CCRN Pediatric Certification Exam
Review (2026/2027) – Pediatric Critical
Care Nursing Certification | 125 Multiple-
Choice Questions with Correct Answers
and Detailed Rationales
1. A 4-year-old child is admitted to the PICU with respiratory distress. The
nurse notes inspiratory stridor, barking cough, and subcostal retractions. The
child is afebrile. What is the most likely diagnosis?
• A) Bacterial tracheitis
• B) Croup (laryngotracheobronchitis)
• C) Epiglottitis
• D) Foreign body aspiration
Correct ,,,answer,,,: B
Rationale: Croup typically presents with inspiratory stridor, barking cough, and
retractions, often at night. It is usually viral, and fever may be absent. Epiglottitis
(now rare due to Hib vaccine) presents with drooling, dysphagia, and high fever.
Bacterial tracheitis causes high fever and toxic appearance.
2. A 6-month-old infant with tetralogy of Fallot has a hypercyanotic “tet spell”
with oxygen saturation dropping to 65%. The infant is crying and irritable.
Which intervention should the nurse perform first?
, • A) Administer IV propranolol
• B) Place the infant in the knee-chest position
• C) Give a fluid bolus of 20 mL/kg normal saline
• D) Prepare for immediate intubation
Correct ,,,answer,,,: B
Rationale: The knee-chest position increases systemic vascular resistance (SVR),
which reduces right-to-left shunting and improves pulmonary blood flow. This is
the first non-pharmacologic intervention for a tet spell. Other measures include
oxygen, morphine, and fluid bolus if needed.
3. A 2-year-old child with septic shock has received two 20 mL/kg boluses of
isotonic crystalloid but remains hypotensive with poor perfusion. What is the
most appropriate next step?
• A) Administer a third fluid bolus
• B) Start norepinephrine infusion
• C) Start dopamine infusion
• D) Administer packed red blood cells
Correct ,,,answer,,,: B
Rationale: In fluid-refractory septic shock, vasoactive agents are indicated.
Norepinephrine is now recommended as the first-line vasopressor for pediatric
septic shock (2024 Surviving Sepsis Campaign guidelines) due to lower mortality
and arrhythmia risk compared to dopamine.
,4. A 10-year-old child is intubated and mechanically ventilated. The ventilator
alarms show high peak inspiratory pressure. The nurse assesses the child and
notes absent breath sounds on the left. What is the most likely cause?
• A) Right mainstem intubation
• B) Mucous plug in the left main bronchus
• C) Pneumothorax on the left
• D) Kinked endotracheal tube
Correct ,,,answer,,,: A
Rationale: Right mainstem intubation occurs when the ETT is advanced too far,
entering the right bronchus. This causes absent breath sounds on the left and high
peak pressures. Immediate verification of ETT depth (e.g., chest X-ray or
repositioning) is needed.
5. A 3-year-old child with status asthmaticus is receiving continuous albuterol
nebulization. The child develops tremors, tachycardia (heart rate 190 bpm),
and a potassium level of 2.9 mEq/L. Which intervention is most appropriate?
• A) Discontinue albuterol immediately
• B) Administer IV potassium replacement and continue albuterol
• C) Switch to levalbuterol
• D) Add IV magnesium sulfate
Correct ,,,answer,,,: B
Rationale: Albuterol causes beta-2 mediated intracellular shift of potassium,
leading to hypokalemia. The potassium should be replaced (IV cautiously) and
albuterol continued because it is essential for bronchodilation. Tremors and
tachycardia are expected side effects but not indications to stop.
, 6. A 5-year-old child with a traumatic brain injury has an intracranial
pressure (ICP) of 26 mm Hg, mean arterial pressure (MAP) of 65 mm Hg, and
cerebral perfusion pressure (CPP) of 39 mm Hg. What is the priority
intervention?
• A) Administer mannitol 0.5 g/kg IV
• B) Elevate head of bed to 30 degrees
• C) Increase sedation with fentanyl
• D) Administer a fluid bolus of normal saline
Correct ,,,answer,,,: D
Rationale: CPP = MAP – ICP. The CPP is dangerously low (<40 mm Hg).
Increasing MAP with a fluid bolus is the initial step. If MAP does not improve,
vasopressors may be needed. Mannitol would lower ICP further but could worsen
hypotension.
7. A 12-year-old child with diabetic ketoacidosis (DKA) has a blood glucose of
450 mg/dL, pH 7.20, and serum potassium of 3.5 mEq/L. The nurse starts an
insulin drip at 0.1 U/kg/hr. Which fluid and electrolyte management is most
appropriate initially?
