Pediatric CCRN Exam Pediatric CCRN Neurological 1 — Questions and Answers
Question 1: A 4-year-old in the PICU has a Glasgow Coma Scale (GCS) score of 8. Which component of the pediatric GCS is CORRECTLY described?
- Eye opening: 4 = opens to verbal command
- Verbal response: 5 = oriented, coos/babbles appropriately for age
- Motor response: 6 = withdraws from pain
- Best motor response: 6 = obeys commands (Correct answer)
Correct answer: Best motor response: 6 = obeys commands
In the GCS motor subscale, a score of 6 indicates the patient obeys commands, which is the highest possible motor response and indicates intact voluntary motor function.
Question 2: Which intervention is HIGHEST priority in the first hour of management of severe traumatic brain injury in a child?
- Obtain MRI of the brain
- Prevent secondary injury by maintaining adequate CPP and avoiding hypoxia/hypotension (Correct answer)
- Administer high-dose steroids
- Initiate hypertonic saline prophylactically
Correct answer: Prevent secondary injury by maintaining adequate CPP and avoiding hypoxia/hypotension
After TBI, secondary brain injury from hypoxia, hypotension, hyperthermia, and elevated ICP causes most preventable deaths; maintaining CPP and oxygenation is the top priority.
Question 3: What is the TARGET cerebral perfusion pressure (CPP) range recommended for a 6-year-old with severe TBI?
- 30–40 mmHg
- 40–50 mmHg
- 50–60 mmHg (Correct answer)
- 70–80 mmHg
Correct answer: 50–60 mmHg
Pediatric TBI guidelines recommend maintaining CPP between 40–65 mmHg (age-dependent), with 50–60 mmHg generally appropriate for school-age children to ensure adequate brain perfusion.
Question 4: A 2-year-old has continuous focal seizure activity for 20 minutes unresponsive to two doses of benzodiazepines. What is the NEXT pharmacologic step?
- Administer a third dose of lorazepam
- Load IV fosphenytoin or levetiracetam (Correct answer)
- Start a midazolam infusion immediately
- Perform emergent EEG only
Correct answer: Load IV fosphenytoin or levetiracetam
After two failed benzodiazepine doses, status epilepticus is refractory; second-line therapy with IV fosphenytoin or levetiracetam should be given per established treatment algorithms.
Question 5: Which clinical sign indicates transtentorial (uncal) herniation in a child with elevated ICP?
- Bilateral pinpoint pupils
- Ipsilateral fixed and dilated pupil with contralateral hemiplegia (Correct answer)
- Bilateral fixed midposition pupils
- Bilateral hyperreflexia
Correct answer: Ipsilateral fixed and dilated pupil with contralateral hemiplegia
Uncal herniation compresses CN III, causing ipsilateral pupil dilation and loss of reactivity, while the herniated brain displaces the contralateral motor tract, producing contralateral weakness.
Question 6: A 3-year-old has an intracranial pressure (ICP) of 28 mmHg with a mean arterial pressure of 65 mmHg. What is the calculated cerebral perfusion pressure (CPP)?
- 93 mmHg
- 37 mmHg (Correct answer)
- 28 mmHg
- 65 mmHg
Correct answer: 37 mmHg
CPP = MAP − ICP = 65 − 28 = 37 mmHg, which is critically low and indicates inadequate cerebral perfusion requiring urgent intervention.
Pediatric CCRN Exam Pediatric CCRN Neurological 1
A 4-year-old in the PICU has a Glasgow Coma Scale (GCS) score of 8.
Which component of the pediatric GCS is CORRECTLY described?