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Peds CCRN Review Questions with correct answers, Exams of Nursing

Peds CCRN Review Questions with correct answers PEEP is intended to do which of the following? A. Improve ventilation/perfusion matching B. Decrease functional residual capacity C. Increased venous return to the heart D. Increased cardiac output - Correct Answer A. Improve ventilation/perfusion matching - PEEP increases alveolar volume, thereby improving ventilation/perfusion matching and increasing functional residual capacity. - A detrimental effect of PEEP (especially at high levels) is a decrease in venous return to the heart and a subsequent decrease in cardiac output.

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Peds CCRN Review Questions with correct answers
PEEP is intended to do which of the following?
A. Improve ventilation/perfusion matching
B. Decrease functional residual capacity
C. Increased venous return to the heart
D. Increased cardiac output - Correct Answer A. Improve ventilation/perfusion matching
- PEEP increases alveolar volume, thereby improving ventilation/perfusion matching and
increasing functional residual capacity.
- A detrimental effect of PEEP (especially at high levels) is a decrease in venous return to
the heart and a subsequent decrease in cardiac output.
In an infant with sepsis, factors that impair the release of oxygen by negatively
affecting oxyhemoglobin dissociation include:
A. Hyperthermia
B. Metabolic acidosis
C. Respiratory acidosis
D. Hypothermia - Correct Answer D. Hypothermia
- To answer this question, you must consider the factors that would cause a left shift of the
oxyhemoglobin curve.
- Hypothermia, decreased CO2, and increased pH (alkalosis) would all cause a left shift.
- Hyperthermia and acidosis would cause a right shift of the curve
In which condition might you observe a decreased V/Q ratio (<0.8)?
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Peds CCRN Review Questions with correct answers

PEEP is intended to do which of the following? A. Improve ventilation/perfusion matching B. Decrease functional residual capacity C. Increased venous return to the heart D. Increased cardiac output - Correct Answer A. Improve ventilation/perfusion matching

  • PEEP increases alveolar volume, thereby improving ventilation/perfusion matching and increasing functional residual capacity.
  • A detrimental effect of PEEP (especially at high levels) is a decrease in venous return to the heart and a subsequent decrease in cardiac output. In an infant with sepsis, factors that impair the release of oxygen by negatively affecting oxyhemoglobin dissociation include: A. Hyperthermia B. Metabolic acidosis C. Respiratory acidosis D. Hypothermia - Correct Answer D. Hypothermia
  • To answer this question, you must consider the factors that would cause a left shift of the oxyhemoglobin curve.
  • Hypothermia, decreased CO2, and increased pH (alkalosis) would all cause a left shift.
  • Hyperthermia and acidosis would cause a right shift of the curve In which condition might you observe a decreased V/Q ratio (<0.8)?

A. Status asthmaticus B. Sepsis C. Pulmonary emboli D. Tricuspid atresia - Correct Answer A. Status asthmaticus

  • A V/Q ratio of <0.8 is indicative of perfusion exceeding ventilation. Air trapping from diseases such as asthma is a common cause of this scenario Factors such as small nostrils, larger tongue, and narrower airways in an infant.... A. Decrease airway resistance B. Make intubation easier C. Increase airway resistance D. Improve airway obstruction - Correct Answer C. Increase airway resistance
  • There are a number of factors that increase airway resistance and obstruction in young infants, including their larger heads and tongues, smaller nostrils, decreased muscle tone, and narrower airways.
  • Intubation is more difficult because of an anterior larynx and narrow cricoid ring. Indications that a patient is ready to wean from mechanical ventilation include: A. Hemodynamic instability B. Adequate cough and gag reflexes C. Persistent coma D. PEEP > 8 - Correct Answer B. Adequate cough and gag reflexes
  • Before being extubated, a child needs to have an adequate level of consciousness to protect his or her airway. This includes having an adequate cough and gag; hemodynamic stability (not instability); and a PEEP <5, with an oxygen requirement generally less than an FiO2 of 0.4.

This child's blood gas results include a decreased pH and an increase in PaCO2 — both of which indicate a state of respiratory acidosis. An intubated, mechanically ventilated patient has a sudden decrease in SpO2 from 95% to 78%, and the ventilator is alarming high peak pressures. Your first intervention is to: A. Increase the FiO2 and ventilator rate B. Assess the patency of the endotracheal tube C. Administer a neuromuscular blocking agent D. Prepare to reposition the endotracheal tube - Correct Answer B. Assess the patency of the endotracheal tube

