AACN CCRN-Pediatric - CCRN (Pediatric) - Direct Care Eligibility Pathway Exam

This statement reflectsemotional and existential distressrather than a purely educational need. Apalliative care consultis appropriate to provideholistic support,clarify goals of care, and ensure that the family's values and quality-of-life concerns are addressed within a multidisciplinary approach.

“Palliative care is appropriate when families face complex, life-altering decisions. It supports communication, decision-making, and emotional well-being alongside curative or life-sustaining treatments.”

(Referenced from CCRN Pediatric – Professional Caring and Ethical Practice: Palliative Care and Family-Centered Decision-Making)

Myeloablationprior to bone marrow transplantdestroys bone marrow cells, leading toprofound neutropenia and thrombocytopenia. As a result, patients are atextremely high risk for infection and bleeding, requiring close monitoring, isolation, and transfusion support.

“Pre-transplant conditioning regimens cause neutropenia and thrombocytopenia, making infection and bleeding the primary complications during marrow ablation.”

(Referenced from CCRN Pediatric – Direct Care: Hematology, Bone Marrow Transplantation and Myelosuppression)

Febrile seizuresare the mostcommon cause of seizures in infants and young children, typically between 6 months and 5 years. They often occur with arapid rise in body temperature, even inthe absence of intracranial infection or metabolic disturbances.

“In infants, febrile seizures are the most likely cause of new-onset seizures. Tonic-clonic activity confined to extremities is typical. Evaluation focuses on identifying the febrile source.”

(Referenced from CCRN Pediatric – Direct Care: Neurological, Pediatric Seizure Disorders)

Lead poisoning and structural brain anomalies are less common and usually not the first consideration in an acute setting with fever.

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)

Early in career development,identifying a mentor or role modelprovides foundational support for leadership growth. This allows the nurse to observe effective leadership behaviors, gain guidance, anddevelop long-term goals through structured exposure.

“Mentorship is essential in leadership development. New nurses with administrative goals should be encouraged to identify and learn from respected leaders to develop the skills and behaviors required for advanced roles.”

(Referenced from CCRN Pediatric – Professional Caring and Ethical Practice: Leadership Development and Mentorship)

Septic shockin pediatric patients requiresearly goal-directed therapy, including:

Fluid resuscitationto restore perfusion,

Antibioticswithin the first hour to treat the underlying infection, and

Inotropesif shock persists after fluids.

“Early interventions for pediatric septic shock include aggressive fluid resuscitation, timely administration of broad-spectrum antibiotics, and initiation of vasopressors or inotropes if hypotension remains.”

(Referenced from CCRN Pediatric – Direct Care: Multisystem, Sepsis Management)

Elevated serum ammoniais often associated withhepatic encephalopathyor metabolic disturbances.Lactuloseis the standard treatment to reduce ammonia levels by promoting ammonia excretion via the GI tract.

“Lactulose lowers serum ammonia levels by converting ammonia into ammonium, which is then excreted in stool. It is a cornerstone in the treatment of encephalopathy caused by hyperammonemia.”

(Referenced from CCRN Pediatric – Direct Care: Gastrointestinal, Hepatic Failure and Encephalopathy)

The described symptoms indicateanticholinergic toxicity, which is classically associated with tricyclic antidepressant (TCA) overdose.Amitriptyline, a TCA, causesanticholinergic symptoms: tachycardia, dilated pupils, dry mucosa, urinary retention, altered mental status, and PVCs on ECG.

“TCA toxicity presents with anticholinergic signs—dry mouth, mydriasis, tachycardia, neurologic changes, and cardiac conduction abnormalities. Amitriptyline overdose is life-threatening and requires immediate supportive care and cardiac monitoring.”

(Referenced from CCRN Pediatric – Direct Care: Neurological Emergencies and Toxicology)

High levels of PEEP(≥15 cm H₂O) can increaseintrathoracic pressure, leading todecreased venous returnand subsequentlydecreased cardiac output. This hemodynamic effect is the most immediate concern before longer-term issues like fibrosis arise.

“Elevated PEEP levels in ventilated children with RDS can compromise cardiac output by reducing preload. Monitor for hypotension and poor perfusion.”

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

Ethics committees are convened to help resolvecomplex, value-laden clinical issuesby offeringguidanceto care teams and families. These committees are composed of interdisciplinary professionals and focus onsupporting ethical decision-makingin patient care.

“Ethics committees assist healthcare professionals, patients, and families in addressing ethical dilemmas, including end-of-life decisions, treatment refusal, and moral distress.”

(Referenced from CCRN Pediatric – Professional Caring and Ethical Practice: Ethical Decision-Making Support Structures)