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Quiz Session - Attempts With Random Questions

AACN CCRN (Pediatric) Exam Questions

Page 2 of 20

21.

What term is characterized by fair treatment without discrimination?

  • Justice

  • Veracity

  • Fidelity

  • Autonomy

Correct answer: Justice

Justice, which is fair treatment without discrimination, focuses on the fair distribution of the benefits, risks, and costs among members of society in relation to healthcare needs. 

Veracity is best described as being truthful, being honest, and having integrity. Fidelity is an obligation to care to the best of one's ability and to keep one's promises. Autonomy is self-determination and freedom of choice.

22.

Guidelines for assessing pain in an infant include all the following, EXCEPT:

  • Assess and document pain only when obtaining vital signs

  • Assess pain after each potentially painful clinical intervention

  • Use standardized pain assessments with evidence of validity, reliability, and clinical utility

  • Reevaluate pain after interventions to assess their efficacy

Correct answer: Assess and document pain only when obtaining vital signs

Pain should be documented and assessed with vital signs every four to six hours or as indicated by pain scores and/or the infant's clinical condition. The other choices are accurate guidelines for assessing pain.

23.

A pediatric critical care nurse is developing a plan of care for an 11-year-old child admitted to the PICU with the syndrome of inappropriate antidiuretic hormone (SIADH). What would be a potential nursing diagnosis for this patient? 

  • Fluid volume excess

  • Deficient fluid volume 

  • Risk for impaired skin integrity 

  • Acute pain 

Correct answer: Fluid volume excess

SIADH is a disorder of impaired water excretion caused by the inability to suppress the secretion of antidiuretic hormone (ADH). If water intake exceeds the reduced urine output, the ensuing water retention leads to hyponatremia. 

This syndrome should be suspected in any child presenting with hyponatremia, hypoosmolality, and a urine osmolality above 100 mOsmol/kg. In SIADH, the urine sodium concentration is usually above 40 mEq/L, serum potassium concentration is normal, there is no acid-base disturbance, and the serum uric acid concentration is often low. 

Nursing diagnoses include fluid and volume excess and congestive heart failure related to excessive ADH secretion and water retention. Other potential diagnoses include an alteration in mental state related to underlying conditions, hyponatremia, or acute changes in serum osmolality; potential for seizures related to hyponatremia; and potential for cerebral hemorrhage that results from correcting the hypoosmolar state too rapidly. 

24.

A nurse is caring for an infant with DiGeorge syndrome (DGS). Which of the following electrolyte imbalances is caused by an aplastic or hypoplastic parathyroid gland that often accompanies this syndrome?

  • Hypocalcemia 

  • Hypercalcemia 

  • Hypokalemia 

  • Hyperkalemia 

Correct answer: Hypocalcemia 

DGS, a genetic disorder caused by a microdeletion on chromosome 22, is characterized by a conotruncal heart defect, hypocalcemia (due to hypoparathyroidism), and thymic hypoplasia. This defect is detected by fluorescence in situ hybridization (FISH), which is a molecular cytogenetic test.

DGS occurs in 1 in 1,000 fetuses and is the most commonly occurring microdeletion syndrome in humans. Potassium is not generally affected by DGS. 

25.

A nurse is providing care to an intubated and mechanically ventilated child for the treatment and management of pediatric acute respiratory distress syndrome (PARDS). The child's respiratory function has continued to deteriorate over the past 24 hours, and the physician has ordered arterial blood gases (ABGs) for reassessment. 

The ABG results that are expected with this diagnosis will correlate with which of the following acid-base imbalances? 

  • Respiratory acidosis

  • Respiratory alkalosis 

  • Metabolic alkalosis 

  • Metabolic acidosis 

Correct answer: Respiratory acidosis

ARDS is respiratory failure due to diffuse alveolar-capillary membrane injury, causing permeability or elevated protein pulmonary edema. Management may include high positive end-expiratory pressure (PEEP) with low tidal volume, high-frequency oscillation ventilation (HFOV), permissive hypercapnia, and hemodynamic monitoring. 

