CFRN Pediatric and Neonatal Patients 4 — Questions and Answers
Question 1: A 2-week-old term neonate presents with poor feeding, hypotonia, and a serum sodium of 118 mEq/L. The SAFEST rate of sodium correction is:
- Correct sodium to normal within 4 hours using 3% NaCl
- Increase serum sodium no faster than 0.5 mEq/L/hr (max 10–12 mEq/L/24 hr) (Correct answer)
- Bolus 2 mL/kg of 3% NaCl and repeat every 15 minutes until 125 mEq/L
- Give isotonic NS at 20 mL/kg boluses until symptoms resolve
Correct answer: Increase serum sodium no faster than 0.5 mEq/L/hr (max 10–12 mEq/L/24 hr)
Overcorrection of hyponatremia risks osmotic demyelination; the safe rate is no faster than 0.5 mEq/L/hr or 10–12 mEq/L per 24 hours.
Question 2: A 5-month-old in respiratory distress has nasal flaring, subcostal retractions, and diffuse wheezing. RSV bronchiolitis is suspected. Which intervention has the BEST evidence for flight transport?
- Nebulized albuterol every 20 minutes
- High-flow nasal cannula oxygen therapy (Correct answer)
- Nebulized epinephrine 5 mg
- Systemic corticosteroids IV
Correct answer: High-flow nasal cannula oxygen therapy
High-flow nasal cannula therapy is the best-supported intervention for moderate-to-severe bronchiolitis, reducing work of breathing without the inconsistent response seen with bronchodilators.
Question 3: A premature neonate on a ventilator develops sudden oxygen desaturation, absent breath sounds on the left, and a trachea deviated to the right. The flight nurse should first:
- Order a chest X-ray
- Withdraw the ETT 1 cm to reposition
- Needle decompress the left chest at the 2nd ICS MCL (Correct answer)
- Increase PEEP to recruit alveoli
Correct answer: Needle decompress the left chest at the 2nd ICS MCL
Absent unilateral breath sounds with tracheal deviation in a ventilated neonate is a tension pneumothorax requiring immediate needle decompression.
Question 4: A 9-year-old with status epilepticus has failed two doses of lorazepam. Per current pediatric guidelines, what is the next appropriate medication?
- Phenobarbital 20 mg/kg IV
- Fosphenytoin 20 PE/kg IV (Correct answer)
- Ketamine 1–2 mg/kg IV
- Valproate 40 mg/kg IV
Correct answer: Fosphenytoin 20 PE/kg IV
Fosphenytoin 20 PE/kg IV is the recommended second-line agent for pediatric benzodiazepine-refractory status epilepticus per current guidelines.
Question 5: A 12-hour-old neonate has a blood glucose of 32 mg/dL and is symptomatic with jitteriness. The appropriate initial IV treatment is:
- D50W 1 mL/kg IV bolus
- D10W 2 mL/kg IV bolus followed by D10W infusion at GIR 6 mg/kg/min (Correct answer)
- D5W 5 mL/kg IV bolus
- Glucagon 0.03 mg/kg IM only
Correct answer: D10W 2 mL/kg IV bolus followed by D10W infusion at GIR 6 mg/kg/min
Symptomatic neonatal hypoglycemia is treated with D10W 2 mL/kg IV bolus (200 mg/kg), then a continuous D10W infusion to maintain glucose; D50W is too concentrated for neonates.
Question 6: During rotor-wing transport of an 8-year-old burn patient with 40% TBSA burns, fluid resuscitation in the first 24 hours using the Parkland formula should be calculated as:
- 2 mL × weight (kg) × % TBSA, half given in first 8 hours from burn time
- 4 mL × weight (kg) × % TBSA, half given in first 8 hours from burn time
- 4 mL × weight (kg) × % TBSA plus maintenance, half given in first 8 hours from burn time (Correct answer)
- 3 mL × weight (kg) × % TBSA, all given in first 24 hours
Correct answer: 4 mL × weight (kg) × % TBSA plus maintenance, half given in first 8 hours from burn time
Pediatric burn resuscitation uses the modified Parkland formula: 4 mL × kg × % TBSA plus maintenance fluids, with half delivered in the first 8 hours from time of burn.
Question 7: A 4-year-old presents with sudden onset drooling, a muffled 'hot potato' voice, trismus, and unilateral tonsillar bulging with uvular deviation. The most likely diagnosis requiring surgical consultation is:
- Severe croup (subglottic stenosis)
- Retropharyngeal abscess
- Peritonsillar abscess (Correct answer)
- Epiglottitis
Correct answer: Peritonsillar abscess
Unilateral peritonsillar bulging with uvular deviation away from the affected side and trismus are classic signs of peritonsillar abscess requiring drainage.
CFRN Pediatric and Neonatal Patients 4
A 2-week-old term neonate presents with poor feeding, hypotonia, and a serum sodium of 118 mEq/L.
The SAFEST rate of sodium correction is: