Free AACN CCRN-Pediatric Practice Exam with Questions & Answers | Set: 4

Neutropenic fever or hypothermiais a medical emergency in oncology patients.Blood cultures should always be obtained before starting antibioticsto guide therapy.Hypothermiacan be a sign of sepsis in immunocompromised children.

“First steps in febrile neutropenia evaluation include obtaining blood cultures before initiating antibiotics to allow pathogen identification and targeted treatment.”

(Referenced from CCRN Pediatric – Direct Care: Hematology, Oncology Emergencies and Infection Management)

The patient is stable withsupraventricular tachycardia (SVT). Initial treatment in stable pediatric SVT involvesvagal maneuversto increase vagal tone and potentially terminate the arrhythmia. Having the childblow through a straw or simulate blowing a hornis a safe and effective method in a cooperative child.

“In stable pediatric patients with SVT, vagal maneuvers are the first-line intervention. Activities such as forced exhalation (blowing through a straw) may revert the rhythm.”

(Referenced from CCRN Pediatric – Direct Care: Cardiovascular, Pediatric Tachyarrhythmias Management)

Central venous catheter placementcan lead toiatrogenic pneumothorax, particularly on the side of the subclavian or internal jugular access. Signs of sudden desaturation, hypotension, and tachycardia suggesttension pneumothorax, which requiresemergent chest tube insertion.

“Following central line placement, sudden cardiorespiratory compromise should prompt evaluation for pneumothorax. Treatment is immediate decompression and chest tube placement.”

(Referenced from CCRN Pediatric – Direct Care: Pulmonary, Air Leak Syndromes and Ventilator Complications)

Hypertrophic cardiomyopathy (HCM)causesleft ventricular outflow tract obstruction, impairing cardiac output. The low blood pressure, tachycardia, and hypoxemia are classic signs ofventricular dysfunction—specificallydiastolic dysfunctiondue to a thickened, stiff left ventricle.

“HCM may lead to ventricular dysfunction due to impaired relaxation and outflow obstruction, especially during increased demand. Symptoms include hypotension, tachycardia, and hypoxia.”

(Referenced from CCRN Pediatric – Direct Care: Cardiovascular, Cardiomyopathies and Shock States)

Free air on abdominal x-rayindicatesbowel perforation, andloculated fluidsuggests hemoperitoneum or intra-abdominal bleeding. This is asurgical emergency, and the child requiresimmediate operative interventionto prevent further deterioration.

“Free intraperitoneal air and fluid suggest perforation and hemorrhage, which require emergent surgical exploration and correction to prevent peritonitis and shock.”

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

Children withSMA Type Ihave profound muscle weakness, including respiratory muscles. RSV increases respiratory workload, and once non-invasive measures and suctioning fail,intubation and mechanical ventilationare indicated to reduce fatigue and support gas exchange.

“Patients with neuromuscular disorders such as SMA are at increased risk for respiratory failure during acute infections. Mechanical ventilation is required when oxygenation does not improve with non-invasive methods or when respiratory fatigue is evident.”

(Referenced from CCRN Pediatric – Direct Care: Pulmonary Disorders and Neuromuscular Disease)

O₂ saturations in the low 90s despite 50% FiO₂ signal worsening gas exchange. Non-invasive support may be inadequate in the setting of hypotonia and viral pneumonia.

Abdominal compartment syndrome (ACS)occurs whenintra-abdominal pressure increases, impairing organ function.Oliguriais a key early sign due to decreased renal perfusion. Other signs may include increased ventilator pressures (PIP), hypotension, and a tense/distended abdomen.

“Oliguria and increased abdominal girth following trauma or transfusion suggest early abdominal compartment syndrome.”

(Referenced from CCRN Pediatric – Direct Care: Gastrointestinal, Abdominal Trauma and Compartment Syndrome)

Left ventricular failureleads todecreased cardiac output(cool extremities, low urine output) andincreased pulmonary pressures(pulmonary edema). Viral myocarditis causesmyocardial inflammationthat impairs left ventricular function in many pediatric cases.

“In myocarditis, left ventricular dysfunction manifests as signs of low cardiac output and pulmonary congestion. Close monitoring is essential for early intervention.”

(Referenced from CCRN Pediatric – Direct Care: Cardiovascular, Inflammatory Myocardial Disorders)

In neonates and young infants,hypoventilationanddecreased level of consciousness (LOC)are late and critical signs ofdecompensationin systemic infection or shock. A progression from normal respiratory rate tohypoventilation, especially with altered LOC, indicatesimpending respiratory failure or septic shock.

“Hypoventilation and changes in mental status (such as lethargy or decreased LOC) are indicators of deterioration in infants with sepsis or dehydration. Immediate intervention is required to prevent arrest.”

(Referenced from CCRN Pediatric – Direct Care: Multisystem, Pediatric Sepsis and Deterioration Cues)

SIRS leads towidespread vasodilation and increased capillary permeability, which causesfluid shifting, hypotension, and potential multi-organ dysfunction. This systemic response is part of the pathophysiology ofsepsis and MODS.

“SIRS involves a cytokine-mediated vasodilatory response with increased capillary permeability, leading to third-spacing, hypoperfusion, and potential organ dysfunction.”

(Referenced from CCRN Pediatric – Direct Care: Multisystem, Inflammatory Cascade in Sepsis)