AACN Updated CCRN-Pediatric Exam Questions and Answers by clay

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.

High PEEP levels can causebarotrauma, leading totension pneumothorax—a life-threatening complication. Symptoms include sudden hypoxia, bradycardia, hypotension, and reduced perfusion.Thoracentesis (needle decompression)is the emergency intervention.

“Sudden hemodynamic instability in a ventilated child on high PEEP may indicate pneumothorax. Immediate decompression is warranted to restore cardiopulmonary function.”

(Referenced from CCRN Pediatric – Direct Care: Pulmonary, Mechanical Ventilation and Complications)

Peritoneal dialysis (PD)is used in pediatric patients withrenal failure, especially when associated withfluid overload (hypervolemia), uremia, or electrolyte imbalances not responsive to medical therapy. It is particularly effective forgradual fluid removalin children.

“Indications for peritoneal dialysis in children include fluid overload, hyperkalemia, and acidosis not corrected by conservative measures.”

(Referenced from CCRN Pediatric – Direct Care: Renal, Indications for Dialysis)

It is a best practice—and often required by hospital policy—fortrained personnel such as an organ donation liaison or organ procurement organization (OPO)representative to approach families about organ donation. This ensures that the conversation is handled sensitively, accurately, and in accordance with regulatory requirements.

“The nurse should notify the designated organ donation liaison or team when a patient meets criteria for brain death. These individuals are trained to communicate effectively and ethically with families.”

(Referenced from CCRN Pediatric – Professional Caring and Ethical Practice: Ethics, End-of-Life Care, and Organ Donation)