NR 110.646 Exam 3 V1 | NR 110.646
Advanced Pediatric Acute Care Topics |
Actual Q&A with Rationale (NR110646
Exam 3) | Johns Hopkins University
1. A 6-year-old child presents to the emergency department in septic shock. What is the initial
recommended volume for fluid resuscitation in a pediatric patient according to PALS
guidelines?
A. 10 mL/kg of 0.45% normal saline
B. 5 mL/kg of 5% albumin
C. 20 mL/kg of an isotonic crystalloid
D. 40 mL/kg of lactated ringers
Answer: C
Rationale: Fluid resuscitation for pediatric septic shock begins with a 20 mL/kg bolus of
isotonic crystalloid such as normal saline or lactated ringers. This rapid expansion of
intravascular volume is crucial to maintain cardiac output and organ perfusion. Clinicians
should reassess the patient after each bolus for signs of fluid overload or clinical
improvement.
,2. In the management of status asthmaticus refractory to continuous albuterol and
corticosteroids, which medication is used for its bronchodilatory effects via calcium channel
blockade?
A. Ipratropium bromide
B. Terbutaline
C. Theophylline
D. Magnesium sulfate
Answer: D
Rationale: Magnesium sulfate acts as a smooth muscle relaxant by inhibiting calcium
uptake in the bronchial cells. It is typically administered as an intravenous infusion in
severe, life-threatening asthma exacerbations. Close monitoring for hypotension and
respiratory depression is required during its administration.
3. A 10-year-old child with a traumatic brain injury (TBI) has an ICP of 20 mmHg and a Mean
Arterial Pressure (MAP) of 75 mmHg. What is the calculated Cerebral Perfusion Pressure
(CPP)?
A. 95 mmHg
B. 55 mmHg
C. 45 mmHg
D. 60 mmHg
, Answer: B
Rationale: The Cerebral Perfusion Pressure (CPP) is calculated by subtracting the
Intracranial Pressure (ICP) from the Mean Arterial Pressure (MAP). In this case, 75 mmHg
minus 20 mmHg equals 55 mmHg. Maintaining adequate CPP is vital in pediatric TBI to
prevent secondary ischemic injury to the brain tissue.
4. Which of the following electrolyte abnormalities is a primary risk factor for the
development of cerebral edema during the treatment of Diabetic Ketoacidosis (DKA)?
A. Hyperkalemia
B. Hypomagnesemia
C. Rapid decline in serum osmolality
D. Hypercalcemia
Answer: C
Rationale: Cerebral edema in DKA is often associated with aggressive fluid resuscitation
and a rapid drop in serum glucose and osmolality. This shift causes water to move
intracellularly into brain cells, leading to swelling. Standard protocols emphasize a gradual
correction of glucose levels and careful fluid management to mitigate this risk.
5. An infant with Tetralogy of Fallot presents with cyanosis and agitation, indicating a ‘Tet
spell.’ What is the first-line nursing intervention?
A. Place the infant in a knee-chest position
B. Administer high-flow oxygen via non-rebreather
Advanced Pediatric Acute Care Topics |
Actual Q&A with Rationale (NR110646
Exam 3) | Johns Hopkins University
1. A 6-year-old child presents to the emergency department in septic shock. What is the initial
recommended volume for fluid resuscitation in a pediatric patient according to PALS
guidelines?
A. 10 mL/kg of 0.45% normal saline
B. 5 mL/kg of 5% albumin
C. 20 mL/kg of an isotonic crystalloid
D. 40 mL/kg of lactated ringers
Answer: C
Rationale: Fluid resuscitation for pediatric septic shock begins with a 20 mL/kg bolus of
isotonic crystalloid such as normal saline or lactated ringers. This rapid expansion of
intravascular volume is crucial to maintain cardiac output and organ perfusion. Clinicians
should reassess the patient after each bolus for signs of fluid overload or clinical
improvement.
,2. In the management of status asthmaticus refractory to continuous albuterol and
corticosteroids, which medication is used for its bronchodilatory effects via calcium channel
blockade?
A. Ipratropium bromide
B. Terbutaline
C. Theophylline
D. Magnesium sulfate
Answer: D
Rationale: Magnesium sulfate acts as a smooth muscle relaxant by inhibiting calcium
uptake in the bronchial cells. It is typically administered as an intravenous infusion in
severe, life-threatening asthma exacerbations. Close monitoring for hypotension and
respiratory depression is required during its administration.
3. A 10-year-old child with a traumatic brain injury (TBI) has an ICP of 20 mmHg and a Mean
Arterial Pressure (MAP) of 75 mmHg. What is the calculated Cerebral Perfusion Pressure
(CPP)?
A. 95 mmHg
B. 55 mmHg
C. 45 mmHg
D. 60 mmHg
, Answer: B
Rationale: The Cerebral Perfusion Pressure (CPP) is calculated by subtracting the
Intracranial Pressure (ICP) from the Mean Arterial Pressure (MAP). In this case, 75 mmHg
minus 20 mmHg equals 55 mmHg. Maintaining adequate CPP is vital in pediatric TBI to
prevent secondary ischemic injury to the brain tissue.
4. Which of the following electrolyte abnormalities is a primary risk factor for the
development of cerebral edema during the treatment of Diabetic Ketoacidosis (DKA)?
A. Hyperkalemia
B. Hypomagnesemia
C. Rapid decline in serum osmolality
D. Hypercalcemia
Answer: C
Rationale: Cerebral edema in DKA is often associated with aggressive fluid resuscitation
and a rapid drop in serum glucose and osmolality. This shift causes water to move
intracellularly into brain cells, leading to swelling. Standard protocols emphasize a gradual
correction of glucose levels and careful fluid management to mitigate this risk.
5. An infant with Tetralogy of Fallot presents with cyanosis and agitation, indicating a ‘Tet
spell.’ What is the first-line nursing intervention?
A. Place the infant in a knee-chest position
B. Administer high-flow oxygen via non-rebreather
