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CCRN Pediatric Practice Exam Questions and answers
To promote effective grieving in a 6 - year-old sibling following the death of an infant, 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 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 - Correct Answer Answer: D) Explain to the sibling that thoughts and wishes did not cause the infant's death: At age 6, children may take words literally and because of their egocentrism, they believe that thoughts are all-powerful. They may truly believe they caused the death of their sibling. A simple, honest explanation of why the sibling died is indicated. This intervention is consistent with Caring Processes. A) Recommend that the sibling not attend the infant's memorial service: This intervention is not a solution to the problem and will not promote effective grieving for the sibling. It is not consistent with Caring Processes. B) Encourage the parents to minimize their expression of grief with the sibling: This intervention will lead to ineffective grieving for the sibling and is not consistent with Caring Processes C) Explain to the sibling that the infant went to heaven: This intervention will not address the sibling's problem A 5 - year-old with a history of congenital hydrocephalus and VP shunt placement at four weeks of age is admitted with increased somnolence, decreased appetite, and increased complaints of headache. This morning the child vomited twice. The nurse should anticipate: A) The physician ordering lumbar puncture and blood and urine cultures B) the patient having a CT scan followed by possible shunt revision C) Administering mannitol or hypertonic saline
D) Administering phenytoin (Dilantin) or fosphenytoin (Cerebyx) - Correct Answer Answer: B) The patient having a CT scan followed by possible shunt revision: This patient is demonstrating signs of increased intracranial pressure. The most likely etiology is malfunction of the VP shunt as a result of blockage or disconnection, which is particularly likely over time as the child grows. The definitive diagnosis is made by a CT scan and a shunt series. Surgical intervention for a shunt revision would be indicated. A) The physician ordering lumbar puncture and blood and urine cultures: These interventions will not address the most likely primary problem, which is suspected VP shunt malfunction. Additionally, lumbar puncture is contraindicated in the presence of increased intracranial pressure, because downward herniation of the brainstem can occur. C) Administering mannitol or hypertonic saline: These medication are indicated for the medical management of increased intracranial pressure, of which this patient has symptoms. However, they will not address the most likely primary problem, which is suspected VP shunt malfunction. D) Administering phenytoin (Dilantin) or fosphenytoin (Cerebyx): These medications are indicated for seizure management and would not address the patient's most likely primary problem, which is suspected increased intracranial pressure as a result of VP shunt malfunction An adolescent trauma patient is complaining of left upper quadrant abdominal pain radiating to the left shoulder. Blood pressure has dropped to 80/50. Which condition is most likely? A) Small Bowel Injury B) Cardiac Contusion C) Splenic Laceration D) Pulmonary Embolism - Correct Answer Answer: C) Splenic laceration: Kehr's sign, which is referred pain to the left shoulder during compression of the left upper abdominal quadrant, is an indication of splenic injury. Additional symptoms include tachycardia, hypotension, and leukocytosis A) Small bowel injury: Signs of small bowel injury may include progressive abdominal distension, not referred left shoulder pain. B) Cardiac Contusion: Signs of cardiac contusion include chest pain, arrhythmias, and other indicators of myocardial dysfunction, such as elevated cardiac isoenzymes. Upper quadrant abdominal pain with radiation to the left shoulder is not consistent with a cardiac contusion
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 is the most useful resource for a nurse caring for this infant? A) Classes conducted by the primary nurse as the need arises B) An interpreter who is proficient in the parents' language C) Information about the cultural backgrounds represented in the community D) Ongoing classes addressing the cultural needs of the community - Correct Answer Answer: B) An interpreter who is proficient in the parents' language: This intervention is consistent with Response to Diversity. Providing an interpreter may facilitate communication by the parents. Trained interpreters can improve outcomes by helping to ensure effective communication between the healthcare team and the patient/family A) Classes conducted by the primary nurse as the need arises: This intervention is not consistent with Response to Diversity. It will not help in this situation. While addressing needs as they arise is important, the parents are not communicating these needs at present. C) Information about the cultural backgrounds represented in the community: This intervention will not help in this situation. Cultural backgrounds in the community will not address the parents' needs during this stressful time. D) Ongoing classes addressing the cultural needs of the community: This intervention will not help in this situation. Cultural backgrounds in the community will not address the parents; needs during this stressful time. A toddler with a history of unrepaired tetralogy of Fallot begins to cry while intravenous access is attempted. Cyanosis, diaphoresis and tachypnea are noted. The most appropriate nursing intervention would be to: A) Administer A pre-medication before attempting the IV B) Apply a face mask with oxygen C) Transfuse red blood cells D) Place the child in knee-chest position - Correct Answer Answer: D) Place the child in knee-chest position: This maneuver aids blood return to the heart, thus alleviating cyanotic spells A) Administer a pre-medication before attempting the IV: This may be appropriate if it helps the infant to experience minimal pain, and thus cry less during the IV start.
