal urine odor
1. In caring for a patient with salicylate intoxication, the critical care nurse would anticipate
which of the following as a primary treatment measure?
A. Administration of protamine sulfate
B. Administration of glucose
C. Transfusion of packed RBCs
D. Replacement of fluid and electrolytes - ANS-D. Replacement of fluid and electrolytes
100. A 12-year-old is admitted after being struck by a speeding car. During the initial
evaluation, the nurse notes increasing respiratory distress and displacement of a segment of
the chest wall inward during inspiration. The nurse should suspect
A. Open pneumothorax
B. Flail chest
C. Traumatic asphyxia
D. Cardiac tamponade - ANS-Flail chest
101. A 17-year-old patient is received from the operating room following insertion of a
ventriculoperitoneal shunt. The patient is receiving propofol (Diprivan) intravenously for
assistance with ventilation and reduction of oxygen consumption. The nurse recognizes that
the following lab values need to be reported immediately:
pH PCO2 HCO3 PO2
A. 7.2 50 30 75
B. 7.2 35 19 95
C. 7.6 45 30 95
D. 7.6 30 19 95 - ANS-7.2 35 19 95
102. A 10-year-old is admitted after an accidental shooting to the femur and pelvis.
Significant blood loss has occurred. Following adequate fluid resuscitation, perfusion
remains poor, and oxygen requirements and work of breathing are increasing. The nurse
should suspect
A. Acute systemic inflammatory response syndrome (SIRS).
B. Severe anemia related to blood loss
,C. Compartment syndrome
D. Fat embolism syndrome - ANS-Acute systemic inflammatory response syndrome (SIRS).
103. While performing an exchange transfusion for a sickle cell patient, which of the
following electrolyte abnormalities should the nurse anticipate?
A. Hypocalcemia
B. Hypercalcemia
C. Hypoglycemia
D. Hyperglycemia - ANS-Hypocalcemia
104. The nurse is caring for a 14-year-old patient who is day one status post resection of a
brain tumor. The nurse would report the following assessment finding immediately:
A. CPP 40
B. SBP 120-130
C. ETCO2 35
D. MAP 65 - ANS-CPP 40
105. An infant is admitted after unsuccessful reduction of an intussception. Further
assessment reveals abdominal distention, fever and hypoactive bowel sounds. The nurse
should immediately notify the surgeon if the patient has
A. Abdominal erythema
B. Hypertension
C. Tachycardia
D. White stools - ANS-Tachycardia
106. A 6-year-old is admitted with a temporal lobe skull fracture. Which type of bleed is
suspected?
A. Chronic subdural hematoma
B. Subarachnoid hematoma
C. Acute subdural hematoma
D. Acute epidural hematoma - ANS-Acute epidural hematoma
107. A child is admitted with a tricyclic antidepressant overdose. The most common
arrhythmias seen are
A. Atrial
B. Sinus
C. Heart blocks
D. Ventricular - ANS-Ventricular
108. A 4-year-old with sickle cell disease is admitted with confusion, aphasia and complaints
of "head hurting." An order for IVF and one unit of PRBCs is to be administered prior to MRI
with contrast. The nurse explains to the mother that this is done because can
A. Cause cerebral hemorrhage
B. Increase sickling of hemoglobin
C. Cause severe allergic reaction
D. Decrease circulation to the brain - ANS-Increase sickling of hemoglobin
109. Which one of the following is the first action to take in the case of a patient with a
suspected tension pneumothorax?
, A. Administer a NaCl fluid bolus
B. Assist with intubation
C. Call for a chest radiograph
D. Prepare for a needle thoracostomy - ANS-Prepare for a needle thoracostomy
11. A 2-month-old with a history of unrepaired Tetralogy of Fallot begins to cry
while intravenous access is attempted. Cyanosis, diaphoresis and
tachypnea are noted. Nursing interventions are aimed at
A. Increasing pulmonary flow and relaxing the infundibulum.
B. Decreasing systemic flow and increasing pulmonary vascular
resistance.
