CCRN Pediatric Practice Exam Questions from AACN and Answers – 100% Solved
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 - ✔✔✔-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 1-year-old who is ventilator dependent has been hospitalized since birth. The physician has
indicated that the patient will be discharged home with a tracheostomy and a gastrostomy in
one week. In order to determine the discharge needs of the patient, the nurse 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 adequacy of the home environment
C) An outreach educator to determine the learning needs of the family
D) A multidisciplinary care conference before discharge - ✔✔✔-Answer: B) A social worker to
meet with the family and assess adequacy of the home environment: The first predischarge
priority for a technology-dependent child is to assess the adequacy of the home environemtn.
Further discharge planning is then based on the needs of the patient and family.
A) Home nursing care for the first few days following discharge: While home nursing care may
be needed after discharge, the first predischarge priority in this scenario is to evaluate the home
environment. From there, a determination can be made about nursing care that will be needed
at home. The home may not be adequate for a safe transition for the infant.
C) An outreach educator to determine the learning needs of the family: Education may be
necessary before discharging a technology-dependent child, but that cannot be determined
without further information about the patient's home environment and family needs.
,CCRN Pediatric Practice Exam Questions from AACN and Answers – 100% Solved
D) A multidisciplinary care conference before discharge: This is not consistent with Systems
Thinking. Waiting until discharge for a multidisciplinary conference will not allow the family
adequate time to prepare to meet the complex needs of the child at home.
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: 7.28
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. Settings are as follows: rate of
20, PIP/PEEP: 24/4 cmH20, Fio2: 100%.
Subsequent ABG results show:
pH: 7.27
pCO2: 28
pO2: 50
HCO3: 15
The most probably etiology off the patient's cardiopulmonary status is which of the following?
A) Tetrology of Fallot
B) Hypoplasia
,CCRN Pediatric Practice Exam Questions from AACN and Answers – 100% Solved
C) Coarctation of aorta
D) Transposition of the great arteries - ✔✔✔-Answer: B) Hypoplasia: Ten days after birth, the
ductus arteriosus has closed, increasing pulmonary blood flow, and aortic flow and ysstemic
perfusion decreasing. This causes severe deterioration, including severe cyanosis, hypoxemia,
acidosis, and low cardiac output. The hypoxemia does not improve with oxygen administration
or mechanical ventilation.
A) Tetralogy of Fallot: an infant with tetralogy of fallot will have hypercapnia during a hypoxemic
spell ("tet" spell). This patient has lower than normal pCO2.
C) Coarctation of the Aorta: Patients with coarctation of the aorta present with poor feeding,
tachypnea, pallow, listlessness, acidosis, and weak or absent lower extremity pulses, but not
sudden onset of respiratory distress.
D) Transposition of the great arteries: In patients with transposition of the great arteries,
cyanosis will not improve with oxygen administration. But oxygen administration helps decrease
pulmonary vascular resistance, leading to increased pulmonary blood flow, which improves
mixing of systemic and venous blood and improves arterial oxygen saturation.
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/m2
SVR: 2000 dynes/sec/cm-5
The nurse should suspect:
A) A pulmonary embolus
B) Cardiac Tamponade
C) Cardiogenic Shock
D) Hypovolemic Shock - ✔✔✔-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
, CCRN Pediatric Practice Exam Questions from AACN and Answers – 100% Solved
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.
A 2-year-old with left-sided ventricular heart failure and pulmonary edema is experiencing
extreme dyspnea. Which of the following would the nurse suggest to improve the work of
breathing and decrease the child's anxiety and agitation?
A) Digoxin (Lanoxin)
B) Morphine (Duramorph)
C) Furosemide (Lasix)
D) Dobutamine (Dobutrex) - ✔✔✔-Answer: B) Morphine (Duramorph): Morphine relaxes the
smooth muscles in the bronchial tubes, making the work of breathing easier, and it helps to
control associated anxiety and agitation.
A) Digoxin (Lanoxin): Digoin is a cardiac glycoside, which improves cardiac contractility and may
be indicated for this patient. However, digoxin is not specifically used to treat dyspnea or
anxiety/agitation.
