CPEN Exam 5 — Questions and Answers
Question 1: A 16-year-old presents with acute scrotal pain that began 3 hours ago. The affected testicle is elevated and horizontal, with absent cremasteric reflex. What is the priority nursing action?
- Prepare ice packs and analgesia
- Collect a urine sample for STI testing
- Notify the provider for urgent surgical consultation (Correct answer)
- Apply doppler ultrasound assessment independently
Correct answer: Notify the provider for urgent surgical consultation
Testicular torsion is a surgical emergency; the cremasteric reflex absent and acute onset indicate immediate urological surgery is needed within 4-6 hours to save the testicle.
Question 2: 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?
- Actively rewarm all submersion victims to 37°C before declaring death
- Cold water submersion may be protective; do not declare death until normothermic (Correct answer)
- Hypothermia always worsens outcome in pediatric drowning
- Target temperature management is contraindicated in children
Correct 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.
Question 3: A nurse is performing a pain assessment on a 2-year-old after a laceration repair. Which validated pain scale is most appropriate?
- Numeric Rating Scale (NRS 0-10)
- FACES Pain Scale-Revised
- FLACC Scale (Correct answer)
- Visual Analog Scale (VAS)
Correct answer: FLACC Scale
The FLACC (Face, Legs, Activity, Cry, Consolability) scale is a validated behavioral pain tool designed for children aged 2 months to 7 years who cannot self-report pain.
Question 4: A 13-year-old is brought in after a motor vehicle collision with suspected pelvic fracture and hemodynamic instability. The nurse anticipates which massive transfusion protocol ratio?
- 10:1 PRBCs to FFP
- 1:1:1 PRBCs to FFP to platelets (Correct answer)
- 3:1 PRBCs to FFP
- PRBCs only until surgical intervention
Correct answer: 1:1:1 PRBCs to FFP to platelets
Massive transfusion protocols utilize a 1:1:1 ratio of packed red blood cells, fresh frozen plasma, and platelets to mimic whole blood and reduce coagulopathy.
Question 5: A 7-year-old with type 1 diabetes presents with Kussmaul respirations, fruity breath, a glucose of 480 mg/dL, and a bicarbonate of 10. Which intervention must be completed BEFORE starting insulin therapy?
- Administer a sodium bicarbonate bolus
- Ensure adequate fluid resuscitation is initiated (Correct answer)
- Obtain a urine ketone test
- Administer a loading dose of IV potassium
Correct answer: Ensure adequate fluid resuscitation is initiated
Fluid resuscitation must begin before insulin in DKA because insulin shifts potassium into cells and fluids help correct hypovolemia and dilute glucose.
Question 6: 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?
- Report immediately to law enforcement as a self-inflicted injury
- Maintain strict confidentiality per patient request
- Notify the provider and initiate a psychiatric safety evaluation (Correct answer)
- Discharge with a follow-up referral and safety plan
Correct 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.
Question 7: A 3-month-old is brought in with a history of 'fussiness' and is found to have multiple rib fractures at different stages of healing. The nurse's priority action is to:
- Reassure the family and discharge with follow-up
- Document the findings and notify the provider for a child abuse evaluation (Correct answer)
- Obtain a detailed feeding history
- Apply supplemental oxygen and arrange orthopedic consult
Correct answer: Document the findings and notify the provider for a child abuse evaluation
Multiple rib fractures in different stages of healing in an infant are highly suspicious for non-accidental trauma (child abuse) and mandate immediate provider notification and abuse evaluation.
CPEN Exam 5
A 16-year-old presents with acute scrotal pain that began 3 hours ago.
The affected testicle is elevated and horizontal, with absent cremasteric reflex.
What is the priority nursing action?