Respiratory acidosis occurs in later stages of PARDS when CO2 levels rise high enough to lower the serum pH below 7.35. Increased CO2 can be the result of CNS depression, intrinsic airway disease, chest wall instability, a compromised diaphragm, compromised upper airway muscle function, or alveolar disease. 

26.

A pediatric critical care nurse is caring for a child with central diabetes insipidus (DI). The nurse is administering maintenance intravenous fluids slowly to correct the patient's hypernatremia and monitoring the child's laboratory values closely to ensure sodium levels fall no faster than which value?

  • 0.5 mEq/L per hour over 48 to 72 hours 

  • 0.5 mEq/L per hour over 12 to 24 hours 

  • 1 mEq/L per hour over 48 to 72 hours 

  • 1 mEq/L per hour over 12 to 24 hours 

Correct answer: 0.5 mEq/L per hour over 48 to 72 hours 

Fluid is given to children with central DI as maintenance IV fluids plus urine replacement at 1 mL per 1 mL for all urine output greater than 2 mL/kg/hr. In severe cases, when shock or seizures are present, airway management, fluid resuscitation, and seizure control must take priority. If dehydration is present, normal saline should be bolused at 20 mL/kg. Anticonvulsant therapy with lorazepam or Valium should be administered. 

Fluid and sodium levels should be normalized slowly over 48 to 72 hours. Hypernatremia is corrected slowly, as rapid correction of osmolality can result in cerebral edema. Sodium levels should fall no faster than 0.5 mEq/L per hour over 48 to 72 hours. 

27.

What is the neuroimaging study of choice for a suspected intraventricular hemorrhage (IVH) in a pediatric patient?  

  • Cranial ultrasound (CUS)

  • Doppler ultrasound 

  • CT scan of the head 

  • MRI of the head 

Correct answer: Cranial ultrasound (CUS)

IVH is most commonly associated with prematurity. This is due to the immaturity and fragility of the brain's germinal matrix, as well as the immaturity of the infant's ability to autoregulate cerebral blood flow. In the case of a suspected IVH, based on history and/or physical findings, a CUS is most often performed to identify the degree and location of the bleed. 

Doppler ultrasound may be used for imaging and flow-velocity measurements. CT scan and MRI identify structures, but disadvantages include transporting the patient to a different location, maintaining patient stability during the procedure, and the difficulty of doing serial examinations. CT scans also have the added adverse effects of radiation.

MRI is superior to CUS only when it is important to detect white matter abnormalities.

28.

Which of the following interventions does the American Academy of Pediatrics (AAP) recommend to prevent sudden infant death syndrome (SIDS)?

  • Proper sleep positioning 

  • Side-lying positioning devices 

  • Home pulse oximetry monitoring during sleep

  • Swaddling during sleep 

Correct answer: Proper sleep positioning 

The most recent AAP position paper on infant sleep states that healthy infants should be placed only in the supine position for sleep, beginning immediately after birth, to decrease the risk of SIDS. Side-lying for sleep is not recommended because the infant may spontaneously roll from side-lying to prone. 

Home pulse oximetry monitoring may be indicated for infants at risk for apnea, bradycardia, and hypoxemia post-discharge, but the AAP does not recommend it for the prevention of SIDS. Swaddling is associated with a small but significant risk of SIDS when infants are placed on their backs for sleep, and swaddled infants placed prone have the highest risk of SIDS. While swaddling can be beneficial to infants for several reasons, the AAP does not recommend it for the prevention of SIDS. 

29.

While a nurse is educating the parents of a child with acute kidney injury (AKI) who is in the diuretic phase of acute tubular necrosis (ATN), the parents ask how long this phase is expected to last. What is the nurse's BEST response? 

  • 7 to 14 days

  • 24 to 72 hours

  • 5 to 7 days

  • 12 months or more

Correct answer: 7 to 14 days

The clinical course of ATN can be divided into four phases: 

  1. The initiating phase is the time from precipitating event until cell injury occurs and can last from a few hours to several days.
  2. The oliguric phase is the time from cell injury to the development of uremia, spanning 1-2 weeks.
  3. The diuretic phase is the beginning of recovery as evidenced by improved urine output, increased urea excretion, and solute excretion, lasting 7 to 14 days.
  4. The recovery phase is the time that renal function slowly returns to normal, which may take years.

30.

A nurse is educating an infant's family about the significant complications of a ventriculoperitoneal (VP) shunt. All the following manifestations would be important for the family to report immediately to the nursing staff, EXCEPT:

  • An increase in temperature to 99 degrees F (37.2 degrees C)

  • Swelling, redness, or drainage along the pathway of the shunt tube

  • Poor feeding

  • Bulging soft spot when the baby is sitting quietly

Correct answer: An increase in temperature to 99 degrees F (37.2 degrees C)

A VP shunt is indicated for acute and chronic hydrocephalus. 

If the infant's temperature increases to 99 degrees F, it does not have to be reported immediately but should be monitored closely. A temperature of 101 degrees F (38.3 degrees C) or higher should be immediately reported to nursing staff. 

Parents should be informed that swelling, redness, or drainage along the shunt tubing pathway, lethargy or irritability, poor feeding, and a bulging soft spot when the baby is quietly sitting are also reportable symptoms that could indicate an infection or a shunt malfunction (e.g., obstruction). Other complications of the VP shunt include bowel perforation, ascites, and ileus.  

31.

A teenage patient is admitted to the emergency department in a shock state after a drug overdose. The patient is experiencing insufficient oxygen delivery to the tissues, resulting in anaerobic metabolism and lactic acid production. Their serum lactate level is 5 mmol/L. The patient is diaphoretic and clammy to the touch with diminished peripheral pulses. 

What phase of shock is this patient experiencing? 

  • Compensated 

  • Uncompensated 

  • Refractory 

  • Initial 

Correct answer: Compensated

A patient who is in shock will experience anaerobic metabolism secondary to hypoxia. The cells are no longer able to use oxygen for energy because of inadequate tissue perfusion. Cardiac output is low, and blood cannot get to the organs and tissues. 

The body is attempting to compensate for this problem by switching from aerobic to anaerobic metabolism, resulting in increased lactic acid production (a waste product). Normal lactic acid levels are generally below 2 mmol/L. Vasoconstriction in this phase results in cool, pale, or mottled skin with delayed capillary filling time, diminished peripheral pulses, and narrow pulse pressure. Diaphoresis results in clammy, moist skin. 

32.

A nurse is caring for an infant with tetralogy of Fallot (TOF) who is recovering from palliative surgery in which a modified Blalock-Taussig shunt procedure was performed. Which structures does this shunt connect?

  • Subclavian artery and ipsilateral pulmonary artery 

  • Subclavian artery and superior vena cava

  • Superior vena cava and aorta 

  • Superior vena cava and ipsilateral pulmonary artery 

Correct answer: Subclavian artery and ipsilateral pulmonary artery 

The modified Blalock-Taussig (B-T) shunt is one of the most common pulmonary-to-systemic shunt procedures performed in children with cyanotic heart disease as a palliative therapy before a definitive correction is performed. The B-T shunt consists of an anastomosis of the subclavian artery to the ipsilateral pulmonary artery, utilizing a GORE-TEX conduit (interposition tube) between the subclavian and pulmonary artery.

33.

A nurse is caring for a 12-year-old child who is receiving a unit of packed red blood cells (PRBCs). The nurse should instruct the child on the need to report which sign(s) and/or symptom(s) immediately? 

  • Itching, back pain 

  • Sore throat, ear pain

  • Unusual fatigue, nausea

  • Mild discomfort at the catheter site

Correct answer: Itching, back pain 

Prior to a blood transfusion, the patient should be instructed to report chills, urticaria, or lumbar pain (classic sign) immediately because these could be indicative of an acute hemolytic transfusion reaction. Other signs and symptoms include a fever, hypotension, hemoglobinemia and hemoglobinuria, dyspnea, diaphoresis, anxiety, chest pain, and restlessness. 

Mild discomfort at the catheter site may be indicative of a problem, or it could be because of the large IV catheter required for infusing blood. A sore throat, ear pain, and fatigue are not related to a transfusion reaction. Nausea and vomiting may occur with an anaphylactic reaction but not coupled with unusual fatigue. 

