CPEN Certified Pediatric Emergency Nurse Exam — Questions and Answers

Question 1: In a pediatric patient with suspected increased intracranial pressure, which pupillary finding indicates uncal herniation?

Unilateral fixed and dilated pupil (Correct answer)
Bilateral sluggish but equal pupils
Hippus (rhythmic pupil oscillation)
Bilaterally pinpoint pupils

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 2: A child presents with opioid overdose. What is the correct initial nursing intervention?

Administer naloxone and support airway/breathing (Correct answer)
Administer atropine
Perform activated charcoal lavage
Administer flumazenil

Correct answer: Administer naloxone and support airway/breathing

Naloxone reverses opioid-induced respiratory depression, but airway support must be maintained concurrently as naloxone duration may be shorter than the opioid.

Question 3: An 8-year-old (30 kg) requires epinephrine 0.01 mg/kg IV for refractory anaphylaxis. The concentration available is 1:10,000 (0.1 mg/mL). What volume should be given?

0.03 mL
30 mL
0.3 mL
3 mL (Correct answer)

Correct answer: 3 mL

Dose = 0.01 × 30 = 0.3 mg; volume = 0.3 mg ÷ 0.1 mg/mL = 3 mL.

Question 4: In a 9-month-old infant, the anterior fontanelle is bulging and tense at rest. This finding is MOST consistent with which condition?

Increased intracranial pressure (Correct answer)
Normal variant for age
Dehydration
Hypothyroidism

Correct answer: Increased intracranial pressure

A bulging, tense anterior fontanelle at rest in an infant suggests elevated intracranial pressure requiring urgent evaluation.

Question 5: During triage, a mother states her 5-year-old 'has not been the same' since witnessing domestic violence last month. The nurse recognizes this as a potential sign of:

Oppositional defiant disorder
Post-traumatic stress disorder (Correct answer)
Attention deficit hyperactivity disorder
Separation anxiety disorder

Correct answer: Post-traumatic stress disorder

Behavioral change following a traumatic event such as witnessing domestic violence is a classic presentation of PTSD in young children.

Question 6: An 8-year-old ingested a large amount of acetaminophen 6 hours ago. The MOST important laboratory test to guide antidote therapy at this time is:

Serum acetaminophen level plotted on the Rumack-Matthew nomogram (Correct answer)
Liver function tests (AST/ALT)
Serum creatinine
Complete blood count

Correct answer: Serum acetaminophen level plotted on the Rumack-Matthew nomogram

The serum acetaminophen level drawn 4 or more hours post-ingestion and plotted on the Rumack-Matthew nomogram determines the risk of hepatotoxicity and the need for N-acetylcysteine.

Question 7: 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
Urine or serum pregnancy test (Correct answer)
CBC and comprehensive metabolic panel
Pelvic ultrasound

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 8: A 4-year-old (18 kg) requires IV morphine for pain. The standard pediatric dose is 0.1 mg/kg. What is the correct dose?

0.18 mg
18 mg
1.8 mg (Correct answer)
0.9 mg

Correct answer: 1.8 mg

0.1 mg/kg × 18 kg = 1.8 mg is the correct weight-based dose.

Question 9: What is the value of continuing education in environmental emergencies for CPEN professionals?

It is only needed for recertification
It is primarily a social activity
It replaces workplace experience
It keeps professionals current with evolving standards and practices (Correct answer)

Correct 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.

Question 10: A 13-year-old runner presents with anterior knee pain that worsens with stair climbing and kneeling. There is tenderness over the tibial tubercle apophysis. Which condition is most likely?

Patellar tendinopathy
Prepatellar bursitis
Chondromalacia patellae
Osgood-Schlatter disease (Correct answer)

Correct answer: Osgood-Schlatter disease

Osgood-Schlatter disease is traction apophysitis of the tibial tubercle caused by repetitive quadriceps stress during adolescent growth spurts.

Question 11: What is the value of continuing education in gastrointestinal emergencies for CPEN professionals?

It keeps professionals current with evolving standards and practices (Correct answer)
It is primarily a social activity
It replaces workplace experience
It is only needed for recertification

Correct 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.

Question 12: When using the intranasal (IN) route for medication delivery in a pediatric patient, what device is preferred to atomize the medication?

Standard needleless syringe tip
Mucosal Atomization Device (MAD) (Correct answer)
Bulb syringe
Nebulizer mask

Correct answer: Mucosal Atomization Device (MAD)

The MAD atomizes the medication into fine particles that maximize mucosal absorption and minimize the risk of the child swallowing the dose.

Question 13: Which sign differentiates obstructive shock from distributive shock in a pediatric patient?

Tachycardia
Wide pulse pressure
Distended neck veins and muffled heart sounds (Correct answer)
Warm, flushed skin

Correct answer: Distended neck veins and muffled heart sounds

Jugular venous distension and muffled heart sounds (Beck's triad) suggest obstructive shock from cardiac tamponade, distinguishing it from distributive shock.

Question 14: A 10-year-old receiving chemotherapy presents with a fever of 38.6°C. His absolute neutrophil count (ANC) is 320/mm³. What is the MOST appropriate management?

Administer G-CSF (filgrastim) subcutaneously and reassess in 2 hours
Discharge with oral ciprofloxacin and follow-up in 24 hours
Admit and initiate IV broad-spectrum antibiotics immediately (Correct answer)
Observe in the ED for 6 hours and recheck the CBC

Correct answer: Admit and initiate IV broad-spectrum antibiotics immediately

Febrile neutropenia (ANC less than 500/mm³) in an immunocompromised child requires immediate hospitalization and empiric IV broad-spectrum antibiotics to prevent rapidly fatal sepsis.

Question 15: A 10-year-old post-cardiac arrest is receiving targeted temperature management. The target core temperature range is:

30–32°C for 6 hours
33–34°C for 12 hours only
36–37.5°C (normothermia) for 72 hours (Correct answer)
32–34°C for 24–48 hours

Correct answer: 36–37.5°C (normothermia) for 72 hours

Current pediatric post-arrest guidelines support targeted temperature management at 36–37.5°C (normothermia prevention of fever) for at least 72 hours.

Question 16: When using the Pediatric Early Warning Score (PEWS), which three domains are typically assessed?

Level of consciousness, urine output, and blood pressure
Temperature, heart rate, and oxygen saturation
Behavior, cardiovascular status, and respiratory status (Correct answer)
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 17: A 6-year-old presents with drooling, tripod positioning, and refusal to swallow. The nurse should FIRST:

Keep the child calm and prepare for definitive airway management (Correct answer)
Attempt to visualize the oropharynx with a tongue blade
Obtain a lateral neck X-ray before any intervention
Administer nebulized epinephrine immediately

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 18: An 18-month-old presents with 3 days of fever and irritability. Examination reveals a bulging, erythematous tympanic membrane with loss of the light reflex. Which antibiotic is FIRST-LINE per AAP guidelines?

Trimethoprim-sulfamethoxazole
Cephalexin
Amoxicillin (Correct answer)
Azithromycin

Correct answer: Amoxicillin

Amoxicillin is the first-line antibiotic for acute otitis media per AAP guidelines due to its efficacy against S. pneumoniae, the most common causative organism.

Question 19: Which approach best demonstrates mastery of environmental emergencies in CPEN practice?

Avoiding complex scenarios
Applying principles to novel situations with sound judgment (Correct answer)
Following procedures without understanding
Relying entirely on technology

Correct answer: Applying principles to novel situations with sound judgment

True mastery involves understanding underlying principles well enough to apply them to new and unfamiliar situations with professional judgment.

Question 20: When performing a nasogastric lavage on a pediatric patient with suspected upper GI bleed, which finding would indicate active bleeding requiring urgent intervention?

Pink-tinged return that clears after lavage
Persistent bright red blood despite lavage (Correct answer)
Clear return after 200 mL of saline
Coffee-ground material that clears with lavage

Correct answer: Persistent bright red blood despite lavage

Persistent bright red blood despite gastric lavage indicates active, ongoing hemorrhage requiring urgent endoscopy or surgical intervention.

Question 21: A child with a long bone fracture develops increasing pain, paresthesias, and a tense extremity 6 hours post-casting. What is the priority nursing action?

Bivalve or remove the cast immediately and notify the physician (Correct answer)
Elevate the extremity higher and apply ice
Administer additional analgesia and reassess in 2 hours
Obtain an X-ray to confirm fracture alignment

Correct answer: Bivalve or remove the cast immediately and notify the physician

Progressive pain, paresthesias, and extremity tightness under a cast are signs of compartment syndrome; the cast must be bivalved or removed immediately to relieve pressure.

