Pediatric CCRN Exam Pediatric CCRN Ultimate 4 — Questions and Answers
Question 1: A 9-year-old with severe TBI has an ICP of 28 mmHg and 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; therefore 70 − 28 = 42 mmHg, which is below the recommended minimum of 50–60 mmHg in pediatric TBI.
Question 2: Which clinical finding is the EARLIEST sign of increasing intracranial pressure in a child?
- Fixed and dilated pupils
- Cushing's triad (bradycardia, hypertension, irregular respirations)
- Altered level of consciousness and irritability (Correct answer)
- Decorticate posturing
Correct answer: Altered level of consciousness and irritability
Altered LOC and irritability are early signs of elevated ICP; Cushing's triad and fixed pupils are late, often pre-terminal findings.
Question 3: A 5-year-old with bacterial meningitis develops a generalized tonic-clonic seizure lasting 4 minutes. Which drug should be administered FIRST?
- Phenytoin 20 mg/kg IV load
- Lorazepam 0.1 mg/kg IV (Correct answer)
- Levetiracetam 60 mg/kg IV
- Phenobarbital 20 mg/kg IV
Correct answer: Lorazepam 0.1 mg/kg IV
Benzodiazepines (lorazepam IV) are the first-line treatment for acute seizures per PALS and most pediatric status epilepticus guidelines.
Question 4: A 12-year-old after a near-drowning has a GCS of 6. Which GCS subscores produce this total?
- Eye 1, Verbal 2, Motor 3
- Eye 2, Verbal 1, Motor 3
- Eye 1, Verbal 3, Motor 2
- Eye 2, Verbal 2, Motor 2 (Correct answer)
Correct answer: Eye 2, Verbal 2, Motor 2
Eye 2 + Verbal 2 + Motor 2 = 6; any combination totaling 6 is valid, but 2+2+2 is a common testing scenario reflecting severe impairment in all domains.
Question 5: Which intervention is CONTRAINDICATED in a child with suspected increased intracranial pressure and an intact airway?
- Elevating the head of bed to 30 degrees
- Administering hyperosmolar therapy (3% saline)
- Performing a lumbar puncture immediately (Correct answer)
- Maintaining normocapnia on mechanical ventilation
Correct answer: Performing a lumbar puncture immediately
Lumbar puncture is contraindicated with elevated ICP because sudden CSF drainage can cause transtentorial herniation.
Question 6: A 3-year-old with a VP shunt presents with vomiting, sunset sign, and irritability. Which action is MOST appropriate?
- Reassure parents; symptoms are normal with VP shunts
- Obtain a STAT CT head and notify neurosurgery (Correct answer)
- Administer anti-emetics and observe for 2 hours
- Place the child supine in Trendelenburg position to increase shunt flow
Correct answer: Obtain a STAT CT head and notify neurosurgery
Sunset sign, vomiting, and irritability suggest VP shunt malfunction with raised ICP, requiring urgent neuroimaging and neurosurgical evaluation.
Question 7: Which medication is used as a second-line osmotic agent for refractory elevated ICP when mannitol has already been given?
- Dextrose 50% IV bolus
- Hypertonic saline (3% NaCl) (Correct answer)
- Furosemide 1 mg/kg IV
- Albumin 5% infusion
Correct answer: Hypertonic saline (3% NaCl)
Hypertonic saline is the preferred second-line osmotic agent for elevated ICP, particularly effective when mannitol has been used or the patient is hypovolemic.
Pediatric CCRN Exam Pediatric CCRN Ultimate 4
A 9-year-old with severe TBI has an ICP of 28 mmHg and MAP of 70 mmHg.
What is the cerebral perfusion pressure (CPP)?