  • Your first priority is assessing the patency of the ETT.
  • Once you have confirmed whether the tube is or is not patent, that will help to direct your next interventions.
  • The alarms for high peak pressure may indicate that the ETT is kinked or blocked with secretions. The most important intervention when caring for the patient with epiglottitis and who is in significant respiratory distress is to: A. Keep the child quiet and comfortable B. Administer racemic epinephrine C. Place the child in a supine position D. Administer antibiotics - Correct Answer A. Keep the child quiet and comfortable
  • The goal is to keep the child quiet, comfortable, and in whatever position that allows them to maintain their own airway until a skilled provider who can control the airway is present and ready to do so.
  • Racemic epinephrine might be helpful for the patient with croup
  • Although the patient with epiglottitis needs antibiotics, that's not the priority intervention until the airway is secure. Which of the following is the first action to take in the case of a patient with a

suspected tension pneumothorax? A. Assess blood pressure B. Prepare for intubation C. Obtain a chest radiograph D. Prepare for needle thoracostomy - Correct Answer D. Prepare for needle thoracostomy Tension pneumothorax is an emergency requiring needle decompression. The child will require monitoring of vital signs during the procedure and an x-ray post-procedure. The need for intubation will be determined based on the child's clinical exam following evacuation of the tension pneumothorax. For a patient with status asthmaticus, chest x-ray will reveal: A. Perihilar infiltration B. Hyperinflation C. Foreign body aspiration D. An elevated diaphragm - Correct Answer B. Hyperinflation Remembering that air "trapping" is a common phenomenon in status asthmatics, you would anticipate seeing hyperinflation on this x-ray. A term newborn develops difficulty breathing and cyanosis. The nurse has difficulty hearing breath sounds and notes the baby has a scaphoid abdomen. Which should the nurse suspect? A. Tracheoesophageal fistula B. Diaphragmatic hernia C. Pneumothorax D. Congenital heart defect - Correct Answer B. Diaphragmatic hernia

D. Constrict the pulmonary vascular bed - Correct Answer B. Dilate the pulmonary vascular bed Infants with pulmonary hypertension have significantly increased pulmonary vascular resistance. The goal of therapy is to lower the pulmonary vascular resistance through dilation of the pulmonary bed. Patients at risk for pulmonary embolus include those with an inherited hypercoagulable state and: A. Sickle cell disease B. Diabetes C. Asthma D. Pneumonia - Correct Answer A. Sickle cell disease Patients with sickle cell disease are at risk for developing a pulmonary embolus. Sickling of the RBCs within the small blood vessels of the lung and other organs leads to small vessel occlusion and, ultimately, infarction of areas of the pulmonary parenchyma. A baby with BPD will have: A. Left-sided heart failure B. Increased fluid requirements C. Decreased pulmonary vascular resistance D. Increased caloric needs - Correct Answer D. Increased caloric needs

  • Infants with BPD have increased caloric needs because of the chronic increased work of breathing distress.
  • They require diuretics and generally do not tolerate fluid overload. - And, they experience increased pulmonary vascular resistance and resultant right-sided heart failure. Cerebrospinal fluid is produced by the: A. Choroid plexus

B. Cerebral ventricles C. Arachnoid villi D. Pia mater - Correct Answer A. Choroid plexus Cerebrospinal fluid is formed in the choroid plexus and reabsorbed in the arachnoid villi. Problems with CSF production or absorption can result in hydrocephalus. A child is admitted after falling off a golf cart. The child was initially awake and alert, but now is unresponsive. The nurse should suspect which condition? A. Hydrocephalus B. Epidural hematoma C. Subdural hematoma D. Diffuse axonal injury - Correct Answer B. Epidural hematoma Epidural hematomas result from hemorrhage into the extradural space, usually from a tear in the middle meningeal artery. With the classic presentation, the child is initially awake and alert, but as the bleeding continues, the hematoma gets larger and the child can become unresponsive. An infant with a ventriculoperitoneal shunt is irritable with a high-pitched cry and setting-sun sign. The nurse should be concerned this child may have: A. Diabetes insipidus B. Stroke C. New-onset seizures D. Shunt malfunction - Correct Answer D. Shunt malfunction This child is demonstrating symptoms of hydrocephalus and increased ICP. The most common cause of this in a child with a VP shunt is shunt malfunction. This needs further investigation

A. Hypertonic saline administration B. Maintain head midline C. Initiate blood transfusion D. Administer sedation - Correct Answer B. Maintain head midline

  • This question asks about the initial independent nursing intervention.
  • Of the choices offered, maintaining the head midline is the only independent nursing action. This will help to promote venous drainage, which can improve cerebral perfusion. A patient presents with agitation, nuchal rigidity, and a positive Brudzinski sign. The priority intervention is: A. ICP monitoring B. Medical restraints C. Antibiotic administration D. Intraventricular catheter - Correct Answer C. Antibiotic administration
  • This patient is demonstrating signs of meningitis. Initial treatment includes antibiotic administration.
  • ICP monitoring and placement of an intraventricular catheter are not indicated in this scenario.
  • Restraints may be needed, but they could further agitation. A child is admitted to the ICU following a motor vehicle collision in which he was an unrestrained passenger. He is complaining of numbness and tingling in his legs and feet, and has decreased sensation. Preliminary imaging studies are normal. The nurse anticipates: A. Removal of the cervical collar B. Discontinuation of log rolling C. Administration of anti-anxiety medications D. Ongoing spinal cord protective measures - Correct Answer D. Ongoing spinal cord protective measures.
  • This patient's clinical picture is consistent with spinal cord injury, even though there were no findings on imaging studies. He may have Spinal Cord Injury Without Radiograph Abnormality (SCIWORA).
  • The patient should have spinal cord protective measures in place (eg, log rolling, cervical collar) at this point. Which is a required element of the exam for brain death determination? A. Apnea test B. EEG C. MRI D. Spinal cord reflexes - Correct Answer A. Apnea test
  • Brain death determination requires two exams separated by an observation period based on the child's age. Apnea testing must occur with each exam, unless the patient's condition prevents it.
  • In that case, an ancillary test such as four-vessel cerebral angiography or EEG is needed.
  • MRI and testing of spinal cord reflexes are not part of the brain death exam. A patient is admitted with status epilepticus. After arrival, the SpO2 decreases to 85%. The priority response is: A. Oxygen administration B. Anticonvulsant administration C. Intubation D. Bite block insertion - Correct Answer A. Oxygen administration Hypoxia is a complication of seizures, and the therapeutic priority in the management of a seizure is to maintain oxygenation and ventilation. A nasogastric tube should not be inserted in the child with which injury? A. Linear skull fracture

body's compensatory mechanism to retain more fluid, increase intravascular volume, and thereby improve tissue perfusion. Common laboratory findings associated with AKI include an increase in the BUN level, as well as which of the following changes in the concentrations of potassium and creatinine? A. Increased potassium and increased creatinine B. Decreased potassium and increased creatinine C. Increased potassium and decreased creatinine D. Decreased potassium and decreased creatinine - Correct Answer A. Increased potassium and increased creatinine

  • In AKI, there is an accumulation of nitrogenous waste products (BUN and creatinine). Additionally, many patients develop hyperkalemia as the result of injury to the distal tubules.
  • Hypokalemia and/or a decreased serum creatinine are not commonly seen in AKI. Which is a potential result of a significant, sudden occurrence of hyponatremia? A. Respiratory failure B. Cerebral edema C. Hypotension D. Hyperkalemia - Correct Answer B. Cerebral edema
  • A significant, sudden decrease in serum Na+ levels will result in a sudden decrease in serum osmolality. This, in turn, will lead to a shift of fluid into the intracellular space.
  • When there is a significant decrease in serum Na over a short period of time, this can result in cerebral edema and increased ICP. Classic signs of hemolytic uremic syndrome (HUS) include: A. Chronic kidney disease, oliguria, and pernicious anemia

B. Chronic kidney disease, leukopenia, and hemolytic anemia C. Thrombocytopenia, hemolytic anemia, and acute kidney injury D. Acute kidney injury, positive Coombs test, and anemia - Correct Answer C. Thrombocytopenia, hemolytic anemia, and acute kidney injury. The priority intervention for symptomatic hyperkalemia is: A. Initiation of CVVH B. Administration of 20 mL/kg fluid bolus C. Administration of sodium polystyrene D. Administration of insulin and glucose - Correct Answer D. Administration of insulin and glucose

  • While each of the interventions listed may be utilized, the intervention choice that will have the most immediate effect is the administration of insulin and glucose. This will help to shift potassium back into the cells and decrease the serum potassium levels.
  • Additionally, calcium chloride or calcium gluconate should be administered first in order to protect the heart A young child is admitted with hemolytic uremic syndrome. The preferred mode of dialysis in this patient is: A.Peritoneal dialysis B. Hemodialysis C. CVVH D. Dialysis is not indicated - Correct Answer A. Peritoneal dialysis Peritoneal dialysis (PD) is the preferred mode for the patient with HUS. These patients are usually of a younger age, which makes PD a good choice.

The nurse caring for a child who was injured in a motor vehicle crash notes positive Cullen's sign in the right abdomen around the umbilicus. This is indicative of: A. Impending disseminated intravascular coagulopathy B. Necrotic bowel process C. Sepsis D. Intra-abdominal bleeding - Correct Answer D. Intra-abdominal bleeding In cases of severe intra-abdominal bleeding, Cullen's sign (bluish discoloration around the periumbilical area) may be seen. The nurse should be concerned that the child has severe injuries and may need surgical exploration or repair. The primary concern for a child diagnosed with intussusception is: A. Dehydration B. Bowel infarction C. Infection D. Pain - Correct Answer B. Bowel infarction

  • When intussusception occurs, part of the bowel telescopes inside itself. This can result in decreased arterial blood flow to the area and resultant bowel infarction.
  • Intervention to correct the telescoping bowel needs to be initiated immediately.
  • The child may experience severe paroxysmal pain, is at risk for dehydration, and can develop an infection if perforation occurs. You are caring for an adolescent with multiple traumatic injuries sustained in a motor vehicle collision. Upon assessment, you notice that the patient has developed shallow, rapid respirations and abdominal distention; is now complaining of pain in the area of the right shoulder; and whose BP has also dropped to 80/50 mmHg. You suspect that this patient has sustained a traumatic injury to the: A. Spleen

B. Liver C. Kidneys D. Clavicle - Correct Answer B. Liver Abdominal distention and rapid, shallow respirations may be seen with many abdominal injuries.

  • Pain that radiates to the right shoulder is consistent with hepatic injury.
  • Additionally, the patient is showing signs of shock, which can be associated with bleeding from a lacerated liver. Which would be an indication for urgent surgical intervention in the child with a gastrointestinal hemorrhage? A. Presence of free air on abdominal radiograph B. Weakness and faintness C. Age <3 months D. Unknown etiology of the gastrointestinal hemorrhage - Correct Answer A. Presence of free air on abdominal radiograph
  • Indications for urgent surgical intervention include the presence of free air on abdominal radiograph (sign of possible intestinal perforation) or severe hemorrhage that is unresponsive to blood component therapy.
  • Less invasive measures can be used to determine the cause of the Gl bleed. Which finding is most concerning for necrotizing enterocolitis (NEC)? A. Sausage-shaped mass in the RUQ B. Apnea and bradycardia C. Pneumatosis intestinalis D. Hyperbilirubinemia - Correct Answer C. Pneumatosis intestinalis
  • These reactions occur with transfusions of ABO-incompatible blood, resulting in hemolysis of the red cells. The first intervention to manage your patient's acute hemolytic reaction should be to: A. Notify the physician B. Treat shock and/or respiratory distress C.Stop the transfusion D. Keep vein open with an infusion of 0.9% NaCl - Correct Answer C. Stop the transfusion Each intervention is important, but the first intervention must be to stop the transfusion if you suspect that your patient is having an acute hemolytic reaction. Which electrolyte disturbances would you monitor for in the patient who is receiving multiple, large-volume blood transfusions? A. Hypernatremia and hyperphosphatemia B. Hypocalcemia and hypophosphatemia C. Hyperkalemia and hyponatremia D. Hypocalcemia and hyperkalemia - Correct Answer D. Hypocalcemia and hyperkalemia
  • Patients who receive large-volume blood transfusions must be monitored for the development of hypocalcemia and hyperkalemia.
  • The hypocalcemia is the result of calcium binding to the citrate used as a preservative in the blood
  • The hyperkalemia is typically associated with the breakdown of cells in "older" blood. Which should be avoided in the patient with sickle cell disease? A. Opioids B. Oxygen

C. Dehydration D. Normothermia - Correct Answer C. Dehydration Management strategies for the patient with sickle cell disease include providing hydration, oxygenation, pain control, and antibiotics if infection is a suspected cause The triad of metabolic disturbances most frequently seen with tumor lysis syndrome is: A. Hypophosphatemia, hyperkalemia, hypercalcemia B. Hyperphosphatemia, hyperkalemia, hyperuricemia C. Hyperphosphatemia, hyperuricemia, hypocalcemia D. Hypophosphatemia, hypokalemia, hypocalcemia - Correct Answer B. Hyperphosphatemia, hyperkalemia, hyperuricemia

  • Tumor cells have a higher concentration of potassium and phosphorous than normal cells do.
  • The hyperuricemia is from the breakdown of nucleic acids in tumor cells.
  • The hypocalcemia that occurs is secondary to the hyperphosphatemia. Strategies for managing tumor lysis syndrome include increasing: A. Oral potassium intake B. Hydration C. Intravenous phosphate intake D. Uric acid production - Correct Answer B. Hydration
  • The purpose of hydration is to maximize renal excretion of potassium, phosphate, and uric acid.
  • It would be contraindicated to administer potassium or phosphate to this patient.
  • An additional goal is to decrease the uric acid level, not increase production. A toddler was extubated 2 days ago after 10 days of mechanical ventilation for viral bronchiolitis. With your initial assessment, you note bleeding from the patient's nares and