CCRN Pediatric Practice Exam Questions from AACN, All Answered & Explained

CCRN Pediatric Practice Exam Questions from AACN, All Answered & Explained-A 1-month old infant presents with failure to thrive, frequent vomiting and irritability since birth. The mother reports having another infant wi ...

CCRN Pediatric Practice Exam Questions from AACN, All Answered & Explained-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 - 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 1-year-old who is ventilator dependent has been hospitalized since birth. The physician has indicated that the patient will be discharged home with a tracheostomy and a gastrostomy in one week. In order to determine the discharge needs of the patient, the nurse should arrange for: A) Home nursing care for the first few days following discharge B) A social worker to meet with the family and assess adequacy of the home environment C) An outreach educator to determine the learning needs of the family D) A multidisciplinary care conference before discharge - Answer: B) A social worker to meet with the family and assess adequacy of the home environment: The first predischarge priority for a technology-dependent child is to assess the adequacy of the home environemtn. Further discharge planning is then based on the needs of the patient and family. A) Home nursing care for the first few days following discharge: While home nursing care may be needed after discharge, the first predischarge priority in this scenario is to evaluate the home environment. From there, a determination can be made about nursing care that will be needed at home. The home may not be adequate for a safe transition for the infant. C) An outreach educator to determine the learning needs of the family: Education may be necessary before discharging a technology-dependent child, but that cannot be determined without further information about the patient's home environment and family needs. D) A multidisciplinary care conference before discharge: This is not consistent with Systems Thinking. Waiting until discharge for a multidisciplinary conference will not allow the family adequate time to prepare to meet the complex needs of the child at home. A 2-year-old with left-sided ventricular heart failure and pulmonary edema is experiencing extreme dyspnea. Which of the following would the nurse suggest to improve the work of breathing and decrease the child's anxiety and agitation? A) Digoxin (Lanoxin) B) Morphine (Duramorph) C) Furosemide (Lasix) D) Dobutamine (Dobutrex) - Answer: B) Morphine (Duramorph): Morphine relaxes the smooth muscles in the bronchial tubes, making the work of breathing easier, and it helps to control associated anxiety and agitation. A) Digoxin (Lanoxin): Digoin is a cardiac glycoside, which improves cardiac contractility and may be indicated for this patient. However, digoxin is not specifically used to treat dyspnea or anxiety/agitation. C) Furosemide (Lasix): Furosemide, a diuretic that blocks reabsorption of sodium and water, may be indicated for this patient, but is not specifically used to treat dyspnea or anxiety/agitation. D) Dobutamine (Dobutrex): Dobutamine has selective beta-adrenergic effects, which increase cardiac contractility. Dobutamine may be indicated for this patient but is not specifically used to treat dyspnea or anxiety/agitation. 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) - 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 A 10-day-old infant is admitted with a suspected congenital heart defect, due to a history of poor feeding and sudden onsent of respiratory distress and cyanosis. Initial assessment shows: HR: 180 pH: 7.28 RR: 72 pCO2: 30 BP: 48/ Doppler pO2: 48 CRT: greater than 5 sec HCO3: 16 The patient is intubated and placed on mechanical ventilation. Settings are as follows: rate of 20, PIP/PEEP: 24/4 cmH20, Fio2: 100%. Subsequent ABG results show: pH: 7.27 pCO2: 28 pO2: 50 HCO3: 15 The most probably etiology off the patient's cardiopulmonary status is which of the following? A) Tetrology of Fallot B) Hypoplasia C) Coarctation of aorta D) Transposition of the great arteries - Answer: B) Hypoplasia: Ten days after birth, the ductus arteriosus has closed, increasing pulmonary blood flow, and aortic flow and ysstemic perfusion decreasing. This causes severe deterioration, including severe cyanosis, hypoxemia, acidosis, and low cardiac output. The hypoxemia does not improve with oxygen administration or mechanical ventilation. A) Tetralogy of Fallot: an infant with tetralogy of fallot will have hypercapnia during a hypoxemic spell ("tet" spell). This patient has lower than normal pCO2. C) Coarctation of the Aorta: Patients with coarctation of the aorta present with poor feeding, tachypnea, pallow, listlessness, acidosis, and weak or absent lower extremity pulses, but not sudden onset of respiratory distress. D) Transposition of the great arteries: In patients with transposition of the great arteries, cyanosis will not improve with oxygen administration. But oxygen administration helps decrease pulmonary vascular resistance, leading to increased pulmonary blood flow, which improves mixing of systemic and venous blood and improves arterial oxygen saturation. A 15 yo patient underwent a classic Fontan repair of tricuspid atresia 12 hours ago. The patient is cool, diaphoretic, restless, mottled peripherally, with no 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-5 The 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 associated with 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 elevated CVP would not be seen with hypovolemic shock.