Free CNA Critical Care Pediatric Nursing Certification Exam Practice Questions

About CNA Critical Care Pediatric Nursing Certification Exam

CNA Critical Care Pediatric Nursing Certification Exam · CA

Key exam facts

Provider

Canadian Nurses Association (CNA) certification examination; Meazure Learning provides testing/statistical services, with ProctorU for remote proctoring and Meazure Learning for in-person centres.

Format

Computer-based multiple-choice examination, remotely proctored or at selected Canadian test centres. Blueprint: 30–50% independent and 50–70% case-based questions.

Exam questions

Total questions: 160–165.

Time limit

Four hours (240 minutes) to answer examination questions; booking, identification and setup are separate from this answer-time statement.

Passing score

Pass mark is not published. The specialty committee sets it using a modified Angoff method with statistical validation; results are pass or unsuccessful.

Exam fee

Canadian exam fee table publishes dollar ($) amounts: application $588 for CNA members or $780 for non-members; appointment additionally $85 remotely or $110 in person; applicable taxes extra. Application includes $130 non-refundable administration. Eligible unsuccessful candidates pay $378/$500 to rewrite within the next two calendar years. The fee page does not explicitly print an ISO currency code.

Topics covered

The authority publishes percentage ranges for each content area. The practice percentages below use the midpoint of each range, normalized to 100%; they are not exact percentages published by the authority. Practice question counts may differ slightly because of rounding.

• Professional Practice — Official range: 2–5% (Practice allocation: 3.33%)

  • 1.1 Recognizes actual and potential issues related to practice including: a) the identification and consideration of legal and ethical decision-making (e.g., documentation, consent, confidentiality, end-of-life care); b) the components of a healthy practice environment (e.g., workload, moral distress, work-life balance, self-care, violence prevention, care planning including the child and family); c) interprofessional collaboration and teamwork (e.g., situational awareness, roles and responsibilities, communication, decision-making); and d) safety (e.g., environmental, child and family, interprofessional team members, infection control practices).
  • 1.2 Identifies and accesses available resources to address actual and potential issues (e.g., debriefing, child safety rounds, morbidity/mortality rounds, quality improvement initiatives, research).
  • 1.3 Uses techniques to promote safety and support for the child and family during procedures.

• Pain, Agitation, Delirium and Withdrawal — Official range: 10–15% (Practice allocation: 11.9%)

  • 2.1 Evaluates data related to pain, agitation, delirium and withdrawal including: a) child’s health history (e.g., culture, previous experiences, communication patterns, coping strategies, mechanism of injury); b) developmentally appropriate assessment tools; and c) physical assessment (e.g., vital signs, precipitating factors, intensity, quality, duration).
  • 2.2 Recognizes types of pain (e.g., acute, chronic, neuropathic) and the pain process (e.g., behavioural, cognitive and physiological responses).
  • 2.3 Recognizes the consequences of ineffective pain management (e.g., delayed recovery, sleep alterations, hyperesthesia, chronic pain syndromes, delirium).
  • 2.4 Recognizes agitation and the consequences of ineffective management (e.g., delayed recovery, sleep alterations, delirium, increased safety risk).
  • 2.5 Recognizes signs and implications of delirium (hallucinations, confusion, disorientation, memory loss, anxiety, depression).
  • 2.6 Recognizes signs and implications of withdrawal from pharmacological agents (e.g., benzodiazepines, narcotics).
  • 2.7 Implements nursing interventions related to the prevention and alleviation of pain, agitation, delirium and withdrawal including: a) using non-pharmacological strategies (e.g., family presence, mobilization, therapeutic play, hot/cold compresses, distraction, positioning, environmental management, non-nutritive sucking, oral sucrose administration, relaxation techniques); b) administering and adjusting pharmacological agents appropriate to assessment findings of pain, agitation, delirium and withdrawal (e.g., analgesics, sedatives, adjunctive therapies); and c) managing medication delivery devices to promote optimal comfort minimizing the inappropriate use of pharmacological agents (e.g., child-controlled analgesia pumps, continuous infusions, local and regional continuous infusions, epidurals).

