Pediatric CCRN Exam Pediatric CCRN Neonatal 5 — Questions and Answers
Question 1: A neonate with suspected sepsis has cultures drawn and empiric antibiotics are started. Blood culture results at 48 hours show no growth. The neonate has been clinically improving. The BEST course of action is:
- Continue antibiotics for the full 14-day course regardless
- Discontinue antibiotics if clinical status is good and CRP trending down (Correct answer)
- Switch to oral antibiotics and discharge home
- Repeat blood cultures daily until negative x3
Correct answer: Discontinue antibiotics if clinical status is good and CRP trending down
In clinically improving neonates with negative cultures and normalizing inflammatory markers, antibiotic de-escalation at 48 hours is recommended to reduce antibiotic-associated complications.
Question 2: A NICU nurse notes that a 29-week neonate's endotracheal tube (ETT) has migrated. Chest X-ray shows the tube tip at the level of the carina. The MOST immediate action is:
- Obtain a repeat chest X-ray in 2 hours
- Withdraw the ETT 1-2 cm and confirm placement (Correct answer)
- Immediately extubate the neonate
- Increase peak inspiratory pressure to compensate
Correct answer: Withdraw the ETT 1-2 cm and confirm placement
An ETT at the carina risks right mainstem intubation or atelectasis; the tube should be immediately withdrawn to the correct position (T2-T3) and placement confirmed.
Question 3: A term neonate has Apgar scores of 2 at 1 minute and 4 at 5 minutes. During neonatal resuscitation, positive pressure ventilation is initiated. After 30 seconds with adequate chest rise, heart rate remains 55 bpm. The NEXT step is:
- Continue PPV and reassess in 60 seconds
- Begin chest compressions at a 3:1 compression-to-ventilation ratio (Correct answer)
- Administer epinephrine IV immediately
- Switch to high-flow nasal cannula
Correct answer: Begin chest compressions at a 3:1 compression-to-ventilation ratio
Per NRP guidelines, chest compressions are initiated when heart rate remains <60 bpm despite 30 seconds of effective PPV, using a 3:1 compression-to-ventilation ratio.
Question 4: A nurse is caring for a neonate with gastroschisis immediately post-delivery. Which nursing intervention has the HIGHEST priority?
- Obtaining IV access for TPN initiation
- Covering exposed bowel with warm saline-soaked dressing and plastic wrap (Correct answer)
- Positioning the neonate supine for abdominal assessment
- Administering prophylactic antibiotics per protocol
Correct answer: Covering exposed bowel with warm saline-soaked dressing and plastic wrap
Exposed bowel in gastroschisis must be immediately covered with warm saline-soaked gauze and a plastic wrap or bowel bag to prevent heat loss, fluid evaporation, and infection.
Question 5: A 34-week neonate with respiratory distress syndrome (RDS) is on mechanical ventilation. The nurse notes increasing peak inspiratory pressures with decreased breath sounds on the left. The MOST likely cause is:
- Surfactant deficiency worsening
- Left-sided pneumothorax (Correct answer)
- ETT migration to the right mainstem bronchus
- Mucus plug in the left mainstem bronchus
Correct answer: Left-sided pneumothorax
Sudden increase in PIP with unilateral decreased breath sounds and hemodynamic instability in a ventilated neonate is most consistent with pneumothorax requiring emergency treatment.
Question 6: A mother who is HIV-positive delivers a term neonate. Which intervention is MOST important to initiate within the first 6 hours of life?
- Immediate formula feeding (avoid breastfeeding)
- Initiation of antiretroviral prophylaxis (e.g., zidovudine) (Correct answer)
- Isolation in a negative-pressure room
- HIV ELISA testing of the neonate
Correct answer: Initiation of antiretroviral prophylaxis (e.g., zidovudine)
Antiretroviral prophylaxis (typically zidovudine) should be initiated within 6-12 hours of birth to prevent mother-to-child transmission of HIV.
Question 7: A nurse is assessing a 3-day-old neonate for hypoglycemia. The neonate is jittery, has a high-pitched cry, and appears lethargic. A point-of-care glucose is 38 mg/dL. The neonate is breastfeeding. The BEST initial intervention is:
- Initiate IV dextrose bolus immediately
- Encourage breastfeeding and recheck glucose in 30 minutes
- Administer oral dextrose gel and encourage feeding (Correct answer)
- Hold feeds and initiate continuous glucose monitoring
Correct answer: Administer oral dextrose gel and encourage feeding
Oral dextrose gel (40%) plus feeding is recommended as first-line treatment for symptomatic mild-to-moderate neonatal hypoglycemia and is superior to IV glucose for appropriate candidates.
Pediatric CCRN Exam Pediatric CCRN Neonatal 5
A neonate with suspected sepsis has cultures drawn and empiric antibiotics are started.
Blood culture results at 48 hours show no growth.
The neonate has been clinically improving.
The BEST course of action is: