Pediatric CCRN Exam Pediatric CCRN Sample 2 — Questions and Answers
Question 1: A 3-year-old presents with inspiratory stridor, a barking cough, and low-grade fever. Which intervention is the priority?
- Administer nebulized racemic epinephrine (Correct answer)
- Perform immediate endotracheal intubation
- Obtain chest X-ray before any treatment
- Start IV antibiotics for suspected epiglottitis
Correct answer: Administer nebulized racemic epinephrine
Nebulized racemic epinephrine rapidly reduces subglottic edema in croup, providing immediate airway relief.
Question 2: A 7-year-old with known asthma has an SpO2 of 88%, accessory muscle use, and a silent chest on auscultation. What does the silent chest indicate?
- Pneumothorax has developed
- Airflow is so severely obstructed that breath sounds are absent (Correct answer)
- The child is improving and bronchospasm is resolving
- Mucus plugging limited to the upper airway
Correct answer: Airflow is so severely obstructed that breath sounds are absent
A silent chest in asthma signals near-complete airflow obstruction—a life-threatening finding requiring immediate aggressive intervention.
Question 3: Which hemodynamic pattern is most consistent with septic shock in a 5-year-old in the early (warm) phase?
- High CO, low SVR, warm extremities (Correct answer)
- Low CO, high SVR, cool extremities
- High CO, high SVR, bounding pulses
- Low CO, low SVR, mottled skin
Correct answer: High CO, low SVR, warm extremities
Early septic shock (warm shock) is characterized by vasodilation (low SVR) and compensatory high cardiac output with warm, flushed extremities.
Question 4: A 10-year-old post-cardiac surgery has a sudden drop in BP, muffled heart sounds, and JVD. The nurse should suspect:
- Tension pneumothorax
- Cardiac tamponade (Correct answer)
- Hypovolemic shock
- Pulmonary embolism
Correct answer: Cardiac tamponade
Beck's triad (hypotension, muffled heart sounds, JVD) is the classic presentation of cardiac tamponade following cardiac surgery.
Question 5: When calculating maintenance IV fluids using the Holliday-Segar method for a 25 kg child, how many mL/hour should be administered?
- 65 mL/hr (Correct answer)
- 75 mL/hr
- 85 mL/hr
- 100 mL/hr
Correct answer: 65 mL/hr
Holliday-Segar: 100 mL/kg for first 10 kg (1000) + 50 mL/kg for next 10 kg (500) + 20 mL/kg for remaining 5 kg (100) = 1600 mL/day ÷ 24 = ~65 mL/hr.
Question 6: A nurse is caring for a neonate with suspected hypoxic-ischemic encephalopathy (HIE). Which intervention is most important to initiate within 6 hours of birth?
- Phenobarbital loading dose
- Therapeutic hypothermia (33–34°C) (Correct answer)
- High-frequency oscillatory ventilation
- Administration of surfactant
Correct answer: Therapeutic hypothermia (33–34°C)
Therapeutic hypothermia initiated within 6 hours of birth is the standard of care for moderate-to-severe HIE to reduce neuronal injury.
Question 7: A 6-year-old with bacterial meningitis develops sudden unilateral pupil dilation, bradycardia, and hypertension. The nurse recognizes this as:
- Cushing's triad indicating herniation (Correct answer)
- Normal sympathetic response to pain
- Medication side effect from mannitol
- SIADH causing cerebral edema correction
Correct answer: Cushing's triad indicating herniation
Cushing's triad (bradycardia, hypertension, irregular respirations) with pupil changes indicates brainstem herniation—a neurologic emergency.
Pediatric CCRN Exam Pediatric CCRN Sample 2
A 3-year-old presents with inspiratory stridor, a barking cough, and low-grade fever.
Which intervention is the priority?