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Peds CCRN Review Questions (from
AACN) with Accurate Answers
A 16-year-old crashes her car into a wooden fence and is impaled through the chest by a fence post. She presents with significant shortness of breath. You are unable to auscultate breath sounds on the right side and you palpate crepitus throughout the right side of the chest. Her HR is 146 and you are unable to obtain a blood pressure. She is most likely experiencing: A. Cardiomyopathy B. Cardiogenic shock C. Hypertensive crisis D. Cardiogenic/obstructive shock correct answer D. Cardiogenic/obstructive shock -Cardiogenic/obstructive shock occurs when cardiac output is obstructed and there is an inability to provide adequate tissue perfusion despite normal intravascular volume and myocardial function. -Causes include trauma to the great vessels, tamponade, pulmonary embolism, valvular stenosis, and coarctation of the aorta A 4-month-old arrives with a 24-hour history of vomiting and diarrhea. The patient is lethargic, pale, cool, and clammy. Weak peripheral pulses can be palpated and her capillary refill time is >4 seconds. The child is in: A. Hypovolemic shock B. Septic shock
C. Anaphylactic shock D. Cardiogenic shock correct answer A. Hypovolemic shock -This patient's history and clinical exam are consistent with hypovolemic shock. -Gastroenteritis is a common cause of fluid loss in an infant, which can result in significant hypovolemia. A 5-month-old arrives unconscious with a history of falling from a changing table. Head CT reveals a subdural hematoma. Which additional assessment finding is concerning for abusive head trauma? A. Forehead bruising B. Poorly reactive pupils C. Retinal hemorrhage D. Linear skull fracture correct answer C. Retinal hemorrhage -You would not anticipate seeing retinal hemorrhage with the history provided. -You could see a bruise on the head where the baby fell, poorly reactive pupils, or a linear skull fracture. -A history that does not match the patient's injuries is concerning for inflicted trauma. A 9-month-old arrives with a burn injury. Which of these is most concerning for inflicted injury? A. The burn injury is consistent with the history
A child being treated for DKA becomes more lethargic, is difficult to arouse, and has vomited twice in the past hour. These symptoms could be interpreted as indications of: A. Exhaustion due to lack of sleep B. The development of hypoglycemia C. Decreased intestinal motility D. Cerebral edema and increased ICP correct answer D. Cerebral edema and increased ICP -These symptoms are indications that the child may be developing cerebral edema and an increased ICP. -Nurses must recognize that children with DKA are at a higher risk for the development of cerebral edema and must monitor closely for any changes in neurological status. A child experiences sudden cardiac death after playing soccer. The most likely etiology is: A. Restrictive cardiomyopathy B. Hypertrophic cardiomyopathy C. Dilated cardiomyopathy D. Kawasaki disease correct answer B. Hypertrophic cardiomyopathy -Hypertrophic cardiomyopathy involves thickening of the heart muscles, which can obstruct blood flow out of the left ventricle.
-Intense exercise can worsen the outflow obstruction, which makes this type of cardiomyopathy the most common cause of sudden cardiac death in people younger than age 35 and in athletes. A child experiencing Diabetes Insipidus (DI) has a urine output >4 mL/kg/hr and a serum sodium of 158 mEq/L. The nurse should expect the patient will need: A. Hypotonic intravenous fluids and urine output replacement B. Vasopressin administration and urine output replacement C. Hypertonic saline administration and 75% maintenance intravenous fluid D. Vasopressin and hypertonic saline administration correct answer B. Vasopressin and urine output replacement -Immediate treatment for a patient with symptomatic DI is ADH replacement and urine output replacement to keep the patient from progressing to profound hypovolemic shock. -Hypotonic fluids and hypertonic saline administration are contraindicated in this situation. -Fluid restriction to 75% of maintenance needs is a treatment for SIADH. A child has just died. What's the nurse's best response to the parents? A." You can always have other children" B. "She's in a better place now" C. "I'm so sorry for your loss" D. "It's God's will when children die". correct answer C. "I'm so sorry for your loss"
B. Sodium bicarbonate C. Dextrose solution D. Subcutaneous insulin correct answer C. Dextrose solution -As the glucose decreases to 250 mg/dL, it will become necessary to administer glucose in addition to the insulin infusion that this patient is likely already receiving. -The child in DKA will not receive SQ insulin, as she will not be able to utilize that as effectively as IV insulin. -You have no information to suggest that this patient requires electrolyte supplementation. -Sodium bicarbonate is not appropriate A child is admitted after falling off a golf cart. The child was initially awake and alert, but now is unresponsive. The nurse should suspect which condition? A. Hydrocephalus B. Epidural hematoma C. Subdural hematoma D. Diffuse axonal injury correct answer B. Epidural hematoma Epidural hematomas result from hemorrhage into the extradural space, usually from a tear in the middle meningeal artery. With the classic presentation, the child is initially awake and alert, but as the bleeding continues, the hematoma gets larger and the child can become unresponsive.
A child is admitted in a hypertensive crisis and vasodilators are ordered. The nurse understands that the intention is to improve cardiac function through: A. Increasing SVR B. Inotropic and chronotropic actions C. Decreasing afterload D. Improving renal function correct answer C. Decreasing afterload -Introducing vasodilators into this child's medical management will allow for reduction of systemic vascular pressures, thereby reducing afterload. -Medications that increase SVR or have inotropic and chronotropic actions would worsen this situation. A child is admitted to the ICU following a motor vehicle collision in which he was an unrestrained passenger. He is complaining of numbness and tingling in his legs and feet, and has decreased sensation. Preliminary imaging studies are normal. The nurse anticipates: A. Removal of the cervical collar B. Discontinuation of log rolling C. Administration of anti-anxiety medications D. Ongoing spinal cord protective measures correct answer D. Ongoing spinal cord protective measures.
B. Serum Na+ 134 mEq/L; serum Osm 280 mOsm/L C. Serum Na+ 144 mEq/L; serum Osm 282 mOsm/L D. Serum Na+ 158 mEq/L; serum Osm 295 mOsm/L correct answer A. Serum Na+ 122 mEq/L; serum Osm 262 mOsm/L -You know that patients with SIADH have hyponatremia and hypo-osmolality, you know that answer "A" is the best response. A critically ill patient is hypotensive with pale, mottled, and cool extremities. The nurse should be concerned for: A. Skin failure B. Bacterial colonization C. Over hydration D. Dehydration correct answer A. Skin failure -Skin failure can occur when blood is shunted away from the skin to other vital organs in a critically ill patient. -It is also associated with impaired temperature control and metabolic conditions. -Skin failure and the injuries it causes may not be preventable. A family of Middle Eastern descent requests that no male caregivers enter the room when the mother is there alone at night. What's the best response?
A. Notify the social worker that the family is interfering with care B. Assign male caregivers if necessary to meet the unit's staffing needs C. Transfer the patient to a larger intensive care unit D. Document the request and include the information in the handoff report correct answer D. Document the request and include the information in the handoff report -An appropriate response to diversity is to honor this family's request. -Of the options listed, documenting and including the information in the handoff report is the best way to communicate the request. -It would be important for the nurse to talk with the family about emergency scenarios where it might not be possible to honor this while still meeting the urgent needs of the child. -A plan for this scenario could then be articulated with the family's agreement. A large pediatric/adult hospital is implementing a new continuous renal replacement therapy. Crucial considerations in the process include identifying equipment, financial resources and: A. Key stakeholders B. Staff educators C. Appropriate patients D. Attending physicians correct answer A. Key stakeholders -From a systems thinking perspective, key stakeholder identification is vital in the early stages of a major planned change.
