CPEN UPDATED STUDY EXAM GUIDE QUESTIONS AND
ANSWERS RATED A+
✔✔A child with 30% body surface area burns is awaiting transfer to the burn center.
The nurse should
A. cover the burns with moist gauze.
B. cover the burns with dry towel or sheet.
C. wrap the burns with silvadene.
D. keep the burns open for evaluation. - ✔✔B. Superficial burns less than 10% TBSA
cool burned tissue. Maintenance of body temperature is crucial in patients with burns
since they have lost their protective skin barrier. Cover with dry sheets to keep the
patient warm.
✔✔An afebrile 12-year-old male is complaining of abdominal pain, nausea and vomiting
upon waking. What information is a PRIORITY for the nurse to obtain?
A. "What has your fluid intake been in the last 12 hours?"
B. "Have you had any trauma to your abdomen?"
C. "When was the last time you had a bowel movement?"
D. "Have you had any burning with urination?" - ✔✔B. Testicular torsion occurs annually
in 1 in every 1500 males under the age of 18 years (Afsarlar, Ryan, Donel, et al., 2016).
Rapid growth and increasing vascularity of the testicle are thought to be precursors to
torsion, accounting for the occurrence at puberty. Typically, the adolescent complains of
pain that is severe and acute; nausea, vomiting, and abdominal pain may accompany
the pain. Although the other questions are important, the PRIORITY is to rule out
testicular torsion. Constipation, UTI and dehydration would not be as urgent as
testicular torsion.
✔✔An infant presenting with tachypnea, intercostal retractions, and clear nasal
drainage is diagnosed with bronchiolitis. The respiratory distress is probably caused by
the infant's
A. smaller upper airways.
B. proportionally larger tongue.
C. less compliant chest wall.
D. higher tidal volume requirement. - ✔✔A. A small amount of edema or secretions can
cause airway restriction and obstruction in the smaller airways of infants.
✔✔A 6-year-old presents with a sudden onset of fever, chills, and macular rash of the
palms, wrist, ankles, and soles of the feet. The child was recently on a camping trip. The
nurse suspects
A. Rocky Mountain Spotted Fever.
B. scabies infestation.
C. Henoch-Schonlein purpura.
D. hand foot mouth disease. - ✔✔A. Rocky Mountain Spotted Fever is a tick-borne
illness. Symptoms generally occur 2-5 days after the tick bite. Characteristic symptoms
,include fever, headache, nausea, and a maculopapular rash that begins on the wrists
and ankles and spreads to the trunk.
✔✔A patient with a traumatic head injury presents with signs and symptoms of
Cushing's triad. Which of the following would be an expected finding?
A. narrowing pulse pressure
B. ecchymosis behind the ears
C. irregular, decreased respirations
D. Tachycardia - ✔✔C. Cushing's Triad indicates neurological decompensation. The
signs and symptoms are irregular, decreased respirations, widening pulse pressure and
bradycardia.
✔✔A 16-year-old presents after running a cross country match. The patient is extremely
fatigued with muscle pain and reports nausea and dark urine. The nurse should expect
a diagnosis of
A. hydronephrosis.
B. pyelonephritis.
C. glomerulonephritis.
D. rhabdomyolysis. - ✔✔D. The symptoms of fatigue, muscle pain, nausea and dark
urine are indicative of rhabdomyolysis. Muscle pain and dark urine help to differentiate
this diagnosis from the others listed.
✔✔A child complains of headache, nausea, and dizziness shortly after moving to an
older home. Which of the following interventions is MOST appropriate?
A. Place the child on pulse oximetry.
B. Administer an antiemetic.
C. Prepare for hyperbaric oxygen therapy.
D. Obtain carboxyhemoglobin level - ✔✔D. Carbon monoxide poisoning symptoms
include headache, nausea, dizziness, and impaired judgement. Pulse oximetry in
unreliable as the carbon monoxide molecule will bind with the hemoglobin giving a false
reading. A carboxyhemoglobin level is the standard for determining carbon monoxide
poisoning.
✔✔An adolescent with cerebral palsy fell and broke off a permanent tooth. The priority
treatment for this patient is to
A. have the patient place the tooth in their mouth.
B. rinse the tooth with saline.
C. place the tooth on ice.
D. scrub the tooth with water. - ✔✔B. Rinsing the tooth with saline will provide cleaning
and keep it moist. The nurse should not scrub the tooth or place it on ice as these
options can destroy the nerve roots hampering reimplantation. The patient has an
underlying neurological disorder so placing it in the mouth may result in the patient
swallowing the tooth.
, ✔✔A 2-year-old with known cardiac history is brought in by ambulance for prolonged
cyanosis following a temper tantrum. Treatment for this child would include
A. morphine.
B. albuterol nebulizers.
C. epinephrine drip.
D. intubation - ✔✔A. Children with congenital heart disease involving cyanosis spells
after a decrease in oxygen availability are characterized by hyper cyanosis. Morphine
will calm and decrease tachypnea and peripheral vascular resistance.
✔✔When assessing an infant with coarctation of the aorta, a nurse should expect to find
A. absent or diminished femoral pulses.
B. cyanotic episodes.
C. heart failure and pulmonary edema.
D. hypotension and tachycardia. - ✔✔A. Characteristic manifestations of a coarctation
include absent or diminished femoral pulses and higher blood pressures in the upper
extremities than lower extremities. Heart failure may develop if a critical coarctation is
present (a situation which would normally be identified in the nursery and surgically
corrected).
✔✔A 2-month-old presents with difficulty breathing associated with tachypnea, mild
retractions, and copious amounts of nasal drainage. The MOST appropriate intervention
is to
A. administer supplemental oxygen.
B. suction the nares.
C. obtain a chest x-ray.
D. measure oxygen saturation. - ✔✔B. Infants up to 6 months of age are preferential
nose breathers and may develop respiratory distress from nasal congestion. Suctioning
the nares clears the airway of secretions for more effective ventilation.
✔✔Which discharge instructions should be included for a teenage patient with a
hematocrit of 30%?
A. "Consistently use sunscreen when outside."
B. "Take the iron with a protein supplement."
C. "Take the iron with vitamin D."
D. "Taking iron with vitamin C will increase its efficiency." - ✔✔D. Taking iron with
vitamin C will result in a breakdown of the iron to its most soluble state. Protein and
vitamin D can interfere with absorption. Taking an iron supplement does not result in
photosensitivity.
✔✔An 18-month-old patient presents to the Emergency Department with upper
respiratory symptoms and wheezing. Chest x-ray reveals a radiopaque object in the left
lower lobe. The nurse prepares the patient for a:
A. Rigid bronchoscopy
B. Flexible bronchoscopy
C. Foreign body removal with fluoroscopy
ANSWERS RATED A+
✔✔A child with 30% body surface area burns is awaiting transfer to the burn center.
The nurse should
A. cover the burns with moist gauze.
B. cover the burns with dry towel or sheet.
C. wrap the burns with silvadene.
D. keep the burns open for evaluation. - ✔✔B. Superficial burns less than 10% TBSA
cool burned tissue. Maintenance of body temperature is crucial in patients with burns
since they have lost their protective skin barrier. Cover with dry sheets to keep the
patient warm.
✔✔An afebrile 12-year-old male is complaining of abdominal pain, nausea and vomiting
upon waking. What information is a PRIORITY for the nurse to obtain?
A. "What has your fluid intake been in the last 12 hours?"
B. "Have you had any trauma to your abdomen?"
C. "When was the last time you had a bowel movement?"
D. "Have you had any burning with urination?" - ✔✔B. Testicular torsion occurs annually
in 1 in every 1500 males under the age of 18 years (Afsarlar, Ryan, Donel, et al., 2016).
Rapid growth and increasing vascularity of the testicle are thought to be precursors to
torsion, accounting for the occurrence at puberty. Typically, the adolescent complains of
pain that is severe and acute; nausea, vomiting, and abdominal pain may accompany
the pain. Although the other questions are important, the PRIORITY is to rule out
testicular torsion. Constipation, UTI and dehydration would not be as urgent as
testicular torsion.
✔✔An infant presenting with tachypnea, intercostal retractions, and clear nasal
drainage is diagnosed with bronchiolitis. The respiratory distress is probably caused by
the infant's
A. smaller upper airways.
B. proportionally larger tongue.
C. less compliant chest wall.
D. higher tidal volume requirement. - ✔✔A. A small amount of edema or secretions can
cause airway restriction and obstruction in the smaller airways of infants.
✔✔A 6-year-old presents with a sudden onset of fever, chills, and macular rash of the
palms, wrist, ankles, and soles of the feet. The child was recently on a camping trip. The
nurse suspects
A. Rocky Mountain Spotted Fever.
B. scabies infestation.
C. Henoch-Schonlein purpura.
D. hand foot mouth disease. - ✔✔A. Rocky Mountain Spotted Fever is a tick-borne
illness. Symptoms generally occur 2-5 days after the tick bite. Characteristic symptoms
,include fever, headache, nausea, and a maculopapular rash that begins on the wrists
and ankles and spreads to the trunk.
