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Quiz Session - Attempts With Random Questions

AACN CCRN (Pediatric) Exam Questions

Page 5 of 20

81.

When teaching a caregiver to perform an aspect of patient care, a pediatric critical care nurse must recognize which of the following?

  • The best learning occurs when the caregiver perceives a need to learn 

  • Caregivers are unaffected by the timing of teaching 

  • Caregivers learn best if shown a complicated aspect of care in a single teaching session 

  • Caregivers are unaffected by the purpose of a task 

Correct answer: The best learning occurs when the caregiver perceives a need to learn 

According to adult learning theory, establishing a perception of a need to learn prior to providing education is an important first step toward optimal educational efforts. Caregivers are affected by the timing of teaching and the purpose of a task, and they often need to be shown complex procedures over several teaching sessions before fully grasping information. 

82.

An 11-year-old male is brought to the emergency department via ambulance after a motor vehicle accident (MVA) and requires immediate placement of a chest tube for a right pneumothorax. Once the patient has been stabilized, he is transferred to the pediatric intensive care unit (PICU). Approximately four hours later, the nurse performs another hourly assessment and suspects he is experiencing cardiac tamponade. 

In addition to decreasing blood pressure, which of the following assessment findings is anticipated with this condition? 

  • Increased central venous pressure (CVP)

  • Increased chest tube output 

  • Increased cardiac contractility 

  • Polyuria 

Correct answer: Increased central venous pressure (CVP)

Cardiac tamponade can occur from a contusion or from penetrating trauma, resulting in blood or fluid accumulation in the pericardial sac. The fluid accumulation compresses the atria, causing elevated right atrial filling pressures (increased CVP), impairing ventricular filling, and reducing cardiac output (CO) and contractility. This decreased CO leads to hypoperfusion of the kidneys, resulting in a sudden decrease in urine output (oliguria). Chest tube output is decreased in cardiac tamponade.

83.

What is the MOST common cause of true nasal obstruction in a newborn?   

  • Choanal atresia 

  • Septal deviation 

  • Pyriform aperture stenosis 

  • Turbinate hypertrophy 

Correct answer: Choanal atresia 

Choanal atresia is a congenital disorder that can be unilateral or bilateral, in which the nasal choanae (openings that connect the nasal cavity with the nasopharynx) are occluded by soft tissue, bone, or a combination of both. It is the most common cause of true nasal obstruction. Because newborns are obligate nasal breathers, it can be an acute otolaryngologic emergency if bilateral occlusion is present. Intubation or an oral airway may be necessary in severe cases pending surgical intervention to open the bony membrane that is blocking the airway.

The other choices are differential diagnoses. 

84.

A nurse is caring for a 6-year-old patient with a closed tibial fracture that has recently been reduced and cast. Which of the following nursing interventions is NOT appropriate in the case of suspected compartment syndrome for this patient? 

  • Elevate the affected extremity above the level of the heart 

  • Loosen and remove restrictive items 

  • Perform hourly neurovascular examinations 

  • Notify the physician 

Correct answer: Elevate the affected extremity above the level of the heart 

Compartment syndrome occurs when too much pressure is exerted within the myofascial compartments, decreasing blood flow to the tissues. As the pressure builds within the affected compartment, this will inhibit blood supply and nerve function to this muscle. If it is left untreated for over 6 hours, the damage is irreversible. 

While compartment syndrome is rare in children, it does still happen. It is more often seen in the lower extremities compared to the upper extremities. High suspicion of compartment syndrome should be raised if the child complains of sharp pain or numbness in the casted extremity, despite adequate pain relief. 

When treating a patient with suspected compartment syndrome, the nurse should loosen and remove restrictive items to help alleviate any extra pressure on the compartment and call the physician for follow-up orders (i.e., cut the cast in half and/or prepare for fasciotomy). In addition, the affected extremity should be kept at the heart level (not above) to help maintain arterial pressure as the muscle compartment is experiencing ischemia. Finally, the nurse should perform serial neurovascular checks to monitor for the six "Ps," which are increased pain (early sign), pallor, paresthesia, paralysis, poikilothermia, and loss of pulse (late sign). 

85.

A 4-year-old male is admitted to the pediatric intensive care unit (PICU) after a near-drowning accident. His respiratory function has been steadily deteriorating over the last 12 hours, despite noninvasive positive-pressure ventilation (NPPV). 

Which of the following findings on chest radiographs is indicative of pediatric acute respiratory distress syndrome (PARDS)? 

  • Bilateral white-out infiltrates 

  • Heart enlargement with bilateral upper lobe infiltrates 

  • Infiltrates on the bilateral lower lobes 

  • Normal chest radiograph 

Correct answer: Bilateral white-out infiltrates 

Chest imaging findings of new pronounced, bilateral white-out infiltrates, consistent with acute pulmonary parenchyma disease, are necessary to diagnose PARDS. 

86.

A PICU nurse is caring for a 3-year-old male who is recovering from a Fontan procedure for a diagnosis of hypoplastic left heart syndrome (HLHS). What is the primary purpose of this procedure? 

  • To prevent ventricular hypertrophy and dysfunction from volume overload 

  • To provide venous blood flow to the lungs and a stable form of oxygenation 

  • To direct systemic venous return to the right ventricle 

  • To create an unobstructed right ventricular outflow tract 

Correct answer: To prevent ventricular hypertrophy and dysfunction from volume overload 

The Fontan procedure is a palliative procedure used in the management of HLHS (it can also be done for tricuspid atresia and single-ventricle hearts of diagnostic categories other than HLHS). This procedure is the final stage of physiologic palliation in a three-stage surgical repair process for HLHS, with the outcome of diverting blood from the right ventricle (RV). This prevents ventricular hypertrophy and dysfunction from volume overload and optimizes long-term ventricular function. During this procedure, a baffle is placed in the right atrium to divert systemic venous return to the pulmonary artery. 

The first stage of palliative reconstructive surgery for HLHS is the Norwood operation, which creates an unobstructed right ventricular outflow tract. Second-stage palliation for HLHS is with a bidirectional cavopulmonary shunt, which provides venous blood flow to the lungs and a stable form of oxygenation. 

87.

A 10-month-old infant is brought into the emergency department via ambulance and stops breathing. The nurse confirms the infant still has a pulse by checking the brachial artery in the infant's upper arm. The nurse ensures the infant is positioned correctly and immediately begins CPR. 

When two rescuers are performing CPR, what technique should be used for compressions? 

  • Two thumbs on the sternum with hands encircling the chest to deliver compressions 

  • Two hands on the sternum using the heel of the hands to deliver compressions 

  • Two fingers on the sternum to deliver compressions 

  • One hand on the sternum using the heel of the hand to deliver compressions 

Correct answer: Two thumbs on the sternum with hands encircling the chest to deliver compressions 

External chest compressions consist of serial, rhythmic compressions of the chest to maintain circulation to the vital organs until the infant begins spontaneously breathing again or advanced life support can be initiated. 

For an infant, the fingers should be placed at a point on the lower sternum just below the intersection of the sternum and an imaginary line drawn between the nipples. Lone rescuers should use two fingers on the sternum to deliver compressions. When two rescuers are present, the two-thumb encircling hands technique may be used. 

88.

A 14-year-old male is admitted to the PICU after sustaining closed fractures from a motor vehicle collision. The patient is diagnosed with fat embolism syndrome (FES). Which bone fracture is frequently associated with the development of this dangerous complication? 

  • Femoral fracture

  • Forearm fracture

  • Wrist and hand fractures 

  • Rib fracture

Correct answer: Femoral fracture

Although rare, FES is a dangerous complication of fractures and is more commonly seen in closed versus open fractures. It occurs primarily in the long bones and pelvis of major trauma victims and can also be a complication of orthopedic surgery. 

It is postulated to be the result of a disruption to blood supply caused by fat globules that enter the venous channels at the fracture site, leading to embolization. 

89.

What is the preferred method of debriding a painful wound? 

  • Autolytic debridement 

  • Surgical debridement 

  • Mechanical debridement 

  • Enzymatic debridement 

Correct answer: Autolytic debridement 

Autolytic debridement uses the body's enzymes and moisture to rehydrate, soften, and ultimately liquefy hard eschar and slough with the use of occlusive or semi-occlusive dressings. It is best for use on clean wounds with slight to moderate exudate. There is little to no pain for the patient with this form of wound debridement. 

Surgical, mechanical, and enzymatic debridement methods usually increase pain during the procedures. 

90.

A 2-year-old male presents to the emergency department with symptoms indicative of acute epiglottitis. The child is intubated for airway management and admitted to the pediatric intensive care unit (PICU). The nurse caring for the child would NOT expect orders to administer which treatment?

  • Racemic epinephrine 

  • Parenteral antibiotics 

  • Antipyretics 

  • Corticosteroids 

Correct answer: Racemic epinephrine 

Acute epiglottitis is a life-threatening medical emergency in which the epiglottis swells due to a bacterial infection, and the airway is compromised. Signs and symptoms include an abrupt onset of a high fever, a sore throat, dysphagia, drooling, a muffled voice, and stridor. Airway management with the placement of an endotracheal tube (ETT) is generally indicated, along with parenteral antibiotics (ceftriaxone, cefotaxime, or a combination of ampicillin and sulbactam, pending culture and susceptibility reports). Antibiotics should be given for 7 to 10 days. Antipyretics for fevers and comfort with intravenous fluids are also given; corticosteroids should be administered to reduce edema during the early treatment phase. 

Racemic epinephrine is indicated for the treatment of acute laryngotracheobronchitis (LTB), not for acute epiglottitis. Croup is the general medical term that refers to this inflammatory process. 

91.

An adolescent male is admitted to the emergency department with symptoms of nausea and vomiting, headache and dizziness, altered mental status, and left-sided hemiparesis. The physician suspects the teenager is experiencing a cerebrovascular accident (CVA). 

The nurse begins intravenous hydration and expects which of the following initial studies to be ordered? 

  • Non-contrast CT of the brain 

  • Head MRI 

  • Cranial ultrasound (CUS)

  • Doppler ultrasound 

Correct answer: Non-contrast CT of the brain 

The incidence of CNS events in children in the first 20 years of life is rare at approximately 0.7%. A CVA is an acute infarction in the brain, most commonly related to intracranial arterial stenosis or obstruction, which can lead to stroke. It may be ischemic or hemorrhagic. The child presents with any of the following symptoms: hemiparesis, headache, dizziness, emesis, lethargy, aphasia, focal seizures, gait and visual disturbances, or altered mentation or alertness. 

Initial stabilization should be performed prior to radiographic evaluation. Once the child is stable, non-contrast CT of the brain is the initial study of choice. 

MRI results may be normal initially because several days of evolution are necessary to detect an edematous infarcted area. CUS is indicated in the case of suspected intraventricular hemorrhage (IVH), not CVA. Doppler ultrasound may be used for imaging and flow-velocity measurements. 

92.

In a child suspected of having a small bowel obstruction (SBO), the nurse anticipates which of the following tests will be performed first?  

  • Plain abdominal radiograph

  • Abdominal ultrasound 

  • Magnetic resonance imaging (MRI) 

  • Abdominal computed tomography (CT)

Correct answer: Plain abdominal radiograph

Abdominal x-ray examination may reveal a paucity of gas, dilated loops of bowel, or air-fluid levels with a bowel obstruction. It is usually the first radiologic study done. A lateral view reveals the presence of free air with bowel perforation.

An abdominal U/S and CT scan may be indicated, but they are generally not the first diagnostic tests that are ordered. 

Abdominal U/S or MRI are often done to evaluate for appendicitis, as nonionizing radiation is employed. MRI is not indicated for diagnosis of SBO. 

93.

Which of the following congenital heart defects is considered cyanotic heart disease? 

  • Tetrology of Fallot (TOF)

  • Atrial septal defect (ASD)

  • Ventricular septal defect (VSD)

  • Patent ducts arteriosis (PDA)

Correct answer: Tetrology of Fallot (TOF)

TOF consists of four defects: VSD, pulmonary stenosis (PS), right ventricular hypertrophy (RVH), and an overriding aorta. It is the most common form of cyanotic congenital heart disease, accounting for as much as 10% of CHD, and it occurs slightly more often in boys. 

ASD, VSD, and PDA are acyanotic heart diseases. 

94.

A child is in the PICU for hypertension management. The nurse is monitoring the patient after the administration of propranolol (Inderal). Which assessment finding indicates a potential complication associated with this medication? 

  • Audible expiratory wheezes 

  • Blurred vision 

  • Alterations in taste 

  • Respiratory depression 

Correct answer: Audible expiratory wheezes 

Propranolol is a beta-blocker that reduces sympathetic excitation of the heart; it is used for the management of cardiac arrhythmias, myocardial infarction, tachyarrhythmias, and hypertension. Audible expiratory wheezes may indicate bronchospasm, a serious side effect of this mediation. 

Other side effects include laryngospasm, bone marrow suppression, bradycardia, and hypotension. 

95.

Cushing's triad is representative of signs of increasing intracranial pressure (ICP) in a child and includes which of the following? 

  • Increasing systolic blood pressure (BP)

  • Increasing diastolic blood pressure (BP)

  • Tachycardia 

  • Tachypnea 

Correct answer: Increasing systolic blood pressure (BP)

Cushing's triad includes the following three signs, which are indicative of increasing ICP:

  • a widening pulse pressure in which the systolic BP increases and the diastolic BP decreases
  • a decreasing pulse (bradycardia)
  • irregular respirations (Cheyne-Stokes respirations, a pattern of crescendo-decrescendo respirations followed by a period of apnea)

The patient may also exhibit hyperpyrexia, or an elevated temperature, as ICP rises. This phenomenon is due to changes in the hypothalamus. Ongoing evaluation and intervention can avert later signs of increased ICP, as seen in Cushing's triad. 

96.

An 18-month-old male is brought to the emergency department by his mother with a sudden onset of choking, gagging, and coughing. The patient is afebrile and has a pulse of 125/min and a respiratory rate of 42/min. The nurse auscultates decreased breath sounds over the right lower lung field. 

What is the next step in the evaluation of this child? 

  • Plain neck and chest radiographs 

  • Lateral soft tissue radiograph of the neck 

  • Finger sweep 

  • Indirect laryngoscopy 

Correct answer: Plain neck and chest radiographs 

Foreign-body aspiration is a common cause of accidental death in infants and children. The initial episode is frequently associated with choking and coughing. Examination findings may be normal or nonspecific, such as decreased air entry, wheezing, rhonchi, or inspiratory stridor. The right bronchus is more often the site of the foreign body than the left, and thus decreased breath sounds may be heard over the right lung field. 

After a thorough history and physical exam, plain neck and chest radiographs should be obtained. Approximately 10% of aspirated foreign bodies are radiopaque, making the diagnosis a simple one. Unfortunately, the majority of foreign bodies are not obvious, and changes are seen secondary to obstruction of the airway by the object. Anteroposterior and lateral views of the neck and chest may show signs of a partially obliterated tracheobronchial air column. 

However, chest radiography alone does not diagnose the condition; a final diagnosis is only achieved at the time of bronchoscopic evaluation. 

97.

What is the general hemoglobin threshold for a packed red blood cell (PRBC) transfusion for an acute and critically ill child? 

  • 7 g/dL

  • 6 g/dL

  • 5 g/dL

  • 8 g/dL

Correct answer: 7 g/dL

According to the American Association of Blood Banks, the recommended hemoglobin level for a blood transfusion is 7 g/dL for acute and critically ill children, with some exceptions based on cardiac pathophysiology and other specific conditions. 

98.

A nurse is caring for a child with acute pericarditis. Which assessment finding would prompt the nurse to contact the physician immediately? 

  • Muffled heart sounds 

  • Chest pain that is worse in supine positioning 

  • Pericardial friction rub 

  • Shortened PR interval 

Correct answer: Muffled heart sounds 

Acute pericarditis is inflammation of the pericardium characterized by pericarditic chest pain, pericardial friction rub, and serial ECG changes, which may show ST elevation or depression, an inverted T wave, a prolonged PR interval [not shortened], diminished QRS and T-wave voltage, or arrhythmias.  

Muffled heart sounds may indicate cardiac tamponade, which is a serious complication of acute pericarditis, and is considered a medical emergency. Because of this, the nurse should immediately contact the physician. 

Chest pain and pericardial friction rub are both expected symptoms of acute pericarditis, and while the nurse should closely monitor these elements, they would not immediately indicate a potential emergency situation. 

99.

Which hypersensitivity reaction releases enzymes that cause the destruction of tissues? 

  • Type III

  • Type I

  • Type II

  • Type IV

Correct answer: Type III 

Type III hypersensitivity reactions, otherwise known as immune-complex reactions, result in local edema, neutrophil attraction, and degradative lysosomal enzymes that cause tissue injury. They are triggered by the formation of antigen-antibody complexes that activate the complement cascade and are then deposited in blood vessels or healthy tissue. Examples include serum sickness and glomerulonephritis, among others. 

100.

A nurse is providing education to the family of an infant with DiGeorge syndrome and associated congenital heart disease (CHD). The family was unaware of the infant's condition prior to delivery.

Which support and anticipatory guidance measures are appropriate to discuss? 

  • Encourage breastfeeding and pumping to maintain supply 

  • Arrange social work, palliative care, and genetics referrals 

  • During resuscitative measures and procedures, limit and/or avoid family presence since the diagnosis was a shock

  • Reassure the family that the infant's condition will not interfere with normal growth and development

Correct answer: Encourage breastfeeding and pumping to maintain supply

This infant may be intubated and will not be able to eat prior to surgery (NPO). In addition, the infant's bowel function may be at risk due to surgery, and the incidence of necrotizing enterocolitis (NEC) is higher in these infants. Critical illness, genetic predisposition, and the use of cardiopulmonary bypass during surgical repair all place the infant at higher risk of immunosuppression.

Breastmilk provides an easily digestible feeding that includes antibodies to assist with immune suppression, decrease the risk of NEC, and optimize feeding progression. Pumping should be encouraged to maintain the breast milk supply until the infant can tolerate enteral feedings. This will require support from nursing, lactation, nutrition, and social work.

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