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PICU Practice Exam 1: Pediatric Critical Care Questions and Answers, Exams of Nursing

Chamberlain College of NursingNursing

Practice questions and verified answers for pediatric intensive care unit (PICU) procedures and management. Covers critical care topics like increased intracranial pressure, septic shock, post-tonsillectomy care, respiratory distress, blood transfusion reactions, cerebral edema, asthma management, ET tube placement, post-cardiac arrest care, electrolyte imbalances, tracheostomy care, DKA, RSV, status asthmaticus, VAP, sedation, epiglottitis, head injuries, bronchiolitis, oxygen delivery, VP shunt malfunction, skin breakdown prevention, tissue perfusion, burn management, post-appendectomy complications, pain assessment, child abuse suspicion, seizure management, and septic shock management. Designed to test knowledge and critical thinking for PICU nurses and professionals.

Typology: Exams

2024/2025

Available from 06/30/2025

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PROPHECY RN PEDIATRIC ICU PICU
PRACTICE EXAM 1 QUESTIONS AND
CORRECT ANSWERS (VERIFIED
ANSWERS) PLUS RATIONALES 2025
1. A 4-year-old is admitted to the PICU with increased intracranial
pressure. Which of the following is the priority nursing intervention?
A. Maintain child in Trendelenburg position
B. Perform deep suctioning every hour
C. Maintain head midline and elevate HOB 30 degrees
D. Administer high-flow oxygen via nasal cannula
Elevating the head and keeping it midline promotes venous drainage and
reduces ICP without compromising cerebral perfusion.
2. A child with septic shock is receiving dopamine. Which assessment
finding indicates the medication is effective?
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PROPHECY RN PEDIATRIC ICU PICU

PRACTICE EXAM 1 QUESTIONS AND

CORRECT ANSWERS (VERIFIED

ANSWERS) PLUS RATIONALES 2025

  1. A 4-year-old is admitted to the PICU with increased intracranial pressure. Which of the following is the priority nursing intervention? A. Maintain child in Trendelenburg position B. Perform deep suctioning every hour C. Maintain head midline and elevate HOB 30 degrees D. Administer high-flow oxygen via nasal cannula Elevating the head and keeping it midline promotes venous drainage and reduces ICP without compromising cerebral perfusion.
  2. A child with septic shock is receiving dopamine. Which assessment finding indicates the medication is effective?

A. Decreased heart rate B. Increased capillary refill time C. Increased urine output D. Decreased mean arterial pressure Dopamine improves renal perfusion and cardiac output, which increases urine output—an indicator of improved organ perfusion.

  1. A toddler post-tonsillectomy begins to swallow frequently. What should the nurse do? A. Offer ice chips B. Assess for bleeding C. Elevate the head of the bed D. Suction the oropharynx Frequent swallowing may indicate bleeding from the surgical site and should be assessed immediately.
  2. A 6-month-old in the PICU develops grunting and nasal flaring. What is the nurse's priority action? A. Apply nasal saline B. Reposition to side-lying C. Notify the provider and prepare for respiratory support D. Administer a feeding
  1. A pediatric patient with asthma is wheezing and struggling to breathe. First-line treatment is: A. Intravenous corticosteroids B. Inhaled albuterol C. Subcutaneous epinephrine D. Oral prednisone Albuterol is a rapid-acting beta-agonist used to relieve acute bronchospasm in asthma.
  2. The best method to confirm ET tube placement in a pediatric patient is: A. Bilateral breath sounds B. Chest rise and fall C. End-tidal CO₂ detector D. Auscultation over the stomach End-tidal CO₂ is the gold standard to verify tube placement because it confirms exhaled CO₂ from lungs.
  3. A child is post-cardiac arrest and comatose. Which intervention helps reduce neurological injury?

A. Hyperthermia protocol B. Targeted temperature management (TTM) C. Keeping child NPO D. Frequent suctioning TTM (therapeutic hypothermia) can protect brain cells by reducing metabolic demand and inflammation.

  1. Which lab value is most concerning in a child receiving Lasix (furosemide)? A. Sodium 140 mEq/L B. Potassium 2.8 mEq/L C. Chloride 100 mEq/L D. BUN 12 mg/dL Lasix causes potassium loss. A potassium of 2.8 is dangerously low and may lead to arrhythmias.
  2. A child with a tracheostomy becomes cyanotic and apneic. What is the nurse’s first action? A. Call the code team B. Administer oxygen via face mask C. Remove the tracheostomy and begin bag-valve-mask ventilation D. Suction the tracheostomy
  1. A 2-year-old is admitted for respiratory syncytial virus (RSV). The most appropriate isolation is: A. Droplet only B. Contact and droplet C. Airborne D. Contact and airborne RSV spreads via contact and large droplets, requiring both contact and droplet precautions.
  2. Which finding indicates improvement in a child with status asthmaticus? A. Silent chest B. Use of accessory muscles C. SpO₂ 85% D. Decreased wheezing with increased air movement Decreased wheezing accompanied by better airflow suggests effective treatment and improved ventilation.
  3. A PICU patient is on mechanical ventilation. What intervention helps prevent ventilator-associated pneumonia (VAP)?

A. Continuous suction B. Trendelenburg positioning C. Elevate head of bed 30–45 degrees D. Daily chest X-rays Head elevation prevents aspiration and reduces VAP risk.

