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Quiz Session - Attempts With Random Questions

AACN CCRN (Pediatric) Exam Questions

Page 8 of 20

141.

A 14-year-old patient is in the PICU with peritonitis and has a nasogastric (NG) tube in place due to the presence of an ileus. The nurse anticipates administering which of the following medications to increase gastric motility?  

  • Metoclopramide (Reglan) 

  • Sucralfate (Carafate) 

  • Ranitidine (Zantac)

  • Famotidine (Pepcid) 

Correct answer: Metoclopramide (Reglan) 

Metoclopramide is an antiemetic and a gut-motility stimulator; it improves gastric motility.  

Sucralfate is used to treat and prevent ulcers, coating the ulcer and thereby protecting the area from further injury. Ranitidine and famotidine are often used in the treatment of gastroesophageal reflux disease (GERD). 

142.

Which of the following explanations BEST reflects ABO incompatibility?

  • ABO incompatibility occurs more often than Rh isoimmunization but is not as severe

  • Infants with ABO incompatibility have a negative DAT (direct Coombs test)

  • ABO incompatibility is limited to mothers of blood group A and affects infants of blood group O or B

  • RhoGAM (anti-D gamma globulin) is administered antenatally at 32 to 34 weeks of gestation to prevent the sensitization of nonsensitized pregnant Rh-negative women

Correct answer: ABO incompatibility occurs more often than Rh isoimmunization but is not as severe

ABO incompatibility is limited to mothers of blood group O and affects infants of blood group A or B. The most frequent cause of hemolytic disease of the newborn is ABO blood group incompatibility. Fortunately, the use of RhoGAM‚ particularly antenatal administration at 26 to 28 weeks of gestation, to prevent the sensitization of nonsensitized pregnant Rh-negative women has markedly decreased the incidence of Rh isoimmunization and resulting hyperbilirubinemia in newborns. 

Approximately 33% of infants with ABO incompatibilities show a positive direct antiglobulin test (DAT or Coombs test). If their DAT is negative, these infants do not have an increased incidence of significant hyperbilirubinemia compared with non-ABO-incompatible infants.

143.

Which of the following anticonvulsant medications is used in the initial therapy phase when the seizure duration reaches 5 minutes?

  • Intravenous (IV) lorazepam 

  • Intravenous (IV) midazolam 

  • Intravenous (IV) phenobarbitol 

  • Intravenous (IV) fosphenytoin 

Correct answer: Intravenous (IV) lorazepam 

Benzodiazepines act rapidly and are used as a first-line treatment when the seizure duration reaches 5 minutes and should conclude by 20 minutes. Lorazepam is preferred for IV administration because it has a fast onset of action (2-5 minutes). 

Midazolam is preferred via the intramuscular (IM) route, not the IV route. Fosphenytoin is used during the second phase of therapy when seizure activity has exceeded 20 minutes. Phenobarbitol is often used in conjunction with other anticonvulsants because it is longer acting. It may also be used during the second phase when other medications are not available or effective.  

144.

In children, bacterial meningitis often presents with three classic signs. Which of the following is NOT typically seen in pediatric bacterial meningitis? 

  • Petechial rash 

  • Nuchal rigidity

  • Brudzinski's sign 

  • Kernig's sign 

Correct answer: Petechial rash 

In children, the three classic signs of bacterial meningitis are a stiff neck (nuchal rigidity), Brudzinski's sign (flexion of the hips and knees with passive flexion of the neck), and Kernig's sign (back pain and resistance after passive extension of the lower legs). Although these signs are commonly present, they do not reliably occur in all children and cannot be used to diagnose or exclude meningitis. 

A petechial rash may occur with Neisseria meningitidis, otherwise known as meningococcal disease. 

145.

A nurse is caring for a 12-year-old trauma patient in the PICU. The patient sustained multiple fractures as a result of a motor vehicle accident, including a closed fracture of the left femur, which has been cast. The nurse includes monitoring for complications of the femoral fracture in the daily plan of care. 

Which of the following signs and/or symptoms would likely indicate the formation of fat emboli? 

