AACN CCRN Pediatric Critical Care Nurse

A 4-year-old with Tetralogy of Fallot is experiencing a hypercyanotic spell. Which nursing intervention is the priority?

• AAdminister supplemental oxygen
• BPlace the child in knee-chest position
• CStart an IV for fluid administration
• DPrepare for emergency surgery

Which hemodynamic parameter best reflects preload of the left ventricle in a pediatric patient?

• ACentral venous pressure (CVP)
• BPulmonary artery pressure (PAP)
• CPulmonary capillary wedge pressure (PCWP)
• DSystemic vascular resistance (SVR)

A child with dilated cardiomyopathy develops signs of low cardiac output. Which medication would be the priority to administer?

• APropranolol
• BMilrinone
• CEpinephrine
• DNitroprusside

Following cardiac surgery, a pediatric patient has a chest tube drainage of 5 mL/kg/hr for 2 consecutive hours. What is the appropriate nursing action?

• AContinue routine monitoring
• BNotify the surgeon immediately
• CDecrease suction on the chest tube
• DAdminister diuretics

Which ECG finding is most characteristic of a child with transposition of the great arteries (TGA)?

• ARight axis deviation and right ventricular hypertrophy
• BLeft axis deviation and left ventricular hypertrophy
• CProlonged QT interval
• DST-segment elevation in leads V1-V4

A pediatric patient is receiving epinephrine for low cardiac output. Which adverse effect should the nurse monitor for most closely?

• ABradycardia
• BHypotension
• CVentricular arrhythmias
• DDecreased myocardial oxygen demand

What is the primary physiologic benefit of balloon atrial septostomy (Rashkind procedure) in a neonate with transposition of the great arteries?

• ACorrects the ventricular septal defect
• BCreates an atrial opening for mixing of blood
• CWidens the pulmonary valve
• DReverses the great arteries

A child with status asthmaticus receiving continuous albuterol nebulization develops tremors and a heart rate of 180 bpm. What is the most appropriate nursing intervention?

• ADiscontinue the albuterol immediately
• BDecrease the albuterol dose and continue monitoring
• CSwitch to intermittent dosing
• DAdminister a beta-blocker

Which arterial blood gas result indicates the need for immediate intubation in a pediatric patient with respiratory failure?

• ApH 7.35, PaCO2 50, PaO2 65
• BpH 7.28, PaCO2 55, PaO2 70
• CpH 7.20, PaCO2 70, PaO2 45
• DpH 7.40, PaCO2 45, PaO2 80

A child on mechanical ventilation has a sudden drop in oxygen saturation from 95% to 78%. The nurse notes absent breath sounds on the right side. What is the priority intervention?

• AIncrease the FiO2 to 100%
• BPerform a chest X-ray
• CCall for immediate chest tube insertion
• DDisconnect the ventilator and bag manually

What is the primary rationale for using permissive hypercapnia in a pediatric patient with acute respiratory distress syndrome (ARDS)?

• ATo decrease the work of breathing
• BTo prevent ventilator-induced lung injury
• CTo improve cardiac output
• DTo decrease metabolic rate

Which intervention is most appropriate for a pediatric patient with a new tracheostomy who experiences accidental decannulation within the first week?

• AImmediately reinsert the tracheostomy tube using the obturator
• BBag-mask ventilate and prepare for oral intubation
• CAttempt to insert a smaller tracheostomy tube
• DPosition the patient supine and call the physician

A child with cystic fibrosis has thick, tenacious secretions. Which airway clearance technique is most effective?

• AChest percussion and postural drainage
• BIncentive spirometry
• CPositive expiratory pressure (PEP) therapy
• DHigh-frequency chest wall oscillation

What is the appropriate nursing action when a pediatric patient receiving non-invasive positive pressure ventilation (NIPPV) via BiPAP becomes increasingly anxious and attempts to remove the mask?

• AImmediately sedate the patient
• BRemove the mask and switch to high-flow nasal cannula
• CReassure the patient and assess for proper mask fit
• DRestrain the patient's hands

A pediatric patient presents with fever, hypotension, tachycardia, and altered mental status. Lactate is 4.5 mmol/L. What is the priority intervention?

• AObtain blood cultures
• BAdminister empiric antibiotics within 1 hour
• CInitiate fluid resuscitation with 20 mL/kg bolus
• DInsert a central venous catheter

Which combination of findings best defines Systemic Inflammatory Response Syndrome (SIRS) in a pediatric patient?

• AFever and leukocytosis only
• BFever, tachycardia, and altered mental status
• CAbnormal temperature, heart rate, respiratory rate, and WBC count
• DHypotension and lactic acidosis

A child with severe sepsis has received 60 mL/kg of fluid and remains hypotensive with poor perfusion. What is the next appropriate intervention?

• AContinue fluid boluses up to 100 mL/kg
• BInitiate vasopressor therapy
• CAdminister hydrocortisone
• DBegin blood transfusion