CPEN MAIN EXAMINATION SET QUESTIONS AND
ANSWERS RATED A+
✔✔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. - ✔✔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. - ✔✔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 - ✔✔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. - ✔✔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. - ✔✔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 - ✔✔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. - ✔✔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. - ✔✔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. - ✔✔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 - ✔✔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 - ✔✔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. - ✔✔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. - ✔✔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 - ✔✔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 - ✔✔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. - ✔✔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.
ANSWERS RATED A+
✔✔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. - ✔✔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. - ✔✔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 - ✔✔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. - ✔✔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. - ✔✔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 - ✔✔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. - ✔✔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. - ✔✔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. - ✔✔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 - ✔✔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 - ✔✔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. - ✔✔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. - ✔✔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 - ✔✔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 - ✔✔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. - ✔✔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.
