Pediatric CCRN Exam Pediatric CCRN Sample 4 — Questions and Answers
Question 1: A 2-year-old with RSV bronchiolitis has an SpO2 of 89% on room air. Which intervention has the strongest evidence for improving outcomes?
- Nebulized albuterol every 4 hours
- Supplemental oxygen to maintain SpO2 ≥ 90–92% (Correct answer)
- Hypertonic saline nebulization with airway suctioning
- Systemic corticosteroids to reduce inflammation
Correct answer: Supplemental oxygen to maintain SpO2 ≥ 90–92%
Supportive care with supplemental oxygen to maintain adequate saturation is the only consistently evidence-based intervention for RSV bronchiolitis; bronchodilators and steroids are not routinely recommended.
Question 2: Which of the following best describes the mechanism of pulmonary hypertension in a newborn with persistent pulmonary hypertension of the newborn (PPHN)?
- Left ventricular failure causing pulmonary venous hypertension
- Failure of normal postnatal pulmonary vascular resistance reduction causing right-to-left shunting (Correct answer)
- Pulmonary arterial thromboembolism blocking blood flow
- Overcirculation from a large left-to-right shunt
Correct answer: Failure of normal postnatal pulmonary vascular resistance reduction causing right-to-left shunting
PPHN results from failure of pulmonary vascular resistance to drop after birth, maintaining fetal circulation with right-to-left shunting through the ductus arteriosus and foramen ovale.
Question 3: A 5-year-old is admitted for hypertensive urgency. The drug of choice for acute, controlled reduction of blood pressure in a PICU setting is:
- Oral nifedipine (sublingual administration)
- Continuous IV nicardipine or labetalol infusion (Correct answer)
- IV furosemide bolus dosing
- IM hydralazine every 6 hours
Correct answer: Continuous IV nicardipine or labetalol infusion
Continuous IV nicardipine or labetalol allows precise, titratable blood pressure control, preventing the dangerous overcorrection associated with bolus agents.
Question 4: A 12-year-old with acetaminophen overdose presents 18 hours post-ingestion with elevated AST/ALT. What is the priority intervention?
- Administer activated charcoal to reduce absorption
- Begin N-acetylcysteine (NAC) IV infusion immediately (Correct answer)
- Perform emergent plasmapheresis
- Administer IV methylene blue for toxin reduction
Correct answer: Begin N-acetylcysteine (NAC) IV infusion immediately
NAC restores glutathione stores and is the antidote for acetaminophen toxicity; it remains effective up to 24 hours post-ingestion and should be started without delay.
Question 5: A neonate born at 28 weeks gestation is on high-frequency oscillatory ventilation (HFOV). Which parameter is primarily adjusted to control oxygenation on HFOV?
- Frequency (Hz)
- Amplitude (ΔP)
- Mean airway pressure (MAP) (Correct answer)
- Inspiratory time
Correct answer: Mean airway pressure (MAP)
On HFOV, mean airway pressure (MAP) controls lung volume and oxygenation, while amplitude (ΔP) controls CO2 elimination.
Question 6: A 4-year-old with nephrotic syndrome develops sudden severe abdominal pain, fever, and peritoneal signs. The most likely diagnosis is:
- Intussusception from bowel edema
- Spontaneous bacterial peritonitis (Correct answer)
- Splenic sequestration crisis
- Mesenteric adenitis from viral infection
Correct answer: Spontaneous bacterial peritonitis
Children with nephrotic syndrome are highly susceptible to spontaneous bacterial peritonitis (typically Streptococcus pneumoniae) due to loss of immunoglobulins in the urine.
Question 7: When interpreting a pediatric 12-lead ECG, which finding is most concerning for Wolff-Parkinson-White (WPW) syndrome?
- Prolonged QTc interval > 460 ms
- Short PR interval with a delta wave (Correct answer)
- Right bundle branch block pattern
- ST elevation in leads V1–V3
Correct answer: Short PR interval with a delta wave
WPW is characterized by a short PR interval (<120 ms) and a slurred upstroke (delta wave) on the QRS, representing pre-excitation via an accessory pathway.
Pediatric CCRN Exam Pediatric CCRN Sample 4
A 2-year-old with RSV bronchiolitis has an SpO2 of 89% on room air.
Which intervention has the strongest evidence for improving outcomes?