Free AACN CCRN-Pediatric Practice Exam with Questions & Answers

The correct approach in end-of-life and ethical situations is to useopen-ended, family-centered communicationthat exploresvalues, hopes, and goals. This response promotesshared decision-making, validates emotional experience, and begins an appropriate dialogue about care direction.

“Ask families open-ended questions to explore goals and values, especially in cases of poor neurologic prognosis. It guides ethical, supportive decision-making.”

(Referenced from CCRN Pediatric – Professional Caring and Ethical Practice: End-of-Life Care, Family Communication)

ThePlan-Do-Study-Act (PDSA)cycle is the most widely acceptedquality improvement methodologyin healthcare. It's iterative and promotes continuous improvement:

Plan: Identify a goal and create an intervention

Do: Implement the intervention on a small scale

Study: Analyze the data and assess the outcome

Act: Adopt, adjust, or abandon the intervention based on the findings

“PDSA methodology supports quality improvement in healthcare, especially in infection prevention initiatives such as reducing CLABSIs.”

(Referenced from CCRN Pediatric – Professional Caring & Ethical Practice: Evidence-Based Practice and Quality Improvement)

In pediatric hemorrhagic shock, theinitial fluid bolus is 20 mL/kgofisotonic crystalloid(e.g.,normal saline or lactated Ringer's). For a 20-kg child, this equals400 mL of 0.9% NS. Albumin and PRBCs are considered after fluid responsiveness is evaluated or if ongoing blood loss is confirmed.

“The initial step in pediatric fluid resuscitation for hemorrhagic or hypovolemic shock is 20 mL/kg isotonic fluid bolus. Normal saline is the preferred initial fluid.”

(Referenced from CCRN Pediatric – Direct Care: Multisystem, Shock Management)

In DKA, despite high blood glucose levels, thelack of insulinprevents glucose from entering cells. The body perceives this ascellular glucose deficiencyand responds by stimulatinggluconeogenesis(production of glucose from non-carbohydrate sources) andketogenesis, worsening hyperglycemia and acidosis.

“The insulin-deficient state in DKA leads to a cellular energy crisis, triggering gluconeogenesis due to a perceived intracellular glucose deficiency.”

(Referenced from CCRN Pediatric – Direct Care: Endocrine, Diabetic Ketoacidosis Pathophysiology)

APT of 14 seconds and PTT of 40 secondsare at the upper limit of normal, and the patient hashepatic failure, which can lead tocoagulopathy. Prior to liver biopsy—a high-risk procedure forbleeding—FFP is administered to replace all clotting factorsand reduce bleeding risk.

“Patients with liver dysfunction undergoing procedures should receive FFP if coagulopathy is present, as it replaces multiple clotting factors synthesized in the liver.”

(Referenced from CCRN Pediatric – Direct Care: Hematology, Coagulation and Transfusion Support)

Panic attacksare common in adolescents and present withsympathetic overdrivesymptoms—palpitations, dyspnea, dizziness, chest discomfort, nausea, and diaphoresis. A history of anxiety strongly supports this diagnosis, especially in the absence of objective cardiac or respiratory findings.

“Panic attacks in adolescents can mimic cardiopulmonary emergencies. The presence of a prior anxiety disorder and resolution of symptoms without intervention support the diagnosis.”

(Referenced from CCRN Pediatric – Direct Care: Psychosocial, Mental Health Emergencies)

This patient demonstratesfailure to thrive(FTT) as evidenced by growth parameters below the 5th percentile and signs of malabsorption (diarrhea, dermatitis). While respiratory issues are present, theGI/nutritional status is a critical concernthat must be addressed for recovery and long-term health.

“Patients with chronic illness, diarrhea, and poor weight gain should receive early and comprehensive nutritional assessments. Malnutrition exacerbates respiratory disease and delays recovery.”

(Referenced from CCRN Pediatric – Direct Care: Gastrointestinal and Nutritional Considerations)

In unilateral lung injury (like pulmonary contusion), placing theinjured lung in the dependent positionworsensventilation/perfusion (V/Q) mismatch, as perfusion is gravity-dependent while ventilation is reduced due to contusion. This results inhypoxemia.

“In lung injuries, dependent positioning of the injured lung increases perfusion to poorly ventilated areas, leading to V/Q mismatch and hypoxemia.”

(Referenced from CCRN Pediatric – Direct Care: Pulmonary, Positioning in Ventilated Patients)

Blunt abdominal trauma, such as from a bicycle fall, can result inhollow viscus injury(e.g., bowel perforation). Classic signs includenausea, vomiting, fever, and decreased bowel sounds, often developing12–24 hours post-injurydue to peritonitis.

“After blunt abdominal trauma, particularly with handlebars or falls, visceral perforation must be suspected when symptoms like fever, ileus, and abdominal pain develop. Surgical evaluation is urgent.”

(Referenced from CCRN Pediatric – Direct Care: Gastrointestinal, Trauma and Acute Abdomen)

Expressions ofhopelessness, fatigue, and unbearable painare red flags forsuicidal ideation, particularly in pediatric patients. Immediate action is needed toassess suicide riskto ensure patient safety.

“In pediatric patients, behavioral cues such as excessive sleep, hopelessness, and verbal expressions of despair should trigger immediate suicide screening and risk assessment protocols.”

(Referenced from CCRN Pediatric – Direct Care: Psychosocial and Emotional Assessment in Critically Ill Children)

This is apriority safety concernand must be addressed before any further medical assessments or reviews.