CCRN-PEDIATRIC sample questions

Question 1

A 4-year-old child with septic shock and worsening encephalopathy requires rapid sequence intubation (RSI). When preparing the child for endotracheal intubation, which evidence-based practice aligns with current pediatric resuscitation standards?

Accepted Answer

Administering premedication with atropine to prevent vagally mediated or succinylcholine-induced bradycardia

Answer

Routine application of continuous firm cricoid pressure (Sellick maneuver) throughout mask ventilation

Answer

Using an uncuffed endotracheal tube exclusively to prevent subglottic tracheal ulceration

Answer

Hyperventilating the patient with 100% oxygen to achieve an ETCO2 less than 25 mm Hg prior to induction

Question 2

True or False: In a pediatric intensive care unit, continuous waveform capnography (ETCO2) monitoring is the recommended standard of care to confirm tracheal tube placement and continuously verify ongoing tube maintenance.

Accepted Answer

True

Answer

False

Question 3

An intubated 2-year-old patient receiving mechanical ventilation for severe pneumonia experiences sudden bradycardia, a drop in oxygen saturation from 96% to 68%, and loss of chest rise. The nurse initiates the DOPE algorithm to systematically troubleshoot the cause. Which sequence reflects the correct systematic assessment?

```mermaid
flowchart LR
Start[Acute Deterioration] --> Step1[Step 1: Check D]
Step1 --> Step2[Step 2: Check O]
Step2 --> Step3[Step 3: Check P]
Step3 --> Step4[Step 4: Check E]
```

Accepted Answer

Dislodgement/Displacement, Obstruction, Pneumothorax, Equipment failure

Answer

Disconnection, Oxygen failure, PEEP loss, Esophageal intubation

Answer

Dysrhythmia, Occlusion, Pulmonary edema, Endotracheal cuff leak

Answer

Desaturation, Overventilation, Peak airway pressure, Extubation

Question 4

A 3-year-old child admitted with idiopathic pulmonary arterial hypertension becomes acutely agitated. The nurse notices the systemic blood pressure plummeting, tachycardia, and peripheral cyanosis. Which pathophysiological sequence explains why distress triggers a pulmonary hypertensive crisis?

Accepted Answer

Increased catecholamines trigger an acute surge in pulmonary vascular resistance, inducing right ventricular failure and reduced left ventricular filling

Answer

Hyperventilation during distress causes extreme hypocapnia, which directly triggers acute bronchospasm and dynamic air trapping

Answer

Sympathetic surge causes sudden pulmonary vasodilation, flooding the left atrium and precipitating acute pulmonary edema

Answer

Agitation stimulates vagal tone, producing severe systemic vasodilation and excessive right ventricular volume overload

Question 5

A mechanically ventilated infant with severe pulmonary hypertension is receiving inhaled nitric oxide (iNO) at 20 ppm. The nurse understands that which property makes iNO uniquely advantageous compared to intravenous vasodilators?

Accepted Answer

It diffuses selectively into pulmonary vascular smooth muscle and is rapidly inactivated by hemoglobin, preventing systemic hypotension

Answer

It provides sustained systemic arterial vasodilation without requiring central venous catheter administration

Answer

It eliminates the risk of ventilation-perfusion mismatch by constricting capillaries in poorly ventilated alveoli

Answer

It converts rapidly into methemoglobin, which increases the affinity of red blood cells for oxygen delivery to peripheral tissues

Question 6

An 8-month-old infant with Down syndrome is 6 hours postoperative following complete surgical repair of a balanced atrioventricular septal defect. The patient is intubated on conventional mechanical ventilation. Arterial blood gas results show: pH 7.26, PaCO2 56 mm Hg, PaO2 62 mm Hg, and HCO3 24 mEq/L.

During endotracheal suctioning, the infant becomes restless. The bedside monitor displays an acute rise in pulmonary artery pressure from 28/14 mm Hg to 54/30 mm Hg (systemic arterial blood pressure falls from 82/46 mm Hg to 48/24 mm Hg). The pulse oximetry reading plummets from 95% to 64%, and heart rate drops to 65 beats/min with poor capillary refill.

The nurse immediately hand-ventilates the infant with 100% FiO2 and administers prescribed fentanyl and vecuronium. Which additional pharmacologic intervention is most urgently indicated to selectively reverse this acute crisis?

Accepted Answer

Initiation of inhaled nitric oxide (iNO)

Answer

Rapid fluid bolus with 0.9% normal saline at 20 mL/kg

Answer

Continuous intravenous infusion of sodium nitroprusside

Answer

Administration of high-dose intravenous epinephrine bolus

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Free CCRN-PEDIATRIC sample questions

A 4-year-old child with septic shock and worsening encephalopathy requires rapid sequence intubation (RSI). When preparing the child for endotracheal intubation, which evidence-based practice aligns with current pediatric resuscitation standards?

True or False: In a pediatric intensive care unit, continuous waveform capnography (ETCO2) monitoring is the recommended standard of care to confirm tracheal tube placement and continuously verify ongoing tube maintenance.

A 3-year-old child admitted with idiopathic pulmonary arterial hypertension becomes acutely agitated. The nurse notices the systemic blood pressure plummeting, tachycardia, and peripheral cyanosis. Which pathophysiological sequence explains why distress triggers a pulmonary hypertensive crisis?

A mechanically ventilated infant with severe pulmonary hypertension is receiving inhaled nitric oxide (iNO) at 20 ppm. The nurse understands that which property makes iNO uniquely advantageous compared to intravenous vasodilators?

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