• Neurologic System — Official range: 12–18% (Practice allocation: 14.29%)

  • 3.1 Evaluates data related to the neurologic system including: a) child’s health history (e.g., sensory or motor function, developmental milestones, toxic ingestions); b) physical assessment (e.g., Glasgow Coma Scale, level of consciousness, protective reflexes, motor/sensory assessment, pupillary response, head shape and circumference, fontanels, newborn reflexes, respiratory patterns); c) information from monitoring devices: i. intracranial pressure; and ii. cerebral perfusion pressure.
  • 3.2 Laboratory reports (e.g., serum and urine glucose, serum and urine osmolality, serum and urine electrolytes, cerebral spinal fluid, blood gases, urine specific gravity, toxicology and drug levels, coagulation profile).
  • 3.3 Investigative reports (e.g., electroencephalogram, computed tomography scan, magnetic resonance imaging, biopsies, head ultrasound).
  • 3.4 Recognizes actual or potential life-threatening alterations in neurologic function including: a) increased intracranial pressure (e.g., hydrocephalus, cerebral edema, intracranial bleed, tumour, Cushing’s triad); b) inflammatory brain processes (e.g., vasculitis, encephalitis, posterior reversible encephalopathy syndrome); c) seizures and status epilepticus; d) dystonia, status dystonicus; e) cerebral vascular integrity (e.g., stroke, arteriovenous malformation); f) traumatic brain injury (e.g., epidural hematoma, subdural hematoma, diffuse axonal injury); g) infection (e.g., meningitis, encephalitis); h) motor and sensory function (e.g., Guillain-Barré syndrome, spinal cord injury); i) spinal cord crises (e.g., neurogenic shock, autonomic dysreflexia); j) neurosurgical intervention (e.g., tumour resection); and k) anoxic brain injury (e.g., submersion injury, hypoxic ischemic encephalopathy, strangulation).
  • 3.5 Recognizes the signs of an irreversible brain injury including: a) herniation; and b) neurological determination of death (e.g., apnea testing, oculovestibular and oculocephalic reflexes).
  • 3.6 Implements nursing interventions to optimize cerebral perfusion and prevent secondary injury including: a) preventing and managing spinal cord crises; b) preserving spinal cord integrity (e.g., C-spine precautions, pharmacological agents); c) managing mean arterial pressure to optimize cerebral perfusion pressure (e.g., fluids, pharmacological agents); d) using techniques to promote cerebral venous and spinal fluid drainage (e.g., positioning, elevating head of bed, minimizing intrathoracic pressure); e) managing PaCO 2 and PaO 2 ; f) administering pharmacological agents (e.g., anticonvulsants, diuretics, hyperosmolar therapy, barbiturates, analgesics, sedatives, neuromuscular blocking agents, steroids); g) providing support with insertion and management of intracranial pressure monitoring and/or cerebral spinal fluid drainage devices (e.g., set-up, drainage, levelling of intracranial device, specimen collection); h) minimizing noxious stimuli (e.g., environmental, nursing care considerations); i) managing metabolic demands (e.g., thermoregulation, pharmacological agents, pain); j) managing endocrine alterations (e.g., hyperglycemia, syndrome of inappropriate antidiuretic hormone, diabetes insipidus, cerebral salt wasting); and k) preventing and managing seizure activity.
  • 3.7 Recognizes, responds and mobilizes team for a neurosurgical emergency (e.g., bone flap removal, evacuation of hematoma).