B) Apply a face mask with oxygen: Administering oxygen is helpful to minimize the hypoxia, but the mask may cause even more distress. C) Transfuse red blood cells: If other measures do not alleviate the spells, volume in the form of packed red blood cells may be ordered to maintain the hematocrit greater than or equal to 45% A 1 - month old infant presents with failure to thrive, frequent vomiting and irritability since birth. The mother reports having another infant with the same symptoms who died at 2 months of age. Which additional assessment finding would cause the nurse to suspect an inborn error of metabolism? A) Micrognathia B) Microglossia C) Petite Facial Features D) Musty Urine Odor - Correct Answer Answer: D) Musty urine odor: This is a common indicator of a metabolic disorder, especially with a family history of siblings dying early A) Micrognathia: This is not associated with an inborn error of metabolism B) Microglossia: This is not associated with an inborn error of metabolism C) Petite Facial Features: This is not associated with an inborn error of metabolism A school-aged child with autism is admitted with a fractured femur and possible head injury. Which of the following is important to promote adjustment to the hospital setting? A) Assign a child life therapist per shift B) Encourage lots of visitors C) Adhere to a home schedule D) Initiate new activities to keep the patient occupied - Correct Answer Answer: C) Adhere to a home schedule: Autism spectrum disorders are a complex neurodevelopmental disorder of brain function accompanied by a broad range and severity of intellectual and behavioral deficits, which is best managed when adhering to a schedule and minimizing change, so adhering to a home schedule is optimal. The schedule allows the child and family to optimally cope. A) Assign a child life therapist per shift: The assignment of a child life therapist can be very beneficial to help facilitate patient and family understanding of the hospital environment and provide therapeutic coping interventions, but it is not realistic that a child life therapist would be assigned to an individual patient for every shift.
B) Guide the family to a nearby room where they can express their emotions C) Tell the family they must quiet down, or they will have to leave the unit D) Tell the other staff they are being insensitive to the family's expression of grief - Correct Answer Answer: B) Guide the family to a nearby room where they can express their emotions: People from various cultures express grief and mourning in different ways. This expression may include loud, emotional responses. Providing the family a place close to the patient's room allows them privacy while minimizing disruption to other patients and staff in the area. A) Ask a security officer to remove the family from the unit: Removing the family is not a culturally sensitive way to allow the family to experience their grief and mourning C) Tell the family they must quiet down or they will have to leave the unit: Asking the family to be quiet or removing them from the unit are not culturally sensitive ways to allow the family toe experience their grief and mourning D) Tell the other staff they are being insensitive to the family's expression of grief: Telling other staff members that they are being insensitive does not promote cultural awareness and does not address the family's need to express their grief and mourning. Cardiac defects associated with increased pulmonary blood flow place the patient at greatest risk for: A) Heart Failure B) Air Emboli C) Hypoxemia D) Syncope - Correct Answer Answer: A) Heart Failure: Heart Failure is a common manifestation associated with increased pulmonary blood flow B) Air Emboli: Although air emboli are possible with a septal defect, it would be a rare occurrence. This may be seen later in life due to chronic increased pulmonary blood flow C) Hypoxemia: Hypoxemia is not usually associated with cardiac defects that result in increased pulmonary blood flow D) Syncope: Syncope is not associated with cardiac defects that result in increased pulmonary blood flow A nurse believes the number of hemolyzed blood samples that have been reported by the laboratory is excessive. The best action for the nurse would be to A) Track the number of blood samples drawn, by what method and the number reported as hemolyzed
