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Quiz Session - Attempts With Random Questions

AACN CCRN (Pediatric) Exam Questions

Page 6 of 20

101.

Which of the following is an example of a passive surgical drain? 

  • Penrose drain 

  • Jackson-Pratt drain 

  • Hemovac drain 

  • Negative-pressure wound therapy (NPWT) 

Correct answer: Penrose drain 

Surgical drains may be placed in or near surgical wounds to prevent fluid buildup and must be maintained properly until the fluid from the wound begins to lessen. 

There are two types of surgical drains. Active drains, also referred to as closed or closed suction drains, use negative pressure to remove fluid. Examples include Jackson-Pratt, Hemovac, and NPWT. Passive drains, also referred to as open drains, depend on the high pressure in the wound and gravity to drain the surgical site. The Penrose drain is an example of a passive drain and relies on gravity to remove fluid from the wound. Passive drains are generally sutured in place. 

102.

Which of the following represents the highest level of evidence on which to base nursing practice?

  • Systematic reviews of randomized controlled trials (RCTs)

  • Cohort studies

  • Case-control studies

  • Evidence syntheses

Correct answer: Systematic reviews of randomized controlled trials (RCTs)

Systematic reviews of RCTs or meta-analyses are regarded as the strongest level of evidence. However, evidence from descriptive and qualitative studies should be factored into clinical decisions.

103.

An infant is being treated with inhaled nitric oxide (iNO) for hypoxic respiratory failure secondary to pulmonary hypertension. The nurse should be aware of which of the following potential side effects while providing care to an infant receiving iNO therapy? 

  • Methemoglobinemia 

  • Rebound pulmonary hypertension 

  • Significant GI distress 

  • Hepatic dysfunction 

Correct answer: Methemoglobinemia 

Nitric oxide (NO) is an inhaled pulmonary vasodilator. A potential side effect of iNO is methemoglobinemia, which can reduce the oxygen-carrying capacity of the hemoglobin. For this reason, weaning the patient as quickly as possible is vital. Methemoglobin levels should be closely monitored while the child is receiving iNO therapy. 

Use iNO with caution in patients with left-sided obstructive heart lesions. Rebound pulmonary hypertension may occur with discontinuation; do not abruptly discontinue but rather wean the patient. GI distress and hepatic dysfunction are not considered to be side effects of iNO. 

104.

A 7-year-old patient is admitted to the emergency department after a motor vehicle crash. The child experienced blunt trauma to the abdomen as a result of direct compression from external forces related to the crash. The nurse suspects the physician will order which of the following imaging studies to assess for renal trauma in this patient? 

  • Computed tomography (CT) scan 

  • Abdominal x-ray

  • Arteriography 

  • Intravenous pyelogram (IVP) 

Correct answer: Computed tomography (CT) scan 

CT is the gold-standard imaging study for renal trauma in children. Advantages include a more accurate demonstration of renal injury, visualization of nonvascularized regions, and simultaneous visualization of the other intraabdominal organs. Abdominal or kidney, ureter, and bladder (KUB) film demonstrating obliteration of the renal shadow suggests renal trauma. Up to 85% of plain abdominal x-ray films demonstrate normal findings despite proven renal trauma. 

Arteriography may assist in planning surgical intervention if vascular disruption has occurred. IVP may be done if an isolated urogenital injury is suspected, allowing visualization of all genitourinary structures.  

105.

An 11-month-old male is brought to the emergency department by his parents, who state the infant was playing on the floor when he started to cough and choke. The coughing has gotten worse, and the child is starting to have trouble breathing. 

Based on this data, what is the most likely cause of the child's symptoms? 

  • Foreign body aspiration 

  • Upper respiratory tract infection 

  • Exposure to allergens (e.g., dust, pollen, pet dander)

  • Anaphylactic reaction to a food 

Correct answer: Foreign body aspiration 

A leading cause of accidental death in toddlers is foreign body aspiration, occurring when a foreign object like a nut, coin, or small toy gets lodged in the airway. Mobile infants and toddlers are at an increased risk, as they are inherently curious and tend to place objects into their mouths when exploring the world around them. In addition, children younger than 2 do not yet have molars, so they are unable to grind their food into smaller, more manageable pieces. 