• Cardiovascular System — Official range: 20–25% (Practice allocation: 21.43%)

  • 4.1 Evaluates data related to the cardiovascular system including: a) child’s health history (e.g., congenital heart defects, previous surgery, acquired cardiac disease, newborn transitional circulation); b) physical assessment as it pertains to the cardiovascular system (e.g., heart sounds, perfusion, hepatosplenomegaly); c) information from monitoring devices: i. non-invasive (e.g., ECG for rhythm and rate, pulse oximetry, pre-/post-ductal saturations, blood pressure [including four limb BP], temperature); and ii. invasive pressures and waveforms (e.g., venous, arterial and intracardiac [right atrial, left atrial]). d) laboratory reports (e.g., CBC, arterial, venous, capillary and central venous blood gases, coagulation, electrolytes, lactate, drug levels); and e) investigative reports (e.g., echocardiogram, ECG, X-ray, ultrasound).
  • 4.2 Recognizes actual or potential life-threatening alterations in cardiac output and perfusion including: a) cardiogenic shock (e.g., cardiomyopathy, congenital heart defects); b) hypovolemic shock (e.g., hemorrhagic and non-hemorrhagic); c) distributive shock (e.g., neurogenic, anaphylaxis); d) obstructive shock (e.g., cardiac tamponade, tension pneumothorax, mediastinal mass, superior vena cava syndrome); e) sepsis and septic shock; f) multiple organ dysfunction syndrome; g) congenital heart defects (e.g., increased/decreased pulmonary blood flow and obstructive defects); h) congestive heart failure (e.g., increased pulmonary blood flow defects, myocarditis); i) systemic hypertension (e.g., coarctation of the aorta, obesity, renal dysfunction); j) pulmonary hypertension (e.g., persistent pulmonary hypertension of the newborn, secondary pulmonary hypertension related to congenital heart defects); and k) dysrhythmias (e.g., asystole, ventricular dysrhythmias, supraventricular tachycardia, bradycardia, heart blocks, junctional ectopic tachycardia).
  • 4.3 Recognizes indications for extracorporeal life support (ECLS): a) veno-arterial ECLS (e.g., severe hypothermia, refractory shock, myocardial dysfunction); and b) veno-venous ECLS (e.g., pulmonary dysfunction).
  • 4.4 Recognizes contraindications for ECLS (e.g., irreversible disease, coagulopathy, access).
  • 4.5 Recognizes goals of ECLS (e.g., bridge to transplant, bridge to recovery).
  • 4.6 Recognizes complications of ECLS (e.g., bleeding, clotting, neurological insult, infection).
  • 4.7 Implements nursing interventions to optimize perfusion and cardiac output including: a) administering oxygen (e.g., differentiating cardiac versus respiratory cyanosis, consequences of oxygen administration); b) establishing and/or managing vascular access (e.g., PIVs, central venous lines, IOs); c) supporting preload, contractility, afterload (e.g., pharmacological agents, fluid administration); d) supporting heart rate or rhythm (e.g., fluid administration, pharmacological agents, pacing, cardioversion, defibrillation); e) managing coagulation (e.g., thrombolytics, anticoagulants, blood products); and f) participating in the provision of high quality CPR.
  • 4.8 Manages hemodynamic monitoring devices (e.g., evaluating findings, set-up, levelling, patency).

• Respiratory System — Official range: 20–25% (Practice allocation: 21.43%)

