CCRN PEDS AACN 2024 POSSIBLE QUESTIONS AND ANSWERS (100% Verified), Exams of Pediatrics

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CCRN PEDS AACN 2024 POSSIBLE QUESTIONS AND

ANSWERS (100% Verified)

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 D. Replacement of fluid and electrolytes
2. An adolescent with the developmental age of a 4-year-old requires placement of a chest tube. The best way to prepare the patient for this procedure is to A. Use short simple sentences and limit descriptions to concrete explanations. B. Show the patient a chest tube and explain how it will feel. C. Explain in detail why a chest tube is needed and how it works. D. Tell the parents what will be done so they can explain it to their child. Use short simple sentences and limit descriptions to concrete explanations.
3. A child admitted with a gunshot wound to the head, accidentally inflicted by an older sibling. The parents are overcome with grief and appear to be ignoring the following statements made by the older sibling: "It was an accident; I didn't mean to do it; I'm sorry!" Which of the following actions by the nurse would be most appropriate? A. Discuss the importance of gun safety with the older sibling while the parents are at the bedside. B. Seek additional support for the parents for ways they can assist the older sibling C. Tell the parents that they need to provide support for the older sibling D. Tell the older sibling, "Accidents happen; I know you didn't mean to do it." Seek additional support for the parents for ways they can assist the older sibling
4. Which of the following laboratory findings is indicative of the syndrome of inappropriate ADH secretion (SIADH)? A. Serum sodium = 148 mEq/L B. Decreased serum osmolality C. Blood urea nitrogen (BUN) = 28 mg/dl D. Serum potassium = 5. mEq/L Decreased serum osmolality
5. A 3-year-old is admitted to the ICU with a 10-hour history of an acute- onset asthma attack. Initial assessment reveals the following HR 160 pH 7.

• RR
• pCO2

BP

112/

pO2 40 T 32*C HCO 22 A. Administration of NaHCO B. Fluid resuscitation C. Racemic epinephrine D. Intubati on Intubation

6. A 2-year-old is experiencing manifestations of digoxin (Lanoxin) toxicity. BP is 94/60, capillary refill time is 2 seconds and the electrocardiogram reveals AV block with a heart rate of 60. The critical care nurse would anticipate which of the following interventions? A. Performance of cardioversion B. Administration of Atropine C. Performance of vasovagal maneuvers D. Monitoring of HR and rhythm and perfusion status Monitoring of HR and rhythm and perfusion status
7. An adolescent with asthma is readmitted just a week after discharge from the hospital. On questioning, the nurse learns that the patient refuses to use the inhalers at school. The nurse should A. Talk to the teen about long-term consequences of the disease if the treatment plan is not followed B. Talk to the school nurse to find out why they are not monitoring the medications at school C. Help the parents set up a disciplinary contract with the teen D. Arrange for the teen to attend an asthma support group Arrange for the teen to attend an asthma support group
8. An unconscious 5-month-old is admitted. The parent reports the baby fell off the table during a diaper change by an older sibling. What findings would indicate further inquiry of the history? A. A reddened or bruised are on the skull B. Poorly reactive pupils C. Retinal hemorrhage D. A linear skull fracture Retinal hemorrhage
9. 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

abnormal urine odor

2. Cardiac defects associated with increased pulmonary blood flow place the patient at greatest risk for A. heart failure. B. systemic air emboli. C. hypoxemia. D. syncop e. heart failure
3. Which ventilator parameters would be weaned first in a patient with bronchopulmonary dysplasia (BPD)? A. VT and FiO B. peak inspiratory pressure and IMV C. FiO2 and IMV D. FiO2 and peak inspiratory pressure FiO2 and peak inspiratory pressure
4. Amrinone lactate (Inocor) produces which of the following effects? A. vasodilation B. phospholipid inhibition C. decreased myocardial contractility D. antagonism to other catecholamines vasodilation
5. Which of the following procedures would be most valuable in aiding management of a child requiring PEEP of 14 cm of water? A. ECMO therapy B. placement of a thoracostomy tube C. placement of a pulmonary artery catheter D. high-frequency ventilation high- frequency ventilation
6. A 15-year-old patient underwent a classic Fontan repair of tricuspid atresia 12 hours ago. The patient is cool, diaphoretic, restless, mottled peripherally, with no pedal pulses and faint femoral pulses. Vital signs are: HR 140 MAP 60 mm Hg CVP 20 mm Hg Cardiac Index 2. 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.

cardiogenic shock.

7. The nurse is providing patient education for a family whose child has cerebral palsy and will be receiving a Baclofen (Lioresal) pump to control spasticity. Which of the following is most important for the nurse to include in the discussion? A. The drug acts to inhibit the neurotransmitter gamma-amniobutyric acid (GABA). B. Parents can be taught to regulate the dosage based on symptoms. C. The child will have a normal gait after insertion of the pump. D. Parents must bring the child back to the clinic to have the medicine added to the pump. Parents must bring the child back to the clinic to have the medicine added to the pump.
8. A nurse is interested in including other disciplines in the educational process of developmental care in the NICU. The best way to convince administration that this venture is financially worthwhile is to A. present a report summarizing research relating developmental care to decreased length of stay. B. request that the neonatologist present the plan. C. present case studies demonstrating favorable outcomes to developmental care. D. invite members of administration to attend the classes. present a report summarizing research relating developmental care to decreased length of stay.
9. PEEP is intended to do which of the following? A. increase functional residual capacity B. decrease functional residual capacity C. increase venous return to the heart D. increase cardiac output increase functional residual capacity An 8-month-old with bronchopulmonary dysplasia (BPD) is admitted with heart failure. Nursing interventions should be done to A. decrease preload. B. increase afterload. C. decrease heart rate. D. increase contractility. decrease preload
10. 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. Increasing pulmonary flow and relaxing the infundibulum. During surgery on a 2-month-old with Tetralogy of Fallot, a trans-thoracic PA catheter was placed. Upon removal of this line, the PA pressure is 29 mm Hg systolic. As the line is 'pulled back' into the right ventricle, the pressure measures 72 mm Hg systolic. RA Sat=72, PA Sat=72. This change in measurement may indicate a/an A. right bundle branch block. B. residual VSD. C. incompetent pulmonic valve. D. residual right ventricular outflow obstruction residual right ventricular outflow obstruction A 4-year-old has been admitted twice in the past six months for status asthmaticus. The parents smell of smoke when they come to the hospital, but state they don't smoke in the house. The most appropriate discharge planning intervention would be to A. discuss with the parents how to avoid asthma triggers at home. B. give the parents literature about smoking cessation treatment and support groups. C. call Child Protective Services to report a medically unsafe home environment. D. remind parents they shouldn't smoke around the child. give the parents literature about smoking cessation treatment and support groups. A 4-year-old presents with a chief complaint of blood in her urine. A review of the medical records shows multiple admissions for the same symptom. No etiology has been found. The patient is symptomatic only when the mother is present. The most appropriate diagnosis for this patient would be A. Munchausen syndrome by proxy. B. non-accidental trauma. C. physical abuse D. sexual abuse. Munchausen syndrome by proxy A 13-year-old male with diabetes is admitted after collapsing in class. On admission, he is tachycardic, has shallow respirations, dilated pupils, and is hyperreflexic. The plan of care would be to administer A. glucagon IM. B. naloxone (Narcan IV).

C. 50% dextrose IV. D. regular insulin SQ.

50% dextrose IV. The initial therapy for children at risk for pulmonary embolus related to venous thromboembolism from a central venous line (CVL) is A. placement of an inferior vena cava filter. B. administration of anticoagulants. C. immediate removal of the CVL. D. thrombectomy by a surgeon. administration of anticoagulants In an infant with bronchopulmonary dysplasia (BPD), factors that impair the release of oxygen by negatively affecting oxyhemoglobin dissociation include A. hyperthermia. B. metabolic acidosis C. respiratory acidosis D. hypotherm ia hypothermia When inhaled nitric oxide (iNO) is administered to infants with congenital heart disease complicated by pulmonary artery hypertension, the desired result is A. smooth muscle relaxation. B. pulmonary vasoconstriction. C. pulmonary vasodilation. D. systemic vasodilation. pulmonary vasodilation 19.A patient with hypovolemic shock is receiving fluid resuscitation. Dopamine (Intropin) is started at 3 mcg/kg/min for A. hypotension. B. decreased cardiac contractility. C. decreased heart rate. D. renal perfusion. renal perfusion 20.A patient admitted following an acute asthma attack has been given multiple albuterol (Proventil) inhalation treatments. The following measurements are obtained: BP 130/ HR 160 RR 48