✔✔A patient with a traumatic head injury presents with signs and symptoms of
Cushing's triad. Which of the following would be an expected finding?
A. narrowing pulse pressure
B. ecchymosis behind the ears
C. irregular, decreased respirations
D. Tachycardia - ✔✔C. Cushing's Triad indicates neurological decompensation. The
signs and symptoms are irregular, decreased respirations, widening pulse pressure and
bradycardia.
✔✔A 16-year-old presents after running a cross country match. The patient is extremely
fatigued with muscle pain and reports nausea and dark urine. The nurse should expect
a diagnosis of
A. hydronephrosis.
B. pyelonephritis.
C. glomerulonephritis.
D. rhabdomyolysis. - ✔✔D. The symptoms of fatigue, muscle pain, nausea and dark
urine are indicative of rhabdomyolysis. Muscle pain and dark urine help to differentiate
this diagnosis from the others listed.
✔✔A child complains of headache, nausea, and dizziness shortly after moving to an
older home. Which of the following interventions is MOST appropriate?
A. Place the child on pulse oximetry.
B. Administer an antiemetic.
C. Prepare for hyperbaric oxygen therapy.
D. Obtain carboxyhemoglobin level - ✔✔D. Carbon monoxide poisoning symptoms
include headache, nausea, dizziness, and impaired judgement. Pulse oximetry in
unreliable as the carbon monoxide molecule will bind with the hemoglobin giving a false
reading. A carboxyhemoglobin level is the standard for determining carbon monoxide
poisoning.
✔✔An adolescent with cerebral palsy fell and broke off a permanent tooth. The priority
treatment for this patient is to
A. have the patient place the tooth in their mouth.
B. rinse the tooth with saline.
C. place the tooth on ice.
D. scrub the tooth with water. - ✔✔B. Rinsing the tooth with saline will provide cleaning
and keep it moist. The nurse should not scrub the tooth or place it on ice as these
options can destroy the nerve roots hampering reimplantation. The patient has an
underlying neurological disorder so placing it in the mouth may result in the patient
swallowing the tooth.
, ✔✔A 2-year-old with known cardiac history is brought in by ambulance for prolonged
cyanosis following a temper tantrum. Treatment for this child would include
A. morphine.
B. albuterol nebulizers.
C. epinephrine drip.
D. intubation - ✔✔A. Children with congenital heart disease involving cyanosis spells
after a decrease in oxygen availability are characterized by hyper cyanosis. Morphine
will calm and decrease tachypnea and peripheral vascular resistance.
✔✔When assessing an infant with coarctation of the aorta, a nurse should expect to find
A. absent or diminished femoral pulses.
B. cyanotic episodes.
C. heart failure and pulmonary edema.
D. hypotension and tachycardia. - ✔✔A. Characteristic manifestations of a coarctation
include absent or diminished femoral pulses and higher blood pressures in the upper
extremities than lower extremities. Heart failure may develop if a critical coarctation is
present (a situation which would normally be identified in the nursery and surgically
corrected).
✔✔A 2-month-old presents with difficulty breathing associated with tachypnea, mild
retractions, and copious amounts of nasal drainage. The MOST appropriate intervention
is to
A. administer supplemental oxygen.
B. suction the nares.
C. obtain a chest x-ray.
D. measure oxygen saturation. - ✔✔B. Infants up to 6 months of age are preferential
nose breathers and may develop respiratory distress from nasal congestion. Suctioning
the nares clears the airway of secretions for more effective ventilation.
✔✔Which discharge instructions should be included for a teenage patient with a
hematocrit of 30%?
A. "Consistently use sunscreen when outside."
B. "Take the iron with a protein supplement."
C. "Take the iron with vitamin D."
D. "Taking iron with vitamin C will increase its efficiency." - ✔✔D. Taking iron with
vitamin C will result in a breakdown of the iron to its most soluble state. Protein and
vitamin D can interfere with absorption. Taking an iron supplement does not result in
photosensitivity.
✔✔An 18-month-old patient presents to the Emergency Department with upper
respiratory symptoms and wheezing. Chest x-ray reveals a radiopaque object in the left
lower lobe. The nurse prepares the patient for a:
A. Rigid bronchoscopy
B. Flexible bronchoscopy
C. Foreign body removal with fluoroscopy
