CPEN Exam Questions and Answers
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. Correct Answer 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. Correct Answer 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. Correct Answer 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 Correct Answer 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
, CPEN Exam Questions and Answers
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 Correct Answer 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 Correct Answer 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 Correct Answer 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.
, CPEN Exam Questions and Answers
C. turning patient to the side.
D. placing an intraosseous needle. Correct Answer 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. Correct Answer 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 Correct Answer 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. Correct Answer 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.
, CPEN Exam Questions and Answers
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. Correct Answer 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 Correct Answer 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. Correct Answer 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. Correct Answer 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
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. Correct Answer 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. Correct Answer 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. Correct Answer 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 Correct Answer 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
, CPEN Exam Questions and Answers
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 Correct Answer 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 Correct Answer 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 Correct Answer 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.
, CPEN Exam Questions and Answers
C. turning patient to the side.
D. placing an intraosseous needle. Correct Answer 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. Correct Answer 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 Correct Answer 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. Correct Answer 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.
, CPEN Exam Questions and Answers
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. Correct Answer 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 Correct Answer 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. Correct Answer 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. Correct Answer 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
