Pediatric CCRN Exam Pediatric CCRN Sample 3 — Questions and Answers
Question 1: A 4-year-old with diabetic ketoacidosis (DKA) receives IV fluid resuscitation. Four hours later, the child complains of headache and becomes lethargic. The nurse's priority concern is:
- Hypokalemia from insulin therapy
- Cerebral edema from rapid fluid shifts (Correct answer)
- Hypoglycemia from overcorrection
- Hypernatremia from normal saline infusion
Correct answer: Cerebral edema from rapid fluid shifts
Cerebral edema is the most feared complication of pediatric DKA treatment, presenting with altered mental status hours into fluid resuscitation.
Question 2: Which finding on a neonatal cardiac assessment most strongly suggests a ductal-dependent congenital heart lesion?
- Differential oxygen saturation (preductal > postductal) (Correct answer)
- Loud systolic murmur at the left sternal border
- Bounding peripheral pulses with wide pulse pressure
- Cyanosis that worsens with crying
Correct answer: Differential oxygen saturation (preductal > postductal)
Preductal SpO2 higher than postductal SpO2 indicates right-to-left shunting through the ductus arteriosus, characteristic of ductal-dependent lesions like coarctation.
Question 3: A PICU nurse is preparing to administer a blood transfusion to a 2-year-old. What is the standard weight-based volume for a packed red blood cell transfusion in pediatrics?
- 5 mL/kg
- 10–15 mL/kg (Correct answer)
- 20 mL/kg
- 30 mL/kg
Correct answer: 10–15 mL/kg
The standard pediatric PRBC transfusion dose is 10–15 mL/kg, infused over 2–4 hours, to raise hemoglobin by approximately 2–3 g/dL.
Question 4: A 9-year-old on a ventilator has peak airway pressures of 42 cm H2O and plateau pressures of 20 cm H2O. What is the most likely cause?
- Decreased lung compliance from ARDS
- Increased airway resistance from bronchospasm or secretions (Correct answer)
- Tension pneumothorax developing
- ET tube displacement into the right mainstem bronchus
Correct answer: Increased airway resistance from bronchospasm or secretions
A high peak pressure with a normal plateau pressure indicates increased resistance in the airways (bronchospasm, mucus), not reduced compliance.
Question 5: Which electrolyte imbalance is most likely in a child with prolonged nasogastric suctioning?
- Hyperkalemia and metabolic acidosis
- Hypokalemia and metabolic alkalosis (Correct answer)
- Hypernatremia and metabolic acidosis
- Hyponatremia and metabolic alkalosis
Correct answer: Hypokalemia and metabolic alkalosis
Gastric fluid loss via NG suctioning depletes hydrochloric acid, potassium, and sodium, resulting in hypokalemic, hypochloremic metabolic alkalosis.
Question 6: A 3-month-old presents with poor feeding, weak cry, constipation, and decreased muscle tone. The nurse suspects infant botulism. What is the most appropriate initial intervention?
- Administer botulism antitoxin (HBAT) immediately
- Administer BabyBIG (botulism immune globulin) and prepare for respiratory support (Correct answer)
- Start broad-spectrum IV antibiotics
- Initiate activated charcoal to bind toxin
Correct answer: Administer BabyBIG (botulism immune globulin) and prepare for respiratory support
BabyBIG (heptavalent botulism immune globulin) is the specific treatment for infant botulism, and respiratory support should be anticipated due to progressive weakness.
Question 7: A child in the PICU has an intracranial pressure (ICP) of 28 mmHg and a mean arterial pressure (MAP) of 70 mmHg. What is the cerebral perfusion pressure (CPP)?
- 28 mmHg
- 42 mmHg (Correct answer)
- 70 mmHg
- 98 mmHg
Correct answer: 42 mmHg
CPP = MAP − ICP = 70 − 28 = 42 mmHg; adequate pediatric CPP should be maintained above 40–50 mmHg.
Pediatric CCRN Exam Pediatric CCRN Sample 3
A 4-year-old with diabetic ketoacidosis (DKA) receives IV fluid resuscitation.
Four hours later, the child complains of headache and becomes lethargic.
The nurse's priority concern is: