CCRN (Pediatric) - Direct Care Eligibility Pathway Exam Questions and Answers
A patient with suspected abdominal compartment syndrome has a bladder pressure of 8 mmHg. Which of the following actions should the nurse take first?
An 8-year-old patient who sustained intracerebral hemorrhage after a traumatic incident was intubated in the field. Head CT scan showed a 5 mm midline shift. The patient is difficult to arouse but pulls away from noxious stimuli. The most concerning sign of clinical deterioration is:
Early management of a child in septic shock includes:
A nursing practice council is reviewing a protocol for flushing unused IV lines. A team member questions the use of saline vs. dextrose. What should the council do first?
To lead a unit-based initiative to decrease central line-associated bloodstream infections, which of the following is the most appropriate approach?
A 2-month-old with ventricular septal defect (VSD) and CHF should be managed with:
A nurse preceptor and new nurse are caring for a 16-year-old patient following a crush injury. The lab report is significant for a creatine kinase (CK) level of 150 U/L and the patient’s urine is dark yellow. Vital signs are:
BP: 95/60
HR: 115
RR: 22
Temp: 100.5°F (38.1°C)
Which of the following statements by the new nurse is most correct?
A 6-year-old patient with ARDS has been mechanically ventilated for 10 days. The patient is being assessed for readiness to wean. The patient will open his eyes spontaneously but not to command. The pupils are equal and reactive but the patient is restless, sleeping only for short intervals. A nurse suspects the patient is demonstrating signs of:
Early symptoms of carbon monoxide poisoning include:
An adolescent patient presents with altered mental status following ingestion of unknown substances at a party. Lab values include an elevated serum ammonia. The nurse should anticipate an order for which of the following?
A child who nearly drowned received CPR, was resuscitated quickly, and regained consciousness. What should the nurse anticipate?
The primary function of an institutional ethics committee in the critical care area is to:
Following resuscitation of a 2-year-old near-drowning patient, which of the following changes is indicative of a poor neurologic outcome?
A child with ALL presents 1 week after chemo, fatigued and hypothermic. Initial expected nursing intervention?
A 10-year-old child presents with peri-umbilical pain, rebound tenderness, nausea, and fever up to 102°F (38.9°C). The pain prevents him from standing up straight. Which of the following should a nurse anticipate first?
A family member has not left a child’s bedside in 3 days and says, “I would leave, but I don’t know where to go.” The best nursing response is:
A patient on peritoneal dialysis has high blood glucose. Most likely cause is:
In a pediatric patient with viral myocarditis, clinical manifestations of decreased urine output, cool hands and feet, and pulmonary edema are most likely indicative of:
A young patient is admitted from the PACU to the ICU with complications following surgery. The parents are angry and confused as they were originally told by the surgeon their child was stable and the plan was to transfer the child to a regular room. How should the nurse best address the parents' concerns?
What is the best method to ensure parents of a child with a new tracheostomy are adequately prepared for home care?
The plan of care for a child with possible epiglottitis should include:
A 6-year-old child is admitted following ingestion of an unidentified substance. Assessment reveals:
BP: 120/84
HR: 190
RR: 44
ECG: Sinus rhythm with occasional PVCs
Dilated pupils
Dry mucous membranes
Disorientation
Urinary retention
These findings are consistent with ingestion of:
Following a MVC with prolonged entrapment of the legs, a 7-year-old has:
BP: 75/40
HR: 145
K⁺: 5.9 mEq/L
Hypocalcemia
Elevated CK
What urine output should the nurse expect?
The relationship between the family of a long-term patient and ICU healthcare providers has become strained. A nurse should first:
An infant is admitted with tonic-clonic movement of the lower extremities. The most likely etiology of the seizure is:
A patient exhibits acute hypervigilance, refusal of treatment, impulsive acts, and hallucinations alternating with lucidity. Family members argue about the hallucinations. The nurse should:
An infant with a sternal wound infection has a negative-pressure wound therapy device in place. A nurse should recognize that the primary purpose of the device is to speed healing of the wound through:
An infant with acute exacerbation of bronchopulmonary dysplasia (BPD) is placed on mechanical ventilation. The most appropriate ventilator strategy is:
A transgender adolescent requests to be addressed by preferred name/pronouns, different from medical record. What is the best response?
An irritable child has an acute fever, conjunctivitis, rash, and a strawberry tongue. A prolonged PR interval is observed on the ECG monitor. These findings are most likely due to:
A patient has a right groin central venous catheter with vasoactive infusions. The nurse notices swelling and increased circumference of the right thigh and calf. The first action should be to:
In a 3-year-old diagnosed with hemolytic uremic syndrome, which of the following findings requires immediate intervention?
CSF analysis shows: glucose 36 mg/dL, protein 110 mg/dL, and WBCs (PMNs) 1,000/microliters. These findings are indicative of:
A patient with restrictive cardiomyopathy is ambulating and begins to complain of fatigue and chest pain. A nurse should expect initial treatment to be aimed at:
A 2-day-old infant develops a tachycardia of 300. A 12-lead ECG reveals narrow complexes and prominent delta waves. The patient most likely has:
A patient’s mother shares with a nurse that the patient has been sleeping more than usual, and has expressed feelings of hopelessness and "unbearable pain". Which of the following is the priority nursing intervention?
While ventilating with 100% FiO₂ via Ambu bag, an intubated child desaturates. Breath sounds are decreased in all fields. What is the best action?
Which of the following interventions is most effective in preventing pulmonary vasospasm in an infant with persistent pulmonary hypertension of the newborn (PPHN)?
During an exchange transfusion for sickle cell crisis, the patient becomes anxious and reports tingling and numbness around the mouth. The nurse should administer:
A 2-year-old child in septic shock is receiving nitroprusside (Nipride). Which of the following findings indicates the need to increase the nitroprusside dosage?
A 12-year-old presents with behavior changes and new-onset tonic-clonic seizures. Likely brain tumor location?
An 18-month-old child is irritable and restless. Retractions, grunting with crackles, and an S3 gallop are noted. Vital signs:
BP: 70/56
HR: 160
RR: 60
Temp: 99°F (37.4°C)
Which of the following types of shock is this patient most likely experiencing?
Following a traumatic brain injury, an intubated 2-year-old patient requires an infusion of cisatracurium (Nimbex) to assist with intracranial pressure. On day 3, the ventilator’s mean airway pressure begins to alarm frequently and suctioning needs have increased. The patient’s vital signs are:
BP: 99/58
HR: 148
RR: 20
T: 102.2°F (39°C)
ICP: 19
CPP: 53
WBC: 22,000
Na⁺: 153 mEq/L
A nurse should anticipate the patient will require:
A patient on prolonged mechanical ventilation and in an unresponsive state is showing no signs of progression toward recovery. The healthcare team suggested a comfort care approach. Family members are conflicted. Which of the following should the nurse suggest as the next course of action?
High lead levels present a medical emergency because they are associated with the development of:
