The Pediatric 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 exam contains 25 pretest questions, which do not contribute to the final score. These questions, impossible to identify, help develop future versions of the exam. An unofficial score report is provided immediately after the test.
The Pediatric CCRN Exam is divided into two parts: clinical judgment (80 percent of the exam) and professional caring and ethical practice (20 percent). The clinical judgment portion has nine domains:
- The cardiovascular section covers (14 percent of the exam) issues like acute pulmonary edema, cardiogenic shock, heart failure, and hypovolemic shock.
- In the pulmonary section (18 percent), questions relate to conditions such as acute respiratory failure, asthma, chronic bronchitis, and thoracic surgery.
- In the domain on the endocrine system (5 percent), questions address acute hypoglycemia, diabetes insipidus, diabetic ketoacidosis, inborn errors of metabolism, and the syndrome of inappropriate secretic antidiuretic hormone.
- The hematology and immunology section of the Pediatric CCRN Exam (3 percent) includes questions on coagulopathies and oncologic complications.
- The neurology section (14 percent) covers acute spinal cord injury, brain death, head trauma, neurosurgery, and other issues.
- In the gastrointestinal domain (6 percent), questions relate to issues like acute abdominal trauma, GI surgeries, bowel infarction, and hepatic failure.
- The renal section (6 percent) addresses acute renal failure, chronic renal failure, and life-threatening electrolyte imbalances.
- The multisystem domain (11 percent) covers issues such as asphyxia, near drowning, toxic ingestions, sepsis, and shock.
- The section on behavioral and psychosocial subjects (3 percent) reviews abuse, neglect, developmental delays, and other similar topics.
The professional caring and ethical practice portion of the Pediatric CCRN exam has seven domains: advocacy and moral agency (2 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 (4 percent).
Pediatric CCRN Study Guide
Start learning how to be successful on your Pediatric CCRN exam. Our Pediatric CCRN study guide is guaranteed to help you get the results you deserve on your Pediatric CCRN test. Some test takers prefer to study using flashcards and so we have created the best Pediatric CCRN flashcards that cover everything you need to know for the Pediatric CCRN exam. Note that using multiple study aids will help you maximize the benefit from your study time.
Pediatric CCRN Study Guide
Pediatric CCRN Flashcards
Pediatric CCRN Exam Practice Test
1. Which of the following statements regarding the use of inotropic agents in the critically ill pediatric patient is most accurate?
A. Inotropic agents should be initiated before fluid resuscitation in patients with hypovolemic shock.
B. Dobutamine infusion is contraindicated in patients with cardiogenic shock.
C. Milrinone administration requires less invasive monitoring than other inotropic agents.
D. Inotropic agents, such as dopamine and norepinephrine, with vasoconstrictive effects may be indicated in patients with septic shock.
2. A nurse is taking care of a 7-year-old patient with heart failure who is being treated with diuretics. Because of the diuretic therapy, the critical care nurse knows that this child needs close monitoring for:
A. cardiac enzymes.
B. overall fluid status.
C. serum white blood cell count.
D. pulmonary compliance.
3. The hospital administration has decided to replace all of the defibrillators with a new model because of concerns about quality. Which of the following methods is most effective for preparing the nursing staff for the defibrillator change?
A. Formal teaching sessions about the new defibrillators
B. Prominent display of both written and visual instructions on each new machine
C. Hands-on teaching/demonstration sessions
D. Lecture-style teaching sessions by a representative of the defibrillator company
4. The mother of a 3-day old infant girl would like to breastfeed after the child’s surgical repair of a myelomeningocele and ventriculoperitoneal shunt placement. The child is awake and alert and has been cleared to resume feeding. The most appropriate response by the nurse to this request is to tell the mother:
A. that myelomeningocele repair is a contraindication for breastfeeding.
B. how to position the infant for breastfeeding so that the infant is not lying on her back.
C. that the infant can only take pumped breast milk through a bottle.
D. that the infant requires more calories than breast milk can provide.
5. A 4-year-old girl with type I diabetes mellitus is treated with intravenous fluids and continuous insulin administration for diabetic ketoacidosis. Four hours after admission, she is alert, and her serum electrolytes and glucose are normalizing. Eight hours after admission, she begins to complain of headache and seems tired. Two hours later, she develops bradycardia and extremity posturing. On the basis of this information, the critical care nurse suspects that the patient has developed:
