CPEN CERTIFIED PEDIATRIC EMERGENCY NURSE
PRACTICE EXAMINATION 2026–2027 — STUDY GUIDE
| LATEST UPDATE 2026/2027 | PRACTICE QUESTIONS
AND ANSWERS | EXAM REVIEW | 100% CORRECT
ANSWERS | VERIFIED SOLUTIONS | ALREADY
GRADED A+
1. A 2-year-old child presents with a barking cough, stridor, and low-
grade fever. The child is alert and interactive. What is the most
likely diagnosis?
A) Epiglottitis
B) Croup (laryngotracheobronchitis)
C) Bacterial tracheitis
D) Foreign body aspiration
Correct Answer: B
Croup presents with a barky cough, stridor, and low-grade fever,
typically in children 6 months to 3 years, and is often viral. Epiglottitis
has high fever, drooling, toxic appearance, and tripod positioning.
Bacterial tracheitis is more severe with high fever and toxic appearance.
Foreign body aspiration has sudden onset without preceding viral
symptoms.
2. A 3-year-old child with a peanut allergy develops stridor, urticaria,
and wheezing after eating a cookie. An epinephrine auto-injector
is available. What is the correct first action?
A) Administer diphenhydramine orally
, B) Administer epinephrine intramuscularly into the lateral thigh
C) Call 911 first and wait
D) Have the child drink water and observe
Correct Answer: B
Anaphylaxis with stridor requires immediate intramuscular epinephrine
as first-line therapy. Diphenhydramine is an adjunct and should not
delay epinephrine. Calling 911 is important but epinephrine comes first.
Drinking water or observing delays life-saving treatment.
3. A 6-month-old infant presents with respiratory distress, wheezing,
and nasal flaring during the winter. The infant has a low-grade
fever and poor feeding. What is the most likely diagnosis?
A) Asthma
B) Bronchiolitis
C) Croup
D) Epiglottitis
Correct Answer: B
Bronchiolitis, commonly caused by RSV, affects infants and presents with
wheezing, respiratory distress, nasal flaring, poor feeding, and low-
grade fever in winter. Asthma is possible but less common in infants.
Croup has barky cough and stridor. Epiglottitis is rare and more toxic.
4. A 4-year-old child has a fever, drooling, and sits in a tripod
position. The child appears anxious and refuses to swallow. What
should the nurse do?
A) Inspect the throat with a tongue depressor
B) Keep the child calm, allow a parent to stay, and prepare for
emergency airway management
, C) Offer oral fluids
D) Lay the child flat to examine
Correct Answer: B
The presentation suggests epiglottitis. Throat inspection with a tongue
depressor can trigger complete airway obstruction and should be
avoided. The child should be kept calm with the parent nearby, and
emergency airway equipment should be ready. Oral fluids and supine
positioning are unsafe.
5. A 7-year-old child with asthma has a peak expiratory flow rate of
40% of personal best after two albuterol treatments. The child has
intercostal retractions and speaks in short phrases. What is the
priority intervention?
A) Discharge home with oral prednisone
B) Continue aggressive bronchodilation and prepare for
hospitalization
C) Give only oxygen and observe
D) Administer an antibiotic
Correct Answer: B
PEFR <40% after initial treatment indicates a severe asthma
exacerbation requiring continued aggressive bronchodilation, systemic
corticosteroids, and likely hospitalization. Discharge is unsafe. Oxygen
alone is insufficient. Antibiotics are not indicated unless there is a
bacterial infection.
6. An 18-month-old child presents with sudden onset of coughing,
wheezing, and decreased breath sounds on the right. The child
was playing with small toys. What is the most likely diagnosis?
A) Croup
, B) Foreign body aspiration
C) Bronchiolitis
D) Epiglottitis
Correct Answer: B
Sudden onset of cough, wheezing, and asymmetric breath sounds after
playing with small toys strongly suggests foreign body aspiration. Croup
and bronchiolitis have prodromal symptoms. Epiglottitis has fever and
drooling without toy exposure.
7. A 5-year-old child has a fever and a purple, non-blanching rash.
Vital signs show tachycardia and capillary refill of 4 seconds. What
is the priority nursing action?
A) Apply warm compresses
B) Obtain blood cultures and start antibiotics immediately
C) Wait for laboratory confirmation
D) Administer antipyretics only
Correct Answer: B
Fever with purpura and signs of poor perfusion suggests meningococcal
sepsis. Blood cultures should be obtained and empiric antibiotics started
immediately without waiting for lab confirmation. Warm compresses
and antipyretics do not address sepsis. Waiting is dangerous.
8. A 3-year-old child with a history of sickle cell disease presents with
pain and swelling of the hands and feet. What is the most likely
cause?
A) Osteomyelitis
B) Vaso-occlusive crisis (dactylitis)
C) Fracture
D) Septic arthritis
PRACTICE EXAMINATION 2026–2027 — STUDY GUIDE
| LATEST UPDATE 2026/2027 | PRACTICE QUESTIONS
AND ANSWERS | EXAM REVIEW | 100% CORRECT
ANSWERS | VERIFIED SOLUTIONS | ALREADY
GRADED A+
1. A 2-year-old child presents with a barking cough, stridor, and low-
grade fever. The child is alert and interactive. What is the most
likely diagnosis?
A) Epiglottitis
B) Croup (laryngotracheobronchitis)
C) Bacterial tracheitis
D) Foreign body aspiration
Correct Answer: B
Croup presents with a barky cough, stridor, and low-grade fever,
typically in children 6 months to 3 years, and is often viral. Epiglottitis
has high fever, drooling, toxic appearance, and tripod positioning.
Bacterial tracheitis is more severe with high fever and toxic appearance.
Foreign body aspiration has sudden onset without preceding viral
symptoms.
2. A 3-year-old child with a peanut allergy develops stridor, urticaria,
and wheezing after eating a cookie. An epinephrine auto-injector
is available. What is the correct first action?
A) Administer diphenhydramine orally
, B) Administer epinephrine intramuscularly into the lateral thigh
C) Call 911 first and wait
D) Have the child drink water and observe
Correct Answer: B
Anaphylaxis with stridor requires immediate intramuscular epinephrine
as first-line therapy. Diphenhydramine is an adjunct and should not
delay epinephrine. Calling 911 is important but epinephrine comes first.
Drinking water or observing delays life-saving treatment.
3. A 6-month-old infant presents with respiratory distress, wheezing,
and nasal flaring during the winter. The infant has a low-grade
fever and poor feeding. What is the most likely diagnosis?
A) Asthma
B) Bronchiolitis
C) Croup
D) Epiglottitis
Correct Answer: B
Bronchiolitis, commonly caused by RSV, affects infants and presents with
wheezing, respiratory distress, nasal flaring, poor feeding, and low-
grade fever in winter. Asthma is possible but less common in infants.
Croup has barky cough and stridor. Epiglottitis is rare and more toxic.
4. A 4-year-old child has a fever, drooling, and sits in a tripod
position. The child appears anxious and refuses to swallow. What
should the nurse do?
A) Inspect the throat with a tongue depressor
B) Keep the child calm, allow a parent to stay, and prepare for
emergency airway management
, C) Offer oral fluids
D) Lay the child flat to examine
Correct Answer: B
The presentation suggests epiglottitis. Throat inspection with a tongue
depressor can trigger complete airway obstruction and should be
avoided. The child should be kept calm with the parent nearby, and
emergency airway equipment should be ready. Oral fluids and supine
positioning are unsafe.
5. A 7-year-old child with asthma has a peak expiratory flow rate of
40% of personal best after two albuterol treatments. The child has
intercostal retractions and speaks in short phrases. What is the
priority intervention?
A) Discharge home with oral prednisone
B) Continue aggressive bronchodilation and prepare for
hospitalization
C) Give only oxygen and observe
D) Administer an antibiotic
Correct Answer: B
PEFR <40% after initial treatment indicates a severe asthma
exacerbation requiring continued aggressive bronchodilation, systemic
corticosteroids, and likely hospitalization. Discharge is unsafe. Oxygen
alone is insufficient. Antibiotics are not indicated unless there is a
bacterial infection.
6. An 18-month-old child presents with sudden onset of coughing,
wheezing, and decreased breath sounds on the right. The child
was playing with small toys. What is the most likely diagnosis?
A) Croup
, B) Foreign body aspiration
C) Bronchiolitis
D) Epiglottitis
Correct Answer: B
Sudden onset of cough, wheezing, and asymmetric breath sounds after
playing with small toys strongly suggests foreign body aspiration. Croup
and bronchiolitis have prodromal symptoms. Epiglottitis has fever and
drooling without toy exposure.
7. A 5-year-old child has a fever and a purple, non-blanching rash.
Vital signs show tachycardia and capillary refill of 4 seconds. What
is the priority nursing action?
A) Apply warm compresses
B) Obtain blood cultures and start antibiotics immediately
C) Wait for laboratory confirmation
D) Administer antipyretics only
Correct Answer: B
Fever with purpura and signs of poor perfusion suggests meningococcal
sepsis. Blood cultures should be obtained and empiric antibiotics started
immediately without waiting for lab confirmation. Warm compresses
and antipyretics do not address sepsis. Waiting is dangerous.
8. A 3-year-old child with a history of sickle cell disease presents with
pain and swelling of the hands and feet. What is the most likely
cause?
A) Osteomyelitis
B) Vaso-occlusive crisis (dactylitis)
C) Fracture
D) Septic arthritis
