CCRN-Pediatric AACN CCRN (Pediatric) - Direct Care Eligibility Pathway Exam Free Practice Exam Questions (2025 Updated)

Positive End-Expiratory Pressure (PEEP)helpskeep alveoli open at end-expiration, therebyincreasing functional residual capacityand improvinggas exchange. In aspiration-related lung injury, alveolar collapse and inflammation impair oxygenation, soPEEP is used to recruit alveoli and improve oxygenation.

“PEEP increases oxygenation by preventing alveolar collapse, especially important in aspiration pneumonitis and ARDS. It improves oxygen delivery while minimizing barotrauma.”

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

This response usesreflective, supportive communicationand encourages the family member toconnect with their own coping mechanisms and preferences. It shows empathy, builds rapport, and helps the individual think about self-care without directing them or dismissing their feelings.

“Psychosocial support includes guiding family members to express their feelings and reconnect with their coping resources. Open-ended, supportive questions are most therapeutic.”

(Referenced from CCRN Pediatric – Direct Care: Psychosocial, Family Stress and Coping in Critical Illness)

Homografts(cryopreserved human donor valves) candegenerate over time, leading tocusp dysfunction, includingregurgitation or stenosis. This can compromise cardiac output and may requirere-intervention.

“Aortic homografts carry a risk of cusp deterioration over time, especially in growing children, potentially resulting in valve dysfunction.”

(Referenced from CCRN Pediatric – Direct Care: Cardiovascular, Valve Replacement Risks in Pediatrics)

Chest physiotherapy (CPT)isnot recommended in asthmabecause it can lead tobronchospasm and increased airway resistance. Unlike conditions with excessive mucus production (e.g., cystic fibrosis), asthma management focuses onairway relaxation and inflammation reduction, not mechanical clearance.

“Chest physiotherapy is contraindicated in asthma due to the risk of increasing bronchospasm. Treatment should focus on bronchodilators and anti-inflammatory medications.”

(Referenced from CCRN Pediatric – Direct Care: Pulmonary, Asthma Management in Ventilated Patients)

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)

Neonatal Respiratory Distress Syndrome (RDS) is primarily caused by surfactant deficiency, which results in alveolar collapse and increased permeability of the alveolar-capillary membrane. This leads to pulmonary edema, impaired gas exchange, and hypoxemia.

“The hallmark of RDS is increased permeability of the alveolar-capillary membrane, which allows fluid to leak into alveoli, contributing to atelectasis and reduced oxygenation. Surfactant deficiency is the initiating factor.”

(Referenced from CCRN Pediatric – Direct Care: Pulmonary, Neonatal RDS Pathophysiology)

Increased surfactant production would be protective, not pathological. Pulmonary vascular hypertension can occur secondarily but is not the initiating pathophysiology.

Naloxone has ashorter half-lifethan many opioids. After the initial reversal, the opioid's effects canresurge, leading torespiratory depressionand sedation. This is calledre-sedationoropioid re-narcotization. Re-dosing or initiating analoxone infusionmay be required.

“Recurrent sedation or respiratory depression after naloxone administration suggests opioid duration outlasting naloxone’s half-life. Repeat dosing or continuous infusion may be necessary.”

(Referenced from CCRN Pediatric – Direct Care: Multisystem, Opioid Toxicity and Naloxone Pharmacology)

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)

Effective communication is a pillar of ethical and professional nursing practice. In complex care situations,coordination and unified messagingare vital to support family understanding and reduce distress.

“When families express confusion or frustration due to inconsistent communication, it is the nurse’s responsibility to advocate for a coordinated approach by facilitating interdisciplinary collaboration and clarity of plan.”

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

Arranging a team meeting promotes collaboration, consistency, and ensures that the family receives accurate, unified information.

Wolff-Parkinson-White (WPW)syndrome involves anaccessory conduction pathwaycausingreentrant tachycardias.Catheter ablationis thedefinitive treatment, especially in symptomatic children.Digoxin is contraindicatedin WPW as it may enhance conduction through the accessory pathway.

“Catheter ablation is the treatment of choice for recurrent or refractory supraventricular tachycardia in WPW. Digoxin should be avoided in pre-excitation syndromes.”

(Referenced from CCRN Pediatric – Direct Care: Cardiovascular, Supraventricular Tachycardia and WPW Management)

Aplanned transition, includingunit orientation, helps reduce family anxiety, provides clear expectations, and improves continuity of care. After long ICU stays, families benefit from structured support as they adjust to alower-acuity environmentand new staff.

“ICU discharge can be distressing for families. Orienting them to the receiving unit fosters trust, continuity, and a smoother emotional and clinical transition.”

(Referenced from CCRN Pediatric – Professional Caring and Ethical Practice: Family Support and Transitional Care)

Before initiating policy changes, the nurse must conduct anevidence-based literature reviewto assess the benefits and risks associated with altering visitation policies. This aligns with professional nursing standards that promoteevidence-informed practiceandfamily-centered care.

“In professional practice, initiating a literature review is the first step in evidence-based change. This supports the rationale for modifying clinical practices and promotes interdisciplinary consensus.”

(Referenced from CCRN Pediatric – Professional Caring and Ethical Practice: Evidence-Based Practice and Family-Centered Care)

Infants, particularly neonates, are at risk forhypoglycemiaduring transfusions ifglucose-containing maintenance fluids are heldfor a significant period. Monitoringblood glucoseis critical during and after the transfusion to detect and treat any hypoglycemia promptly.

“When glucose-containing IV fluids are held in infants, monitor blood glucose closely. Transfusions without concurrent dextrose infusion can precipitate hypoglycemia, especially in neonates.”

(Referenced from CCRN Pediatric – Direct Care: Hematology, Transfusion Guidelines in Neonates and Infants)

Nitroprusside is used invasodilatory shockto reduce afterload andlower systemic vascular resistance (SVR). A persistently elevated SVR (normal: ~800–1200 dynes/sec/cm⁻⁵) indicatesineffective vasodilation, necessitating an increase in dosage to optimize cardiac output.

“SVR is an essential parameter in the management of septic shock. Nitroprusside is titrated to decrease SVR and improve tissue perfusion. A persistently high SVR suggests inadequate response to therapy.”

(Referenced from CCRN Pediatric – Direct Care: Cardiovascular Shock and Hemodynamic Monitoring)

Expressions ofhopelessness, fatigue, and unbearable painare red flags forsuicidal ideation, particularly in pediatric patients. Immediate action is needed toassess suicide riskto ensure patient safety.

“In pediatric patients, behavioral cues such as excessive sleep, hopelessness, and verbal expressions of despair should trigger immediate suicide screening and risk assessment protocols.”

(Referenced from CCRN Pediatric – Direct Care: Psychosocial and Emotional Assessment in Critically Ill Children)

This is apriority safety concernand must be addressed before any further medical assessments or reviews.

Tachycardiaanddecreased urine outputare early clinical signs ofcardiac allograft rejectionin pediatric transplant recipients. Because transplanted hearts aredenervated,tachycardiais often thefirst compensatory responseto decreased cardiac output, while low urine output reflectsend-organ hypoperfusion.

“Rejection may present subtly with signs like persistent tachycardia, fatigue, or poor perfusion. Urine output is a sensitive measure of systemic perfusion.”

(Referenced from CCRN Pediatric – Direct Care: Cardiovascular, Heart Transplant Rejection Indicators)

Stored blood containscitrate, an anticoagulant that bindsionized calcium, leading tohypocalcemiawith multiple transfusions. This can causetetany, arrhythmias, and hypotensionif not corrected.

“Massive transfusion can cause hypocalcemia due to citrate toxicity. Monitoring ionized calcium is essential during and after blood product administration.”

(Referenced from CCRN Pediatric – Direct Care: Hematologic Emergencies and Transfusion Management)

Toxic shock syndrome (TSS)is asystemic inflammatory responsecaused by bacterial exotoxins, often leading toshock and multiorgan failure.Procalcitoninhelps confirm bacterial sepsis, andlactateis a marker fortissue hypoperfusion—both critical in TSS workup.

“In systemic infections and toxic shock, procalcitonin supports diagnosis of bacterial origin, while lactate levels reflect perfusion and guide resuscitation.”

(Referenced from CCRN Pediatric – Direct Care: Multisystem, Sepsis and Toxic Shock Syndrome)

Kawasaki disease is an acute vasculitis that primarily affects children under 5 and presents with classic signs:fever, rash, conjunctivitis, strawberry tongue, and extremity changes. It may also causecoronary artery aneurysmsandconduction abnormalities, such as PR prolongation.

“Kawasaki disease presents with mucocutaneous inflammation, and cardiac complications may include myocarditis and conduction delays, such as first-degree AV block.”

(Referenced from CCRN Pediatric – Direct Care: Cardiovascular, Inflammatory Heart Disease)