Neonatal CCRN Exam

The Neonatal CCRN exam is a challenging and comprehensive assessment for men and women who want to enter this exciting and rewarding field of health care. The exam takes three hours and consists of 150 multiple-choice questions.

Each version of the test contains 25 pretest questions, which do not contribute to the final score. These questions, which are impossible to identify, help develop future versions of the exam.

The Neonatal CCRN exam is divided into two parts: clinical judgment, representing 80 percent of the exam, and professional caring and ethical practice, making up the remaining 20 percent.

The section on clinical judgment covers nine domains:

  1. The cardiovascular section (10 percent of the exam) addresses issues such as acute pulmonary edema, cardiogenic shock, heart failure, and hypovolemic shock.
  2. In the pulmonary section (24 percent), questions relate to conditions such as acute respiratory failure, asthma, chronic bronchitis, and thoracic surgery.
  3. In the section on the endocrine system (3 percent), there are questions regarding inborn errors of metabolism and neonatal hypoglycemia.
  4. The hematology and immunology section of the Neonatal CCRN exam (6 percent) includes questions on anemia of prematurity, coagulopathies, pathological hyperbilirubinemia, physiological hyperbilirubinemia, Rh incompatibilities, ABO incompatibilities, and hydrops fetalis.
  5. The neurology domain (10 percent) focuses on birth injuries, brain death, neurosurgery, and other issues.
  6. The gastrointestinal section (6 percent) covers issues such as GI surgeries, bowel infarction, and hepatic failure.
  7. The portion on the renal system (5 percent) addresses acute renal failure and life-threatening electrolyte imbalances.
  8. The multisystem section (10 percent) covers issues like asphyxia, near drowning, toxic ingestions, sepsis, and shock.
  9. The domain on behavioral and psychosocial (7 percent) has questions on topics such as abuse, neglect, developmental delays, stress, and failure to thrive.

The professional caring and ethical practice portion of the Neonatal CCRN exam has seven domains: advocacy and moral agency (3 percent of the exam); caring practices (4 percent); collaboration (4 percent); systems thinking (2 percent); responses to diversity (2 percent); clinical inquiry (2 percent); and the facilitation of learning (3 percent).

An unofficial score report for the Neonatal CCRN exam is provided to test takers immediately after the exam is completed.

Neonatal CCRN Exam Practice Questions

1. A newborn with a congenital heart defect causing systemic to pulmonary shunting develops signs of cardiogenic shock. Which of the following are characteristics of cardiogenic shock?

A. Decreased cardiac output, increased systemic vascular resistance, pulmonary edema, and right ventricular failure.
B. Decreased cardiac output, peripheral edema, decreased systemic vascular resistance, and left ventricular failure.
C. Decreased cardiac output, decreased systemic vascular resistance, pulmonary edema, and left ventricular failure.
D. Increased cardiac output, increased systemic vascular resistance, peripheral edema, and right ventricular failure.

2. A neonate on mechanical ventilation develops a left pneumothorax with obvious tachypnea, displaced apical heartbeat, and unequal air exchange, requiring needle aspiration. What is the correct insertion site for the needle?

A. Left anterior axillary line, second or third intercostal space.
B. Left midsternal line, second or third intercostal space.
C. Left midclavicular line, third or fourth intercostal space.
D. Left midclavicular line, second or third intercostal space.

3. The nursing staff is preparing posters to explain handwashing and gowning procedures for family members to reduce the chance of cross-contamination in the NICU. Which of the following is the best type of poster?

A. A poster with detailed text at 9th grade level and small sketches.
B. A poster with large pictures and minimal text written at 6th grade level.
C. A poster with pictures only.
D. A poster with text only at adult reading level.

4. After insertion of an endotracheal tube (ETT), the nurse auscultates the infant for breath sounds and notes that the right lung is better ventilated than the left. What does this suggest?

A. The ETT is positioned too high.
B. The ETT is positioned too low.
C. The ETT is in the stomach.
D. The ETT is correctly positioned.

5. A premature neonate was maintained on mechanical ventilation for 3 weeks. Extubation was done with some difficulty, and the infant subsequently developed stridor, recurrent pneumonitis, and frequent choking. What complication of long-term intubation most likely explains these symptoms?

A. Tracheal stenosis.
B. Staphylococcus aureus infection.
C. Pulmonic stenosis.
D. Tracheobronchial fistula.

Answers

1. (A) Cardiogenic shock causes increased preload and afterload and decreased contractibility. Together, these result in decreased cardiac output and increased systemic vascular resistance to compensate. This increases afterload in the left ventricle, which fails to adequately pump blood as cardiac output and coronary and peripheral perfusion continue to decrease. Fluid builds up, causing pulmonary edema and right ventricular failure.

2. (D) The correct needle insertion point for a needle aspiration to treat pneumothorax in a neonate is on the left midclavicular line at the second or third intercostal space. The infant should be given oral sucrose, placed in supine position, given IV fentanyl 250 mcg over 2 to 3 minutes, and given a local anesthetic with 1% lidocaine. The needle is inserted directly into the intercostal space until air is aspirated in a syringe. The air is expelled through a stopcock. A chest tube may be inserted in the same space or at the anterior axillary line, fourth, fifth, or sixth intercostal space.

3. (B) The best poster is one with large pictures so that family members can see what they need to do and minimal text at 6th-grade reading level. Readability (the grade level of material) is a concern because many patients and families may have limited English skills or low literacy, so pictures are important. The average American reads effectively at the 6th- to 8th-grade level (regardless of education achieved). Additionally, research indicates that even people with much higher reading skills learn medical and health information most effectively when the material is presented at the 6th- to 8th-grade readability level.

4. (B) If the right lung is better ventilated than the left after insertion of an ETT, this suggests that the ETT is positioned too low. ETT placement should immediately be verified by auscultation and radiograph, ultrasound, or disposable end-tidal carbon dioxide detectors. Esophageal intubation is indicated if no air exchange is detected bilaterally or if there is air sound over left upper abdomen. The tube may be too high if air sounds are diminished. An ETT may be inserted nasally or orally.

5. (A) The difficulty extubating the infant and subsequent development of strider, recurrent pneumonitis, and frequent choking are often associated with tracheal stenosis caused by pressure necrosis of the tissues from the intubation tube. Incidence of tracheal stenosis increases if the infant’s mucosa becomes infected, so pathogens may have a role in the disorder. Treatment with balloon dilatation per endoscopy is often successful, although some infants require surgical repair.

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By Lindsay Downs

Last Updated: 07/28/2014

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