CPEN
CPEN Practice Questions & Rationales
An anxious adolescent presents with palpitations, a heart rate of 184 beats/min, and
normal skin tone. Which of the following is the PRIORITY intervention?
A. Obtain urine drug screen.
B. Administer IV adenosine (Adenocard) rapidly.
C. Instruct the patient to bear down.
D. Provide comfort and reassurance. - Correct Ans-D. SVT is defined as heart rate
>220 in infants and >180 in children. Thus putting the child in SVT. Search and treat the
cause. The PRIORITY intervention to provide comfort and reassurance could lower
heart rate while preparing other interventions and assessments. Vagal maneuvers
would be the next intervention, followed by adenosine.
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. - Correct Ans-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.
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. - Correct Ans-B. Implied Consent
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 - Correct Ans-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.
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Which developmental task is expected in a toddler?
A. industry
B. trust
C. initiative
D. autonomy - Correct Ans-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.
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 - Correct Ans-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
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 - Correct Ans-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.
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. - Correct Ans-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.
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.
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D. obtain a chest radiograph. - Correct Ans-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.
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 - Correct Ans-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.
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. - Correct Ans-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.
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. - Correct Ans-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
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 - Correct Ans-B. The concentration of 1 mg/mL is indicated
for allergic reaction and anaphylaxis to be administered IM. The concentration of 1
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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.
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. - Correct Ans-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.
A child presents with fever, left eye pain, swelling, and impaired extraocular movement.
The nurse anticipates a workup for
A. orbital cellulitis.
B. uveitis/iritis.
C. conjunctivitis.
D. periorbital cellulitis. - Correct Ans-A. Orbital cellulitis is an acute inflammation of the
orbital contents posterior to the orbital septum. It is deeper and more serious infection
behind the septum and involving the posterior eye structures. Periorbital cellulitis is an
acute infection and inflammation involving the eyelid and surrounding tissues anterior to
the septum. Both orbital and periorbital cellulitis are serious conditions because of their
proximity to the brain.
What would be the most appropriate intervention for a child with suspected
intussusception?
A. Laxative administration.
B. Barium enema.
C. Nasogastric placement.
D. Air enema. - Correct Ans-D. An air enema may reduce the telescoping of the bowel.
Barium enemas are used less often and have higher complication rates due to the
potential for perforation and peritonitis. Administering a laxative is not indicated.
Placement of an NG tube will not assist in this disease process.
A 5-week-old infant is brought in with a 2-day history of profuse vomiting after every
feeding, constant hunger, and decreased wet diaper count. The infant has sunken eyes
and dry mucus membranes. Vital signs:
BP 61/32 HR 184 RR 56 Cap refill 2s
Which of the following is the most appropriate INITIAL IV fluid?
A. D5 0.45 NS
B. 0.9 NS
C. D10 0.9 NS
D. D5 0.25 NS - Correct Ans-B. In many cases, rapid restoration of blood volume is the
main therapy needed in the resuscitation of the child in shock. An isotonic crystalloid
CPEN
CPEN Practice Questions & Rationales
An anxious adolescent presents with palpitations, a heart rate of 184 beats/min, and
normal skin tone. Which of the following is the PRIORITY intervention?
A. Obtain urine drug screen.
B. Administer IV adenosine (Adenocard) rapidly.
C. Instruct the patient to bear down.
D. Provide comfort and reassurance. - Correct Ans-D. SVT is defined as heart rate
>220 in infants and >180 in children. Thus putting the child in SVT. Search and treat the
cause. The PRIORITY intervention to provide comfort and reassurance could lower
heart rate while preparing other interventions and assessments. Vagal maneuvers
would be the next intervention, followed by adenosine.
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. - Correct Ans-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.
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. - Correct Ans-B. Implied Consent
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 - Correct Ans-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.
CPEN
,CPEN
Which developmental task is expected in a toddler?
A. industry
B. trust
C. initiative
D. autonomy - Correct Ans-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.
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 - Correct Ans-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
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 - Correct Ans-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.
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. - Correct Ans-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.
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.
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,CPEN
D. obtain a chest radiograph. - Correct Ans-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.
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 - Correct Ans-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.
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. - Correct Ans-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.
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. - Correct Ans-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
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 - Correct Ans-B. The concentration of 1 mg/mL is indicated
for allergic reaction and anaphylaxis to be administered IM. The concentration of 1
CPEN
, CPEN
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.
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. - Correct Ans-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.
A child presents with fever, left eye pain, swelling, and impaired extraocular movement.
The nurse anticipates a workup for
A. orbital cellulitis.
B. uveitis/iritis.
C. conjunctivitis.
D. periorbital cellulitis. - Correct Ans-A. Orbital cellulitis is an acute inflammation of the
orbital contents posterior to the orbital septum. It is deeper and more serious infection
behind the septum and involving the posterior eye structures. Periorbital cellulitis is an
acute infection and inflammation involving the eyelid and surrounding tissues anterior to
the septum. Both orbital and periorbital cellulitis are serious conditions because of their
proximity to the brain.
What would be the most appropriate intervention for a child with suspected
intussusception?
A. Laxative administration.
B. Barium enema.
C. Nasogastric placement.
D. Air enema. - Correct Ans-D. An air enema may reduce the telescoping of the bowel.
Barium enemas are used less often and have higher complication rates due to the
potential for perforation and peritonitis. Administering a laxative is not indicated.
Placement of an NG tube will not assist in this disease process.
A 5-week-old infant is brought in with a 2-day history of profuse vomiting after every
feeding, constant hunger, and decreased wet diaper count. The infant has sunken eyes
and dry mucus membranes. Vital signs:
BP 61/32 HR 184 RR 56 Cap refill 2s
Which of the following is the most appropriate INITIAL IV fluid?
A. D5 0.45 NS
B. 0.9 NS
C. D10 0.9 NS
D. D5 0.25 NS - Correct Ans-B. In many cases, rapid restoration of blood volume is the
main therapy needed in the resuscitation of the child in shock. An isotonic crystalloid
CPEN
