CPEN Practice Questions & Rationales
An 18-month-old patient presents to the Emergency Department with upper respiratory symptoms and wheezing. Chest x-ray reveals a radiopaque object in the left lower lobe. The nurse prepares the patient for a: A. Rigid bronchoscopy B. Flexible bronchoscopy C. Foreign body removal with fluoroscopy D. CT scan-guided lung biopsy
A A radiographic study will be done, usually a chest x-ray to identify any possible foreign bodies. If there is a suspected foreign body, an Otolaryngologist will start with a rigid bronchoscopy, if the procedure is not straight forward they could switch to a flexible bronchoscopy, but the rigid is preferred. CT scan-guided lung biopsies are not performed for foreign body removal. Foreign bodies are also not removed through fluoroscopy.
Which of the following pediatric patients should be referred to a burn center? A. A patient with approximately 3% partial thickness burns to the wrist. B. A patient with approximately 5% partial thickness burns to the thigh. C. A patient with approximately 6% partial thickness burns to the back. D. A patient with approximately 7% partial thickness burns to the chest.
A. A burn to the wrist can result in an alteration of functionality and mobility. The other injuries should be able to be treated at the facility of arrival.
A mother runs into the emergency department screaming that her child is choking on a piece of candy. The nurse observes a fearful 5-year-old with minimal air movement and dusky in color. The nurse's initial action should be to A. perform abdominal thrusts. B. obtain an oxygen saturation level. C. facilitate oral tracheal intubation. D. obtain a chest radiograph.
A. A child brought to the ED with sudden onset of respiratory distress should be evaluated for foreign body aspiration if no other cause is apparent. Initially, a foreign body obstruction produces choking, gassing, wheezing, or coughing. If the object becomes lodged in the larynx, the child cannot speak or breathe, For children 1 year or older, abdominal thrusts should be used.
An infant presenting with tachypnea, intercostal retractions, and clear nasal drainage is diagnosed with bronchiolitis. The respiratory distress is probably caused by the infant's A. smaller upper airways. B. proportionally larger tongue. C. less compliant chest wall. D. higher tidal volume requirement.
A. A small amount of edema or secretions can cause airway restriction and obstruction in the smaller airways of infants.
While caring for an intubated patient, the nurse notices a sudden drop in end tidal carbon dioxide from 38 mmHg to 22 mmHg. The nurse immediately suspects? A. tube obstruction B. return of spontaneous respiration C. asthma complications D. tube dislodgement
A. A sudden drop in end tidal carbon dioxide is an indication of tube obstruction. Tube dislodgement would result in a loss of both the end tidal carbon dioxide waveform and numerical value. A return of spontaneous respiration, would indicate a spike upward, not downward. Asthma complications may show an increased numerical value and a shark-fin appearance.
A 5-day-old patient presents with feeding intolerance, lethargy, temperature instability, and apnea. The nurse has a high suspicion for A. neonatal sepsis B. brief resolved unexplained event. C. viral infection. D. congenital heart disease.
A. All neonates presenting with temperature instability should be considered a septic workup. Neonatal sepsis is a clinical syndrome of systemic illness accompanied by bacteremia occurring in the first month of life. The common sites of infection are blood, cerebral spinal fluid, and lungs.
A diagnosis of intussusception is made on a 2-year-old. The nurse should anticipate an initial treatment of A. an air enema. B. a colonoscopy. C. a barium enema. D. an open laparotomy.
A. An air enema would be administered to reduce the potential for peritonitis from barium in the event of a perforation. Surgery would be performed in the case of perforation. A colonoscopy would not be performed in the presence of a known intussusception.
A 3-year-old is being admitted following a submersion injury in a swimming pool. The patient is alert and responds appropriately. The following vital signs are noted: BP 80/40 HR 88 RR 24 A student nurse questions the need for admission. An appropriate response is that the patient: A. "needs to monitored for cerebral edema." B. "needs to monitored for child abuse." C. "needs to be observed for cervical spine injury." D. "needs to be observed for pulmonary emboli."
A. Cerebral edema and aspiration can be delayed up to 24 hours post near drowning. There are no indications of child abuse. There are no indications of cervical spine injury as those occur with diving injuries into shallow water. Pulmonary emboli is not observed in patient's with a submersion injury.
When assessing an infant with coarctation of the aorta, a nurse should expect to find A. absent or diminished femoral pulses. B. cyanotic episodes. C. heart failure and pulmonary edema. D. hypotension and tachycardia.
A. Characteristic manifestations of a coarctation include absent or diminished femoral pulses and higher blood pressures in the upper extremities than lower extremities. Heart failure may develop if a critical coarctation is present (a situation which would normally be identified in the nursery and surgically corrected).
A 2-year-old with known cardiac history is brought in by ambulance for prolonged cyanosis following a temper tantrum. Treatment for this child would include A. morphine. B. albuterol nebulizers. C. epinephrine drip. D. intubation
A. Children with congenital heart disease involving cyanosis spells after a decrease in oxygen availability are characterized by hyper cyanosis. Morphine will calm and decrease tachypnea and peripheral vascular resistance.
An 8-year-old presents with mild dyspnea and drooling following an all-terrain vehicle crash. There is bruising around the neck at the laryngeal area. Upon palpation, the nurse should expect to feel A. subcutaneous emphysema. B. tracheal deviation. C. distended neck veins. D. bony crepitus.
A. Common causes associated with larynx fracture include motor vehicle crashes, strangulation, and physical trauma. Airway management is a priority. Objective data include respiratory distress, ecchymosis, abrasions, soft tissue swelling, and subcutaneous emphysema.