FiO2 60% (by non-rebreather mask) O2 Sat 88% Physical findings could include which of the following?

A. wheezing and agitation B. coughing and grunting C. pleural rub and wheezing D. stridor and bronchospasm wheezing and agitation 21.Respiratory therapists, physical therapists, occupational therapists and nurses are all responsible for discharge teaching, with each discipline currently documenting on its own flow sheet. The best way to coordinate teaching would be to have A. daily care conferences to review and discuss patient teaching and the flow sheets. B. each discipline distribute copies of its flow sheets to each team member. C. nurses review the flow sheets of all disciplines during shift change. D. all disciplines document patient teaching on the same flow sheet. all disciplines document patient teaching on the same flow sheet A 10-day-old infant is admitted with a suspected congenital heart defect, a history of poor feeding, and sudden onset of respiratory distress and cyanosis. Initial assessment shows: HR 180 pH 7. RR 72 pCO2 30 BP 48/Doppler pO2 48 CRT greater than 5 sec. HCO3 16 The patient is intubated and placed on mechanical ventilation at a rate of 20; PIP/PEEP=24/4 cm water; FiO2=100%. Subsequent ABG results show: pH 7. pCO2 28 pO2 50 HCO3 15 The most probable etiology of the patient's cardiopulmonary status is A. Tetralogy of Fallot. B. hypoplastic left heart syndrome. C. persistent pulmonary hypertension. D. diaphragmatic hernia. hypoplastic left heart syndrome A teenager post cardiac arrest has a new diagnosis of hypertrophic cardiomyopathy. The parents are concerned about what to do if their son collapses again. The nurse's best response would be

A. "Now that your son has been diagnosed and treated, you need not

worry." B. "Would teaching you CPR help ease your anxieties?" C. "Do you know how to access the EMS system?" D. "I will have your son's cardiologist talk to you." "Would teaching you CPR help ease your anxieties?" A child is admitted after sustaining a head injury. The most important aspect of the nurse's continuing neurological assessment is A. level of consciousness. B. papillary response. C. motor response. D. assessment of the cranial nerves. level of consciousness A survey reveals that all of a hospital's nurses feel that the routine 4 a.m. chest x-rays cause an interruption in children's sleep patterns. The best strategy for addressing this issue would be to A. Assemble a work group to discuss the current hospital policy. B. Reschedule all non-emergent 4 a.m. chest x-rays during daytime hours. C. Request an in-service for the radiology department on the effects of sleep deprivation in children. D. Send the results of the survey to the hospital administrator. Assemble a work group to discuss the current hospital policy The chest x-ray of a patient with status asthmaticus will reveal A. hyperinflation. B. foreign-body aspiration. C. perihilar infiltrations. D. an elevated diaphragm hyperinflation Which of the following rhythms is expected one day post cardiac catheterization for repair of an arterial septal defect (ASD)? A. premature atrial contraction B. junctional ectopic tachycardia C. sinus bradycardia D. sinus tachycardia premature atrial contraction A patient who does not speak or understand English is admitted. Guidelines for using a translator may include A. having the translator ask questions that you don't feel comfortable asking. B. standing next to the translator and as close to the patient as possible.

C. providing all of the information, then allowing for translation and asking of questions.

D. allowing time for the translator to decode the medical jargon used in the teaching. standing next to the translator and as close to the patient as possible An infant post cardiac surgery is displaying signs of hypovolemia. The nurse suspects there is an increased insensible fluid loss due to A. decreased activity. B. hypothermia. C. the radiant warmer. D. sedation. the radiant warmer The primary objective in the treatment of an infant with persistent pulmonary hypertension is to A. maintain the pH level at less than 7.40. B. dilate the pulmonary vascular bed. C. dilate the systemic vascular bed. D. constrict the pulmonary vascular bed. dilate the pulmonary vascular bed

31. A 26-week-gestation infant with multiple congenital abnormalities dies shortly after admission to the NICU. The parents saw the infant briefly in the delivery room, but decline to come to the NICU. The nurse should first A. Take the infant to the parents. B. Refer the parents to a genetic counselor. C. Prepare a memory box for the parents. D. Take an instant photo of the infant to the parents. Take an instant photo of the infant to the parents. For an acetaminophen level of 140 mcg/mL, the treatment choice is A. activated charcoal. B. N-acetylcysteine (Acetadote). C. deferoxamine (Desferal). D. pralidoxime chloride (Protopam). N-acetylcysteine (Acetadote). 33.Which of the following actions would be appropriate after the administration of desmopressin (DDAVP) to a patient with diabetes insipidus? A. Decreasing IV fluid rate B. Maintaining current fluid rate C. Increasing sodium intake D. Decreasing glucose intake Decreasing IV fluid rate

34.A 15-year-old with acute myelogenous leukemia has undergone multiple rounds of chemotherapy. One night, the patient tells the nurse, "I'm tired of all the chemo and I want to stop." The nurse should

A. Explain the adolescent patients cannot legally make healthcare decisions B. Encourage the patient to, "express these feelings to your parents." C. Arrange for the patient to discuss the treatment plan with the physicians D. Ask the patient, "Do you realize you could die if you stop chemotherapy?" Encourage the patient to, "express these feelings to your parents." 35.A 9-year-old presents with recurrent episodes of intermittent palpitations associated with weakness. Physical examination is unremarkable. An ECG reveals a heart rate of 125 beats per minute, a shortened PR interval and a slurred upstroke prior to each widened QRS complex. This slurred upstroke (Delta wave) can be explained by A. Atrial pre-excitation B. Atrial depolarization C. Ventricular repolarization D. Ventricular pre- excitation Ventricular pre-excitation 36.A patient with end-stage liver failure secondary to Hepatitis C virus has been declared brain dead. The parents decide to discontinue feedings and donate their daughter's organs. In response to the parents' request, the most appropriate action by the nurse would be to A. Contact the organ procurement agency B. Convene a multidisciplinary care conference C. Tell the parents that their daughter's condition precludes organ donation D. Discontinue feedings per the parents' request Contact the organ procurement agency 37.Which of the following tests will confirm brain death in a 6-month-old? A. Absence of spontaneous breathing when PaCO2 goes above 60 mmHg B. Eyes deviate toward the right when ice water is injected into the ears C. Radionuclide scan shows cerebral arterial blood flow into the brain stem D. Low voltage amplitude observed on electroencephalogram (EEG) Absence of spontaneous breathing when PaCO2 goes above 60 mmHg 38.The acute treatment of esophageal varices includes A. Placement of a large NGT to low intermittent suction B. Immediate surgical intervention C. Administration of vasopressin (Pitressin) or octreotide (Sandostatin) D. Placement of a central venous line for hyperalimentation (TPN) Administration of vasopressin (Pitressin) or octreotide (Sandostatin) 39.A 1-year-old who in ventilator dependent has been hospitalized since birth. He is now being discharged home with a tracheostomy and a gastrostomy. In order to determine the discharge needs of the patient, the should arrange for

A. Home nursing care for the first few days following discharge B. A social worker to meet with the family and assess the adequacy of the home environment

C. An outreach educator to determine the learning needs of the family D. A multidisciplinary care conference prior to discharge A multidisciplinary care conference prior to discharge 40.A 10-year old patient is intubated due to a sudden deterioration in respiratory status. ABGs post intubation are as follows: pH 7.31 pCO2 50 pO2 80 HCO3 22 O2 Sat 95% The blood gases reflect A. Respiratory acidosis B. Respiratory alkalosis C. Metabolic alkalosis D. Metabolic acidosis Respiratory acidosis 41.A 4-year-old has been admitted following repair of coarctation of the aorta. The child's vital signs are: HR 80 BP 150/80 RR 20 CVP 10 The arterial blood gas results are: pH 7.32 pCO2 42 pO2 96 HCO3 23 The child is comfortable and resting quietly. The most likely cause of the hypertension is A. Expected physiologic response to an aortic incision B. Excessive volume expansion during the surgical period C. Diminished baroreflex sensitivity to changes in arterial pressure D. Inadequate pain control following a thoracotomy Diminished baroreflex sensitivity to changes in arterial pressure 42.A 10-year-old is admitted for colitis. Eight hours after admission the patient develops respiratory distress, abdominal distension and capillary refill time greater than 4 seconds. The nurse should suspect A. Aspiration pneumonia B. Malabsorption syndrome C. Adhesions D. Bowel perforation Bowel perforation

43.A hospital's current policy states that medication drips should be changed within 24 hours after surgery. Nurses note that many postoperative cardiac patients develop

blood pressure instability after inotrope syringes are changed. The best approach to solving this problem is to A. Notify the physician of a patient's blood pressure instability B. Disregard the policy and wait for the syringes to empty C. Form a committee to examine the problem and look for solutions D. Give a bolus of inotrope immediately prior to changing a drip Form a committee to examine the problem and look for solutions 44.An acutely ill infant is born to a Vietnamese family. The father asks few questions about the infant's condition and the mother asks none. Both parents appear to be proficient in English. Which of the following would be the most useful resource for a nurse caring for this patient? A. Classes conducted by the primary nurse as the need arises B. An interpreter proficient in the parents' language C. Information about Vietnamese culture D. Ongoing classes addressing the cultural needs of the local community Information about Vietnamese culture 45.The pediatric patient with suspected asphyxia from smoke inhalation will typically present with A. Tachypnea B. Cyanosis C. Confusion D. Hypertensi on Confusion 46.A child with myelomeningocele is started on a bowel management plan. The nurse would recognize that more education is needed when the mother states, "My child A. Tends to more prone to diarrhea B. Will be unable to control his stools C. Will require more activity to increase stools D. Needs to have a stool every day Tends to more prone to diarrhea 47.A 3-month-old infant has been admitted with encephalitis. The nurse should first assess the patient's A. Pupillary response B. Blood glucose level C. Level of consciousness D. Ability to maintain airway Ability to maintain airway 48.A 15-year-old trauma patient admitted for evaluation is complaining of left upper quadrant abdominal pain radiating to the left shoulder. BP has dropped to 80/50. Which condition is indicated?

A. Small bowel injury B. Cardiac contusion C. Splenic laceration D. Pulmonary embolism Splenic laceration 49.A newborn is admitted with transposition of the great arteries. The SaO2 equals 46%. No murmur is heard. Until a balloon septostomy can be performed, which one of the following should be administered as a temporary measure? A. Alprostadil (PGE1) B. Tolazoline (Priscoline) C. Indomethacin (Indocin) D. Digoxin (Lanoxin) Alprostadil (PGE1) 50.To promote effective grieving in a 6-year-old sibling following the death of a neonate, the nurse should A. Recommend that the sibling not attend the infant's memorial service B. Encourage the parents to minimize their expression of grief when with the sibling C. Explain to the sibling that the infant went to heaven D. Explain to the sibling that thoughts and wishes did not cause the infant's death Explain to the sibling that thoughts and wishes did not cause the infant's death 51.A patient admitted with multiple trauma develops flank pain, hematuria and costovertebral-angle tenderness. The nurse would suspect the child has experienced injury to the A. Pancreas B. Kidney C. Liver D. Bladde r Kidney 52.Common laboratory findings associated with acute renal failure include an increase in the blood urea nitrogen (BUN) level, as well as which of the following changes in the concentrations of potassium and creatinine? Potassium Creatinine A. increased increased B. decreased increased C. increased decreased D. decreased decreased increased increased 53.Prior to the administration of digoxin (Lanoxin), the nurse assesses the heart rate and rhythm, as well as the

A. Serum calcium level and QRS duration B. Serum potassium level and PR interval