Pediatric CCRN Exam Pediatric CCRN Ultimate 2 — Questions and Answers
Question 1: A 3-year-old with Tetralogy of Fallot develops a hypercyanotic ('Tet') spell. Which intervention is the PRIORITY?
- Place the child in knee-chest position (Correct answer)
- Administer 100% oxygen via non-rebreather mask
- Give IV adenosine 0.1 mg/kg
- Initiate immediate synchronized cardioversion
Correct answer: Place the child in knee-chest position
Knee-chest position increases systemic vascular resistance, reducing right-to-left shunting and improving pulmonary blood flow during a Tet spell.
Question 2: A 6-month-old post-operative Norwood procedure has a central venous saturation of 40%. What does this finding indicate?
- Adequate oxygen delivery to tissues
- Imbalance between oxygen delivery and consumption (Correct answer)
- Normal finding for single-ventricle physiology
- Pulmonary over-circulation
Correct answer: Imbalance between oxygen delivery and consumption
An SvO2 below 50–55% in a single-ventricle patient indicates that oxygen consumption is outpacing delivery, signaling hemodynamic compromise.
Question 3: Which electrocardiographic finding is most consistent with hyperkalemia in a pediatric patient?
- Prolonged QT interval
- Delta waves with shortened PR interval
- Tall, peaked T waves with widened QRS (Correct answer)
- ST-segment depression with U waves
Correct answer: Tall, peaked T waves with widened QRS
Hyperkalemia classically causes tall peaked T waves, widened QRS complexes, and ultimately a sine-wave pattern as potassium rises.
Question 4: A 10-year-old with dilated cardiomyopathy has a cardiac index of 1.7 L/min/m². Which medication is MOST appropriate to increase cardiac output?
- Metoprolol
- Milrinone (Correct answer)
- Digoxin loading dose IV
- Nifedipine
Correct answer: Milrinone
Milrinone is a phosphodiesterase inhibitor that increases cardiac contractility and reduces afterload without increasing myocardial oxygen demand significantly.
Question 5: A neonate with transposition of the great arteries (TGA) is awaiting surgery. Which intervention maintains ductal patency?
- Indomethacin infusion
- Prostaglandin E1 (alprostadil) infusion (Correct answer)
- High-flow oxygen therapy
- Furosemide bolus
Correct answer: Prostaglandin E1 (alprostadil) infusion
PGE1 infusion maintains ductal patency, allowing mixing of oxygenated and deoxygenated blood until corrective surgery can be performed.
Question 6: A child post-cardiac surgery develops jugular venous distension, muffled heart sounds, and hypotension. Which condition should the nurse suspect FIRST?
- Tension pneumothorax
- Cardiac tamponade (Correct answer)
- Pulmonary embolism
- Cardiogenic shock from graft failure
Correct answer: Cardiac tamponade
Beck's triad (JVD, muffled heart sounds, hypotension) is classic for cardiac tamponade, a life-threatening emergency requiring immediate pericardiocentesis.
Question 7: When calculating a safe defibrillation dose for a pediatric patient in ventricular fibrillation, which is correct per current PALS guidelines?
- 1 J/kg for the first shock, 0.5 J/kg for subsequent shocks
- 2 J/kg for the first shock, 4 J/kg for subsequent shocks (Correct answer)
- 4 J/kg for all shocks regardless of response
- 10 J/kg maximum for the first shock
Correct answer: 2 J/kg for the first shock, 4 J/kg for subsequent shocks
PALS recommends starting defibrillation at 2 J/kg, then escalating to 4 J/kg for subsequent shocks if the initial shock is unsuccessful.
Pediatric CCRN Exam Pediatric CCRN Ultimate 2
A 3-year-old with Tetralogy of Fallot develops a hypercyanotic ('Tet') spell.
Which intervention is the PRIORITY?