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

Ethics committees are convened to help resolvecomplex, value-laden clinical issuesby offeringguidanceto care teams and families. These committees are composed of interdisciplinary professionals and focus onsupporting ethical decision-makingin patient care.

“Ethics committees assist healthcare professionals, patients, and families in addressing ethical dilemmas, including end-of-life decisions, treatment refusal, and moral distress.”

(Referenced from CCRN Pediatric – Professional Caring and Ethical Practice: Ethical Decision-Making Support Structures)

Before initiating policy changes, the nurse must conduct anevidence-based literature reviewto assess the benefits and risks associated with altering visitation policies. This aligns with professional nursing standards that promoteevidence-informed practiceandfamily-centered care.

“In professional practice, initiating a literature review is the first step in evidence-based change. This supports the rationale for modifying clinical practices and promotes interdisciplinary consensus.”

(Referenced from CCRN Pediatric – Professional Caring and Ethical Practice: Evidence-Based Practice and Family-Centered Care)

PPHN is caused by the failure of the pulmonary vasculature to relax after birth. Management includes:

Oxygen therapyas a pulmonary vasodilator

Alkalinization(e.g., sodium bicarbonate) toincrease pH, which helps decrease pulmonaryvascular resistance

Inhaled nitric oxide and ECMO are also advanced interventions if initial therapies fail.

“Initial management of PPHN includes oxygen, mechanical ventilation, and alkalinization to reduce pulmonary vascular resistance.”

(Referenced from CCRN Pediatric – Direct Care: Pulmonary, Neonatal Pulmonary Hypertension)

Digoxinenhancescontractilityof the heart throughpositive inotropic effects, which is beneficial indilated cardiomyopathy, where the ventricles are weakened and unable to pump efficiently. It improves cardiac output and reduces symptoms of heart failure.

“Positive inotropic agents like digoxin are used in dilated cardiomyopathy to improve myocardial contractility and cardiac output.”

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

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)

Epiglottitis is a life-threatening conditionoften caused by Haemophilus influenzae type B. It presents withstridor, drooling, and dysphagia. Direct visualization may provokelaryngospasm and complete airway obstruction, making itcontraindicated unless in a controlled OR environment. Alateral neck x-raymay reveal the “thumbprint sign” (swollen epiglottis) and is the safer diagnostic choice.

“For suspected epiglottitis, lateral neck radiographs are recommended prior to airway manipulation. Visualization of the airway is avoided due to risk of precipitating obstruction.”

(Referenced from CCRN Pediatric – Direct Care: Pulmonary, Airway Emergencies)

In DKA, despite high blood glucose levels, thelack of insulinprevents glucose from entering cells. The body perceives this ascellular glucose deficiencyand responds by stimulatinggluconeogenesis(production of glucose from non-carbohydrate sources) andketogenesis, worsening hyperglycemia and acidosis.

“The insulin-deficient state in DKA leads to a cellular energy crisis, triggering gluconeogenesis due to a perceived intracellular glucose deficiency.”

(Referenced from CCRN Pediatric – Direct Care: Endocrine, Diabetic Ketoacidosis Pathophysiology)

Intracranial pressure (ICP) above 20–25 mm Hg is abnormal, and 35 mm Hg is a critical level requiring urgent intervention. After sedation and analgesia fail to reduce ICP,osmotic therapy is the next step, withhypertonic salinebeing a frontline choice for its rapid effect in reducing cerebral edema.

“In patients with traumatic brain injury and elevated ICP, first-line therapies include sedation, analgesia, and head positioning. If ineffective, hyperosmolar therapy such as hypertonic saline or mannitol is indicated to decrease cerebral edema and reduce ICP.”

(Referenced from CCRN Pediatric – Direct Care: Neurologic Dysfunction and Intracranial Hypertension Management)

Hypertonic saline pulls fluid from the brain into the vascular space, lowering ICP and improving cerebral perfusion.

Left ventricular failureleads todecreased cardiac output(cool extremities, low urine output) andincreased pulmonary pressures(pulmonary edema). Viral myocarditis causesmyocardial inflammationthat impairs left ventricular function in many pediatric cases.

“In myocarditis, left ventricular dysfunction manifests as signs of low cardiac output and pulmonary congestion. Close monitoring is essential for early intervention.”

(Referenced from CCRN Pediatric – Direct Care: Cardiovascular, Inflammatory Myocardial Disorders)

This infant presents withhyponatremia and seizures, but without signs of structural neurologic abnormalities. In formula-fed infants,excessive water dilution of formulais a common cause of hyponatremia. The first step is toevaluate feeding practicesfor possible over-dilution leading to water intoxication.

“In infants with unexplained hyponatremia, especially formula-fed, assess for over-diluted formula. Water intoxication can cause seizures without infection or anatomical findings.”

(Referenced from CCRN Pediatric – Direct Care: Endocrine, Electrolyte Imbalances in Infants)