Peds CCRN Review Questions (from AACN)
PEEP is intended to do which of the following?
A. Improve ventilation/perfusion matching
B. Decrease functional residual capacity
C. Increased venous return to the heart
D. Increased cardiac output - ✅✅-A. Improve ventilation/perfusion matching
- PEEP increases alveolar volume, thereby improving ventilation/perfusion matching
and increasing functional residual capacity.
- A detrimental effect of PEEP (especially at high levels) is a decrease in venous return
to the heart and a subsequent decrease in cardiac output.
In an infant with sepsis, factors that impair the release of oxygen by negatively
affecting oxyhemoglobin dissociation include:
A. Hyperthermia
B. Metabolic acidosis
C. Respiratory acidosis
D. Hypothermia - ✅✅-D. Hypothermia
- To answer this question, you must consider the factors that would cause a left shift of
the oxyhemoglobin curve.
- Hypothermia, decreased CO2, and increased pH (alkalosis) would all cause a left shift.
- Hyperthermia and acidosis would cause a right shift of the curve
In which condition might you observe a decreased V/Q ratio (<0.8)?
A. Status asthmaticus
B. Sepsis
C. Pulmonary emboli
D. Tricuspid atresia - ✅✅-A. Status asthmaticus
- A V/Q ratio of <0.8 is indicative of perfusion exceeding ventilation. Air trapping from
diseases such as asthma is a common cause of this scenario
Factors such as small nostrils, larger tongue, and narrower airways in an infant....
,Peds CCRN Review Questions (from AACN)
A. Decrease airway resistance
B. Make intubation easier
C. Increase airway resistance
D. Improve airway obstruction - ✅✅-C. Increase airway resistance
- There are a number of factors that increase airway resistance and obstruction in
young infants, including their larger heads and tongues, smaller nostrils, decreased
muscle tone, and narrower airways.
- Intubation is more difficult because of an
anterior larynx and narrow cricoid ring.
Indications that a patient is ready to wean from mechanical ventilation include:
A. Hemodynamic instability
B. Adequate cough and gag reflexes
C. Persistent coma
D. PEEP > 8 - ✅✅-B. Adequate cough and gag reflexes
- Before being extubated, a child needs to have an adequate level of consciousness to
protect his or her airway. This includes having an adequate cough and gag;
hemodynamic stability (not instability); and a PEEP <5, with an oxygen requirement
generally
less than an FiO2 of 0.4.
A toddler who was found unresponsive in a swimming pool is in respiratory distress. On
chest x-ray you see bilateral infiltrates and the PaO2/FiO2 ratio is 190.
These findings suggest:
A. Aspiration pneumonia
B. Viral pneumonia
C. Acute respiratory distress syndrome
D. Pneumothorax - ✅✅-C. Acute respiratory distress syndrome
- This child has signs of acute respiratory distress syndrome (ARDS), which include
bilateral infiltrates on chest x-ray, PaO2/FiO2 ratio <200, and pulmonary edema, among
other things.
- Both aspiration and viral pneumonia may lead to ARDS, but that's not the correct
answer for this question.
- The symptoms described are not
,Peds CCRN Review Questions (from AACN)
consistent with a pneumothorax.
An infant with bronchiolitis is intubated due to an acute respiratory failure.
Post-intubation ABG results demonstrate:
pH 7.22
PaCO2 62
PaO2 75
HCO3 22
O2 sat 90%
This blood gas reflects:
A. Metabolic acidosis
B. Respiratory acidosis
C. Metabolic alkalosis
D. Respiratory alkalosis - ✅✅-B. Respiratory acidosis
This child's blood gas results include a decreased pH and an increase in PaCO2 —
both of which indicate a state of respiratory acidosis.
An intubated, mechanically ventilated patient has a sudden decrease in SpO2 from 95%
to 78%, and the ventilator is alarming high peak pressures. Your first intervention is to:
A. Increase the FiO2 and ventilator rate
B. Assess the patency of the endotracheal tube
C. Administer a neuromuscular blocking agent
D. Prepare to reposition the endotracheal tube - ✅✅-B. Assess the patency of the
endotracheal tube
- Your first priority is assessing the patency of the ETT.