The initial episode is frequently associated with choking and coughing, and examination findings may be normal or reveal nonspecific signs, such as decreased air entry, wheezing, rhonchi, or inspiratory stridor. Treatment depends on the cause and location of the obstruction and is primarily focused on maintaining adequate ventilation; oxygen is administered if necessary. 

While the other choices are possibilities to be ruled out, the most likely answer in this scenario is a foreign body aspiration.  

106.

A nurse reviews the laboratory values of a child in their care and notes a serum calcium level of 7.8 mg/dL. Which of the following conditions would MOST likely cause this calcium level? 

  • Hyperphosphatemia 

  • Adrenal insufficiency 

  • Hyperparathyroidism 

  • Excessive ingestion of vitamin D

Correct answer: Hyperphosphatemia 

The normal serum value of calcium is 9 to 11 mg/dL. Serum calcium declines reciprocally as phosphorus rises; therefore, a decrease in calcium is most often secondary to hyperphosphatemia. Other reasons for hypocalcemia include severe muscle damage, prolonged bed rest (the long-term effect is hypocalcemia), induced resistance to the action of PTH, sepsis, hypomagnesemia, and transfusions of citrate-containing blood products. 

The other choices are causative factors associated with hypercalcemia. 

107.

A social worker has been consulted about a toddler who is nearing discharge after the parents informed the nurse that they do not have a car seat that will fit the toddler. When questioned further, the parents admit not being able to afford one. 

How should the social worker respond? 

  • Provide the parents with an approved car seat and discuss any further aid they may need beyond the hospital stay 

  • Refer the parents to a local community resource to obtain a car seat 

  • Report to the charge nurse that discharge may be delayed due to the lack of a car seat 

  • Offer personally to give the family a car seat

Correct answer: Provide the parents with an approved car seat and discuss any further aid they may need beyond the hospital stay 

Utilizing an interdisciplinary resource (social work) that can address multiple needs of a patient exemplifies the nursing competency of systems thinking (i.e., recognizing the interrelationship within and across healthcare systems). This holistic approach takes into consideration what aid the family may need beyond the hospital stay, in addition to providing a car seat prior to hospital discharge. The social worker should also provide community resources for post-discharge needs. 

108.

A 4-year-old female presents to the emergency department via ambulance with severe wheezing and cyanosis. She is pale and restless. Her respiratory rate is 40 breaths per minute, her heart rate is 155 beats per minute, and her oxygen saturation is 89%. The mother reports the child has been experiencing a prolonged asthma attack and is not responding to her usual asthma treatments. 

What is this patient likely experiencing?

  • Status asthmaticus 

  • Anaphylaxis 

  • Reactive airway disease 

  • Congestive heart failure (CHF)

Correct answer: Status asthmaticus 

Status asthmatics is one of the most common causes of emergency room encounters in the United States. This condition is characterized by impending respiratory failure from a severe asthma attack that is unresponsive to routine therapy, thus necessitating hospitalization. The child presents with severe wheezing, is usually pale and restless, and is sometimes cyanotic. Respiratory rate and heart rate are elevated, and a pulsus paradoxus of >15 mm Hg may be noted. Dehydration, vomiting, and abdominal pain with distention are common manifestations. 

Status asthmaticus can be misdiagnosed when wheezing occurs from an acute cause other than asthma. The child in this scenario has a diagnosis of asthma, and the mother has already reported a prolonged asthma attack that has been unresponsive to usual treatments. This rules out other causes of wheezing (including anaphylaxis and CHF). Reactive airway disease generally precedes a formal diagnosis of asthma. 

109.

A pediatric critical care nurse is caring for a patient with acute kidney injury (AKI) and notes changes in the patient's ECG waveform on the cardiopulmonary monitor suggesting hyperkalemia, requiring emergent medical care. 

Which ECG finding is NOT characteristic of hyperkalemia? 