C. Decreasing pulmonary flow and increasing systemic vascular resistance
(SVR).
D. Increasing systemic flow and relaxing the left ventricular outflow tract. - ANS-Increasing
pulmonary flow and relaxing the infundibulum.
110. A 3-year-old is admitted after being found in the family swimming pool. The family does
not know how long he was in the pool before they found him. He is intubated on mechanical
ventilation with no spontaneous respirations and does not respond to painful stimuli. The
most likely reason for this is
A. Temporary depletion of ATP
B. Reversible failure of the sodium potassium
C. Concurrent head injury when he fell into the pool
D. Sever cerebral injury with neuronal death due to hypoxemia - ANS-Sever cerebral injury
with neuronal death due to hypoxemia
111. A 1-month-old is admitted with failure to thrive. The mother states that the baby has
been taking Similac with iron, 4 ounces about every four hours. Bright red blood is noted in
the stool. The nurse should suspect
A. Parental neglect
B. Vitamin K deficiency
C. Milk protein allergy
D. Gastritis - ANS-Milk protein allergy
112. A child has the following physical findings: decrease in tissue perfusion, lethargy,
acidosis and oliguria. The patient's hemodynamic status remains unstable after three fluid
boluses. The next intervention should be
A. Use of inotropic agents to increase myocardial contractility
B. Administration of diuretics for vascular congestion
C. Use of vasodilators to decrease afterload
D. Administration of NaHCO3 - ANS-Use of inotropic agents to increase myocardial
contractility
113. A 9.6 kg toddler is admitted after vomiting 250 mL of frank blood in the emergency
department. The history is significant for end-stage liver failure. The assessment would be
expected to reveal
A. Tachycardia with bounding pulse
1. A 1-month-old infant presents with poor feeding, vomiting and diarrhea since birth. The
infant is lethargic and in mild respiratory distress. The mother reports having another infant
with the same symptoms who died at 2 months of age. Which finding would cause the nurse
to suspect an inborn error of metabolism?
A. micrognathia
B. microglossia
C. petite facial features
D. abnormal urine odor - ANS-abnormal urine odor
1. In caring for a patient with salicylate intoxication, the critical care nurse would anticipate
which of the following as a primary treatment measure?
A. Administration of protamine sulfate
B. Administration of glucose
C. Transfusion of packed RBCs
D. Replacement of fluid and electrolytes - ANS-D. Replacement of fluid and electrolytes
100. A 12-year-old is admitted after being struck by a speeding car. During the initial
evaluation, the nurse notes increasing respiratory distress and displacement of a segment of
the chest wall inward during inspiration. The nurse should suspect
A. Open pneumothorax
B. Flail chest
C. Traumatic asphyxia
D. Cardiac tamponade - ANS-Flail chest
101. A 17-year-old patient is received from the operating room following insertion of a
ventriculoperitoneal shunt. The patient is receiving propofol (Diprivan) intravenously for
assistance with ventilation and reduction of oxygen consumption. The nurse recognizes that
the following lab values need to be reported immediately:
pH PCO2 HCO3 PO2
A. 7.2 50 30 75
B. 7.2 35 19 95
C. 7.6 45 30 95
D. 7.6 30 19 95 - ANS-7.2 35 19 95
102. A 10-year-old is admitted after an accidental shooting to the femur and pelvis.
Significant blood loss has occurred. Following adequate fluid resuscitation, perfusion
remains poor, and oxygen requirements and work of breathing are increasing. The nurse
should suspect
A. Acute systemic inflammatory response syndrome (SIRS).
B. Severe anemia related to blood loss
,C. Compartment syndrome
D. Fat embolism syndrome - ANS-Acute systemic inflammatory response syndrome (SIRS).
103. While performing an exchange transfusion for a sickle cell patient, which of the
following electrolyte abnormalities should the nurse anticipate?
A. Hypocalcemia
B. Hypercalcemia
C. Hypoglycemia
D. Hyperglycemia - ANS-Hypocalcemia
104. The nurse is caring for a 14-year-old patient who is day one status post resection of a
brain tumor. The nurse would report the following assessment finding immediately:
A. CPP 40
B. SBP 120-130
C. ETCO2 35
D. MAP 65 - ANS-CPP 40
105. An infant is admitted after unsuccessful reduction of an intussception. Further
assessment reveals abdominal distention, fever and hypoactive bowel sounds. The nurse
should immediately notify the surgeon if the patient has
A. Abdominal erythema
B. Hypertension
C. Tachycardia
D. White stools - ANS-Tachycardia
106. A 6-year-old is admitted with a temporal lobe skull fracture. Which type of bleed is
suspected?
A. Chronic subdural hematoma
B. Subarachnoid hematoma
C. Acute subdural hematoma
D. Acute epidural hematoma - ANS-Acute epidural hematoma
107. A child is admitted with a tricyclic antidepressant overdose. The most common
arrhythmias seen are
A. Atrial
B. Sinus
C. Heart blocks
D. Ventricular - ANS-Ventricular
108. A 4-year-old with sickle cell disease is admitted with confusion, aphasia and complaints
of "head hurting." An order for IVF and one unit of PRBCs is to be administered prior to MRI
with contrast. The nurse explains to the mother that this is done because can
A. Cause cerebral hemorrhage
B. Increase sickling of hemoglobin
C. Cause severe allergic reaction
D. Decrease circulation to the brain - ANS-Increase sickling of hemoglobin
109. Which one of the following is the first action to take in the case of a patient with a
suspected tension pneumothorax?
, A. Administer a NaCl fluid bolus
B. Assist with intubation
C. Call for a chest radiograph
D. Prepare for a needle thoracostomy - ANS-Prepare for a needle thoracostomy
11. A 2-month-old with a history of unrepaired Tetralogy of Fallot begins to cry
while intravenous access is attempted. Cyanosis, diaphoresis and
tachypnea are noted. Nursing interventions are aimed at
A. Increasing pulmonary flow and relaxing the infundibulum.
B. Decreasing systemic flow and increasing pulmonary vascular
resistance.
C. Decreasing pulmonary flow and increasing systemic vascular resistance
(SVR).
D. Increasing systemic flow and relaxing the left ventricular outflow tract. - ANS-Increasing
pulmonary flow and relaxing the infundibulum.
110. A 3-year-old is admitted after being found in the family swimming pool. The family does
not know how long he was in the pool before they found him. He is intubated on mechanical
ventilation with no spontaneous respirations and does not respond to painful stimuli. The
most likely reason for this is
A. Temporary depletion of ATP
B. Reversible failure of the sodium potassium
C. Concurrent head injury when he fell into the pool
D. Sever cerebral injury with neuronal death due to hypoxemia - ANS-Sever cerebral injury
with neuronal death due to hypoxemia
111. A 1-month-old is admitted with failure to thrive. The mother states that the baby has
been taking Similac with iron, 4 ounces about every four hours. Bright red blood is noted in
the stool. The nurse should suspect
A. Parental neglect
B. Vitamin K deficiency
C. Milk protein allergy
D. Gastritis - ANS-Milk protein allergy
112. A child has the following physical findings: decrease in tissue perfusion, lethargy,
acidosis and oliguria. The patient's hemodynamic status remains unstable after three fluid
boluses. The next intervention should be
A. Use of inotropic agents to increase myocardial contractility
B. Administration of diuretics for vascular congestion
C. Use of vasodilators to decrease afterload
D. Administration of NaHCO3 - ANS-Use of inotropic agents to increase myocardial
contractility
113. A 9.6 kg toddler is admitted after vomiting 250 mL of frank blood in the emergency
department. The history is significant for end-stage liver failure. The assessment would be
expected to reveal
A. Tachycardia with bounding pulse
