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Exam Review

Key Facts: CCRN Pediatric Exam

150

Total Items

AACN CCRN Pediatric handbook

125 + 25

Scored + Unscored

AACN CCRN Pediatric handbook

3h

Exam Time

AACN CCRN Pediatric handbook

83

Passing Cut Score

AACN standard-setting (approx 70%)

80/20

Clinical Judgment / Professional Caring

AACN CCRN Pediatric test plan

$260/$375

Member/Nonmember Fee

AACN CCRN Pediatric handbook

AACN's CCRN Pediatric exam uses 150 total items with 125 scored and 25 unscored items, delivered in 3 hours. The 2025 test plan framework is Clinical Judgment 80% and Professional Caring & Ethical Practice 20%. Within Clinical Judgment (test plan for exams taken on or after November 19, 2025): Cardiovascular 11%, Respiratory 13%, Endocrine/Hematology/Immunology/Gastrointestinal/Renal/Genitourinary/Integumentary 25%, Musculoskeletal/Neurological/Behavioral-Psychosocial 15%, and Multisystem 17%.

Sample CCRN Pediatric Practice Questions

Try these sample questions to review concepts for the CCRN Pediatric exam. Each question includes a detailed explanation. Start the interactive quiz above for the full 200+ question experience with AI tutoring.

