CCRN-PEDIATRIC CCRN (Pediatric) - Acute/Critical Care Nursing Certification, Direct Care Eligibility Pathway Practice Questions
Prepare for CCRN-PEDIATRIC with more than an answer.
- 1
A 3-year-old child admitted with idiopathic pulmonary arterial hypertension becomes acutely agitated. The nurse notices the systemic blood pressure plummeting, tachycardia, and peripheral cyanosis. Which pathophysiological sequence explains why distress triggers a pulmonary hypertensive crisis?
Show answer details
Correct answer: B
Agitation, hypoxia, and acidosis cause acute surges in pulmonary vascular resistance. This leads to acute right ventricular strain/failure, severe drop in LV preload, and cardiovascular collapse.
- 2
A mechanically ventilated infant with severe pulmonary hypertension is receiving inhaled nitric oxide (iNO) at 20 ppm. The nurse understands that which property makes iNO uniquely advantageous compared to intravenous vasodilators?
Show answer details
Correct answer: B
Inhaled nitric oxide selectively relaxes pulmonary vascular beds in ventilated lung units and is rapidly bound/inactivated by hemoglobin, avoiding systemic hypotension.
- 3
An 8-month-old infant with Down syndrome is 6 hours postoperative following complete surgical repair of a balanced atrioventricular septal defect. The patient is intubated on conventional mechanical ventilation. Arterial blood gas results show: pH 7.26, PaCO2 56 mm Hg, PaO2 62 mm Hg, and HCO3 24 mEq/L.
During endotracheal suctioning, the infant becomes restless. The bedside monitor displays an acute rise in pulmonary artery pressure from 28/14 mm Hg to 54/30 mm Hg (systemic arterial blood pressure falls from 82/46 mm Hg to 48/24 mm Hg). The pulse oximetry reading plummets from 95% to 64%, and heart rate drops to 65 beats/min with poor capillary refill.
The nurse immediately hand-ventilates the infant with 100% FiO2 and administers prescribed fentanyl and vecuronium. Which additional pharmacologic intervention is most urgently indicated to selectively reverse this acute crisis?
Show answer details
Correct answer: B
Inhaled nitric oxide selectively dilates pulmonary vasculature without dropping systemic afterload, reversing acute postoperative pulmonary hypertensive crises.
flowchart TD Crisis[Pulmonary Hypertensive Crisis] --> HighPVR[Surge in PVR] HighPVR --> RVStrain[Acute RV Failure & Low LV Preload] HighPVR -.->|Inhaled Nitric Oxide| Dilation[Selective Pulmonary Vasodilation] - 4
An infant with hypoplastic left heart syndrome who underwent a Norwood procedure with a Blalock-Taussig shunt 12 hours ago exhibits a gradual rise in SpO2 from 78% to 94%, accompanied by a drop in mean arterial pressure from 52 mm Hg to 38 mm Hg, widening pulse pressure, and an increase in serum lactate from 1.8 to 4.2 mmol/L. Which pathophysiologic mechanism best accounts for this deterioration?
Show answer details
Correct answer: D
SpO2 >85% and falling MAP indicate pulmonary overcirculation (Qp > Qs), causing systemic hypoperfusion. Shunt occlusion would cause severe hypoxemia, not hyperoxia.
- 5
A 4-year-old child with tricuspid atresia is admitted to the pediatric intensive care unit following an extracardiac Fontan completion. To maintain adequate cardiac output in this patient, which hemodynamic principle must guide the nurse's priority assessments and interventions?
Show answer details
Correct answer: C
Fontan circulation lacks a subpulmonary pump; pulmonary blood flow is entirely passive and preload-dependent. High PEEP or hypovolemia severely impedes flow to the single systemic ventricle.
- 6
A 5-month-old infant with hypoplastic left heart syndrome is admitted to the pediatric intensive care unit following a stage II bidirectional Glenn procedure (superior vena cava to right pulmonary artery anastomosis). The child is mechanically ventilated on pressure control ventilation. Invasive arterial blood pressure is 68/42 mm Hg (mean 50 mm Hg), central venous pressure (CVP) transduced from the internal jugular line is 18 mm Hg, and pulse oximetry is 81% on an FiO2 of 0.35.
Over the past hour, the nurse observes that somatic near-infrared spectroscopy (NIRS) remains stable at 65%, but cerebral NIRS has dropped progressively from 62% to 41%. The infant is noted to have facial plethora and non-reactive periorbital edema.
Which postoperative complication should the nurse suspect as the primary cause of this presentation?
Show answer details
Correct answer: A
Elevated cranial CVP with head/neck swelling and a unilateral drop in cerebral NIRS indicates obstruction or thrombosis of the superior vena cava-to-pulmonary artery anastomosis.
flowchart TD SVC[SVC Anastomosis Clot/Stenosis] --> HighCVP[Elevated Cranial CVP >15-18 mmHg] HighCVP --> Swelling[Facial Plethora & Edema] HighCVP --> LowNIRS[Decreased Cerebral NIRS]