  • Prominent U wave 

  • Peaked T waves 

  • Prolonged PR interval 

  • Absent P waves 

Correct answer: Prominent U wave 

A prominent U wave on an ECG is characteristic of hypokalemia, not hyperkalemia.

Hyperkalemia occurs secondary to decreased renal excretion. ECG changes secondary to hyperkalemia can range from peaked T waves, PR prolongation, P wave flattening (no P waves), and a widening of the QRS complex to complete heart block and ventricular fibrillation as the potassium levels increase. 

This is a life-threatening emergency because of the risk of cardiac arrest.  

110.

Nursing management and treatment of a child with hemolytic uremic syndrome (HUS) includes which of the following? 

  • Recognition and treatment of neurologic complications 

  • Platelet transfusion(s) 

  • Sodium and water restriction 

  • Diuretics, antihypertensive medications, and dietary salt restriction to manage symptoms 

Correct answer: Recognition and treatment of neurologic complications 

HUS is the simultaneous occurrence of hemolytic anemia, thrombocytopenia, and acute kidney failure; it is characterized by microangiopathy with platelet aggregation and fibrin deposition in small vessels in the kidney, gut, and CNS. Management and treatment are primarily focused on general supportive care and treatment of complications such as acute kidney injury (AKI), anemia, CNS symptoms, and abdominal symptoms.

Platelet transfusion is warranted only if the patient is actively bleeding. Peritoneal dialysis (PD) is the treatment of choice until renal function returns. 

Sodium and water restriction are indicated in the management of acute glomerulonephritis. Diuretics, antihypertensive medications, and dietary salt restrictions are utilized to manage symptoms of nephrotic syndrome.  

111.

Which of the following infectious causes of stridor has a viral etiology with an allergic component? 

  • Acute spasmodic laryngitis 

  • Acute bacterial tracheitis 

  • Acute epiglottitis 

  • Acute laryngotracheobronchitis (LTB) 

Correct answer: Acute spasmodic laryngitis 

Acute spasmodic laryngitis is distinct from laryngitis and LTB. It is characterized by recurrent paroxysmal attacks of laryngeal obstruction that happen specifically at night. The child feels well the following day. This condition is viral, and some children may be predisposed to it; allergies or hypersensitivities may be implicated in some cases. Management is the same as for infectious croup. 

Acute epiglottitis and acute bacterial tracheitis are both caused by bacterial infections. Croup, or acute laryngotracheobronchitis, is viral but is not associated with allergies or hypersensitivities.  

112.

A 7-year-old female presents to the emergency department with her mother after falling out of a tree she had been climbing. The nurse suspects the child fractured her left upper arm. X-ray findings reveal a humeral fracture in which one side of the bone is bent and the other is broken. 

This represents what type of bone fracture? 

  • Greenstick 

  • Avulsion

  • Transverse

  • Oblique 

Correct answer: Greenstick 

Musculoskeletal trauma is suspected in the child with pain at the injury point, soft-tissue swelling and/or bruising, limited range of motion (ROM), function loss, changes in vital signs, and altered sensory perception. Most fractures are simple and nondisplaced, requiring only the application of a cast. Fracture stabilization is important to protect soft tissues, decrease pain, and facilitate healing and rehabilitation. 

A greenstick fracture is when a bone bends and cracks as a result of compression force, and it usually occurs in children younger than 10 years of age. The bone doesn't break completely in this type of fracture, as a child's bones tend to be more flexible and the periosteum is stronger than that of an adult's bones. 

An avulsion fracture results from muscle mass contracting forcefully, causing bone fragments to tear at insertion. A transverse fracture results from angulation force or direct trauma and occurs when the bone breaks at a 90-degree angle (the fracture line is perpendicular to the long part of the bone). An oblique fracture results from a twisting force, with the break at an angle through the bone. 

113.

A nurse is providing education to the parents of a child admitted to the PICU for Kawasaki disease (KD) regarding the purpose of administering intravenous immunoglobulin (IVIG). Which statement, if made by the mother, indicates an understanding of the nurse's teaching?  

  • "My child needs IVIG to decrease their risk of coronary artery disease." 

  • "The IVIG will fight the infection that is causing KD." 