  1. Which sedative is preferred for short procedures in a child with intact airway reflexes? A. Lorazepam B. Ketamine C. Propofol D. Midazolam Ketamine preserves airway reflexes and provides sedation and analgesia.
  2. A 3-year-old with suspected epiglottitis presents with stridor, drooling, and tripod posture. What is the nurse's first priority? A. Start IV line B. Do not attempt to visualize the throat and call the provider immediately C. Give racemic epinephrine D. Administer antibiotics
  1. Which oxygen delivery method is best for a stable infant needing high oxygen flow? A. Nasal cannula B. High-flow nasal cannula (HFNC) C. Simple face mask D. Partial rebreather mask HFNC provides humidified, heated, high-concentration oxygen comfortably and supports work of breathing.
  2. Which of the following is most indicative of septic shock in a child? A. Hypertension and bradycardia B. Tachycardia and delayed capillary refill C. Increased urine output D. Bounding pulses Poor perfusion (delayed cap refill) and tachycardia are early signs of compensated shock in children.
  3. You are caring for a child with a ventriculoperitoneal (VP) shunt. What finding suggests shunt malfunction?

A. Hypotension B. Vomiting and bulging fontanel C. Jaundice D. Diarrhea Signs of increased ICP (vomiting, bulging fontanel) may indicate shunt blockage.

  1. Which intervention is best when caring for a sedated child at risk for skin breakdown? A. Apply barrier creams B. Reposition the child every 2 hours C. Use heated blankets D. Restrict fluids Scheduled repositioning is key in preventing pressure ulcers, especially in immobile patients.
  2. The most reliable sign of poor tissue perfusion in a pediatric patient is: A. Hypertension B. Decreased temperature C. Prolonged capillary refill time D. Increased pulse pressure
  1. A 5-year-old post-appendectomy complains of increased pain and has a rigid abdomen. What should you suspect? A. Wound infection B. Peritonitis C. Paralytic ileus D. Constipation Rigid abdomen and increased pain may indicate peritoneal infection and need immediate evaluation.
  2. Which pain assessment tool is most appropriate for a 4-year- old? A. Numeric scale B. FLACC scale C. Wong-Baker Faces D. PAINAD scale The FLACC scale is valid for nonverbal or young children, assessing five behavioral categories.
  3. You suspect child abuse in a 2-year-old with spiral femur fracture. Your action should be:

A. Document and discharge B. Question the child C. Report to Child Protective Services (CPS) per policy D. Notify the child’s teacher Mandatory reporting is required by law when abuse is suspected in children.

  1. A child is having a seizure lasting over 5 minutes. What is the first-line medication? A. Phenytoin B. Lorazepam C. Ketamine D. Haloperidol Benzodiazepines (e.g., lorazepam) are the first-line treatment for status epilepticus.
  2. A child in DKA is transitioning to subcutaneous insulin. What is essential during the transition? A. Discontinue IV insulin immediately B. Overlap IV and subcutaneous insulin for 1–2 hours C. Delay meals D. Stop glucose checks
  1. A child with Kawasaki disease receives IVIG. What is the key teaching point? A. Avoid dairy B. Delay live vaccines for 11 months C. Monitor blood glucose D. Restrict fluids IVIG interferes with the immune response to live vaccines like MMR and varicella.
  2. A 2-month-old with RSV suddenly stops breathing. What is the nurse’s first action? A. Call the provider B. Start bag-valve-mask ventilation C. Begin chest compressions D. Administer naloxone Immediate ventilation is required for apnea; chest compressions follow if HR <60 bpm.
  3. A 6-year-old presents with bradycardia and hypotension. Which drug is first?

A. Amiodarone B. Epinephrine C. Procainamide D. Lidocaine Epinephrine is the first-line treatment for pediatric bradycardia with poor perfusion.

  1. What is a late sign of respiratory failure in children? A. Nasal flaring B. Grunting C. Cyanosis D. Head bobbing Cyanosis indicates hypoxemia and is a late, life-threatening sign.
  2. A child with congenital heart disease has polycythemia. What is the main risk? A. Infection B. Bleeding C. Stroke D. Seizures
  1. A child has a positive blood culture and is febrile. What is the first action? A. Administer antipyretics B. Draw more labs C. Start antibiotics as ordered D. Place on isolation Prompt antibiotic therapy is critical to control infection in septic pediatric patients.
  2. A child in cardiogenic shock has low BP and crackles. The best medication is: A. Lasix B. Dobutamine C. Albuterol D. Epinephrine Dobutamine improves contractility without significantly increasing heart rate or systemic vascular resistance.
  3. A child with a central line develops sudden chest pain and SOB. What should the nurse suspect?

A. Fever B. Air embolism C. Sepsis D. Pneumonia Air embolism is a known complication of central lines and presents with acute chest symptoms.

  1. What position reduces the risk of aspiration in a ventilated pediatric patient? A. Supine B. Trendelenburg C. Semi-Fowler’s (30–45°) D. Side-lying Semi-Fowler’s reduces aspiration risk and promotes ventilation in ventilated children.
  2. A neonate in the PICU has low calcium. What clinical sign is expected? A. Hyperreflexia B. Tetany C. Bradycardia D. Mydriasis