- Once you have confirmed whether the tube is or is not patent, that will help to direct
your next interventions.
- The alarms for high peak pressure may indicate that the ETT is kinked or blocked with
secretions.
The most important intervention when caring for the patient with epiglottitis and who is
in significant respiratory distress is to:
A. Keep the child quiet and comfortable
, Peds CCRN Review Questions (from AACN)
B. Administer racemic epinephrine
C. Place the child in a supine position
D. Administer antibiotics - ✅✅-A. Keep the child quiet and comfortable
- The goal is to keep the child quiet, comfortable, and in whatever position that allows
them to maintain their own airway until a skilled provider who can control the airway is
present and ready to do so.
- Racemic epinephrine might be helpful for the patient with croup
- Although the patient with epiglottitis needs antibiotics, that's not the priority intervention
until the airway is secure.
Which of the following is the first action to take in the case of a patient with a
suspected tension pneumothorax?
A. Assess blood pressure
B. Prepare for intubation
C. Obtain a chest radiograph
D. Prepare for needle thoracostomy - ✅✅-D. Prepare for needle thoracostomy
Tension pneumothorax is an emergency requiring needle decompression. The child will
require monitoring of vital signs during the procedure and an x-ray post-procedure. The
need for intubation will be determined based on the child's clinical exam
following evacuation of the tension pneumothorax.
For a patient with status asthmaticus, chest x-ray will reveal:
A. Perihilar infiltration
B. Hyperinflation
C. Foreign body aspiration
D. An elevated diaphragm - ✅✅-B. Hyperinflation
Remembering that air "trapping" is a common phenomenon in status asthmatics, you
would anticipate seeing hyperinflation on this x-ray.
A term newborn develops difficulty breathing and cyanosis. The nurse has difficulty
hearing breath sounds and notes the baby has a scaphoid abdomen.
Which should the nurse suspect?
A. Tracheoesophageal fistula
B. Diaphragmatic hernia
PEEP is intended to do which of the following?
A. Improve ventilation/perfusion matching
B. Decrease functional residual capacity
C. Increased venous return to the heart
D. Increased cardiac output - ✅✅-A. Improve ventilation/perfusion matching
- PEEP increases alveolar volume, thereby improving ventilation/perfusion matching
and increasing functional residual capacity.
- A detrimental effect of PEEP (especially at high levels) is a decrease in venous return
to the heart and a subsequent decrease in cardiac output.
In an infant with sepsis, factors that impair the release of oxygen by negatively
affecting oxyhemoglobin dissociation include:
A. Hyperthermia
B. Metabolic acidosis
C. Respiratory acidosis
D. Hypothermia - ✅✅-D. Hypothermia
- To answer this question, you must consider the factors that would cause a left shift of
the oxyhemoglobin curve.
- Hypothermia, decreased CO2, and increased pH (alkalosis) would all cause a left shift.
- Hyperthermia and acidosis would cause a right shift of the curve
In which condition might you observe a decreased V/Q ratio (<0.8)?
A. Status asthmaticus
B. Sepsis
C. Pulmonary emboli
D. Tricuspid atresia - ✅✅-A. Status asthmaticus
- A V/Q ratio of <0.8 is indicative of perfusion exceeding ventilation. Air trapping from
diseases such as asthma is a common cause of this scenario
Factors such as small nostrils, larger tongue, and narrower airways in an infant....
,Peds CCRN Review Questions (from AACN)
A. Decrease airway resistance
B. Make intubation easier
C. Increase airway resistance
D. Improve airway obstruction - ✅✅-C. Increase airway resistance
- There are a number of factors that increase airway resistance and obstruction in
young infants, including their larger heads and tongues, smaller nostrils, decreased
muscle tone, and narrower airways.
- Intubation is more difficult because of an
anterior larynx and narrow cricoid ring.
