CPEN COMPREHENSIVE EXAM SCRIPT COMPLETE QUESTIONS VERIFIED SOLUTIONS
Question:
Continuous monitoring of a child's ETCO2 during cardiac arrest reveals 8 mmHg. This indicates
that CPR is A. ineffective and adjustments need to be made to compressions. B. no longer needed;
there is a return of spontaneous circulation. C. no longer needed; further resuscitation is futile. D.
ineffective and adjustments need to be made to ventilation.
Answer:
A. The 2010 guidelines recommended that if the partial pressure of ETCO2 is consistently less than
15 mm Hg efforts should focus on improving CPR quality, particularly improving chest
compressions and ensuring the child does not receive excessive ventilations.
Question:
A child presents to emergency department with symptoms of anaphylaxis after eating cookies at a
birthday party. The friend's parent is accompanying the child and is unable to reach the parents. The
nurse recognizes this legal issue as A. informed consent. B. implied consent. C. an EMTALA
violation. D. a HIPPA violation.
Answer:
B. Implied Consent
Question:
9-month-old presents to the Emergency Department with a mid-shaft tibia fracture. Which of the
following statements from the parent might indicate history of non-accidental trauma (NAT). A.
Patient was being changed on top of a table and rolled off. B. Patient was an unrestrained passenger
in a motor vehicle collision. C. Patient was crawling on a deck and fell off approximately 4 feet. D.
Patient was riding a tricycle and fell off
Answer:
D. The patient does not have the development and coordination to ride a tricycle. A 9- month-old
can roll over and it is possible to fall and fracture their arm. Even though the patient was
unrestrained, it may not involve NAT. A 9- month-old is often crawling and, if the patient was not
,being watched, could have fallen off a deck and again not be considered NAT.
Question:
Which developmental task is expected in a toddler? A. industry B. trust C. initiative D. autonomy
Answer:
D. Toddlers learn to exercise will and do things for themselves. Developmental task of toddlerhood
is acquiring a sense of autonomy. Several characteristics, especially negativism and ritualism, are
typical of toddlers.
Question:
Following a motor vehicle collision, a patient is diagnosed with a C7 fracture and anterior spinal
cord syndrome. The nurse understands this patient will: A. will be able to ambulate with assistance
B. be wheelchair dependent C. will regain most function at some point D. be ventilator dependent
Answer:
B. The patient will be a paraplegic and may be able to complete movement with their arms. He will
not be ventilator dependent or be able to ambulate independently. He will be evaluated
independently but will be unable to walk
Question:
Which of the following is the BEST method to assess adequacy of ventilation during procedural
sedation? A. breath sounds B. oxygen saturation C. respiratory rate D. capnography value
Answer:
D. capnography is used to determine adequacy of ventilation. Oxygen saturation provides the
percentage of hemoglobin carrying oxygen. Hypoventilation is detected more rapidly by
capnography than by auscultation of breath sounds, oxygen saturation or respiratory rate.
Question:
A 2-year-old presents to the emergency department with tonic-clonic movements which the
caregivers report occurring for one minute prior to arrival. The priority intervention is A. preparing
for intubation. B. administering oxygen via a nonrebreathing mask. C. turning patient to the side. D.
placing an intraosseous needle.
,Answer:
C. Turning the patient to a side is part of the initial assessment to reduce the risk of aspiration and
tongue obstruction. There is no indication for an intraosseous needle as most antiseizure
medications can be given via other routes. Currently, there is no indication for intubation. Oxygen
will not assist if the airway is not patent.
Question:
A mother runs into the emergency department screaming that her child is choking on a piece of
candy. The nurse observes a fearful 5- year-old with minimal air movement and dusky in color. The
nurse's initial action should be to A. perform abdominal thrusts. B. obtain an oxygen saturation
level. C. facilitate oral tracheal intubation. D. obtain a chest radiograph.
Answer:
A. A child brought to the ED with sudden onset of respiratory distress should be evaluated for
foreign body aspiration if no other cause is apparent. Initially, a foreign body obstruction produces
choking, gassing, wheezing, or coughing. If the object becomes lodged in the larynx, the child
cannot speak or breathe, For children 1 year or older, abdominal thrusts should be used.
Question:
A 2-month-old presents with irritability and is inconsolable. Which finding would lead the
emergency nurse to suspect shaken baby syndrome? A. Unilateral retinal hemorrhage B. Bruising of
the legs. C. Decreased movement of the legs D. Bilateral retinal hemorrhages
Answer:
D. Shaken baby syndrome is common in children less than one year of age. Male caregivers have a
higher rate of shaken baby syndrome. Bilateral retinal hemorrhages are more common due to weak
neck muscles and large occiput. The infant is usually held by the arms and shaken. Bruises of the
arms would occur. Decreased movement of the legs would usually be a spinal cord injury. Bruising
of the legs are not indicative of shaken baby syndrome.
Question:
A 2-year-old child has not used his left arm for the past hour. His mother reported grabbing his hand
to prevent him from falling from a slide. The nurse should suspect A. a forearm fracture. B. a
supracondylar fracture. C. shoulder dislocation. D. subluxation of the radial head.
Answer:
, D. Subluxation of the radial head, or a nursemaid's elbow, is one of the most common injuries seen
in toddlers. Resulting from a sudden pull on the child's arms, the child refuses to move or use the
affected extremity.
Question:
A 1-year-old presents unconscious and is being ventilated with a bag- mask device. Ventilation has
become progressively more difficult. Which of the following is the PRIORITY intervention? A.
Insert a nasogastric tube. B. Obtain a pulse oximeter reading. C. Place padding under the shoulders.
Answer:
C. Due to a large occiput, optimal airway position is achieved by placing padding under the
shoulders. The padding provides neutral alignment of the airway and cervical spine. The other
options need to occur, but they are not the priority intervention
Question:
If administering epinephrine to a pediatric patient having a severe allergic reaction, the proper dose
and concentration should be epinephrine A. 0.10 mL/kg and 1mg/10 mL B. 0.01 mL/kg and 1
mg/mL C. 0.01 mL/kg and 1 mg/10 mL D. 0.10 mL/kg and 1 mg/mL
Answer:
B. The concentration of 1 mg/mL is indicated for allergic reaction and anaphylaxis to be
administered IM. The concentration of 1 mg/10 mL is for cardiac arrest treatments to be
administered IV or IO. The correct dosing of either concentration is 0.01 mL/kg.
Question:
An adolescent presents with superficial lacerations to both forearms. She is tearful and avoids eye
contact with staff. Which of the following is the PRIORITY intervention for this patient? A.
Maintain a safe environment. B. Initiate wound care. C. Notify the police. D. Order a social work
consultation.
Answer:
A. During the pediatric triage and assessment process, the main concern of the nursing is to maintain
a safe environment for the patient and to foster hopefulness.
Question:
Continuous monitoring of a child's ETCO2 during cardiac arrest reveals 8 mmHg. This indicates
that CPR is A. ineffective and adjustments need to be made to compressions. B. no longer needed;
there is a return of spontaneous circulation. C. no longer needed; further resuscitation is futile. D.
ineffective and adjustments need to be made to ventilation.
Answer:
A. The 2010 guidelines recommended that if the partial pressure of ETCO2 is consistently less than
15 mm Hg efforts should focus on improving CPR quality, particularly improving chest
compressions and ensuring the child does not receive excessive ventilations.
Question:
A child presents to emergency department with symptoms of anaphylaxis after eating cookies at a
birthday party. The friend's parent is accompanying the child and is unable to reach the parents. The
nurse recognizes this legal issue as A. informed consent. B. implied consent. C. an EMTALA
violation. D. a HIPPA violation.
Answer:
B. Implied Consent
Question:
9-month-old presents to the Emergency Department with a mid-shaft tibia fracture. Which of the
following statements from the parent might indicate history of non-accidental trauma (NAT). A.
Patient was being changed on top of a table and rolled off. B. Patient was an unrestrained passenger
in a motor vehicle collision. C. Patient was crawling on a deck and fell off approximately 4 feet. D.
Patient was riding a tricycle and fell off
Answer:
D. The patient does not have the development and coordination to ride a tricycle. A 9- month-old
can roll over and it is possible to fall and fracture their arm. Even though the patient was
unrestrained, it may not involve NAT. A 9- month-old is often crawling and, if the patient was not
,being watched, could have fallen off a deck and again not be considered NAT.
Question:
Which developmental task is expected in a toddler? A. industry B. trust C. initiative D. autonomy
Answer:
D. Toddlers learn to exercise will and do things for themselves. Developmental task of toddlerhood
is acquiring a sense of autonomy. Several characteristics, especially negativism and ritualism, are
typical of toddlers.
