CCRN PEDIATRIC PRACTICE EXAM
1. Clinical manifestations observed in a child diagnosed with failure to thrivemay include
A) Avoidance of eye contact and delayed motor development
B) Excessive crying and delayed language development
C) Distress when held of left alone
D) No interest in surroundings: Answer: A) Avoidance of eye contact and delayed motor
development: The clinical manifestations of failure to thrive may include growth failure, apathy,
avoidance of eye contact and delayed motor development
B) Excessive crying and delayed language development: The child may have ahistory of
excessive irritability and may cry during feedings. Delayed languagedevelopment is not
associated with failure to thrive.
C) Distress when held of left alone: When held these children may protest brieflywhen being
put down but are apathetic when left alone
D) No interest in surroundings: These children may display intense interest in inanimate
objects such as toys but are much less interested in social interactions
2. A nursing unit needs to be able to place patients back on ventilator support, as ordered,
while patients nap Due to staffing patters, the respiratorytherapist is not always available on the
unit to place patients on the ventilator.An appropriate response by the nurse would be to:
A) Place the patient on the ventilator when needed, despite current policy
B) Wait for the therapist to intervene.
C) Ask the parent to be responsible for this task.
D) Question the current policy that only respiratory therapists can manage theventilator.:
Answer: D) Question the current policy that only respiratory therapistscan manage the
ventilator: Clinical Inquiry is questioning the appropriateness of policies, guidelines, and
current practices to improve patient care
A) Place the patient on the ventilator when needed, despite current policy: This is not a Caring
Practice as the RN may not have the knowledge to perform this tasksafely
B) Wait for the therapist to intervene: This may not be satisfactory if the patienthypoventilates
during sleep.
C) Ask the parent to be responsible for this task: This response is not a safe or CaringPractice
3. A patient with bronchopulmonary dysplasia (BPD) is admitted with heartfailure. the
nurse can expect to perform interventions to:
A) Decrease Preload
B) Increase Afterload
C) Decrease Heart Rate
D) Increase Contractility: Answer: A) Decrease Preload: Decreasing the preload for a patient
with BPD will improve right-sided heart failure related to chronic lungdisease
B) Increase Afterload: Increasing afterload would impede ventricular ejection, mak- ing heart
failure worse.
C) Decrease heart rate: Decreasing the heart rate would decrease cardiac output (CO = HR x
,SV) which would worsen the patient's heart failure.
D) Increase contractility: Although increasing contractility may help improve left-sided heart
failure, patients with BPD usually have right-sided heart failure.
4. Factors that impair the release of oxygen to tissues by negatively affectingoxyhemoglobin
dissociation include:
A) Hyperthermia
B) Metabolic acidosis
C) Respiratory Acidosis
D) Hypothermia: Answer: D) Hypothermia: Hypothermia shifts the oxyhemoglobin
dissociation curve to the left, resulting in oxygen that is more tightly bound to hemoglobin
A) Hyperthermia: Hyperthermia shifts the oxyhemoglobin dissociation curve to theright,
resulting in hemoglobin that has less affinity for oxygen
B) Metabolic Acidosis: Acidosis shifts the oxyhemoglobin dissociation curve tot ehright,
resulting in hemoglobin that has less affinity for oxygen
C) Respiratory Acidosis: Acidosis shifts the oxyhemoglobin dissociation curve to theright,
resulting in hemoglobin that has less affinity for oxygen
5. A 15 yo patient underwent a classic Fontan repair of tricuspid atresia 12 hours ago. The
patient is cool, diaphoretic, restless, mottled peripherally, withno 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-5The 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 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 associatedwith 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 elevatedCVP would not be seen
with hypovolemic shock.
, 6. While performing an exchange transfusion for a patient with sickle cell disease, which of
the following electrolyte abnormalities should the nurseanticipate?
A) Hypocalcemia
B) Hypercalcemia
C) Hypokalemia
D) Hypomagnesemia: Answer: A) Hypocalcemia: metabolic complications of bloodtransfusion
include hypocalcemia
B) Hypercalcemia: Hypocalcemia is a complication of blood transfusion.