Indications that a patient is ready to wean from mechanical ventilation include:
A. Hemodynamic instability
B. Adequate cough and gag reflexes
C. Persistent coma
D. PEEP > 8 - ✅✅-B. Adequate cough and gag reflexes
- Before being extubated, a child needs to have an adequate level of consciousness to
protect his or her airway. This includes having an adequate cough and gag;
hemodynamic stability (not instability); and a PEEP <5, with an oxygen requirement
generally
less than an FiO2 of 0.4.
A toddler who was found unresponsive in a swimming pool is in respiratory distress. On
chest x-ray you see bilateral infiltrates and the PaO2/FiO2 ratio is 190.
These findings suggest:
A. Aspiration pneumonia
B. Viral pneumonia
C. Acute respiratory distress syndrome
D. Pneumothorax - ✅✅-C. Acute respiratory distress syndrome
- This child has signs of acute respiratory distress syndrome (ARDS), which include
bilateral infiltrates on chest x-ray, PaO2/FiO2 ratio <200, and pulmonary edema, among
other things.
- Both aspiration and viral pneumonia may lead to ARDS, but that's not the correct
answer for this question.
- The symptoms described are not
,Peds CCRN Review Questions (from AACN)
consistent with a pneumothorax.
An infant with bronchiolitis is intubated due to an acute respiratory failure.
Post-intubation ABG results demonstrate:
pH 7.22
PaCO2 62
PaO2 75
HCO3 22
O2 sat 90%
This blood gas reflects:
A. Metabolic acidosis
B. Respiratory acidosis
C. Metabolic alkalosis
D. Respiratory alkalosis - ✅✅-B. Respiratory acidosis
This child's blood gas results include a decreased pH and an increase in PaCO2 —
both of which indicate a state of respiratory acidosis.
An intubated, mechanically ventilated patient has a sudden decrease in SpO2 from 95%
to 78%, and the ventilator is alarming high peak pressures. Your first intervention is to:
A. Increase the FiO2 and ventilator rate
B. Assess the patency of the endotracheal tube
C. Administer a neuromuscular blocking agent
D. Prepare to reposition the endotracheal tube - ✅✅-B. Assess the patency of the
endotracheal tube
- Your first priority is assessing the patency of the ETT.
- Once you have confirmed whether the tube is or is not patent, that will help to direct
your next interventions.
- The alarms for high peak pressure may indicate that the ETT is kinked or blocked with
secretions.
The most important intervention when caring for the patient with epiglottitis and who is
in significant respiratory distress is to:
A. Keep the child quiet and comfortable
, Peds CCRN Review Questions (from AACN)
B. Administer racemic epinephrine
C. Place the child in a supine position
D. Administer antibiotics - ✅✅-A. Keep the child quiet and comfortable
- The goal is to keep the child quiet, comfortable, and in whatever position that allows
them to maintain their own airway until a skilled provider who can control the airway is
present and ready to do so.
- Racemic epinephrine might be helpful for the patient with croup
- Although the patient with epiglottitis needs antibiotics, that's not the priority intervention
until the airway is secure.
Which of the following is the first action to take in the case of a patient with a
suspected tension pneumothorax?
A. Assess blood pressure
B. Prepare for intubation
C. Obtain a chest radiograph
D. Prepare for needle thoracostomy - ✅✅-D. Prepare for needle thoracostomy
Tension pneumothorax is an emergency requiring needle decompression. The child will
require monitoring of vital signs during the procedure and an x-ray post-procedure. The
need for intubation will be determined based on the child's clinical exam
following evacuation of the tension pneumothorax.
For a patient with status asthmaticus, chest x-ray will reveal:
A. Perihilar infiltration
B. Hyperinflation
C. Foreign body aspiration
D. An elevated diaphragm - ✅✅-B. Hyperinflation
Remembering that air "trapping" is a common phenomenon in status asthmatics, you
would anticipate seeing hyperinflation on this x-ray.
A term newborn develops difficulty breathing and cyanosis. The nurse has difficulty
hearing breath sounds and notes the baby has a scaphoid abdomen.
Which should the nurse suspect?
A. Tracheoesophageal fistula
B. Diaphragmatic hernia
