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Quiz Session - Attempts With Random Questions

AACN CCRN (Pediatric) Exam Questions

Page 7 of 20

121.

In the Synergy Model for Patient Care, what refers to the ability of a nurse to utilize their skillset and knowledge-base to comprehend how one decision can impact health care as a whole? 

  • Systems thinking 

  • Advocacy/moral agency

  • Caring practices

  • Clinical judgment 

Correct answer: Systems thinking 

The AACN Synergy Model for Patient Care focuses on the extent to which nurses' competencies match patient characteristics. The goal of this model is to restore the patient to an optimal level of wellness, as defined by the patient and their family. 

Systems thinking is a nurse competency best defined as the ability of a nurse to manage environmental and system resources through the use of their knowledge and skills in a way that enables them to comprehend how one decision can impact the system as a whole; it is the recognition of interrelationship within and across healthcare systems. 

Advocacy/moral agency is the nurse's ability to work on each patient's behalf, resolving ethical concerns. Caring practices involve ensuring a therapeutic environment is established based on the unique needs of the patient and family. Clinical judgment is the nurse's possession of clinical reasoning and critical thinking skills.  

122.

A pediatric nurse is caring for a child with epiglottitis and is providing education to the child's parents. What is the most common cause of epiglottitis?

  • Haemophilus influenzae type b (Hib)

  • Respiratory syncytial virus (RSV)

  • Streptococcus pyogenes 

  • Influenza virus

Correct answer: Haemophilus influenzae type b (Hib)

Epiglottitis is a life-threatening condition in which the epiglottis swells and obstructs airflow into the lungs. It is a rapidly progressive infection requiring prompt medical attention. The organism most often responsible for epiglottitis is Haemophilus influenza type b (Hib); caregivers should be taught that the Hib vaccine can be given as a preventative measure. This vaccine is administered in a four-dose series at 2, 4, 6, and 12-15 months.

Other less common infectious organisms include Streptococcus pyogenes, Streptococcus pneumoniae, or Staphylococcus aureus. RSV and the influenza virus do not cause epiglottitis. 

123.

A 9-month-old male presents to the emergency department with his mother after falling and hitting the back of his head. The mother reports she was doing laundry and momentarily sat the infant on top of the dryer so she could switch the load from the washer to the dryer. As she was bending over, the infant fell off the dryer and landed on the concrete flooring. The mother reports the child has been acting normal but vomited once, which prompted this visit.

Upon assessment, the nurse notes blood collection behind the left tympanic membrane. Based on this finding, which type of basilar skull fracture is likely present? 

  • Temporal bone fracture 

  • Anterior skull base fracture 

  • Occipital transverse fracture 

  • Middle fossa basilar fracture 

Correct answer: Temporal bone fracture 

Falls are responsible for the majority of traumatic brain injuries in children younger than 9 years old. Infants and toddlers are more likely to fall from furniture, beds, or parents' arms, while older children are more likely to fall from playground equipment. 

Basilar fractures present with specific physical findings. Hemotypanum represents a blood collection behind the tympanic membrane from a temporal bone fracture. If the dura mater is torn at the same time, cerebrospinal fluid (CSF) may leak from the ear canal (otorrhea).

An anterior skull base fracture will present with a raccoon or panda sign (periorbital blood without subconjunctival hemorrhage). 

An occipital transverse fracture is evidenced by acute deterioration in a patient with associated hemorrhage and increased intracranial pressure (ICP). This is due to the close proximity to the vital centers of the brainstem. 

A middle fossa basilar fracture is associated with rhinorrhea (representative of CSF leakage into the middle ear cavity with drainage through the Eustachian tube into the nose) and anosmia (lack of smell from a damaged olfactory nerve). 

124.

A nurse performs a urinalysis on a pediatric patient with suspected acute kidney injury (AKI). The urine is a "dirty' brown color with sediment. What does this indicate? 

  • Intrinsic kidney failure 

  • Tumor lysis syndrome (TLS)

  • Acute glomerulonephritis

  • Interstitial nephritis 

Correct answer: Intrinsic kidney failure 

The presence of urinary sediment with a "dirty" brown color to the urine indicates the presence of intrinsic kidney failure. Normal urine sediment is indicative of prerenal causes of AKI, usually caused by poor perfusion. If the urine sediment has red blood cell casts and cellular debris, it suggests acute tubular necrosis (ATN). 

Uric acid crystals in the urine indicate TLS; a reddish-brown tinge to the urine would indicate acute glomerulonephritis (the presence of red blood cell casts); white blood cell (WBC) casts would suggest a diagnosis of interstitial nephritis. 

125.

Congestive heart failure and hypoxemia are major complications associated with which of the following congenital heart defects?  