34.

A pediatric critical care nurse is caring for an 11-year-old male experiencing rhabdomyolysis from acute renal failure. When formulating a plan of care for this patient, the nurse would NOT consider which intervention?

  • Maintaining NPO (nothing by mouth) status 

  • Ensuring proper fluid resuscitation 

  • Giving electrolyte replacement 

  • Placing a Foley catheter and closely monitoring output 

Correct answer: Maintaining NPO (nothing by mouth) status 

The manifestations and complications of rhabdomyolysis result from muscle cell death, with the release of intracellular muscle constituents (particularly, myoglobin, potassium, phosphorous, and enzymes) into the bloodstream. This condition can be caused directly by muscle injury or indirectly by various medical conditions. 

Some nursing considerations are to ensure proper fluid resuscitation, record the patient's intake and output (the patient will need a Foley catheter to monitor output status), monitor serum electrolytes and laboratory values (serum creatinine kinase, bicarbonate, electrolytes, kidney function, etc), replace electrolytes as per ordered, monitor for signs of compartment syndrome, and offer discharge planning on prevention. 

Desired outcomes for this patient include adequate hydration, normal electrolyte levels, implementing a proper diet, and using caution when exercising to avoid further skeletal muscle breakdown. 

35.

Which of the following is considered to be a late sign of compartment syndrome?  

  • Loss of pulse

  • Pain and swelling 

  • Paresthesia 

  • Inability to maintain normothermia 

Correct answer: Loss of pulse 

Compartment syndrome, a dangerous complication of a casted extremity, occurs when pressure increases within one or more muscle compartments, leading to decreased blood flow, tissue ischemia, and neurovascular impairment. Within 4 to 6 hours of the onset of compartment syndrome, neurovascular damage is irreversible if not treated. 

Signs and symptoms include unrelieved pain or increased pain in the affected limb (early sign); tissue that is distal to the involved area becoming cool to the touch, pale, dusky, or edematous; pain with passive movement or joint dysfunction; loss of sensation (paresthesia); and pulselessness of the affected limb (a late sign). Poikilothermia is the inability to regulate body temperature, which may also be present. 

36.

A nurse is caring for a 6-year-old child on digoxin therapy for congestive heart failure. The nurse reviews the child's laboratory values and is MOST concerned with which of the following findings? 

  • Potassium level of 3.2 mEq/L

  • Digoxin level of 1.2 ng/mL

  • Calcium level of 9.4 mg/dL

  • Magnesium level of 1.5 mEq/L

Correct answer: Potassium level of 3.2 mEq/L

Digoxin is used for the treatment of mild to moderate heart failure, to decrease the ventricular response rate in fast atrial arrhythmias, and to treat fetal tachycardia in the absence of hydrops. Digoxin has inotropic effects from the inhibition of the sodium-potassium pump. The nurse should assess the potassium level, watching for hypokalemia (evidenced by serum levels that fall below 3.5 mEq/L), the calcium level for hypercalcemia (evidenced by serum levels that rise above 10 mg/dL). and the magnesium level for hypomagnesia (evidenced by serum levels that fall below 1.4 mEq/L). These may aggravate digoxin cardiotoxicity, even if the digoxin level is normal (therapeutic trough range is 0.5 to 2 ng/mL). 

The nurse should also assess the child's heart rate (HR) prior to each dose administered to assure a HR greater than 60 bpm. 

37.

For an infant with suspected pulmonary hypertension (PH), which symptoms would likely accompany this condition?  

  • Tachypnea, tachycardia, and failure to thrive

  • Exertional dyspnea, chest pain, and syncope

  • Tachycardia, dyspnea, and loss of vision 

  • Bradycardia, clubbing, and cyanosis 

Correct answer: Tachypnea, tachycardia, and failure to thrive

PH is a disease characterized by elevated pulmonary artery pressure (PAP), which can result in right ventricular (RV) failure. In children, PH is most commonly associated with underlying cardiac or lung disease (e.g., bronchopulmonary dysplasia), but may also be idiopathic or familial. 