A. seizure activity from the hypoglycemia.
B. hyperkalemia.
C. cerebral edema.
D. hyperosmolar coma.
Answers
1. D: Inotropic medications are used primarily in the setting of shock. Inotropes increase the contraction force of the myocardium and may cause peripheral vasodilation or constriction, depending on the medication. Dopamine is used in almost every type of shock and has variable dose-dependent effects. At low doses, dopamine primarily leads to end-organ vasodilation. At midrange doses, dopamine acts on beta-1 receptors and exerts inotropic and chronotropic effects, leading to increased cardiac output. At high doses, dopamine primarily affects alpha receptors, leading to increased blood pressure from peripheral vasoconstriction.
Norepinephrine is a strong alpha-agonist, causing peripheral vasoconstriction, and acts on cardiac beta-1 receptors as well, increasing cardiac contractility and heart rate. Dobutamine is primarily an inotrope, acting on beta-1 receptors to increase cardiac contractility, and is used primarily in the setting of cardiogenic shock. Milrinone is a phosphodiesterase inhibitor and works by increasing intracellular cyclic adenosine monophosphate, leading to increased cardiac contractility and peripheral vasodilation. The phosphodiesterase inhibitors are associated with a significantly increased risk of cardiac arrhythmias, and therefore, patients receiving milrinone would require continuous careful monitoring during administration.
2. B: Diuretics increase urine output by increasing renal sodium (and water) excretion. They may be used in a variety of clinical conditions, including congestive heart failure, bronchopulmonary dysplasia, hypertension, and primary renal disease. There are three classes of diuretic medications, which are differentiated by their mechanism and site of action in the kidney. Thiazide diuretics (e.g., chlorthiazide) block reabsorption of sodium in the distal tubule, leading to potassium wasting and hypokalemia in addition to the diuretic effect. Loop diuretics (e.g., furosemide) inhibit sodium reabsorption in the proximal renal tubule and may also cause hypokalemia, although to a lesser degree than with thiazide diuretics. Finally, potassium-sparing diuretics (e.g., spironolactone) work via antagonism of aldosterone effects in the distal tubule. The overall fluid balance and the effect of fluid shifts from diuretic administration require close monitoring in the critically ill pediatric patient to avoid the complications of electrolyte abnormalities and reduced intravascular volume.
3. C: Educational opportunities provided to nursing staff should be designed to maximize effective transmission of critical information to staff and to provide hands-on practice so that important clinical skills can be honed in the educational setting, allowing for effective and confident practice in the patient care setting. When new equipment is introduced, plenty of time must be allowed for staff to learn about equipment use, to ask questions as difficulties arise, and to use the equipment in an educational setting. Whenever possible, this should be accomplished before the changes take place to avoid a rough transition as new skills and practices are implemented.
4. B: Infants who have undergone myelomeningocele repair generally require side-lying or prone positioning until the surgical wound has healed sufficiently. Resuming normal feedings, including breastfeeding, should be started as soon as possible after surgical repair. All of the benefits of breastfeeding in the normal infant also apply to the infant with myelomeningocele and an early return to breastfeeding should be encouraged. Mothers can be taught how to position themselves and their infant so that the infant is not lying supine on the surgical wound. Although some newborns require fortified feedings for growth concerns, this is not typically a major concern in the infant with myelomeningocele.
5. C: Cerebral edema is a rare but potentially fatal complication of diabetic ketoacidosis (DKA), occurring in up to 1% of pediatric patients with DKA. Risk factors for the development of cerebral edema in the setting of DKA are not entirely clear despite the attempts of numerous studies to identify clear etiologic factors. Young age, rapid correction of hyperglycemia and dehydration, and a severe degree of acidosis on initial presentation have all been thought to play a role in the development of cerebral edema. Classically, symptoms of cerebral edema (e.g. lethargy, headache, altered mental status, bradycardia) develop several hours after the initiation of therapy and can rapidly progress to brain herniation and death. Prompt treatment for increased intracranial pressure as soon as the patient exhibits signs of cerebral edema offers the best chance of recovery, including intravenous mannitol, head-of-bed elevation, hyperventilation, and invasive intracranial monitoring if indicated.
