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

Even with a good initial response,delayed respiratory complications, such asacute respiratory distress syndrome (ARDS)orpulmonary edema, can develop within 24–48 hours after submersion. All pediatric near-drowning cases should bemonitored in an ICU settingfor at least 24 hours.

“Post-submersion patients are at high risk for delayed onset ARDS. Observation in a monitored setting is essential regardless of initial neurologic status.”

(Referenced from CCRN Pediatric – Direct Care: Pulmonary, Submersion Injuries and Post-Resuscitation Care)

Wolff-Parkinson-White (WPW) syndromeis characterized by anaccessory conduction pathway, resulting inshort PR interval, narrow QRS complexes, and delta waves. Tachycardia in neonates with WPW is oftenparoxysmal supraventricular tachycardia (PSVT).

“WPW is a pre-excitation syndrome seen in neonates and children, diagnosed by ECG findings of delta waves, and is associated with recurrent tachyarrhythmias.”

(Referenced from CCRN Pediatric – Direct Care: Cardiovascular, Pediatric Arrhythmias)

Cor pulmonalerefers toright ventricular hypertrophyand failure due tochronic pulmonary hypertension, a known complication of long-standingbronchopulmonary dysplasia (BPD)and chronic hypoxia in infants.

“Chronic hypoxia and pulmonary inflammation in BPD lead to vascular remodeling and increased pulmonary vascular resistance, resulting in right heart strain and cor pulmonale.”

(Referenced from CCRN Pediatric – Direct Care: Pulmonary, Chronic Lung Disease and Cardiac Effects)

The elevated WBC count, fever, rising airway pressures, and increased secretions are consistent with adeveloping ventilator-associated pneumonia (VAP). Asputum cultureis needed to identify the infectious agent and guide antibiotic therapy.

“Signs of VAP include increased airway secretions, elevated temperature, and rising ventilator pressures. Diagnostic workup includes obtaining sputum culture to guide treatment.”

(Referenced from CCRN Pediatric – Direct Care: Pulmonary, Ventilator Complications and Infection)

Abdominal compartment syndrome (ACS)occurs whenintra-abdominal pressure increases, impairing organ function.Oliguriais a key early sign due to decreased renal perfusion. Other signs may include increased ventilator pressures (PIP), hypotension, and a tense/distended abdomen.

“Oliguria and increased abdominal girth following trauma or transfusion suggest early abdominal compartment syndrome.”

(Referenced from CCRN Pediatric – Direct Care: Gastrointestinal, Abdominal Trauma and Compartment Syndrome)

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)

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)

Education must beindividualizedbased on theparent’s learning style and comprehension.Combiningdemonstration, return demonstration, written materials, and verbal teaching—as preferred by the family—ensures the greatestretention and competence.Ongoing evaluationof skills is essential before discharge.

“Use of preferred teaching methods, with return demonstration and skill validation, ensures family readiness for complex care like tracheostomy management.”

(Referenced from CCRN Pediatric – Professional Caring and Ethical Practice: Family-Centered Teaching and Discharge Readiness)

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)

After aheart transplant, the native atrial tissue may continue to generateP waves, even though the donor heart generates its own rhythm. This results in the appearance oftwo P waveson ECG — one from the native sinoatrial node and one from the donor atrium. This is anormal findingpost-transplant and doesnot require intervention.

“Dual P waves seen post-transplant are common due to retained native atrial activity. The QRS response from donor conduction confirms proper graft function.”

(Referenced from CCRN Pediatric – Direct Care: Cardiovascular, Post-Transplant Electrophysiology Monitoring)