Free Practice Questions for AACN CCRN-Pediatric Exam

Beta-agonists such asterbutalineare frequently used in severe asthma to promote bronchodilation. However, these agents stimulate beta-2 receptors, which drivepotassium and phosphate into cells, leading tohypokalemia and hypophosphatemia—a well-documented side effect in patients receiving frequent or continuous beta-agonist therapy.

“Beta-adrenergic medications can cause intracellular shifting of potassium and phosphorus, especially when administered in high doses or for prolonged periods, as in status asthmaticus. This results in hypokalemia and hypophosphatemia, necessitating close electrolyte monitoring.”

(Referenced from CCRN Pediatric – Direct Care: Endocrine Disorders and Critical Pharmacologic Management)

This infant displays signs ofearly septic shock, includingtachycardia,fever,normal cap refill, andlow CVP. In thehyperdynamic early phase of septic shock, patients may initially havewarm, flushed skinandbounding pulses, with preserved perfusion before progressing to a decompensated state.

“Septic shock may present with increased HR, fever, and warm extremities in its compensated phase. CVP may be low due to vasodilation and capillary leakage.”

(Referenced from CCRN Pediatric – Direct Care: Cardiovascular, Types of Shock and Sepsis Pathophysiology)

When communication and relationships become strained, themost appropriate first action is to initiate a care conference. This collaborative approach provides a forum for the family and healthcare team to align goals, express concerns, andrebuild trustthrough structured, clear communication.

“Care conferences serve as a critical strategy to address and resolve family-staff conflict, particularly in long-term ICU stays where emotional fatigue and communication breakdowns are common.”

(Referenced from CCRN Pediatric – Professional Caring and Ethical Practice: Family-Centered Communication and Collaboration)

TheFLACC scale(Face, Legs, Activity, Cry, Consolability) is abehavioral pain assessment tool validated for use in non-verbal or cognitively impaired children, as well as those who are intubated or developmentally delayed.

“For non-verbal children or those with developmental delay, the FLACC scale is most appropriate. It assesses behavioral cues and is validated for use in ICU and post-op settings.”

(Referenced from CCRN Pediatric – Direct Care: Neurological, Pain and Sedation Assessment Tools)

Families depend onclear, consistent communicationfrom healthcare providers, especially when care plans change unexpectedly. Thenurse’s roleincludescoordinating communicationamong the team and ensuringclarity and alignment of messagingto prevent misunderstandings.

“Nurses are responsible for ensuring consistency of communication across interdisciplinary teams. Discrepancies between what families are told and what occurs can damage trust and must be promptly addressed.”

(Referenced from CCRN Pediatric – Professional Caring and Ethical Practice: Communication and Family Advocacy)

In BPD, the lungs are already injured and prone tovolutrauma and barotrauma. Ventilator strategies often include“gentle ventilation”withlower tidal volumesandpermissive hypercapniato reduce lung injury. This accepts slightly elevated CO₂ levels to avoid high pressures.

“Permissive hypercapnia is a lung-protective strategy used in infants with BPD to minimize ventilator-induced injury. Target PaCO₂ levels are allowed to be mildly elevated as long as pH is maintained.”

(Referenced from CCRN Pediatric – Direct Care: Pulmonary, Chronic Lung Disease Management)

High PEEP levels can causebarotrauma, leading totension pneumothorax—a life-threatening complication. Symptoms include sudden hypoxia, bradycardia, hypotension, and reduced perfusion.Thoracentesis (needle decompression)is the emergency intervention.

“Sudden hemodynamic instability in a ventilated child on high PEEP may indicate pneumothorax. Immediate decompression is warranted to restore cardiopulmonary function.”

(Referenced from CCRN Pediatric – Direct Care: Pulmonary, Mechanical Ventilation and Complications)

In a trauma situation, theprimary and secondary surveys take precedenceto assess life-threatening injuries and prioritize interventions. While a certified interpreter should be used for communicationas soon as possible, thenurse should not delay the physical assessmentduring a critical time.

“The priority in trauma is completion of the primary and secondary assessments. While interpreter use is standard, care must not be delayed in critical evaluations.”

(Referenced from CCRN Pediatric – Professional Caring and Ethical Practice: Cultural Competence and Emergency Protocols)

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.

Arapid drop in blood glucose, especially duringDKA treatment, can result incerebral edema—a life-threatening complication. Symptoms includebradycardia, irregular respirations, altered mental status, andwidened pulse pressuredue to increased intracranial pressure.

“A drop in serum glucose >100 mg/dL/hr in DKA increases risk for cerebral edema. Monitor for bradycardia, abnormal breathing, and neurologic decline.”

(Referenced from CCRN Pediatric – Direct Care: Endocrine, DKA and Cerebral Edema Monitoring)