An adolescent presents with superficial lacerations to both forearms. She is tearful and avoids eye contact with staff. Which of the following is the PRIORITY intervention for this patient? A. Maintain a safe environment. B. Initiate wound care. C. Notify the police. D. Order a social work consultation.
A. During the pediatric triage and assessment process, the main concern of the nursing is to maintain a safe environment for the patient and to foster hopefulness.
A 16-year-old boy presents with gradual onset of left scrotal pain, fever, and abdominal pain. These symptoms are suggestive of A. epididymitis. B. urinary tract infection. C. testicular torsion. D. appendicitis.
A. Epididymitis is an inflammatory or infectious process of the epididymis. Epididymitis can be present in the pediatric population and results from infection or from structural, neurologic, or functional abnormalities of the lower urinary tract. Symptoms include gradual onset of scrotal or groin pain, fever, and urethral discharge.
Post-tonsillectomy bleeding is A. most common 5-10 days after surgery B. most common 1-2 days after surgery. C. most common 2-3 weeks after surgery. D. expected and not a cause for concern.
A. Following a tonsillectomy, scabs form where the former tonsil tissues were removed. They develop after surgery when the bleeding stops. During the recovery phase, the scabs fall off over the course of 5-10 days. This is the time period when bleeding may occur.
A 4-month-old presents with excessive crying. Assessment reveals a red swollen penis. The nurse should be concerned that the child may be suffering from A. a hair tourniquet. B. vaso-occlusive episode. C. diaper rash. D. Epididymitis.
A. Hair tourniquet is a condition where hair or thread becomes tightly wrapped around most commonly a toe, and occasionally a finger, genital or other body parts. This results in pain and swelling of the affected area.
Which of the following assessment findings should the nurse find worrisome? A. an infant who does not respond to soothing B. a toddler who insists upon holding their blanket during a painful procedure C. a school-age child who appears modest and does not want to get undressed D. a preschooler who wants to help put on their own bandage
A. In the younger infant, because of limited vocabulary and verbal skills, the nurse must depend upon the parent and subtle clues from the child for history. A child's response to illness or injury depends on his/her current developmental stage. Toddlers cling to parents, whereas adolescents are more independent.
A child with cellulitis of the lower leg is being discharged. Which of the following statements indicates the parents understand the discharge instructions? A. "We will bring our child back to the emergency department if the leg continues to swell." B. "We will follow up with the pediatrician in one week." C. "We will stop antibiotics when the leg is better." D. "We will elevate the leg if our child is experiencing pain."
A. Increased swelling indicates the leg is getting worse or potentially compartment syndrome may be occurring. Antibiotics need to be completed. The child will need early follow up even if it is in the ED.
A child presents with fever, malaise, and generalized flat, red rash for 24 hours. The caregiver notes white spots inside the mouth. The nurse should suspect A. measles. B. scarlet fever. C. varicella. D. viral exanthema.
A. Koplicks spots in the mouth are diagnostic of measles.
Abdominal pain can be a characteristic of which respiratory diagnosis? A. pneumonia B. pulmonary edema C. pertussis D. Pneumothorax
A. Lower lobe pneumonia is commonly present with abdominal pain in children.
A child presents with fever, left eye pain, swelling, and impaired extraocular movement. The nurse anticipates a workup for A. orbital cellulitis. B. uveitis/iritis. C. conjunctivitis. D. periorbital cellulitis.
A. Orbital cellulitis is an acute inflammation of the orbital contents posterior to the orbital septum. It is deeper and more serious infection behind the septum and involving the posterior eye structures. Periorbital cellulitis is an acute infection and inflammation involving the eyelid and surrounding tissues anterior to the septum. Both orbital and periorbital cellulitis are serious conditions because of their proximity to the brain.
A 6-year-old female presents for a possible urinary tract infection. During assessment, patchy areas of hair loss are noted. The nurse should also consider A. physical abuse. B. Wilson disease. C. hypermagnesemia. D. hypercalcemia.
A. Patchy hair loss (traction alopecia) may be seen in young girls who are being physically abused. A further concern would be the possible urinary tract infection in a 6-year-old female. Low magnesium or hypercalcemia are not indicated in alopecia. Wilson disease is an excess of copper.
A 6-year-old presents with a sudden onset of fever, chills, and macular rash of the palms, wrist, ankles, and soles of the feet. The child was recently on a camping trip. The nurse suspects A. Rocky Mountain Spotted Fever. B. scabies infestation. C. Henoch-Schonlein purpura. D. hand foot mouth disease.
A. Rocky Mountain Spotted Fever is a tick-borne illness. Symptoms generally occur 2-5 days after the tick bite. Characteristic symptoms include fever, headache, nausea, and a maculopapular rash that begins on the wrists and ankles and spreads to the trunk.
A frantic parent reports that her 4-week-old had an episode of stiffening and lip smacking at home. The infant is now alert and pink, with flexed extremities. Which of the following is the MOST likely cause of this episode? A. seizure B. gastroesophageal reflux C. breath holding D. Choking
A. Seizures in the neonate may be subtle. Common manifestations include lip smacking, repetitive blinking, and arm and leg movements suggestive of rowing or bicycling.
Continuous monitoring of a child's ETCO2 during cardiac arrest reveals 8 mmHg. This indicates that CPR is A. ineffective and adjustments need to be made to compressions. B. no longer needed; there is a return of spontaneous circulation. C. no longer needed; further resuscitation is futile. D. ineffective and adjustments need to be made to ventilation.
A. The 2010 guidelines recommended that if the partial pressure of ETCO2 is consistently less than 15 mm Hg efforts should focus on improving CPR quality, particularly improving chest compressions and ensuring the child does not receive excessive ventilations.
