Free AACN CCRN-Pediatric Practice Exam with Questions & Answers | Set: 3

Nitroprusside is used invasodilatory shockto reduce afterload andlower systemic vascular resistance (SVR). A persistently elevated SVR (normal: ~800–1200 dynes/sec/cm⁻⁵) indicatesineffective vasodilation, necessitating an increase in dosage to optimize cardiac output.

“SVR is an essential parameter in the management of septic shock. Nitroprusside is titrated to decrease SVR and improve tissue perfusion. A persistently high SVR suggests inadequate response to therapy.”

(Referenced from CCRN Pediatric – Direct Care: Cardiovascular Shock and Hemodynamic Monitoring)

The described symptoms indicateanticholinergic toxicity, which is classically associated with tricyclic antidepressant (TCA) overdose.Amitriptyline, a TCA, causesanticholinergic symptoms: tachycardia, dilated pupils, dry mucosa, urinary retention, altered mental status, and PVCs on ECG.

“TCA toxicity presents with anticholinergic signs—dry mouth, mydriasis, tachycardia, neurologic changes, and cardiac conduction abnormalities. Amitriptyline overdose is life-threatening and requires immediate supportive care and cardiac monitoring.”

(Referenced from CCRN Pediatric – Direct Care: Neurological Emergencies and Toxicology)

Diabetes insipidus (DI) results from insufficient antidiuretic hormone (ADH), leading to polyuria and dehydration. Management involves fluid replacement to correct volume loss and administration of vasopressin (or desmopressin) to replace deficient ADH.

“Central DI is treated with fluid resuscitation to manage hypovolemia and administration of vasopressin or desmopressin to reduce urinary losses and restore water balance.”

(Referenced from CCRN Pediatric – Direct Care: Endocrine, Water Balance Disorders)

Aldosterone is not indicated in the treatment of central DI. Restriction of fluids is contraindicated, as the patient is losing large volumes of free water.

Positive End-Expiratory Pressure (PEEP)helpskeep alveoli open at end-expiration, therebyincreasing functional residual capacityand improvinggas exchange. In aspiration-related lung injury, alveolar collapse and inflammation impair oxygenation, soPEEP is used to recruit alveoli and improve oxygenation.

“PEEP increases oxygenation by preventing alveolar collapse, especially important in aspiration pneumonitis and ARDS. It improves oxygen delivery while minimizing barotrauma.”

(Referenced from CCRN Pediatric – Direct Care: Pulmonary, Mechanical Ventilation Strategies)

The first step in any evidence-based practice (EBP) or quality improvement (QI) process is toclearly define the clinical problem or question. Before outcomes or interventions are addressed, the council mustdetermine the exact issue to be studied.

“In quality improvement and evidence-based practice, step one is always problem identification. A well-defined problem leads to targeted and effective research.”

(Referenced from CCRN Pediatric – Professional Caring and Ethical Practice: Evidence-Based Practice and QI Models)

Prerenal failureis caused by conditions that impairrenal perfusionwithout direct injury to the kidneys themselves.Septic shockleads to systemic vasodilation, hypotension, and decreased renal perfusion, making it a classic prerenal etiology.

“Prerenal causes of acute kidney injury (AKI) include any condition resulting in reduced renal blood flow. Septic shock is a common prerenal cause, where hypoperfusion leads to decreased glomerular filtration.”

(Referenced from CCRN Pediatric – Direct Care: Renal Dysfunction and Fluid Balance)

Bronchiolitis causeslower airway obstruction, air trapping, andhypoventilation. On chest radiographs,hypoinflation(low lung volumes) and peribronchial thickening are common. The ABG showsrespiratory acidosis and hypoxemia, consistent withbronchiolar obstructionand hypoinflation.

“In bronchiolitis, hypoinflation and peribronchial thickening are typical CXR findings. ABG shows respiratory acidosis with hypoxemia in severe cases requiring ventilation.”

(Referenced from CCRN Pediatric – Direct Care: Pulmonary, Bronchiolitis and Ventilatory Support)

Sickle cell anemiais strongly associated withpediatric stroke, especially in children with HbSS. Sickled red cells can occlude cerebral vessels, leading toischemic strokes—often presenting withfocal deficits, such as hemiparesis or speech changes.

“Children with sickle cell anemia are at significantly increased risk for ischemic stroke. Stroke is a major neurologic complication, particularly in those with prior vaso-occlusive episodes.”

(Referenced from CCRN Pediatric – Direct Care: Neurological, Hemoglobinopathies and Stroke Risk)

The first step in quality improvement or post-event evaluation—such as after a disaster drill—is tosystematically identify all problems or deviationsfrom expected protocols. Only once the problems are fully defined canroot causes be analyzedand process improvement initiated.

“After-action reviews following drills or emergencies should begin with problem identification. Comprehensive review and categorization of issues precede root cause analysis and protocol modification.”

(Referenced from CCRN Pediatric – Professional Caring and Ethical Practice: Systems-Based Practice and Quality Improvement)

In BPD, the lungs are already injured and prone tovolutrauma and barotrauma. Ventilator strategies often include“gentle ventilation”withlower tidal volumesandpermissive hypercapniato reduce lung injury. This accepts slightly elevated CO₂ levels to avoid high pressures.

“Permissive hypercapnia is a lung-protective strategy used in infants with BPD to minimize ventilator-induced injury. Target PaCO₂ levels are allowed to be mildly elevated as long as pH is maintained.”

(Referenced from CCRN Pediatric – Direct Care: Pulmonary, Chronic Lung Disease Management)