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AACN
CCRN-Pediatric
Critical Care Nursing Exam

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 Latest Version
Question: 1
A 3-year-old boy with Hemophilia is going to stat infusion of recombinant form of Factor VIII
prophylactically three times a week. The nurse should advise the parents to administer the infusion on
the days designated:

A. after dinner
B. in the morning
C. before dinner
D. after lunch

Answer: B

Explanation: Due to Hemophilia, Factor VIII should be given in the morning on designated days. The half-
life is short. If it was given later in the day, protection would not be adequate when the child is most
active and prone to bleeding.

Question: 2
A mother of an 18-month-old toddler asks the nurse about the diet of her baby. The nurse learned that
the baby has iron deficiency anemia. The nurse should suggest:

A. a cup of grapes
B. a slice of pumpkin pie
C. slices of whole apple
D. bread pudding with raisins

Answer: D
Explanation: The nurse should suggest bread pudding with raisins. This provides iron and protein; in
addition, it can be eaten with spoon which encourages mastery of fine motor muscle. Pumpkin has iron
but has spicy taste. A cup of grapes will be difficult to finish for such a young individual.

Question: 3
A 15-year-old girl was recently diagnosed of idiopathic scoliosis. She is worried about being different
form her friends and upset about the treatment regimen. How would the nurse help her to develop a
positive self-image:

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A. remind her that her back would be crooked if she doesn’t adhere to the treatment
B. be focus on her positive rather her negative attributes
C. assist her in selecting clothes to improve her appearance
D. refer her to a psychiatrist for consult.

Answer: C
Explanation: The nurse would help her by selecting appropriate clothing that will help minimize the
appearance of a brace, especially if an effort is made to wear the current style.

Question: 4
Hillary is a 6 year old who has meningitis. The nurse at the unit noticed that she assumes an opisthotonic
position. The nurse should place her in :

A. knee-chest position
B. side-lying position
C. semi-fowler’s position
D. high fowler’s position

Answer: B
Explanation: In meningitis, side-lying position is for maximum safety and comfort because the child with
meningitis has hyperextended neck and back.

Question: 5
A toddler admitted to the hospital has malabsorption syndrome and later develops signs and symptoms
of tetany. The nurse is aware that this is due to insufficient absorption of:

A. Zinc
B. Potassium
C. Calcium
D. Sodium

Answer: C
Explanation: Muscle contraction and relaxation cycle needs normal serum calcium: phosphorous ratio.
The reduction of the ionized serum calcium level associated with malabsorption syndrome causes
spastic muscle spasms.

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 Question: 6
A 7-week-old infant was admitted after 2 days of vomiting. She was diagnosed of hypertrophic pyloric
stenosis. The nurse at the emergency room knows that the most important nursing assessment is the:

A. amount, frequency, amd character of vomiting.

B. amount of milk and water taken at the time of last feeding
C. presence of olive shaped mass in the hypogastric area
D. amount and color of urine, skin turgor and respirations

Answer: D
Explanation: If an infant has dark scanty urine, poor skin turgor, and increased depth of respirations then
dehydration and metabolic alkalosis are present. It happens due to fluid and hydrochloric acid loss and
the depletion of Potassium.

Question: 7
Which of the following nursing diagnosis would the nurse identify as the priority for a 4-month-old
infant with heart failure and congenital heart disease:

A. risk for infection

B. impaired mobility
C. activity intolerance
D. ineffective health maintenance

Answer: C
Explanation: An infant with congenital heart disease and congestive heart failure tires very easily,
leading to a priority nursing diagnosis of Activity Intolerance. Nursing care needs to focus on allowing
the infant to have frequent rest periods. Infants with congenital heart disease and congestive heart
failure are not necessarily at risk for more infections than other infants. Impaired Mobility usually is not
a problem because an infant with congenital heart disease usually exhibits normal physical mobility.
Ineffective Health Maintenance usually is not a problem because these infants still need regular and
routine health check-ups

Question: 8
When developing a plan of care that includes interventions aimed at preventing complications of a low
platelet count in a child with leukemia, which of the following is most appropriate:

A. placing the child in protective isolation

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B. consulting doctor about the use of a stool softener
C. eliminating raw vegetables and fruits from the child’s diet
D. using heparin instead of saline to flush an intermittent IV access device

Answer: B
Explanation: The use of a stool softener would assist in preventing damage to the rectal mucosa due to
hard stool, thereby decreasing the chances of rectal bleeding. Placing the child in protective isolation
would be appropriate for the child if the neutrophil count was low. The use of heparin is contraindicated
in situations in which there is a possibility of increased bleeding due to low platelets. Avoiding raw
vegetables or fruits would be indicated if the child’s neutrophil count were low.

Question: 9
A mother brings her 18-month-old child to the clinic because the child “eats ashes, crayons, and paper.”
Which of the following information would be most important to obtain first about this toddler?

A. currently cutting large teeth

B. experiencing a growth spurt
C. experiencing changes in the home environment
D. eating a soft, low-roughage diet

Answer: C
Explanation: It is important to determine if the child is experiencing any change in the home
environment that could cause anxiety that is relieved through oral gratification. A craving to eat
nonfood substances is known Aspica.

Question: 10
Which of the following interventions would be included in the plan of care for a child with juvenile
rheumatoid arthritis to reduce joint pain in the morning just after arising?

A. Having the child sleep in a sleeping bag

B. Increasing pain medication at bedtime
C. Having the child sleep with the joints flexed
D. Awakening the child once nightly to exercise the joints

Answer: A
Explanation: Sleeping in a sleeping bag keeps the joints warm, therefore more flexible. Thus, joint pain in
the morning would be lessened. Increasing bedtime pain medications may help the child sleep but will
not decrease early morning stiffness. The child’s joints should be kept in an extended position during

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sleep to maintain function. Lack of sleep such as from awakening the child at night for exercises is a
stressor that can lead to exacerbation of juvenile rheumatoid arthritis.

Question: 11
After the nurse instructs the parents of a 5-month-old infant about the purpose of the Denver
Developmental Screening Test (DDST), which of the following statements by the parents about what the
test measures would indicate that the teaching was effective:

A. Social and physical abilities

B. Intelligence quotient
C. Emotional development
D. Potential for future development

Answer: A
Explanation: DDST measures a child’s social, language, and fine and gross motor skills by testing abilities
that usually occur at a given age. The DDST is not designed to measure intelligence or emotional
development nor does it necessarily predict future development.

Question: 12
After teaching the parents of an 18-month-old child who has undergone cleft palate repair how to use
elbow restraints, which of the following statements by the parents indicates effective teaching:

A. “We’ll keep the restraints in place continuously until the doctor says it’s okay to remove them.”
B. “We can take off the restraints while our child is playing but we’ll make sure to put them back on at
night.”
C. “The restraints should be taped directly to our child’s arms so that they will stay in one place.”
D. “We’ll remove the restraints temporarily at least three times a day to check his skin then put them
right back on.”

Answer: D
Explanation: Elbow restraints help to keep the child from placing fingers or any other object in the
mouth that would cause injury to the operative site. The restraints are worn at all times except when
they are removed to check the skin. Because of the risk for skin breakdown, the restraints are removed
periodically during the day to assess the child’s underlying skin. It is advisable to remove only one
restraint at a time while keeping hold of the child’s hand on the unrestrained side.

Question: 13

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When determining the effectiveness of teaching a child’s mother about sickle cell disease, which of the
following statements by the mother indicates the need for additional teaching:

A. “I’ve started to give him some extra fluids with and between meals.”
B. “I’m concerned about how the hospital staff will manage his pain.”
C. “He’s going to be playing on a soccer team when he’s feeling better.”
D. “I’ve told the child’s father that both he and I are carriers of the disease.”

Answer: C
Explanation: “He’s going to be playing on a soccer team when he’s feeling better” definitely indicated
the need of additional teaching. Physical and emotional stress can precipitate a sickle cell crisis. Physical
exercise such as running involved in soccer would increase the child’s risk for a crisis. Thus, the mother
needs additional instructions about this area.

Question: 14
After the nurse has taught the parents of a 5-year-old boy who has leukemia how to talk with their child
about death and dying, which of the following would indicate that the parents have age-appropriate
expectations about their child’s reaction to his impending death:

A. “He is too young to understand what is happening to him.”

B. “He might think he can cause his death because he has misbehaved.”
C. “He will accept his death as caused by his disease.”
D. “He will understand how much his siblings will miss him.”

Answer: B
Explanation: A 5-year-old child is in the preoperational stage of cognitive development and thinks of
death as temporary. Also, for a child this age, thinking about behavior often is believed to be magical;
thus, the child may think that his behavior can cause death. Generally, children under 3 years of age are
unable to differentiate death from temporary separation and are unable to understand what is
happening.

Question: 15
The mother of a 16-month-old child who is coughing and having trouble breathing calls the clinic to ask
advice because she suspects that her child has croup. Which of the following instructions would be most
appropriate?

A. Administer acetaminophen (Tylenol) every 4 hours

B. Take the child into the bathroom and run the hot water
C. Give over-the-counter cough syrup every 6 hours
D. Get the child to take as much fluid as possible

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 Answer: B
Explanation: For a child with croup who is coughing and having difficulty breathing, the child should be
taken into the shower where hot water is running to make the bathroom steamy. Steam helps to loosen
secretion and relieve some of the respiratory distress. Giving acetaminophen is helpful but will not ease
difficult breathing. Giving over-the-counter cough syrup is inappropriate because the underlying
problem is airway inflammation and subsequent mucus accumulation and bronchoconstriction. Getting
the child to take as much fluid as possible is important but it will not be effective in easing difficult
breathing.

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