A chest tube has been inserted for an adolescent presenting with a spontaneous pneumothorax. The nurse notes no fluctuation in the water seal chamber of the chest drainage system. Which of the following is the priority intervention? A. checking for kinks in the tubing B. adding additional water to the water seal chamber C. assessing the system for an air leak D. increasing the negative pressure suction level
A. The water level in the water seal should fluctuate with inspiration and expiration. Fluctuations stop when the tube is kinked, compressed, or when the lung is fully re-expanded.
A 22-month-old presents after drinking windshield wiper fluid. Symptoms of this ingestion include A. vomiting, diarrhea, ataxia, and visual impairment. B. hot flushed skin, dilated pupils, and excessive salvation. C. decreased level of consciousness, tachycardia, and hypotension. D. agitation, nystagmus, elevated temperature, and drooling.
A. Windshield wiper fluid contains methanol which is associated with GI disturbance, CNS depression, and ocular symptoms.
Le Forte fractures involve the A. facial bones. B. pelvic bones. C. thoracic spine. D. cervical spine.
A. facial bones
The discharge instructions that should be reinforced to the parents of a breast feeding infant diagnosed with otitis media are A. "You should follow up in three weeks with the pediatrician." B. "Continue to allow the child to nurse as before." C. "You can continue to smoke as long as you do it outside." D. "You can stop the medication when the symptoms subside.
B. Mastoiditis is a risk for children with otitis media. Increasing the risk are smoking, bottle propping, and pacifier use along with being unvaccinated. Follow-up with the pediatrician should take place within 1-2 weeks.
If administering epinephrine to a pediatric patient having a severe allergic reaction, the proper dose and concentration should be epinephrine A. 0.10 mL/kg and 1mg/10 mL B. 0.01 mL/kg and 1 mg/mL C. 0.01 mL/kg and 1 mg/10 mL D. 0.10 mL/kg and 1 mg/mL
B. The concentration of 1 mg/mL is indicated for allergic reaction and anaphylaxis to be administered IM. The concentration of 1 mg/10 mL is for cardiac arrest treatments to be administered IV or IO. The correct dosing of either concentration is 0.01 mL/kg.
A child with a head injury presents with altered mentation, nausea and vomiting. They are afebrile. The nurse places the head midline with the head of bed elevated 30 degrees. The nurse should prioritize administration of: A. furosemide (Lasix). B. 3% sodium chloride. C. levetiracetam (Keppra). D. D5 ½ normal saline.
B. 3% sodium chloride will pull fluid from the brain to the plasma. Furosemide will increase urine production but will not pull fluid off the brain. D5 ½ normal saline would not help to resolve the symptoms of intracranial pressure and Levetiracetam (Keppra) is used for seizure management/prevention.
Which of the following is a common sign of meningococcal meningitis? A. hypothermia B. petechiae C. photophobia D. vomiting
B. A petechial or purpuric rash is a sign of meningococcal disease.
A 5-day-old neonate is diagnosed with hyperbilirubinemia. If left untreated, the infant may have long-term issues with A. bleeding disorders. B. intellectual deficits. C. dehydration. D. change in skin color.
B. As production of bilirubin exceeds the newborn capacity to conjugate and plasma levels begin to rise rapidly, free bilirubin can migrate into the brain cells via the blood-brain barrier and cause kernicterus. Kernicterus is acute bilirubin encephalopathy. Characteristics of fully developed encephalopathy may not be clearly evident for several years and can include intellectual deficits.
A child presents with lethargy and bilateral ptosis after eating home canned vegetables. Which of the following additional findings would the nurse expect? A. excessive salivation B. Leg weakness C. constricted pupils D. elevated temperature
B. Botulism is a neurotoxin that is acquired by eating canned goods that are not properly prepared. Symptoms include ptosis, dry mouth, and muscle flaccid muscles leading to paralysis
In order to assess a patient with suspected hyphema, the nurse knows the best position to assess the patient is: A. semi-fowlers B. high-fowlers C. prone D. supine
B. By sitting upright, it allows the blood to pool and gives the provider the ability to grade the amount of blood in the anterior chamber. The ability to grade the amount of blood determines treatment and need for observation. The other positions would not give an accurate assessment due to gravity.
A nurse caring for a child with a traumatic brain injury observes drainage from the child's nose. The nurse should suspect the drainage is cerebral spinal fluid if A. a dark ring forms around a light ring when drainage is placed on gauze. B. the drainage tests positive for glucose. C. there is a copious amount of drainage. D. the nasal drainage is serosanguineous.
B. CSF contains glucose, where tears, mucus, and wound drainage do not contain glucose. If suspected CSF is placed on gauze, it will produce a dark inner ring surrounded by a lighter outer ring. Serosanguineous fluid is not indicative of CSF. CSF leaks do not produce large amount of drainage.
Which of the following would be a contraindication to access a tunneled central venous access device? A. temperature of 101° F (38.3° C) B. redness and pain at the site C. respiratory rate of 32 breaths/min D. ecchymosis at the site
B. Cellulitis (as evidenced by redness and pain at the insertion site) of a central venous access device is a contraindication for access.
EMS arrives with a 6-year-old who was an improperly restrained rear-seat passenger in a head-on collision. The patient complains of diffuse abdominal pain, nausea, and is tachycardic. Which injury should the nurse MOST suspect? A. liver laceration B. small bowel injury C. lumbar spine injury D. spleen injury
B. Force applied to the abdomen from the lap belt compresses the small bowel between the abdominal wall and spine and can cause a rupture of the bowel or hematoma. Sudden deceleration forces can cause tearing of the small bowel at its fixed points. Assessment findings include tachycardia and rebound tenderness.