  • "The IVIG is necessary to minimize the spread of my child's rash." 

  • "Because my child's spleen is enlarged, IVIG will help decrease their spleen size." 

Correct answer: "My child needs IVIG to decrease their risk of coronary artery disease." 

Anti-inflammatory agents will reduce inflammation and decrease the incidence of coronary abnormalities. High-dose aspirin therapy with IVIG is the recommended initial treatment for KD, with the primary goal of coronary disease prevention. Repeat doses of IVIG or pulse steroids are used if treatment fails and symptoms persist. 

A polymorphous rash, lymphadenopathy, and splenomegaly are expected clinical manifestations of KD; IVIG therapy is not indicated to reduce the incidence of these findings. 

114.

Which of the following conditions may result in difficulty weaning an infant from mechanical ventilation? 

  • Patent ductus arteriosus (PDA) 

  • Respiratory distress syndrome (RDS)

  • Transient tachypnea of the newborn (TTN)  

  • Meconium aspiration syndrome (MAS)

Correct answer: Patent ductus arteriosus (PDA) 

A left-to-right shunt via the PDA results in blood flow from the aorta into the pulmonary artery and lungs, thus increasing pulmonary blood flow. The increased pulmonary artery pressure and increased left ventricular pressure and volume lead to pulmonary edema and bilateral congestive heart failure, limiting the physiologic ability to wean successfully from the ventilator. The PDA will often present clinically in 4 to 7 days after birth with an inability to wean from the ventilator or a need for increased ventilatory and oxygen support. 

115.

A 15-year-old female is admitted to the ED with a suspected overdose after her mother found her unconscious in her bedroom and rushed her to the hospital. She had a prescription bottle of her father's nortriptyline at her bedside table. 

Which of the following signs and symptoms would the nurse expect to observe in this type of toxicity? 

  • Dysrhythmias and hypotension

  • Hypothermia and tachycardia

  • Profound hypertension and diaphoresis

  • Respiratory distress and drooling

Correct answer: Dysrhythmias and hypotension

The toxicity of tricyclic antidepressants (TCAs) is related to the effects of the following: 

  • anticholinergic effects 
  • direct alpha-adrenergic blockage 
  • inhibition of norepinephrine and serotonin reuptake 
  • blockade of fast sodium channels in myocardial cells

The most serious adverse effects of TCA toxicity are CNS effects and cardiovascular instability. A classic presentation of overdose poisoning includes profound hypotension, metabolic acidosis, and numerous dysrhythmias (especially ventricular dysrhythmias, conduction delays, and potentially the rapid onset of grand mal seizures and coma shortly after ingestion). In addition, sinus tachycardia on ECG is common.  

116.

When considering the use of a translator for a patient's parents who do not speak English, which of the following considerations is MOST important?

  • The interpreter must have training in medical vocabulary for both languages

  • The interpreter must speak both languages well

  • The interpreter must be available on-site

  • The interpreter must know the patient's history

Correct answer: The interpreter must have training in medical vocabulary for both languages

The interpreter should have training in medical vocabulary for both languages. Just speaking the languages well does not mean that the interpreter will adequately translate medical information and terminology.

It is not necessary for the interpreter to know the patient's history, as their job is only to interpret what is said, not add to or filter it based on prior knowledge. While on-site interpreters are ideal, translation can be done via phone.

117.

What is a systematic review of current literature that uses statistical methods to combine and summarize the results of individual studies?

  • Meta-analysis

  • Randomized controlled trial (RCT)

  • Case-control study

  • Retrospective cohort study

Correct answer: Meta-analysis

By combining smaller studies, a meta-analysis gives researchers a way to see an effect that smaller studies cannot. The results produce unbiased estimates of the effect of an intervention on clinical outcomes, and practitioners can learn the strengths or weaknesses of clinical trials and evaluate the claims of benefit prior to implementing a strategy.

118.

A 7-year-old female is admitted to the emergency department for acute asphyxia caused by smoke inhalation from a house fire. Based on this diagnosis, the nurse prepares to administer which of the following treatments? 

