Pediatric CCRN Exam Pediatric CCRN Respiratory 2 — Questions and Answers
Question 1: What is the RECOMMENDED initial PEEP setting when initiating mechanical ventilation in a child with moderate pediatric ARDS?
- 0–2 cmH2O
- 3–5 cmH2O
- 8–10 cmH2O (Correct answer)
- 15–18 cmH2O
Correct answer: 8–10 cmH2O
Current pediatric ARDS guidelines recommend a PEEP of 8–10 cmH2O for moderate ARDS to maintain alveolar recruitment and prevent cyclic atelectasis.
Question 2: A 9-month-old intubated for RSV bronchiolitis has a sudden decrease in SpO2 and increased peak inspiratory pressures. The DOPE mnemonic is used. After repositioning the ET tube and ruling out obstruction, the NEXT step is:
- Increase FiO2 to 1.0 and observe
- Perform needle decompression of the chest
- Check for pneumothorax by CXR or transillumination (Correct answer)
- Administer a bronchodilator
Correct answer: Check for pneumothorax by CXR or transillumination
The 'E' in DOPE stands for Equipment failure/pneumothorax — after ruling out displacement and obstruction, evaluate for pneumothorax with CXR or transillumination in infants.
Question 3: Which inhaled agent is used as rescue therapy in pediatric acute severe asthma unresponsive to standard bronchodilators?
- Heliox (helium-oxygen mixture) (Correct answer)
- Isoflurane
- Nitric oxide
- Sodium bicarbonate nebulization
Correct answer: Heliox (helium-oxygen mixture)
Heliox reduces gas turbulence in narrowed airways, decreasing work of breathing and improving distal bronchodilator delivery in severe asthma refractory to standard therapy.
Question 4: A neonate at 28 weeks gestation requires surfactant therapy. What is the PRIMARY mechanism by which exogenous surfactant improves oxygenation?
- Reduces pulmonary vascular resistance
- Decreases alveolar surface tension to prevent collapse (Correct answer)
- Stimulates type II pneumocyte maturation
- Increases mucociliary clearance
Correct answer: Decreases alveolar surface tension to prevent collapse
Exogenous surfactant replaces deficient endogenous surfactant, reducing alveolar surface tension and preventing atelectasis to improve ventilation-perfusion matching and oxygenation.
Question 5: Which finding on a chest X-ray is CHARACTERISTIC of surfactant deficiency (respiratory distress syndrome) in a premature neonate?
- Hyperinflation with flattened diaphragms
- Unilateral opacification with mediastinal shift
- Diffuse ground-glass opacity with air bronchograms (Correct answer)
- Cardiomegaly with pulmonary edema
Correct answer: Diffuse ground-glass opacity with air bronchograms
RDS produces a diffuse ground-glass or 'white-out' pattern with air bronchograms on CXR due to widespread atelectasis from surfactant deficiency in premature lungs.
Question 6: A 6-year-old on high-frequency oscillatory ventilation (HFOV) for ARDS has improved oxygenation but worsening CO2 retention. Which adjustment corrects this?
- Increase mean airway pressure (MAP)
- Increase amplitude (delta P) (Correct answer)
- Decrease frequency (Hz)
- Increase FiO2
Correct answer: Increase amplitude (delta P)
In HFOV, CO2 elimination is controlled by amplitude (delta P) — increasing amplitude improves the tidal oscillation volume, enhancing CO2 washout.
Pediatric CCRN Exam Pediatric CCRN Respiratory 2
What is the RECOMMENDED initial PEEP setting when initiating mechanical ventilation in a child with moderate pediatric ARDS?