Question 22: A 3-year-old child has several bruises on her arms, legs, and face that range in color from purple to yellow-green to brown, as well as a spiral fracture of the shaft of her right humerus. The toddler reportedly fell off a swing set the day before while playing, according to the mother. The best suitable course of action is:

tell the mother that you suspect child abuse
ask the child what happened
contact the local child protective services agency (Correct answer)
caution the mother to supervise the child during play

Correct answer: contact the local child protective services agency

The presence of multiple bruises in various stages of healing (purple to yellow-green to brown) and a spiral fracture of the humerus, especially when inconsistent with the reported mechanism of injury (falling off a swing set), are strong indicators of potential child abuse. Healthcare professionals have a legal and ethical obligation to report suspected child abuse to the local child protective services agency to ensure the child's safety.

Question 23: A 7-year-old has a Glasgow Coma Scale (GCS) score of 8. Which airway intervention is MOST indicated?

Bag-mask ventilation
Jaw thrust maneuver only
Definitive airway management (intubation) (Correct answer)
Supplemental oxygen by nasal cannula

Correct answer: Definitive airway management (intubation)

A GCS of 8 or below is a widely accepted threshold indicating inability to protect the airway and the need for definitive airway management.

Question 24: What is the CORRECT pediatric dose of lorazepam for an actively seizing child?

0.05–0.1 mg/kg IV, max 4 mg per dose (Correct answer)
0.5 mg/kg IV, max 10 mg
0.01 mg/kg IV, max 0.5 mg
1 mg/kg IV, max 20 mg

Correct answer: 0.05–0.1 mg/kg IV, max 4 mg per dose

Lorazepam 0.05–0.1 mg/kg IV (max 4 mg per dose) is the first-line benzodiazepine for acute pediatric seizure management.

Question 25: A child with sickle cell disease presents with severe pain, swelling, and warmth of the hand and feet. What condition should the nurse recognize?

Dactylitis (hand-foot syndrome) (Correct answer)
Septic arthritis of the wrist
Rheumatoid arthritis flare
Osteomyelitis from Salmonella

Correct answer: Dactylitis (hand-foot syndrome)

Dactylitis is the earliest manifestation of sickle cell disease in infants, caused by vaso-occlusion in the small bones of the hands and feet producing symmetric painful swelling.

Question 26: During a pediatric code, the cardiac monitor shows ventricular fibrillation in a 5-year-old (20 kg). What is the correct initial defibrillation dose?

360 J (monophasic)
4 J/kg
2 J/kg (Correct answer)
1 J/kg

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 27: When assessing hydration status in a 9-month-old, which finding BEST indicates severe dehydration (>10% fluid deficit)?

Mildly dry mucous membranes
Slightly decreased urine output
Heart rate at the upper limit of normal
Sunken anterior fontanelle and absent tears with mottled skin (Correct answer)

Correct answer: Sunken anterior fontanelle and absent tears with mottled skin

A sunken fontanelle, absent tears, and mottled skin together indicate severe dehydration requiring urgent fluid resuscitation.

Question 28: A 16-year-old male with depression is being discharged after a suicidal ideation evaluation. Which discharge instruction is MOST important for lethal means reduction?

Ensure all firearms and medications are secured or removed from the home (Correct answer)
Schedule a follow-up appointment within two weeks
Provide a list of crisis hotline numbers
Instruct the patient to call 911 if symptoms worsen

Correct answer: Ensure all firearms and medications are secured or removed from the home

Lethal means counseling, specifically securing or removing firearms and medications, is the most evidence-based strategy to reduce suicide risk at home.

Question 29: A 10-year-old swimmer is rescued from a cold lake (water temperature 10°C). Core temp is 30°C, the child is shivering vigorously, and is conscious but confused. This presentation represents which stage of hypothermia?

Profound hypothermia (Stage IV)
Mild hypothermia (Stage I) (Correct answer)
Moderate hypothermia (Stage II)
Severe hypothermia (Stage III)

Correct answer: Mild hypothermia (Stage I)

Mild hypothermia (32–35°C) is characterized by shivering, confusion, and preserved consciousness.

Question 30: A 6-year-old ingests a button battery. X-ray confirms it is lodged in the esophagus. What is the most appropriate next step?

Perform a barium swallow to confirm location
Observation with repeat X-ray in 24 hours
Immediate endoscopic removal (Correct answer)
Administer cathartics to facilitate passage

Correct answer: Immediate endoscopic removal

Button batteries lodged in the esophagus require immediate endoscopic removal due to the risk of liquefactive necrosis, perforation, and aortoesophageal fistula within hours.

Question 31: What is the most effective approach to medication administration in the CPEN field?

Following competitors
Reactive problem-solving
Systematic planning and continuous improvement (Correct answer)
Maintaining the status quo

Correct answer: Systematic planning and continuous improvement

Systematic planning combined with continuous improvement ensures sustainable success and allows for proactive management of challenges.

Question 32: Which finding on echocardiography is MOST consistent with Kawasaki disease complication requiring immediate intervention?

Small patent foramen ovale
Trivial tricuspid regurgitation
Mild mitral valve prolapse
Giant coronary artery aneurysm (≥8 mm) (Correct answer)

Correct answer: Giant coronary artery aneurysm (≥8 mm)

Giant coronary aneurysms (≥8 mm) in Kawasaki disease carry high risk of thrombosis and myocardial infarction, requiring anticoagulation.

Question 33: A child with a suspected supracondylar fracture should be monitored closely for which neurovascular complication?

Radial nerve palsy only
Axillary nerve palsy
Anterior interosseous nerve injury and brachial artery compromise (Correct answer)
Peroneal nerve palsy

Correct answer: Anterior interosseous nerve injury and brachial artery compromise

Supracondylar fractures put the anterior interosseous nerve and brachial artery at risk due to the close proximity of these structures to the fracture site.

Question 34: A 16-year-old with a history of alcohol use presents with epigastric pain radiating to the back, nausea, and vomiting. Serum lipase is 800 U/L. What is the most important initial management priority?

Aggressive IV fluid resuscitation with lactated Ringer's solution (Correct answer)
Start enteral nutrition within 2 hours
Obtain immediate ERCP
Administer IV proton pump inhibitor

Correct answer: Aggressive IV fluid resuscitation with lactated Ringer's solution

Aggressive IV fluid resuscitation is the cornerstone of acute pancreatitis management, with lactated Ringer's preferred to reduce systemic inflammation.

Question 35: During a secondary survey of a 2-year-old trauma patient, the nurse notes bruising in various stages of healing on the trunk and buttocks. The PRIORITY nursing action is:

Reassure the parent that bruising is common in toddlers
Apply warm compresses to reduce swelling
Notify the physician and initiate child protective services protocol (Correct answer)
Document the bruising and continue the survey

Correct answer: Notify the physician and initiate child protective services protocol

Patterned or multi-stage bruising on the trunk and buttocks in a young child is a red flag for non-accidental trauma, requiring mandatory reporting per child protective services protocol.

Question 36: A 5-year-old presents with acute onset ataxia, nystagmus, and dysarthria 2 weeks after a varicella infection. The MOST likely diagnosis is:

Posterior fossa tumor
Acute cerebellar ataxia (Correct answer)
Brainstem encephalitis
Guillain-Barré syndrome

Correct answer: Acute cerebellar ataxia

Acute cerebellar ataxia is a post-infectious complication most commonly seen 1–3 weeks after varicella, presenting with sudden gait unsteadiness.

Question 37: A 13-year-old with penetrating abdominal trauma has tachycardia and peritoneal signs. The MOST appropriate next step is:

Diagnostic peritoneal lavage
FAST exam followed by observation
Immediate surgical consultation for exploratory laparotomy (Correct answer)
CT scan of the abdomen with contrast

Correct answer: Immediate surgical consultation for exploratory laparotomy

Peritoneal signs (rigidity, rebound tenderness) after penetrating trauma indicate the need for emergent surgical consultation and likely operative intervention.

Question 38: Which professional attribute is most valued in psychosocial emergencies within the CPEN field?

Working in isolation
Avoiding challenging situations
Prioritizing personal convenience
Accountability and commitment to standards (Correct answer)

Correct answer: Accountability and commitment to standards

Accountability and commitment to professional standards build trust and ensure consistent, high-quality practice.

Question 39: A 3-year-old presents after ingesting acetaminophen. Which antidote is indicated for acetaminophen toxicity?

Naloxone
Flumazenil
N-acetylcysteine (NAC) (Correct answer)
Atropine

Correct answer: N-acetylcysteine (NAC)

N-acetylcysteine (NAC) is the antidote for acetaminophen toxicity as it replenishes hepatic glutathione and prevents liver injury.

Question 40: During a recreational diving accident, a 15-year-old surfaces rapidly from 18 meters and develops joint pain, skin mottling, and right-sided hemiparesis. Which treatment is DEFINITIVE for decompression sickness?