  • FiO2 at 100% for 6 hours 

  • FiO2 at 100% for 4 hours 

  • FiO2 at 90% for 6 hours 

  • FiO2 at 90% for 4 hours 

Correct answer: FiO2 at 100% for 6 hours 

Acute asphyxia is an inhalation injury often seen in burn patients because of carbon monoxide (CO) toxicity. The most common sources of CO poisoning are smoke from house fires, engine fumes and automobile exhaust, and non-electric heaters. The chemical inhalation of the byproducts of combustion causes airway injury. Symptoms include headaches, nausea, and lethargy, which are all related to hypoxemia. Tachypnea and cyanosis may be absent because the body's peripheral chemoreceptors perceive a normal partial pressure of oxygen in arterial blood (PaO2). 

CO has a constant half-life and is reduced by 50% in 4 hours in room air. To ensure complete removal, 100% FiO2 for 6 hours is the treatment of choice for CO inhalation. 

Administration of 90% to 100% O2 will displace some of the carboxyhemoglobin before arrival at the ED or before an ABG analysis can be performed.  

119.

For brain death testing on a child, which of the following findings is confirmatory? 

  • Absence of respiratory effort and PaCO2 ≥60 mm Hg

  • Presence of nystagmus and oculovestibular reflexes 

  • Electroencephalogram (EEG) revealing low-voltage amplitude 

  • Doll's eyes and absent gag reflex 

Correct answer: Absence of respiratory effort and PaCO2 ≥60 mm Hg

To determine brain death, the physical examination should demonstrate that coma and apnea coexist. The clinical examination should demonstrate a lack of function in the entire brain, including flaccidity, absence of movement (except for spinal cord reflexes), and absence of brainstem function. 

Apnea testing must be performed with the clinical examination, and the patient must have a complete absence of respiratory effort with standardized apnea testing. After ventilator discontinuance, adequate time (5-10 min) must be given to allow PaCO2 to increase to levels sufficient to stimulate respiration, adequate oxygenation, and absence of cardiovascular instability. The PaCO2 must be 20 mm Hg above baseline PaCO2 and ≥60 mm Hg. 

Complete absence of amplitude on EEG is consistent with brain death; doll's eyes and absent gag reflex are a part of the physical examination, but apnea testing must also accompany the physical exam and reveal a complete absence of respiratory effort with PaCO2 ≥60 mm Hg. The presence of nystagmus and oculovestibular reflexes indicate the brain is functioning and reacting to stimuli.

120.

A nurse is caring for a preterm infant and notes upon morning assessment that the infant is lethargic with a heart rate of 92 bpm, has a distended abdomen, has grossly bloody stool, and is refusing to breastfeed. The nurse suspects necrotizing enterocolitis (NEC). 

Which of the following orders should the nurse initially request from the attending physician? 

  • An abdominal x-ray 

  • An abdominal ultrasound (US)

  • A complete blood count (CBC), serum electrolyte evaluation, and C-reactive protein (CRP)

  • Stool cultures to rule out viral enteritis 

Correct answer: An abdominal x-ray 

Obtaining an order for an abdominal x-ray should be the nurse's priority. Radiographic imaging has the greatest diagnostic power for NEC and is capable of identifying intestinal dilation, pnematosis intestinalis, hepatobiliary gas, and pneumoperitoneum (if intestinal perforation has occurred). The diagnostic test of choice is a three-way abdominal x-ray series (i.e., flat, left lateral decubitus, and sometimes cross-table views). 

Abdominal ultrasonography and associated bloodwork are utilized to confirm or support the diagnosis. An abdominal US is becoming increasingly important in determining when surgical intervention may be indicated and is more sensitive in detecting portal venous gas and intra-abdominal free fluid. CBC and serum electrolyte evaluations typically reveal thrombocytopenia, leukocytosis or leukopenia, and metabolic acidosis. CRP levels are increasingly obtained and appear to be a good marker of the onset, persistence, and subsequent resolution of NEC. Stool cultures provide a differential diagnosis for spontaneous intestinal perforation; however, this is not the nurse's priority at this time. 

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