Which of the following congenital conditions might benefit from the use of High-frequency chest compression (HFCC) to assist with mucus breakdown? A. Pierre-Robin B. Cystic Fibrosis C. Pulmonary atresia D. Tracheal Malesia
B. High-frequency chest compression (HFCC) is a "vest that is worn by the patient that helps by using mechanical "shaking" of the chest." It helps with providing rapid entry of air along with rapid exit of air to help loosen and breakdown mucus in the lungs. Patients with Tracheal Malesia, Pierre-Robin syndrome, and pulmonary atresia do not require the use of HFCC
A nurse is caring for a 3-year-old that has a decrease in hearing and pain to right ear. Upon exam, the nurse notes impacted cerumen. The nurse should question an order for irrigation if the caregiver mentions a history of A. gingivitis. B. tympanic membrane rupture C. nasal septum deviation. D. a fever greater than 39.4 (103˚F).
B. If the patient has a tympanic membrane rupture, the warm irrigation solution could become trapped and provide an environment that could produce bacterial or fungal growth. While a fever may be present due to an ear infection, it should not prevent the use of irrigation. Gingivitis and a nasal septum deviation do not prevent the use of irrigation.
Which of the following injuries is MOST suggestive of child maltreatment? A. cigarette burn on the face B. circumferential burns to both feet C. bruises to the anterior surface of both lower legs D. bluish patches on lower back and buttocks
B. Immersion injuries occur when the child is forcibly held in the hot water for a prolonged period of time. The burns are uniform in depth and symmetrical.
A child presents to emergency department with symptoms of anaphylaxis after eating cookies at a birthday party. The friend's parent is accompanying the child and is unable to reach the parents. The nurse recognizes this legal issue as A. informed consent. B. implied consent. C. an EMTALA violation. D. a HIPPA violation.
B. Implied Consent
Seizures resulting from diluting infant formula are MOST likely caused by A. hypomagnesemia. B. hyponatremia. C. hypocalcemia. D. hypokalemia.
B. Improperly prepared formula may cause excessive intake of water in infants resulting in water intoxication and hyponatremia. Seizures are a severe manifestation of hyponatremia.
A child with a large ventricular septal defect may display A. cool lower extremities and hypotension. B. congestive heart failure C. cyanosis that increases with crying. D. widened pulse pressure and bounding pulses.
B. In a large ventricular septal defect, there is increased blood flow through the defect causing pulmonary hypertension. Right ventricular and atrial enlargement may lead to increased work load.
Following a diagnosis of hyphema, discharge instructions to the care giver should include A. lay flat to prevent eye pressure. B. re-bleeding may occur. C. continue with regular activity. D. use ibuprofen for pain.
B. In hyphema, re-bleeding can occur in approximately 20% of the patients. Ibuprofen may increase the risk of bleeding. Lying flat has been shown to increase intraocular pressure. Regular activity may slow the healing process.
A 5-week-old infant is brought in with a 2-day history of profuse vomiting after every feeding, constant hunger, and decreased wet diaper count. The infant has sunken eyes and dry mucus membranes. Vital signs: BP 61/32 HR 184 RR 56 Cap refill 2s Which of the following is the most appropriate INITIAL IV fluid? A. D5 0.45 NS B. 0.9 NS C. D10 0.9 NS D. D5 0.25 NS
B. In many cases, rapid restoration of blood volume is the main therapy needed in the resuscitation of the child in shock. An isotonic crystalloid solution (0.9% normal saline or lactated Ringer's solution) is usually the first choice for fluid replacement
A 2-month-old presents with difficulty breathing associated with tachypnea, mild retractions, and copious amounts of nasal drainage. The MOST appropriate intervention is to A. administer supplemental oxygen. B. suction the nares. C. obtain a chest x-ray. D. measure oxygen saturation.
B. Infants up to 6 months of age are preferential nose breathers and may develop respiratory distress from nasal congestion. Suctioning the nares clears the airway of secretions for more effective ventilation.
What is a PRIORITY treatment for Ludwig's angina? A. administrating analgesics as ordered B. administrating antibiotics as ordered C. preparing the patient for a CT scan D. preparing the patient for placement of a central line
B. Ludwig's angina a rapidly progressive gangrenous cellulitis of the soft tissues of the neck and floor of the mouth that can lead to airway management problems if not treated promptly. Treatment of the infection should be initiated as soon as possible, which often includes a combination of penicillin, clindamycin and metronidazole. The other options are not appropriate for the treatment of Ludwig's angina.
A child arrives by ambulance following a witnessed seizure. As the nurse is preparing to start a peripheral IV, the child begins to have generalized seizure activity. Which medication can be given intranasally to control the seizure? A. fosphenytoin (Cerebyx) B. midazolam (Versed) C. diazepam (Valium) D. levetiracetam (Keppra)
B. Midazolam can be safely administered intranasally to control seizure activity if there is no IV access available. Diazepam can be administered rectally if there is no IV access available. Levetiracetam and fosphenytoin are administered IV and should not be given intranasally.
In addition to airway, breathing, and circulation, which of the following assessments is MOST critical when assessing a 2-year-old with a temperature of 101.3° F (38.5° C)? A. past medical history B. Glasgow Coma Scale score C. medication given D. history of current illness
B. Once airway, breathing, and circulation have been stabilized, disability/neuro-assessment is the next component of the primary survey. The other options are elements of the secondary survey.
Which of the following is MOST indicative of compartment syndrome? A. decreased pulse pressure distal to the injury site B. pain out of proportion to the severity of the injury C. sensory deficit at the injury site D. compartment pressure of 8 mmHg
B. Pain is the hallmark sign of compartment syndrome. Pain out of proportion to the extent of the injury or pain on passive range of motion of the affected compartment can indicate development of or existing compartment syndrome. Generally pressures should be >20.
