CFRN - Certified Flight Registered Nurse Pediatric and Neonatal Patients Questions and Answers — Questions and Answers
Question 1: A term neonate is born through thick meconium-stained amniotic fluid and is limp with poor respiratory effort and a heart rate of 70 bpm. According to the most recent Neonatal Resuscitation Program (NRP) guidelines, what is the most appropriate initial action?
- Provide vigorous tactile stimulation to encourage crying.
- Immediately intubate and perform deep tracheal suctioning.
- Begin positive-pressure ventilation (PPV) with a bag-mask device. (Correct answer)
- Administer blow-by oxygen and reassess in 30 seconds.
Correct answer: Begin positive-pressure ventilation (PPV) with a bag-mask device.
Current NRP guidelines prioritize establishing effective ventilation. For a non-vigorous neonate (defined by depressed respirations, poor muscle tone, and/or heart rate <100 bpm) born through meconium-stained fluid, the initial steps are to warm, clear the airway (mouth and nose), and stimulate. If the infant remains apneic or has a heart rate less than 100 bpm, positive-pressure ventilation should be initiated immediately. Routine intubation for tracheal suctioning is no longer recommended as the first step, as delaying ventilation can be harmful.
Question 2: A 12 kg, 2-year-old child is being transported with suspected septic shock, presenting with tachycardia, delayed capillary refill, and cool extremities. According to Pediatric Advanced Life Support (PALS) guidelines, what is the appropriate initial isotonic crystalloid fluid bolus?
- A 500 mL bolus administered over 30 minutes.
- A 120 mL bolus administered as rapidly as possible.
- A 480 mL bolus administered over one hour.
- A 240 mL bolus administered over 5-20 minutes. (Correct answer)
Correct answer: A 240 mL bolus administered over 5-20 minutes.
PALS guidelines for septic shock recommend an initial fluid bolus of 20 mL/kg of an isotonic crystalloid, administered over 5 to 20 minutes. For a 12 kg child, the calculation is 12 kg * 20 mL/kg = 240 mL.
Question 3: A flight crew is dispatched for a 3-year-old in acute respiratory distress. The child is sitting in a tripod position, is drooling, has a muffled voice, and appears toxic with a high fever. Which of the following conditions is most likely, and what is the priority action?
- Croup; prepare to administer nebulized racemic epinephrine.
- Anaphylaxis; administer intramuscular epinephrine immediately.
- Epiglottitis; minimize stimulation and prepare for definitive airway management. (Correct answer)
- Foreign body aspiration; perform abdominal thrusts.
Correct answer: Epiglottitis; minimize stimulation and prepare for definitive airway management.
The clinical presentation of drooling, dysphagia (difficulty swallowing), distress, and dysphonia (muffled voice), often with a high fever and toxic appearance, is classic for epiglottitis. This is a life-threatening airway emergency. The priority is to keep the child calm and avoid any procedures (like using a tongue blade) that could provoke laryngospasm and complete airway obstruction. Management should focus on preparing for definitive airway management by a skilled provider in a controlled setting.
Question 4: When utilizing the Broselow Pediatric Emergency Tape on a critically ill child, the flight nurse places the red end at the child's head. The measurement corresponding to the child's heels falls within the purple color zone. This information primarily provides the user with:
- The child's exact age and allergy information.
- Estimated weight, pre-calculated drug doses, and equipment sizes. (Correct answer)
- A definitive diagnosis based on the color zone.
- The percentage of body surface area burned.
Correct answer: Estimated weight, pre-calculated drug doses, and equipment sizes.
The Broselow Tape is a length-based resuscitation tool. By measuring the child from head ('red to head') to heel, the corresponding color zone provides a rapid estimation of the child's weight. Within that color zone, the tape provides pre-calculated medication dosages and sizes for critical equipment such as endotracheal tubes, catheters, and chest tubes, reducing the cognitive load and potential for error during a pediatric emergency.
Question 5: A flight nurse is transporting a 2-day-old neonate who becomes jittery and lethargic. A point-of-care blood glucose is 28 mg/dL (1.6 mmol/L). What is the most appropriate immediate intervention?
- Administer an intravenous bolus of 2 mL/kg of D10W. (Correct answer)
- Administer an intravenous bolus of 2 mL/kg of D25W.
- Provide a 5 mL/kg bolus of formula via orogastric tube.
- Administer glucagon 1 mg intramuscularly.
Correct answer: Administer an intravenous bolus of 2 mL/kg of D10W.
Symptomatic hypoglycemia in a neonate is a medical emergency requiring immediate correction with intravenous dextrose. The appropriate concentration for a neonate is D10W to avoid the hyperosmolarity and potential for venous damage associated with higher concentrations like D25W or D50W. The standard bolus dose is 2 mL/kg of D10W. While feeding is important, it is not rapid enough for a symptomatic infant. Glucagon is a second-line option if IV access cannot be obtained.
Question 6: According to the most recent PALS guidelines, which of the following is the correct intravenous (IV) or intraosseous (IO) dose of epinephrine for a 10 kg child in pulseless ventricular tachycardia?
- 1 mg of 1:1,000 concentration
- 0.1 mg of 1:10,000 concentration (Correct answer)
- 0.01 mg of 1:1,000 concentration
- 1 mg of 1:10,000 concentration
Correct answer: 0.1 mg of 1:10,000 concentration
The correct PALS dose for epinephrine via the IV/IO route in pediatric cardiac arrest is 0.01 mg/kg of the 1:10,000 concentration. For a 10 kg child, this calculates to 0.01 mg/kg * 10 kg = 0.1 mg. The 1:1,000 concentration is 10 times more concentrated and is primarily used for the endotracheal route (if IV/IO access is delayed) or for intramuscular injection for anaphylaxis.
CFRN - Certified Flight Registered Nurse Pediatric and Neonatal Patients Questions and Answers
A term neonate is born through thick meconium-stained amniotic fluid and is limp with poor respiratory effort and a heart rate of 70 bpm.
According to the most recent Neonatal Resuscitation Program (NRP) guidelines, what is the most appropriate initial action?