BCEN CPEN® (Certified Pediatric Emergency
Nurse) ACTUAL EXAM ALL QUESTIONS AND
ANSWERS ALREADY GRADED A+. 100%
VERIFIED SOLUTIONS | UPDATED PER
LATEST GUIDELINES | GRADED A+
SECTION 1: TRIAGE PROCESS
Question 1
A triage nurse in the emergency department is assessing four children. Which patient should
receive the HIGHEST priority?
• A. 8-month-old who is vomiting and has a sunken fontanel
• B. 16-month-old who has a cough and a respiratory rate of 48 breaths/min
• C. 3-year-old who has a swollen wrist with numbness and tingling
• D. 4-year-old who has a barky cough and stridor when crying
Answer: D. 4-year-old who has a barky cough and stridor when crying
Rationale: The child with a barky cough and stridor when crying is exhibiting signs of upper
airway obstruction, most likely croup or epiglottitis. Stridor is a sign of impending airway
compromise and requires immediate attention. While the 8-month-old with vomiting and a
sunken fontanel shows signs of dehydration (high priority), the airway concern takes
precedence. The 16-month-old with tachypnea and the 3-year-old with neurovascular
compromise are also urgent but not immediately life-threatening.
,Question 2
According to the Pediatric Assessment Triangle (PAT), which components should the nurse
assess during the initial visual assessment of a pediatric patient?
• A. Appearance, work of breathing, and circulation to the skin
• B. Airway, breathing, and circulation
• C. Level of consciousness, pupillary response, and motor function
• D. Heart rate, respiratory rate, and blood pressure
Answer: A. Appearance, work of breathing, and circulation to the skin
Rationale: The Pediatric Assessment Triangle (PAT) is a rapid, visual assessment tool used to
determine the child's clinical status within seconds. The three components are: Appearance
(tone, interactiveness, consolability, gaze, speech/cry), Work of Breathing (abnormal sounds,
positions, retractions), and Circulation to the Skin (pallor, mottling, cyanosis). This assessment
guides the initial triage priority.
Question 3
A 2-year-old child presents to the emergency department with a fever of 103°F, drooling, and
tripod positioning. The nurse should:
• A. Obtain a throat culture
• B. Administer racemic epinephrine
• C. Prepare for emergent airway management
• D. Administer oral corticosteroids
Answer: C. Prepare for emergent airway management
Rationale: Fever, drooling, and tripod positioning in a child are classic signs of epiglottitis, a life-
threatening airway emergency. The priority is to prepare for emergent airway management, as
the child is at imminent risk of airway obstruction. The child should be kept calm, and no
invasive procedures (such as throat cultures) should be performed until the airway is secured.
Racemic epinephrine is used for croup, not epiglottitis.
,Question 4
A 6-year-old child presents with a history of a witnessed seizure lasting 8 minutes. The child is
now postictal but breathing spontaneously. What is the priority nursing action?
• A. Administer rectal diazepam
• B. Obtain a CT scan of the head
• C. Assess airway, breathing, and circulation
• D. Start an IV for anticonvulsant therapy
Answer: C. Assess airway, breathing, and circulation
Rationale: The priority in any pediatric emergency is to assess airway, breathing, and circulation
(ABCs). Although the seizure has stopped, the child remains at risk for airway compromise,
aspiration, or postictal respiratory depression. The other interventions may be appropriate but
only after the ABCs are assessed and stabilized.
Question 5
A triage nurse is using the Emergency Severity Index (ESI) to triage a 4-year-old with a fever and
petechial rash. This patient should be assigned which ESI level?
• A. ESI Level 1
• B. ESI Level 2
• C. ESI Level 3
• D. ESI Level 4
Answer: B. ESI Level 2
Rationale: Fever with a petechial rash in a child is a high-risk presentation that could indicate
meningococcemia or sepsis. ESI Level 2 is for high-risk patients who should not wait. While the
patient is not requiring immediate life-saving intervention (Level 1), the potential for rapid
deterioration makes this a high-acuity presentation requiring urgent evaluation.
Question 6
A 10-year-old child presents with suicidal ideation and a plan to harm themselves. The triage
nurse should:
• A. Discharge the child with a safety plan
, • B. Place the child on a 1:1 observation and initiate psychiatric evaluation
• C. Administer antidepressants
• D. Refer to outpatient therapy
Answer: B. Place the child on a 1:1 observation and initiate psychiatric evaluation
Rationale: A child with suicidal ideation and a plan requires immediate psychiatric evaluation
and a safe environment. The child should be placed on 1:1 observation to ensure safety. A safety
plan is insufficient when the patient has a plan and intent. Antidepressants are not appropriate
in the acute setting.
Question 7
A 3-month-old infant is brought to the ED with a chief complaint of "not acting right." The infant
is lethargic, has a weak cry, and is difficult to arouse. Which triage level is most appropriate?
• A. ESI Level 1
• B. ESI Level 2
• C. ESI Level 3
• D. ESI Level 4
Answer: A. ESI Level 1
Rationale: A lethargic infant with a weak cry and difficulty arousing is showing signs of
significant neurological depression or shock. This patient requires immediate life-saving
intervention and should be triaged as ESI Level 1. Infants can decompensate rapidly, and this
presentation indicates a high risk of respiratory or cardiac arrest.
Question 8
A 5-year-old child presents with a cough, fever, and difficulty breathing. The nurse notes the
child is sitting upright, leaning forward with the mouth open, and drooling. Which condition
should the nurse suspect?
