Pediatric CCRN Exam Pediatric CCRN Pharmacology 2

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?

Accepted Answer

Vasopressin

Answer

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?

Accepted Answer

Calcium channel blockers (nicardipine IV)

Answer

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?

Accepted Answer

Serum phenobarbital levels and respiratory status

Answer

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?

Accepted Answer

Life-threatening hyperkalemia

Answer

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?

Accepted Answer

Low antithrombin III levels

Answer

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.

Pediatric CCRN Exam Practice Test

Pediatric CCRN Exam Practice Test

Pediatric CCRN Exam Pediatric CCRN Pharmacology 2