When discharging a patient home with maxillomandibular fixation in place, the nurse recognizes the MOST important item for the caregivers to keep with them at all times is: A. Ice packs B. Wire cutters C. Pain medication D. Wound care supplies
B. Patients with maxillomandibular fixation will need wire cutters at the bedside in case of vomiting or airway issues. With maxillomandibular fixation, the patient's mouth is wired shut. While pain control is important, pain medication is not the MOST important item to have readily available. Wound care supplies and ice packs may be needed for home care, but the wire cutters are imperative to airway emergencies.
A 7-month-old child presents with vomiting and diarrhea. The child's weight is down approximately 2 kilograms from a previous visit one month ago. The parents relate they have been diluting the formula due to an inability to obtain formula. After stabilization of the child, what is the priority? A. Assess for developmental milestones. B. Obtain a social services consult. C. Give the caregivers a box of formula. D. Provide written information about formula dilution.
B. RN's are mandated reporters of possible neglect and abuse. Due to the weight loss, further investigation is needed. Social services may help get the caregivers assistance to provide the child with needed food if this is deemed to be a financial/supply constraint. If this is determined to be actual neglect and withholding of food, the nurse would need to follow mandated reporting guidelines. Giving the caregivers a limited supply of formula is not an appropriate choice. Assessing for milestones is not a priority that is appropriate at this time. The caregivers already admitted to diluting the formula. They were aware of the correct mixing of formula.
An adolescent with cerebral palsy fell and broke off a permanent tooth. The priority treatment for this patient is to A. have the patient place the tooth in their mouth. B. rinse the tooth with saline. C. place the tooth on ice. D. scrub the tooth with water.
B. Rinsing the tooth with saline will provide cleaning and keep it moist. The nurse should not scrub the tooth or place it on ice as these options can destroy the nerve roots hampering reimplantation. The patient has an underlying neurological disorder so placing it in the mouth may result in the patient swallowing the tooth.
The nurse should anticipate notifying the proper authorities for which of the following patients? A. 10-year-old with a straddle injury B. 6-year-old with positive gonorrhea C. 6-month-old with labial adhesions D. 16-month-old with a yeast infection
B. Sexually transmitted infections are not expected in children and are suggestive of sexual abuse. This finding is reportable to child protective services and/or appropriate legal authorities for your state.
A child with 30% body surface area burns is awaiting transfer to the burn center. The nurse should A. cover the burns with moist gauze. B. cover the burns with dry towel or sheet. C. wrap the burns with silvadene. D. keep the burns open for evaluation.
B. Superficial burns less than 10% TBSA cool burned tissue. Maintenance of body temperature is crucial in patients with burns since they have lost their protective skin barrier. Cover with dry sheets to keep the patient warm.
An afebrile 12-year-old male is complaining of abdominal pain, nausea and vomiting upon waking. What information is a PRIORITY for the nurse to obtain? A. "What has your fluid intake been in the last 12 hours?" B. "Have you had any trauma to your abdomen?" C. "When was the last time you had a bowel movement?" D. "Have you had any burning with urination?"
B. Testicular torsion occurs annually in 1 in every 1500 males under the age of 18 years (Afsarlar, Ryan, Donel, et al., 2016). Rapid growth and increasing vascularity of the testicle are thought to be precursors to torsion, accounting for the occurrence at puberty. Typically, the adolescent complains of pain that is severe and acute; nausea, vomiting, and abdominal pain may accompany the pain. Although the other questions are important, the PRIORITY is to rule out testicular torsion. Constipation, UTI and dehydration would not be as urgent as testicular torsion.
A child is complaining of abdominal and shoulder pain after an all-terrain vehicle crash. He is pale and tachycardic. These symptoms are suggestive of A. dislocated shoulder. B. splenic injury. C. cardiac contusion. D. clavicle fracture.
B. The child presenting appearing pale and tachycardia suggests the child is internally bleeding. These signs, accompanied by abdominal pain and shoulder pain (Kehr's sign), make the diagnosis of splenic injury the most likely.
Which of the following is a component of the Pediatric Assessment Triangle (PAT)? A. vital signs B. circulation C. Glasgow Coma Scale D. history
B. The components of the Pediatric Assessment Triangle are appearance, breathing, and circulation.
A 14-year-old male presents with the caregiver. He recently experienced the loss of a classmate. The caregiver reports recent poor attendance at school accompanied by weight loss, hypersomnia, limited interaction with the caregiver and a desire to be with the deceased classmate. Prior to discharge and away from the patient, what is the PRIORITY question to ask the caregiver? A. "Is he on any medications?" B. "Are there any guns in the house?" C. "What other behavior have you witnessed?" D. "Are there any illegal drugs being used?"
B. The patient is at risk for suicide due to the recent loss of a classmate. While the other questions are important, the risk for suicide is elevated.
Following a motor vehicle collision, a patient is diagnosed with a C7 fracture and anterior spinal cord syndrome. The nurse understands this patient will: A. will be able to ambulate with assistance B. be wheelchair dependent C. will regain most function at some point D. be ventilator dependent
B. The patient will be a paraplegic and may be able to complete movement with their arms. He will not be ventilator dependent or be able to ambulate independently. He will be evaluated independently but will be unable to walk
A mother arrives with her three children. The children present with sudden onset of vomiting, diarrhea, abdominal pain, and rhinorrhea. The mother states that they were playing in the yard and shed earlier in the day. Which of the following is the BEST next intervention for the nurse? A. Notify the supervisor while isolating the family in the triage area. B. Escort the family outside to the decontamination area. C. Escort the family to a room with negative pressure. D. Complete the assessment for each child and then place each in a separate area of the waiting room.