Emergent neurosurgical consultation for arterial gas embolism
Hyperbaric oxygen (HBO) recompression therapy (Correct answer)
Aspirin and anticoagulation to prevent thrombosis
100% O₂ via NRB mask and IV normal saline

Correct answer: Hyperbaric oxygen (HBO) recompression therapy

Hyperbaric oxygen recompression therapy is the definitive treatment for decompression sickness, reducing bubble size and restoring oxygen delivery to ischemic tissues.

Question 41: A 5-year-old presents with sudden, severe periumbilical pain that migrates to the right lower quadrant, low-grade fever, and anorexia. The Rovsing sign is positive. Which diagnostic tool is preferred to confirm the diagnosis while minimizing radiation exposure?

Ultrasound of the right lower quadrant (Correct answer)
Abdominal X-ray
MRI of the abdomen
CT scan of the abdomen and pelvis

Correct answer: Ultrasound of the right lower quadrant

Ultrasound is the preferred first-line imaging for suspected appendicitis in children to avoid ionizing radiation, with CT reserved for indeterminate ultrasound results.

Question 42: Which assessment finding would MOST suggest hypovolemic shock in a 3-year-old rather than cardiogenic shock?

S3 gallop on cardiac auscultation
Bilateral rales and jugular venous distension
Pulmonary crackles and hepatomegaly
History of vomiting and diarrhea with flat neck veins (Correct answer)

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 43: A 7-year-old with known VP shunt presents with headache and vomiting for 24 hours. His temperature is 38.8°C. What is the priority intervention?

Perform lumbar puncture to rule out meningitis
Start empiric antibiotics and discharge
Obtain immediate neurosurgical consultation for shunt evaluation (Correct answer)
Administer acetaminophen and observe

Correct answer: Obtain immediate neurosurgical consultation for shunt evaluation

Fever with VP shunt malfunction symptoms requires urgent neurosurgical evaluation because shunt infection or obstruction can be life-threatening.

Question 44: Sodium bicarbonate is administered for a pediatric TCA overdose with wide-complex dysrhythmia. What is the PRIMARY mechanism by which it helps?

It increases urinary excretion of the TCA
It stimulates beta-adrenergic receptors
Alkalinization reverses sodium channel blockade and increases protein binding of the drug (Correct answer)
It chelates the TCA molecule directly

Correct answer: Alkalinization reverses sodium channel blockade and increases protein binding of the drug

Sodium bicarbonate alkalinizes the serum, which increases protein binding of TCAs and partially reverses sodium channel blockade, reducing QRS widening and dysrhythmia risk.

Question 45: Which assessment finding in a neonate (0–28 days) requires the MOST immediate intervention?

Central cyanosis with respiratory rate of 70 breaths/min (Correct answer)
Mild acrocyanosis of the hands
Heart rate of 140 bpm
Respiratory rate of 45 breaths/min

Correct answer: Central cyanosis with respiratory rate of 70 breaths/min

Central cyanosis with tachypnea (RR >60) in a neonate indicates significant cardiorespiratory compromise requiring immediate intervention.

Question 46: A 7-year-old presents 4 hours after last seizure with persistent confusion and no return to baseline. The MOST appropriate diagnosis to rule out immediately is:

Simple febrile seizure
Post-ictal state (normal)
Syncope with prolonged recovery
Nonconvulsive status epilepticus (NCSE) (Correct answer)

Correct answer: Nonconvulsive status epilepticus (NCSE)

Persistent altered consciousness beyond the expected post-ictal period requires EEG to exclude nonconvulsive status epilepticus, which is treatable but easily missed.

Question 47: In a pediatric patient with suspected spinal cord injury without radiographic abnormality (SCIWORA), which imaging modality is MOST sensitive for diagnosis?

CT spine with reconstruction
Plain X-rays of the spine
MRI of the spine (Correct answer)
Bone scan

Correct answer: MRI of the spine

MRI is the gold standard for SCIWORA, as it visualizes cord edema, hemorrhage, and ligamentous injury not seen on CT or X-ray.

Question 48: What is the role of informed consent in trauma care?

It ensures the patient understands and agrees to the plan (Correct answer)
It is a mere formality
It protects only the provider
It is only needed for surgery

Correct answer: It ensures the patient understands and agrees to the plan

Informed consent ensures patients understand the proposed interventions, alternatives, risks, and benefits before agreeing to proceed.

Question 49: In CPEN practice, what is the primary purpose of strategic planning?

To satisfy external auditors
To align resources with goals and anticipate challenges (Correct answer)
To create paperwork
To reduce workforce

Correct answer: To align resources with goals and anticipate challenges

Strategic planning aligns organizational resources with goals and helps anticipate challenges before they become critical issues.

Question 50: In CPEN practice, when should a patient's condition be reassessed?

Only at admission and discharge
At regular intervals and when status changes (Correct answer)
Only when the patient requests it
Once per week

Correct answer: At regular intervals and when status changes

Regular reassessment and reassessment upon status changes ensure that care plans remain appropriate and responsive to the patient's needs.

Question 51: Which pain assessment tool is MOST appropriate for a 4-year-old child who can understand simple instructions but cannot verbalize a numeric score?

FLACC scale
CPOT scale
Numeric Rating Scale (NRS)
Wong-Baker FACES scale (Correct answer)

Correct answer: Wong-Baker FACES scale

The Wong-Baker FACES scale is validated for children ages 3 and older who can point to a face representing their pain but cannot use numeric scales.

Question 52: Which laboratory finding is MOST consistent with severe sepsis and tissue hypoperfusion?

Blood glucose above 200 mg/dL
White blood cell count below 5,000/mm³ only
Elevated serum lactate level greater than 2 mmol/L (Correct answer)
Normal C-reactive protein with elevated procalcitonin

Correct answer: Elevated serum lactate level greater than 2 mmol/L

Elevated lactate greater than 2 mmol/L indicates anaerobic metabolism from tissue hypoperfusion and is a key diagnostic and prognostic marker in severe sepsis.

Question 53: A 12-year-old returns from a camping trip with fever, headache, myalgias, and a macular rash starting on the wrists and ankles spreading centrally. Which treatment should be initiated IMMEDIATELY?

Doxycycline (Correct answer)
Amoxicillin-clavulanate
Ciprofloxacin
Azithromycin

Correct answer: Doxycycline

Rocky Mountain Spotted Fever (RMSF) is treated with doxycycline in all age groups, including children, and delay in treatment significantly increases mortality.

Question 54: A 6-year-old girl presents with fever, dysuria, and urinary frequency. Urinalysis shows positive leukocyte esterase and nitrites. Which organism is the most common cause of urinary tract infections in pediatric patients?

Escherichia coli (Correct answer)
Pseudomonas aeruginosa
Staphylococcus aureus
Klebsiella pneumoniae

Correct answer: Escherichia coli

E. coli accounts for approximately 80% of UTIs in children, particularly girls. Its fimbriae allow it to adhere to uroepithelial cells, making it the predominant pathogen. This knowledge guides empiric antibiotic selection while culture results are pending.

Question 55: A 2-year-old presents with refusal to use his right arm after being lifted by the arm. Which injury is most likely?

Shoulder dislocation
Supracondylar fracture
Clavicle fracture
Nursemaid's elbow (radial head subluxation) (Correct answer)

Correct answer: Nursemaid's elbow (radial head subluxation)

Nursemaid's elbow occurs when longitudinal traction on an outstretched arm causes subluxation of the radial head beneath the annular ligament, common in toddlers.

Question 56: When administering activated charcoal to a pediatric patient, which condition is an ABSOLUTE contraindication?

Tricyclic antidepressant ingestion
Salicylate ingestion
Unprotected airway or altered mental status (Correct answer)
Acetaminophen overdose

Correct answer: Unprotected airway or altered mental status

Activated charcoal is absolutely contraindicated when the airway is unprotected due to the high risk of aspiration pneumonitis.

Question 57: A child presents with pain and inability to bear weight after a fall. Which radiographic finding is unique to pediatric fractures?

Comminuted fracture pattern
Spiral shaft fracture only
Open fracture with bone exposure
Salter-Harris growth plate fracture (Correct answer)

Correct answer: Salter-Harris growth plate fracture

Salter-Harris fractures involve the physis (growth plate) and are unique to skeletally immature patients, with classification guiding prognosis and treatment.

Question 58: Which clinical feature helps DIFFERENTIATE a complex febrile seizure from simple febrile seizure?