The presenting symptoms in children with PH are highly variable. In infants, the presentation involves signs of low cardiac output (e.g., tachypnea, tachycardia, poor appetite, failure to thrive, lethargy, diaphoresis, and irritability). 

Cyanosis may be present with exertion due to right-to-left shunting through a patent foramen ovale (PFO) or congenital heart disease (CHD). The most common presenting symptoms in older children include exertional dyspnea and chest pain. Children without adequate shunting may develop syncope (fainting) due to the inability to achieve an adequate CO with exertion. Clubbing may manifest in a child with underlying lung disease. 

38.

A pediatric intensive care unit (PICU) nurse is caring for a 2-month-old male with an unrepaired aortic coarctation. Which of the following assessment findings would the nurse expect for this infant? 

  • A heaving precordium with equally diminished femoral pulses 

  • Shortness of breath, pallor, systemic edema

  • Feeding intolerance, diaphoresis, and tachypnea

  • Decreased appetite, shortness of breath, and hepatomegaly 

Correct answer: A heaving precordium with equally diminished femoral pulses 

In coarctation of the aorta, a narrowed, thickened aorta causes elevation of pressure proximally and decreased pressure distally. Because of this, pulses are decreased or absent in the lower extremities prior to surgical repair. Coarctation occurs in about 8% to 10% of CHD cases and is more common in males than in females. 

Other exam findings reveal a heaving precordium and a nonspecific systolic murmur at the LSB. In a child, examination finds a blood pressure differential between the upper and lower extremities, systemic hypertension, and a short systolic ejection murmur at the LSB. 

Hepatomegaly, shortness of breath, pallor, and systemic edema indicate a ventricular septal defect (VSD). Feeding intolerance, diaphoresis, and tachypnea are associated with aortic stenosis. Transposition of the great arteries (TGA) reveals a patient with a decreased appetite, shortness of breath, and cyanosis.

39.

Which of the following is the MOST critical component of creating an ethical environment in a pediatric ICU setting? 

  • Empathetic communication

  • Conscientious objection

  • Provision of palliative care when indicated

  • Involvement of the family in all aspects of infant care

Correct answer: Empathetic communication

Although all these choices are important in creating an ethical environment in the ICU, empathetic communication is the most critical. Clinicians should be compassionate not only in their listening but also in their communication with parents and families. 

40.

A patient with congestive heart failure (CHF) has been diagnosed with acute pulmonary edema and is being treated with morphine. Morphine is indicated in this condition to achieve which of the following desired effects? 

  • Left ventricular preload reduction and relief of dyspnea  

  • Chest pain relief and increased left ventricular afterload 

  • Increased left ventricular preload, decreased pain, and anxiety reduction 

  • Increased left ventricular preload and increased left ventricular afterload 

Correct answer: Left ventricular preload reduction and relief of dyspnea  

Acute pulmonary edema is characterized by the movement of fluid into the alveoli and interstitium of the lungs (fluid in the air spaces); this is caused by the extravasation of fluid from the pulmonary vasculature. The condition can be categorized into cardiac and non-cardiac causes. Cardiogenic pulmonary edema causes include CHF, coronary artery disease (CAD), hypertension, heart valve disease, excessive IV fluid administration, and reperfusion injury after cardiovascular surgery, among others. Noncardiogenic causes include near-drowning, inhalation injury, and acute respiratory distress syndrome (ARDS). 

Symptoms often include extreme dyspnea, cyanosis, tachypnea, tachycardia, diminished breath sounds, anxiety, agitation, confusion, diaphoresis, orthopnea, respiratory crackles, heart murmur, and jugular vein distention (JVD). 

Morphine has been used as a treatment for acute pulmonary edema because it causes vasodilation, resulting in venous pooling and preload reduction (decreased left ventricular preload). In addition, morphine reduces dyspnea and sympathetic nervous system activity, which can greatly reduce the distress and anxiety that is associated with dyspnea. 

The goal of treatment with morphine is decreased left ventricular preload and afterload (not increased), and morphine is not used for chest pain in this diagnosis. 

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