Pediatric CCRN Exam Pediatric CCRN Pharmacology 1 — Questions and Answers
Question 1: A 10 kg child requires an epinephrine infusion at 0.1 mcg/kg/min. Using the rule of 6, how many mg of epinephrine should be added to 100 mL of D5W to run at 1 mL/hr?
- 0.6 mg (Correct answer)
- 6 mg
- 0.06 mg
- 60 mg
Correct answer: 0.6 mg
Rule of 6: weight (kg) × 0.6 = mg to add to 100 mL; for 10 kg: 10 × 0.06 = 0.6 mg, resulting in a concentration where 1 mL/hr delivers 0.1 mcg/kg/min.
Question 2: Which opioid is CONTRAINDICATED in a child with renal failure requiring pain management in the PICU?
- Fentanyl
- Hydromorphone
- Meperidine (Correct answer)
- Morphine
Correct answer: Meperidine
Meperidine's active metabolite normeperidine accumulates in renal failure, causing CNS excitation, tremors, and seizures, making it contraindicated in patients with impaired renal function.
Question 3: A 5-year-old receives IV vancomycin for MRSA bacteremia. Which monitoring parameter is MOST important to prevent toxicity?
- Peak and trough serum levels
- AUC/MIC ratio via Bayesian pharmacokinetic monitoring (Correct answer)
- Random vancomycin level at 2 hours post-dose
- Daily urinalysis only
Correct answer: AUC/MIC ratio via Bayesian pharmacokinetic monitoring
Current ASHP/IDSA guidelines recommend AUC/MIC-guided vancomycin dosing using Bayesian pharmacokinetic monitoring to optimize efficacy while minimizing nephrotoxicity.
Question 4: What is the CORRECT dose of IV atropine to treat symptomatic bradycardia in a 20 kg child?
- 0.01 mg (minimum dose)
- 0.02 mg/kg = 0.4 mg (Correct answer)
- 0.1 mg/kg = 2 mg
- 0.5 mg flat dose
Correct answer: 0.02 mg/kg = 0.4 mg
The pediatric atropine dose for bradycardia is 0.02 mg/kg IV (minimum 0.1 mg, maximum 0.5 mg per dose); for a 20 kg child: 0.02 × 20 = 0.4 mg.
Question 5: A child in the PICU receives a continuous midazolam infusion for 5 days. When the infusion is weaned, the child develops agitation, tremors, and diaphoresis. This presentation is MOST consistent with:
- Sepsis-associated delirium
- Benzodiazepine withdrawal syndrome (Correct answer)
- Opioid toxicity
- Thyroid storm
Correct answer: Benzodiazepine withdrawal syndrome
Prolonged benzodiazepine infusions cause physical dependence; abrupt weaning produces a withdrawal syndrome with CNS excitability, autonomic instability (diaphoresis, tachycardia), and tremors.
Question 6: Which medication is the antidote for acetaminophen (paracetamol) toxicity in a pediatric patient?
- Flumazenil
- N-acetylcysteine (NAC) (Correct answer)
- Naloxone
- Physostigmine
Correct answer: N-acetylcysteine (NAC)
N-acetylcysteine replenishes hepatic glutathione, binding the toxic NAPQI metabolite to prevent liver injury, and is most effective when given within 8–10 hours of acetaminophen ingestion.
Pediatric CCRN Exam Pediatric CCRN Pharmacology 1
A 10 kg child requires an epinephrine infusion at 0.1 mcg/kg/min.
Using the rule of 6, how many mg of epinephrine should be added to 100 mL of D5W to run at 1 mL/hr?