1A 4-year-old with Tetralogy of Fallot is experiencing a hypercyanotic spell. Which nursing intervention is the priority?
A.Administer supplemental oxygen
B.Place the child in knee-chest position
C.Start an IV for fluid administration
D.Prepare for emergency surgery
Explanation: During a hypercyanotic (Tet) spell, the knee-chest position is the priority intervention. This position increases systemic vascular resistance, which decreases right-to-left shunting and improves pulmonary blood flow. While oxygen may help, it is often ineffective because the issue is decreased pulmonary blood flow rather than poor oxygenation. The knee-chest position should be initiated immediately while preparing for further interventions such as IV fluids, morphine, or phenylephrine if needed.
2Which hemodynamic parameter best reflects preload of the left ventricle in a pediatric patient?
A.Central venous pressure (CVP)
B.Pulmonary artery pressure (PAP)
C.Pulmonary capillary wedge pressure (PCWP)
D.Systemic vascular resistance (SVR)
Explanation: Pulmonary capillary wedge pressure (PCWP) reflects left ventricular preload because it estimates left atrial pressure. CVP reflects right ventricular preload. PAP indicates pressures in the pulmonary vasculature, and SVR represents afterload, not preload. In pediatric critical care, understanding the relationship between these pressures is essential for managing patients with cardiac dysfunction.
3A child with dilated cardiomyopathy develops signs of low cardiac output. Which medication would be the priority to administer?
A.Propranolol
B.Milrinone
C.Epinephrine
D.Nitroprusside
Explanation: Milrinone is the priority medication for a child with dilated cardiomyopathy and low cardiac output. It is a phosphodiesterase-3 inhibitor that provides both inotropic support (increased contractility) and lusitropic effects (improved relaxation), while also causing pulmonary and systemic vasodilation. This reduces afterload and improves cardiac output without significantly increasing myocardial oxygen demand. Propranolol is a negative inotrope and would worsen cardiac output.
4Following 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?
A.Continue routine monitoring
B.Notify the surgeon immediately
C.Decrease suction on the chest tube
D.Administer diuretics
Explanation: Chest tube drainage exceeding 3-5 mL/kg/hr for more than 2-3 consecutive hours post-cardiac surgery indicates significant hemorrhage and requires immediate notification of the surgeon. This patient may need to return to the operating room for exploration. Prompt recognition and communication are critical to prevent hemodynamic compromise from excessive blood loss.
5Which ECG finding is most characteristic of a child with transposition of the great arteries (TGA)?
A.Right axis deviation and right ventricular hypertrophy
B.Left axis deviation and left ventricular hypertrophy
C.Prolonged QT interval
D.ST-segment elevation in leads V1-V4
Explanation: In transposition of the great arteries, the aorta arises from the right ventricle and the pulmonary artery from the left ventricle. This causes the right ventricle to pump against systemic resistance, resulting in right ventricular hypertrophy and right axis deviation on ECG. Left axis deviation would suggest other defects like AV canal. Prolonged QT and ST elevation are not characteristic of TGA.
6A pediatric patient is receiving epinephrine for low cardiac output. Which adverse effect should the nurse monitor for most closely?
A.Bradycardia
B.Hypotension
C.Ventricular arrhythmias
D.Decreased myocardial oxygen demand
Explanation: Epinephrine increases myocardial contractility and heart rate, which significantly increases myocardial oxygen demand and can precipitate ventricular arrhythmias. This is the most serious adverse effect requiring close monitoring. Epinephrine typically causes tachycardia, not bradycardia, and increases blood pressure through alpha-1 effects. Continuous cardiac monitoring is essential during epinephrine infusion.
7What is the primary physiologic benefit of balloon atrial septostomy (Rashkind procedure) in a neonate with transposition of the great arteries?
A.Corrects the ventricular septal defect
B.Creates an atrial opening for mixing of blood
C.Widens the pulmonary valve
D.Reverses the great arteries
Explanation: Balloon atrial septostomy creates or enlarges an atrial septal defect to allow mixing of oxygenated and deoxygenated blood. In TGA, oxygenated blood returns to the left atrium and is pumped back to the lungs, while deoxygenated blood returns to the right atrium and is pumped to the body. Creating an atrial communication allows some mixing, which improves systemic oxygenation until definitive repair (arterial switch) can be performed.
8A child with status asthmaticus receiving continuous albuterol nebulization develops tremors and a heart rate of 180 bpm. What is the most appropriate nursing intervention?
A.Discontinue the albuterol immediately
B.Decrease the albuterol dose and continue monitoring
C.Switch to intermittent dosing
D.Administer a beta-blocker
Explanation: Tremors and tachycardia are common side effects of beta-2 agonists like albuterol. In status asthmaticus, completely discontinuing albuterol could worsen the respiratory crisis. The appropriate response is to decrease the dose while continuing to monitor the patient. Beta-blockers are contraindicated as they would antagonize the bronchodilatory effects. The risks of untreated status asthmaticus generally outweigh the side effects of beta-agonist therapy.
9Which arterial blood gas result indicates the need for immediate intubation in a pediatric patient with respiratory failure?
A.pH 7.35, PaCO2 50, PaO2 65
B.pH 7.28, PaCO2 55, PaO2 70
C.pH 7.20, PaCO2 70, PaO2 45
D.pH 7.40, PaCO2 45, PaO2 80
Explanation: A pH of 7.20 with hypercapnia (PaCO2 70) and severe hypoxemia (PaO2 45) indicates severe respiratory acidosis with inadequate oxygenation despite supplemental oxygen. This meets criteria for immediate intubation and mechanical ventilation. Compensated or mild respiratory acidosis (options A and B) may be managed non-invasively or with supportive care depending on the clinical picture. Option D represents a normal ABG.
10A 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?
A.Increase the FiO2 to 100%
B.Perform a chest X-ray
C.Call for immediate chest tube insertion
D.Disconnect the ventilator and bag manually
Explanation: The sudden drop in oxygen saturation with absent breath sounds on one side suggests a tension pneumothorax. The immediate priority is to increase FiO2 to 100% while preparing for emergency decompression. While a chest tube will ultimately be needed, the first step is maximizing oxygen delivery. Manually bagging could worsen a tension pneumothorax by forcing more air into the pleural space. A chest X-ray would delay critical intervention.

About the CCRN Pediatric Exam

CCRN Pediatric is AACN's specialty certification for pediatric critical care nurses working in PICU and pediatric critical care settings. The exam validates clinical judgment across pediatric body systems and professional caring practice for critically ill children and their families.

Exam sponsor: AACN Certification Corporation / PSI. The requirements and fees below concern the certification or admission exam, separate from our free practice resources.

