Pediatric CCRN Exam Pediatric CCRN from AACN 2 — Questions and Answers
Question 1: A 4-year-old with Tetralogy of Fallot has a hypercyanotic (Tet) spell. Which intervention should be performed FIRST?
- Place in knee-chest position (Correct answer)
- Administer 100% oxygen via mask
- Give IV morphine 0.1 mg/kg
- Administer IV propranolol
Correct answer: Place in knee-chest position
The knee-chest position is the first-line intervention as it increases systemic vascular resistance and decreases right-to-left shunting, improving oxygenation.
Question 2: A 10-year-old post-Fontan procedure develops plastic bronchitis. Which finding is MOST characteristic of this complication?
- Hemoptysis with bright red blood
- Expectoration of branching airway casts (Correct answer)
- Bilateral pleural effusions on CXR
- Sudden onset of stridor
Correct answer: Expectoration of branching airway casts
Plastic bronchitis, a known complication of Fontan circulation, is characterized by expectoration of gelatinous, branching bronchial casts that conform to the airway.
Question 3: A 6-year-old with ARDS is on mechanical ventilation. Lung-protective ventilation strategy includes tidal volume of:
- 10–12 mL/kg ideal body weight
- 6–8 mL/kg ideal body weight (Correct answer)
- 4–5 mL/kg ideal body weight
- 2–3 mL/kg ideal body weight
Correct answer: 6–8 mL/kg ideal body weight
Lung-protective ventilation for ARDS uses low tidal volumes of 6–8 mL/kg ideal body weight to minimize ventilator-induced lung injury.
Question 4: A 3-year-old presents with sudden onset of high fever, toxic appearance, drooling, and tripod positioning. The PRIORITY intervention is:
- Obtain lateral neck X-ray immediately
- Prepare for emergent airway management (Correct answer)
- Start IV antibiotics without delay
- Perform direct laryngoscopy to visualize the epiglottis
Correct answer: Prepare for emergent airway management
Epiglottitis can cause complete airway obstruction; the priority is securing the airway in a controlled environment before any other intervention.
Question 5: Which electrolyte abnormality is MOST likely in a child with prolonged nasogastric suction and metabolic alkalosis?
- Hyperkalemia and hyperchloremia
- Hypokalemia and hypochloremia (Correct answer)
- Hypernatremia and hypercalcemia
- Hyponatremia and hyperphosphatemia
Correct answer: Hypokalemia and hypochloremia
Nasogastric suction removes gastric acid (HCl), leading to loss of hydrogen, chloride, and potassium, causing metabolic alkalosis with hypokalemia and hypochloremia.
Question 6: A 7-year-old in septic shock receives fluid resuscitation of 60 mL/kg with normal saline without improvement. The NEXT appropriate intervention is:
- Administer another 20 mL/kg bolus of normal saline
- Start norepinephrine as vasopressor
- Begin dopamine or epinephrine per PALS guidelines (Correct answer)
- Initiate dobutamine for cardiac support
Correct answer: Begin dopamine or epinephrine per PALS guidelines
Per PALS guidelines, children with fluid-refractory septic shock should be started on vasoactive agents such as dopamine or epinephrine after adequate fluid resuscitation.
Question 7: A 14-year-old with diabetic ketoacidosis has an initial serum potassium of 3.2 mEq/L. What is the CORRECT approach to insulin therapy?
- Start insulin immediately at 0.1 units/kg/hr
- Withhold insulin until potassium is ≥3.5 mEq/L and repleted (Correct answer)
- Start insulin at a reduced dose of 0.05 units/kg/hr
- Give insulin only after serum glucose is below 300 mg/dL
Correct answer: Withhold insulin until potassium is ≥3.5 mEq/L and repleted
Insulin causes potassium to shift intracellularly; starting insulin when potassium is already low can cause life-threatening hypokalemia, so potassium must be repleted to ≥3.5 mEq/L first.
Pediatric CCRN Exam Pediatric CCRN from AACN 2
A 4-year-old with Tetralogy of Fallot has a hypercyanotic (Tet) spell.
Which intervention should be performed FIRST?