CCRN (Pediatric) - Acute/Critical Care Nursing Certification, Direct Care Eligibility Pathway Free Sample Questions

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?

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?

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?

In pediatric patients, which electrocardiographic measurement criteria differentiates a wide-complex tachycardia from a narrow-complex tachycardia?

An alert 6-year-old child presents to the pediatric intensive care unit with sudden-onset palpitations and lightheadedness. The bedside cardiac monitor shows a regular, narrow-complex tachycardia at 230 beats/min with absent P waves. The patient's blood pressure is 96/60 mm Hg, capillary refill is 2 seconds, and peripheral pulses are strong. Which TWO initial interventions are appropriate for this hemodynamically stable supraventricular tachycardia? (Select TWO)

A 12-year-old adolescent with a known history of Wolff-Parkinson-White (WPW) syndrome develops atrial fibrillation with rapid ventricular response and an irregularly irregular wide QRS morphology on the monitor. The patient remains conscious with a blood pressure of 104/68 mm Hg. Which medication is contraindicated because it accelerates conduction down the accessory pathway and risks precipitating ventricular fibrillation?