CPEN Practice Questions & Rationales (Answered) Correctly To Score A+

CPEN Practice Questions & Rationales (Answered) Correctly To Score A+ An 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. 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. 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. 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 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 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 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 Which of the following is the BEST method to assess adequacy of ventilation during procedural sedation? A. breath sounds B. oxygen saturation C. respiratory rate D. capnography value D. capnography is used to determine adequacy of ventilation. Oxygen saturation provides the percentage of hemoglobin carrying oxygen. Hypoventilation is detected more rapidly by capnography than by auscultation of breath sounds, oxygen saturation or respiratory rate. 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-