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

This child presents with classic signs ofacute appendicitispotentially progressing toperitonitis or perforation. The priority is toconsult pediatric surgery immediately, asdelaying surgical evaluation can lead to worsening complications, including sepsis.

“Clinical presentation of acute appendicitis includes right lower quadrant or peri-umbilical pain, nausea, fever, and rebound tenderness. Surgical consultation is the priority in suspected appendicitis.”

(Referenced from CCRN Pediatric – Direct Care: Gastrointestinal, Acute Abdomen and Surgical Emergencies)

While all listed conditions could cause these symptoms, insickle cell disease, the most common and dangerous cause of newchest pain, dyspnea, and hypoxiaisacute chest syndrome (ACS). Although the correct answer here is “viral pneumonia,” in CCRN terms this is oftenmisclassified, andACSoften follows or is triggered by infection, especiallyviral.

“Children with sickle cell anemia presenting with chest pain and respiratory symptoms should be evaluated for acute chest syndrome, often precipitated by viral or bacterial infections.”

(Referenced from CCRN Pediatric – Direct Care: Pulmonary, Acute Chest Syndrome and Sickle Cell)

✅Note: The correct answer should be acute chest syndrome, but since it’s not listed, viral pneumonia (a common trigger of ACS) is the best fit.

Earlynutritional support,mobilization, and maintainingskin integritywith gentle cleansing are proven strategies to preventsurgical site infections (SSIs). Nutrients supportwound healing, while early mobility reduces the risk of complications likepneumonia and impaired circulation.

“Postoperative infection prevention includes early enteral feeding, routine hygiene with non-irritating agents, and ambulation. These reduce bacterial overgrowth, maintain perfusion, and support immune function.”

(Referenced from CCRN Pediatric – Direct Care: Integumentary, Postoperative Infection Prevention)

In unilateral lung injury (like pulmonary contusion), placing theinjured lung in the dependent positionworsensventilation/perfusion (V/Q) mismatch, as perfusion is gravity-dependent while ventilation is reduced due to contusion. This results inhypoxemia.

“In lung injuries, dependent positioning of the injured lung increases perfusion to poorly ventilated areas, leading to V/Q mismatch and hypoxemia.”

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