Pediatric CCRN Exam Pediatric CCRN Critical Care 3 — Questions and Answers
Question 1: A 6-year-old with acute liver failure develops asterixis, confusion, and an elevated ammonia level. Which dietary modification is part of hepatic encephalopathy management?
- High-protein diet to support liver regeneration
- Protein restriction to 0.5-1 g/kg/day (Correct answer)
- Complete protein restriction (NPO)
- High-fat, low-carbohydrate diet
Correct answer: Protein restriction to 0.5-1 g/kg/day
Moderate protein restriction (0.5-1 g/kg/day) reduces ammonia production while preventing catabolism in hepatic encephalopathy.
Question 2: During assessment of a child in septic shock, you note a capillary refill time of 4 seconds, cool mottled extremities, and weak peripheral pulses. This presentation is consistent with which type of shock?
- Warm distributive shock
- Cold (vasoconstricted) septic shock (Correct answer)
- Obstructive shock
- Hypovolemic shock
Correct answer: Cold (vasoconstricted) septic shock
Cool extremities, prolonged capillary refill, and weak peripheral pulses indicate cold septic shock with high systemic vascular resistance, common in children.
Question 3: A 2-year-old is admitted with 40% TBSA burns. Using the Parkland formula, what is the total fluid volume to be given in the first 24 hours if the child weighs 12 kg?
- 960 mL
- 1440 mL
- 1920 mL (Correct answer)
- 2400 mL
Correct answer: 1920 mL
Parkland formula: 4 mL × kg × % TBSA = 4 × 12 × 40 = 1920 mL in the first 24 hours (half given in first 8 hours).
Question 4: A 14-year-old with type 1 diabetes is admitted in DKA with a blood glucose of 540 mg/dL, pH 7.1, and bicarbonate of 8 mEq/L. The initial fluid of choice is:
- D5W with 20 mEq/L KCl
- 0.9% Normal saline (isotonic saline) (Correct answer)
- Lactated Ringer's solution
- 0.45% Half-normal saline with dextrose
Correct answer: 0.9% Normal saline (isotonic saline)
Initial resuscitation in DKA uses isotonic saline (0.9% NS) to restore intravascular volume before transitioning to hypotonic fluids.
Question 5: A child with severe traumatic brain injury has an ICP of 28 mmHg and a MAP of 65 mmHg. What is the cerebral perfusion pressure (CPP)?
- 28 mmHg
- 37 mmHg (Correct answer)
- 65 mmHg
- 93 mmHg
Correct answer: 37 mmHg
CPP = MAP – ICP = 65 – 28 = 37 mmHg; a CPP <40-50 mmHg in children indicates inadequate cerebral perfusion.
Question 6: Which medication is used as a continuous infusion to maintain ductal patency in a neonate with ductal-dependent congenital heart disease?
- Indomethacin
- Prostaglandin E1 (alprostadil) (Correct answer)
- Furosemide
- Milrinone
Correct answer: Prostaglandin E1 (alprostadil)
Prostaglandin E1 (alprostadil) maintains patency of the ductus arteriosus in neonates with ductal-dependent cardiac lesions until surgical correction.
Question 7: A 5-year-old post-operative cardiac patient has a urine output of 0.3 mL/kg/hr for 3 consecutive hours, rising creatinine, and BUN of 40 mg/dL. These findings are most consistent with:
- Prerenal azotemia from dehydration
- Acute kidney injury (AKI) (Correct answer)
- Syndrome of inappropriate ADH (SIADH)
- Normal post-operative diuresis
Correct answer: Acute kidney injury (AKI)
Oliguria (UO <0.5 mL/kg/hr), rising creatinine, and elevated BUN after cardiac surgery indicate acute kidney injury requiring prompt intervention.
Pediatric CCRN Exam Pediatric CCRN Critical Care 3
A 6-year-old with acute liver failure develops asterixis, confusion, and an elevated ammonia level.
Which dietary modification is part of hepatic encephalopathy management?