Pediatric CCRN Exam Pediatric CCRN Ultimate 3 — Questions and Answers
Question 1: A 4-year-old on mechanical ventilation has a plateau pressure of 32 cmH₂O and peak pressure of 48 cmH₂O. What does the difference indicate?
- Decreased lung compliance
- Increased airway resistance (Correct answer)
- Appropriate PEEP level
- Endotracheal tube occlusion
Correct answer: Increased airway resistance
A large gradient between peak and plateau pressure reflects high airway resistance, commonly caused by bronchospasm, secretions, or a kinked ETT.
Question 2: A 7-year-old with RSV bronchiolitis has an SpO2 of 88% on 2 L/min nasal cannula and increased work of breathing. What is the BEST next step?
- Administer nebulized albuterol immediately
- Trial high-flow nasal cannula (HFNC) therapy (Correct answer)
- Proceed directly to endotracheal intubation
- Administer IV corticosteroids and reassess in 1 hour
Correct answer: Trial high-flow nasal cannula (HFNC) therapy
HFNC reduces work of breathing, improves oxygenation, and can avert the need for intubation in moderate bronchiolitis.
Question 3: A mechanically ventilated child has a sudden drop in SpO2 with right-sided breath sounds absent. Which immediate action is CORRECT?
- Increase FiO2 to 1.0 and call pharmacy for albuterol
- Suction the endotracheal tube for secretions
- Withdraw the ETT 1–2 cm and reassess breath sounds (Correct answer)
- Obtain a STAT chest X-ray before any intervention
Correct answer: Withdraw the ETT 1–2 cm and reassess breath sounds
Unilateral absent breath sounds after intubation suggest right mainstem bronchus intubation; withdrawing the ETT slightly should restore bilateral ventilation.
Question 4: Which arterial blood gas pattern is consistent with acute respiratory acidosis in a pediatric patient?
- pH 7.52, PaCO2 28, HCO3 22
- pH 7.28, PaCO2 58, HCO3 25 (Correct answer)
- pH 7.35, PaCO2 60, HCO3 32
- pH 7.48, PaCO2 38, HCO3 28
Correct answer: pH 7.28, PaCO2 58, HCO3 25
Acute respiratory acidosis shows a low pH with elevated PaCO2 and a normal or minimally elevated bicarbonate (no time for metabolic compensation).
Question 5: A 2-year-old with epiglottitis arrives in significant respiratory distress. Which action takes highest priority?
- Obtain a lateral neck X-ray immediately in the PICU
- Allow the child to remain in a position of comfort and prepare for controlled intubation in the OR (Correct answer)
- Place a nasopharyngeal airway and start IV antibiotics
- Apply a non-rebreather mask and perform laryngoscopy at bedside
Correct answer: Allow the child to remain in a position of comfort and prepare for controlled intubation in the OR
Epiglottitis airway management is safest in the OR with anesthesia and ENT present; agitating the child can precipitate complete obstruction.
Question 6: In a child with ARDS, which ventilator strategy is associated with improved survival?
- High tidal volumes (12 mL/kg IBW) to prevent atelectasis
- Lung-protective ventilation with tidal volumes of 4–6 mL/kg IBW (Correct answer)
- Permissive hypocapnia to reduce PaCO2 below 35 mmHg
- Zero PEEP to minimize barotrauma
Correct answer: Lung-protective ventilation with tidal volumes of 4–6 mL/kg IBW
Lung-protective ventilation using low tidal volumes (4–6 mL/kg IBW) reduces volutrauma and barotrauma, improving survival in ARDS.
Question 7: A pediatric patient on mechanical ventilation develops a sudden decrease in compliance, tracheal deviation, and absent breath sounds on the left. Which intervention is IMMEDIATELY required?
- Bolus IV methylprednisolone 2 mg/kg
- Needle decompression of the left chest (Correct answer)
- Urgent chest physiotherapy
- Reposition the endotracheal tube to the right mainstem
Correct answer: Needle decompression of the left chest
Absent breath sounds, tracheal deviation, and decreased compliance indicate tension pneumothorax requiring immediate needle decompression.
Pediatric CCRN Exam Pediatric CCRN Ultimate 3
A 4-year-old on mechanical ventilation has a plateau pressure of 32 cmH₂O and peak pressure of 48 cmH₂O.
What does the difference indicate?