Pass the AACN CCRN CCRN-Pediatric Questions and answers with CertsForce

Prolonged aortic cross-clampingcan impairrenal perfusion, especially during cardiac surgery.Decreased urine outputpostoperatively may be a sign ofacute kidney injury (AKI)secondary to hypoperfusion during the clamping phase.

“Renal hypoperfusion during prolonged aortic cross-clamping may manifest postoperatively as oliguria or anuria, indicating renal compromise.”

(Referenced from CCRN Pediatric – Direct Care: Cardiovascular, Postoperative Transplant Complications)

The patient is stable withsupraventricular tachycardia (SVT). Initial treatment in stable pediatric SVT involvesvagal maneuversto increase vagal tone and potentially terminate the arrhythmia. Having the childblow through a straw or simulate blowing a hornis a safe and effective method in a cooperative child.

“In stable pediatric patients with SVT, vagal maneuvers are the first-line intervention. Activities such as forced exhalation (blowing through a straw) may revert the rhythm.”

(Referenced from CCRN Pediatric – Direct Care: Cardiovascular, Pediatric Tachyarrhythmias Management)

In asthma management, patient education andself-management skills, including proper use of an inhaler, are crucial to preventing readmission. School-aged children are often capable of learning and demonstrating proper technique, which should be assessed prior to discharge.

“Before discharge following asthma exacerbation, nurses should assess the child’s ability to self-administer inhaled medications, understand controller vs. rescue medications, and demonstrate correct technique.”

(Referenced from CCRN Pediatric – Direct Care: Pulmonary, Asthma Management and Discharge Planning)

In pediatric hemorrhagic shock, theinitial fluid bolus is 20 mL/kgofisotonic crystalloid(e.g.,normal saline or lactated Ringer's). For a 20-kg child, this equals400 mL of 0.9% NS. Albumin and PRBCs are considered after fluid responsiveness is evaluated or if ongoing blood loss is confirmed.

“The initial step in pediatric fluid resuscitation for hemorrhagic or hypovolemic shock is 20 mL/kg isotonic fluid bolus. Normal saline is the preferred initial fluid.”

(Referenced from CCRN Pediatric – Direct Care: Multisystem, Shock Management)

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)

Even with a good initial response,delayed respiratory complications, such asacute respiratory distress syndrome (ARDS)orpulmonary edema, can develop within 24–48 hours after submersion. All pediatric near-drowning cases should bemonitored in an ICU settingfor at least 24 hours.

“Post-submersion patients are at high risk for delayed onset ARDS. Observation in a monitored setting is essential regardless of initial neurologic status.”

(Referenced from CCRN Pediatric – Direct Care: Pulmonary, Submersion Injuries and Post-Resuscitation Care)

Earlynutritional support,mobilization, and maintainingskin integritywith gentle cleansing are proven strategies to preventsurgical site infections (SSIs). Nutrients supportwound healing, while early mobility reduces the risk of complications likepneumonia and impaired circulation.

“Postoperative infection prevention includes early enteral feeding, routine hygiene with non-irritating agents, and ambulation. These reduce bacterial overgrowth, maintain perfusion, and support immune function.”

(Referenced from CCRN Pediatric – Direct Care: Integumentary, Postoperative Infection Prevention)

ST segment elevationindicatesmyocardial ischemia, andfrothy secretions + desaturationsuggestpulmonary edemaor shunting. Aresidual ventricular septal defect (VSD)post-surgery can lead toright-to-left shunting, bypassing the lungs and resulting inhypoxemiadespite adequate ventilation.

“Residual intracardiac shunts, especially VSDs, can lead to desaturation and heart failure symptoms post arterial switch. ST changes suggest myocardial ischemia secondary to hypoxia.”

(Referenced from CCRN Pediatric – Direct Care: Cardiovascular, Postoperative Congenital Heart Disease Complications)

Lead toxicity is particularly dangerous in young children due to their developing central nervous systems.Irreversible encephalopathyis a known severe consequence ofacute or chronic lead exposure, and it may present withseizures, altered mental status, and developmental regression. It requiresimmediate chelation therapyand environmental remediation.

“High lead levels, especially >70 mcg/dL, are associated with irreversible neurologic damage such as encephalopathy, cerebral edema, and seizures.”

(Referenced from CCRN Pediatric – Direct Care: Neurological, Toxic Encephalopathy and Heavy Metal Poisoning)

Chest physiotherapy (CPT)isnot recommended in asthmabecause it can lead tobronchospasm and increased airway resistance. Unlike conditions with excessive mucus production (e.g., cystic fibrosis), asthma management focuses onairway relaxation and inflammation reduction, not mechanical clearance.

“Chest physiotherapy is contraindicated in asthma due to the risk of increasing bronchospasm. Treatment should focus on bronchodilators and anti-inflammatory medications.”

(Referenced from CCRN Pediatric – Direct Care: Pulmonary, Asthma Management in Ventilated Patients)