CCRN Pediatric Practice Exam Questions from
AACN 150 Questions, Answers, and Rationale from
AACN Practice Book
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
D) Pulmonary Embolism: Symptoms of pulmonary embolism include chest pain and dyspnea on
exertion, not left shoulder pain
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 Correct Answer: 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.
The pediatric patient with suspected asphyxia from smoke inhalation will typically present with:
A) Tachypnea
B) Cyanosis
C) Confusion
D) Hypotension Correct Answer: 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
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
AACN 150 Questions, Answers, and Rationale from
AACN Practice Book
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
D) Pulmonary Embolism: Symptoms of pulmonary embolism include chest pain and dyspnea on
exertion, not left shoulder pain
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 Correct Answer: 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.
The pediatric patient with suspected asphyxia from smoke inhalation will typically present with:
A) Tachypnea
B) Cyanosis
C) Confusion
D) Hypotension Correct Answer: 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
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