B. The presenting symptoms clearly indicate an organophosphate exposure. The organophosphate exposed individual is at significant risk for contaminating others. Perform resuscitation and decontamination in a well-ventilated, isolated area. All people coming into contact with the poisoned individual require full personal protective equipment, including gloves and goggles.
Parents arrive with an unresponsive toddler and report finding her lying in the yard. Glascow Coma Scale (GCS) score is 5. Which of the following is the PRIORITY intervention for this patient? A. Administer 100% oxygen via a nonrebreathing mask. B. Perform jaw thrust with cervical spine motion restriction. C. Establish vascular access. D. Obtain history from the parents.
B. The priority is to establish an open airway while maintaining cervical spine motion restriction. When a child is unresponsive with an unknown mechanism of injury, the jaw thrust is the preferred method of opening the airway.
A 5-week-old presenting with vomiting is noted to have a slightly bulging fontanel, hypothermia, and petechiae. The nurse should anticipate a workup for A. hydrocephalus. B meningitis. C. dehydration. D. leukemia.
B. The signs and symptoms presented are all signs of sepsis in the neonate. Leukemia would present with a fever and fatigue. Hydocephalus would not present with petechiae and dehydration would not present with a bulging fontanel, it would be sunken. Meningitis would present with all of the signs and symptoms provided.
A patient arrives to the emergency department intubated and ventilated via a bag-mask device. EMS reports that the patient fell from a climbing apparatus at school. Upon assessment, the patient is difficult to ventilate and has absent breath sounds on the left side. A needle decompression is performed. The nurse anticipates the PRIORITY will be to A. connect the patient to a ventilator. B. continue the primary assessment. C. insert a chest tube. D. order a chest X-ray.
C. A chest tube needs to be inserted immediately after needle decompression for resolution of a tension pneumothorax. While the other interventions are important, they are not the priority intervention.
A 6-year-old presents to triage. The caregiver reports the child is pulling at their ears and is restless. Vital signs are as follows: BP: 90/50 HR: 168 RR: 36 T: 99.5˚ F (37.5˚C), axillary A priority question during a review of the child's history is: A. "Have any members of the household been sick?" B. "When was the last time they ate?" C. "When the last time they had pain medication?" D. "What immunizations have they had?"
C. Although the other questions are important, the priority should be to treat the pain. The elevated heart rate and restlessness indicate the patient potentially needs pain medication.
A 10-year-old presents to the emergency department with abdominal pain, vomiting and a sudden onset of scrotal pain with swelling. The parent states that the symptoms started approximately one hour ago while the child was playing outside. The nurse should anticipate which diagnostic test will be ordered? A. CT scan B. urinalysis C. ultrasound D. x-ray
C. An ultrasound is used to detect a testicular torsion. Neither an X-ray, nor a urinalysis will detect a torsion. CT scans expose a patient to high levels of radiation that are unnecessary for diagnosis of this condition.
A patient with a traumatic head injury presents with signs and symptoms of Cushing's triad. Which of the following would be an expected finding? A. narrowing pulse pressure B. ecchymosis behind the ears C. irregular, decreased respirations D. Tachycardia
C. Cushing's Triad indicates neurological decompensation. The signs and symptoms are irregular, decreased respirations, widening pulse pressure and bradycardia.
A 1-year-old presents unconscious and is being ventilated with a bag-mask device. Ventilation has become progressively more difficult. Which of the following is the PRIORITY intervention? A. Insert a nasogastric tube. B. Obtain a pulse oximeter reading. C. Place padding under the shoulders.
C. Due to a large occiput, optimal airway position is achieved by placing padding under the shoulders. The padding provides neutral alignment of the airway and cervical spine. The other options need to occur, but they are not the priority intervention
An adolescent presents with severe eye pain, stating "there is something stuck in my eye." The globe is intact. Which of the following is the PRIORITY intervention? A. Patch both eyes. B. Instill fluorescein stain. C.Administer topical analgesics. D. Irrigate eye with saline
C. Eye drops and ophthalmic ointments are used to decrease pain. Patching is not supported any longer by evidence. Both irrigation and fluoroscein will happen but after pain control.
After receiving the medications for an allergic reaction to an unknown substance, what discharge instructions should the nurse reinforce prior to discharge? A. "Call the pediatrician if diarrhea occurs." B. "Your child should stay home from school for the next two days." C. "Keep a record of everything the child eats. D. "Use diphenhydramine every 6 hours as ordered.
C. Food allergies are common. While peanuts are the most common, other foods such as milk and fish can also lead to allergic responses in children. It is important to provide education about maintaining a record of food intake. Diphenhydramine would be given as needed. Diarrhea is not related to an allergic reaction but could be a food intolerance. The child would not necessarily need to stay home from school.
An 8-month-old infant presents with irritability, and a swollen third digit of the foot. They are afebrile with normal vital signs. The infant should first be evaluated for A. cellulitis. B. child abuse. C. hair tourniquet D. fifth disease.
C. Hair tourniquets are common in infants. While cellulitis is a possible diagnosis, there is a low probability. Patients having cellulitis or fifth disease will usually be febrile. Child abuse is usually demonstrated by bruising in various stages of healing.
A child with hemophilia presents with pain and swelling to the elbow. Factor replacement was administered by the caregivers prior to arrival. Pain is rated as 8 out of 10. The nurse's MOST appropriate intervention is to A. obtain an order for an x-ray. B. apply heat packs to the site. C. obtain an order for a narcotic analgesic. D. obtain an order for a NSAID.