Age younger than 18 months
Seizure lasting more than 15 minutes or focal features (Correct answer)
Fever greater than 40°C
Postictal drowsiness lasting 15 minutes

Correct answer: Seizure lasting more than 15 minutes or focal features

Complex febrile seizures are defined by duration >15 minutes, focal onset, or recurrence within 24 hours, distinguishing them from simple generalized febrile seizures.

Question 59: A 16-year-old is brought to the ED after a rave event with suspected MDMA (ecstasy) use. She is hyperthermic (39.9°C), diaphoretic, and has Na of 118 mEq/L with seizures. What is the mechanism of hyponatremia in this scenario?

MDMA stimulates ADH release combined with excessive water intake (Correct answer)
MDMA causes direct renal sodium wasting
MDMA inhibits aldosterone, causing sodium loss
Hyperthermia causes osmotic shift of sodium into cells

Correct answer: MDMA stimulates ADH release combined with excessive water intake

MDMA stimulates inappropriate ADH (SIADH) secretion and users often drink excessive water to prevent hyperthermia, causing dilutional hyponatremia.

Question 60: What is the purpose of a long arm splint versus a circumferential cast in the acute management of a pediatric fracture?

A cast provides better pain control
A splint is only used for open fractures
A cast is always preferred for unstable fractures acutely
A splint allows for swelling while reducing compartment syndrome risk (Correct answer)

Correct answer: A splint allows for swelling while reducing compartment syndrome risk

Splints are preferred acutely because they accommodate post-injury swelling and reduce the risk of iatrogenic compartment syndrome from a circumferential cast.

Question 61: A 6-year-old with a displaced supracondylar humerus fracture has absent radial pulse but a warm, pink hand with good capillary refill. The nurse should prepare for:

Closed reduction and percutaneous pinning in the OR (Correct answer)
Non-operative management with a long arm cast
Emergent vascular surgery consultation only
Discharge with neurovascular checks

Correct answer: Closed reduction and percutaneous pinning in the OR

A pulseless but perfused hand ('pink pulseless') in a supracondylar fracture is managed with emergent closed reduction and percutaneous pinning, which typically restores perfusion.

Question 62: A 2-year-old is found in a garage with suspected CO exposure. The child is crying and has a carboxyhemoglobin (COHb) level of 22%. SpO₂ by pulse oximetry reads 98%. Which statement BEST explains this discrepancy?

The child has compensatory polycythemia from chronic exposure
The oximeter malfunctioned in the cold environment
Tissue oxygen delivery is normal at this COHb level
Pulse oximetry cannot distinguish COHb from oxyhemoglobin (Correct answer)

Correct answer: Pulse oximetry cannot distinguish COHb from oxyhemoglobin

Standard pulse oximeters cannot differentiate carboxyhemoglobin from oxyhemoglobin, giving falsely normal SpO₂ readings; co-oximetry blood gas is required.

Question 63: A 9-year-old with a traumatic brain injury (TBI) has a GCS of 7, HR 52, BP 160/90, and irregular respirations. This triad is known as:

Virchow's triad
Cushing's triad (Correct answer)
Beck's triad
Charcot's triad

Correct answer: Cushing's triad

Cushing's triad (hypertension, bradycardia, irregular respirations) indicates dangerously elevated intracranial pressure and impending herniation.

Question 64: In CPEN practice, reliability in assessment refers to:

The speed of administration
The cost of the assessment tool
The consistency and reproducibility of results (Correct answer)
The popularity of the instrument

Correct answer: The consistency and reproducibility of results

Reliability refers to the consistency and reproducibility of assessment results when the test is repeated under similar conditions.

Question 65: A child presents after ingesting a calcium channel blocker. Which hemodynamic pattern is expected?

Bradycardia and hypotension (Correct answer)
Tachycardia and hypertension
Tachycardia and hypotension
Bradycardia and hypertension

Correct answer: Bradycardia and hypotension

Calcium channel blocker overdose classically causes bradycardia and hypotension due to decreased cardiac conduction and peripheral vasodilation.

Question 66: What is the standard first-line treatment for Kawasaki disease?

IV methylprednisolone and oral azithromycin
Oral prednisone and ibuprofen
IV ceftriaxone and low-dose aspirin
IV immunoglobulin (IVIG) and high-dose aspirin (Correct answer)

Correct answer: IV immunoglobulin (IVIG) and high-dose aspirin

IVIG (2 g/kg single infusion) and high-dose aspirin are the standard treatment for Kawasaki disease to reduce inflammation and prevent coronary artery aneurysms.

Question 67: A premature neonate at 28 weeks gestation in the NICU develops abdominal distension, bloody stools, and pneumatosis intestinalis on X-ray. What is the most critical immediate intervention?

Begin total parenteral nutrition and continue enteral feeds
Administer corticosteroids to reduce intestinal inflammation
Make the infant NPO and start broad-spectrum antibiotics (Correct answer)
Perform immediate surgical resection

Correct answer: Make the infant NPO and start broad-spectrum antibiotics

Necrotizing enterocolitis requires immediate bowel rest (NPO), nasogastric decompression, and broad-spectrum antibiotics as initial management.

Question 68: A 3-year-old needs rectal diazepam for status epilepticus. What is the most critical nursing action after administration?

Massage the rectal area vigorously
Place child prone to prevent aspiration
Hold buttocks together for several minutes to ensure retention (Correct answer)
Administer a saline enema to aid absorption

Correct answer: Hold buttocks together for several minutes to ensure retention

Holding the buttocks together for 3–5 minutes prevents expulsion and ensures adequate drug absorption.

Question 69: A 5-year-old has a suspected spinal cord injury after diving into a shallow pool. In-line cervical stabilization is initiated. Which statement about pediatric cervical spine injury is TRUE?

Cervical spine injuries are more common in children than adults
Children are more vulnerable to upper cervical (C1-C3) injuries than adults (Correct answer)
A normal X-ray rules out cervical spine injury in children
Cervical collars eliminate all movement and are sufficient alone

Correct answer: Children are more vulnerable to upper cervical (C1-C3) injuries than adults

Due to a proportionally larger head, horizontal facet joints, and ligamentous laxity, children are more susceptible to upper cervical spine injuries (C1-C3).

Question 70: The sick vs not sick visual assessment's objectives are to:

allocate resources where they are most needed
triage patients during admission based on the level of interventions required
differentiate the critically ill from those who appear stable (Correct answer)
determine the need for transport

Correct answer: differentiate the critically ill from those who appear stable

The 'sick vs. not sick' visual assessment is a rapid, initial evaluation used in pediatric emergency care to quickly categorize patients based on their overall appearance and physiological state. Its primary objective is to differentiate children who are critically ill and require immediate intervention from those who appear stable. This assessment guides the urgency of further evaluation and treatment, ensuring prompt prioritization of care.

Question 71: Which blood product ratio is currently recommended for massive transfusion in pediatric trauma to simulate whole blood?

1:2:1
1:1:1 (PRBCs:FFP:Platelets) (Correct answer)
3:1:1
2:1:1

Correct answer: 1:1:1 (PRBCs:FFP:Platelets)

A 1:1:1 ratio of packed red blood cells, fresh frozen plasma, and platelets is recommended to address all components of coagulopathy in massive hemorrhage.

Question 72: An infant presents with a smooth, non-tender flank mass and hematuria. Which condition should the nurse suspect?

Intussusception
Pyloric stenosis
Neuroblastoma
Wilms tumor (nephroblastoma) (Correct answer)

Correct answer: Wilms tumor (nephroblastoma)

Wilms tumor is the most common renal malignancy in children, typically presenting between ages 3–4 with a smooth, non-tender abdominal mass and hematuria. Neuroblastoma also presents with an abdominal mass but typically crosses the midline and has adrenergic symptoms. Pyloric stenosis and intussusception do not cause flank masses or hematuria.

Question 73: Which pediatric weight-based dosing reference is recommended by ACEP and PALS for use during resuscitation?

UpToDate calculator
Harriet Lane Handbook
Pediatric Dosage Handbook
Broselow-Luten tape (Correct answer)

Correct answer: Broselow-Luten tape

The Broselow-Luten tape correlates length with weight to provide pre-calculated drug doses and equipment sizes during resuscitation.

Question 74: A nurse is preparing to administer adenosine 0.1 mg/kg IV to a 20 kg child for SVT. What dose should be prepared?

20 mg
2 mg (Correct answer)
1 mg
0.2 mg

Correct answer: 2 mg

0.1 mg/kg × 20 kg = 2 mg; adenosine must be followed by a rapid saline flush due to its extremely short half-life.

Question 75: What is the value of continuing education in cardiac emergencies for CPEN professionals?

It is primarily a social activity
It keeps professionals current with evolving standards and practices (Correct answer)
It is only needed for recertification
It replaces workplace experience

Correct 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.

Question 76: Which approach best demonstrates mastery of gastrointestinal emergencies in CPEN practice?