B) Request a staff meeting to discuss the problem and ask for feedback C) Develop an educational in-service on the proper blood-sampling technique for the staff D) Create a poster and post-test demonstrating the proper method of drawing blood samples - Correct Answer Answer: A) Track the number of blood samples drawn, by what method and the number reported as hemolyzed: Evidence-based practice is the use of available data to support care and address care concerns. The nurse currently has only an impression and no data to support the concern B) Request a staff meeting to discuss the problem and ask for feedback: this intervention will not address the need for data to validate the concern C) Develop an educational in-service on the proper blood-sampling technique for the staff: This intervention will not address the need for data to validate the concern D) Create a poster and post-test demonstrating the proper method of drawing blood samples: This intervention will not address the need for data to validate the concern Which ventilatory parameters should be weaned first in a patient with bronchopulmonary dysplasia (BPD)? A) Tidal Volume (VT) and oxygen (FiO2) B) Peak inspiratory pressure (PIP) and intermittent mandatory ventilation (IMV) C) Oxygen (FiO2) and intermittent mandatory ventilation (IMV) D) Oxygent (FiO2) and peak inspiratory pressure (PIP) - Correct Answer Answer: D) Oxygen (FiO2) and peak inspiratory pressure (PIP): FiO2 should be weaned as soon as oxygenation improves. PIP is weaned as lung compliance improves A) Tidal Volume (VT) and oxygen (FiO2): Patients with BPD are usually ventilated using a pressure cycled ventilator mode, as breaths delivered at a set volume to non compliant lungs may generate a pressure higher than the desired peak pressure. B) Peak inspiratory pressure (PIP) and intermittent mandatory ventilation (IMV): PIP is weaned as the lung compliance improves but IMV is a mode of ventilation, not a weanable parameter C) Oxygent (FiO2) and intermittent mandatory ventilation (IMV): FiO2 is weaned as oxygenation improves but IMV is a mode of ventilation, not a weanable parameter Which of the following interventions would be the most valuable in aiding management of a child requiring PEEP of 14 cm water? A) Extracorporeal membrane oxygenation (ECMO) B) Placement of a thoracostomy tube
D) Question the current policy that only respiratory therapists can manage the ventilator. - Correct Answer Answer: D) Question the current policy that only respiratory therapists can manage the ventilator: Clinical Inquiry is questioning the appropriateness of policies, guidelines, and current practices to improve patient care A) Place the patient on the ventilator when needed, despite current policy: This is not a Caring Practice as the RN may not have the knowledge to perform this task safely B) Wait for the therapist to intervene: This may not be satisfactory if the patient hypoventilates during sleep. C) Ask the parent to be responsible for this task: This response is not a safe or Caring Practice A patient with bronchopulmonary dysplasia (BPD) is admitted with heart failure. the nurse can expect to perform interventions to: A) Decrease Preload B) Increase Afterload C) Decrease Heart Rate D) Increase Contractility - Correct Answer Answer: A) Decrease Preload: Decreasing the preload for a patient with BPD will improve right-sided heart failure related to chronic lung disease B) Increase Afterload: Increasing afterload would impede ventricular ejection, making heart failure worse. C) Decrease heart rate: Decreasing the heart rate would decrease cardiac output (CO = HR x SV) which would worsen the patient's heart failure. D) Increase contractility: Although increasing contractility may help improve left-sided heart failure, patients with BPD usually have right-sided heart failure. Factors that impair the release of oxygen to tissues by negatively affecting oxyhemoglobin dissociation include: A) Hyperthermia B) Metabolic acidosis C) Respiratory Acidosis D) Hypothermia - Correct Answer Answer: D) Hypothermia: Hypothermia shifts the oxyhemoglobin dissociation curve to the left, resulting in oxygen that is more tightly bound to hemoglobin
A) Hyperthermia: Hyperthermia shifts the oxyhemoglobin dissociation curve to the right, resulting in hemoglobin that has less affinity for oxygen B) Metabolic Acidosis: Acidosis shifts the oxyhemoglobin dissociation curve tot eh right, resulting in hemoglobin that has less affinity for oxygen C) Respiratory Acidosis: Acidosis shifts the oxyhemoglobin dissociation curve to the right, resulting in hemoglobin that has less affinity for oxygen A 15 yo 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 mmHg CVP: 20 mmHg Cardiac Index: 2.3 L/min/m SVR: 2000 dynes/sec/cm- 5 The nurse should suspect: A) A pulmonary embolus B) Cardiac Tamponade C) Cardiogenic Shock D) Hypovolemic Shock - Correct Answer Answer: C) Cardiogenic Shock: After the Fontan operation, low cardiac output is the most common and severe complication. It is often caused by inadequate blood flow into the pulmonary circulation that results from hypovolemia and inadequate systemic venous pressure, elevated pulmonary vascular resistance, obstruction at the surgical site, or pump failure. A) A pulmonary embolus: A pulmonary embolus (PE) is most commonly associated with a deep vein thrombus. Other risk factors bacterial endocarditis, sepsis, and hematologic/oncologic pathology. There is no mention of complaints of chest pain or dyspnea, which are primary indicators of a PE. B) Cardiac Tamponade: This is a sudden accumulation of fluid in the pericardial sac. Signs and symptoms are similar to shock, hypotension, tachycardia, high CVP, narrowing of pulse pressure and deteriorating systemic perfusion. D) Hypovolemic Shock: Although some of the classic signs of hypovolemic shock are present (cool, restless, decreased pulses, tachycardia) diaphoresis and elevated CVP would not be seen with hypovolemic shock.
C) Decreased myocardial contractility D) Catecholamine antagonism - Correct Answer Answer: A) Vasodilation: Amrinone is a phosphodiesterase inhibitor that increases intercellular cAMP and delays uptake of intercellular calcium, resulting in improved cardiac contractility and vasodilation. B) Phospholipid Inhibition: This is not an effect of amrinone administration C) Decreased myocardial contractility: This is not an effect of amrinone administration. D) Catecholamine antagonism: This is not an effect of amrinone administration A family meeting is planned to discuss the family's ethical concerns regarding continuing life support measures for a child with end-stage cancer. The nurse's role should be to: A) Provide the legal standpoint regarding end-of-life decisions for children. B) Articulate the reason for the child's poor prognosis and anticipated life expectancy C) Coordinate the meeting to ensure that everyone has the opportunity to speak D) Assist the parents in articulating their questions and concerns. - Correct Answer Answer: D) Assist the parents in articulating their questions and concerns: The parents' thoughts and understanding are critical for making decisions about their child's care. Nurses act as advocates by assisting the parents in articulating their questions and concerns and empowering the family to speak for their child and themselves. A) Provide the legal standpoint regarding end-of-life decisions for children: This does not address the parents' concenrs. B) Articulate the reason for the child's poor prognosis and anticipated life expectancy: This does not specifically address the parents' concerns regarding continued life support measures and is not consistent with Caring Practices. C) Coordinate the meeting to ensure that everyone has the opportunity to speak: This intervention is not consistent with Caring Practices or Advocacy and Moral Agency, as the nurse's opinions and decisions may be in conflict with those of the parents. A hypertensive crisis as evidenced by acidosis, hypothermia, and alveolar hypoxia may be demostrated in which of the following children? A) Those with reactive pulmonary vascular bed B) Those with systemic vascular disease. C) Those with increases in ventricular afterload.