  • Hypoxia and petechial rash

  • Swelling and severe pain in the cast leg

  • Fever and tachycardia 

  • Dark, reddish-brown urine and extreme muscle cramping 

Correct answer: Hypoxia and petechial rash

Although rare, fat embolism syndrome (FES) is a dangerous complication of fractures and is more commonly seen in closed versus open fractures of the long bones and pelvis of major trauma victims. It 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. 

FES may manifest within 12 hours post-injury or surgery with symptoms peaking within 48 to 72 hours. Although this syndrome can be difficult to diagnose, respiratory distress symptoms manifest in up to 90% of cases. Other common symptoms include a petechial rash seen on the anterior torso, axillary regions, and conjunctiva (usually appears 3-5 days after the onset of symptoms) and altered mental status (particularly confusion). 

Swelling and severe pain are indicative of compartment syndrome. Fever and tachycardia could signal osteomyelitis. Muscle cramping and dark urine are symptoms of rhabdomyolysis. 

146.

An infant with unrepaired aortic coarctation and subsequent aortic arch hypoplasia has decreased cardiac output. The nurse is closely monitoring blood pressure as part of this infant's plan of care. The physician asks the nurse to measure and record a four-extremity blood pressure. 

Which of the following is expected in this condition?

  • A systolic pressure that is more than 10 mm Hg higher in the right upper extremity compared with the lower extremity 

  • A diastolic pressure that is more than 10 mm Hg higher in the right upper extremity compared with the lower extremity

  • A systolic pressure that is more than 20 mm Hg higher in the right upper extremity compared with the lower extremity 

  • A diastolic pressure that is more than 20 mm Hg higher in the right upper extremity compared with the lower extremity 

Correct answer: A systolic pressure that is more than 10 mm Hg higher in the right upper extremity compared with the lower extremity

Coarctation of the aorta is the narrowing of the aorta, causing elevation of pressure proximally and decreased pressure distally. 

Infants with this defect are at risk for decreased cardiac output and should have their blood pressure evaluated frequently, as well as frequent monitoring of capillary refill and peripheral pulses. A blood pressure reading should be taken in both arms and both legs. A systolic pressure that is more than 10 mm Hg higher in the right upper extremity compared with the lower body is an expected finding of coarctation of the aorta, aortic arch hypoplasia, or an interrupted aortic arch. 

147.

A nurse is receiving a change-of-shift report on a 9-year-old male patient who is on palliative care for a terminal cancer diagnosis. How can the nurse meet this patient's emotional needs throughout the shift? 

  • Take the time to listen and answer questions honestly and openly

  • Avoid interruptions by coordinating nursing interventions 

  • Encourage the patient to write thoughts and feelings in a personal journal

  • Give the patient the opportunity to interact with other patients of the same age 

Correct answer: Take the time to listen and answer questions honestly and openly

Early school-age children still believe death is temporary and may see it as scary or violent, but older school-age children understand death as permanent and inevitable. When working with children ages 6-12 years old, speak directly to them, explaining what you are doing and why. Take the time to listen and allow them to ask questions. Answer honestly and frankly, as a school-age child can understand simple bodily functions and conceptualize death. 

The other answer choices may be acceptable, but the most appropriate nursing action in this scenario is to listen and answer any questions openly and honestly.  

148.

A child suspected of having aortic stenosis (AS) is admitted to the PICU for a full diagnostic work-up. Estimations of valvular gradients are used to determine the severity of the defect but may be falsely low if the patient has which condition?

  • A low cardiac output (CO) 

  • A high cardiac output (CO)

  • Compromised left ventricular (LV) function 

  • Associated cardiac lesions 

Correct answer: A low cardiac output (CO) 

AS is characterized by malformation of the aortic valve, which obstructs an ejection of blood from the LV. Associated cardiac lesions are common (PDA, VSD, or coarctation). In most cases, the aortic valve is bicuspid with a single, fused commissure and an eccentrically placed orifice. 

Valvular gradients can give some estimation of the degree of stenosis. This number may be misleading in instances of low CO in which output across the valve is already diminished, producing a falsely low gradient reading. 

149.

A nurse is admitting a pediatric patient to the PICU who is in septic shock after sustaining third-degree burns from an apartment fire. The nurse anticipates administering which of the following treatments first? 

  • Normal saline (NS) bolus 

  • Intravenous (IV) antibiotics

  • Intravenous (IV) corticosteroids 

  • Intravenous (IV) vasopressors 

Correct answer: Normal saline (NS) bolus

Circulation and perfusion are priorities, so IV fluids will be initiated immediately to replace volume in the case of septic shock. 

Vasoactive medications are then used to increase the SVR and decrease the dilation of the blood vessels. After blood cultures are obtained, broad-spectrum antibiotics are given without delay. Steroids are given to treat septic shock that results in adrenal insufficiency and refractory hypotension.

150.

A child presents to the emergency department with abrupt-onset, large-volume hemoptysis secondary to right lower lobe pneumonia that the patient has been battling for approximately two weeks. The child does not have any underlying pulmonary, cardiac, hematologic, or neoplastic disease but is coughing up significant amounts of blood. The child requires airway stabilization with intubation and mechanical ventilation, and the emergency team is preparing for a blood transfusion. 

Which of the following tests, if ordered by the physician, is diagnostic of pulmonary hemorrhage? 

  • Sputum or gastric aspirate revealing hemosiderin in the lung 

  • Hematocrit, reticulocyte count, and stool sample for occult blood 

  • Culture of bronchoalveolar lavage (BAL) samples via bronchoscopy 

  • Chest radiographs in at least two views to detect the site and extent of bleeding

Correct answer: Sputum or gastric aspirate revealing hemosiderin in the lung 

Infection is the most common cause of hemoptysis in children without underlying disease. It can be caused by any pneumonia or lung abscess, tuberculosis, or aspergilloma. Influenza virus may present with significant bleeding, and infections with relatively common community-acquired organisms such as Staphylococcus, Streptococcus, Klebsiella, and Pseudomonas can also cause hemoptysis.

Initial management for patients with large-volume hemoptysis includes airway stabilization and prevention of further bleeding. Once the patient is stable, laboratory work is performed (acute hemorrhage is accompanied by a drop in hematocrit, an increase in reticulocyte count, and a stool positive for occult blood). Chest radiography may indicate the site and extent of the bleeding, and culturing of BAL samples for bacteria, viruses, and fungi will help exclude infectious processes. 

The diagnosis of pulmonary hemorrhage is most readily confirmed with the detection of hemosiderin-laden macrophages in sputum or gastric aspirate using Prussian blue staining. 

151.

What is the MOST common complication of endotracheal intubation in a child? 

  • Intubating the right mainstream bronchus 

  • Perforating the trachea 

  • Intubating the esophagus 

  • Dental damage 

Correct answer: Intubating the right mainstream bronchus 

The most common complication of endotracheal intubation is inadvertent intubation of the right mainstem bronchus (if the tube is placed too deep) or dislodgment of the endotracheal tube (ETT) into the right mainstream bronchus if the child is positioned for procedures or transported within the facility. When this situation arises, chest expansion may not be equal, and breath sounds are absent or diminished in the left side of the chest. Pulse oximetry readings may be low, and ventilation may be difficult. 

Prompt recognition of this complication is essential; it is corrected by withdrawing the ETT until equal breath sounds and equal chest movement are observed. It is important to document ETT placement measurement at the nose or lip once intubation is established. 

152.

Which of the following statements is accurate regarding the evidence-based treatment of pediatric sepsis? 

  •  Initial fluid resuscitation with a crystalloid solution is the best choice for septic shock 

  • Administering sodium bicarbonate is recommended for all infants with lactic acidemia 

  • Initiating an insulin infusion is recommended to maintain tight glucose control

  • Gastric feeding is contraindicated for septic infants; IV gluconate or total parenteral nutrition (TPN) is preferred for nutritional intake 

Correct answer: Initial fluid resuscitation with a crystalloid solution is the best choice for septic shock 

For a child with septic shock who is hypovolemic, an aggressive approach is taken. Fluid resuscitation can reverse the shock state and increase the odds of survival. Treat hypovolemia with a large volume of isotonic crystalloid solution (normal saline, lactated Ringer's solution) for acute volume expansion. In addition, provide adequate ventilatory support, transfuse for blood loss, correct metabolic and electrolyte abnormalities, treat hypotension, and initiate antibiotic therapy. 

There is no evidence to support the use of bicarbonate for infants with lactic acidemia with a pH of greater than or equal to 7.15. Insulin can only be used if indicated. Tight glucose control has not been shown to improve outcomes and can increase the risk of hypoglycemia. Oral or enteral feedings should be administered as tolerated for infants with sepsis.

153.

A nurse educator of a pediatric intensive care unit (PICU) has noticed an increase in cases of skin breakdown in patients when the standard wound dressing protocol is utilized. Which of the following actions is the MOST appropriate initial step for the nurse to take? 

  • Evaluate the current dressing protocol 

  • Experiment with dressing a multitude of wounds using a different technique

  • Search the literature to identify current trends in dressing protocols 

  • Apply an antibiotic ointment to all wounds when performing dressing changes 

Correct answer: Evaluate the current dressing protocol 

At this point, the nurse educator does not know for certain whether the technical aspect of the current wound dressing protocol is the cause of the skin breakdown. Using a systematic approach, the PICU team should first problem-solve by attempting to understand the myriad of factors that may be contributing to the problem. The team should gather data to validate their perceptions of the issues around the patients with poor outcomes, and the current protocol. 

Assessing compliance with the dressing change protocol should be the initial step in determining the root of the problem. 

154.

A pediatric patient is being treated for cardiogenic shock secondary to myocarditis. Which of the following statements describes this form of shock? 

  • Cardiogenic shock leads to pulmonary and systemic congestion, resulting in pulmonary and peripheral edema and respiratory compromise.

  • Cardiogenic shock leads to increased preload, afterload, and contractility. 

  • Cardiogenic shock is characterized by extreme tachycardia, low systemic vascular resistance (SVR), and decreased cardiac output (CO). 

  • Cardiogenic shock occurs because the heart has an inadequate volume of blood to pump and insufficient oxygen-carrying capacity. 

Correct answer: Cardiogenic shock leads to pulmonary and systemic congestion, resulting in pulmonary and peripheral edema and respiratory compromise.

Cardiogenic shock is the result of the heart's inability to pump enough blood to the rest of the body (i.e., inadequate perfusion due to a weakened heart muscle) resulting from myocardial dysfunction. Hypovolemic shock is due to inadequate blood volume, usually from blood loss related to trauma). Causes include congenital heart disease (CHD), myocarditis, cardiomyopathy, arrhythmias, sepsis, poisoning or drug toxicity, and myocardial injury. 

Symptoms include severe tachycardia, high SVR (not low SVR), and decreased CO from the reduction in stroke volume (SV). Pulmonary congestion leads to pulmonary edema and respiratory compromise. Systemic congestion leads to effusions, ascites, and peripheral edema. Preload is variable, afterload is increased, and contractility is decreased. This causes decreased tissue perfusion and injury to the cells of the tissues/organs. 

155.

A child who is in septic shock begins to demonstrate signs of decompensation. Which of the following assessment findings does the nurse anticipate? 

  • Hypotension 

  • Cool, pale, moist skin

  • Pupillary dilation 

  • Decreased level of consciousness (LOC)

Correct answer: Hypotension 

Decompensated (uncompensated) shock occurs when the body's physiologic attempts to maintain blood pressure, tissue perfusion, and oxygen delivery fail, leading to multisystem organ failure. Hypotension is a late sign and is the result of compensated failure because organ perfusion can no longer be maintained. 

The other choices reflect the compensated phase of shock. Cool, pale, moist (diaphoretic) skin is a response of the sympathetic nervous system causing vasoconstriction. Decreased LOC is indicated by restlessness, confusion, and lethargy. Pupils may dilate in this phase as well. 

156.

Which of the following statements regarding syndrome of inappropriate antidiuretic hormone (SIADH) and diabetes insipidus (DI) is accurate? 

