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CPEN PRACTICE QUESTIONS & RATIONALES
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CPEN PRACTICE QUESTIONS & RATIONALES
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CPEN PRACTICE QUESTIONS & RATIONALESAn 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. - Answers -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. - Answers -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. - Answers -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 - Answers -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 - Answers -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 - Answers -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
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 - Answers -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.
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. - Answers -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. - Answers -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. - Answers -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 - Answers -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
solution (0.9% normal saline or lactated Ringer's solution) is usually the first choice for
fluid replacement
A 10-year-old presents to the emergency department with abdominal pain, vomiting and
a sudden onset of scrotal pain with swelling. The parent states that the symptoms
started approximately one hour ago while the child was playing outside. The nurse
should anticipate which diagnostic test will be ordered?
A. CT scan
B. urinalysis
C. ultrasound
D. x-ray - Answers -C. An ultrasound is used to detect a testicular torsion. Neither an X-
ray, nor a urinalysis will detect a torsion. CT scans expose a patient to high levels of
radiation that are unnecessary for diagnosis of this condition.
A 6-year-old female presents for a possible urinary tract infection. During assessment,
patchy areas of hair loss are noted. The nurse should also consider
A. physical abuse.
B. Wilson disease.
C. hypermagnesemia.
D. hypercalcemia. - Answers -A. Patchy hair loss (traction alopecia) may be seen in
young girls who are being physically abused. A further concern would be the possible
urinary tract infection in a 6-year-old female. Low magnesium or hypercalcemia are not
indicated in alopecia. Wilson disease is an excess of copper.
, A child is complaining of abdominal and shoulder pain after an all-terrain vehicle crash.
He is pale and tachycardic. These symptoms are suggestive of
A. dislocated shoulder.
B. splenic injury.
C. cardiac contusion.
D. clavicle fracture. - Answers -B. The child presenting appearing pale and tachycardia
suggests the child is internally bleeding. These signs, accompanied by abdominal pain
and shoulder pain (Kehr's sign), make the diagnosis of splenic injury the most likely.
An adolescent presents with severe eye pain, stating "there is something stuck in my
eye." The globe is intact. Which of the following is the PRIORITY intervention?
A. Patch both eyes.
B. Instill fluorescein stain.
C.Administer topical analgesics.
D. Irrigate eye with saline - Answers -C. Eye drops and ophthalmic ointments are used
to decrease pain. Patching is not supported any longer by evidence. Both irrigation and
fluoroscein will happen but after pain control.
Which of the following patients requires the MOST emergent intervention?
A. a crying child with delayed capillary refill
B. an anxious child with decreased breath sounds
C. an alert infant with a bulging fontanel
D. an obtunded child who is vomiting - Answers -D. The Patient Assessment Triangle
(PAT) is an "across the room" visual assessment. An obtunded child is the most
concerning as a sign of decreased mentation.
A 5-day-old neonate is diagnosed with hyperbilirubinemia. If left untreated, the infant
may have long-term issues with
A. bleeding disorders.
B. intellectual deficits.
C. dehydration.
D. change in skin color. - Answers -B. As production of bilirubin exceeds the newborn
capacity to conjugate and plasma levels begin to rise rapidly, free bilirubin can migrate
into the brain cells via the blood-brain barrier and cause kernicterus. Kernicterus is
acute bilirubin encephalopathy. Characteristics of fully developed encephalopathy may
not be clearly evident for several years and can include intellectual deficits.
A child presents with fever, malaise, and generalized flat, red rash for 24 hours. The
caregiver notes white spots inside the mouth. The nurse should suspect
A. measles.
B. scarlet fever.
C. varicella.
D. viral exanthema. - Answers -A. Koplicks spots in the mouth are diagnostic of
measles.
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