Relying entirely on technology
Avoiding complex scenarios
Following procedures without understanding
Applying principles to novel situations with sound judgment (Correct answer)

Correct answer: Applying principles to novel situations with sound judgment

True mastery involves understanding underlying principles well enough to apply them to new and unfamiliar situations with professional judgment.

Question 77: When using the Broselow tape for a pediatric trauma patient, what does it primarily estimate?

Blood pressure by age
Glasgow Coma Scale score
Weight-based drug doses and equipment sizes (Correct answer)
Expected blood volume

Correct answer: Weight-based drug doses and equipment sizes

The Broselow tape uses the child's length to estimate weight and provide color-coded drug dosing and equipment size recommendations.

Question 78: A 7-year-old presents with acute limp and hip pain. Which condition requires urgent orthopedic evaluation due to risk of avascular necrosis?

Minor muscle strain
Septic arthritis of the hip (Correct answer)
Legg-Calvé-Perthes disease only
Toxic synovitis

Correct answer: Septic arthritis of the hip

Septic arthritis of the hip is a surgical emergency because elevated intra-articular pressure and bacterial enzymes can rapidly destroy the femoral head vascularity, causing avascular necrosis.

Question 79: 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?

Type II (Correct answer)
Type I
Type IV
Type III

Correct answer: Type II

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

Question 80: Which medication is the antidote for benzodiazepine overdose in a pediatric patient?

Physostigmine
Flumazenil (Correct answer)
Naloxone
Pyridoxine

Correct answer: Flumazenil

Flumazenil competitively antagonizes benzodiazepine receptors and reverses CNS and respiratory depression caused by benzodiazepine overdose.

Question 81: 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?

Observation and follow serial X-rays, as most coins pass spontaneously (Correct answer)
Surgical removal due to risk of bowel obstruction
Administer magnesium citrate to speed passage
Immediate endoscopic retrieval

Correct 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.

Question 82: Which pain assessment tool is MOST appropriate for a non-verbal 18-month-old?

Numeric Rating Scale (NRS)
Visual Analog Scale (VAS)
FLACC Scale (Correct answer)
Wong-Baker FACES Scale

Correct answer: FLACC Scale

The FLACC scale (Face, Legs, Activity, Cry, Consolability) is a validated behavioral pain tool for non-verbal infants and toddlers.

Question 83: A child with epiglottitis is most likely to assume which position to maximize airway patency?

Tripod (sniffing) position (Correct answer)
Left lateral decubitus
Prone position
Supine with neck extended

Correct answer: Tripod (sniffing) position

Children with epiglottitis instinctively sit in the tripod (sniffing) position — leaning forward with neck extended — to open the supraglottic airway.

Question 84: What is the first priority in trauma care for CPEN practitioners?

Following insurance requirements
Meeting productivity targets
Ensuring patient safety and well-being (Correct answer)
Completing documentation

Correct answer: Ensuring patient safety and well-being

Patient safety and well-being must always be the first priority in clinical practice, taking precedence over administrative concerns.

Question 85: A 16-year-old is involved in a high-speed motor vehicle collision and arrives with BP 70/40, HR 138, distended abdomen, and decreasing GCS. The PRIORITY intervention is:

Two large-bore IV lines and immediate type and crossmatch (Correct answer)
CT scan to identify the source of bleeding
Fluid bolus of 60 mL/kg normal saline
Foley catheter placement to monitor urine output

Correct answer: Two large-bore IV lines and immediate type and crossmatch

Establishing large-bore IV access and obtaining blood for type and crossmatch is the immediate priority to prepare for blood product transfusion in this patient with signs of hemorrhagic shock.

Question 86: A 3-year-old is brought in after ingesting an unknown quantity of iron tablets. Which finding is MOST consistent with iron toxicity?

Hyperthermia and seizures
Miosis and diaphoresis
Bradycardia and hypertension
Gastrointestinal hemorrhage and metabolic acidosis (Correct answer)

Correct answer: Gastrointestinal hemorrhage and metabolic acidosis

Iron toxicity causes GI bleeding, vomiting, diarrhea, and an anion-gap metabolic acidosis due to free radical damage and cellular toxicity.

Question 87: Which approach best demonstrates mastery of respiratory emergencies in CPEN practice?

Avoiding complex scenarios
Applying principles to novel situations with sound judgment (Correct answer)
Relying entirely on technology
Following procedures without understanding

Correct answer: Applying principles to novel situations with sound judgment

True mastery involves understanding underlying principles well enough to apply them to new and unfamiliar situations with professional judgment.

Question 88: A 4-year-old presents with fever, headache, and a rash that began on the wrists and ankles 3 days ago and has now spread to the trunk. There is a history of tick exposure. Which infection is MOST likely?

Tularemia
Ehrlichiosis
Rocky Mountain Spotted Fever (RMSF) (Correct answer)
Lyme disease (erythema migrans)

Correct answer: Rocky Mountain Spotted Fever (RMSF)

RMSF classically begins with a macular or petechial rash on the palms, wrists, and ankles that spreads centripetally (inward toward the trunk), along with fever and tick exposure history.

Question 89: 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?

Sodium bicarbonate
Flumazenil
N-acetylcysteine (NAC) (Correct answer)
Naloxone

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 90: A 16-year-old presents with paranoia, auditory hallucinations, and disorganized speech that began three weeks ago. After ruling out substance use and medical causes, the nurse anticipates collaboration with psychiatry for which diagnosis?

Dissociative identity disorder
Major depressive disorder with psychotic features only if mood symptoms are present
Brief psychotic disorder or first-episode psychosis evaluation (Correct answer)
Reactive attachment disorder

Correct answer: Brief psychotic disorder or first-episode psychosis evaluation

New-onset psychotic symptoms lasting less than a month after medical and substance causes are excluded point to brief psychotic disorder or first-episode psychosis.

Question 91: Which clinical sign differentiates a greenstick fracture from a buckle (torus) fracture in a child?

A buckle fracture always requires surgical fixation
Both fractures have the same treatment
A greenstick fracture involves cortical disruption on one side; a buckle fracture shows cortical compression without disruption (Correct answer)
A greenstick fracture only occurs in the femur

Correct answer: A greenstick fracture involves cortical disruption on one side; a buckle fracture shows cortical compression without disruption

In a greenstick fracture the cortex breaks on the tension side while intact on the compression side; in a buckle fracture the cortex buckles inward without complete disruption.

Question 92: When measuring blood pressure in a pediatric patient, which cuff size principle is MOST important for accuracy?

Cuff bladder should cover 50% of arm circumference
Cuff bladder should cover the entire upper arm
Cuff bladder width should be 40% of mid-arm circumference (Correct answer)
Use the largest cuff that fits on the arm

Correct answer: Cuff bladder width should be 40% of mid-arm circumference

The cuff bladder width should be approximately 40% of mid-arm circumference to ensure accurate blood pressure readings in children.

Question 93: Which of the following vital sign parameters is MOST age-appropriate for a healthy 1-year-old?

Heart rate 140–160 bpm, RR 40–60
Heart rate 60–80 bpm, RR 12–20
Heart rate 80–100 bpm, RR 18–24
Heart rate 100–160 bpm, RR 25–35 (Correct answer)

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.

Question 94: What is the value of continuing education in psychosocial emergencies for CPEN professionals?

It is primarily a social activity
It replaces workplace experience
It keeps professionals current with evolving standards and practices (Correct answer)
It is only needed for recertification

Correct 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.

Question 95: A 14-year-old presents after ingesting 20 acetaminophen tablets. She states she 'just wanted to sleep.' Which initial nursing action is the priority?

Obtain a psychiatric consult
Notify child protective services
Administer activated charcoal immediately
Assess suicide intent using a validated tool such as the Columbia Suicide Severity Rating Scale (Correct answer)

Correct answer: Assess suicide intent using a validated tool such as the Columbia Suicide Severity Rating Scale

A structured suicide risk assessment using a validated tool is the priority to determine immediate safety needs and guide management.

Question 96: Which finding is most consistent with Beck's triad in a pediatric trauma patient?

Hypertension, bradycardia, irregular respirations
Bradycardia, hypertension, widened pulse pressure
Tachycardia, hypotension, diaphoresis
Hypotension, muffled heart sounds, distended neck veins (Correct answer)

Correct answer: Hypotension, muffled heart sounds, distended neck veins

Beck's triad (hypotension, muffled heart sounds, JVD) is the classic presentation of cardiac tamponade.

Question 97: A child presents with massive periorbital and peripheral edema, heavy froth in the urine, and laboratory results showing severe hypoalbuminemia and hyperlipidemia. Which condition does this constellation represent?