D)Those with sustained increases in afterload - Correct Answer Answer: A) Those with reactive pulmonary vascular bed: Children with pulmonary vascular disease are at risk for developing a pulmonary hypertensive crisis. B) Those with systemic vascular disease: Systemic vascular disease does not affect pulmonary pressure C) Those with increases in ventricular afterload: The pediatric ventricle adapts to increases in ventricular afterload, provided the increases are not severe or acute. D) Those with sustained increases in afterload: Acute increases in afterload are poorly tolerated. 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 durg acts to inhibit the neurotransmitter gamma-aminobutyric 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 medicine added to the pump. - Correct Answer Answer: D) Parents must bring the child back to the clinic to have medicine added to the pump: The intrathecal dose of baclofen delivered via implanted pump is adjusted in the outpatient clinic using a telemetry wand every three to six months. A) The drug acts to inhibit the neurotransmitter gamma-aminobutyric acid (GABA): Baclofen has the opposite effect described in this answer, as it is a GABA agonist. B) Parents can be taught to regulate the dosage based on symptoms: The intrathecal dose of baclofen is adjusted in the outpatient clinic using a telemetry wand. C) The child will have a normal gait after insertion of the pump: The child's gait may be improved due to relief of severe spasticity, but there is no guarantee of a normal gait with this therapy. Positive end-expiratory pressure (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 - Correct Answer Answer: A) Increase functional residual capacity: PEEP increases functional residual capacity (FRC) by keeping the alveoli open after expiration, increasing alveolar volume
C) Furosemide (Lasix): Furosemide, a diuretic that blocks reabsorption of sodium and water, may be indicated for this patient, but is not specifically used to treat dyspnea or anxiety/agitation. D) Dobutamine (Dobutrex): Dobutamine has selective beta-adrenergic effects, which increase cardiac contractility. Dobutamine may be indicated for this patient but is not specifically used to treat dyspnea or anxiety/agitation. Which of the following statements by staff would be most concerning to the nurse who is championing the reduction of catheter-associated urinary tract infections (CAUTI) in his/her unit? A) "The urinary catheter was placed last night in the emergency department during trauma resuscitation." B) "I found the catheter disconnected from the collection device during my hourly assessment." C) "The patient is transferring to the floor today. They can discontinue the urinary catheter once they get him settled." D) "It is so much easier to monitor hourly output with a catheter in place." - Correct Answer Answer: C) "The patient is transferring to the floor today. They can discontinue the urinary catheter once they get him settled.": Catheters should be removed as soon as possible to prevent infection related to urinary catheters. A) "The urinary catheter was placed last night in the emergency department during trauma resuscitation.": Because catheters placed in the ED during resuscitation may pose a higher risk for infection, it is important to strictly monitor output following resuscitation. B) "I found the catheter disconnected from the collection device during my hourly assessment.": This is a potential risk for introducing infection bacteria. However, if the nurse replaced the device and reported the incident to the provider, the risk is low. D) "It is so much easier to monitor hourly output with a catheter in place.": This is not an appropriate use of a urinary catheter. A child 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 nurse suspects that the diagnosis will be: A) Muchausen syndrome by proxy. B) Nonaccidental Trauma C) Physical Abuse
D) Sexual Abuse - Correct Answer Answer: A) Munchausen syndrome by proxy: Also known as medical child abuse or factitious disorder by proxy. Munchausen syndrome by proxy is the diagnosis given when a caregiver deliberately exaggerates or fabricates a medical history and symptoms, or induces symptoms resulting in caregiver gratification. The child's condition does not match the history, and diagnostic evidence does not support the diagnosis suggested by the history. B) Nonaccidental Trauma: Nonaccidental trauma resulting in hematuria would leave visible signs of abuse, such as bruising. C) Physical Abuse: Physical abuse resulting in hematuria would leave visible signs of abuse, such as bruising. D) Sexual Abuse: Sexual abuse of a child often involves exposure of genitalia, touching/fondling and/or oral genital contact. Hematuria alone would not support this diagnosis. 