• A) 0.9% normal saline with 20 mEq/L potassium chloride at 1.5 times
maintenance
• B) 0.45% normal saline with no potassium
• C) Dextrose 5% in 0.45% normal saline with 40 mEq/L potassium chloride
• D) Lactated Ringer’s solution at maintenance rate
Review (2026/2027) – Pediatric Critical
Care Nursing Certification | 125 Multiple-
Choice Questions with Correct Answers
and Detailed Rationales
1. A 4-year-old child is admitted to the PICU with respiratory distress. The
nurse notes inspiratory stridor, barking cough, and subcostal retractions. The
child is afebrile. What is the most likely diagnosis?
• A) Bacterial tracheitis
• B) Croup (laryngotracheobronchitis)
• C) Epiglottitis
• D) Foreign body aspiration
Correct ,,,answer,,,: B
Rationale: Croup typically presents with inspiratory stridor, barking cough, and
retractions, often at night. It is usually viral, and fever may be absent. Epiglottitis
(now rare due to Hib vaccine) presents with drooling, dysphagia, and high fever.
Bacterial tracheitis causes high fever and toxic appearance.
2. A 6-month-old infant with tetralogy of Fallot has a hypercyanotic “tet spell”
with oxygen saturation dropping to 65%. The infant is crying and irritable.
Which intervention should the nurse perform first?
, • A) Administer IV propranolol
• B) Place the infant in the knee-chest position
• C) Give a fluid bolus of 20 mL/kg normal saline
• D) Prepare for immediate intubation
Correct ,,,answer,,,: B
Rationale: The knee-chest position increases systemic vascular resistance (SVR),
which reduces right-to-left shunting and improves pulmonary blood flow. This is
the first non-pharmacologic intervention for a tet spell. Other measures include
oxygen, morphine, and fluid bolus if needed.
3. A 2-year-old child with septic shock has received two 20 mL/kg boluses of
isotonic crystalloid but remains hypotensive with poor perfusion. What is the
most appropriate next step?
• A) Administer a third fluid bolus
• B) Start norepinephrine infusion
• C) Start dopamine infusion
• D) Administer packed red blood cells
Correct ,,,answer,,,: B
Rationale: In fluid-refractory septic shock, vasoactive agents are indicated.
Norepinephrine is now recommended as the first-line vasopressor for pediatric
septic shock (2024 Surviving Sepsis Campaign guidelines) due to lower mortality
and arrhythmia risk compared to dopamine.
,4. A 10-year-old child is intubated and mechanically ventilated. The ventilator
alarms show high peak inspiratory pressure. The nurse assesses the child and
notes absent breath sounds on the left. What is the most likely cause?
• A) Right mainstem intubation
• B) Mucous plug in the left main bronchus
• C) Pneumothorax on the left
• D) Kinked endotracheal tube
Correct ,,,answer,,,: A
Rationale: Right mainstem intubation occurs when the ETT is advanced too far,
entering the right bronchus. This causes absent breath sounds on the left and high
peak pressures. Immediate verification of ETT depth (e.g., chest X-ray or
repositioning) is needed.
5. A 3-year-old child with status asthmaticus is receiving continuous albuterol
nebulization. The child develops tremors, tachycardia (heart rate 190 bpm),
and a potassium level of 2.9 mEq/L. Which intervention is most appropriate?
• A) Discontinue albuterol immediately
• B) Administer IV potassium replacement and continue albuterol
• C) Switch to levalbuterol
• D) Add IV magnesium sulfate
Correct ,,,answer,,,: B
Rationale: Albuterol causes beta-2 mediated intracellular shift of potassium,
leading to hypokalemia. The potassium should be replaced (IV cautiously) and
albuterol continued because it is essential for bronchodilation. Tremors and
tachycardia are expected side effects but not indications to stop.
, 6. A 5-year-old child with a traumatic brain injury has an intracranial
pressure (ICP) of 26 mm Hg, mean arterial pressure (MAP) of 65 mm Hg, and
cerebral perfusion pressure (CPP) of 39 mm Hg. What is the priority
intervention?
• A) Administer mannitol 0.5 g/kg IV
• B) Elevate head of bed to 30 degrees
• C) Increase sedation with fentanyl
• D) Administer a fluid bolus of normal saline
Correct ,,,answer,,,: D
Rationale: CPP = MAP – ICP. The CPP is dangerously low (<40 mm Hg).
Increasing MAP with a fluid bolus is the initial step. If MAP does not improve,
vasopressors may be needed. Mannitol would lower ICP further but could worsen
hypotension.
7. A 12-year-old child with diabetic ketoacidosis (DKA) has a blood glucose of
450 mg/dL, pH 7.20, and serum potassium of 3.5 mEq/L. The nurse starts an
insulin drip at 0.1 U/kg/hr. Which fluid and electrolyte management is most
appropriate initially?
• A) 0.9% normal saline with 20 mEq/L potassium chloride at 1.5 times
maintenance
• B) 0.45% normal saline with no potassium
• C) Dextrose 5% in 0.45% normal saline with 40 mEq/L potassium chloride
• D) Lactated Ringer’s solution at maintenance rate
