EDPNA/BCEN CPEN Certification Examination
ACTUAL EXAM 2026/2027 | Certified Pediatric
Emergency Nurse | Verified Q&A | Pass
Guaranteed - A+ Graded
Domain 1: Triage, Assessment, and Stabilization (20 questions)
Q1: A 3-year-old is brought to triage by parents who report 2 days of fever and decreased oral intake.
Using the Pediatric Assessment Triangle (PAT), you note the child is listless with poor muscle tone, has
nasal flaring with head bobbing, and generalized pallor with cool extremities. What is your priority
classification?
A. ESI Level 4 – non-urgent, routine care
B. ESI Level 3 – multiple resources needed
C. ESI Level 2 – high risk, immediate bed needed [CORRECT]
D. ESI Level 5 – minimal resources, fast track
Rationale: The PAT reveals a critically ill child: Appearance (TICLS) shows poor
tone/interaction/listlessness; Work of Breathing shows increased effort (nasal flaring, head bobbing);
Circulation shows poor perfusion (pallor, cool extremities). This meets ESI Level 2 criteria. ESI 4/5 (A, D)
are inappropriate for this high-acuity presentation. ESI 3 (B) underestimates the immediate threat to
life.
Q2: An 8-month-old infant weighs 8.5 kg. The Broselow tape places the child in the purple zone. Which
medication dosing is CORRECT for this weight zone?
A. Epinephrine 0.85 mg IV/IO for cardiac arrest
B. Adenosine 8.5 mg rapid IV push for SVT
C. Defibrillation at 34 joules (4 J/kg) [CORRECT]
D. Amiodarone 85 mg bolus for VF/pulseless VT
,Rationale: Purple zone = 8.5 kg. Defibrillation dose is 4 J/kg = 34 J. Epinephrine (A) should be 0.085 mg
(0.01 mg/kg), not 0.85 mg. Adenosine (B) first dose is 0.1 mg/kg = 0.85 mg, not 8.5 mg. Amiodarone (D)
is 5 mg/kg = 42.5 mg, not 85 mg.
Q3: A 14-year-old trauma patient arrives via EMS with GCS 13, HR 118, RR 24, BP 98/62. The Pediatric
Assessment Triangle shows appropriate appearance, mild increased work of breathing, and normal
circulation to skin. What is the FIRST priority intervention?
A. CT scan of head to evaluate for intracranial injury
B. Establish IV access and begin fluid resuscitation [CORRECT]
C. Administer morphine 0.1 mg/kg for pain control
D. Apply cervical collar and prepare for spinal motion restriction
Rationale: BP 98/62 in a 14-year-old indicates compensated shock (tachycardia + borderline
hypotension). Per PALS trauma algorithm, fluid resuscitation is priority. CT (A) before stabilization risks
deterioration. Pain medication (C) may worsen hemodynamics. C-spine (D) is important but secondary
to addressing shock.
Q4: A 2-year-old is being assessed for pain. The child is pre-verbal and crying. Which assessment tool is
MOST appropriate?
A. Numeric Rating Scale (0-10)
B. Visual Analog Scale
C. FLACC Scale (Face, Legs, Activity, Cry, Consolability) [CORRECT]
D. McGill Pain Questionnaire
Rationale: FLACC is validated for children 2 months to 7 years, including pre-verbal children. Numeric (A)
and VAS (B) require cognitive ability to quantify pain. McGill (D) is for adults with complex pain
descriptors.
Q5: During resuscitation of a 5-year-old with septic shock, the parents request to remain present. What
is the BEST response?
A. Ask them to wait in the family room until the child is stable
B. Allow family presence with a designated support person assigned to them [CORRECT]
C. Permit presence but require them to stand at the room entrance only
D. Deny presence citing infection control concerns
,Rationale: Family presence during resuscitation is supported by ENA/ENA guidelines when a support
person is assigned. Complete exclusion (A) contradicts family-centered care. Restricting to doorway (C)
is arbitrary. Infection control (D) is not a valid reason to exclude family.
Q6: A 6-month-old presents with fever. What are the normal vital sign parameters for this age?
A. HR 80-120, RR 20-30, SBP 70-90
B. HR 100-140, RR 25-35, SBP 85-105 [CORRECT]
C. HR 60-100, RR 15-25, SBP 90-110
D. HR 120-160, RR 30-40, SBP 95-115
Rationale: Normal infant (6-12 months) vitals: HR 100-140, RR 25-35, SBP 85-105. Option A shows
bradycardic rates. Option C shows adult rates. Option D shows toddler rates with elevated BP.
Q7: A 10-year-old with known asthma presents in moderate distress. Which finding indicates the MOST
severe respiratory compromise?
A. Respiratory rate of 28
B. Oxygen saturation of 92% on room air
C. Silent chest with poor air movement [CORRECT]
D. Use of accessory muscles
Rationale: Silent chest indicates severe airway obstruction and impending respiratory failure—a pre-
arrest finding. Tachypnea (A), mild hypoxemia (B), and accessory muscle use (D) are concerning but not
as critical as silent chest.
Q8: An 18-month-old is being prepared for a painful procedure (laceration repair). Which developmental
approach is MOST appropriate?
A. Detailed explanation of the procedure using medical terminology
B. Allowing the child to hold the needle and syringe to reduce fear
C. Positioning for comfort (parent holding child), distraction, and topical anesthetic [CORRECT]
D. Restraint without explanation to complete procedure quickly
Rationale: Toddlers (1-3 years) need comfort positioning, distraction, and minimal restraint. Detailed
explanations (A) are beyond their cognitive level. Allowing needle play (B) is unsafe. Forceful restraint
without support (D) causes psychological trauma.
, Q9: A 4-year-old weighs 18 kg. Using the "2-4-6-8-10" rule for endotracheal tube size, what is the
APPROPRIATE uncuffed tube size?
A. 4.0 mm
B. 4.5 mm
C. 5.0 mm [CORRECT]
D. 5.5 mm
Rationale: Formula: (Age/4) + 4 = (4/4) + 4 = 5.0 mm. Or 18 kg ≈ 4 years. 4.0 (A) and 4.5 (B) are too
small. 5.5 (D) is appropriate for a 6-year-old.
Q10: During primary survey of a pediatric trauma patient, you assess circulation. Which finding requires
IMMEDIATE intervention?
A. Capillary refill 2 seconds
B. Heart rate 110 (age 6 years)
C. Weak, thready pulses with delayed capillary refill >3 seconds [CORRECT]
D. Warm, pink extremities
Rationale: Weak, thready pulses with delayed capillary refill >3 seconds indicate decompensated shock
requiring immediate fluid resuscitation. Normal cap refill (A), appropriate tachycardia (B), and warm
extremities (D) are reassuring findings.
Q11: A 7-year-old with sickle cell disease presents with fever 39.2°C and looks ill. What is the MOST
important immediate action?
A. Obtain detailed family history of sickle cell complications
B. Draw blood cultures and administer empiric antibiotics within 60 minutes [CORRECT]
C. Apply supplemental oxygen 2L NC
D. Start IV fluids at maintenance rate only
Rationale: Febrile children with sickle cell disease are at high risk for sepsis from encapsulated
organisms. Antibiotics within 60 minutes per sepsis guidelines. Family history (A) can wait. Oxygen (C) if
hypoxemic. Maintenance fluids (D) are insufficient—need aggressive hydration.
Q12: A 3-month-old infant presents with fever 38.8°C, well-appearing, normal labs. What is the
APPROPRIATE management per current guidelines?
A. Lumbar puncture, blood culture, admit for 48-hour observation
ACTUAL EXAM 2026/2027 | Certified Pediatric
Emergency Nurse | Verified Q&A | Pass
Guaranteed - A+ Graded
Domain 1: Triage, Assessment, and Stabilization (20 questions)
Q1: A 3-year-old is brought to triage by parents who report 2 days of fever and decreased oral intake.
Using the Pediatric Assessment Triangle (PAT), you note the child is listless with poor muscle tone, has
nasal flaring with head bobbing, and generalized pallor with cool extremities. What is your priority
classification?
A. ESI Level 4 – non-urgent, routine care
B. ESI Level 3 – multiple resources needed
C. ESI Level 2 – high risk, immediate bed needed [CORRECT]
D. ESI Level 5 – minimal resources, fast track
Rationale: The PAT reveals a critically ill child: Appearance (TICLS) shows poor
tone/interaction/listlessness; Work of Breathing shows increased effort (nasal flaring, head bobbing);
Circulation shows poor perfusion (pallor, cool extremities). This meets ESI Level 2 criteria. ESI 4/5 (A, D)
are inappropriate for this high-acuity presentation. ESI 3 (B) underestimates the immediate threat to
life.
Q2: An 8-month-old infant weighs 8.5 kg. The Broselow tape places the child in the purple zone. Which
medication dosing is CORRECT for this weight zone?
A. Epinephrine 0.85 mg IV/IO for cardiac arrest
B. Adenosine 8.5 mg rapid IV push for SVT
C. Defibrillation at 34 joules (4 J/kg) [CORRECT]
D. Amiodarone 85 mg bolus for VF/pulseless VT
,Rationale: Purple zone = 8.5 kg. Defibrillation dose is 4 J/kg = 34 J. Epinephrine (A) should be 0.085 mg
(0.01 mg/kg), not 0.85 mg. Adenosine (B) first dose is 0.1 mg/kg = 0.85 mg, not 8.5 mg. Amiodarone (D)
is 5 mg/kg = 42.5 mg, not 85 mg.
Q3: A 14-year-old trauma patient arrives via EMS with GCS 13, HR 118, RR 24, BP 98/62. The Pediatric
Assessment Triangle shows appropriate appearance, mild increased work of breathing, and normal
circulation to skin. What is the FIRST priority intervention?
A. CT scan of head to evaluate for intracranial injury
B. Establish IV access and begin fluid resuscitation [CORRECT]
C. Administer morphine 0.1 mg/kg for pain control
D. Apply cervical collar and prepare for spinal motion restriction
Rationale: BP 98/62 in a 14-year-old indicates compensated shock (tachycardia + borderline
hypotension). Per PALS trauma algorithm, fluid resuscitation is priority. CT (A) before stabilization risks
deterioration. Pain medication (C) may worsen hemodynamics. C-spine (D) is important but secondary
to addressing shock.
Q4: A 2-year-old is being assessed for pain. The child is pre-verbal and crying. Which assessment tool is
MOST appropriate?
A. Numeric Rating Scale (0-10)
B. Visual Analog Scale
C. FLACC Scale (Face, Legs, Activity, Cry, Consolability) [CORRECT]
D. McGill Pain Questionnaire
Rationale: FLACC is validated for children 2 months to 7 years, including pre-verbal children. Numeric (A)
and VAS (B) require cognitive ability to quantify pain. McGill (D) is for adults with complex pain
descriptors.
Q5: During resuscitation of a 5-year-old with septic shock, the parents request to remain present. What
is the BEST response?
A. Ask them to wait in the family room until the child is stable
B. Allow family presence with a designated support person assigned to them [CORRECT]
C. Permit presence but require them to stand at the room entrance only
D. Deny presence citing infection control concerns
,Rationale: Family presence during resuscitation is supported by ENA/ENA guidelines when a support
person is assigned. Complete exclusion (A) contradicts family-centered care. Restricting to doorway (C)
is arbitrary. Infection control (D) is not a valid reason to exclude family.
Q6: A 6-month-old presents with fever. What are the normal vital sign parameters for this age?
A. HR 80-120, RR 20-30, SBP 70-90
B. HR 100-140, RR 25-35, SBP 85-105 [CORRECT]
C. HR 60-100, RR 15-25, SBP 90-110
D. HR 120-160, RR 30-40, SBP 95-115
Rationale: Normal infant (6-12 months) vitals: HR 100-140, RR 25-35, SBP 85-105. Option A shows
bradycardic rates. Option C shows adult rates. Option D shows toddler rates with elevated BP.
Q7: A 10-year-old with known asthma presents in moderate distress. Which finding indicates the MOST
severe respiratory compromise?
A. Respiratory rate of 28
B. Oxygen saturation of 92% on room air
C. Silent chest with poor air movement [CORRECT]
D. Use of accessory muscles
Rationale: Silent chest indicates severe airway obstruction and impending respiratory failure—a pre-
arrest finding. Tachypnea (A), mild hypoxemia (B), and accessory muscle use (D) are concerning but not
as critical as silent chest.
Q8: An 18-month-old is being prepared for a painful procedure (laceration repair). Which developmental
approach is MOST appropriate?
A. Detailed explanation of the procedure using medical terminology
B. Allowing the child to hold the needle and syringe to reduce fear
C. Positioning for comfort (parent holding child), distraction, and topical anesthetic [CORRECT]
D. Restraint without explanation to complete procedure quickly
Rationale: Toddlers (1-3 years) need comfort positioning, distraction, and minimal restraint. Detailed
explanations (A) are beyond their cognitive level. Allowing needle play (B) is unsafe. Forceful restraint
without support (D) causes psychological trauma.
, Q9: A 4-year-old weighs 18 kg. Using the "2-4-6-8-10" rule for endotracheal tube size, what is the
APPROPRIATE uncuffed tube size?
A. 4.0 mm
B. 4.5 mm
C. 5.0 mm [CORRECT]
D. 5.5 mm
Rationale: Formula: (Age/4) + 4 = (4/4) + 4 = 5.0 mm. Or 18 kg ≈ 4 years. 4.0 (A) and 4.5 (B) are too
small. 5.5 (D) is appropriate for a 6-year-old.
Q10: During primary survey of a pediatric trauma patient, you assess circulation. Which finding requires
IMMEDIATE intervention?
A. Capillary refill 2 seconds
B. Heart rate 110 (age 6 years)
C. Weak, thready pulses with delayed capillary refill >3 seconds [CORRECT]
D. Warm, pink extremities
Rationale: Weak, thready pulses with delayed capillary refill >3 seconds indicate decompensated shock
requiring immediate fluid resuscitation. Normal cap refill (A), appropriate tachycardia (B), and warm
extremities (D) are reassuring findings.
Q11: A 7-year-old with sickle cell disease presents with fever 39.2°C and looks ill. What is the MOST
important immediate action?
A. Obtain detailed family history of sickle cell complications
B. Draw blood cultures and administer empiric antibiotics within 60 minutes [CORRECT]
C. Apply supplemental oxygen 2L NC
D. Start IV fluids at maintenance rate only
Rationale: Febrile children with sickle cell disease are at high risk for sepsis from encapsulated
organisms. Antibiotics within 60 minutes per sepsis guidelines. Family history (A) can wait. Oxygen (C) if
hypoxemic. Maintenance fluids (D) are insufficient—need aggressive hydration.
Q12: A 3-month-old infant presents with fever 38.8°C, well-appearing, normal labs. What is the
APPROPRIATE management per current guidelines?
A. Lumbar puncture, blood culture, admit for 48-hour observation
