PEDIATRIC CCRN FINAL PAPER EXAM 2026
COMPLETE QUESTIONS AND VERIFIED
SOLUTIONS
◉ DI labs. Answer: *urine chemistry*:
-think *DILUTE*
>>decreased spec gravity (<1.005)
>>decreased urine osmolality
>>decreased urine pH, Na, and K
*Serum chemistry*
-think *CONCENTRATED*
>>increased serum osmolality (>300m/Osm/L)
>>increased serum Na and K
*Radioimmunassay*: decreased ADH
◉ SIADH causes. Answer: TBI, HIE, Injury to hypothalamus or post
pituitary
,◉ SIADH Patho. Answer: excess ADH= fluid retention, decrased
serum osm(low solute to H2O ratio), dilutional hyponatremia (a fast
drop leads to neuro change)
◉ SIADH tx. Answer: Fluid restriction, IV hypertonic saline SLOWLY
to prevent central pontine myelinolysis,
conivaptan/tolvaptan, *demeclocycline*
Stop cyclophosphamide
Loop diuretics
◉ DI causes. Answer: Damage to the brain (tumors, trauma,
surgery); pituitary hypothalamus lesions
◉ DI s/s. Answer: Polyuria (greater than 5 L/day;
polydipsia (4 to 40 L/day);
nocturia; fatigue; dehydration; weight loss; muscle weakness and
pain; headache; hypotension; tachycardia; CNS manifestations
ranging from irritability and mental dullness , SEIZURE RISK to
coma
◉ DI tx. Answer: fluid replacement of urine >2ml/kg/hr
Correct Na+ 0.5-1mEQ/hr
DDAVP Or vassopressin gtt
, ◉ cerebral salt wasting. Answer: low blood Na+ & dehydration to
truama/injury/tumor
Low blood sodium levels leads to decreased serum osmolality
resulting in cerebral edema & intravascular vol depletion
◉ s/s cerebral salt wasting. Answer: thirst, -FB, hyponatremia + Low
Plasma Osm
increased urine osm
Na+ in Urine
◉ tx of cerebral salt wasting. Answer: hypertonic to correct vol
depletion, decrease Na_ & replace urine sodium loss
mineralcorticoids to enhance Na+ reabsorption in kidneys
◉ calculate osmolality. Answer: 2Na + glucose/18 + BUN/2.8
◉ normal serum osmolality. Answer: 280-300 mOsm/kg
◉ normal urine osmolality. Answer: 300-900
◉ DIC Labs. Answer: -Low platelets
-prolonged PT and PTT
COMPLETE QUESTIONS AND VERIFIED
SOLUTIONS
◉ DI labs. Answer: *urine chemistry*:
-think *DILUTE*
>>decreased spec gravity (<1.005)
>>decreased urine osmolality
>>decreased urine pH, Na, and K
*Serum chemistry*
-think *CONCENTRATED*
>>increased serum osmolality (>300m/Osm/L)
>>increased serum Na and K
*Radioimmunassay*: decreased ADH
◉ SIADH causes. Answer: TBI, HIE, Injury to hypothalamus or post
pituitary
,◉ SIADH Patho. Answer: excess ADH= fluid retention, decrased
serum osm(low solute to H2O ratio), dilutional hyponatremia (a fast
drop leads to neuro change)
◉ SIADH tx. Answer: Fluid restriction, IV hypertonic saline SLOWLY
to prevent central pontine myelinolysis,
conivaptan/tolvaptan, *demeclocycline*
Stop cyclophosphamide
Loop diuretics
◉ DI causes. Answer: Damage to the brain (tumors, trauma,
surgery); pituitary hypothalamus lesions
◉ DI s/s. Answer: Polyuria (greater than 5 L/day;
polydipsia (4 to 40 L/day);
nocturia; fatigue; dehydration; weight loss; muscle weakness and
pain; headache; hypotension; tachycardia; CNS manifestations
ranging from irritability and mental dullness , SEIZURE RISK to
coma
◉ DI tx. Answer: fluid replacement of urine >2ml/kg/hr
Correct Na+ 0.5-1mEQ/hr
DDAVP Or vassopressin gtt
, ◉ cerebral salt wasting. Answer: low blood Na+ & dehydration to
truama/injury/tumor
Low blood sodium levels leads to decreased serum osmolality
resulting in cerebral edema & intravascular vol depletion
◉ s/s cerebral salt wasting. Answer: thirst, -FB, hyponatremia + Low
Plasma Osm
increased urine osm
Na+ in Urine
◉ tx of cerebral salt wasting. Answer: hypertonic to correct vol
depletion, decrease Na_ & replace urine sodium loss
mineralcorticoids to enhance Na+ reabsorption in kidneys
◉ calculate osmolality. Answer: 2Na + glucose/18 + BUN/2.8
◉ normal serum osmolality. Answer: 280-300 mOsm/kg
◉ normal urine osmolality. Answer: 300-900
◉ DIC Labs. Answer: -Low platelets
-prolonged PT and PTT
