PCC 301 – Pediatric Critical Care Nursing
ACTUAL UPDATED QUESTIONS AND
CORRECT ANSWERS
Describe the primary components of a rapid pediatric assessment in the ICU (ABCs plus
critical adjuncts).
CORRECT ANSWERS ✅✅
The rapid pediatric assessment prioritizes Airway, Breathing, Circulation (ABCs), with
simultaneous evaluation of disability (neurologic status) and exposure/environmental
concerns. Adjuncts include pulse oximetry, capnography, bedside glucose, and quick vascular
access checks. Age-appropriate airway size, look, listen, and feel techniques, and assessment
for life-threatening causes (tension pneumothorax, tamponade, massive bleeding) are
performed. This focused survey guides immediate interventions while preparing definitive
diagnostics.
Explain the differences in pediatric versus adult airway anatomy and implications for
intubation.
CORRECT ANSWERS ✅✅
Children have proportionally larger heads and tongues, a more cephalad and anterior larynx,
a floppy U-shaped epiglottis, and a narrower subglottic (cricoid) region. These differences
make airway obstruction and difficulty with intubation more likely; small changes in
diameter greatly increase resistance. Providers must use appropriately sized equipment,
maintain neutral positioning (or slight sniffing in older children), and expect rapid
desaturation — thus preoxygenation and readiness for rapid-sequence intubation are critical.
Nurses prepare size charts, check equipment, and ensure rapid availability of suction and
emergency drugs.
Discuss pediatric respiratory distress recognition and initial management (including use of
high-flow nasal cannula and CPAP).
CORRECT ANSWERS ✅✅
Recognize distress by tachypnea, retractions, nasal flaring, grunting, head bobbing in infants,
and altered mental status. Initial management focuses on positioning, oxygen to maintain age-
appropriate saturations, suctioning secretions, and treating reversible causes (bronchodilators
for reactive airways). For escalating support, high-flow nasal cannula (HFNC) provides
warmed, humidified high-flow oxygen with some positive pressure and is useful for moderate
distress; CPAP provides higher continuous positive pressure for alveolar recruitment.
Nursing duties include close monitoring of work of breathing, respiratory rate, oxygenation,
, and readiness to escalate to noninvasive ventilation or intubation if fatigue or hypercapnia
develops.
Describe indications, preparation, and nursing role during rapid sequence intubation (RSI) in
children.
CORRECT ANSWERS ✅✅
Indications include respiratory failure, impending airway compromise, severe apnea, or
inability to protect the airway. Preparation entails pre-calculating equipment sizes,
medications (weight-based sedative + paralytic), suction, oxygenation devices, and difficult
airway backup. Nurses confirm doses, prepare meds, secure monitoring (ECG, pulse ox,
capnography), and act as medication and equipment checks. Post-intubation, nurses confirm
tube placement with end-tidal CO₂ and chest rise, secure the tube, obtain chest x-ray, and
monitor ventilation, sedation, and hemodynamics.
Explain ventilator strategies for pediatric ARDS including lung-protective principles.
CORRECT ANSWERS ✅✅
Pediatric ARDS management emphasizes lung-protective ventilation: low tidal volumes
(typically 6–8 mL/kg ideal body weight when feasible), limiting plateau pressures,
appropriate PEEP to prevent alveolar collapse, and permissive hypercapnia within safe limits.
Consider adjuncts for severe ARDS: neuromuscular blockade, recruitment maneuvers, prone
positioning, inhaled pulmonary vasodilators, and ECMO for refractory cases. Nurses monitor
ventilator waveforms, blood gases, sedation, fluid balance, and implement VAP-prevention
bundles while coordinating with the team for adjustments and rescue therapies.
Discuss pediatric shock types (hypovolemic, distributive/septic, cardiogenic, obstructive) and
initial nursing interventions.
CORRECT ANSWERS ✅✅
Hypovolemic shock results from fluid loss; initial care is rapid IV/IO access and isotonic
fluid boluses (20 mL/kg) with frequent reassessment. Distributive/septic shock features
vasodilation and capillary leak — early antibiotics, aggressive fluids, and early vasoactive
support (if fluid-refractory) are priorities. Cardiogenic shock needs cautious fluid
administration and early inotropes rather than large boluses. Obstructive shock (tamponade,
tension pneumothorax) requires immediate mechanical relief (pericardiocentesis, needle
decompression). Nurses rapidly establish access, administer fluids/meds per protocol,
monitor perfusion and urine output, and prepare for escalation.
Explain early recognition and bundle-based management of pediatric sepsis in the first hour.
