CPEN Certification Pediatric Emergency
Nursing Practice Exam A Comprehensive
150-Question Advanced Practice
Assessment with Detailed Rationales
for the Certified Pediatric Emergency
Nurse Examination
Table of Contents
Section Topic Questions
I Triage Process and Assessment 1–25
II Respiratory Emergencies 26–50
III Cardiovascular Emergencies 51–70
IV Neurological Emergencies 71–85
V Gastrointestinal and Genitourinary Emergencies 86–100
VI Trauma Emergencies 101–120
VII Environmental and Toxicological Emergencies 121–135
Behavioral Health, Professional Issues, and Special
VIII 136–150
Populations
Section I: Triage Process and Assessment
,🟢 Question 1. A 4-year-old child arrives by private car after falling from a playground structure. The child
is crying, has a large scalp hematoma, and is holding the left arm. Which triage acuity level is most
appropriate using the Emergency Severity Index (ESI)?
A) Level 1 – Resuscitation
B) Level 2 – High risk
C) Level 3 – Multiple resources
D) Level 4 – One resource
🔴 Correct Answer: C – The child is stable but will require multiple resources (X-ray for possible fracture,
wound care, CT if neurological concerns). ESI level 3 is for stable patients expected to need ≥2 resources.
🟢 Question 2. In addition to work of breathing, which of the following are components of the Pediatric
Assessment Triangle (PAT)?
A) General appearance and circulation to the skin
B) Patency of airway and circulation to the skin
C) General appearance and developmental level
D) Patency of airway and developmental level
🔴 Correct Answer: A – The PAT consists of three components: general appearance, work of breathing,
and circulation to the skin. It is a rapid visual and auditory assessment tool used to determine if a child is
"sick" or "not sick."
🟢 Question 3. A 12-year-old arrives in the emergency department with a history of infrequent but
unusual activity consisting of facial grimacing, picking at her clothes, and not responding to her teacher's
questions. This behavior is most suggestive of:
A) Absence seizure
B) Pseudoseizure
C) Complex partial seizure
D) Simple partial seizure
🔴 Correct Answer: C – Complex partial seizures (now termed focal impaired awareness seizures) involve
impaired consciousness and automatisms such as facial grimacing, lip smacking, and picking at clothes.
Absence seizures typically involve staring spells without automatisms.
,🟢 Question 4. The Pediatric Assessment Triangle reveals that a 6-month-old has decreased muscle tone,
head bobbing with respirations, and pale skin color. The PRIORITY intervention is to:
A) Start an IV and administer 20 mL/kg of warmed crystalloid solution
B) Proceed with rapid assessment of airway, breathing, and circulation
C) Place the infant on a stretcher and manually open the airway
D) Administer oxygen via non-rebreather at 6 L/min
🔴 Correct Answer: B – When the PAT reveals an abnormal appearance, work of breathing, and/or
circulation, the priority is to proceed immediately to the primary assessment (ABCs). The PAT is a
screening tool that triggers rapid assessment, not immediate intervention without further evaluation.
🟢 Question 5. A 2-week-old infant presents with fever (38.5°C), lethargy, and poor feeding. Vital signs
are stable. What is the priority action?
A) Administer acetaminophen and discharge with follow-up
B) Perform a full sepsis workup (CBC, blood culture, urine culture, CSF analysis)
C) Obtain a chest X-ray
D) Give oral antibiotics
🔴 Correct Answer: B – Any febrile infant ≤28 days is at high risk for serious bacterial infection and
requires a complete sepsis evaluation, including lumbar puncture, and hospital admission for empiric
antibiotics.
🟢 Question 6. A 3-month-old is brought to triage with nausea, vomiting, and diarrhea. The mother
states, "My baby just isn't acting normal, she won't wake up to feed and didn't take her bottle this
morning." The child has a weak cry and sleeps through the vitals assessment. Vitals: T-38°C, HR-180, BP-
72/42, RR-40, SaO₂-96% on room air. Which of the following actions is the most appropriate next step?
A) Give acetaminophen orally to treat the fever as that will help bring down the heart rate
B) Advise the parents that this is a typical reaction to immunizations
C) Initiate a cool bath to reduce the fever
D) Check a glucose at triage
🔴 Correct Answer: D – The infant is presenting with concerning signs including lethargy, weak cry, poor
feeding, and inability to wake for feeding, along with fever and tachycardia. Bedside glucose should be
checked immediately as hypoglycemia is a reversible cause of altered mental status and lethargy in
infants.
, 🟢 Question 7. An 8-year-old presents to triage with nausea, left shoulder pain of 8/10, and diffuse
abdominal pain of 2/10. The history is unremarkable except for a fall from a tree one day prior to arrival.
Vital signs: BP 90/50 mmHg, HR 120 bpm, RR 28, T 98.6°F. Which of the following injuries should the
nurse suspect?
A) Clavicle fracture
B) Humerus fracture
C) Liver laceration
D) Splenic laceration
🔴 Correct Answer: D – Left shoulder pain (Kehr's sign) referred from diaphragmatic irritation, combined
with diffuse abdominal pain, tachycardia, and hypotension following trauma, is highly suggestive of
splenic laceration. The spleen is located in the left upper quadrant, and bleeding irritates the diaphragm,
causing referred pain to the left shoulder.
🟢 Question 8. A 4-day-old neonate presents with jaundice. Which of the following is the PRIORITY
intervention?
A) Obtain a transcutaneous bilirubin level
B) Initiate phototherapy immediately
C) Assess feeding patterns and weight
D) Obtain a serum bilirubin level and blood type
🔴 Correct Answer: D – The priority in neonatal jaundice is to obtain a serum bilirubin level and blood
type to determine the severity and risk of kernicterus. Transcutaneous bilirubin can be used as a
screening tool, but serum bilirubin is definitive.
🟢 Question 9. A school-age child presents with a 4-day history of abdominal pain, vomiting, fever, and
constipation. There are no beds currently available. Which of the following is a PRIORITY intervention?
A) Administer an enema to relieve constipation
B) Obtain an order for an abdominal X-ray
C) Instruct the parents to keep the child NPO
D) Obtain a clean catch urine specimen
🔴 Correct Answer: C – The child presents with signs of possible appendicitis or bowel obstruction.
Keeping the child NPO is essential in case surgical intervention is required. Enemas are contraindicated if
obstruction or appendicitis is suspected.
Nursing Practice Exam A Comprehensive
150-Question Advanced Practice
Assessment with Detailed Rationales
for the Certified Pediatric Emergency
Nurse Examination
Table of Contents
Section Topic Questions
I Triage Process and Assessment 1–25
II Respiratory Emergencies 26–50
III Cardiovascular Emergencies 51–70
IV Neurological Emergencies 71–85
V Gastrointestinal and Genitourinary Emergencies 86–100
VI Trauma Emergencies 101–120
VII Environmental and Toxicological Emergencies 121–135
Behavioral Health, Professional Issues, and Special
VIII 136–150
Populations
Section I: Triage Process and Assessment
,🟢 Question 1. A 4-year-old child arrives by private car after falling from a playground structure. The child
is crying, has a large scalp hematoma, and is holding the left arm. Which triage acuity level is most
appropriate using the Emergency Severity Index (ESI)?
A) Level 1 – Resuscitation
B) Level 2 – High risk
C) Level 3 – Multiple resources
D) Level 4 – One resource
🔴 Correct Answer: C – The child is stable but will require multiple resources (X-ray for possible fracture,
wound care, CT if neurological concerns). ESI level 3 is for stable patients expected to need ≥2 resources.
🟢 Question 2. In addition to work of breathing, which of the following are components of the Pediatric
Assessment Triangle (PAT)?
A) General appearance and circulation to the skin
B) Patency of airway and circulation to the skin
C) General appearance and developmental level
D) Patency of airway and developmental level
🔴 Correct Answer: A – The PAT consists of three components: general appearance, work of breathing,
and circulation to the skin. It is a rapid visual and auditory assessment tool used to determine if a child is
"sick" or "not sick."
🟢 Question 3. A 12-year-old arrives in the emergency department with a history of infrequent but
unusual activity consisting of facial grimacing, picking at her clothes, and not responding to her teacher's
questions. This behavior is most suggestive of:
A) Absence seizure
B) Pseudoseizure
C) Complex partial seizure
D) Simple partial seizure
🔴 Correct Answer: C – Complex partial seizures (now termed focal impaired awareness seizures) involve
impaired consciousness and automatisms such as facial grimacing, lip smacking, and picking at clothes.