C. Hemarthrosis due to hemophilia can be treat with narcotics and non-narcotics but aspirin and NSAIDs should be avoided as they can prolong. Cold, not heat can also help. There is no indication that an xray is needed.
A 12-month-old presents with a 2-day history of nausea and vomiting. Vital signs include: BP 80/60 HR 56 RR 12 The child is limp and ashen. Which of the following is the PRIORITY intervention? A. complete history from the parent B. venous access and fluid bolus C. manual ventilations D. humidified oxygen
C. Normal respiration rate should be 30-60 breaths/min for this age group. A respiratory rate of 12 breaths/min requires positive pressure ventilation. Assisting ventilation is expected to increase the heart rate. HYPOVENTILATION IS THE LEADING CAUSE OF BRADYCARDIA.
A 2-year-old presents with a left thigh deformity after tripping over a toy. Further assessment and diagnostic studies show a left femur fracture, multiple healed fractures to bilateral legs, and blue-tinted sclera. The nurse is suspicious for A. child maltreatment. B. medical child abuse. C. osteogenesis imperfecta. D. juvenile arthritis.
C. Osteogenesis imperfecta is a connective tissue disorder that causes osteoporosis in children. Clinical features include varying degrees of bone fragility, deformity, fracture, blue sclerae, hearing loss, and discolored teeth. It is an inherited autosomal dominant gene.
A patient with a head injury is receiving mannitol at an appropriate dose. The nurse anticipates monitoring the: A. magnesium level B. glucose level C. potassium level D. calcium level
C. Potassium would be the most important as mannitol causes increased urinary output and may lead to hypokalemia. Glucose is not an electrolyte. Magnesium and calcium are not altered with mannitol administration.
An infant presents to the emergency department with feeding intolerance after 3 days of cold-like symptoms. Upon assessment, the patient is found to have an altered mental status, sunken fontanels, and decreased muscle tone. Vital signs are as follows: BP 66/30 HR 198 RR 50 T (rectal) 97.3˚ F (36.3˚ C) The PRIORITY intervention is to A. administer a vasopressor. B. encourage oral intake. C. administer antibiotics. D. initiate IV fluids at a controlled rate.
C. The infant is presenting with septic shock that requires immediate administration of antibiotics and IV boluses. Oral intake should be withheld due to mental status. Vasopressors are not indicated at this stage of intervention.
An unvaccinated child presents with difficulty breathing, temperature of 104° F (40°C), sore throat, and difficulty handling secretions. Which of the following is suspected? A. aspiration pneumonia B. croup C. epiglottitis D. Pertussis
C. The signs and symptoms listed are most suggestive of epiglottitis. The Hib vaccine provides protection against the most common causes of epiglottitis
A 3-year-old presents with nausea, vomiting, and diarrhea for 5 days. The vital signs are: BP 85/45 HR 136 RR 32 T (rectal) 100.0F (37.8C) sat 96% RA The nurse should anticipate orders for: A. acetaminophen. B. IV rehydration. C. oral rehydration. D. Oxygen.
C. This patient demonstrates signs of mild dehydration. Initiation of oral rehydration is recommended by providing a solution that contains balanced osmolality, glucose and sodium. Give 2-5 mL of oral rehydration solution every 2-5 minutes
A child presents with cyanosis and petechial hemorrhages to the upper chest, neck, and face after being pinned under a dresser. The nurse should suspect A. aortic rupture. B. tension pneumothorax. C. traumatic asphyxia. D. cardiac tamponade.
C. Traumatic asphyxia is hallmarked by cyanosis and petechial hemorrhages to the upper chest, neck, and face. The mechanism of being pinned under a large object results in increased thoracic and superior vena cava pressure and closure of the glottis, which increases the central venous pressure.
A 2-year-old presents to the emergency department with tonic-clonic movements which the caregivers report occurring for one minute prior to arrival. The priority intervention is A. preparing for intubation. B. administering oxygen via a nonrebreathing mask. C. turning patient to the side. D. placing an intraosseous needle.
C. Turning the patient to a side is part of the initial assessment to reduce the risk of aspiration and tongue obstruction. There is no indication for an intraosseous needle as most antiseizure medications can be given via other routes. Currently, there is no indication for intubation. Oxygen will not assist if the airway is not patent.
Several healthcare providers are visibly upset after the death of an infant. The NEXT appropriate action is to A. follow up with the nurses a week later to ensure they are okay. B. plan a meeting for the next day with a crisis counselor. C. instruct the nurses to speak to a chaplain instead of each other. D. invite the nurses to a quiet area to express their feelings.
D. Caring for a critically ill or injured child and their family in the emergency department is a difficult challenge physically and emotionally. Critical incidents are defined as any significant emotional event that has the power, because of its own nature or because of the circumstances in which it occurs, to cause unusual psychological distress in normal healthy people. Giving staff members a break and time to regroup, and importantly, recognizing difficult situation promotes a healthy work environment.
Which federal regulation ensures that a medical screening exam is performed to determine if an emergent condition exists? A. Health Insurance Portability and Accountability Act B. Consolidated Omnibus Budget Reconciliation Act C. Occupational Safety and Health Administration D. Emergency Medical Treatment and Active Labor Act
D. EMTALA
What would be the most appropriate intervention for a child with suspected intussusception? A. Laxative administration. B. Barium enema. C. Nasogastric placement. D. Air enema.
D. An air enema may reduce the telescoping of the bowel. Barium enemas are used less often and have higher complication rates due to the potential for perforation and peritonitis. Administering a laxative is not indicated. Placement of an NG tube will not assist in this disease process.