Question:
Following a motor vehicle collision, a patient is diagnosed with a C7 fracture and anterior spinal
cord syndrome. The nurse understands this patient will: A. will be able to ambulate with assistance
B. be wheelchair dependent C. will regain most function at some point D. be ventilator dependent
Answer:
B. The patient will be a paraplegic and may be able to complete movement with their arms. He will
not be ventilator dependent or be able to ambulate independently. He will be evaluated
independently but will be unable to walk
Question:
Which of the following is the BEST method to assess adequacy of ventilation during procedural
sedation? A. breath sounds B. oxygen saturation C. respiratory rate D. capnography value
Answer:
D. capnography is used to determine adequacy of ventilation. Oxygen saturation provides the
percentage of hemoglobin carrying oxygen. Hypoventilation is detected more rapidly by
capnography than by auscultation of breath sounds, oxygen saturation or respiratory rate.
Question:
A 2-year-old presents to the emergency department with tonic-clonic movements which the
caregivers report occurring for one minute prior to arrival. The priority intervention is A. preparing
for intubation. B. administering oxygen via a nonrebreathing mask. C. turning patient to the side. D.
placing an intraosseous needle.
,Answer:
C. Turning the patient to a side is part of the initial assessment to reduce the risk of aspiration and
tongue obstruction. There is no indication for an intraosseous needle as most antiseizure
medications can be given via other routes. Currently, there is no indication for intubation. Oxygen
will not assist if the airway is not patent.
Question:
A mother runs into the emergency department screaming that her child is choking on a piece of
candy. The nurse observes a fearful 5- year-old with minimal air movement and dusky in color. The
nurse's initial action should be to A. perform abdominal thrusts. B. obtain an oxygen saturation
level. C. facilitate oral tracheal intubation. D. obtain a chest radiograph.
Answer:
A. A child brought to the ED with sudden onset of respiratory distress should be evaluated for
foreign body aspiration if no other cause is apparent. Initially, a foreign body obstruction produces
choking, gassing, wheezing, or coughing. If the object becomes lodged in the larynx, the child
cannot speak or breathe, For children 1 year or older, abdominal thrusts should be used.
Question:
A 2-month-old presents with irritability and is inconsolable. Which finding would lead the
emergency nurse to suspect shaken baby syndrome? A. Unilateral retinal hemorrhage B. Bruising of
the legs. C. Decreased movement of the legs D. Bilateral retinal hemorrhages
Answer:
D. Shaken baby syndrome is common in children less than one year of age. Male caregivers have a
higher rate of shaken baby syndrome. Bilateral retinal hemorrhages are more common due to weak
neck muscles and large occiput. The infant is usually held by the arms and shaken. Bruises of the
arms would occur. Decreased movement of the legs would usually be a spinal cord injury. Bruising
of the legs are not indicative of shaken baby syndrome.
Question:
A 2-year-old child has not used his left arm for the past hour. His mother reported grabbing his hand
to prevent him from falling from a slide. The nurse should suspect A. a forearm fracture. B. a
supracondylar fracture. C. shoulder dislocation. D. subluxation of the radial head.
Answer:
, D. Subluxation of the radial head, or a nursemaid's elbow, is one of the most common injuries seen
in toddlers. Resulting from a sudden pull on the child's arms, the child refuses to move or use the
affected extremity.
Question:
A 1-year-old presents unconscious and is being ventilated with a bag- mask device. Ventilation has
become progressively more difficult. Which of the following is the PRIORITY intervention? A.
Insert a nasogastric tube. B. Obtain a pulse oximeter reading. C. Place padding under the shoulders.
Answer:
C. Due to a large occiput, optimal airway position is achieved by placing padding under the
shoulders. The padding provides neutral alignment of the airway and cervical spine. The other
options need to occur, but they are not the priority intervention
Question:
If administering epinephrine to a pediatric patient having a severe allergic reaction, the proper dose
and concentration should be epinephrine A. 0.10 mL/kg and 1mg/10 mL B. 0.01 mL/kg and 1
mg/mL C. 0.01 mL/kg and 1 mg/10 mL D. 0.10 mL/kg and 1 mg/mL
Answer:
B. The concentration of 1 mg/mL is indicated for allergic reaction and anaphylaxis to be
administered IM. The concentration of 1 mg/10 mL is for cardiac arrest treatments to be
administered IV or IO. The correct dosing of either concentration is 0.01 mL/kg.
Question:
An adolescent presents with superficial lacerations to both forearms. She is tearful and avoids eye
contact with staff. Which of the following is the PRIORITY intervention for this patient? A.
Maintain a safe environment. B. Initiate wound care. C. Notify the police. D. Order a social work
consultation.
Answer:
A. During the pediatric triage and assessment process, the main concern of the nursing is to maintain
a safe environment for the patient and to foster hopefulness.