C) Hypokalemia: Hyperkalemia is a complication of blood transfusion.
D) Hypomagnesemia: This is not a complication of blood transfusion
7. An adolescent with a history of admission for chronic status asthmaticusis being prepared
for discharge. The nurse determines that the patient has not been compliant with medications,
because doing so "makes him feel toodifferent" from his peers. The nurse should:
A) Arrange for the patient's school nurse to monitor compliance
B) Provide the patient with articles on the relationship of hospitalization andmedication
compliance.
C) refer the patient to a support group for adolescents with asthma
D) Advise the parents to withhold privileges if the patient remains non-compli- ant.: Answer: C)
Refer the patient to a support group for adolescents with asthma: this intervention will help
normalize the experience and increase compliance
A) Arrange for the patient's school nurse to monitor compliance: This will not helpwith the
issue causing noncompliance and may worsen the problem.
B) Provide the patient with articles on the relationship of hospitalization and med-ication
compliance: Parents and older children often need education about eh maintenance aspect of
asthma management to be reinforced.
D) Advise the parents to withhold privileges if the patient remains non-compliant: Formost
children, withholding privileges is not a motivator to promote compliance.
8. Amrinone lactate (Inocor) is given for which desired effect?
A) Vasodilation
B) Phospholipid inhibition
C) Decreased myocardial contractility
D) Catecholamine antagonism: Answer: A) Vasodilation: Amrinone is a phosphodiesterase
inhibitor that increases intercellular cAMP and delays uptake of intercellular calcium, resulting
in improved cardiac contractility and vasodilation.
B) Phospholipid Inhibition: This is not an effect of amrinone administration
C) Decreased myocardial contractility: This is not an effect of amrinone administration.
D) Catecholamine antagonism: This is not an effect of amrinone administration
9. A family meeting is planned to discuss the family's ethical concerns regarding continuing
life support measures for a child with end-stage cancer.The nurse's role should be to:
A) Provide the legal standpoint regarding end-of-life decisions for children.
1. Clinical manifestations observed in a child diagnosed with failure to thrivemay include
A) Avoidance of eye contact and delayed motor development
B) Excessive crying and delayed language development
C) Distress when held of left alone
D) No interest in surroundings: Answer: A) Avoidance of eye contact and delayed motor
development: The clinical manifestations of failure to thrive may include growth failure, apathy,
avoidance of eye contact and delayed motor development
B) Excessive crying and delayed language development: The child may have ahistory of
excessive irritability and may cry during feedings. Delayed languagedevelopment is not
associated with failure to thrive.
C) Distress when held of left alone: When held these children may protest brieflywhen being
put down but are apathetic when left alone
D) No interest in surroundings: These children may display intense interest in inanimate
objects such as toys but are much less interested in social interactions
2. A nursing unit needs to be able to place patients back on ventilator support, as ordered,
while patients nap Due to staffing patters, the respiratorytherapist is not always available on the
unit to place patients on the ventilator.An appropriate response by the nurse would be to:
A) Place the patient on the ventilator when needed, despite current policy
B) Wait for the therapist to intervene.
C) Ask the parent to be responsible for this task.
D) Question the current policy that only respiratory therapists can manage theventilator.:
Answer: D) Question the current policy that only respiratory therapistscan manage the
ventilator: Clinical Inquiry is questioning the appropriateness of policies, guidelines, and
current practices to improve patient care
A) Place the patient on the ventilator when needed, despite current policy: This is not a Caring
Practice as the RN may not have the knowledge to perform this tasksafely
B) Wait for the therapist to intervene: This may not be satisfactory if the patienthypoventilates
during sleep.
C) Ask the parent to be responsible for this task: This response is not a safe or CaringPractice
3. A patient with bronchopulmonary dysplasia (BPD) is admitted with heartfailure. the
nurse can expect to perform interventions to:
A) Decrease Preload
B) Increase Afterload
C) Decrease Heart Rate
D) Increase Contractility: Answer: A) Decrease Preload: Decreasing the preload for a patient
with BPD will improve right-sided heart failure related to chronic lungdisease
B) Increase Afterload: Increasing afterload would impede ventricular ejection, mak- ing heart
failure worse.
