Pediatric CCRN Sample Flashcards

A 6-year-old on ECMO develops sudden loss of the ECMO flow waveform, circuit chattering, and hypotension. The nurse's first action should be:

Answer: Clamp the ECMO circuit and notify the ECMO specialist

Circuit chattering with flow loss suggests volume deficit or suction events; clamping the circuit and alerting the ECMO specialist prevents air entrainment and allows safe assessment.

A 9-year-old with sickle cell disease presents with acute chest syndrome. Which set of interventions is most appropriate?

Answer: Supplemental O2, IV hydration, analgesics, and exchange transfusion if severe

Acute chest syndrome is managed with supplemental oxygen, careful hydration, analgesia, antibiotics, and exchange transfusion for severe hypoxemia.

A 7-year-old post-operative Fontan procedure has a central venous pressure of 22 mmHg, low urine output, and hepatomegaly. The nurse suspects:

Answer: Fontan failure with elevated systemic venous pressure

Elevated CVP, hepatomegaly, and oliguria after Fontan indicate elevated systemic venous pressures secondary to Fontan circuit obstruction or failure.

A nurse is titrating norepinephrine for a child in septic shock. Which clinical endpoint best indicates adequate perfusion has been restored?

Answer: Age-appropriate MAP, capillary refill < 2 seconds, and normal urine output (1 mL/kg/hr)

Perfusion adequacy in pediatric septic shock is assessed with age-appropriate MAP targets, capillary refill time, and urine output, not a single adult threshold.

A premature neonate has abdominal distension, bloody stools, and pneumatosis intestinalis on X-ray. These findings are consistent with:

Answer: Necrotizing enterocolitis (NEC)

Pneumatosis intestinalis (air in the bowel wall) is pathognomonic for NEC, a life-threatening intestinal emergency in premature neonates.

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.

A child with Trisomy 21 (Down syndrome) is intubated in the PICU. The nurse should be aware that this population has a higher incidence of which airway-related complication?

Answer: Atlantoaxial instability requiring cervical spine precautions

Up to 15% of children with Down syndrome have atlantoaxial instability; positioning and airway manipulation require cervical spine precautions to prevent cord injury.