Acute glomerulonephritis
Hemolytic uremic syndrome
Renal tubular acidosis
Nephrotic syndrome (Correct answer)

Correct answer: Nephrotic syndrome

Nephrotic syndrome is defined by the classic tetrad of massive proteinuria (>3.5 g/day), hypoalbuminemia, edema, and hyperlipidemia. Loss of albumin through damaged glomerular filtration lowers oncotic pressure, causing fluid to shift into tissues. Acute glomerulonephritis is characterized by hematuria and hypertension rather than massive proteinuria.

Question 98: A 4-year-old presents with acute onset right-sided facial droop and inability to close the right eye, but normal eye movements and no limb weakness. The MOST likely diagnosis is:

Ramsay Hunt syndrome
Bell's palsy (peripheral CN VII palsy) (Correct answer)
Brainstem tumor
Central facial nerve palsy from stroke

Correct answer: Bell's palsy (peripheral CN VII palsy)

Bell's palsy is a peripheral CN VII palsy causing complete unilateral facial weakness including forehead and eye closure, distinguishing it from central causes.

Question 99: An infant presents with opisthotonus, high-pitched cry, and a bulging fontanelle. Bacterial meningitis is confirmed. When should dexamethasone be given?

Only after 48 hours if the child is not improving
15–20 minutes before or with the first antibiotic dose (Correct answer)
It is contraindicated in infants under 6 weeks
30 minutes after the first antibiotic dose

Correct answer: 15–20 minutes before or with the first antibiotic dose

Dexamethasone is most effective when given 15–20 minutes before or concurrently with the first antibiotic dose to blunt the inflammatory response.

Question 100: A nurse is about to give IV vancomycin rapidly and the child develops flushing, erythema, and hypotension. What is the most likely cause?

Vasovagal response
Anaphylaxis to vancomycin
Red Man Syndrome from rapid infusion (Correct answer)
Septic shock progression

Correct 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.

Question 101: Which of the following is the safest practice when programming a high-alert medication infusion on a smart pump?

Use the drug library to select the medication and concentration (Correct answer)
Program based on a verbal order from the physician
Manually calculate and override all pump limits
Bypass the drug library to save time in an emergency

Correct answer: Use the drug library to select the medication and concentration

Drug libraries with hard and soft dose limits provide a safety check that reduces programming errors with high-alert medications.

Question 102: 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?

Hypothermia always worsens outcome in pediatric drowning
Cold water submersion may be protective; do not declare death until normothermic (Correct answer)
Target temperature management is contraindicated in children
Actively rewarm all submersion victims to 37°C before declaring death

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 103: A child with end-stage liver disease presents with massive hematemesis. Which medication should be given immediately while preparing for endoscopy?

Propranolol PO
Omeprazole IV
Vasopressin IM
Octreotide IV (Correct answer)

Correct answer: Octreotide IV

Octreotide (a somatostatin analogue) reduces portal pressure by causing splanchnic vasoconstriction and is the preferred pharmacologic agent for acute variceal bleeding in children.

Question 104: When applying a traction splint to a pediatric femur fracture in the ED, what is the primary goal?

To eliminate the need for IV analgesia
To completely reduce the fracture
To reduce muscle spasm, decrease pain, and control hemorrhage by restoring femur length (Correct answer)
To replace surgical fixation

Correct answer: To reduce muscle spasm, decrease pain, and control hemorrhage by restoring femur length

Traction splints counter muscle spasm in femur fractures, restore bone length, reduce pain, and decrease potential blood loss into the thigh compartment.

Question 105: A 10-year-old with Crohn disease presents to the ED with severe right lower quadrant pain and a palpable tender mass. Imaging reveals a periappendiceal abscess. What is the initial management?

High-dose corticosteroids
Immediate appendectomy
IV antibiotics and interventional radiology-guided drainage (Correct answer)
Oral antibiotics and outpatient follow-up

Correct answer: IV antibiotics and interventional radiology-guided drainage

A periappendiceal abscess in pediatric patients is typically managed initially with IV antibiotics and percutaneous drainage, with interval appendectomy considered later.

Question 106: The AVPU scale is used to rapidly assess a child's level of consciousness. What does the 'P' stand for?

Purposeful movement
Posturing
Peripheral perfusion
Pain response (Correct answer)

Correct answer: Pain response

In the AVPU scale, 'P' stands for responding to Pain, indicating the child responds only to painful stimuli.

Question 107: Which position of comfort is typically seen in a child with septic arthritis of the hip?

Hip extended and internally rotated
Hip fully adducted and extended
Hip flexed, abducted, and externally rotated (Correct answer)
Knee flexed with hip in neutral

Correct answer: Hip flexed, abducted, and externally rotated

Children with septic arthritis of the hip hold the joint in flexion, abduction, and external rotation to maximize joint space volume and reduce intra-articular pressure.

Question 108: Which ingestion requires whole bowel irrigation as a decontamination method?

Alcohol
Iron tablets or sustained-release medications (Correct answer)
Liquid antihistamines
Household bleach

Correct answer: Iron tablets or sustained-release medications

Whole bowel irrigation with polyethylene glycol is indicated for iron tablets and sustained-release drug ingestions not adsorbed by activated charcoal.

Question 109: During a rapid assessment, a pediatric nurse notes that a 3-year-old has grunting respirations. Grunting PRIMARILY serves to:

Expel secretions from the lower airways
Signal upper airway obstruction above the glottis
Indicate pain rather than respiratory compromise
Increase end-expiratory pressure to prevent alveolar collapse (Correct answer)

Correct answer: Increase end-expiratory pressure to prevent alveolar collapse

Grunting is produced by partial closure of the glottis during expiration to generate intrinsic PEEP and maintain alveolar patency in conditions like pneumonia or pulmonary edema.

Question 110: What role does collaboration play in neurological emergencies for CPEN professionals?

It reduces individual accountability
It slows down work unnecessarily
It is only needed in emergencies
It enhances outcomes through diverse perspectives and shared expertise (Correct answer)

Correct answer: It enhances outcomes through diverse perspectives and shared expertise

Collaboration leverages diverse perspectives and combined expertise to achieve better outcomes than any individual could alone.

Question 111: Which approach best demonstrates mastery of neurological emergencies in CPEN practice?

Following procedures without understanding
Applying principles to novel situations with sound judgment (Correct answer)
Relying entirely on technology
Avoiding complex scenarios

Correct answer: Applying principles to novel situations with sound judgment

True mastery involves understanding underlying principles well enough to apply them to new and unfamiliar situations with professional judgment.

Question 112: A child is brought in after a suspected clonidine ingestion. What clinical presentation is expected?

Seizures and hyperthermia
Tachycardia and hyperventilation
Agitation and hypertension
Bradycardia, hypotension, and CNS depression mimicking opioid toxidrome (Correct answer)

Correct answer: Bradycardia, hypotension, and CNS depression mimicking opioid toxidrome

Clonidine stimulates central alpha-2 receptors, producing bradycardia, hypotension, miosis, and sedation that closely mimics opioid toxicity.

Question 113: A 2-year-old presents with painless, maroon-colored rectal bleeding. The child is hemodynamically stable. Which diagnostic study is most appropriate to identify the bleeding source?

Barium enema
Technetium-99m pertechnetate (Meckel) scan (Correct answer)
CT angiography
Upper endoscopy

Correct answer: Technetium-99m pertechnetate (Meckel) scan

Painless lower GI bleeding in a toddler is classic for a Meckel diverticulum containing ectopic gastric mucosa, and a Meckel scan is the preferred diagnostic test.

Question 114: Heliox therapy in pediatric respiratory emergencies is MOST beneficial for which condition?

Upper airway obstruction (croup/foreign body) (Correct answer)
RSV bronchiolitis
Bacterial pneumonia
Pulmonary edema

Correct answer: Upper airway obstruction (croup/foreign body)

Heliox (helium-oxygen mixture) reduces turbulent airflow and work of breathing, making it most useful for upper airway obstruction conditions like croup.

Question 115: A 5-year-old is stung by a scorpion in Arizona. The child is drooling, has roving eye movements, and is agitated with abnormal limb movements. Which medication is MOST effective for severe scorpion envenomation in the US?

Midazolam for symptom control only
Calcium gluconate IV
Diphenhydramine IV
Antivenom (Anascorp) (Correct answer)

Correct answer: Antivenom (Anascorp)

Centruroides scorpion antivenom (Anascorp) rapidly reverses neurotoxic symptoms including cranial nerve dysfunction, excessive secretions, and motor abnormalities.