  • Pulmonary stenosis 

  • Mitral stenosis 

  • Subaortic stenosis

  • Aortic stenosis 

Correct answer: Pulmonary stenosis 

Pulmonary stenosis (PS) results from an embryologic error in the formation of the pulmonary leaflets, and involves a narrowing of the pulmonary valve that causes an obstruction to blood flow from the right ventricle to the pulmonary artery, leading to right ventricular hypertrophy (RVH), congestive heart failure (CHF), and hypoxemia (manifested as cyanosis at birth), if left unrepaired.

With mitral stenosis, the component of the mitral valve is abnormal and, if left untreated, could cause pulmonary artery (PA) hypertension, elevated pulmonary vascular resistance (PVR), and right ventricular (RV) dysfunction from PVOD (pulmonary veno-occlusive disease). In addition, due to a decreased left ventricular (LV) volume load, ischemia, fibrosis, and decreased CO ensue.

Subaortic stenosis consists of a membranous diaphragm or fibrous ring encircling the LV outflow tract underneath the base of the aortic valve; complications include increasing exercise intolerance, dyspnea, fatigue, chest pain, and aortic insufficiency.

Aortic stenosis is the malformation of the aortic valve, causing obstruction to the ejection of blood from the left ventricle (LV). If severe, symptoms of circulatory shock are present at birth from obstruction to systemic blood flow. 

126.

Which phase of shock is characterized as unmanageable, involving irreversible injury? 

  • Refractory phase 

  • Compensated phase

  • Uncompensated phase 

  • Initial phase

Correct answer: Refractory phase 

The refractory phase is the last phase of shock; it is unmanageable and irreversible. Bradycardia and profound hypotension occur with no response to potent vasopressors. Ultimately, this phase results in multisystem organ failure and death. 

127.

A nurse is caring for a 17-year-old patient with appendicitis who is scheduled for a laparoscopic appendectomy. The patient voices concern about the surgical procedure and is fearful of anesthesia. How should the nurse address these concerns initially? 

  • Ask the patient to discuss what they currently know about the planned surgery 

  • Tell the patient that preoperative fear is normal 

  • Explain any possible discomfort or pain that could result from the surgery 

  • Give detailed explanations about the processes involved in the surgery 

Correct answer: Ask the patient to discuss what they currently know about the procedure 

Most children experience some fear and anxiety when hospitalized. Fears may be reality-based, related to past experiences, or the result of an overly active imagination. The information the patient may have gotten could be incorrect, or the child could have heard comments made by others that are scary or out of context.

It's most important to first ask the teenager what they currently know about the planned surgical procedure to guide the remainder of the conversation. If the nurse has a baseline of what information the teenager currently knows, they can add information as needed or correct any misinformation to help alleviate the patient's stress. 

128.

What is the MOST common neurological disorder seen in children? 

  • Seizures 

  • CNS tumors 

  • CNS infections 

  • Scoliosis

Correct answer: Seizures 

Seizures are the most common neurological disorder seen in children, with a 1% estimated lifetime prevalence of epilepsy/seizure disorder. A seizure is characterized as an uncontrolled, time-limited alteration in behavior as a result of abnormal electrical discharge in any part of the brain. Seizures can be genetic, structural/metabolic, or unknown in etiology. Febrile seizures are the most common form of childhood seizure, with an occurrence rate of 2% to 5% of all children. 

Central nervous system (CNS) tumors, CNS infections, and scoliosis are not as commonly seen in children as seizures are. 

129.

Which of the following factors will negatively impact the oxyhemoglobin dissociation curve by causing a shift to the left?  

  • Hypocapnia 

  • Acidosis

  • Hyperthermia 

  • Increased PaCO2

Correct answer: Hypocapnia 

The oxyhemoglobin dissociation curve is a graph (S-shaped curve) representing hemoglobin's affinity for oxygen. The partial pressure of oxygen (PaO2) is on the x-axis and oxygen saturation (% hemoglobin saturation) is on the y-axis. 

A left shift represents hemoglobin with more affinity for oxygen; factors shifting the curve to the left include alkalosis, hypocapnia (decreased PaCO2), and hypothermia. 

A shift to the right reflects hemoglobin with less affinity for oxygen; factors shifting the curve to the right include acidosis, fever (hyperthermia), and hypercapnia (increased PaCO2). 

130.

A child has just returned to the PICU after an above-knee amputation of the left leg. The nurse should plan to place the patient in which position immediately following this surgical procedure?  

  • Supine, with pillows supporting the residual limb

  • Supine, with the residual limb flat on the bed

  • Prone

  • Slight reverse Trendelenburg

Correct answer: Supine, with pillows supporting the residual limb

Specific management of a child with a traumatic amputation includes wound management and stump protection, limb splinting as indicated in partial amputations, antibiotics, and tetanus prophylaxis. Appropriate imaging of the stump is also imperative to proper healing. 

