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

PPHNis a condition in which pulmonary vascular resistance remains abnormally high after birth. In this fragile state,handling or stresscan worsen pulmonary vasospasm.Minimal stimulation—such as reducing noise, light, and touch—is critical to preventing exacerbation.

“Infants with PPHN are highly sensitive to stress. Minimal stimulation reduces sympathetic discharge and prevents exacerbation of pulmonary vasoconstriction.”

(Referenced from CCRN Pediatric – Direct Care: Pulmonary, Neonatal Pulmonary Hypertension Management)

Alprostadilis used in ductal-dependent congenital heart lesions, not in primary management of PPHN.

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.

In a trauma situation, theprimary and secondary surveys take precedenceto assess life-threatening injuries and prioritize interventions. While a certified interpreter should be used for communicationas soon as possible, thenurse should not delay the physical assessmentduring a critical time.

“The priority in trauma is completion of the primary and secondary assessments. While interpreter use is standard, care must not be delayed in critical evaluations.”

(Referenced from CCRN Pediatric – Professional Caring and Ethical Practice: Cultural Competence and Emergency Protocols)

In esophageal atresia with tracheoesophageal fistula,secretions can accumulate in the blind-ending proximal pouch, riskingaspiration. Areplogle tube with low continuous suction (sump)is placed tokeep the pouch draineduntil surgical repair.

“Management of esophageal atresia includes placement of a sump in the upper pouch to prevent aspiration and respiratory compromise. This is standard preoperative care.”

(Referenced from CCRN Pediatric – Direct Care: Gastrointestinal, Congenital Abnormalities)

It is a best practice—and often required by hospital policy—fortrained personnel such as an organ donation liaison or organ procurement organization (OPO)representative to approach families about organ donation. This ensures that the conversation is handled sensitively, accurately, and in accordance with regulatory requirements.

“The nurse should notify the designated organ donation liaison or team when a patient meets criteria for brain death. These individuals are trained to communicate effectively and ethically with families.”

(Referenced from CCRN Pediatric – Professional Caring and Ethical Practice: Ethics, End-of-Life Care, and Organ Donation)

Establishingadmission and discharge criteriaensures that care decisions areconsistent, justifiable, and ethically grounded. These criteria guide clinicians inresource allocation, promotingfair accessand minimizing bias in treatment decisions.

“Admission/discharge policies support ethical care delivery by ensuring objective, equitable decision-making, especially in high-acuity environments like ICUs.”

(Referenced from CCRN Pediatric – Professional Caring and Ethical Practice: Ethical Resource Management and Clinical Guidelines)

Pulse oximetry (SpOâ‚‚)is inaccurate incarbon monoxide (CO) poisoningbecause itcannot differentiate between oxyhemoglobin and carboxyhemoglobin. SpOâ‚‚ may appear falsely normal despitesevere hypoxia. Direct measurement withco-oximetryis required for accurate oxygen saturation.

“In CO poisoning, SpO₂ readings are falsely elevated due to inability to distinguish carboxyhemoglobin from oxyhemoglobin. Co-oximetry is needed to assess true oxygenation.”

(Referenced from CCRN Pediatric – Direct Care: Pulmonary, Toxic Inhalation and Oxygenation Monitoring)

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)

Bronchiolitis causeslower airway obstruction, air trapping, andhypoventilation. On chest radiographs,hypoinflation(low lung volumes) and peribronchial thickening are common. The ABG showsrespiratory acidosis and hypoxemia, consistent withbronchiolar obstructionand hypoinflation.

“In bronchiolitis, hypoinflation and peribronchial thickening are typical CXR findings. ABG shows respiratory acidosis with hypoxemia in severe cases requiring ventilation.”

(Referenced from CCRN Pediatric – Direct Care: Pulmonary, Bronchiolitis and Ventilatory Support)