Pediatric CCRN Sample Flashcards

A 2-year-old with RSV bronchiolitis has an SpO2 of 89% on room air. Which intervention has the strongest evidence for improving outcomes?

Answer: Supplemental oxygen to maintain SpO2 ≥ 90–92%

Supportive care with supplemental oxygen to maintain adequate saturation is the only consistently evidence-based intervention for RSV bronchiolitis; bronchodilators and steroids are not routinely recommended.

Which of the following best describes the mechanism of pulmonary hypertension in a newborn with persistent pulmonary hypertension of the newborn (PPHN)?

Answer: Failure of normal postnatal pulmonary vascular resistance reduction causing right-to-left shunting

PPHN results from failure of pulmonary vascular resistance to drop after birth, maintaining fetal circulation with right-to-left shunting through the ductus arteriosus and foramen ovale.

A 5-year-old is admitted for hypertensive urgency. The drug of choice for acute, controlled reduction of blood pressure in a PICU setting is:

Answer: Continuous IV nicardipine or labetalol infusion

Continuous IV nicardipine or labetalol allows precise, titratable blood pressure control, preventing the dangerous overcorrection associated with bolus agents.

A 12-year-old with acetaminophen overdose presents 18 hours post-ingestion with elevated AST/ALT. What is the priority intervention?

Answer: Begin N-acetylcysteine (NAC) IV infusion immediately

NAC restores glutathione stores and is the antidote for acetaminophen toxicity; it remains effective up to 24 hours post-ingestion and should be started without delay.

A neonate born at 28 weeks gestation is on high-frequency oscillatory ventilation (HFOV). Which parameter is primarily adjusted to control oxygenation on HFOV?

Answer: Mean airway pressure (MAP)

On HFOV, mean airway pressure (MAP) controls lung volume and oxygenation, while amplitude (ΔP) controls CO2 elimination.

A 4-year-old with nephrotic syndrome develops sudden severe abdominal pain, fever, and peritoneal signs. The most likely diagnosis is:

Answer: Spontaneous bacterial peritonitis

Children with nephrotic syndrome are highly susceptible to spontaneous bacterial peritonitis (typically Streptococcus pneumoniae) due to loss of immunoglobulins in the urine.

When interpreting a pediatric 12-lead ECG, which finding is most concerning for Wolff-Parkinson-White (WPW) syndrome?

Answer: Short PR interval with a delta wave

WPW is characterized by a short PR interval (<120 ms) and a slurred upstroke (delta wave) on the QRS, representing pre-excitation via an accessory pathway.