Cpen Practice Questions &
Rationales With Correct
Answers 2025-2026 Graded
+
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. - 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. - 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. - 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 - 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.
Which developmental task is expected in a toddler?
A. industry
B. trust
C. initiative
D. autonomy - 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 - 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 - 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. - 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.
D. obtain a chest radiograph. - 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 - 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. - 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. - 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 - ANS-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.
Rationales With Correct
Answers 2025-2026 Graded
+
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. - 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. - 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. - 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 - 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.
Which developmental task is expected in a toddler?
A. industry
B. trust
C. initiative
D. autonomy - 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 - 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 - 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. - 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.
D. obtain a chest radiograph. - 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 - 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. - 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. - 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 - ANS-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.