CORRECT ANSWERS ✅✅
ACTUAL UPDATED QUESTIONS AND
CORRECT ANSWERS
Describe the primary components of a rapid pediatric assessment in the ICU (ABCs plus
critical adjuncts).
CORRECT ANSWERS ✅✅
The rapid pediatric assessment prioritizes Airway, Breathing, Circulation (ABCs), with
simultaneous evaluation of disability (neurologic status) and exposure/environmental
concerns. Adjuncts include pulse oximetry, capnography, bedside glucose, and quick vascular
access checks. Age-appropriate airway size, look, listen, and feel techniques, and assessment
for life-threatening causes (tension pneumothorax, tamponade, massive bleeding) are
performed. This focused survey guides immediate interventions while preparing definitive
diagnostics.
Explain the differences in pediatric versus adult airway anatomy and implications for
intubation.
CORRECT ANSWERS ✅✅
Children have proportionally larger heads and tongues, a more cephalad and anterior larynx,
a floppy U-shaped epiglottis, and a narrower subglottic (cricoid) region. These differences
make airway obstruction and difficulty with intubation more likely; small changes in
diameter greatly increase resistance. Providers must use appropriately sized equipment,
maintain neutral positioning (or slight sniffing in older children), and expect rapid
desaturation — thus preoxygenation and readiness for rapid-sequence intubation are critical.
Nurses prepare size charts, check equipment, and ensure rapid availability of suction and
emergency drugs.
Discuss pediatric respiratory distress recognition and initial management (including use of
high-flow nasal cannula and CPAP).
CORRECT ANSWERS ✅✅
Recognize distress by tachypnea, retractions, nasal flaring, grunting, head bobbing in infants,
and altered mental status. Initial management focuses on positioning, oxygen to maintain age-
appropriate saturations, suctioning secretions, and treating reversible causes (bronchodilators
for reactive airways). For escalating support, high-flow nasal cannula (HFNC) provides
warmed, humidified high-flow oxygen with some positive pressure and is useful for moderate
distress; CPAP provides higher continuous positive pressure for alveolar recruitment.
Nursing duties include close monitoring of work of breathing, respiratory rate, oxygenation,
, and readiness to escalate to noninvasive ventilation or intubation if fatigue or hypercapnia
develops.
Describe indications, preparation, and nursing role during rapid sequence intubation (RSI) in
children.
CORRECT ANSWERS ✅✅
Indications include respiratory failure, impending airway compromise, severe apnea, or
inability to protect the airway. Preparation entails pre-calculating equipment sizes,
medications (weight-based sedative + paralytic), suction, oxygenation devices, and difficult
airway backup. Nurses confirm doses, prepare meds, secure monitoring (ECG, pulse ox,
capnography), and act as medication and equipment checks. Post-intubation, nurses confirm
tube placement with end-tidal CO₂ and chest rise, secure the tube, obtain chest x-ray, and
monitor ventilation, sedation, and hemodynamics.
Explain ventilator strategies for pediatric ARDS including lung-protective principles.
CORRECT ANSWERS ✅✅
Pediatric ARDS management emphasizes lung-protective ventilation: low tidal volumes
(typically 6–8 mL/kg ideal body weight when feasible), limiting plateau pressures,
appropriate PEEP to prevent alveolar collapse, and permissive hypercapnia within safe limits.
Consider adjuncts for severe ARDS: neuromuscular blockade, recruitment maneuvers, prone
positioning, inhaled pulmonary vasodilators, and ECMO for refractory cases. Nurses monitor
ventilator waveforms, blood gases, sedation, fluid balance, and implement VAP-prevention
bundles while coordinating with the team for adjustments and rescue therapies.
Discuss pediatric shock types (hypovolemic, distributive/septic, cardiogenic, obstructive) and
initial nursing interventions.
CORRECT ANSWERS ✅✅
Hypovolemic shock results from fluid loss; initial care is rapid IV/IO access and isotonic
fluid boluses (20 mL/kg) with frequent reassessment. Distributive/septic shock features
vasodilation and capillary leak — early antibiotics, aggressive fluids, and early vasoactive
support (if fluid-refractory) are priorities. Cardiogenic shock needs cautious fluid
administration and early inotropes rather than large boluses. Obstructive shock (tamponade,
tension pneumothorax) requires immediate mechanical relief (pericardiocentesis, needle
decompression). Nurses rapidly establish access, administer fluids/meds per protocol,
monitor perfusion and urine output, and prepare for escalation.
Explain early recognition and bundle-based management of pediatric sepsis in the first hour.
CORRECT ANSWERS ✅✅