For the first 24 hours following surgery, the residual limb, or stump, should be supported on pillows to facilitate venous return and decrease swelling. After the first 24 hours, it is suitable for the limb to be placed flat on the bed (to reduce hip contracture). Splinting and wrapping techniques can also be utilized to control edema. The surgeon may have additional orders regarding positioning that should be reviewed as well. 

131.

While performing a morning assessment on a newborn infant, the nurse auscultates a murmur at the left upper sternal border of the infant's chest. The nurse suspects the infant may have a patent ductus arteriosus (PDA) and reports their findings to the inpatient pediatrician. 

What type of murmur is a hallmark sign of PDA?  

  • Harsh, loud, continuous 

  • Harsh, loud, systolic 

  • Soft, blowing, diastolic 

  • Soft, blowing, continuous 

Correct answer: Harsh, loud, continuous 

In utero, the ductus arteriosis permits blood flow to be diverted from the high-resistance pulmonary circulation to the descending aorta and the low-resistance placental circulation. 

After delivery, the persistence of this normal fetal channel connecting the aorta and pulmonary artery characterizes an acyanotic cardiac lesion. The hallmark murmur heard in an infant with a PDA is a machine-like, continuous (heard both during diastole and systole) murmur that is harsh and loud. It can be heard best at the left upper sternal border of the chest. 

132.

Tumor lysis syndrome (TLS) is the most common pediatric oncology emergency. What is the MOST common finding in this condition? 

  • Hyperuricemia 

  • Hyperkalemia 

  • Hyperphosphatemia 

  • Hypercalcemia 

Correct answer: Hyperuricemia 

TLS is an oncologic emergency that is caused by massive tumor cell lysis with the release of large amounts of potassium (hyperkalemia), phosphate (hyperphosphatemia), and nucleic acids into the systemic circulation (bloodstream). Catabolism of the nucleic acids to uric acid leads to hyperuricemia, the most common finding in this emergent situation. 

TLS most often occurs after the initiation of cytotoxic therapy for patients with clinically aggressive and highly aggressive lymphomas (particularly the Burkitt subtype) and T-cell acute lymphoblastic leukemia (ALL).

133.

A child is receiving a blood transfusion. Once opened, filtered blood bags should not be used for more than what period?

  • 4 hours

  • 6 hours

  • 8 hours

  • 10 hours

Correct answer: 4 hours 

Each filtered set can be used for up to 4 units and should hang no longer than 4 hours. In addition, the patient's vital signs should be checked immediately before the infusion begins, and the nurse should stay with the patient for the first 15 minutes of the infusion. 

Careful observations should be made for reactions, including increased temperature, diaphoresis, irregular respiration, bradycardia, restlessness, and pallor. If any of these findings are observed, transfusions should be stopped immediately as they could indicate a reaction. Vital signs are monitored every 30 minutes to 1 hour afterward, according to hospital policy. 

134.

A PICU nurse is caring for a burn victim who has developed blistering over the wounds. The nurse knows that debridement is recommended for all blisters greater than which size?

  • 2 cm

  • 1 cm

  • 3 cm

  • 4 cm

Correct answer: 2 cm

Wound debridement involves the removal of necrotic tissue, debris, and foreign material; it can be accomplished through mechanical, chemical, or surgical methods. Mechanical debridement may involve cleaning the wound with coarse mesh gauze, the application and removal of gauze dressings, irrigation, or the use of scissors and forceps to lift and trim loose necrotic tissue. 

All blisters >2 cm should be mechanically derided, as this tissue must be removed to minimize the risk of infection.  

135.

What is the nurse's first priority of care in the emergency department for a pediatric patient admitted with circumferential deep partial-thickness and full-thickness burns?  

  • Airway management 

  • Pain management 

  • Assessing neurological status  

  • Establishing intravenous (IV) access 

Correct answer: Airway management 

The primary assessment of a burn victim in the emergency department follows the "ABCDE" methodology, which is as follows:

  • A: Airway
  • B: Breathing
  • C: Circulation
  • D: Disability
  • E: Expose/Examine

Airway and breathing should be assessed first and addressed as for any trauma victim. Basic life-support measures should be instituted if necessary, including providing 100% supplemental oxygen via facemask, assessing respirations for adequacy of rate and depth with symmetrical and bilateral movement of air throughout the chest wall, and auscultating for bilateral breath sounds. 

IV access should then be established for circulatory support via fluid resuscitation, and pain medications can be administered this way as well. Neurological status is then assessed after airway, breathing, and circulation have been addressed. 

136.

A 2-year-old male is brought to the emergency department by his mother with a sudden onset of choking, gagging, and coughing. The patient has a pulse of 125/min and a respiratory rate of 34/min. The nurse auscultates decreased breath sounds over the right upper lung field. 

