Pediatric CCRN Exam Pediatric CCRN Respiratory

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?

Accepted Answer

Respiratory rate of 60 with subcostal retractions and poor feeding

Answer

SpO2 of 93% on 6 L/min flow

Answer

Mild expiratory wheeze bilaterally

Answer

Temperature of 38.5°C

Question 2

Which ventilator strategy is recommended for pediatric ARDS to minimize ventilator-induced lung injury?

Accepted Answer

Low tidal volumes (4–6 mL/kg) with permissive hypercapnia

Answer

High tidal volumes (12 mL/kg) with low PEEP

Answer

Pressure control with FiO2 1.0 at all times

Answer

Volume-assured pressure support without PEEP

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:

Accepted Answer

Left-sided tension pneumothorax

Answer

Right-sided hemothorax

Answer

Right-sided pleural effusion

Answer

Bronchospasm

Question 4

What is the MOST common trigger for status asthmaticus requiring PICU admission in children?

Accepted Answer

Viral upper respiratory infection

Answer

Exercise-induced bronchospasm

Answer

Allergen exposure

Answer

Cold air inhalation

Question 5

A 4-year-old with croup (laryngotracheobronchitis) has a Westley croup score of 8. Which intervention is MOST appropriate?

Accepted Answer

Nebulized racemic epinephrine and parenteral dexamethasone with observation

Answer

Oral dexamethasone and discharge home

Answer

Immediate endotracheal intubation

Answer

Heliox therapy alone

Question 6

Which blood gas result is MOST consistent with early respiratory failure in a child with acute severe asthma?

Accepted Answer

pH 7.35, PaCO2 42, PaO2 65

Answer

pH 7.50, PaCO2 28, PaO2 70

Answer

pH 7.30, PaCO2 50, PaO2 60

Answer

pH 7.45, PaCO2 35, PaO2 90