NR 110.646 Exam 3 V3 | NR 110.646
Advanced Pediatric Acute Care Topics |
Actual Q&A with Rationale (NR110646
Exam 3) | Johns Hopkins University
1. A 5-year-old child presents with suspected septic shock. According to the Surviving Sepsis
Campaign guidelines, what is the recommended initial fluid bolus volume and timing?
A. 10 mL/kg over 60 minutes
B. 40 mL/kg over 15 minutes
C. 20 mL/kg over 30-60 minutes
D. 20 mL/kg over 5-10 minutes
Answer: D
Rationale: Initial fluid resuscitation in pediatric septic shock should begin with 20 mL/kg
boluses of isotonic crystalloid. These boluses should be administered rapidly, typically over
5 to 10 minutes, while monitoring for signs of fluid overload. Rapid administration is
crucial to restore intravascular volume and improve tissue perfusion in the early stages of
shock.
2. In the management of pediatric warm shock, which of the following is the first-line
vasoactive agent for patients who remain hypotensive despite adequate fluid resuscitation?
A. Norepinephrine
,B. Dopamine
C. Epinephrine
D. Milrinone
Answer: A
Rationale: Warm shock is characterized by low systemic vascular resistance (SVR) and
peripheral vasodilation. Norepinephrine is the preferred agent because its alpha-1
adrenergic effects promote vasoconstriction to increase SVR. This targeted approach helps
stabilize blood pressure in patients who do not respond to fluid volume alone.
3. A 10-year-old child has a Glasgow Coma Scale (GCS) score of 7 after a motor vehicle
accident. What is the priority intervention for this patient?
A. Placement of an intraventricular drain
B. Immediate CT scan of the head
C. Administration of Mannitol
D. Endotracheal intubation
Answer: D
Rationale: A GCS score of 8 or less indicates a severe traumatic brain injury and the
inability of the patient to maintain their own airway. Securing the airway via endotracheal
intubation is the first priority to prevent hypoxia and secondary brain injury. Once the
airway is stabilized, the patient can safely proceed to diagnostic imaging like a CT scan.
,4. Which clinical finding is most indicative of Cushing’s Triad in a pediatric patient with
increased intracranial pressure?
A. Tachycardia, hypertension, and tachypnea
B. Bradycardia, hypertension, and irregular respirations
C. Hypotension, bradycardia, and apnea
D. Tachycardia, hypotension, and Cheyne-Stokes breathing
Answer: B
Rationale: Cushing’s Triad is a late sign of increased intracranial pressure and impending
brain herniation. It consists of hypertension (often with a widened pulse pressure),
bradycardia, and irregular respiratory patterns. This reflex occurs as the brain attempts to
maintain cerebral perfusion pressure against rising intracranial pressure.
5. A 12-year-old is brought to the ED with 30% total body surface area (TBSA) burns. Using the
Parkland formula (4mL/kg/%TBSA), how should the calculated fluid be administered?
A. Equally divided over 24 hours
B. Half over the first 12 hours and half over the next 12 hours
C. Total volume over the first 8 hours
D. Half over the first 8 hours and half over the remaining 16 hours
Answer: D
, Rationale: The Parkland formula dictates that the first half of the calculated 24-hour fluid
requirement should be given within the first 8 hours post-injury. The remaining 50% of the
fluid is administered over the subsequent 16 hours. Timely administration is essential to
prevent burn shock and maintain renal perfusion.
6. Which of the following is the preferred antidote for a pediatric patient with an acute
acetaminophen ingestion who presents 6 hours after ingestion with toxic levels?
A. Activated charcoal
B. Flumazenil
C. Deferoxamine
D. N-acetylcysteine (NAC)
Answer: D
Rationale: N-acetylcysteine (NAC) is the gold standard antidote for acetaminophen toxicity
because it replenishes glutathione stores in the liver. NAC is most effective when
administered within 8 hours of ingestion but can still be beneficial later. It works by
neutralizing the toxic metabolite NAPQI, thereby preventing hepatic necrosis.
7. A pediatric patient with a suspected tricyclic antidepressant (TCA) overdose exhibits a
widened QRS complex on ECG. What is the immediate pharmacological intervention?
A. Lidocaine
B. Amiodarone
C. Sodium Bicarbonate
Advanced Pediatric Acute Care Topics |
Actual Q&A with Rationale (NR110646
Exam 3) | Johns Hopkins University
1. A 5-year-old child presents with suspected septic shock. According to the Surviving Sepsis
Campaign guidelines, what is the recommended initial fluid bolus volume and timing?
A. 10 mL/kg over 60 minutes
B. 40 mL/kg over 15 minutes
C. 20 mL/kg over 30-60 minutes
D. 20 mL/kg over 5-10 minutes
Answer: D
Rationale: Initial fluid resuscitation in pediatric septic shock should begin with 20 mL/kg
boluses of isotonic crystalloid. These boluses should be administered rapidly, typically over
5 to 10 minutes, while monitoring for signs of fluid overload. Rapid administration is
crucial to restore intravascular volume and improve tissue perfusion in the early stages of
shock.
2. In the management of pediatric warm shock, which of the following is the first-line
vasoactive agent for patients who remain hypotensive despite adequate fluid resuscitation?
A. Norepinephrine
,B. Dopamine
C. Epinephrine
D. Milrinone
Answer: A
Rationale: Warm shock is characterized by low systemic vascular resistance (SVR) and
peripheral vasodilation. Norepinephrine is the preferred agent because its alpha-1
adrenergic effects promote vasoconstriction to increase SVR. This targeted approach helps
stabilize blood pressure in patients who do not respond to fluid volume alone.
3. A 10-year-old child has a Glasgow Coma Scale (GCS) score of 7 after a motor vehicle
accident. What is the priority intervention for this patient?
A. Placement of an intraventricular drain
B. Immediate CT scan of the head
C. Administration of Mannitol
D. Endotracheal intubation
Answer: D
Rationale: A GCS score of 8 or less indicates a severe traumatic brain injury and the
inability of the patient to maintain their own airway. Securing the airway via endotracheal
intubation is the first priority to prevent hypoxia and secondary brain injury. Once the
airway is stabilized, the patient can safely proceed to diagnostic imaging like a CT scan.
,4. Which clinical finding is most indicative of Cushing’s Triad in a pediatric patient with
increased intracranial pressure?
A. Tachycardia, hypertension, and tachypnea
B. Bradycardia, hypertension, and irregular respirations
C. Hypotension, bradycardia, and apnea
D. Tachycardia, hypotension, and Cheyne-Stokes breathing
Answer: B
Rationale: Cushing’s Triad is a late sign of increased intracranial pressure and impending
brain herniation. It consists of hypertension (often with a widened pulse pressure),
bradycardia, and irregular respiratory patterns. This reflex occurs as the brain attempts to
maintain cerebral perfusion pressure against rising intracranial pressure.
5. A 12-year-old is brought to the ED with 30% total body surface area (TBSA) burns. Using the
Parkland formula (4mL/kg/%TBSA), how should the calculated fluid be administered?
A. Equally divided over 24 hours
B. Half over the first 12 hours and half over the next 12 hours
C. Total volume over the first 8 hours
D. Half over the first 8 hours and half over the remaining 16 hours
Answer: D
, Rationale: The Parkland formula dictates that the first half of the calculated 24-hour fluid
requirement should be given within the first 8 hours post-injury. The remaining 50% of the
fluid is administered over the subsequent 16 hours. Timely administration is essential to
prevent burn shock and maintain renal perfusion.
6. Which of the following is the preferred antidote for a pediatric patient with an acute
acetaminophen ingestion who presents 6 hours after ingestion with toxic levels?
A. Activated charcoal
B. Flumazenil
C. Deferoxamine
D. N-acetylcysteine (NAC)
Answer: D
Rationale: N-acetylcysteine (NAC) is the gold standard antidote for acetaminophen toxicity
because it replenishes glutathione stores in the liver. NAC is most effective when
administered within 8 hours of ingestion but can still be beneficial later. It works by
neutralizing the toxic metabolite NAPQI, thereby preventing hepatic necrosis.
7. A pediatric patient with a suspected tricyclic antidepressant (TCA) overdose exhibits a
widened QRS complex on ECG. What is the immediate pharmacological intervention?
A. Lidocaine
B. Amiodarone
C. Sodium Bicarbonate