What other immediate physical finding correlates with a diagnosis of partial laryngeal foreign body obstruction? 

  • Inspiratory stridor 

  • Fever 

  • Aphonia

  • Crackles 

Correct answer: Inspiratory stridor 

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. 

Patients who present with laryngeal foreign bodies develop stridor, dyspnea, cyanosis, coughing, and voice change (not an inability to speak). Patients with bronchial foreign bodies manifest with cough, asymmetric breath sounds, wheezing, and dyspnea.

A fever may develop later (not immediately) if the partial obstruction is not resolved. Cyanosis will get progressively worse if the larynx becomes completely blocked or if the child aspirates the foreign body deeper into the lungs. Crackles are not heard in a partial foreign body obstruction. 

137.

A nurse is caring for a patient with a Sengstaken-Blakemore tube in place for bleeding esophageal varices. The nurse is preparing a plan of care for this patient and anticipates deflation of the balloons at which intervals?

  • Every 12 to 24 hours 

  • Every 4 to 6 hours

  • Every 8 to 12 hours

  • Every 48 hours 

Correct answer: Every 12 to 24 hours 

Insertion of a Sengstaken-Blakemore tube may be performed on a patient with esophageal varices if endoscopy is not available. It is often placed in emergency situations to stop bleeding in the stomach or esophagus. 

The tube has three separate lumens for gastric suction, inflation of the gastric balloon, and inflation of the esophageal balloon. Nursing interventions include deflation of the balloons every 12 to 24 hours, as well as ensuring patency of the gastric suction lumen by irrigating frequently. Frequent serious complications of the Sengstaken-Blakemore tube include perforation or erosion of the esophagus or stomach from hyperinflation or prolonged inflation of the balloons. For these reasons, its usefulness is limited. 

138.

Which of the following is the BEST example of expanding learning opportunities for a nursing team in a pediatric intensive care unit (PICU)? 

  • Implement a journal club to review and discuss articles together 

  • Post interesting articles in the break room 

  • Post fliers about educational offerings in the hospital unit

  • Implement mandatory online educational courses and continuing-education units (CEUs)

Correct answer: Implement a journal club to review and discuss articles together 

Utilizing a journal club is an example of clinical inquiry, a nurse competency of the Synergy Model for Patient Care. Clinical inquiry is defined as ongoing questioning and evaluation of nursing practice. A journal club affords the opportunity for literature to be reviewed and discussed by the team together. This will, in turn, contribute to the acquisition of knowledge for the nursing team. 

139.

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's airway is open and immediately begins CPR. 

When two rescuers are performing CPR, what is the ratio of compressions to breaths for an infant patient?

  • 15 compressions to 2 breaths 

  • 15 compressions to 1 breath

  • 30 compressions to 2 breaths 

  • 30 compressions to 1 breath 

Correct answer: 15 compressions to 2 breaths 

Infants and children typically go into cardiac arrest only after they have experienced respiratory failure; prolonged hypoxemia from inadequate oxygenation, ventilation, and circulation will lead to cardiac arrest. Respiratory arrest in the pediatric population is associated with a higher survival rate than cardiac arrest.

If an infant stops breathing and still has a pulse (brachial pulse should be checked for infants, and carotid or femoral pulses should be checked for children older than 1 year), rescuers should initiate CPR with the CAB (compressions, airway, and breathing) sequence. Conventional CPR, using chest compressions with rescue breaths, should be provided. 

When two rescuers are present, 15 compressions to 2 breaths (15:2) should be instituted, and the patient should be reassessed for a pulse every 2 minutes of CPR. When one rescuer is present, the ratio of compressions to breaths is 30:2. 

140.

A nurse is caring for an intubated, mechanically ventilated child. The child suddenly becomes notably pale and has diminished peripheral pulses. Hemodynamic monitoring reveals decreased oxygenation. 

What is the priority nursing action in this scenario? 

  • Call the physician and prepare for needle decompression 

  • Administer IV sedatives and neuromuscular blocking agents 

  • Administer an IV bolus of normal saline 

  • Prepare the patient for chest radiographs 

Correct answer: Call the physician and prepare for needle decompression 

Air leak syndromes (e.g., pneumothorax, pneumomediastinum, pneumopericardium, and pneumoperitoneum) are complications of mechanical ventilation as a result of large tidal volumes and/or high pressure. The physician should be immediately notified in this scenario, and the nurse should prepare for needle decompression. A chest x-ray will be indicated after the procedure to verify the resolution of the pneumothorax.

Administering sedation and neuromuscular blocking agents is indicated in the diagnosis of pulmonary hypertension. A fluid bolus would be necessary in the case of hypotension. 

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