Mixed Deck — All CPEN Topics Flashcards

A 2-year-old is brought in by EMS after being found face-down in a backyard pool. Resuscitation is in progress. Which temperature management consideration is important in pediatric submersion victims?

Answer: Cold water submersion may be protective; do not declare death until normothermic

Cold water submersion can provide neuroprotection; the principle 'not dead until warm and dead' applies, and resuscitation should continue until the patient is rewarmed to near-normal temperature.

A 10 kg toddler requires dopamine at 10 mcg/kg/min. Using a standard concentration of 400 mcg/mL, what is the infusion rate in mL/hr?

Answer: 15 mL/hr

Rate (mL/hr) = (10 mcg/kg/min × 10 kg × 60 min) ÷ 400 mcg/mL = 6000 ÷ 400 = 15 mL/hr.

What is the value of continuing education in gastrointestinal emergencies for CPEN professionals?

Answer: It keeps professionals current with evolving standards and practices

Continuing education ensures professionals stay current with the latest developments, standards, and best practices in their field.

A symptomatic child with complete heart block and a heart rate of 35 bpm should initially be treated with:

Answer: IV atropine 0.02 mg/kg

Atropine is the first pharmacologic intervention for symptomatic bradycardia with a perfusing rhythm before pacing.

A 4-year-old who swallowed a coin has it confirmed by X-ray to be in the stomach. The child is asymptomatic. What is the recommended management?

Answer: Observation and follow serial X-rays, as most coins pass spontaneously

Coins in the stomach of asymptomatic children will pass spontaneously in most cases and require only observation with follow-up imaging if not passed within 4 weeks.

A 15-year-old presents with thunderclap headache — worst of life, sudden onset. After a negative CT, the NEXT step is:

Answer: Lumbar puncture to detect xanthochromia

CT misses ~2% of subarachnoid hemorrhages; LP detecting xanthochromia or blood in CSF is essential when CT is negative after thunderclap headache.

A 2-year-old with sepsis has a serum glucose of 38 mg/dL. Which dextrose concentration and dose is MOST appropriate for IV correction?

Answer: D10W 5 mL/kg IV

D10W at 5 mL/kg (providing 0.5 g/kg glucose) is the standard pediatric hypoglycemia correction dose; higher concentrations risk vascular injury and osmotic shifts.

Which statement by a parent MOST suggests that a child's conversion disorder symptoms are being reinforced?

Answer: 'I carry her everywhere because she can't walk and I don't want her to fall.'

Carrying a child who has functional neurological symptoms reinforces illness behavior and secondary gain, which perpetuates conversion disorder.

A caregiver reports that her 4-year-old has been having nightmares, refusing to sleep alone, and is very clingy since a recent car accident. The most appropriate nursing response is:

Answer: Refer the family for trauma-focused cognitive behavioral therapy evaluation

Persistent post-traumatic symptoms in young children warrant referral for trauma-focused therapy; early intervention improves outcomes.

Which assessment finding best differentiates peritonitis from a non-surgical cause of abdominal pain in a pediatric patient?

Answer: Abdominal guarding and rebound tenderness

Involuntary guarding and rebound tenderness indicate peritoneal irritation and are the most specific signs pointing to a surgical intra-abdominal emergency.

After being stung by a bee, a boy experiences acute facial edema, dyspnea, and hypotension, all of which indicate anaphylaxis. The most crucial intervention is:

Answer: epinephrine

The symptoms of acute facial edema, dyspnea, and hypotension after a bee sting are classic signs of anaphylaxis, a severe, life-threatening allergic reaction. Epinephrine is the first-line and most crucial intervention for anaphylaxis because it rapidly reverses bronchospasm, vasoconstriction, and hypotension, directly addressing the life-threatening aspects of the reaction. While oxygen and diphenhydramine are supportive, epinephrine is the immediate life-saving medication.

A teenager ingests a large amount of acetaminophen 8 hours ago. Which lab value is the priority assessment?

Answer: Serum acetaminophen level and liver function tests

Serum acetaminophen level plotted on the Rumack-Matthew nomogram and LFTs are essential to determine toxicity risk and need for NAC treatment.

A 10-year-old presents after falling on an outstretched hand. X-ray shows a fracture through the distal radial physis with the epiphysis displaced. Which Salter-Harris classification is this?

Answer: Type II

Salter-Harris Type II involves a fracture through the physis that extends into the metaphysis, making it the most common type.

Beck's triad (hypotension, muffled heart sounds, distended neck veins) in a trauma patient suggests:

Answer: Cardiac tamponade

Beck's triad is the hallmark of cardiac tamponade, caused by fluid accumulation in the pericardial sac compressing the heart.

A nurse is about to give IV vancomycin rapidly and the child develops flushing, erythema, and hypotension. What is the most likely cause?

Answer: Red Man Syndrome from rapid infusion

Red Man Syndrome is a rate-dependent reaction caused by mast cell degranulation from rapid vancomycin infusion, not a true allergy.

Racemic epinephrine administered to a child with croup requires a minimum observation period of how long after treatment?

Answer: 2 hours

Children must be observed for a minimum of 2 hours after racemic epinephrine due to the risk of rebound airway edema as the medication wears off.

A 15-year-old reveals to the nurse that she has been self-harming but denies suicidal intent. Under mandatory reporting guidelines, what is the nurse's obligation?

Answer: Notify the provider and initiate a psychiatric safety evaluation

Non-suicidal self-injury requires immediate provider notification and psychiatric evaluation to assess safety; confidentiality has limits when patient safety is at risk.

A 7-year-old with celiac disease presents with severe abdominal pain, distension, and obstipation after being exposed to gluten. Which complication specific to celiac disease is most concerning?

Answer: Celiac crisis with refractory diarrhea and electrolyte imbalance

Celiac crisis is a rare but life-threatening complication triggered by gluten exposure, characterized by severe diarrhea, dehydration, metabolic disturbances, and malnutrition.

Hypertonic saline (3% NaCl) is ordered for a pediatric patient with severe TBI. The GOAL serum sodium target is:

Answer: 150–160 mEq/L

For ICP management with hypertonic saline, the goal serum sodium is typically 150–160 mEq/L to create an osmotic gradient that reduces cerebral edema.

An infant presents with bilious vomiting and abdominal distension within the first 24 hours of life. Which condition is most concerning?

Answer: Malrotation with midgut volvulus

Bilious vomiting in a neonate is a surgical emergency until proven otherwise, with malrotation and midgut volvulus being the most immediately life-threatening cause.