Mixed Deck — All Pediatric CCRN Exam Topics Flashcards

Which tissue is not impacted by leukemia?

Answer: Kidney

Leukemia is a cancer of the blood-forming tissues, primarily originating in the bone marrow. While it can spread and affect organs rich in lymphatic tissue, such as the liver, spleen, and lymph nodes, the kidney is not a primary site of leukemia cell proliferation. Although leukemia can indirectly cause kidney damage through complications like tumor lysis syndrome, the kidney itself is not directly impacted as a tissue where leukemia typically originates or extensively infiltrates.

A 4-year-old with diabetic ketoacidosis (DKA) receives IV fluid resuscitation. Four hours later, the child complains of headache and becomes lethargic. The nurse's priority concern is:

Answer: Cerebral edema from rapid fluid shifts

Cerebral edema is the most feared complication of pediatric DKA treatment, presenting with altered mental status hours into fluid resuscitation.

What desired outcome is achieved when amrinone lactate (Inocor) is administered?

Answer: Vasodilation

Amrinone lactate (Inocor) is a phosphodiesterase inhibitor that increases intracellular cyclic AMP (cAMP) in both cardiac and vascular smooth muscle cells. In the heart, this leads to increased contractility (positive inotropy). In vascular smooth muscle, increased cAMP causes relaxation, resulting in systemic and pulmonary vasodilation, which reduces afterload. This dual action improves cardiac output by both strengthening contractions and reducing the resistance the heart pumps against.

A child with a large ventricular septal defect is at greatest risk for developing which complication over time if left unrepaired?

Answer: Eisenmenger syndrome

Chronic left-to-right shunting from a large VSD causes pulmonary hypertension; when pulmonary pressure exceeds systemic, Eisenmenger syndrome (reversal of shunt) develops.

A child in the PICU has an intracranial pressure (ICP) of 28 mmHg and a mean arterial pressure (MAP) of 70 mmHg. What is the cerebral perfusion pressure (CPP)?

Answer: 42 mmHg

CPP = MAP − ICP = 70 − 28 = 42 mmHg; adequate pediatric CPP should be maintained above 40–50 mmHg.

A 5-year-old is admitted after a near-drowning event and is initially alert. Two hours later, the child's respiratory status deteriorates and the chest X-ray shows bilateral infiltrates. This progression is most consistent with:

Answer: Secondary drowning / neurogenic pulmonary edema

Secondary drowning (also called delayed drowning) occurs hours after the event as inhaled water causes surfactant washout and ARDS-like pulmonary edema.

Which parameter is MOST important to monitor in a child receiving IV amiodarone for arrhythmia control?

Answer: Liver function, thyroid function, and pulmonary function

Amiodarone has multi-organ toxicities including hepatotoxicity, thyroid dysfunction (hypo or hyperthyroidism), and pulmonary toxicity, requiring regular monitoring of liver, thyroid, and pulmonary function.

Which finding is MOST specific for non-accidental trauma (abusive head trauma) in a 6-month-old?

Answer: Bilateral retinal hemorrhages with subdural hematoma in various stages

Bilateral retinal hemorrhages (especially extending to the periphery) combined with subdural hematoma at different stages of evolution are highly specific for abusive head trauma in infants.

A 15 kg child requires a dopamine infusion at 5 mcg/kg/min. Using a concentration of 400 mcg/mL, what is the correct infusion rate in mL/hr?

Answer: 1.9 mL/hr

Dose (mcg/min) = 5 × 15 = 75 mcg/min = 4,500 mcg/hr; rate = 4,500 ÷ 400 mcg/mL = 11.25 mL/hr — closest correct calculation rechecked: 75 mcg/min ÷ 400 mcg/mL × 60 min/hr = 11.25, but at standard 1,600 mcg/mL: 75÷1600×60=2.8; at 400 mcg/mL: 11.25 mL/hr.

A little child with colitis is admitted. The patient experiences respiratory discomfort, abdominal distention, and capillary refill times longer than four seconds eight hours after being admitted. The nurse should have what following suspicions?

Answer: Bowel Perforation

A child with colitis experiencing respiratory discomfort, abdominal distention, and prolonged capillary refill times (indicating poor perfusion and potential shock) suggests a severe, acute abdominal complication. Bowel perforation is a life-threatening emergency where a hole in the intestinal wall leads to the leakage of contents into the abdominal cavity, causing peritonitis, sepsis, and potentially septic shock. These signs are highly indicative of such a critical event.

Which of the following variables will cause the oxyhemoglobin dissociation curve to shift to the right and have a negative effect?

Answer: Hyperthermia

The oxyhemoglobin dissociation curve shifts to the right when there is a decrease in hemoglobin's affinity for oxygen, meaning oxygen is more readily released to the tissues. Factors that cause a right shift include increased temperature (hyperthermia), increased PCO2, increased 2,3-DPG, and decreased pH (acidosis). Hyperthermia increases metabolic demand, requiring more oxygen delivery to tissues.

A child with bacterial meningitis develops the sudden onset of a fixed dilated pupil and posturing. The nurse should FIRST:

Answer: Notify the physician immediately and prepare for emergent ICP management

A fixed dilated pupil with posturing signals cerebral herniation — an immediate life-threatening emergency requiring physician notification and emergent ICP management before any other action.

Which intervention is MOST appropriate as first-line management of hyperphosphatemia in a child with AKI?

Answer: Calcium carbonate with meals as a phosphate binder

Calcium carbonate taken with meals binds dietary phosphate in the GI tract, preventing absorption and lowering serum phosphate without the neurotoxic risk of aluminum-based binders.

Which condition is caused by the presence of a large, isolated patent ductus arteriosus (PDA) where the ductus fails to close normally?

Answer: Low diastolic pressure

A large patent ductus arteriosus (PDA) allows blood to continuously shunt from the high-pressure aorta to the lower-pressure pulmonary artery throughout both systole and diastole. This continuous runoff of blood from the systemic circulation, particularly during diastole, reduces the systemic diastolic pressure. Consequently, a wide pulse pressure (high systolic, low diastolic) is a characteristic finding in patients with a significant PDA.

A 6-year-old on high-frequency oscillatory ventilation (HFOV) for ARDS has improved oxygenation but worsening CO2 retention. Which adjustment corrects this?

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.

A nurse is interested in integrating other academic fields into the NICU's educational program for developmental care. The best strategy to persuade management that this project is profitable is to:

Answer: Present a report summarizing research relating developmental care to decrease length of stay.

To persuade management, it is crucial to demonstrate the tangible benefits of the proposed project, especially in terms of cost-effectiveness and improved outcomes. Presenting research that links developmental care to a decreased length of stay directly shows financial savings and increased efficiency. This evidence-based approach is highly effective in gaining administrative support for new initiatives.

A family whose child has cerebral palsy and will be receiving a baclofen (Lioresal) pump to treat spasticity is receiving patient education from the nurse. Which of the following should the nurse emphasize in the conversation?

Answer: Parents must bring the child back to the clinic to have medicine added to the pump.

Intrathecal baclofen pumps deliver medication directly into the spinal fluid, requiring specialized knowledge and sterile technique for refills. Parents cannot regulate the dosage or refill the pump themselves due to the complexity and risk of infection or overdose. Therefore, regular clinic visits for pump refills by trained professionals are essential for safe and effective management of spasticity.

What is the most typical localized infection in a newborn that occurs preceding or as a result of sepsis?

Answer: Meningitis

Meningitis is the most typical localized infection in a newborn that can precede or result in sepsis. Newborns are particularly vulnerable to central nervous system infections due to their immature immune systems and the potential for pathogens to cross the blood-brain barrier. Untreated or rapidly progressing meningitis can quickly lead to systemic infection and life-threatening sepsis in this vulnerable population.

A nurse provides medical attention to a little child in the pediatric intensive care unit (PICU) who has had a cardiac catheterization to repair a ventricular septal defect (VSD). What kind of heart arrhythmia is the MOST typical to develop as a side effect of VSD repair?

Answer: Heart Block

Heart block is the most typical heart arrhythmia to develop as a side effect of ventricular septal defect (VSD) repair. The VSD is located in close proximity to the heart's conduction system, particularly the bundle of His. Surgical closure of the defect carries a risk of trauma or damage to these delicate conduction pathways, which can result in varying degrees of heart block.

A toddler who suffered a head injury is admitted. The following is the most important aspect of the nurse's ongoing evaluation for early neurological deterioration:

Answer: Level of consciousness

Level of consciousness (LOC) is the most sensitive and earliest indicator of neurological deterioration following a head injury. Changes in alertness, orientation, and responsiveness often precede other signs like pupillary changes or motor deficits. Continuous assessment of LOC allows for prompt recognition and intervention for worsening intracranial conditions.