Pediatric CCRN Exam Pediatric CCRN Sample 5 — Questions and Answers
Question 1: A 6-year-old on ECMO develops sudden loss of the ECMO flow waveform, circuit chattering, and hypotension. The nurse's first action should be:
- Increase vasopressor support immediately
- Clamp the ECMO circuit and notify the ECMO specialist (Correct answer)
- Increase ECMO RPM to restore flow
- Administer an IV fluid bolus of 20 mL/kg
Correct answer: Clamp the ECMO circuit and notify the ECMO specialist
Circuit chattering with flow loss suggests volume deficit or suction events; clamping the circuit and alerting the ECMO specialist prevents air entrainment and allows safe assessment.
Question 2: A 9-year-old with sickle cell disease presents with acute chest syndrome. Which set of interventions is most appropriate?
- Supplemental O2, IV hydration, analgesics, and exchange transfusion if severe (Correct answer)
- IV antibiotics alone, withholding fluids to prevent sickling
- Hydroxyurea loading dose and immediate plasmapheresis
- Aggressive diuresis and high-dose steroids
Correct answer: Supplemental O2, IV hydration, analgesics, and exchange transfusion if severe
Acute chest syndrome is managed with supplemental oxygen, careful hydration, analgesia, antibiotics, and exchange transfusion for severe hypoxemia.
Question 3: A 7-year-old post-operative Fontan procedure has a central venous pressure of 22 mmHg, low urine output, and hepatomegaly. The nurse suspects:
- Systemic ventricular failure with high filling pressures
- Fontan failure with elevated systemic venous pressure (Correct answer)
- Cardiac tamponade from pericardial effusion
- Superior vena cava syndrome from line malposition
Correct answer: Fontan failure with elevated systemic venous pressure
Elevated CVP, hepatomegaly, and oliguria after Fontan indicate elevated systemic venous pressures secondary to Fontan circuit obstruction or failure.
Question 4: A nurse is titrating norepinephrine for a child in septic shock. Which clinical endpoint best indicates adequate perfusion has been restored?
- MAP ≥ 65 mmHg in all age groups
- Age-appropriate MAP, capillary refill < 2 seconds, and normal urine output (1 mL/kg/hr) (Correct answer)
- SpO2 > 95% and heart rate normalization alone
- Lactate clearance ≥ 10% over 6 hours only
Correct answer: Age-appropriate MAP, capillary refill < 2 seconds, and normal urine output (1 mL/kg/hr)
Perfusion adequacy in pediatric septic shock is assessed with age-appropriate MAP targets, capillary refill time, and urine output, not a single adult threshold.
Question 5: A premature neonate has abdominal distension, bloody stools, and pneumatosis intestinalis on X-ray. These findings are consistent with:
- Hirschsprung disease with enterocolitis
- Necrotizing enterocolitis (NEC) (Correct answer)
- Meconium ileus from cystic fibrosis
- Malrotation with mid-gut volvulus
Correct answer: Necrotizing enterocolitis (NEC)
Pneumatosis intestinalis (air in the bowel wall) is pathognomonic for NEC, a life-threatening intestinal emergency in premature neonates.
Question 6: A 5-year-old is admitted after a near-drowning event and is initially alert. Two hours later, the child's respiratory status deteriorates and the chest X-ray shows bilateral infiltrates. This progression is most consistent with:
- Aspiration pneumonia from inhaled water
- Secondary drowning / neurogenic pulmonary edema (Correct answer)
- Delayed tension pneumothorax
- Flash pulmonary edema from hypothermia
Correct answer: Secondary drowning / neurogenic pulmonary edema
Secondary drowning (also called delayed drowning) occurs hours after the event as inhaled water causes surfactant washout and ARDS-like pulmonary edema.
Question 7: A child with Trisomy 21 (Down syndrome) is intubated in the PICU. The nurse should be aware that this population has a higher incidence of which airway-related complication?
- Subglottic stenosis requiring a larger ETT than predicted
- Atlantoaxial instability requiring cervical spine precautions (Correct answer)
- Laryngomalacia causing airway collapse on extubation
- Tracheomalacia causing post-extubation stridor
Correct answer: Atlantoaxial instability requiring cervical spine precautions
Up to 15% of children with Down syndrome have atlantoaxial instability; positioning and airway manipulation require cervical spine precautions to prevent cord injury.
Pediatric CCRN Exam Pediatric CCRN Sample 5
A 6-year-old on ECMO develops sudden loss of the ECMO flow waveform, circuit chattering, and hypotension.
The nurse's first action should be: