CCRN PEDIATRIC EXAM WITH VERIFIED
EXPLANATIONS UPDATED QUESTION BANK
QUESTIONS & DETAILED ANSWERS
1. 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: 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 inter-
vention 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
2. 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): 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
3. 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: 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
C) Pulmonary Embolism: Symptoms of pulmonary embolism include chest pain
and dyspnea on exertion, not left shoulder pain
4. An 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) Airway Patency: Answer: D) Airway Patency: The first priority after admitting
an infant with encephalitis is to assess the patient's ability to maintain airway
patency. Such patients can develop rapid neurologic deterioration, and the
nurse must be prepared to support the airway, oxygenation, and ventilation as
needed.
A) Pupillary Response: The infant with encephalitis should be monitored for
changes in neurologic status, including pupillary response. However, assessing the
patient;s ability to maintain airway patency is the first priority.
B) Blood Glucose Level: The infant with encephalitis will need blood glucose
levels monitored, especially if unable to maintain adequate oral intake. However,
assessing the patient's ability to maintain airway patency is the first priority.
, C) Level of consciousness: The infant with encephalitis should be monitored for
changes in neurologic status, including assessment of the level of consciousness.
However, assessing the patient's ability to maintain airway patency is the first
priority.
5. The pediatric patient with suspected asphyxia from smoke inhalation will
typically present with:
A) Tachypnea
B) Cyanosis
C) Confusion
D) Hypotension: Answer: C) Confusion: The patient with asphyxia from smoke
inhalation will experience cerebral hypoxemia and demonstrate symptoms of
neurologic dysfunction, including confusion
A) Tachypnea: While the patient with smoke inhalation may experience
tachypnea as a result of damage to the lung parenchyma, this symptoms is not
specific to asphyxia
B) Cyanosis: While the patient with smoke inhalation may experience cyanosis
as a result of damage to the lung parenchyma, this symptoms is not specific to
asphyxia D) Hypotension: While the patient with smoke inhalation and a burn
injury may demonstrate hypotension from fluid shifts, this symptoms is not specific
to asphyxia
6. 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
communityD) Ongoing classes addressing the cultural needs of the
community: 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
EXPLANATIONS UPDATED QUESTION BANK
QUESTIONS & DETAILED ANSWERS
1. 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: 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 inter-
vention 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
2. 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): 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
3. 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: 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
C) Pulmonary Embolism: Symptoms of pulmonary embolism include chest pain
and dyspnea on exertion, not left shoulder pain
4. An 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) Airway Patency: Answer: D) Airway Patency: The first priority after admitting
an infant with encephalitis is to assess the patient's ability to maintain airway
patency. Such patients can develop rapid neurologic deterioration, and the
nurse must be prepared to support the airway, oxygenation, and ventilation as
needed.
A) Pupillary Response: The infant with encephalitis should be monitored for
changes in neurologic status, including pupillary response. However, assessing the
patient;s ability to maintain airway patency is the first priority.
B) Blood Glucose Level: The infant with encephalitis will need blood glucose
levels monitored, especially if unable to maintain adequate oral intake. However,
assessing the patient's ability to maintain airway patency is the first priority.
, C) Level of consciousness: The infant with encephalitis should be monitored for
changes in neurologic status, including assessment of the level of consciousness.
However, assessing the patient's ability to maintain airway patency is the first
priority.
5. The pediatric patient with suspected asphyxia from smoke inhalation will
typically present with:
A) Tachypnea
B) Cyanosis
C) Confusion
D) Hypotension: Answer: C) Confusion: The patient with asphyxia from smoke
inhalation will experience cerebral hypoxemia and demonstrate symptoms of
neurologic dysfunction, including confusion
A) Tachypnea: While the patient with smoke inhalation may experience
tachypnea as a result of damage to the lung parenchyma, this symptoms is not
specific to asphyxia
B) Cyanosis: While the patient with smoke inhalation may experience cyanosis
as a result of damage to the lung parenchyma, this symptoms is not specific to
asphyxia D) Hypotension: While the patient with smoke inhalation and a burn
injury may demonstrate hypotension from fluid shifts, this symptoms is not specific
to asphyxia
6. 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
communityD) Ongoing classes addressing the cultural needs of the
community: 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
