CFRN Pediatric and Neonatal Patients 2 — Questions and Answers
Question 1: A 3-year-old weighing 14 kg requires a weight-based dopamine infusion at 5 mcg/kg/min. Using the rule of 6, how many mg of dopamine should be added to 100 mL of D5W?
- 42 mg
- 70 mg
- 84 mg (Correct answer)
- 14 mg
Correct answer: 84 mg
Rule of 6: weight (kg) × 6 = mg added to 100 mL; 14 × 6 = 84 mg, giving 1 mcg/kg/min per 1 mL/hr.
Question 2: During neonatal transport, a 28-week premature infant develops bradycardia to 80 bpm with oxygen saturation dropping to 75%. The FIRST intervention should be:
- Initiate chest compressions
- Administer epinephrine via UVC
- Provide positive pressure ventilation with 100% oxygen (Correct answer)
- Increase CPAP pressure by 2 cmH2O
Correct answer: Provide positive pressure ventilation with 100% oxygen
Neonatal bradycardia is almost always hypoxia-driven, so the first step is to ensure adequate ventilation with PPV.
Question 3: A 6-week-old infant presents with bilious vomiting and abdominal distension. Which diagnosis should the flight nurse prioritize as most life-threatening?
- Pyloric stenosis
- Midgut volvulus (Correct answer)
- Intussusception
- Hirschsprung disease
Correct answer: Midgut volvulus
Midgut volvulus causes rapid intestinal ischemia and can be fatal within hours if untreated, making it the most immediately life-threatening cause of bilious vomiting in an infant.
Question 4: When securing a pediatric endotracheal tube in flight, the flight nurse should verify correct depth using which landmark formula?
- Age/4 + 4 cm at the lip
- Weight (kg)/2 + 8 cm at the lip
- Age/2 + 12 cm at the lip
- 3 × ETT internal diameter (mm) at the lip (Correct answer)
Correct answer: 3 × ETT internal diameter (mm) at the lip
Tube depth (cm at lip) = 3 × internal diameter of the ETT is a reliable bedside formula for pediatric patients.
Question 5: A 10 kg toddler in hemorrhagic shock receives an initial fluid bolus of 20 mL/kg NS. After two boluses with minimal improvement, what is the next most appropriate intervention?
- Give a third NS bolus at 20 mL/kg
- Administer 10 mL/kg packed red blood cells (Correct answer)
- Start dopamine at 10 mcg/kg/min
- Administer sodium bicarbonate 1 mEq/kg
Correct answer: Administer 10 mL/kg packed red blood cells
After two crystalloid boluses with inadequate response in hemorrhagic shock, early transfusion with pRBC at 10 mL/kg is indicated.
Question 6: A 2-year-old ingested a button battery 2 hours ago. X-ray confirms the battery is lodged in the esophagus. The flight nurse should anticipate the need for:
- Observation and serial X-rays only
- Gastric lavage en route
- Emergent endoscopic removal within 2 hours of ingestion (Correct answer)
- High-dose steroids to reduce inflammation
Correct answer: Emergent endoscopic removal within 2 hours of ingestion
Esophageal button battery ingestion causes rapid liquefactive necrosis and requires emergent endoscopic removal, ideally within 2 hours.
Question 7: During air transport at altitude, a neonate with a congenital diaphragmatic hernia (CDH) deteriorates. The priority intervention is:
- Increase FiO2 to 1.0 and bag-mask ventilate
- Insert an orogastric tube to decompress the stomach (Correct answer)
- Administer surfactant intratracheally
- Perform needle decompression of the left chest
Correct answer: Insert an orogastric tube to decompress the stomach
Gas in the herniated bowel expands at altitude, worsening lung compression; OG tube decompression reduces bowel distension and improves ventilation.
CFRN Pediatric and Neonatal Patients 2
A 3-year-old weighing 14 kg requires a weight-based dopamine infusion at 5 mcg/kg/min.
Using the rule of 6, how many mg of dopamine should be added to 100 mL of D5W?