Pediatric CCRN Exam Questions With Correct Answers
Latest 2024
3 causes for Fetal shunt closure
1. increase in aterial oxygen tension
2. decreased prostaglandins
3. decreased adenosine levels
When does the Ductus Arteriosus close?
within 10-24 hours of birth
When does the Foramen Ovale Close?
When LA pressure exceeds RA pressure (can stay open for 6mo to a year)
What does Cardiac Output measure?
Efficiency of the heart
Cardiac Output is the measure of what?
Volume of blood pumped by the heart in one minute
How is cardiac output calculated?
Stroke volume x heart rate
Define Preload
Elasticity of the heart when the ventricles are at max fill
Two factors contributing to DECREASE in preload
1. dehydration
2. vasodilation
Define Afterload
Resistant force that the ventricles must pump against. Work that the ventricles must
do to push blood through the aorta into the periphery of the body
Define Contractility
The amount of force exerted by the heart with each contraction
Name one factor that decreases contractility in the heart
hypoxemia
How does dopamine affect heart function
increases contractility and stroke volume
Describe the conduction pathway of the heart
SA node - Atrium - AV node - Bundle of His - Ventricle - Purkinje Fibers
Define Chronic Heart Failure
The hearts inability to pump oxygenated blood to the body due to abnormalities in
the heart and other areas of the body. Contributing to edema, resp. distress, activity
intolerance, and growth failure
Name 2 compensatory mechanisms of Chronic Heart Failure
1. Activation of the Sympathetic Nervous System
2. Cardiac reserve; i.e. hypertrophy and dilation of cardiac muscle
Describe Right Sided Heart Failure
RV is unable to pump blood efficiently into the Pulmonary artery, so blood backs up
into veins and periphery of body
Describe Left Sided Heart Failure
LV is unable to effectively pump blood into aorta and out into body, so blood backs
up into pulmonary outlets and increases pressure in LA
Name 3 causes of Chronic Heart Failure in Children
,1. Structural Abnormalities
2. Failure of the heart muscle
3. excessive demands on normal heart muscle
List Manifestations of Impaired Myocardial function
1. tachycardia
2. Sweating
2. Decreased UOP
3. fatigue
4. anorexia
5. decrease interest in activities
6. cardiomegaly
7. pale/cool extremities
8. decreased BP
List manifestations of Right Sided Heart Failure
1. weight gain
2. edema
3. hepatomegaly
4. ascites
5. distended neck veins
List manifestations of Left Sided Heart Failure
1. Tachycardia
2. dyspnia
3. Activity intolerance
4. persistent cough
5. cyanosis
6. wheezing/grunting
7. orthopnea
What are treatment goals for heart failure
1. remove excess fluid
2. improve cardiac function
3. reduce respiratory distress
4. decrease cardiac demand
What is the difference between Hypoxemia and hypoxia
Hypoxemia is a measurable lab value in which the arterial oxygen tension is below
normal and can be measured by arterial O2 sats or Pa02, while hypoxia is the
decrease in tissue oxygenation resulting from low saturation levels
Clinical manifestations of hypoxemia
-clubbing
-polycythemia
-fatigue w/ feeding
-poor weight gain
-squatting
-dyspnea
-tachypnea
What are measures to manage Hypoxemia?
-O2
-prevent dehydration and monitor fluid status
-daily weights
-assess resp. status closely
-prevent infection
, List the 4 main manifestations of Shock
1. circulatory failure
2. Metabolic acidosis
3. hypotension
4. hypoxemia
Describe the picture of Compensated Shock
1. Shunting occurs due to sympathetic activation
2. BP is normal initially
3. cool clammy skin/poor perfusion to periphery
4. decreased bowel sounds
5. decreased urine output
6. lactic acid build-up
Describe the picture of Uncompensated Shock
1. Body is unable to compensate and supply blood to microvasculature
2. hypotension
3. tacypnea
4. tachycardia
5. mental status change
6. increased BUN and Creatinine
7. Liver enzymes increase
8. DIC
Define Cardiogenic shock
A decrease in cardiac output and in increase in systemic vascular resistance caused
by in increase in afterload and an decrease in contractility
What is the most common cause of cardiogenic shock in pediatrics?
Chronic Heart Failure
What is the most common type of shock in pediatric populations
hypovolemic shock
What is the main difference between cardiogenic shock and hypovolemic
shock?
There is no change in contractility with hypovolemic shock like there is with
cardiogenic shock and hypovolemic shock also has a decrease in preload
What percent of intravascular body is lost with hypovolemic shock?
15-25%
Give two causes of obstructuve shock
tension pneumo or pulmonary emboli
Define obstructive shock
Severe obstructive to filling or outflow of ventricles
Describe Distributive Shock
decrease in SVR or blood shunting past capillary beds
Name the main mediators in Anaphylactic shock
IgE
histamine
seratonin
bradykinin
PGE
Define Neurogenic Shoick
Vascular muscle tone controlled by sympathetic vasomotor system is lost, and
extreme vasodilation occurs
Most common cause of sudden cardiac death in young healthy athletes
Latest 2024
3 causes for Fetal shunt closure
1. increase in aterial oxygen tension
2. decreased prostaglandins
3. decreased adenosine levels
When does the Ductus Arteriosus close?
within 10-24 hours of birth
When does the Foramen Ovale Close?