C) Decrease heart rate: Decreasing the heart rate would decrease cardiac output (CO = HR x
,SV) which would worsen the patient's heart failure.
D) Increase contractility: Although increasing contractility may help improve left-sided heart
failure, patients with BPD usually have right-sided heart failure.
4. Factors that impair the release of oxygen to tissues by negatively affectingoxyhemoglobin
dissociation include:
A) Hyperthermia
B) Metabolic acidosis
C) Respiratory Acidosis
D) Hypothermia: Answer: D) Hypothermia: Hypothermia shifts the oxyhemoglobin
dissociation curve to the left, resulting in oxygen that is more tightly bound to hemoglobin
A) Hyperthermia: Hyperthermia shifts the oxyhemoglobin dissociation curve to theright,
resulting in hemoglobin that has less affinity for oxygen
B) Metabolic Acidosis: Acidosis shifts the oxyhemoglobin dissociation curve tot ehright,
resulting in hemoglobin that has less affinity for oxygen
C) Respiratory Acidosis: Acidosis shifts the oxyhemoglobin dissociation curve to theright,
resulting in hemoglobin that has less affinity for oxygen
5. A 15 yo patient underwent a classic Fontan repair of tricuspid atresia 12 hours ago. The
patient is cool, diaphoretic, restless, mottled peripherally, withno 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-5The 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 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 associatedwith 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 elevatedCVP would not be seen
with hypovolemic shock.
, 6. While performing an exchange transfusion for a patient with sickle cell disease, which of
the following electrolyte abnormalities should the nurseanticipate?
A) Hypocalcemia
B) Hypercalcemia
C) Hypokalemia
D) Hypomagnesemia: Answer: A) Hypocalcemia: metabolic complications of bloodtransfusion
include hypocalcemia
B) Hypercalcemia: Hypocalcemia is a complication of blood transfusion.
C) Hypokalemia: Hyperkalemia is a complication of blood transfusion.
D) Hypomagnesemia: This is not a complication of blood transfusion
7. An adolescent with a history of admission for chronic status asthmaticusis being prepared
for discharge. The nurse determines that the patient has not been compliant with medications,
because doing so "makes him feel toodifferent" from his peers. The nurse should:
A) Arrange for the patient's school nurse to monitor compliance
B) Provide the patient with articles on the relationship of hospitalization andmedication
compliance.
C) refer the patient to a support group for adolescents with asthma
D) Advise the parents to withhold privileges if the patient remains non-compli- ant.: Answer: C)
Refer the patient to a support group for adolescents with asthma: this intervention will help
normalize the experience and increase compliance
A) Arrange for the patient's school nurse to monitor compliance: This will not helpwith the
issue causing noncompliance and may worsen the problem.
B) Provide the patient with articles on the relationship of hospitalization and med-ication
compliance: Parents and older children often need education about eh maintenance aspect of
asthma management to be reinforced.
D) Advise the parents to withhold privileges if the patient remains non-compliant: Formost
children, withholding privileges is not a motivator to promote compliance.
8. Amrinone lactate (Inocor) is given for which desired effect?
A) Vasodilation
B) Phospholipid inhibition
C) Decreased myocardial contractility
D) Catecholamine antagonism: Answer: A) Vasodilation: Amrinone is a phosphodiesterase
inhibitor that increases intercellular cAMP and delays uptake of intercellular calcium, resulting
in improved cardiac contractility and vasodilation.
B) Phospholipid Inhibition: This is not an effect of amrinone administration
C) Decreased myocardial contractility: This is not an effect of amrinone administration.
D) Catecholamine antagonism: This is not an effect of amrinone administration
9. A family meeting is planned to discuss the family's ethical concerns regarding continuing
life support measures for a child with end-stage cancer.The nurse's role should be to:
A) Provide the legal standpoint regarding end-of-life decisions for children.
