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Pediatric CCRN Review Blog

News and information from Pediatric CCRN Review

Structure of the exam

Structure of the exam

The pediatric CCRN exam is 150 questions, 25 of which are used for statistical analysis for future tests. This equates to 125 questions that are scored. The exam lasts 3 hours and candidates receive their test results immediately if you take the computer based exam.


The test is divided into clinical judgment, which is 80% (120 questions) of the exam, and professional caring and ethical practice, which is 20% of the exam. Clinical judgment is further divided into cardiovascular (15% - 22.5 questions), pulmonary (16% - 24 questions), endocrine/hematology/gastrointestinal/renal/integumentary (19% - 28.5 questions), musculoskeletal/neurology/psychosocial (16% - 24 questions), and multisystem (14% - 21 questions).


Professional caring and ethical practice is the remaining 20%, or 30 questions. Professional caring and ethical practice is based on a model created by the American Association of Critical Care Nurses (AACN) called the Synergy Model. The Synergy model discusses a set of patient characteristics and a set of nurse characteristics.


Synergy occurs when the patient characteristics match the nurse characteristics. Patient characteristics include resiliency, vulnerability, stability, complexity, resource availability, participation in care, participation in decision making, and predictability. Nurse characteristics include clinical judgment, advocacy/moral agency, caring practices, response to diversity, facilitation of learning, collaboration, systems thinking, and clinical inquiry.


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Brain Death

     Most states have determined that brain death guidelines for infants, children, and adults include one or two of the following conditions: 1. irreversible cessation of breathing and circulation OR 2. irreversible cessation of whole-brain functions (such as cortical or brainstem). The process in confirming brain death may vary from state to state. Presence of doll’s eyes and absence of a nystagmus with cold calorics indicates absence of oculocephalic and oculovestibular reflexes. 

     A normal oculovestibular reflex is seen when cold water is flushed into the ears causing nystagmus. Absence of this reflex is abnormal and may indicate brain death. A normal oculocephalic reflex is present when the head is rapidly turned to one side and the eyes deviate to the opposite side of head movement. Presence of doll’s eyes may be indicative of brain death. The time allowed following disconnection from the ventilator to allow PaCO2 to increase to stimulate a spontaneous breath is 5-10 minutes. 

     Brain death is part of the test plan under neurology. Musculoskeletal/Neurology/Psychology makes up 16% of the exam, which equals 24 questions.

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Locating Leaks in Chest Tubes

Have you ever had a patient with a chest tube and you notice new continuous noisy or turbulent bubbling in the water seal chamber? A leak may be present, but first check that all connections are tight and secure. Clamp the chest tube at the insertion site (or closest to the dressing) using padded clamps and reassess the water chamber. If the bubbling stops, the leak is probably caused by patient air leak into the pleural space (in the lung) or at the insertion site. Unclamp immediately. Never clamp the chest tube for more than a few seconds or you risk a tension pneumothorax.  

If the bubbling does not stop, reclamp the chest tube with padded clamps just a few inches distal to the insertion site and reassess the bubbling in the chamber to attempt to locate the air leak. Remember to only clamp the chest tube for a few seconds at a time. If the bubbling stops close when the chest tube is clamped close to a connection, you may be able to reseal the connection and fix the problem. If you clamp the system all the way from the patient to chamber and still have bubbling in the water seal chamber, the entire system may need to be changed.

Check out this video at 2:45 for visual demonstration: https://www.youtube.com/watch?v=Ui0eKmEk38M

Hazinski, M.F. (2013). Nursing Care of the Critically Ill Child. 3rd ed. St. Louis, MO: Mosby/Elsevier

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What’s New in Pediatric CCRN

In 2018, the American Association of Critical Care Nurses (AACN) released a new product for pediatric CCRN certification. The third edition of AACN Core Curriculum for Pediatric High Acuity, Progressive, and Critical Care Nursing is available on the AACN for $83 for members and $98 for non-members. The book was created as a tool for potential pediatric CCRN candidates.

Updates to the new edition include current patient management, updated drug information, a new chapter on professional nursing issues discussing quality, safety, communication, teamwork, work environment, and the ever popular current hot topic of personal wellness. The case studies have also been revised to reflect the latest version of the CCRN exam with questions and rationales. Amazon reviews report that the book is great, but it is very long and very detailed (which is very similar to the second edition).

Every person studies differently. Remember what worked for you in nursing school will likely work for you with this exam. The pediatric CCRN online review course provides over 500 practice questions with rationales, 6 hours of focused video content, a study guide, and a book containing concentrated test content and over 400 practice questions. This allows candidates to study at their own pace with maximum efficiency, which is ideal for nurses work 12 hour shifts.


AACN Core Curriculum for Pediatric High Acuity, Progressive, and Critical Care Nursing. 3rd ed. 2018. Slota M, ed. 968 pages.

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