CPEN (Certified Pediatric Emergency Nurse)
Specialized certification demonstrating
pediatric emergency nursing expertise,
critical assessment, stabilization, and family-
centered emergency care.
Question 1
A 4-year-old child presents to the emergency department with a barking cough,
inspiratory stridor at rest, and mild retractions. Based on the Pediatric Assessment
Triangle (PAT), which component is MOST concerning in this presentation?
A. Appearance – the child is anxious and clinging to parent
B. Work of breathing – stridor at rest and retractions
C. Circulation to skin – pale and diaphoretic
D. Work of breathing – barking cough only
Answer: B. Work of breathing – stridor at rest and retractions
Rationale: The Pediatric Assessment Triangle (PAT) consists of three
components: appearance, work of breathing, and circulation to the skin. Stridor at
rest indicates significant upper airway obstruction and is an emergent finding.
Retractions indicate increased work of breathing. Barking cough alone (without
stridor at rest) would be less concerning. The PAT is a "no-touch" visual
assessment that guides initial triage priority.
Question 2
Which of the following patients should receive the HIGHEST triage priority?
A. 8-month-old who is vomiting and has a sunken fontanel
B. 16-month-old who has a cough and respiratory rate of 48 breaths/min
C. 3-year-old who has a swollen wrist with numbness and tingling
D. 4-year-old who has a barky cough and stridor when crying
Answer: D. 4-year-old who has a barky cough and stridor when crying
,Rationale: Stridor when crying indicates potential upper airway obstruction
(croup) that can progress to respiratory failure. This patient requires immediate
evaluation. The 8-month-old with vomiting and sunken fontanel suggests
dehydration (urgent but not immediately life-threatening). Tachypnea at 48
breaths/min in a 16-month-old is concerning but less emergent than stridor. The 3-
year-old with wrist numbness/tingling suggests possible compartment syndrome
but is not the highest priority.
Question 3
In addition to work of breathing, which of the following are components of the
Pediatric Assessment Triangle (PAT)?
A. General appearance and circulation to the skin
B. Patency of airway and circulation to the skin
C. General appearance and developmental level
D. Patency of airway and developmental level
Answer: A. General appearance and circulation to the skin
Rationale: The three components of the PAT are: (1) appearance, (2) work of
breathing, and (3) circulation to the skin. The PAT is a rapid, visual, "no-touch"
assessment performed from the doorway that does not require physical contact
with the patient. Airway patency is assessed during the primary survey, not as a
separate PAT component.
Question 4
The Pediatric Assessment Triangle (PAT) reveals that a 6-month-old has decreased
muscle tone, head bobbing with respirations, and pale skin color. The PRIORITY
intervention is to:
A. Start an IV and administer 20 mL/kg of warmed crystalloid solution
B. Proceed with rapid assessment of airway, breathing, and circulation
C. Place the infant on a stretcher and manually open the airway
D. Administer oxygen via non-rebreather at 6 L/min
Answer: C. Place the infant on a stretcher and manually open the airway
,Rationale: Head bobbing with respirations is a sign of impending respiratory
failure. Decreased muscle tone and pale skin indicate a "sickest" child with
multiple PAT disruptions. The priority is to establish a patent airway. Manual
opening of the airway (head tilt-chin lift or jaw thrust) must precede any other
intervention. Oxygen administration and IV access are important but secondary to
airway management.
Question 5
During triage, which component of the Pediatric Assessment Triangle (PAT)
primarily evaluates the child's general appearance?
A. Circulatory status
B. Work of breathing
C. Appearance
D. Skin color and temperature
Answer: C. Appearance
Rationale: The appearance component of PAT evaluates the child's general
appearance, including muscle tone, interactivity, consolability, look/gaze, and
speech/cry. This helps determine if the child is "sick" versus "not sick." Circulation
to the skin evaluates skin color, temperature, and capillary refill. Work of breathing
evaluates respiratory effort.
Question 6
Which of the following assessment findings can indicate breathing effectiveness?
A. Symmetrical chest rise and fall
B. Presence of diaphragmatic breathing
C. Absence of secretions and vomitus
D. Ability to vocalize
Answer: A. Symmetrical chest rise and fall
Rationale: Symmetrical chest rise and fall indicates adequate air entry and
effective ventilation. Diaphragmatic breathing in children can be normal but may
also indicate distress. Absence of secretions indicates a clear airway but does not
, confirm effective breathing. Ability to vocalize suggests airway patency but not
necessarily effective gas exchange.
Question 7
Which pediatric triage system is specifically designed for mass-casualty incidents
and uses the categories: Deceased, Immediate, Delayed, and Minor?
A. ESI (Emergency Severity Index)
B. PAT (Pediatric Assessment Triangle)
C. START triage
D. JumpSTART triage
Answer: D. JumpSTART triage
Rationale: JumpSTART is the pediatric-specific mass-casualty triage system. It
modifies the adult START system to account for pediatric physiological
differences, including a brief trial of ventilations for children who are not
breathing. ESI is used for daily ED triage, not mass-casualty incidents.
Question 8
A school-age child presents with a 4-day history of abdominal pain, vomiting,
fever, and constipation. There are no beds currently available. Which of the
following is a PRIORITY intervention?
A. Administer an enema to relieve constipation
B. Obtain an order for an abdominal X-ray
C. Instruct the parents to keep the child NPO
D. Obtain a clean catch urine specimen
Answer: C. Instruct the parents to keep the child NPO
Rationale: The child's presentation suggests possible appendicitis or surgical
abdomen. Keeping the child NPO is critical in case surgery is needed. Enemas are
contraindicated if appendicitis is suspected. Abdominal X-ray and urinalysis may
be part of the workup but are not the priority over NPO status.
SECTION 2: Respiratory Emergencies
Specialized certification demonstrating
pediatric emergency nursing expertise,
critical assessment, stabilization, and family-
centered emergency care.
Question 1
A 4-year-old child presents to the emergency department with a barking cough,
inspiratory stridor at rest, and mild retractions. Based on the Pediatric Assessment
Triangle (PAT), which component is MOST concerning in this presentation?
A. Appearance – the child is anxious and clinging to parent
B. Work of breathing – stridor at rest and retractions
C. Circulation to skin – pale and diaphoretic
D. Work of breathing – barking cough only
Answer: B. Work of breathing – stridor at rest and retractions
Rationale: The Pediatric Assessment Triangle (PAT) consists of three
components: appearance, work of breathing, and circulation to the skin. Stridor at
rest indicates significant upper airway obstruction and is an emergent finding.
Retractions indicate increased work of breathing. Barking cough alone (without
stridor at rest) would be less concerning. The PAT is a "no-touch" visual
assessment that guides initial triage priority.
Question 2
Which of the following patients should receive the HIGHEST triage priority?
A. 8-month-old who is vomiting and has a sunken fontanel
B. 16-month-old who has a cough and respiratory rate of 48 breaths/min
C. 3-year-old who has a swollen wrist with numbness and tingling
D. 4-year-old who has a barky cough and stridor when crying
Answer: D. 4-year-old who has a barky cough and stridor when crying
,Rationale: Stridor when crying indicates potential upper airway obstruction
(croup) that can progress to respiratory failure. This patient requires immediate
evaluation. The 8-month-old with vomiting and sunken fontanel suggests
dehydration (urgent but not immediately life-threatening). Tachypnea at 48
breaths/min in a 16-month-old is concerning but less emergent than stridor. The 3-
year-old with wrist numbness/tingling suggests possible compartment syndrome
but is not the highest priority.
Question 3
In addition to work of breathing, which of the following are components of the
Pediatric Assessment Triangle (PAT)?
A. General appearance and circulation to the skin
B. Patency of airway and circulation to the skin
C. General appearance and developmental level
D. Patency of airway and developmental level
Answer: A. General appearance and circulation to the skin
Rationale: The three components of the PAT are: (1) appearance, (2) work of
breathing, and (3) circulation to the skin. The PAT is a rapid, visual, "no-touch"
assessment performed from the doorway that does not require physical contact
with the patient. Airway patency is assessed during the primary survey, not as a
separate PAT component.
Question 4
The Pediatric Assessment Triangle (PAT) reveals that a 6-month-old has decreased
muscle tone, head bobbing with respirations, and pale skin color. The PRIORITY
intervention is to:
A. Start an IV and administer 20 mL/kg of warmed crystalloid solution
B. Proceed with rapid assessment of airway, breathing, and circulation
C. Place the infant on a stretcher and manually open the airway
D. Administer oxygen via non-rebreather at 6 L/min
Answer: C. Place the infant on a stretcher and manually open the airway
,Rationale: Head bobbing with respirations is a sign of impending respiratory
failure. Decreased muscle tone and pale skin indicate a "sickest" child with
multiple PAT disruptions. The priority is to establish a patent airway. Manual
opening of the airway (head tilt-chin lift or jaw thrust) must precede any other
intervention. Oxygen administration and IV access are important but secondary to
airway management.
Question 5
During triage, which component of the Pediatric Assessment Triangle (PAT)
primarily evaluates the child's general appearance?
A. Circulatory status
B. Work of breathing
C. Appearance
D. Skin color and temperature
Answer: C. Appearance
Rationale: The appearance component of PAT evaluates the child's general
appearance, including muscle tone, interactivity, consolability, look/gaze, and
speech/cry. This helps determine if the child is "sick" versus "not sick." Circulation
to the skin evaluates skin color, temperature, and capillary refill. Work of breathing
evaluates respiratory effort.
Question 6
Which of the following assessment findings can indicate breathing effectiveness?
A. Symmetrical chest rise and fall
B. Presence of diaphragmatic breathing
C. Absence of secretions and vomitus
D. Ability to vocalize
Answer: A. Symmetrical chest rise and fall
Rationale: Symmetrical chest rise and fall indicates adequate air entry and
effective ventilation. Diaphragmatic breathing in children can be normal but may
also indicate distress. Absence of secretions indicates a clear airway but does not
, confirm effective breathing. Ability to vocalize suggests airway patency but not
necessarily effective gas exchange.
Question 7
Which pediatric triage system is specifically designed for mass-casualty incidents
and uses the categories: Deceased, Immediate, Delayed, and Minor?
A. ESI (Emergency Severity Index)
B. PAT (Pediatric Assessment Triangle)
C. START triage
D. JumpSTART triage
Answer: D. JumpSTART triage
Rationale: JumpSTART is the pediatric-specific mass-casualty triage system. It
modifies the adult START system to account for pediatric physiological
differences, including a brief trial of ventilations for children who are not
breathing. ESI is used for daily ED triage, not mass-casualty incidents.
Question 8
A school-age child presents with a 4-day history of abdominal pain, vomiting,
fever, and constipation. There are no beds currently available. Which of the
following is a PRIORITY intervention?
A. Administer an enema to relieve constipation
B. Obtain an order for an abdominal X-ray
C. Instruct the parents to keep the child NPO
D. Obtain a clean catch urine specimen
Answer: C. Instruct the parents to keep the child NPO
Rationale: The child's presentation suggests possible appendicitis or surgical
abdomen. Keeping the child NPO is critical in case surgery is needed. Enemas are
contraindicated if appendicitis is suspected. Abdominal X-ray and urinalysis may
be part of the workup but are not the priority over NPO status.
SECTION 2: Respiratory Emergencies
