Pediatric CCRN Exam Pediatric CCRN Cardiovascular 2 — Questions and Answers
Question 1: A 4-year-old post-Fontan procedure has rising lactate and falling mixed venous oxygen saturation. The MOST likely cause is:
- Pulmonary hypertension crisis
- Low cardiac output syndrome (Correct answer)
- Arrhythmia-induced heart block
- Metabolic alkalosis
Correct answer: Low cardiac output syndrome
Rising lactate and falling SvO2 are hallmarks of low cardiac output syndrome, indicating tissues are extracting more oxygen due to inadequate delivery.
Question 2: Which vasoactive agent is MOST appropriate as first-line therapy for a child in septic shock with poor cardiac contractility?
- Norepinephrine
- Dopamine
- Dobutamine (Correct answer)
- Vasopressin
Correct answer: Dobutamine
Dobutamine is a beta-1 agonist that increases myocardial contractility, making it the preferred agent when septic shock is accompanied by poor cardiac function.
Question 3: A 10-year-old develops complete heart block after surgical repair of an AV canal defect. What is the immediate intervention?
- Administer atropine IV
- Initiate temporary epicardial pacing (Correct answer)
- Perform synchronized cardioversion
- Start IV amiodarone infusion
Correct answer: Initiate temporary epicardial pacing
Epicardial pacing wires are routinely placed during open-heart surgery; activating temporary epicardial pacing is the immediate treatment for postoperative complete heart block.
Question 4: In a child with hypoplastic left heart syndrome (HLHS) after stage I Norwood repair, a rising SaO2 to 95% MOST likely indicates:
- Adequate cardiac output
- Excessive pulmonary blood flow stealing from systemic circulation (Correct answer)
- Successful shunt placement
- Resolution of pulmonary hypertension
Correct answer: Excessive pulmonary blood flow stealing from systemic circulation
In single-ventricle physiology, an SaO2 >85% suggests excessive pulmonary blood flow that is 'stealing' from systemic circulation, threatening vital organ perfusion.
Question 5: Which hemodynamic parameter BEST reflects preload in a pediatric patient on mechanical ventilation?
- Central venous pressure alone
- Pulmonary artery occlusion pressure alone
- Stroke volume variation (SVV) (Correct answer)
- Mean arterial pressure
Correct answer: Stroke volume variation (SVV)
Stroke volume variation dynamically assesses fluid responsiveness and preload in mechanically ventilated patients and is more reliable than static pressures like CVP.
Question 6: A 3-year-old after cardiac surgery has a heart rate of 220 bpm with a narrow QRS and sudden onset. What is the FIRST-LINE treatment?
- Synchronized cardioversion
- Adenosine IV rapid push
- Amiodarone IV infusion
- Vagal maneuvers (Correct answer)
Correct answer: Vagal maneuvers
Vagal maneuvers (e.g., ice to face in infants, Valsalva in older children) are the first-line intervention for stable SVT and should be attempted before pharmacologic therapy.
Pediatric CCRN Exam Pediatric CCRN Cardiovascular 2
A 4-year-old post-Fontan procedure has rising lactate and falling mixed venous oxygen saturation.
The MOST likely cause is: