CPEN Basic Exam 4 — Questions and Answers
Question 1: A 6-month-old presents with a 2-day history of fever, irritability, and a bulging anterior fontanelle. What does the bulging fontanelle MOST likely indicate?
- Normal finding in a crying infant
- Increased intracranial pressure (Correct answer)
- Dehydration
- Hypothyroidism
Correct answer: Increased intracranial pressure
A bulging anterior fontanelle at rest is a sign of increased intracranial pressure and warrants urgent evaluation for meningitis or intracranial pathology.
Question 2: Which dose of epinephrine is correct for anaphylaxis in a 20 kg pediatric patient using an intramuscular auto-injector?
- 0.01 mg/kg IV push
- 0.15 mg IM (junior auto-injector) (Correct answer)
- 0.3 mg IM (standard auto-injector)
- 0.5 mg IM
Correct answer: 0.15 mg IM (junior auto-injector)
For children between 15–30 kg, the 0.15 mg junior epinephrine auto-injector is the appropriate dose administered into the anterolateral thigh.
Question 3: A 9-year-old presents with high fever, stiff neck, photophobia, and a non-blanching purpuric rash. Which pathogen is MOST commonly associated with this presentation?
- Streptococcus pneumoniae
- Neisseria meningitidis (Correct answer)
- Haemophilus influenzae type b
- Listeria monocytogenes
Correct answer: Neisseria meningitidis
Neisseria meningitidis is the leading cause of bacterial meningitis with purpuric/petechial rash due to endotoxin-mediated disseminated intravascular coagulation.
Question 4: A parent reports finding their 2-year-old with an open bottle of acetaminophen. The child has no symptoms currently. What is the recommended antidote?
- Flumazenil
- Naloxone
- N-acetylcysteine (NAC) (Correct answer)
- Sodium bicarbonate
Correct answer: N-acetylcysteine (NAC)
N-acetylcysteine replenishes glutathione stores and prevents hepatotoxicity from acetaminophen overdose; it is most effective when given within 8 hours.
Question 5: A 4-month-old presents with a history of inconsolable crying, vomiting, and the parents report 'shaking the baby.' Funduscopic exam reveals bilateral retinal hemorrhages. Which diagnosis is MOST suspected?
- Benign external hydrocephalus
- Abusive head trauma (shaken baby syndrome) (Correct answer)
- Viral meningitis
- Coagulopathy
Correct answer: Abusive head trauma (shaken baby syndrome)
Bilateral retinal hemorrhages combined with a history consistent with abusive mechanisms strongly suggest abusive head trauma.
Question 6: Which is the MOST appropriate initial management for a 3-year-old with moderate croup (barking cough, mild stridor at rest, SpO2 97%)?
- Immediate intubation for airway protection
- Nebulized racemic epinephrine only
- Oral or IM dexamethasone and cool mist humidification (Correct answer)
- IV methylprednisolone and admission
Correct answer: Oral or IM dexamethasone and cool mist humidification
Moderate croup is treated with a single dose of dexamethasone (0.6 mg/kg) which reduces subglottic edema; cool mist provides comfort.
Question 7: A 12-year-old presents after a diving accident with cervical spine pain and inability to move his legs. Which is the MOST important initial nursing action?
- Assist the patient to a comfortable position to relieve pain
- Maintain inline cervical spine immobilization and call for trauma team (Correct answer)
- Apply a heating pad to the cervical spine area
- Administer high-dose methylprednisolone immediately
Correct answer: Maintain inline cervical spine immobilization and call for trauma team
Inline cervical immobilization prevents secondary spinal cord injury; the trauma team should be activated immediately for suspected cervical spine injury.
CPEN Basic Exam 4
A 6-month-old presents with a 2-day history of fever, irritability, and a bulging anterior fontanelle.
What does the bulging fontanelle MOST likely indicate?