Pediatric CCRN Exam Pediatric CCRN Critical Care 4 — Questions and Answers
Question 1: A 9-month-old infant presents with inspiratory stridor, a barking cough, and a steeple sign on neck X-ray. What is the most appropriate initial treatment?
- Racemic epinephrine and dexamethasone (Correct answer)
- Antibiotics and immediate intubation
- Heliox therapy and bronchodilators
- IV hydration and antiviral therapy
Correct answer: Racemic epinephrine and dexamethasone
Croup (laryngotracheobronchitis) is treated with nebulized racemic epinephrine for acute relief and dexamethasone to reduce airway edema.
Question 2: A 12-year-old with status asthmaticus is not responding to maximum bronchodilator therapy. Arterial blood gas shows pH 7.28, PaCO2 58, PaO2 62. Which indicates imminent respiratory failure requiring intubation?
- Rising PaCO2 with respiratory acidosis despite maximal therapy (Correct answer)
- PaO2 <80 mmHg on room air
- Respiratory rate >30 breaths/min
- Oxygen saturation <95% on supplemental oxygen
Correct answer: Rising PaCO2 with respiratory acidosis despite maximal therapy
A rising PaCO2 (hypercapnia) with respiratory acidosis in a child with status asthmaticus signals respiratory muscle fatigue and imminent respiratory arrest.
Question 3: A 7-year-old receives a blood transfusion and develops fever, chills, back pain, and hemoglobinuria within 30 minutes. What type of transfusion reaction is occurring?
- Febrile non-hemolytic reaction
- Acute hemolytic transfusion reaction (Correct answer)
- Anaphylactic reaction
- Transfusion-related acute lung injury (TRALI)
Correct answer: Acute hemolytic transfusion reaction
Acute hemolytic transfusion reactions present with fever, chills, flank/back pain, and hemoglobinuria due to ABO incompatibility causing intravascular hemolysis.
Question 4: A 3-year-old is suspected of having nonaccidental trauma. Which fracture pattern is MOST specific for child abuse?
- Spiral fracture of the femur in a non-ambulatory child (Correct answer)
- Transverse fracture of the radius from a fall
- Greenstick fracture of the forearm
- Torus (buckle) fracture of the distal radius
Correct answer: Spiral fracture of the femur in a non-ambulatory child
Metaphyseal corner (classic metaphyseal lesion) and spiral fractures in non-ambulatory infants are highly suspicious for nonaccidental trauma.
Question 5: A PICU nurse is titrating a dopamine infusion for a child in cardiogenic shock. At which dose range does dopamine primarily exert beta-1 adrenergic (inotropic) effects?
- 0.5-2 mcg/kg/min (dopaminergic range)
- 2-10 mcg/kg/min (beta-adrenergic range) (Correct answer)
- 10-20 mcg/kg/min (alpha-adrenergic range)
- >20 mcg/kg/min (vasopressor range)
Correct answer: 2-10 mcg/kg/min (beta-adrenergic range)
At 2-10 mcg/kg/min, dopamine primarily stimulates beta-1 receptors, increasing heart rate and contractility (inotropic effect).
Question 6: A 16-year-old with acute respiratory failure has the following ABG: pH 7.48, PaCO2 30, PaO2 58, HCO3 22. How would you interpret this ABG?
- Metabolic alkalosis with hypoxemia
- Respiratory alkalosis with hypoxemia (Correct answer)
- Partially compensated metabolic acidosis
- Mixed respiratory and metabolic alkalosis
Correct answer: Respiratory alkalosis with hypoxemia
pH >7.45 (alkalosis) with low PaCO2 (30) indicates primary respiratory alkalosis; low PaO2 (58) indicates hypoxemia.
Question 7: A 4-year-old with severe sepsis has been started on broad-spectrum antibiotics. Blood cultures grow Candida species on day 3. Which antifungal agent is recommended as first-line treatment?
- Fluconazole
- An echinocandin (e.g., caspofungin or micafungin) (Correct answer)
- Amphotericin B deoxycholate
- Voriconazole
Correct answer: An echinocandin (e.g., caspofungin or micafungin)
Echinocandins are the first-line treatment for invasive candidiasis in critically ill patients due to their efficacy and favorable safety profile.
Pediatric CCRN Exam Pediatric CCRN Critical Care 4
A 9-month-old infant presents with inspiratory stridor, a barking cough, and a steeple sign on neck X-ray.
What is the most appropriate initial treatment?