  • ADH is high in SIADH and low in DI

  • Cerebral hemorrhage is a serious complication of correcting fluid and sodium levels too rapidly in DI

  • ADH is synthesized in the posterior pituitary gland and secreted from the hypothalamus 

  • Laboratory findings in SIADH include a serum sodium level of >145 mEq/L

Correct answer: ADH is high in SIADH and low in DI

In SIADH, ADH release cannot be suppressed, causing an excess of ADH that results in hyponatremia and impaired water excretion; the patient will be in a hypoosmolar state. In DI, there is either an insufficient secretion of ADH (central DI) or failure of the kidneys to respond to ADH (nephrogenic DI), causing an inability to concentrate urine and leading to high volumes of dilute urine with high serum osmolality. Central DI is the most common form; deficiency of ADH is due to failure of the hypothalamus to synthesize, failure of the posterior pituitary to secrete ADH, or both.  

ADH is produced in the hypothalamus and secreted from the posterior pituitary gland into the body. Laboratory findings in DI include hypernatremia (serum sodium >145 mEq/L), not SIADH. Central pontine myelinolysis is a complication that can develop if hyponatremia and hypoosmolality are corrected too quickly in SIADH, causing brain cells to shrink and precipitating cerebral hemorrhage and subsequent brain injury with herniation. 

157.

What is an example of a type III hypersensitivity reaction? 

  • Serum sickness 

  • Asthma 

  • ABO incompatibility 

  • Poison ivy 

Correct answer: Serum sickness 

The classic clinical syndrome of serum sickness is caused by the immunization of a human by nonhuman serum proteins and subsequent illness caused by the formation of immune complexes. Serum sickness is the classic example of "type III" or immune complex-mediated hypersensitivity disease. The reaction requires the presence of the antigen, coincident with antibodies directed against the antigen, leading to the formation of antigen-antibody or immune complexes, which are later deposited in blood vessels or healthy tissue. 

Asthma is an example of a type I anaphylactic reaction. ABO incompatibility is a type II or tissue-specific hypersensitivity. Poison ivy is a type IV, delayed hypersensitivity reaction.  

158.

A 12-year-old male is admitted to the emergency department for wound management after an accident in which gasoline was thrown into a campfire, resulting in an explosion and flash burn. The pediatric nurse is asked to assist with initial debridement and cleaning of the wound. 

Which of the following debridement methods is NOT indicated in this scenario? 

  • Immersion hydrotherapy 

  • Mechanical debridement 

  • Enzymatic debridement 

  • Surgical debridement 

Correct answer: Immersion hydrotherapy 

Wound care should only be initiated after all potentially life-threatening injuries have been addressed. Wound cleansing involves using water and mild soap in a bath basin, or various topical agents, to cleanse the wound(s). While hydrotherapy may be utilized for some burn wounds, immersion hydrotherapy is no longer indicated as a viable treatment option due to its increased risk of bacterial translocation. 

Wound debridement involves the removal of necrotic tissue, debris, and foreign material. Depending on the type and location of the burn wound, debridement can be done via hydrotherapy, mechanical, enzymatic, or surgical debridement.  

159.

A 9-year-old male arrives at the emergency department via ambulance with a left leg fracture. Radiologic findings reveal a closed fracture of the fibula. The physician performs a closed reduction and casts the extremity. The patient is receiving IV morphine every 2-4 hours as needed for pain control. The mother calls the nurse on the call light and states her son is experiencing severe pain in the casted extremity with even the slightest movement, despite the pain medication. 

The nurse suspects which of the following complications? 

  • Compartment syndrome 

  • Fat embolism 

  • Osteomyelitis 

  • Thrombus formation 

Correct answer: Compartment syndrome 

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.  

The other choices are complications of a fracture but not likely given this patient's symptoms. 

160.

With regard to the AACN Synergy Model for Patient Care, optimal outcomes result when patient characteristics and nursing competencies are matched. Outcomes should be patient- and family-driven and include all the following from a patient/family perspective, EXCEPT:

  • Physiologic changes 

  • Functional changes 

  • Behavioral changes 

  • Quality of life 

Correct answer: Physiologic changes 

The needs and characteristics of patients and their families drive the competencies of nurses. Within this model, synergy occurs when individuals work together in ways that move them toward a common goal, and an active relationship between the patient and the nurse will result in optimal outcomes. From the patient's perspective, these outcomes include:

  • functional change
  • behavioral change
  • trust
  • satisfaction
  • comfort
  • quality of life

Physiologic changes would be an outcome from a nursing perspective. 

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