Question 116: A child presents with subcutaneous emphysema in the neck, absent breath sounds on the left, and tracheal deviation to the right. These findings indicate:

Right tension pneumothorax
Diaphragmatic hernia
Left tension pneumothorax (Correct answer)
Massive hemothorax

Correct answer: Left tension pneumothorax

Left tension pneumothorax causes absent breath sounds on the left, tracheal deviation away from the affected side (to the right), and can cause subcutaneous emphysema.

Question 117: A 1-month-old presents with seizures, lethargy, and a sodium of 118 mEq/L after breastfeeding with excessive water supplementation. The SAFEST correction rate for hyponatremia is:

Correct only with free fluid restriction, no sodium supplementation
Correct sodium by 20 mEq/L in the first hour
Rapid correction with 3% NaCl over 30 minutes to 135 mEq/L
Correct sodium by no more than 1–2 mEq/L per hour, max 10–12 mEq/L per day (Correct answer)

Correct answer: Correct sodium by no more than 1–2 mEq/L per hour, max 10–12 mEq/L per day

Overly rapid correction of hyponatremia risks osmotic demyelination; the safe rate is ≤1–2 mEq/L/hr, not exceeding 10–12 mEq/L in 24 hours (except for acute symptomatic seizures).

Question 118: When calculating the estimated weight of a child aged 1–10 years using the Broselow formula, which formula is commonly used?

Weight (kg) = age × 2 + 8 (Correct answer)
Weight (kg) = age × 3 + 7
Weight (kg) = (age + 4) × 2
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 119: A 10-year-old with blunt abdominal trauma has a seat belt sign across the abdomen. Which organ is at highest risk for injury?

Small bowel and mesentery (Correct answer)
Spleen
Liver
Kidney

Correct answer: Small bowel and mesentery

A lap belt sign is strongly associated with hollow viscus injuries (small bowel/mesentery) and Chance fractures of the lumbar spine.

Question 120: A 6-year-old presents with a heart rate of 140 bpm, respiratory rate of 28, capillary refill of 3 seconds, and altered mental status. This constellation BEST describes which pediatric emergency state?

Decompensated shock (Correct answer)
Respiratory failure
Compensated shock
Hypertensive crisis

Correct answer: Decompensated shock

Decompensated shock is present when altered mental status accompanies tachycardia, tachypnea, and prolonged capillary refill, indicating failing compensatory mechanisms.

Question 121: An 11-year-old is brought in by parents after being found in a detached garage where a generator was running. The child is conscious but complains of headache and nausea. The father also has a headache. Which intervention should occur FIRST?

Remove both from the source and apply 100% O₂ via NRB mask (Correct answer)
Administer activated charcoal to prevent further absorption
Perform a 12-lead ECG to assess for dysrhythmia
Obtain IV access and draw COHb level

Correct answer: Remove both from the source and apply 100% O₂ via NRB mask

Removing the patient from the CO source and immediately applying 100% oxygen is the priority to terminate ongoing exposure and accelerate CO elimination.

Question 122: A nurse receives a verbal order for a medication during a pediatric emergency. What is the safest practice after receiving the verbal order?

Administer immediately without delay then document later
Refuse to act on verbal orders unless written first
Have another nurse write it down and administer
Repeat the order back and confirm with the ordering provider before administering (Correct answer)

Correct answer: Repeat the order back and confirm with the ordering provider before administering

Read-back confirmation of verbal orders is a Joint Commission-required safety practice that reduces communication errors.

Question 123: A 3-year-old ingests a button battery and now presents with drooling, stridor, and respiratory distress. The PRIORITY is:

Immediate endoscopy/removal as a surgical emergency (Correct answer)
Induce vomiting to remove the battery
Obtain X-ray series over 24 hours
Administer H2 blocker and observe

Correct answer: Immediate endoscopy/removal as a surgical emergency

Button batteries lodged in the esophagus cause rapid liquefactive necrosis and airway compromise — immediate endoscopic removal is a surgical emergency.

Question 124: A 5-year-old presents with abdominal pain, vomiting, and bloody diarrhea 3 days after eating undercooked hamburger at a cookout. Labs show thrombocytopenia, anemia, and elevated creatinine. Which complication is developing?

Appendicitis
Mesenteric adenitis
Intussusception
Hemolytic uremic syndrome (Correct answer)

Correct answer: Hemolytic uremic syndrome

The triad of microangiopathic hemolytic anemia, thrombocytopenia, and acute kidney injury following E. coli O157:H7 infection is diagnostic of hemolytic uremic syndrome (HUS).

Question 125: A pediatric patient is receiving a continuous heparin infusion. Which laboratory value is used to monitor the therapeutic effect of heparin?

Activated Partial Thromboplastin Time (aPTT) (Correct answer)
Fibrinogen level
Prothrombin Time (PT/INR)
Platelet count

Correct answer: Activated Partial Thromboplastin Time (aPTT)

The aPTT is the standard monitoring parameter for unfractionated heparin therapy, with a therapeutic range typically 60–100 seconds.

Question 126: What is the most important professional competency for CPEN certification in neurological emergencies?

Ability to work alone exclusively
Memorization of all reference materials
Deep knowledge combined with practical application skills (Correct answer)
Speed of task completion

Correct answer: Deep knowledge combined with practical application skills

Professional competency requires both deep knowledge of the subject matter and the ability to apply that knowledge in practical situations.

Question 127: Which statement is TRUE regarding the use of weight-based dosing in obese pediatric patients?

BMI is not considered when calculating pediatric drug doses
All medications should be dosed on actual body weight without exception
Some medications should be dosed on ideal body weight (IBW) to avoid toxicity (Correct answer)
Obese children always need lower doses regardless of the drug

Correct answer: Some medications should be dosed on ideal body weight (IBW) to avoid toxicity

Lipophilic drugs and some antibiotics must be adjusted to ideal or adjusted body weight in obese pediatric patients to prevent toxicity.

Question 128: When assessing respiratory distress in a toddler, nasal flaring PRIMARILY indicates:

Increased respiratory effort to maximize airflow (Correct answer)
Normal breathing variant in children under 2
Impending respiratory failure
Upper airway obstruction only

Correct answer: Increased respiratory effort to maximize airflow

Nasal flaring is a compensatory mechanism in young children that dilates the nares to decrease airway resistance and increase airflow during respiratory distress.

Question 129: A 2-year-old presents after ingesting a dishwasher detergent pod with oral burns, drooling, and refusal to swallow. Which action is CONTRAINDICATED in managing this caustic ingestion?

Induction of vomiting with syrup of ipecac (Correct answer)
Airway assessment and intubation if needed
IV access and pain management
NPO status pending endoscopic evaluation

Correct answer: Induction of vomiting with syrup of ipecac

Inducing vomiting after caustic ingestion is strictly contraindicated because it re-exposes the esophageal and oropharyngeal mucosa to the caustic agent, worsening burns and increasing perforation risk.

Question 130: Which intervention is the priority for a child presenting with suspected carbon monoxide poisoning?

Perform gastric lavage
Administer activated charcoal
Apply 100% oxygen via non-rebreather mask (Correct answer)
Administer sodium bicarbonate IV

Correct answer: Apply 100% oxygen via non-rebreather mask

High-flow 100% oxygen via non-rebreather mask displaces CO from hemoglobin and is the first-line treatment for carbon monoxide poisoning.

Question 131: A 3-year-old is brought in after a seizure. During assessment, you note horizontal nystagmus and ataxia. Which ingestion should be HIGHEST on your differential?

Acetaminophen
Iron tablets
Ethanol or benzodiazepines (Correct answer)
Aspirin

Correct answer: Ethanol or benzodiazepines

Nystagmus and ataxia are classic signs of CNS depressant ingestion such as ethanol or benzodiazepines in the pediatric patient.

Question 132: A 10-year-old with known asthma has an initial PEFR of 40% predicted after two albuterol treatments. This classifies the exacerbation as:

Life-threatening
Moderate
Severe (Correct answer)
Mild

Correct answer: Severe

A PEFR of 40–69% predicted after initial treatment is classified as a moderate exacerbation; below 40% indicates severe — this patient at 40% sits at the severe threshold.

Question 133: What does validity mean when selecting an assessment tool for CPEN certification purposes?

The tool measures what it claims to measure (Correct answer)
The tool is easy to administer
The tool is inexpensive
The tool is widely used

Correct answer: The tool measures what it claims to measure

Validity indicates that an assessment tool accurately measures the construct or ability it was designed to measure.

Question 134: A febrile neonate aged 18 days is brought to the emergency department. The infant appears well but has a rectal temperature of 38.1°C. What is the MOST appropriate management?

Administer oral amoxicillin and recheck in 24 hours
Obtain urinalysis and CBC only before making treatment decision
Observe for 4 hours and discharge if remains well-appearing
Perform full sepsis workup and admit for empiric IV antibiotics (Correct answer)

Correct answer: Perform full sepsis workup and admit for empiric IV antibiotics

All neonates younger than 28 days with fever require a full sepsis evaluation (CBC, blood culture, UA/urine culture, LP, CXR) and empiric IV antibiotics due to high risk of serious bacterial infection.