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.
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 - ✔✔✔-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 1-year-old who is ventilator dependent has been hospitalized since birth. The physician has
indicated that the patient will be discharged home with a tracheostomy and a gastrostomy in
one week. In order to determine the discharge needs of the patient, the nurse 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 adequacy of the home environment
C) An outreach educator to determine the learning needs of the family
D) A multidisciplinary care conference before discharge - ✔✔✔-Answer: B) A social worker to
meet with the family and assess adequacy of the home environment: The first predischarge
priority for a technology-dependent child is to assess the adequacy of the home environemtn.
Further discharge planning is then based on the needs of the patient and family.
A) Home nursing care for the first few days following discharge: While home nursing care may
be needed after discharge, the first predischarge priority in this scenario is to evaluate the home
environment. From there, a determination can be made about nursing care that will be needed
at home. The home may not be adequate for a safe transition for the infant.
C) An outreach educator to determine the learning needs of the family: Education may be
necessary before discharging a technology-dependent child, but that cannot be determined
without further information about the patient's home environment and family needs.
,CCRN Pediatric Practice Exam Questions from AACN and Answers – 100% Solved
D) A multidisciplinary care conference before discharge: This is not consistent with Systems
Thinking. Waiting until discharge for a multidisciplinary conference will not allow the family
adequate time to prepare to meet the complex needs of the child at home.
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: 7.28
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. Settings are as follows: rate of
20, PIP/PEEP: 24/4 cmH20, Fio2: 100%.
Subsequent ABG results show:
pH: 7.27
pCO2: 28
pO2: 50
HCO3: 15
The most probably etiology off the patient's cardiopulmonary status is which of the following?
A) Tetrology of Fallot
B) Hypoplasia
,CCRN Pediatric Practice Exam Questions from AACN and Answers – 100% Solved
C) Coarctation of aorta
D) Transposition of the great arteries - ✔✔✔-Answer: B) Hypoplasia: Ten days after birth, the
ductus arteriosus has closed, increasing pulmonary blood flow, and aortic flow and ysstemic
perfusion decreasing. This causes severe deterioration, including severe cyanosis, hypoxemia,
acidosis, and low cardiac output. The hypoxemia does not improve with oxygen administration
or mechanical ventilation.
A) Tetralogy of Fallot: an infant with tetralogy of fallot will have hypercapnia during a hypoxemic
spell ("tet" spell). This patient has lower than normal pCO2.
C) Coarctation of the Aorta: Patients with coarctation of the aorta present with poor feeding,
tachypnea, pallow, listlessness, acidosis, and weak or absent lower extremity pulses, but not
sudden onset of respiratory distress.
D) Transposition of the great arteries: In patients with transposition of the great arteries,
cyanosis will not improve with oxygen administration. But oxygen administration helps decrease
pulmonary vascular resistance, leading to increased pulmonary blood flow, which improves
mixing of systemic and venous blood and improves arterial oxygen saturation.
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/m2
SVR: 2000 dynes/sec/cm-5
The nurse should suspect:
A) A pulmonary embolus
B) Cardiac Tamponade
C) Cardiogenic Shock
D) Hypovolemic Shock - ✔✔✔-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
, CCRN Pediatric Practice Exam Questions from AACN and Answers – 100% Solved
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.
A 2-year-old with left-sided ventricular heart failure and pulmonary edema is experiencing
extreme dyspnea. Which of the following would the nurse suggest to improve the work of
breathing and decrease the child's anxiety and agitation?
A) Digoxin (Lanoxin)
B) Morphine (Duramorph)
C) Furosemide (Lasix)
D) Dobutamine (Dobutrex) - ✔✔✔-Answer: B) Morphine (Duramorph): Morphine relaxes the
smooth muscles in the bronchial tubes, making the work of breathing easier, and it helps to
control associated anxiety and agitation.
A) Digoxin (Lanoxin): Digoin is a cardiac glycoside, which improves cardiac contractility and may
be indicated for this patient. However, digoxin is not specifically used to treat dyspnea or
anxiety/agitation.
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.
