Pediatric CCRN Exam Pediatric CCRN Critical Care 5

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?

Accepted Answer

Atropine and pralidoxime

Answer

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?

Accepted Answer

Hypertrophic pyloric stenosis

Answer

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:

Accepted Answer

Moderate ARDS (P/F 100-200)

Answer

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?

Accepted Answer

Start broad-spectrum IV antibiotics immediately (within 1 hour)

Answer

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?

Accepted Answer

Transposition of the great arteries (TGA)

Answer

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.

Pediatric CCRN Exam Practice Test

Pediatric CCRN Exam Practice Test

Pediatric CCRN Exam Pediatric CCRN Critical Care 5