Question 135: Which professional attribute is most valued in neurological emergencies within the CPEN field?

Accountability and commitment to standards (Correct answer)
Working in isolation
Avoiding challenging situations
Prioritizing personal convenience

Correct answer: Accountability and commitment to standards

Accountability and commitment to professional standards build trust and ensure consistent, high-quality practice.

Question 136: When assessing a 2-year-old using the Pediatric Assessment Triangle (PAT), which component evaluates the child's skin color and circulation?

Appearance
Mental status
Circulation to skin (Correct answer)
Work of breathing

Correct answer: Circulation to skin

The PAT's Circulation to Skin component evaluates skin color, mottling, pallor, and cyanosis to indicate perfusion status.

Question 137: A 6-year-old ingested a sulfonylurea medication. After initial treatment with dextrose, hypoglycemia recurs. Which agent is MOST appropriate to prevent recurrent hypoglycemia in sulfonylurea overdose?

Octreotide (Correct answer)
Continuous high-dose dextrose infusion alone
Insulin drip
Glucagon IM injection

Correct answer: Octreotide

Octreotide inhibits pancreatic insulin secretion and is preferred over repeated dextrose boluses for sulfonylurea-induced hypoglycemia because dextrose alone stimulates further insulin release.

Question 138: A 4-month-old infant presents with lethargy, bulging fontanelle, and high-pitched cry. Which diagnosis should be IMMEDIATELY considered?

Bacterial meningitis (Correct answer)
Colic
Normal developmental variant
Benign intracranial hypertension

Correct answer: Bacterial meningitis

The triad of lethargy, bulging fontanelle, and high-pitched cry in an infant is a classic presentation of bacterial meningitis requiring urgent assessment and treatment.

Question 139: A 13-year-old presents with a tick embedded in the scalp for an estimated 36 hours after a camping trip in North Carolina. Vital signs show T 39.1°C, HR 118, and the child has petechiae on the wrists and ankles. Which diagnosis requires IMMEDIATE antibiotic treatment?

Lyme disease with early dissemination
Rocky Mountain Spotted Fever (RMSF) (Correct answer)
Tick paralysis
Ehrlichiosis

Correct answer: Rocky Mountain Spotted Fever (RMSF)

Rocky Mountain Spotted Fever presents with fever, rash (petechiae on extremities), and tick exposure, requiring immediate doxycycline regardless of age due to the high mortality of untreated disease.

Question 140: What is the best practice for documenting assessment results in CPEN practice?

Document results from memory at end of day
Document all findings objectively and completely (Correct answer)
Use subjective descriptions only
Record only abnormal findings

Correct answer: Document all findings objectively and completely

Best practice requires documenting all findings objectively and completely at the time of assessment for accuracy and legal protection.

Question 141: In CPEN practice, what is the best approach to quality improvement in psychosocial emergencies?

Copy what other organizations do without analysis
Wait for problems to occur before acting
Use data-driven methods with measurable outcomes (Correct answer)
Make changes without measuring results

Correct answer: Use data-driven methods with measurable outcomes

Data-driven quality improvement with measurable outcomes ensures that changes actually produce the intended improvements and can be verified.

Question 142: What is the primary purpose of assessment in the CPEN context?

To rank individuals competitively
To replace professional judgment
To fulfill administrative requirements only
To gather information for informed decision-making (Correct answer)

Correct answer: To gather information for informed decision-making

Assessment is fundamentally about gathering reliable information to support informed professional decisions and appropriate interventions.

Question 143: When using a non-rebreather mask for a pediatric patient, what minimum flow rate is required to keep the reservoir bag inflated?

6–8 L/min
4–6 L/min
2–4 L/min
10–15 L/min (Correct answer)

Correct answer: 10–15 L/min

A non-rebreather mask requires 10–15 L/min flow rate to maintain reservoir bag inflation and deliver approximately 95% FiO2.

Question 144: A 5-year-old is found unresponsive. The nurse confirms no pulse and begins CPR. What is the correct compression-to-ventilation ratio for a single rescuer?

30:1
30:2 (Correct answer)
5:1
15:2

Correct answer: 30:2

A single rescuer performing CPR on a child uses a 30:2 compression-to-ventilation ratio, consistent with adult BLS guidelines.

Question 145: 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:

Document the findings and notify the provider for a child abuse evaluation (Correct answer)
Reassure the family and discharge with follow-up
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.

Question 146: An infant is receiving a continuous IV infusion and the pump alarms for occlusion. What is the first nursing action?

Replace the IV catheter immediately
Notify the physician before doing anything
Increase the pump pressure limit
Assess the IV site and tubing for kinks or positional occlusion (Correct answer)

Correct answer: Assess the IV site and tubing for kinks or positional occlusion

Assessment of the IV site and tubing is the first step to identify and correct the most common, easily remedied causes of occlusion.

Question 147: Congenital complete heart block in a newborn is most commonly associated with maternal:

Gestational diabetes
Hypothyroidism
Group B streptococcal infection
Lupus erythematosus (anti-Ro/La antibodies) (Correct answer)

Correct answer: Lupus erythematosus (anti-Ro/La antibodies)

Maternal anti-Ro (SSA) and anti-La (SSB) antibodies cross the placenta and damage the fetal AV node, causing congenital complete heart block.

Question 148: A 5-year-old ingested a button battery. What is the most serious immediate risk?

Esophageal perforation from electrical current and alkali burns (Correct answer)
Choking hazard only
Intestinal obstruction
Lead poisoning

Correct answer: Esophageal perforation from electrical current and alkali burns

Button batteries lodged in the esophagus generate an electrical current and hydroxide ions that cause rapid, severe alkali burns and esophageal perforation.

Question 149: Which antiepileptic drug is FIRST-LINE for infantile spasms (West syndrome)?

Phenobarbital
Levetiracetam
ACTH (adrenocorticotropic hormone) (Correct answer)
Carbamazepine

Correct answer: ACTH (adrenocorticotropic hormone)

ACTH is the first-line treatment for infantile spasms and has shown superior efficacy in reducing spasms and improving EEG in West syndrome.

Question 150: A neonate presents at 3 weeks of age with projectile non-bilious vomiting after every feeding and a palpable 'olive-like' mass in the epigastrium. What is the MOST likely diagnosis?

Pyloric stenosis (Correct answer)
Gastroesophageal reflux
Duodenal atresia
Malrotation with volvulus

Correct answer: Pyloric stenosis

Pyloric stenosis classically presents at 2–8 weeks with forceful non-bilious vomiting and a palpable pyloric 'olive' mass.

Question 151: Which symptom cluster represents a sympathomimetic toxidrome in a pediatric patient?

Bradycardia, hypotension, hypothermia
Miosis, respiratory depression, decreased bowel sounds
Tachycardia, hypertension, mydriasis, diaphoresis (Correct answer)
Bradycardia, miosis, salivation

Correct answer: Tachycardia, hypertension, mydriasis, diaphoresis

Sympathomimetic toxidrome (e.g., cocaine, amphetamines) presents with tachycardia, hypertension, hyperthermia, mydriasis, and diaphoresis due to catecholamine excess.

Question 152: A child presents sitting upright and leaning forward in the 'sniffing position' with high fever, drooling, and severe respiratory distress. Epiglottitis is suspected. What is the MOST important immediate action?

Obtain a lateral neck X-ray before any airway intervention
Administer racemic epinephrine via nebulizer as first-line treatment
Perform oral examination with a tongue depressor to visualize the epiglottis
Minimize agitation, prepare for definitive airway management, and call for anesthesia/ENT backup (Correct answer)

Correct answer: Minimize agitation, prepare for definitive airway management, and call for anesthesia/ENT backup

Epiglottitis can cause complete airway obstruction with any agitation; the priority is keeping the child calm and immediately mobilizing resources for controlled intubation or surgical airway.

CPEN Certified Pediatric Emergency Nurse Exam

The CPEN® exam, administered by the Board of Certification for Emergency Nursing (BCEN), certifies nurses in pediatric emergency care across six clinical domains including respiratory, cardiovascular, neurological, trauma, and psychosocial emergencies.

150

Questions

180 min

Time Limit

75%

To Pass

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These practice questions were written with AI tools. They are not real exam questions. Exam facts are checked against the official sources listed below. Not reviewed by a subject-matter expert. Editorial policy

Sources & references

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bcen.org — Score release, retake policy, time limit, eligibility, fees, registration, test dates, test delivery, passing score, score validity · verified Oct 2026