When LA pressure exceeds RA pressure (can stay open for 6mo to a year)
What does Cardiac Output measure?
Efficiency of the heart
Cardiac Output is the measure of what?
Volume of blood pumped by the heart in one minute
How is cardiac output calculated?
Stroke volume x heart rate
Define Preload
Elasticity of the heart when the ventricles are at max fill
Two factors contributing to DECREASE in preload
1. dehydration
2. vasodilation
Define Afterload
Resistant force that the ventricles must pump against. Work that the ventricles must
do to push blood through the aorta into the periphery of the body
Define Contractility
The amount of force exerted by the heart with each contraction
Name one factor that decreases contractility in the heart
hypoxemia
How does dopamine affect heart function
increases contractility and stroke volume
Describe the conduction pathway of the heart
SA node - Atrium - AV node - Bundle of His - Ventricle - Purkinje Fibers
Define Chronic Heart Failure
The hearts inability to pump oxygenated blood to the body due to abnormalities in
the heart and other areas of the body. Contributing to edema, resp. distress, activity
intolerance, and growth failure
Name 2 compensatory mechanisms of Chronic Heart Failure
1. Activation of the Sympathetic Nervous System
2. Cardiac reserve; i.e. hypertrophy and dilation of cardiac muscle
Describe Right Sided Heart Failure
RV is unable to pump blood efficiently into the Pulmonary artery, so blood backs up
into veins and periphery of body
Describe Left Sided Heart Failure
LV is unable to effectively pump blood into aorta and out into body, so blood backs
up into pulmonary outlets and increases pressure in LA
Name 3 causes of Chronic Heart Failure in Children
,1. Structural Abnormalities
2. Failure of the heart muscle
3. excessive demands on normal heart muscle
List Manifestations of Impaired Myocardial function
1. tachycardia
2. Sweating
2. Decreased UOP
3. fatigue
4. anorexia
5. decrease interest in activities
6. cardiomegaly
7. pale/cool extremities
8. decreased BP
List manifestations of Right Sided Heart Failure
1. weight gain
2. edema
3. hepatomegaly
4. ascites
5. distended neck veins
List manifestations of Left Sided Heart Failure
1. Tachycardia
2. dyspnia
3. Activity intolerance
4. persistent cough
5. cyanosis
6. wheezing/grunting
7. orthopnea
What are treatment goals for heart failure
1. remove excess fluid
2. improve cardiac function
3. reduce respiratory distress
4. decrease cardiac demand
What is the difference between Hypoxemia and hypoxia
Hypoxemia is a measurable lab value in which the arterial oxygen tension is below
normal and can be measured by arterial O2 sats or Pa02, while hypoxia is the
decrease in tissue oxygenation resulting from low saturation levels
Clinical manifestations of hypoxemia
-clubbing
-polycythemia
-fatigue w/ feeding
-poor weight gain
-squatting
-dyspnea
-tachypnea
What are measures to manage Hypoxemia?
-O2
-prevent dehydration and monitor fluid status
-daily weights
-assess resp. status closely
-prevent infection
, List the 4 main manifestations of Shock
1. circulatory failure
2. Metabolic acidosis
3. hypotension
4. hypoxemia
Describe the picture of Compensated Shock
1. Shunting occurs due to sympathetic activation
2. BP is normal initially
3. cool clammy skin/poor perfusion to periphery
4. decreased bowel sounds
5. decreased urine output
6. lactic acid build-up
Describe the picture of Uncompensated Shock
1. Body is unable to compensate and supply blood to microvasculature
2. hypotension
3. tacypnea
4. tachycardia
5. mental status change
6. increased BUN and Creatinine
7. Liver enzymes increase
8. DIC
Define Cardiogenic shock
A decrease in cardiac output and in increase in systemic vascular resistance caused
by in increase in afterload and an decrease in contractility
What is the most common cause of cardiogenic shock in pediatrics?
Chronic Heart Failure
What is the most common type of shock in pediatric populations
hypovolemic shock
What is the main difference between cardiogenic shock and hypovolemic
shock?
There is no change in contractility with hypovolemic shock like there is with
cardiogenic shock and hypovolemic shock also has a decrease in preload
What percent of intravascular body is lost with hypovolemic shock?
15-25%
Give two causes of obstructuve shock
tension pneumo or pulmonary emboli
Define obstructive shock
Severe obstructive to filling or outflow of ventricles
Describe Distributive Shock
decrease in SVR or blood shunting past capillary beds
Name the main mediators in Anaphylactic shock
IgE
histamine
seratonin
bradykinin
PGE
Define Neurogenic Shoick
Vascular muscle tone controlled by sympathetic vasomotor system is lost, and
extreme vasodilation occurs
Most common cause of sudden cardiac death in young healthy athletes