• A. Croup
• B. Epiglottitis
• C. Bronchiolitis
Nurse) ACTUAL EXAM ALL QUESTIONS AND
ANSWERS ALREADY GRADED A+. 100%
VERIFIED SOLUTIONS | UPDATED PER
LATEST GUIDELINES | GRADED A+
SECTION 1: TRIAGE PROCESS
Question 1
A triage nurse in the emergency department is assessing four children. Which patient should
receive the HIGHEST priority?
• A. 8-month-old who is vomiting and has a sunken fontanel
• B. 16-month-old who has a cough and a respiratory rate of 48 breaths/min
• C. 3-year-old who has a swollen wrist with numbness and tingling
• D. 4-year-old who has a barky cough and stridor when crying
Answer: D. 4-year-old who has a barky cough and stridor when crying
Rationale: The child with a barky cough and stridor when crying is exhibiting signs of upper
airway obstruction, most likely croup or epiglottitis. Stridor is a sign of impending airway
compromise and requires immediate attention. While the 8-month-old with vomiting and a
sunken fontanel shows signs of dehydration (high priority), the airway concern takes
precedence. The 16-month-old with tachypnea and the 3-year-old with neurovascular
compromise are also urgent but not immediately life-threatening.
,Question 2
According to the Pediatric Assessment Triangle (PAT), which components should the nurse
assess during the initial visual assessment of a pediatric patient?
• A. Appearance, work of breathing, and circulation to the skin
• B. Airway, breathing, and circulation
• C. Level of consciousness, pupillary response, and motor function
• D. Heart rate, respiratory rate, and blood pressure
Answer: A. Appearance, work of breathing, and circulation to the skin
Rationale: The Pediatric Assessment Triangle (PAT) is a rapid, visual assessment tool used to
determine the child's clinical status within seconds. The three components are: Appearance
(tone, interactiveness, consolability, gaze, speech/cry), Work of Breathing (abnormal sounds,
positions, retractions), and Circulation to the Skin (pallor, mottling, cyanosis). This assessment
guides the initial triage priority.
Question 3
A 2-year-old child presents to the emergency department with a fever of 103°F, drooling, and
tripod positioning. The nurse should:
• A. Obtain a throat culture
• B. Administer racemic epinephrine
• C. Prepare for emergent airway management
• D. Administer oral corticosteroids
Answer: C. Prepare for emergent airway management
Rationale: Fever, drooling, and tripod positioning in a child are classic signs of epiglottitis, a life-
threatening airway emergency. The priority is to prepare for emergent airway management, as
the child is at imminent risk of airway obstruction. The child should be kept calm, and no
invasive procedures (such as throat cultures) should be performed until the airway is secured.
Racemic epinephrine is used for croup, not epiglottitis.
,Question 4
A 6-year-old child presents with a history of a witnessed seizure lasting 8 minutes. The child is
now postictal but breathing spontaneously. What is the priority nursing action?
• A. Administer rectal diazepam
• B. Obtain a CT scan of the head
• C. Assess airway, breathing, and circulation
• D. Start an IV for anticonvulsant therapy
Answer: C. Assess airway, breathing, and circulation
Rationale: The priority in any pediatric emergency is to assess airway, breathing, and circulation
(ABCs). Although the seizure has stopped, the child remains at risk for airway compromise,
aspiration, or postictal respiratory depression. The other interventions may be appropriate but
only after the ABCs are assessed and stabilized.
Question 5
A triage nurse is using the Emergency Severity Index (ESI) to triage a 4-year-old with a fever and
petechial rash. This patient should be assigned which ESI level?
• A. ESI Level 1
• B. ESI Level 2
• C. ESI Level 3
• D. ESI Level 4
Answer: B. ESI Level 2
Rationale: Fever with a petechial rash in a child is a high-risk presentation that could indicate
meningococcemia or sepsis. ESI Level 2 is for high-risk patients who should not wait. While the
patient is not requiring immediate life-saving intervention (Level 1), the potential for rapid
deterioration makes this a high-acuity presentation requiring urgent evaluation.
Question 6
A 10-year-old child presents with suicidal ideation and a plan to harm themselves. The triage
nurse should:
• A. Discharge the child with a safety plan
, • B. Place the child on a 1:1 observation and initiate psychiatric evaluation
• C. Administer antidepressants
• D. Refer to outpatient therapy
Answer: B. Place the child on a 1:1 observation and initiate psychiatric evaluation
Rationale: A child with suicidal ideation and a plan requires immediate psychiatric evaluation
and a safe environment. The child should be placed on 1:1 observation to ensure safety. A safety
plan is insufficient when the patient has a plan and intent. Antidepressants are not appropriate
in the acute setting.
Question 7
A 3-month-old infant is brought to the ED with a chief complaint of "not acting right." The infant
is lethargic, has a weak cry, and is difficult to arouse. Which triage level is most appropriate?
• A. ESI Level 1
• B. ESI Level 2
• C. ESI Level 3
• D. ESI Level 4
Answer: A. ESI Level 1
Rationale: A lethargic infant with a weak cry and difficulty arousing is showing signs of
significant neurological depression or shock. This patient requires immediate life-saving
intervention and should be triaged as ESI Level 1. Infants can decompensate rapidly, and this
presentation indicates a high risk of respiratory or cardiac arrest.
Question 8
A 5-year-old child presents with a cough, fever, and difficulty breathing. The nurse notes the
child is sitting upright, leaning forward with the mouth open, and drooling. Which condition
should the nurse suspect?
• A. Croup
• B. Epiglottitis
• C. Bronchiolitis