-Seizures, rash and fever are not significant concerns with this medication. A nurse expresses concern about the high dosage of opioids ordered for the comfort care of a terminally ill and unconscious adolescent. The family's plan is to allow a natural death after extubation, and the nurse is concerned the medications will hasten that. What is the best resource to utilize in this situation? A. Ethics committee B. Hospital chaplain C. Risk manager D. Patient safety advocate correct answer A. Ethics committee -The nurse may be experiencing moral distress in this situation. Of the options listed, the ethics committee is the best resource to clarify the concept of double effect, where a legitimate act, such as relieving pain at the end of life, causes an undesired effect, such as oversedation or a slightly shortened life. -It is ethically acceptable in this situation to use higher than normal dosages of pain and anxiety relieving medications. A nurse manager feels that the number of blood culture samples reported by the laboratory as "contaminated" is excessive. The most appropriate action for the nurse manager would be to: A. Observe the staff as they obtain blood culture samples B. Track the actual blood culture contamination rate C. Convene a staff meeting to discuss the problem
D. Develop a poster demonstrating the correct procedure correct answer B. Track the actual blood culture contamination rate -The first step of analyzing a potential problem is to collect actual data to determine whether or not the problem truly exists. -In this scenario, the blood culture contamination rate would be determined by evaluating the number of blood cultures drawn as compared to the number that are reported as contaminated. -Once that assessment is done, appropriate next steps such as direct observations or education can be determined. A patient is admitted with status epilepticus. After arrival, the SpO2 decreases to 85%. The priority response is: A. Oxygen administration B. Anticonvulsant administration C. Intubation D. Bite block insertion correct answer A. Oxygen administration Hypoxia is a complication of seizures, and the therapeutic priority in the management of a seizure is to maintain oxygenation and ventilation. A patient presents with agitation, nuchal rigidity, and a positive Brudzinski sign. The priority intervention is: A. ICP monitoring B. Medical restraints
A patient with a subclavian central venous catheter develops facial swelling, headache, dyspnea, and jugular vein fullness. The nurse suspects the patient has: A. Deep vein thrombosis B. Pulmonary embolism C. Superior vena cava syndrome D. Catheter infection correct answer C. Superior vena cava syndrome -The main problem in superior vena cava syndrome is impaired return of venous blood from drainage areas like the head and neck, upper extremities, and upper thorax because of some sort of obstruction (In this case, a central venous catheter obstruction) -Symptoms occur due to back-up of blood and include facial swelling, dyspnea, cough, arm edema, and headache, full jugular veins, and engorgement of collateral veins. A patient with congestive heart failure would most likely exhibit all of the following clinical manifestations except: A. Increased urine output B. Decreased cardiac output C. Hepatomegaly D. Cardiomegaly correct answer A. Increased urine output
-Patients with congestive heart failure typically exhibit increased heart size, fluid volume overload with decreased urine output, and hepatomegaly-not increased urine output. A patient with status asthmatics is increasingly somnolent and only able to speak one word between breaths. The priority intervention is: A. Increasing the beta-agonist B. Chest tube placement C. Inhaled nitric oxide D. Intubation correct answer D. Intubation This patient is exhibiting changes in level of consciousness and worsening respiratory distress. The priority intervention at this point is intubation and airway protection. A chest tube may be needed if a pneumothorax develops. A recently admitted child has muscle weakness and a tall, peaked T. wave was observed on electrocardiogram. Which intervention do you anticipate? A. Administration of hypertonic saline B. Administration of potassium replacement C. Emergent cardioversion D. Removal of potassium from all IV fluids correct answer D. Removal of potassium from all IV fluids
D. Ensure parents use a lock box to store medication correct answer D. Ensure parents use a lock box to store medication -Medication should be kept in a lockbox so young children are unable to access it accidentally. -Part of the process of investigating a child's accidental ingestion includes a psychosocial and safety assessment, which may involve the social worker or the child protective team. A toddler was extubated 2 days ago after 10 days of mechanical ventilation for viral bronchiolitis. With your initial assessment, you note bleeding from the patient's nares and two large bruises on the chest, with petechiae on all extremities. Lab results demonstrate a normal PT/PTT and D-dimer, but the platelet count is significantly decreased. What do you suspect? A. Disseminated intravascular coagulopathy B. Thrombotic thrombocytopenic purpura C. Idiopathic thrombocytopenic purpura D. Hemolytic uremic syndrome correct answer C. Idiopathic thrombocytopenic purpura -ITP is an immune-mediated decrease in platelet count. -It often occurs following a viral infection. -Diagnostic studies will reveal a low platelet count, but normal PT/PTT and D- dimer.
A toddler who was found unresponsive in a swimming pool is in respiratory distress. On chest x-ray you see bilateral infiltrates and the PaO2/FiO2 ratio is 190. These findings suggest: A. Aspiration pneumonia B. Viral pneumonia C. Acute respiratory distress syndrome D. Pneumothorax correct answer C. Acute respiratory distress syndrome
- This child has signs of acute respiratory distress syndrome (ARDS), which include bilateral infiltrates on chest x-ray, PaO2/FiO2 ratio <200, and pulmonary edema, among other things.
- Both aspiration and viral pneumonia may lead to ARDS, but that's not the correct answer for this question.
- The symptoms described are not consistent with a pneumothorax. A traumatically injured 8-year-old is being cared for in the ICU. The nurse notes the child has an ICP of 18 mmHg, arterial blood pressure of 112/72 mmHg, with MAP of 86 mmHg and central venous pressure of 7 mmHg. The nurse calculates the cerebral perfusion pressure and anticipates which intervention? A. MRI evaluation B. Ongoing monitoring C. Emergent surgery D. Fluid bolus correct answer B. Ongoing monitoring
