Pediatric CCRN Exam Pediatric CCRN Pharmacology 2 — Questions and Answers
Question 1: A 4-year-old with septic shock is on a norepinephrine infusion but remains hypotensive with vasodilatory shock. Which adjunct vasopressor is MOST appropriate to add?
- Phenylephrine
- Vasopressin (Correct answer)
- Dobutamine
- Milrinone
Correct answer: Vasopressin
Vasopressin acts on V1 receptors in vascular smooth muscle independent of adrenergic pathways, making it an effective adjunct in catecholamine-refractory vasodilatory shock.
Question 2: Which medication class is the FIRST-LINE treatment for hypertensive emergency in a child with acute glomerulonephritis?
- ACE inhibitors
- Calcium channel blockers (nicardipine IV) (Correct answer)
- Beta-blockers
- Diuretics alone
Correct answer: Calcium channel blockers (nicardipine IV)
IV nicardipine provides rapid, titratable blood pressure reduction without the renal afferent arteriole risk of ACE inhibitors, making it preferred for hypertensive emergencies in children.
Question 3: A 3-year-old on phenobarbital for seizure control requires a dose increase. Which monitoring is ESSENTIAL?
- Daily EEG
- Serum phenobarbital levels and respiratory status (Correct answer)
- Daily CBC and BMP
- Continuous cardiac monitoring only
Correct answer: Serum phenobarbital levels and respiratory status
Phenobarbital has a narrow therapeutic index (15–40 mcg/mL); monitoring serum levels prevents toxicity while assessing respiratory status is critical as phenobarbital causes dose-dependent respiratory depression.
Question 4: What is the PRIMARY concern when using succinylcholine for rapid sequence intubation in a child with a crush injury?
- Malignant hyperthermia
- Life-threatening hyperkalemia (Correct answer)
- Prolonged neuromuscular blockade
- Bradycardia
Correct answer: Life-threatening hyperkalemia
Crush injury causes massive upregulation of extrajunctional acetylcholine receptors; succinylcholine depolarization releases dangerous amounts of potassium into the circulation, risking fatal arrhythmias.
Question 5: A 7-year-old is started on a heparin infusion for DVT. The anti-Xa level is subtherapeutic. Which factor MOST commonly explains heparin resistance in pediatric patients?
- Low antithrombin III levels (Correct answer)
- High factor VIII levels
- Vitamin K deficiency
- Protein C deficiency
Correct answer: Low antithrombin III levels
Heparin requires antithrombin III as its cofactor; low AT-III levels (common in neonates, sepsis, and nephrotic syndrome) cause heparin resistance, reducing its anticoagulant effect.
Question 6: A 2-year-old ingests an unknown medication and presents with miosis, bradycardia, excessive secretions, and muscle fasciculations. Which antidote is INDICATED?
- Flumazenil
- Atropine and pralidoxime (2-PAM) (Correct answer)
- Naloxone
- Digoxin-specific antibody fragments
Correct answer: Atropine and pralidoxime (2-PAM)
Miosis, bradycardia, secretions, and fasciculations represent cholinergic toxidrome from organophosphate or carbamate poisoning; atropine reverses muscarinic effects while pralidoxime reactivates acetylcholinesterase.
Pediatric CCRN Exam Pediatric CCRN Pharmacology 2
A 4-year-old with septic shock is on a norepinephrine infusion but remains hypotensive with vasodilatory shock.
Which adjunct vasopressor is MOST appropriate to add?