Pediatric CCRN Exam Pediatric CCRN Critical Care 2 — Questions and Answers
Question 1: A 3-year-old with bacterial meningitis develops a petechial rash, hypotension, and purpura fulminans. Which organism is most likely responsible?
- Streptococcus pneumoniae
- Neisseria meningitidis (Correct answer)
- Haemophilus influenzae
- Listeria monocytogenes
Correct answer: Neisseria meningitidis
Neisseria meningitidis is classically associated with purpura fulminans and septic shock due to its endotoxin-mediated cascade.
Question 2: An infant is admitted with supraventricular tachycardia (SVT) at a rate of 240 bpm with signs of poor perfusion. What is the first-line treatment?
- Synchronized cardioversion at 0.5-1 J/kg (Correct answer)
- Adenosine 0.1 mg/kg IV rapid push
- Amiodarone 5 mg/kg IV over 20-60 minutes
- Vagal maneuvers such as ice to the face
Correct answer: Synchronized cardioversion at 0.5-1 J/kg
Synchronized cardioversion is indicated for unstable SVT with hemodynamic compromise; the starting dose is 0.5–1 J/kg.
Question 3: A 7-year-old on mechanical ventilation has a sudden increase in peak airway pressure and decreased breath sounds on the left. The trachea is deviated to the right. What is the priority action?
- Obtain a stat chest X-ray
- Perform needle thoracostomy on the left (Correct answer)
- Increase PEEP to re-expand the lung
- Suction the endotracheal tube
Correct answer: Perform needle thoracostomy on the left
Clinical signs of tension pneumothorax (tracheal deviation, absent breath sounds, rising airway pressure) require immediate needle decompression without waiting for imaging.
Question 4: When calculating maintenance IV fluids using the Holliday-Segar method for a 25 kg child, how many mL/hour should be given?
- 65 mL/hr
- 75 mL/hr (Correct answer)
- 85 mL/hr
- 100 mL/hr
Correct answer: 75 mL/hr
Using Holliday-Segar: 100 mL/kg for first 10 kg + 50 mL/kg for next 10 kg + 20 mL/kg for remaining 5 kg = 1500 mL/24 hr = 62.5, rounded to 65; standard formula gives 1500 mL/day ÷ 24 = 62.5; for 25 kg: 1500 mL/day = 62.5 mL/hr, closest is 65.
Question 5: A 10-year-old with ARDS is on mechanical ventilation. Which lung-protective ventilation strategy is recommended?
- Tidal volume 10-12 mL/kg IBW, high PEEP
- Tidal volume 6-8 mL/kg IBW, plateau pressure <30 cmH2O (Correct answer)
- Tidal volume 6-8 mL/kg IBW, zero PEEP
- Tidal volume 12-15 mL/kg IBW, low respiratory rate
Correct answer: Tidal volume 6-8 mL/kg IBW, plateau pressure <30 cmH2O
Lung-protective ventilation uses low tidal volumes (6-8 mL/kg IBW) and limits plateau pressure to <30 cmH2O to prevent ventilator-induced lung injury.
Question 6: A neonate presents with cyanosis that does not improve with 100% oxygen, a 'boot-shaped' heart on X-ray, and right axis deviation on ECG. What is the most likely diagnosis?
- Transposition of the great arteries
- Tetralogy of Fallot (Correct answer)
- Tricuspid atresia
- Total anomalous pulmonary venous return
Correct answer: Tetralogy of Fallot
Tetralogy of Fallot classically presents with a boot-shaped heart (coeur en sabot) on X-ray due to right ventricular hypertrophy and a small pulmonary artery.
Question 7: A 4-year-old post-cardiac surgery develops jugular venous distension, muffled heart sounds, and hypotension. Which intervention is most urgently needed?
- Aggressive IV fluid bolus of 20 mL/kg
- Pericardiocentesis (Correct answer)
- Vasopressor infusion with norepinephrine
- Emergent intubation and mechanical ventilation
Correct answer: Pericardiocentesis
Beck's triad (JVD, muffled heart sounds, hypotension) indicates cardiac tamponade requiring emergency pericardiocentesis to relieve pressure.
Pediatric CCRN Exam Pediatric CCRN Critical Care 2
A 3-year-old with bacterial meningitis develops a petechial rash, hypotension, and purpura fulminans.
Which organism is most likely responsible?