  • 5.1 Evaluates data related to the respiratory system including: a) child’s health history (e.g., prematurity, bronchopulmonary dysplasia, congenital defects, airway anatomy); b) physical assessment (e.g., airway, respiratory status, breath sounds, colour, level of consciousness, chest contour, cough, secretions); c) information from monitoring and ventilation devices (e.g., pulse oximetry, CO 2 monitoring, wave forms, pressures); d) laboratory reports (e.g., blood gases, cultures, methemoglobin); and e) investigative reports (e.g., X-ray, ultrasound, bronchoscopy, computed tomography, magnetic resonance imaging).
  • 5.2 Recognizes actual or potential life-threatening alterations in respiratory function including: a) mechanisms of inadequate oxygenation and ventilation leading to impending respiratory failure: i. upper airway process (e.g., foreign body, infections, post-extubation stridor, laryngospasm, inhalation injury, anatomical anomalies); ii. lower airway process (e.g., bronchiolitis, asthma, chronic lung disease); iii. parenchymal conditions (e.g., pneumonia, pulmonary edema, acute respiratory distress syndrome); iv. disordered control of breathing (e.g., seizures, pharmacological agents, brain injury); v. neuromuscular (e.g., Duchenne’s muscular dystrophy, spinal muscular atrophy, anatomical anomalies); vi. intrapleural conditions (e.g., chylothorax, pneumothorax); and vii. mechanisms of hypoxemia (e.g., low ambient PO 2 , alveolar hypoventilation, V-Q mismatch, cyanotic heart lesions).
  • 5.3 Implements nursing interventions to optimize respiratory function including: a) understanding the principles of airway management (e.g., positioning, artificial airway [oral, nasal, laryngeal mask airway, endotracheal tube, tracheostomy], secretion management); b) understanding the principles of an airway emergency (recognition, responding, mobilizing team); c) managing invasive and non-invasive mechanical ventilation systems (e.g., patency, securement, position, alarms, comfort); d) applying knowledge of different types of non-invasive and invasive ventilation systems (e.g., high flow oxygen therapy, CPAP, BiPAP, conventional ventilation modes and alarms); e) administering pharmacological agents (e.g., oxygen, bronchodilators, steroids, neuromuscular blocking agents, intubation medications, pulmonary vasodilators); f) recognizing indications for changes in ventilatory support (e.g., bag-mask ventilation, mode, compliance, airway pressures, PEEP); and g) recognizing child’s need for advanced ventilation concepts (e.g., HFOV, HFJV, ECLS).
  • 5.4 Implements nursing interventions to prevent and manage potential complications of mechanical ventilation (e.g., barotrauma and volutrauma, autoPEEP, hemodynamic effects, infection, trauma related to the endotracheal tube, DOPE).
  • 5.5 Implements nursing interventions to promote successful maintenance of long-term ventilation and weaning of ventilatory support (e.g., assessment of readiness, adequate nutrition, fluid status, level of consciousness, pain, agitation, withdrawal and delirium management).

• Gastrointestinal System — Official range: 3–6% (Practice allocation: 4.29%)

  • 6.1 Evaluates data related to the gastrointestinal system including: a) child’s health history (e.g., congenital defects, failure to thrive, nutrition and stooling patterns, food allergies); b) physical assessment (e.g., intra-abdominal pressure, bowel sounds, distention, quantity/quality of output); c) nutritional assessment (e.g., breastfeeding needs and support, growth chart data, body mass index, caloric intake and needs, supplements); d) laboratory reports (e.g., total protein, liver profiles, albumin, lipid profiles, serum glucose, gastric pH, stool testing); and e) investigative reports (e.g., imaging, swallowing studies).
  • 6.2 Recognizes actual or potential life-threatening alterations to the gastrointestinal function including: a) obstructed/ischemic/infarcted/perforated bowel (e.g., necrotizing enterocolitis); b) infection (e.g., gastroenteritis, Clostridium difficile, peritonitis); c) hepatic function (e.g., biliary atresia, hepatitis); d) congenital defects (e.g., gastroschisis, omphalocele); e) gastroesophageal reflux disease; and f) toxic ingestions (e.g., drugs, hydrocarbons, caustics).
  • 6.3 Implements nursing interventions to optimize gastrointestinal function including: a) early enteral feeding with emphasis on reduction of n.p.o. duration (e.g., positioning, frequency, intestinal or gastric tube insertion/position/care); b) pharmacologic agents (e.g., histamine-reducing agents, motility enhancers); c) managing gastrointestinal bleeding (e.g., pharmacological agents, gastric tubes); and d) managing therapeutic diets (e.g., ketogenic, chylothorax, hypo/hypercaloric).

• Renal System — Official range: 5–10% (Practice allocation: 7.14%)