Questions

150 questions

Time Limit

3 hours

Passing Score

83 correct out of 125 scored items (effective Nov 12, 2025)

Exam / Certification Fees

$260 AACN members / $375 non-members

Exam sponsor website

Reported exam pass rate: 68.72%. first-time candidates, 2025 (AACN Certification Exam Statistics and Cut Scores) This describes exam candidates, not OpenExamPrep users or results from using our resources. Exam sponsor website

Fees, eligibility, and exam policies can change. Confirm them with the exam sponsor before applying or paying.

Our practice resources: topics covered

We aim to reflect publicly available exam outlines and topic information in our study resources. Coverage, format, and difficulty may differ from the actual exam, and we cannot guarantee that every detail is accurate or current. Confirm exam requirements, fees, and policies with the official exam sponsor.

11%

Cardiovascular

Pediatric cardiovascular instability, perfusion risks, and critical intervention priorities.

13%

Respiratory

Airway/ventilation deterioration and escalation decisions in pediatric critical care.

25%

Endocrine, Hematology, Immunology, Gastrointestinal, Renal, Genitourinary, Integumentary

Largest pediatric clinical judgment domain spanning core multisystem abnormalities.

15%

Musculoskeletal, Neurological, Behavioral/Psychosocial

Neurobehavioral, psychosocial, and musculoskeletal critical-care considerations in children.

17%

Multisystem

High-acuity pediatric multisystem crisis management and integrated care prioritization.

20%

Professional Caring and Ethical Practice

AACN Synergy model, ethics, communication, and family-centered pediatric critical care practice.

Preparing for the CCRN Pediatric Exam

What You Need to Know

  • Passing score: 83 correct out of 125 scored items (effective Nov 12, 2025)
  • Exam length: 150 questions
  • Time limit: 3 hours
  • Exam / certification fees: $260 AACN members / $375 non-members Official sources

Using Our Practice Resources

  • Work through all 200 available questions
  • Review every answer and explanation
  • Track weak areas and revisit them
  • Use our AI tutor for tough concepts

CCRN Pediatric: Suggested Study Strategy

1Master pediatric-specific normal ranges (vitals, labs) across age groups from neonate to adolescent
2Focus on family-centered care principles and developmental considerations in pediatric critical care
3Study congenital heart defect pathophysiology and post-operative cardiac care priorities
4Practice pediatric shock recognition and fluid resuscitation calculations (mL/kg)
5Review AACN Synergy Model application to pediatric nursing scenarios

Frequently Asked Questions

How many questions are on the CCRN Pediatric exam?

AACN's CCRN Pediatric handbook lists 150 items total: 125 scored and 25 unscored pretest items.

How long is the CCRN Pediatric exam?

AACN lists a 3-hour exam appointment for CCRN Pediatric testing.

What score is needed to pass CCRN Pediatric?

The passing score for CCRN Pediatric is 83 correct out of 125 scored items (raw cut score effective November 12, 2025), set through AACN's modified Angoff standard-setting process.

What is the CCRN Pediatric exam fee?

AACN's handbook lists $260 for AACN members and $375 for non-members for initial CCRN Pediatric application.

What are the highest-weight CCRN Pediatric content areas?

AACN's revised 2025 test plan weights Clinical Judgment at 80% and Professional Caring/Ethical Practice at 20%. Within Clinical Judgment, the largest weighted areas are the combined Endocrine/Hematology/Immunology/Gastrointestinal/Renal/Genitourinary/Integumentary area (25%), Multisystem (17%), and the combined Musculoskeletal/Neurological/Behavioral area (15%), followed by Respiratory (13%) and Cardiovascular (11%).

What patient population does CCRN Pediatric cover?

CCRN Pediatric focuses on acutely/critically ill pediatric patients from birth through adolescence, emphasizing PICU-level clinical judgment and family-centered care.

What are the eligibility requirements for CCRN Pediatric?

AACN requires current RN/APRN licensure plus direct bedside care hours: either 1,750 hours in the past 2 years (with 875 in the most recent year) OR 2,000 hours in the past 5 years (with 144 in the most recent year), caring for critically ill pediatric patients.