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Pediatric CCRN Exam- Maddy Questions with
Accurate Answers
3 causes for Fetal shunt closure correct answer 1. increase in aterial oxygen tension
- decreased prostaglandins
- decreased adenosine levels a substance that has the ability to accept a free H+ ion is called a correct answer base active form of vitamin D is called correct answer calcitriol bones most commonly involved in basilar skull fracture correct answer Temporal occipital ethmoid sphenoid Cardiac Output is the measure of what? correct answer Volume of blood pumped by the heart in one minute Clinical manifestations of hypoxemia correct answer -clubbing -polycythemia -fatigue w/ feeding -poor weight gain
-squatting -dyspnea -tachypnea Define Afterload correct answer Resistant force that the ventricles must pump against. Work that the ventricles must do to push blood through the aorta into the periphery of the body Define Cardiogenic shock correct answer A decrease in cardiac output and in increase in systemic vascular resistance caused by in increase in afterload and an decrease in contractility Define Chronic Heart Failure correct answer The hearts inability to pump oxygenated blood to the body due to abnormalities in the heart and other areas of the body. Contributing to edema, resp. distress, activity intolerance, and growth failure Define Contractility correct answer The amount of force exerted by the heart with each contraction define decerebrate posturing correct answer outward movement of extremities - midbrain exfixiation define decorticate posturing correct answer inward movement of extremities - cerebral hemisphere loss Define Hypercarbic respiratory failure correct answer PaCO2 >
Describe Hypertrophic Cardiomyopathy correct answer Thickening of the LV and mostly septum without dilation. Mitral valve regurg. occurs and atypical filling pressure and LV outflow tract obstruction Describe Left Sided Heart Failure correct answer LV is unable to effectively pump blood into aorta and out into body, so blood backs up into pulmonary outlets and increases pressure in LA Describe Restrictive Cardiomyopathy correct answer Ventricle walls stiffen and prevent the heart from properly filling with blood, which leads to minimal contractile movement of blood Describe Right Sided Heart Failure correct answer RV is unable to pump blood efficiently into the Pulmonary artery, so blood backs up into veins and periphery of body describe the anatomy of the kidney correct answer cortex, medula, pelvis cortex is outer layer and contains nephrons and glomeruli medulla is the inner portion containing the collecting ductgs pelvis is the upper ureter that directs urine from kidneys to ureters and contains filtered blood that was processed into urine Describe the conduction pathway of the heart correct answer SA node - Atrium - AV node - Bundle of His - Ventricle - Purkinje Fibers
Describe the flow of fluid in the kidney correct answer bowmans capsule to proximal convoluted tubule to descending limb to loop of henle to ascending limb to distal convoluted tubule Describe the fontan procedure correct answer Systemic venous return is directed to the PA and a baffle is put inside the RA to direct blood flow from the IVC to the PA describe the pathophysiology of asthma correct answer mediators are released when IgE binds to mast cells. Inflammatory changes destroy epithelial cells and cause nerve exposure causing bronchiol smooth muscle to contract Describe the picture of Compensated Shock correct answer 1. Shunting occurs due to sympathetic activation
- BP is normal initially
- cool clammy skin/poor perfusion to periphery
- decreased bowel sounds
- decreased urine output
- lactic acid build-up Describe the picture of Uncompensated Shock correct answer 1. Body is unable to compensate and supply blood to microvasculature
- hypotension
- tacypnea
- tachycardia
- mental status change
lower - wheeze differentiate central, nephrogenic, and dipsogenic DI correct answer central: not enough ADH nephrogenic: lack of renal response to ADH Dipsogenic: huge intakes of water differentiate exocrine from endocrine cells correct answer exocrine: acini cells that secrete enzymes useful in digestion endocrine: from Islets of langerhans ALpha: glycogen Beta: insulin Delta: gastrin and somatostatin differentiate grand mal seizure from petit mal seizure correct answer grand - tonic clonic petit - absence distinguish prerenal, intrinsic, and postrenal failure correct answer pre: decrease in perfusion, low urine sodium and high osmolality intrinsic: damaged filtering structures post: due to obstruction
give some examples of upper airway obstruction correct answer croup epiglottitis bacterial tracheitis Give two causes of obstructuve shock correct answer tension pneumo or pulmonary emboli high sodiums corrected too quickly can cause what? correct answer cerebral edema how are the kidneys different in kids? correct answer larger in proximity GFR and renal blood flow are low at birth and gradually increase newborns have limited ability to regulate sodium How can Long QT syndrome be managed? correct answer -ICD -Denervation surgery -Potassium rich diet -Beta blockers -sodium channel blockers -omega 3 fatty acid supps how cool are temps for therapeutic hypothermia> correct answer 32-34 degrees how do the kidneys contribute to RBC production? correct answer decreased hematocrit or O2 tension is sensed and the kidneys release erythropoeitin, which causes RBC to increase