  • 7.1 Evaluates data related to the renal system including: a) child’s health history (e.g., congenital disorders, chronic renal failure, infections); b) physical assessment (e.g., fluid status, edema, urine quality/quantity, weight, body surface area, insensible losses); c) laboratory reports (e.g., serum and urine electrolytes, BUN, creatinine, osmolality, drug levels, urinalysis, blood gas, CBC, culture); and d) investigative reports (e.g., imaging, biopsies, glomerular filtration rate).
  • 7.2 Recognizes actual or potential life-threatening alterations in renal function, including: a) pre-renal causes (e.g., inadequate preload); b) intra-renal causes (e.g., hemolytic uremic syndrome, nephrotic syndrome, nephrotoxic agents, acute tubular necrosis, infections); and c) post-renal causes (e.g., neurogenic bladder, renal outflow obstruction).
  • 7.3 Recognizes the sequelae of renal dysfunction (e.g., uremic encephalopathy, hypertension, posterior reversible encephalopathy syndrome, fluid/electrolyte and acid-base imbalance, nutritional compromise).
  • 7.4 Recognizes indications for and complications of renal replacement therapies (e.g., hemodialysis, peritoneal dialysis, continuous renal replacement therapies).
  • 7.5 Implements nursing interventions to optimize renal function including: a) administering fluid and pharmacological agents (e.g., volume, diuretics, electrolyte replacements); and b) managing peritoneal dialysis.

• Endocrine and Metabolic Systems — Official range: 3–6% (Practice allocation: 4.29%)

  • 8.1 Evaluates data related to the endocrine/metabolic system including: a) child’s health history (e.g., endocrine/metabolic status, familial/genetic disorders); b) physical assessment (e.g., hydration status, respiratory patterns, odour, neurological assessment, vital signs, weight changes and body mass index); c) laboratory reports (e.g., serum and urine glucose, osmolality, electrolytes, pH and acid-base balance, bilirubin, ammonia, lipase); and d) investigative reports (e.g., imaging, genetic screening, biopsies).
  • 8.2 Recognizes actual or potential life-threatening alterations in endocrine/metabolic function including regulation of: a) metabolism (e.g., diabetic ketoacidosis, hypoglycemia, inborn errors of metabolism); b) antidiuretic hormone (e.g., diabetes insipidus, syndrome of inappropriate antidiuretic hormone); c) adrenal corticoid hormones (e.g., adrenal insufficiency); and d) hepatic and pancreatic functions (e.g., liver failure, pancreatitis).
  • 8.3 Implements nursing interventions to optimize endocrine/metabolic function including: a) administering pharmacological agents (e.g., insulin, steroids, dextrose, antidiuretic hormone, electrolyte replacement, hypertonic saline); b) managing fluid status and acid-base balance; and c) managing therapeutic diets (e.g., enzyme replacement).

• Immunology and Hematology Systems — Official range: 3–6% (Practice allocation: 4.29%)

  • 9.1 Evaluates data related to the immunologic and hematologic systems including: a) child’s health history (e.g., immune status, asplenia, blood dyscrasias, oncological disease, post- transplant, infection and infectious contacts, related conditions and awareness of effect on other systems); b) physical assessment (e.g., petechiae, pallor, purpura, bleeding); c) laboratory reports (e.g., cultures/viral screening [e.g., HIV/CMV], CBC and differential, C-reactive protein, coagulation profile, antibody/antigens); and d) investigative reports (e.g., imaging, biopsies).
  • 9.2 Recognizes actual and potential life-threatening alterations in function including: a) immunological (e.g., immediate postoperative solid organ transplants, severe graft vs. host, sepsis, anaphylaxis, vasculitis, Kawasaki disease, Stevens-Johnson syndrome); b) hematological (e.g., sickle cell crisis, disseminated intravascular coagulopathy, severe anemia, neutropenia, heparin-induced thrombocytopenia, thrombosis); and c) oncological (e.g., acute tumour lysis syndrome, hemorrhagic cystitis, myocardial dysfunction, sepsis, superior vena cava syndrome, mediastinal mass).
  • 9.3 Implements nursing interventions to optimize immunological and hematological function including: a) minimizing the risk of and preventing infections (e.g., aseptic techniques, infection control practices, nutrition, hygiene); and b) administering pharmacological agents (e.g., antibiotics, intravenous immunoglobulin, immunizations, antirejection medications, granulocyte colony-stimulating factor, antiretrovirals, anticoagulants, vitamin K, tranexamic acid, protamine, thrombolytics, erythropoietin).

