Pediatric CCRN Exam Pediatric CCRN Respiratory 1 — Questions and Answers
Question 1: A 2-year-old with bronchiolitis on high-flow nasal cannula has worsening work of breathing. What parameter BEST indicates the need to escalate to non-invasive ventilation?
- SpO2 of 93% on 6 L/min flow
- Respiratory rate of 60 with subcostal retractions and poor feeding (Correct answer)
- Mild expiratory wheeze bilaterally
- Temperature of 38.5°C
Correct answer: Respiratory rate of 60 with subcostal retractions and poor feeding
Increasing work of breathing with retractions, tachypnea, and poor feeding despite high-flow oxygen signals impending respiratory failure requiring escalation to CPAP or BiPAP.
Question 2: Which ventilator strategy is recommended for pediatric ARDS to minimize ventilator-induced lung injury?
- High tidal volumes (12 mL/kg) with low PEEP
- Low tidal volumes (4–6 mL/kg) with permissive hypercapnia (Correct answer)
- Pressure control with FiO2 1.0 at all times
- Volume-assured pressure support without PEEP
Correct answer: Low tidal volumes (4–6 mL/kg) with permissive hypercapnia
Lung-protective ventilation using low tidal volumes (4–6 mL/kg IBW) with permissive hypercapnia minimizes volutrauma and barotrauma in pediatric ARDS.
Question 3: A 7-year-old post-op with a right-sided chest tube has sudden respiratory distress, absent breath sounds on the left, and tracheal deviation to the right. The MOST likely diagnosis is:
- Right-sided hemothorax
- Left-sided tension pneumothorax (Correct answer)
- Right-sided pleural effusion
- Bronchospasm
Correct answer: Left-sided tension pneumothorax
Absent left breath sounds, tracheal deviation away from the left, and sudden respiratory distress indicate a left-sided tension pneumothorax compressing mediastinal structures.
Question 4: What is the MOST common trigger for status asthmaticus requiring PICU admission in children?
- Exercise-induced bronchospasm
- Viral upper respiratory infection (Correct answer)
- Allergen exposure
- Cold air inhalation
Correct answer: Viral upper respiratory infection
Viral URIs (most commonly rhinovirus) are the predominant trigger for acute severe asthma exacerbations requiring pediatric intensive care unit admission.
Question 5: A 4-year-old with croup (laryngotracheobronchitis) has a Westley croup score of 8. Which intervention is MOST appropriate?
- Oral dexamethasone and discharge home
- Nebulized racemic epinephrine and parenteral dexamethasone with observation (Correct answer)
- Immediate endotracheal intubation
- Heliox therapy alone
Correct answer: Nebulized racemic epinephrine and parenteral dexamethasone with observation
A Westley score of 8 indicates moderate-to-severe croup; nebulized racemic epinephrine provides rapid relief while systemic dexamethasone reduces airway inflammation and edema.
Question 6: Which blood gas result is MOST consistent with early respiratory failure in a child with acute severe asthma?
- pH 7.50, PaCO2 28, PaO2 70
- pH 7.35, PaCO2 42, PaO2 65 (Correct answer)
- pH 7.30, PaCO2 50, PaO2 60
- pH 7.45, PaCO2 35, PaO2 90
Correct answer: pH 7.35, PaCO2 42, PaO2 65
A normalizing PaCO2 (42 mmHg) with a normal or slightly low pH and mild hypoxia in a severely dyspneic child indicates CO2 retention despite hyperventilation — a sign of impending respiratory failure.
Pediatric CCRN Exam Pediatric CCRN Respiratory 1
A 2-year-old with bronchiolitis on high-flow nasal cannula has worsening work of breathing.
What parameter BEST indicates the need to escalate to non-invasive ventilation?