how does BPD manifest on Xray? correct answer patchy hyperinflation resembling ground glass How does croup manifest? correct answer increased stridor at night with large amounts of thin secretions How does dopamine affect heart function correct answer increases contractility and stroke volume how does Guillan Barre progress? correct answer ascending how does portal HTN manifest? correct answer splenomegaly ascites hypoalbuminemeia upper GI bleed esophageal varices dilated abd. veins How is a PDA managed? correct answer Inducin surgical coil or closure How is a tet spell managed? correct answer Knees to chest position keep patient calm 100% O2 by mask morphine
IV fluid replacement how is acute pulmonary edema managed?> correct answer PEEP to move fluid away from alveoli diuretics inotropes vasodilators how is an upper GI bleed differentiated from a lower GI bleed? correct answer above or below the ligament of treitz for 15 seconds or more how is bacterial meningitis diagnosed on CSF analysis? correct answer increased WBC Increased protein decreased glucose positive gram stain cloudy how is BPD managed? correct answer diuretics ventilation with slow weaning suirfactant oxygen How is brain death diagnosed? correct answer body temp > no CNS depressant drugs on board
neostigmine and pyridostigmine chorticosteroids IVIG how is pancreatitits managed? correct answer TPN, octreotide, analgesics how is pulm. HTN manifested? correct answer -tachycardia -possible elevated R atrial pressure -decreased CO -decreased perfusion how is pulmonary HTN defined? correct answer mean pulm. artery pressure above 25 how is scoliosis diagnosed? correct answer lateral curvature of the spine greater than 10 degrees how is severe scoliosis defined? what is treatment? correct answer >40 degrees. spinal fusion how is viral meningitis diagnosed on CSF analysis? correct answer slightly increased lymphocytes and negative gram stain how long do RBCs live? correct answer 120 how long does it take leukotriene to work? correct answer 24 hours
How long must you be NPO for cath lab? correct answer 4-6hours prior is compliance high or low in newborns? correct answer high large concentrations ADH cause... correct answer increased tubule permeability to water urine is more concentrated large concentrations of aldosterone cause... correct answer sodium reabsorption in distal tubules causes excretion of K+ List Manifestations of Impaired Myocardial function correct answer 1. tachycardia
- Sweating
- Decreased UOP
- fatigue
- anorexia
- decrease interest in activities
- cardiomegaly
- pale/cool extremities
- decreased BP List manifestations of Left Sided Heart Failure correct answer 1. Tachycardia
- dyspnia
Name 2 compensatory mechanisms of Chronic Heart Failure correct answer 1. Activation of the Sympathetic Nervous System
- Cardiac reserve; i.e. hypertrophy and dilation of cardiac muscle Name 3 causes of Chronic Heart Failure in Children correct answer 1. Structural Abnormalities
- Failure of the heart muscle
- excessive demands on normal heart muscle Name one factor that decreases contractility in the heart correct answer hypoxemia Name risk factors for Congenital Heart Disease correct answer Maternal Age Trisomy 21 alcohol ingestion anti-convulsant ingestion diabetes rubella in pregnancy coxsackie virus exposure Name the 3 most common ways to manage Hypertrophic Cardiomyopathy correct answer 1. Beta Blockers: decreases HR to prolong diastole and relaxation
- Calcium channel blockers: ventricular relaxation
- Septal myectomy
name the 4 criteria for ARDS correct answer 1. acute onset
- severe hypoxemia w/o response to O
- bilateral infiltrate
- absence of L atrial hypertension Name the main mediators in Anaphylactic shock correct answer IgE histamine seratonin bradykinin PGE thoracic trauma accounts for what percentage of pediatric deaths? correct answer 14 tumor lysis sybndrome can contribute to which electrolyte imbalance? correct answer hyperphosphatemia Two factors contributing to DECREASE in preload correct answer 1. dehydration
- vasodilation what absorption is the duodenum responsible for? correct answer iron trace metals water soluble vitamins what absorption is the ileum responsible for? correct answer bile salts
synthesize plasma proteins and bile What are beta blockers used to manage? correct answer automatic and reentry tachycardias what are calcium channel blockers used to manage? correct answer reentry SVT what are causes of SIADH? correct answer pulmonary conditions CNS conditions meds such as vasopressin, narcotics, chemo, barbituates what are common adverse effects of anti-epileptic meds? correct answer fatigue dizzy weight gain bone density loss gingival hyperplasia rash aplastic anemia impaired coordination and speech What are common complications to look for after Tet surgery? correct answer Arrhythmias - particularly heart block and junctional rhythms RV dysfunction leading to poor Cardiac output
residual issues with prior defects What are main causes of BPD? correct answer long term need for high O2 causing fibrosis and scarring of alveoli what are manifestation of acute pulmonary edema? correct answer gallop rhythm and pink frothy sputum What are manifestations of a PDA correct answer machine like murmur wide pulse pressure low DBP waterhammer pulse what are manifestations of a subarachnoid bleed? correct answer rapid increase in ICP sudden onset headache loss of consciousness What are manifestations of Aortic Stenosis? correct answer Increased afterload and need for coronary artery blood supply chest pain activity intolerance syncope sudden death what are manifestations of DI? correct answer Blood osmolality >
