CPEN Basic Exam 5 — Questions and Answers
Question 1: Which blood glucose level is considered hypoglycemia in a term neonate during the first 24 hours of life?
- < 60 mg/dL
- < 45 mg/dL (Correct answer)
- < 70 mg/dL
- < 30 mg/dL
Correct answer: < 45 mg/dL
In neonates during the first 24 hours, blood glucose below 45 mg/dL is considered hypoglycemia requiring intervention.
Question 2: A 6-year-old is stung by multiple bees and develops urticaria, angioedema, and wheezing. His blood pressure is 70/40 mmHg. Which route of epinephrine administration is PREFERRED?
- Intravenous bolus
- Subcutaneous injection
- Intramuscular injection into the anterolateral thigh (Correct answer)
- Sublingual administration
Correct answer: Intramuscular injection into the anterolateral thigh
IM epinephrine into the anterolateral thigh is the preferred route for anaphylaxis as it provides the fastest absorption compared to subcutaneous injection.
Question 3: Which finding differentiates bronchiolitis from asthma in an 8-month-old presenting with wheezing and respiratory distress?
- Presence of fever
- Response to bronchodilator therapy
- First episode of wheezing during RSV season with upper respiratory prodrome (Correct answer)
- SpO2 below 95%
Correct answer: First episode of wheezing during RSV season with upper respiratory prodrome
Bronchiolitis typically occurs in infants under 2 years during RSV season, presents as a first wheezing episode with viral URI symptoms, and is distinct from recurrent asthmatic episodes.
Question 4: During a pediatric code, the cardiac monitor shows ventricular fibrillation in a 5-year-old (20 kg). What is the correct initial defibrillation dose?
- 1 J/kg
- 2 J/kg (Correct answer)
- 4 J/kg
- 360 J (monophasic)
Correct answer: 2 J/kg
The initial defibrillation dose for pediatric VF/pulseless VT is 2 J/kg; subsequent doses are 4 J/kg.
Question 5: A 14-year-old female presents with right lower quadrant pain, nausea, and missed menstrual period. Which diagnostic test is MOST critical to obtain FIRST?
- Abdominal CT scan with contrast
- Pelvic ultrasound
- Urine or serum pregnancy test (Correct answer)
- CBC and comprehensive metabolic panel
Correct answer: Urine or serum pregnancy test
A pregnancy test must be performed first in any adolescent female with lower abdominal pain to rule out ectopic pregnancy before other imaging.
Question 6: A toddler presents with burns covering the entire right arm (front and back). Using the Rule of Nines modified for pediatrics, what percentage of TBSA is burned?
- 4.5%
- 9% (Correct answer)
- 18%
- 13.5%
Correct answer: 9%
In children, each arm represents approximately 9% TBSA (4.5% anterior + 4.5% posterior), so the entire right arm equals 9%.
Question 7: A nurse caring for a 4-year-old with suspected child abuse is MOST appropriately guided by which principle?
- Wait for parental consent before documenting injuries
- Document objective findings only and follow mandatory reporting obligations (Correct answer)
- Confront the caregiver directly about suspected abuse
- Discharge the child home with close follow-up to avoid family disruption
Correct answer: Document objective findings only and follow mandatory reporting obligations
Nurses are mandatory reporters; they must objectively document all findings and report suspicions to child protective services, regardless of certainty.
CPEN Basic Exam 5
Which blood glucose level is considered hypoglycemia in a term neonate during the first 24 hours of life?