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Quiz Session - Attempts With Random Questions

AACN CCRN (Pediatric) Exam Questions

Page 3 of 20

41.

A 7-year-old female patient is admitted to the emergency department after suffering second-degree burns and inhalation injury from a house fire. A nurse is preparing to transfer this patient to a burn center and, while reviewing her current laboratory values, notes a carboxyhemoglobin level of 16%. 

Which of the following signs and symptoms is NOT associated with this carboxyhemoglobin level?

  • Syncope 

  • Headache 

  • Confusion 

  • Mild dyspnea

Correct answer: Syncope

Carbon monoxide toxicity secondary to smoke inhalation is evaluated by measuring the patient's arterial carboxyhemoglobin level. Elevated levels serve as indirect evidence for exposure to combustible products, and multiple signs and symptoms have been associated with these levels. 

The normal value is 0%-5%. A patient with a carboxyhemoglobin level of 15%-20% will generally exhibit headaches, mild dyspnea, and confusion. If levels rise above 20% and up to 40%, the patient will often be disoriented, fatigued, and nauseous and may exhibit fainting spells (syncope). Levels greater than 50% will leave a patient comatose with seizure activity, respiratory failure, and even death. 

42.

A nurse is preparing to administer one unit of packed red blood cells to an anemic child. Just before beginning the infusion, the nurse must check which of the following?

  • Vital signs 

  • Skin color 

  • Oxygen saturation 

  • Latest hemoglobin and hematocrit (H&H) levels 

Correct answer: Vital signs 

A change in the patient's vital signs may indicate that a transfusion reaction is occurring. The nurse should check the patient's vital signs immediately before the infusion begins and should stay with the patient for the first 15 minutes of the blood infusion to monitor for signs and symptoms of a transfusion reaction. The first 15 minutes are the most critical and the most likely time a transfusion will occur. Vital signs are monitored every 30 minutes to 1 hour according to hospital policy. 

Oxygen saturation, skin color, and H&H levels may be checked, but are not the most important immediately preceding a blood transfusion. 

43.

A pediatric intensive care unit (PICU) nurse is caring for a 7-year-old child with scald burns to her left hand and forearm from spilling the hot liquid. The wound is classified as a superficial second-degree burn injury, and the nurse has new orders to treat the burn with a topical antimicrobial agent. 

Which of the following topical agents is MOST appropriate for this type of burn injury?

  • Silver sulfadiazine cream 

  • Mafenide acetate cream 

  • Bacitracin ointment 

  • Aloe vera 

Correct answer: Silver sulfadiazine cream 

Silver sulfadiazine cream is the most commonly used topical agent for burn care. It possesses broad-spectrum antimicrobial activity, is painless upon application, is readily available, and can be used with open or closed dressing techniques. 

The use of aloe vera is not supported by evidence. Bacitracin is only effective against gram-positive organisms, and mafenide acetate cream is only effective against gram-negative coverage; neither has the broad-spectrum antimicrobial activity that silver sulfadiazine cream has. 

44.

A 9-year-old male is admitted to the PICU with signs and symptoms indicating astrocytoma, a type of brain tumor. Which of the following interventions should the nurse prioritize when admitting this patient? 

  • Prepare the child for diagnostic testing 

  • Initiate seizure precautions 

  • Begin intravenous (IV) fluid resuscitation 

  • Start aggressive intravenous (IV) antibiotic therapy 

Correct answer: Prepare the child for diagnostic testing 

The child needs to first undergo routine diagnostic testing and neuroimaging studies to confirm this diagnosis. Routine laboratory studies often include a complete blood count (CBC) with differential, coagulation studies, a metabolic panel, and electrolytes. A CT scan is performed often in the emergency setting on a child with nonspecific neurological symptoms, but an MRI is the preferred diagnostic study for nonemergent presentations and is performed with and without contrast. It provides a better definition of the tumor and identifies small tumors not seen on a CT scan. 

Seizures are not common with infratentorial brain tumors, so seizure precautions are unnecessary. IV fluids may be ordered but are not a priority over preparing the child for diagnostic studies. Aggressive antibiotics are not indicated in this scenario.  

45.

A pediatric nurse is caring for a patient who is receiving an intravenous (IV) infusion of a vesicant medication. The nurse assesses the IV site during hourly rounds and notes fluid leaking into the Tegaderm dressing. 

What should be the nurse's initial response? 

  • Stop the IV infusion on the pump and aspirate fluid from the catheter hub 

  • Remove the IV catheter and then cover the site with gauze soaked in saline 

  • Ensure the catheter is intact and administer an antidote for extravasation 

  • Flush the catheter with normal saline and then resume the IV medication infusion  

Correct answer: Stop the IV infusion on the pump and aspirate fluid from the catheter hub 

Vesicants are very irritating medications and solutions and should be either avoided or carefully monitored during infusion. Treatment for a vesicant medication should be determined before discontinuing the intravenous catheter, so the nurse's initial response should be to simply stop the infusion and aspirate fluid from the catheter hub. 

If extravasation is determined to have occurred (i.e., leaking of IV fluids and medications into the tissue surrounding the vessel), immediate measures to reduce injury should be instituted. The device should be carefully removed, the extremity should be elevated, and the nurse should follow hospital protocol for further treatment guidelines. 

46.

Which of the following acid-base imbalances occurs in a child with acute kidney injury (AKI)? 

  • Metabolic acidosis 

  • Respiratory acidosis

  • Metabolic alkalosis 

  • Respiratory alkalosis 

Correct answer: Metabolic acidosis 

Metabolic acidosis occurs in AKI because of changes in renal function, including decreased glomerular filtration rate (GFR), decreased hydrogen ion secretion, decreased bicarbonate reabsorption, and decreased ammonia (NH3) production and ammonium (NH4) excretion. Clinical manifestations include increased minute ventilation, a decreased LOC as ammonium excretion decreases, and hyperkalemia as potassium excretion decreases. Hyperkalemia causes an increased potential for lethal cardiac dysrhythmias and decreased cardiac output. 

Therefore, the treatment and management of AKI involve correcting this metabolic acidosis.

47.

Which of the following cerebrospinal fluid (CSF) analysis findings in a child could indicate bacterial meningitis?

  • Decreased CSF glucose level 

  • Decreased CSF protein level

  • Decreased CSF white blood cell count 

  • CSF that is clear in color 

Correct answer: Decreased CSF glucose level 

CSF analysis is the gold standard for diagnosing bacterial meningitis and should be performed on any child suspected of having meningitis. CSF analysis in bacterial meningitis usually demonstrates the following:

  • elevated white blood count (WBC) with predominately polymorphonuclear cells
  • elevated protein content (normal 10-30 mg/dL)
  • decreased glucose content (normal 40-80 mg/dL)
  • positive results from gram stain
  • positive results from culture for organism
  • turbid or cloudy color

Results may vary in neonates, as the WBC count may be normal, glucose content may be normal (it should be compared to serum), and protein levels are normally higher in neonates (20-170 mg/dL).  

48.

An infant is transitioning to end-of-life care and is being withdrawn from assisted ventilation life-support. The physician has ordered fentanyl to be given to reduce air hunger and pain. Fentanyl has a risk of causing some degree of respiratory depression.

What principle is being demonstrated?

  • Double effect

  • Futile medical treatment

  • Best-interest standard

  • Reasonable person standard

Correct answer: Double effect

The "double effect" theory states that an action may be considered beneficial if the intent of the action is of positive value, even if the secondary effects of the action might be considered harmful if undertaken as the primary goal. This theory is used frequently in the ICU setting.

The reasonable person standard asks, "What would a reasonable person want in this circumstance?" It is part of informed consent. The best-interest standard seeks to accomplish valid moral decision-making in difficult cases and requires a balance of beneficence, nonmaleficence, and justice. Determination of the appropriateness of treatment should be based on medical benefit as determined by family goals for the patient (including physiologic, psychologic, social, and religious factors). Based on all of these aspects of care, a determination of nonbeneficial vs. beneficial therapy can be made.

49.

Which of the following signs and symptoms would the pediatric critical care nurse expect to observe in a child with diabetes insipidus (DI)? 

  • Polyuria

  • Polyphagia

  • Bradycardia

  • Hypertension

Correct answer: Polyuria

DI is characterized by an inability to concentrate urine, leading to high volumes of dilute urine (polyuria), high serum osmolality, and hypernatremia. This condition is caused by either an insufficient secretion of ADH (central) or failure of the kidneys to respond to ADH (nephrogenic).

Central DI is the most common form of DI in critically ill children. Deficiency of ADH is due to failure of the hypothalamus to synthesize, failure of the posterior pituitary to secrete ADH, or both. 

A large quantity of dilute or clear urine is the first sign of DI (>4 mL/kg/hr), which is referred to as polyuria. Hypernatremia occurs (sodium levels >145 mEq/L), serum hyperosmolality occurs (osmolality >300 mOsm/kg), urine osmolality is <200 mOsm/kg, and polydipsia (unrelenting thirst) is present if the child is alert with an intact mental status and able to report thirst. Signs of dehydration are present, including a low central venous pressure, tachycardia (not bradycardia), hypotension (not hypertension), poor skin turgor, dry mucous membranes, and weight loss. Polyphagia is not an expected finding in DI. 

50.

A child's white blood cells (WBCs) play many roles within the body, including defense against antigens or invading microorganisms. There are three main lines of defense within the body. 

Which of the following is NOT an example of the body's second line of defense? 

  • Specific acquired immunity 

  • Phagocytosis 

  • Inflammatory response 

  • Complement activation 

Correct answer: Specific acquired immunity 

Physiologic mechanisms of WBCs are categorized by three lines of defense, each representing more complex and sophisticated means of protection and methods of elimination. 

The first line of defense involves the child's natural, innate barriers to prevent or minimize entry and attachment of the antigen. These barriers include chemicals on the skin, mucus in the respiratory and GI tract, saliva, tears, urine, defecation and vomiting, and an intact GI lining. 

The second line of defense involves the inflammatory response, phagocytosis, and complement activation. It is nonspecific and general and has an immediate onset once triggered if the first line of defense is ineffective.

The third line of defense involves specific, acquired immunity (obtained passively or actively and naturally or artificially) and is triggered if the first and second lines of defense are ineffective in destroying, inactivating, or eliminating the "nonself" antigen. Hallmarks of the third line of defense include specificity, the ability of a lymphocyte to respond to a single antigen for which it was designed, and memory.

51.

What is the MOST common type of brain tumor in the pediatric population? 

  • Astrocytomas

  • Ependymomas

  • Medulloblastomas 

  • Choroid plexus papillomas 

Correct answer: Astrocytomas

The most common types of brain tumors in young children are broadly classified as gliomas and account for 75% of all brain tumors. The three most common glial subtypes are defined by glial tissue: astrocytes, ependymal cells, and oligodendrocytes. 

Astrocytomas are the most common type of brain tumor in children and can be found throughout the central nervous system (CNS). The infratentorial area of the brain has the highest incidence (cerebellum, brainstem, and hypothalamus).

Ependymomas most often arise from the fourth ventricle in children. Medulloblastomas represent approximately 25% of all pediatric brain tumors and are the most common primary malignant CNS tumor. Choroid plexus papillomas are less common and appear in the ventricles of the brain. 

52.

A mother rushes her 3-month-old son to the emergency department after he experienced seizure-like activity. The mother reports she was giving her son "tummy time," and he began having rhythmic jerks lasting 1 to 3 seconds with a slowing of the jerking motion during the seizure. She believes it lasted 2-3 minutes and then stopped spontaneously. The mother reports that the infant was born via an emergency cesarean section, and his Apgar scores were 0 at 1 minute and 3 at 5 minutes. 

Based on this description, how would the nurse classify this type of seizure?

  • Clonic

  • Tonic

  • Myotonic

  • Focal 

Correct answer: Clonic 

A generalized clonic-type seizure is characterized by rhythmic jerking movements of up to 3 seconds in duration that slow during the event. Seizures are common sequelae of hypoxia during a prenatal event. 

53.

Which of the following congenital heart defects (CHD) leads to cyanosis from the mixing of systemic venous and pulmonary venous blood? 

  • Tetrology of Fallot (TOF)

  • Aortic stenosis (AS)

  • Aortic coarctation 

  • Patent ductus arteriosus (PDA)

Correct answer: Tetrology of Fallot (TOF) 

TOF involves four classic features: 

  • ventricular septal defect (VSD)
  • pulmonary stenosis (PS)
  • right ventricular hypertrophy
  • overriding aorta

It is the most common form of cyanotic CHD and accounts for as much as 10% of CHD cases. It occurs slightly more often in boys and is characterized by deoxygenated blood entering the systemic arterial circulation. Normally, blood enters the right ventricle (RV). In TOF, RV outflow obstruction causes shunting across the VSD to the aorta, mixing systemic venous and pulmonary venous return. The severity of PS determines the severity of the patient's cyanosis. 

54.

Hypothermia is part of which toxidrome? 

  • Opioid

  • Sympathomimetic (stimulant)

  • Anticholinergic 

  • Cholinergic 

Correct answer: Opioid

Hypothermia is a symptom of opioid toxidrome. Other symptoms of opioid overdose include hypotension, altered mental status, miosis, unresponsiveness/coma, respiratory depression, bradypnea and bradycardia, and decreased peristalsis/bowel sounds. 

Hyperthermia is a symptom of the sympathomimetic (stimulant) and anticholinergic toxidromes. Symptoms associated with cholinergic overdose include salivation, lacrimation, urination, defecation, diarrhea, emesis, and bradycardia. 

55.

Which of the following clinical signs and symptoms is present in a pediatric case of typical hemolytic uremic syndrome (HUS)? 

  • Bloody diarrhea 

  • Mild to moderate hypotension 

  • Increased urine output 

  • Increased serum glucose 

Correct answer: Bloody diarrhea 

HUS is a thrombotic microangiopathic disease involving endothelial damage leading to platelet and fibrin deposits in the small vessels of the kidney, gut, and CNS. It is characterized by acute hemolytic anemia, thrombocytopenia, and acute kidney injury (AKI). Typical HUS peaks from June to September with gastrointestinal prodromes during the days to weeks preceding onset and is most often the result of E. coli infection. 

Clinical symptoms of HUS include bloody diarrhea (more common in typical HUS), mild to moderate hypertension, fever, lethargy, decreased urine output, paleness, petechia, and dehydration. 

56.

What is the most commonly affected valve in rheumatic heart disease? 

  • Mitral valve 

  • Tricuspid valve 

  • Pulmonary valve 

  • Aortic valve 

Correct answer: Mitral valve 

Rheumatic heart disease is a postinfectious connective tissue disease caused by rheumatic fever. Group A beta-hemolytic streptococcal pharyngitis is the most common bacteria causing acute rheumatic fever, and it often affects children ages 6 to 15 years. While this disease remains common in developing countries, the incidence in the US has decreased after the introduction of antibiotics. 

The streptococcal bacteria that are most often implicated in the patient's recent history of pharyngitis initiate an autoimmune process in a generally susceptible host that attacks collagen. The antibodies produced for streptococcal infections react with the host tissue, producing antibody-induced tissue damage and generally affecting the mitral valve.

57.

A pediatric intensive care unit (PICU) nurse is caring for a 6-month-old infant hospitalized with hydrocephalus who has just undergone surgery for a ventriculoperitoneal (VP) shunt placement. The nurse performs a head-to-toe assessment on the infant and determines they are in pain. 

Which of the following is NOT a common behavioral indicator of pain in an infant? 

  • Oxygen desaturation 

  • High-pitched cry

  • Facial grimacing 

  • Decreased level of activity 

Correct answer: Oxygen desaturation 

Expression of pain through behavior is often an infant's primary means of communicating pain. Crying (high-pitched, tense, or irregular), changes in arousal state (increased or decreased level of activity), and facial grimacing are the most robust pain behaviors in infants experiencing pain. In addition, infants may withdraw from stimuli and exhibit changes in vital signs (increased heart rate, respiratory rate, blood pressure). 

Although physiologic changes (e.g., decreased oxygen saturation) may occur with pain, they are not the most specific and reliable indicators of infant pain and should alert the nurse to other potential underlying pathologies.

58.

Per an annual survey, hospital nursing staff members feel routine 5 a.m. lab draws cause an extreme interruption in pediatric sleep patterns. What is the BEST strategy for addressing this issue? 

  • Create a group of staff members to discuss current hospital policy 

  • Move all non-emergent 5 a.m. lab draws to daytime hours 

  • Request an in-service session for phlebotomy personnel on the effects of sleep deprivation in children

  • Send the results of the survey to the hospital administrator 

Correct answer: Create a group of staff members to discuss the current hospital policy 

Utilizing the nurse competencies—which reflect the integration of nursing knowledge, skills, and experiences that are required to meet the patient's and family's needs and optimize their outcomes—a systematic, collaborative approach to problem-solving is necessary for this scenario. An alternative strategy to not interrupt typical patient sleep patterns may be identified by various team members working together. 

59.

An infant presents to the emergency department with a heart rate of 212 beats/min. The infant is pale and sweating and is diagnosed with acute supraventricular tachycardia (SVT). The nurse should perform which of the following interventions first? 

  • Apply a bag of ice to the face for 15 seconds 

  • Administer propranolol 

  • Administer IV adenosine

  • Apply direct current cardioversion (DCCV)

Correct answer: Apply a bag of ice to the face for 15 seconds 

Vagal maneuvers are used initially for acute SVT to stop the arrhythmia. These maneuvers affect the vagus nerve, which sends signals to the AV node to control the heartbeat and ultimately can slow down the heart rate. Coldwater treatment is a type of vagal maneuver that can be performed quickly and easily for an infant as a primary measure. Applying ice to the face stimulates the vagus nerve and may immediately reverse SVT. 

If ice is not successful, pharmacologic therapy with adenosine for acute termination of the episode is then utilized. Chronic therapy with propranolol is started if the SVT is recurrent, prolonged, or hemodynamically important. DC cardioversion or overdrive pacing if pacemaker wires are present is used for patients who are hemodynamically compromised. 

60.

An infant with a diagnosis of Wolff-Parkinson-White syndrome (WPW) likely has which of the following associated congenital heart defects? 

  • Ebstein's anomaly 

  • Atrial septal defect (ASD)

  • Ventricular septal defect (VSD)

  • Truncus arteriosus 

Correct answer: Ebstein's anomaly 

Ebstein's anomaly is downward displacement of the posterior and septal leaflets of the tricuspid valve with an atrialized portion of the right ventricle; it is the congenital lesion most strongly associated with WPW syndrome. 

As many as 20 percent of these patients have one or more accessory pathways; the majority are located in the right free wall and right posteroseptal spaces. 

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