Pediatric CCRN Exam Study Guide 2026

Leukemia is a cancer of the blood-forming tissues, primarily originating in the bone marrow. While it can spread and affect organs rich in lymphatic tissue, such as the liver, spleen, and lymph nodes, the kidney is not a primary site of leukemia cell proliferation. Although leukemia can indirectly cause kidney damage through complications like tumor lysis syndrome, the kidney itself is not directly impacted as a tissue where leukemia typically originates or extensively infiltrates.

Cerebral edema is the most feared complication of pediatric DKA treatment, presenting with altered mental status hours into fluid resuscitation.

Amrinone lactate (Inocor) is a phosphodiesterase inhibitor that increases intracellular cyclic AMP (cAMP) in both cardiac and vascular smooth muscle cells. In the heart, this leads to increased contractility (positive inotropy). In vascular smooth muscle, increased cAMP causes relaxation, resulting in systemic and pulmonary vasodilation, which reduces afterload. This dual action improves cardiac output by both strengthening contractions and reducing the resistance the heart pumps against.

Chronic left-to-right shunting from a large VSD causes pulmonary hypertension; when pulmonary pressure exceeds systemic, Eisenmenger syndrome (reversal of shunt) develops.

CPP = MAP − ICP = 70 − 28 = 42 mmHg; adequate pediatric CPP should be maintained above 40–50 mmHg.

Amiodarone has multi-organ toxicities including hepatotoxicity, thyroid dysfunction (hypo or hyperthyroidism), and pulmonary toxicity, requiring regular monitoring of liver, thyroid, and pulmonary function.