Pediatric CCRN Exam Pediatric CCRN Ultimate 5 — Questions and Answers
Question 1: A 6-year-old with septic shock has received 60 mL/kg of isotonic crystalloid with persistent hypotension. Which vasoactive agent is FIRST-LINE?
- Vasopressin 0.03 units/kg/min
- Norepinephrine infusion
- Dopamine or epinephrine titrated to effect (Correct answer)
- Phenylephrine infusion
Correct answer: Dopamine or epinephrine titrated to effect
PALS guidelines recommend dopamine or epinephrine (depending on whether shock is warm or cold) as first-line vasoactive agents for fluid-refractory pediatric septic shock.
Question 2: A 4-year-old with acute kidney injury has a urine output of 0.3 mL/kg/hr for the past 8 hours. Which BEST describes this finding?
- Normal urine output for a preschooler
- Oliguria — consistent with AKI (Correct answer)
- Polyuria — suggests diabetes insipidus
- Acceptable only if the child is fluid restricted
Correct answer: Oliguria — consistent with AKI
Normal urine output for children is 1–2 mL/kg/hr; output below 0.5 mL/kg/hr for more than 6–8 hours defines oliguria and indicates AKI.
Question 3: A 10-year-old with new-onset Type 1 diabetes is admitted in DKA with a glucose of 520 mg/dL and pH 7.15. What is the MOST dangerous complication to monitor for during treatment?
- Hypoglycemia from insulin administration
- Cerebral edema (Correct answer)
- Hyperkalemia from insulin therapy
- Pulmonary edema from fluid overload
Correct answer: Cerebral edema
Cerebral edema is the most feared and potentially fatal complication of pediatric DKA treatment, occurring in 0.5–1% of cases during rehydration.
Question 4: A 2-year-old ingests a large amount of acetaminophen. Which antidote is indicated and by what route?
- Activated charcoal administered IV within 1 hour
- N-acetylcysteine (NAC) administered orally or IV (Correct answer)
- Naloxone 0.1 mg/kg IV push
- Flumazenil 0.01 mg/kg IV
Correct answer: N-acetylcysteine (NAC) administered orally or IV
N-acetylcysteine replenishes glutathione stores, preventing hepatotoxicity from acetaminophen overdose and is most effective within 8 hours of ingestion.
Question 5: A pediatric patient on heparin infusion develops thrombocytopenia with new arterial clots. Which condition should the nurse suspect?
- Immune thrombocytopenic purpura (ITP)
- Heparin-induced thrombocytopenia (HIT) (Correct answer)
- Disseminated intravascular coagulation (DIC)
- Thrombotic thrombocytopenic purpura (TTP)
Correct answer: Heparin-induced thrombocytopenia (HIT)
HIT is characterized by a 50% or greater drop in platelets occurring 5–10 days after heparin initiation, paradoxically causing thrombosis.
Question 6: A 5-year-old with adrenal insufficiency in the PICU is found unresponsive with hypoglycemia and hypotension. Which intervention is MOST critical?
- Administer IV dextrose 10% bolus only
- Give high-dose IV hydrocortisone (stress dose steroids) (Correct answer)
- Start vasopressin infusion and obtain cortisol level
- Administer fludrocortisone orally
Correct answer: Give high-dose IV hydrocortisone (stress dose steroids)
Adrenal crisis requires immediate stress-dose hydrocortisone (50–100 mg/m²/day IV) to restore cortisol, which is essential for hemodynamic stability and glucose regulation.
Question 7: A 7-year-old with burns covering 40% TBSA is in the acute resuscitation phase. Using the Parkland formula, how much fluid should be given in the FIRST 8 hours?
- 25% of the total 24-hour calculated volume
- 50% of the total 24-hour calculated volume (Correct answer)
- 75% of the total 24-hour calculated volume
- 100% of the total 24-hour volume as a bolus
Correct answer: 50% of the total 24-hour calculated volume
The Parkland formula gives 4 mL/kg/% TBSA burned over 24 hours, with 50% administered in the first 8 hours and the remaining 50% over the next 16 hours.
Pediatric CCRN Exam Pediatric CCRN Ultimate 5
A 6-year-old with septic shock has received 60 mL/kg of isotonic crystalloid with persistent hypotension.
Which vasoactive agent is FIRST-LINE?