Pediatric CCRN Exam Pediatric CCRN Critical Care 5 — Questions and Answers
Question 1: A 2-year-old is admitted following an ingestion of an unknown substance. He is bradycardic, has pinpoint pupils, excessive secretions, and bronchospasm. Which antidote should be administered?
- N-acetylcysteine
- Atropine and pralidoxime (Correct answer)
- Naloxone
- Flumazenil
Correct answer: Atropine and pralidoxime
Cholinergic toxidrome (SLUDGE: salivation, lacrimation, urination, defecation, GI distress, emesis + bradycardia, bronchospasm) from organophosphate or carbamate poisoning is reversed with atropine and pralidoxime.
Question 2: A 6-week-old infant presents with projectile vomiting after feedings, a palpable olive-shaped mass in the epigastrium, and hypochloremic metabolic alkalosis. What is the diagnosis?
- Intussusception
- Hypertrophic pyloric stenosis (Correct answer)
- Malrotation with volvulus
- Gastroesophageal reflux disease
Correct answer: Hypertrophic pyloric stenosis
Hypertrophic pyloric stenosis classically presents at 3-6 weeks with projectile vomiting, palpable pyloric 'olive,' and hypochloremic metabolic alkalosis from loss of HCl.
Question 3: A mechanically ventilated 8-year-old develops worsening oxygenation, bilateral infiltrates on CXR, and a P/F ratio of 110. No evidence of cardiac failure exists. According to PALICC criteria, this represents:
- Mild ARDS (P/F 200-300)
- Severe ARDS (P/F <100)
- Moderate ARDS (P/F 100-200) (Correct answer)
- Acute lung injury (P/F <300)
Correct answer: Moderate ARDS (P/F 100-200)
According to PALICC criteria, an oxygenation index reflecting P/F ratio 100-200 (with PEEP ≥5) represents moderate pediatric ARDS.
Question 4: A 10-year-old with ALL is neutropenic (ANC 200) and develops a fever of 38.5°C. Blood cultures are obtained. Which is the correct initial management?
- Observe for 24 hours and initiate antibiotics only if culture positive
- Start broad-spectrum IV antibiotics immediately (within 1 hour) (Correct answer)
- Initiate antifungal therapy and await culture results
- Administer G-CSF and delay antibiotics
Correct answer: Start broad-spectrum IV antibiotics immediately (within 1 hour)
Febrile neutropenia is a medical emergency; broad-spectrum IV antibiotics must be initiated within one hour of fever onset to prevent septic death.
Question 5: A term neonate has persistent cyanosis unresponsive to supplemental oxygen, with an egg-shaped heart on CXR and a narrow mediastinum. What is the most likely diagnosis?
- Tetralogy of Fallot
- Transposition of the great arteries (TGA) (Correct answer)
- Truncus arteriosus
- Hypoplastic left heart syndrome
Correct answer: Transposition of the great arteries (TGA)
TGA classically presents with an egg-on-a-string (egg-shaped heart with narrow mediastinum) on CXR and cyanosis unresponsive to oxygen due to parallel circulations.
Question 6: A 5-year-old with meningococcemia develops a fever spike to 40.2°C, new petechiae spreading to the trunk, and a BP drop to 60/30 mmHg. The Waterhouse-Friderichsen syndrome is suspected. Which additional treatment should be considered?
- High-dose IV methylprednisolone 30 mg/kg
- Stress-dose hydrocortisone for adrenal insufficiency (Correct answer)
- Dexamethasone 0.15 mg/kg to reduce cerebral edema
- Fludrocortisone for mineralocorticoid replacement only
Correct answer: Stress-dose hydrocortisone for adrenal insufficiency
Waterhouse-Friderichsen syndrome causes bilateral adrenal hemorrhage and acute adrenal insufficiency, requiring stress-dose hydrocortisone replacement.
Question 7: A PICU nurse is preparing to perform a family-centered care assessment. Which practice is MOST consistent with evidence-based family-centered care in the PICU?
- Restricting visitation to scheduled 2-hour windows to allow rest
- Encouraging family presence during resuscitation and bedside procedures if desired (Correct answer)
- Limiting parental involvement in care decisions to reduce anxiety
- Prohibiting family from staying overnight to maintain staff workflow
Correct answer: Encouraging family presence during resuscitation and bedside procedures if desired
Evidence-based family-centered care supports offering family presence during resuscitation and procedures, which reduces family anxiety and improves satisfaction without hindering outcomes.
Pediatric CCRN Exam Pediatric CCRN Critical Care 5
A 2-year-old is admitted following an ingestion of an unknown substance.
He is bradycardic, has pinpoint pupils, excessive secretions, and bronchospasm.
Which antidote should be administered?