CPEN Pediatric Assessment 4 — Questions and Answers
Question 1: Which assessment finding would MOST suggest hypovolemic shock in a 3-year-old rather than cardiogenic shock?
- Pulmonary crackles and hepatomegaly
- History of vomiting and diarrhea with flat neck veins (Correct answer)
- S3 gallop on cardiac auscultation
- Bilateral rales and jugular venous distension
Correct answer: History of vomiting and diarrhea with flat neck veins
A history of fluid loss with flat (not distended) neck veins points toward hypovolemic shock rather than the fluid-overloaded state seen in cardiogenic shock.
Question 2: When calculating the estimated weight of a child aged 1–10 years using the Broselow formula, which formula is commonly used?
- Weight (kg) = age × 3 + 7
- Weight (kg) = (age + 4) × 2
- Weight (kg) = age × 2 + 8 (Correct answer)
- Weight (kg) = age × 4
Correct answer: Weight (kg) = age × 2 + 8
A commonly used formula for estimating weight in children 1–10 years is Weight (kg) = (age × 2) + 8.
Question 3: In a pediatric patient with suspected increased intracranial pressure, which pupillary finding indicates uncal herniation?
- Bilaterally pinpoint pupils
- Unilateral fixed and dilated pupil (Correct answer)
- Bilateral sluggish but equal pupils
- Hippus (rhythmic pupil oscillation)
Correct answer: Unilateral fixed and dilated pupil
A unilateral fixed and dilated pupil (blown pupil) indicates compression of cranial nerve III from uncal herniation, a neurosurgical emergency.
Question 4: A 12-year-old with known asthma presents with absent breath sounds on auscultation and SpO2 of 84%. This finding MOST likely indicates:
- Mild bronchospasm
- Silent chest indicating severe obstruction (Correct answer)
- Pneumonia
- Normal auscultation for a large child
Correct answer: Silent chest indicating severe obstruction
Absent breath sounds in asthma (silent chest) indicate severe airflow obstruction preventing audible air movement and is a sign of impending respiratory failure.
Question 5: When using the Pediatric Early Warning Score (PEWS), which three domains are typically assessed?
- Temperature, heart rate, and oxygen saturation
- Behavior, cardiovascular status, and respiratory status (Correct answer)
- Level of consciousness, urine output, and blood pressure
- Skin color, capillary refill, and pupil response
Correct answer: Behavior, cardiovascular status, and respiratory status
PEWS assesses Behavior, Cardiovascular status, and Respiratory status to identify early clinical deterioration in hospitalized children.
Question 6: A 6-year-old presents with drooling, tripod positioning, and refusal to swallow. The nurse should FIRST:
- Attempt to visualize the oropharynx with a tongue blade
- Keep the child calm and prepare for definitive airway management (Correct answer)
- Administer nebulized epinephrine immediately
- Obtain a lateral neck X-ray before any intervention
Correct answer: Keep the child calm and prepare for definitive airway management
Drooling, tripod positioning, and dysphagia suggest epiglottitis; agitating the child by examining the throat can precipitate complete airway obstruction.
Question 7: Which of the following vital sign parameters is MOST age-appropriate for a healthy 1-year-old?
- Heart rate 60–80 bpm, RR 12–20
- Heart rate 100–160 bpm, RR 25–35 (Correct answer)
- Heart rate 80–100 bpm, RR 18–24
- Heart rate 140–160 bpm, RR 40–60
Correct answer: Heart rate 100–160 bpm, RR 25–35
Normal vital signs for a 1-year-old include a heart rate of approximately 100–160 bpm and respiratory rate of 25–35 breaths per minute.
CPEN Pediatric Assessment 4
Which assessment finding would MOST suggest hypovolemic shock in a 3-year-old rather than cardiogenic shock?