• Musculoskeletal and Integumentary Systems — Official range: 3–6% (Practice allocation: 4.29%)

  • 10.1 Evaluates data related to the musculoskeletal/integumentary systems including: a) child’s health history (e.g., surgical procedures, trauma, altered mobility, age, nutritional and fluid status, infections and infectious contacts); b) physical assessment (e.g., skin integrity, range of motion, circulation, sensation, petechiae, mobility, risk of skin breakdown using a validated tool, deformities, device insertion sites); c) laboratory reports (e.g., electrolytes, CBC, urine myoglobin, cultures); and d) investigative test reports (e.g., imaging, skin/muscle biopsy).
  • 10.2 Recognizes actual or potential life-threatening alterations of the musculoskeletal/ integumentary systems including: a) compartment syndrome; b) rhabdomyolysis; c) burns (e.g., thermal, chemical or radiation, electrical); d) wounds (e.g., postoperative, post-trauma, pressure ulcers); e) acute skin reactions (e.g., allergic, medication, rashes); and f) muscle weakness/paralysis (e.g., myopathy of critical illness, pharmacologically induced, neuromuscular disorders, spinal cord injury).
  • 10.3 Implements nursing interventions to optimize musculoskeletal/integumentary function including: a) administering fluids and pharmacological agents, optimizing nutrition and maintaining thermoregulation (e.g., analgesics, antibiotics, antispasmodics); b) performing and/or managing wound care (e.g., specialized dressings, escharotomies, stoma devices); and c) preventing and managing complications related to mobility (e.g., positioning, range of motion, physiotherapy, basic hygiene, therapeutic beds, early mobilization).

• Care of Child and Family — Official range: 2–5% (Practice allocation: 3.33%)

  • 11.1 Evaluates data related to the child’s psychosocial needs including: a) child’s health history (e.g., sensory function, developmental stage, previous hospitalizations and experiences, communication patterns, culture, comorbidities, mental health); and b) child’s place within the family unit.
  • 11.2 Recognizes the child’s behavioural and emotional responses to his or her health crisis (e.g., verbal and non-verbal communication, withdrawal, regression, aggression, depression).
  • 11.3 Identifies resources and accesses supports (e.g., family, child life therapy, psychology, pastoral care, social work).
  • 11.4 Implements nursing interventions to address child’s behavioural and emotional responses to illness.
  • 11.5 Provides honest, factual, developmentally appropriate, timely information and support regarding health- care crisis, care in hospital, transfer and/or discharge (e.g., distraction techniques, personalized environment, communication tools, consistency, acknowledging and validating, providing choices).
  • 11.6 Evaluates data related to the family’s psychosocial needs including: a) family health history (e.g., past experience within the PICU and health-care system, mental health); and b) family assessment (e.g., coping skills, family structure, relationships, roles, responsibilities, behavioural/emotional responses, culture, communication patterns).
  • 11.7 Recognizes actual or potential alterations in family well-being (e.g., withdrawal, emotional expressions, evaluation of information, ability to make decisions, risk for violence, addressing stressors with current PICU admission).
  • 11.8 Implements nursing interventions to optimize family functioning during the health crisis including: a) identifying resources and accessing supports (e.g., family, child life therapy, psychology, pastoral care, social work); and b) accessing the child as determined by the family’s needs, the environment and the situation.
  • 11.9 Provides honest, factual, timely information and support regarding health-care crisis, care in hospital, transfer and/or discharge (e.g., personalized environment, communication tools, consistency, acknowledging and validating, supporting decision-making, grief and loss support, engaging in celebrations).

How to prepare

Work through the topics, read the explanation after each answer, and revisit the areas where you miss questions. Use the official outline and reference materials below to guide your study.

These independent practice questions are not actual exam items and do not guarantee a passing result.

Frequently asked questions

Official sources and references

• CNA Critical Care Pediatric Nursing Exam Blueprint and Specialty Competencies

  pp. 4–8

• blueprints

  Exam Competencies & Blueprints

• tips

  CBT exam tips

• results

  Exam Results and Retesting

• fees

  Initial Exam Fees, table and footnotes

Confirm current exam arrangements with the exam provider.