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 sheet 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. - Correct Answer Answer: D) All disciplines document patient teaching on the same flow sheet: This plan is consistent with Collaboration. It gives opportunities for all disciplines to see the contributes of other team members. A) Daily care conferences to review and discuss patient teaching and the flow sheets: This plan is consistent with Collaboration but would be difficult to accomplish. Thus, it is not the best option. B) Each discipline distribute copies of its flow sheet to each team member: This plan is not consistent with Collaboration, and not an effective use of time for each team member. C) Nurses review the flow sheets of all disciplines during shift change: This plan is not consistent with Collaboration. All team members should be involved in the teaching process. Which of the following rhythms is expected one day post-cardiac catheterization for repair of an atrial septal defect (ASD)? A) Premature atrial contraction
C) Motor response: Changes in motor response are a late sign of neurological deterioration and are assessed as part of the Glasgow Coma Score. D) Cranial nerve assessment: While it is important to note changes, cranial nerve assessment is not the most important aspect of a nurse's ongoing neurological assessment. The chest x-ray of a patient with status asthmaticus will most commonly reveal which of the following? A) Hyperinflation B) Lobar consolidation C) Perihilar infiltrates D) An elevated diaphragm - Correct Answer Answer: A) Hyperinflation: Hyperinflation is the expected finding due to air trapping associated with asthma B) Lobar consolidation: Lobar consolidation is typically seen with pneumonia, not asthma. C) Perihilar infiltrates: Perihilar infiltrates are possible but not common. D) An elevated diaphragm: A flattened diaphragm is seen in patients with asthma and is associated with air trapping. A child with diabetes is admitted after collapsing in class. On admission, he is tachycardic, has shallow respirations, and dilated pupil, and is hyperreflexic. the plan of care would be to administer: A) Glucagon IM B) Naloxone (Narcan) IV C) 25% Dextrose IV D) Regular insulin SQ - Correct Answer Answer: C) 25% dextrose IV: The patient has signs of severe hypoglycemia, and administration of IV dextrose will quickly raise the blood glucose level. No more than 12.5% glucose should be given peripherally. A) Glucagon IM: Glucagon is administered for severe hypoglycemia. It requires 15 to 20 minutes to elevate the blood glucose. B) Naloxone (Narcan) IV: Naloxone, which reverses the effects of opioids, is not indicated for this patient. D) Regular Insulin SQ: Regular insulin, which will lower the patient's blood glucose level, is not indicated for this patient with severe hypoglycemia.
A nurse is caring for a patient with type 1 diabetes mellitus who has had multiple admissions over the last year for diabetic ketoacidosis (DKA). Before discharge for this episode of DKA, it is most important that the nurse arranges: A) To teach the patient how to administer sliding scale insulin when blood glucose levels are high. B) To teach the patient to avoid sugar and foods high in carbohydrates C) For the patient and family to meet with social worker to discuss challenges they face with management of the disease. D) For the patient and family to join a diabetes support group. - Correct Answer Answer: C) For the patient and family to meet with social worker to discuss challenges they face with management of the disease: At this point, after multiple admissions, the most important intervention is helping the patient and family navigate through the system to identify available resources that could be helpful in meeting the challenge of the disease. A) To teach the patient how to administer sliding scale insulin when blood glucose levels are high: A patient with diabetes most likely knows how to administer sliding scale insulin, but reinforcing the concepts may be indicated. B) To teach the patient to avoid sugar and foods high in carbohydrates: A patient with diabetes most likely knows the effects of diet on blood glucose, but reinforcing the concepts may be indicated. D) For the patient and family to join a diabetes support group: This may be helpful if the family is willing, but it is not the most important intervention A 10 - day-old infant is admitted with a suspected congenital heart defect, due to a history of poor feeding and sudden onsent 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