Absence seizures typically involve staring spells without automatisms.
,🟢 Question 4. The Pediatric Assessment Triangle reveals that a 6-month-old has decreased muscle tone,
head bobbing with respirations, and pale skin color. The PRIORITY intervention is to:
A) Start an IV and administer 20 mL/kg of warmed crystalloid solution
B) Proceed with rapid assessment of airway, breathing, and circulation
C) Place the infant on a stretcher and manually open the airway
D) Administer oxygen via non-rebreather at 6 L/min
🔴 Correct Answer: B – When the PAT reveals an abnormal appearance, work of breathing, and/or
circulation, the priority is to proceed immediately to the primary assessment (ABCs). The PAT is a
screening tool that triggers rapid assessment, not immediate intervention without further evaluation.
🟢 Question 5. A 2-week-old infant presents with fever (38.5°C), lethargy, and poor feeding. Vital signs
are stable. What is the priority action?
A) Administer acetaminophen and discharge with follow-up
B) Perform a full sepsis workup (CBC, blood culture, urine culture, CSF analysis)
C) Obtain a chest X-ray
D) Give oral antibiotics
🔴 Correct Answer: B – Any febrile infant ≤28 days is at high risk for serious bacterial infection and
requires a complete sepsis evaluation, including lumbar puncture, and hospital admission for empiric
antibiotics.
🟢 Question 6. A 3-month-old is brought to triage with nausea, vomiting, and diarrhea. The mother
states, "My baby just isn't acting normal, she won't wake up to feed and didn't take her bottle this
morning." The child has a weak cry and sleeps through the vitals assessment. Vitals: T-38°C, HR-180, BP-
72/42, RR-40, SaO₂-96% on room air. Which of the following actions is the most appropriate next step?
A) Give acetaminophen orally to treat the fever as that will help bring down the heart rate
B) Advise the parents that this is a typical reaction to immunizations
C) Initiate a cool bath to reduce the fever
D) Check a glucose at triage
🔴 Correct Answer: D – The infant is presenting with concerning signs including lethargy, weak cry, poor
feeding, and inability to wake for feeding, along with fever and tachycardia. Bedside glucose should be
checked immediately as hypoglycemia is a reversible cause of altered mental status and lethargy in
infants.
, 🟢 Question 7. An 8-year-old presents to triage with nausea, left shoulder pain of 8/10, and diffuse
abdominal pain of 2/10. The history is unremarkable except for a fall from a tree one day prior to arrival.
Vital signs: BP 90/50 mmHg, HR 120 bpm, RR 28, T 98.6°F. Which of the following injuries should the
nurse suspect?
A) Clavicle fracture
B) Humerus fracture
C) Liver laceration
D) Splenic laceration
🔴 Correct Answer: D – Left shoulder pain (Kehr's sign) referred from diaphragmatic irritation, combined
with diffuse abdominal pain, tachycardia, and hypotension following trauma, is highly suggestive of
splenic laceration. The spleen is located in the left upper quadrant, and bleeding irritates the diaphragm,
causing referred pain to the left shoulder.
🟢 Question 8. A 4-day-old neonate presents with jaundice. Which of the following is the PRIORITY
intervention?
A) Obtain a transcutaneous bilirubin level
B) Initiate phototherapy immediately
C) Assess feeding patterns and weight
D) Obtain a serum bilirubin level and blood type
🔴 Correct Answer: D – The priority in neonatal jaundice is to obtain a serum bilirubin level and blood
type to determine the severity and risk of kernicterus. Transcutaneous bilirubin can be used as a
screening tool, but serum bilirubin is definitive.
🟢 Question 9. A school-age child presents with a 4-day history of abdominal pain, vomiting, fever, and
constipation. There are no beds currently available. Which of the following is a PRIORITY intervention?
A) Administer an enema to relieve constipation
B) Obtain an order for an abdominal X-ray
C) Instruct the parents to keep the child NPO
D) Obtain a clean catch urine specimen
🔴 Correct Answer: C – The child presents with signs of possible appendicitis or bowel obstruction.
Keeping the child NPO is essential in case surgical intervention is required. Enemas are contraindicated if
obstruction or appendicitis is suspected.