A 12-year-old presents with low-grade fever and diffuse abdominal pain which increases with coughing. These symptoms suggest A. irritable bowel syndrome. B. gastroenteritis. C. diverticulitis. D. appendicitis.
D. Appendicitis presents with a low-grade fever and diffuse abdominal pain which is worse with walking or coughing. Diverticulitis symptoms typically include LLQ pain and irritable bowel symptoms typically include constipation alternating with diarrhea.
A child complains of headache, nausea, and dizziness shortly after moving to an older home. Which of the following interventions is MOST appropriate? A. Place the child on pulse oximetry. B. Administer an antiemetic. C. Prepare for hyperbaric oxygen therapy. D. Obtain carboxyhemoglobin level
D. Carbon monoxide poisoning symptoms include headache, nausea, dizziness, and impaired judgement. Pulse oximetry in unreliable as the carbon monoxide molecule will bind with the hemoglobin giving a false reading. A carboxyhemoglobin level is the standard for determining carbon monoxide poisoning.
Which developmental task is expected in a toddler? A. industry B. trust C. initiative D. autonomy
D. Toddlers learn to exercise will and do things for themselves. Developmental task of toddlerhood is acquiring a sense of autonomy. Several characteristics, especially negativism and ritualism, are typical of toddlers.
An anxious adolescent presents with palpitations, a heart rate of 184 beats/min, and normal skin tone. Which of the following is the PRIORITY intervention? A. Obtain urine drug screen. B. Administer IV adenosine (Adenocard) rapidly. C. Instruct the patient to bear down. D. Provide comfort and reassurance.
D. SVT is defined as heart rate >220 in infants and >180 in children. Thus putting the child in SVT. Search and treat the cause. The PRIORITY intervention to provide comfort and reassurance could lower heart rate while preparing other interventions and assessments. Vagal maneuvers would be the next intervention, followed by adenosine.
The typical presentation for pediatric scabies is a rash that is A. dark red or with purplish discolorations. B. lacy, pink rash that appears on extremities. C. itchy, flat lesions, typically in ring shape. D. small itchy vesicles, common in skin folds.
D. Scabies is a contagious skin infection caused by the mite Sarcoptes Scabiei. Lesions appear as small, itchy blisters that easily break. Commonly found in the skin folds.
A 2-month-old presents with irritability and is inconsolable. Which finding would lead the emergency nurse to suspect shaken baby syndrome? A. Unilateral retinal hemorrhage B. Bruising of the legs. C. Decreased movement of the legs D. Bilateral retinal hemorrhages
D. Shaken baby syndrome is common in children less than one year of age. Male caregivers have a higher rate of shaken baby syndrome. Bilateral retinal hemorrhages are more common due to weak neck muscles and large occiput. The infant is usually held by the arms and shaken. Bruises of the arms would occur. Decreased movement of the legs would usually be a spinal cord injury. Bruising of the legs are not indicative of shaken baby syndrome.
A 2-year-old child has not used his left arm for the past hour. His mother reported grabbing his hand to prevent him from falling from a slide. The nurse should suspect A. a forearm fracture. B. a supracondylar fracture. C. shoulder dislocation. D. subluxation of the radial head.
D. Subluxation of the radial head, or a nursemaid's elbow, is one of the most common injuries seen in toddlers. Resulting from a sudden pull on the child's arms, the child refuses to move or use the affected extremity.
Which discharge instructions should be included for a teenage patient with a hematocrit of 30%? A. "Consistently use sunscreen when outside." B. "Take the iron with a protein supplement." C. "Take the iron with vitamin D." D. "Taking iron with vitamin C will increase its efficiency."
D. Taking iron with vitamin C will result in a breakdown of the iron to its most soluble state. Protein and vitamin D can interfere with absorption. Taking an iron supplement does not result in photosensitivity.
Which of the following patients requires the MOST emergent intervention? A. a crying child with delayed capillary refill B. an anxious child with decreased breath sounds C. an alert infant with a bulging fontanel D. an obtunded child who is vomiting
D. The Patient Assessment Triangle (PAT) is an "across the room" visual assessment. An obtunded child is the most concerning as a sign of decreased mentation.
An infant presents with grunting respirations, faint heart sounds, and decreased peripheral perfusion. Which of the following is the PRIORITY action? A. Obtain vascular access. B. Start chest compressions. C. Start bag-mask ventilation. D. Reposition the airway.
D. The infant is presenting with signs and symptoms of respiratory failure, however, the infant is not in cardiopulmonary arrest. Interventions include supplemental oxygen, repositioning (opening) the airway, positioning, stimulation, suctioning, and potentially early intubation to avert an arrest.
Which of the following is the NEXT step for a newborn with a heart rate of 80 beats/min after initial drying and suctioning? A. Administer epinephrine. B. Perform chest compressions. C. Stimulate the infant D. Initiate ventilations.
D. The neonate's heart rate should be greater than 100 beats per minute. If the newborn's heart rate is less than 100 beats per minute, positive pressure ventilation with blended oxygen and air. When the heart rate stabilizes to greater than 100 beats per minute, reduce the rate and pressure of the assisted ventilations.
9-month-old presents to the Emergency Department with a mid-shaft tibia fracture. Which of the following statements from the parent might indicate history of non-accidental trauma (NAT). A. Patient was being changed on top of a table and rolled off. B. Patient was an unrestrained passenger in a motor vehicle collision. C. Patient was crawling on a deck and fell off approximately 4 feet. D. Patient was riding a tricycle and fell off
D. The patient does not have the development and coordination to ride a tricycle. A 9-month-old can roll over and it is possible to fall and fracture their arm. Even though the patient was unrestrained, it may not involve NAT. A 9-month-old is often crawling and, if the patient was not being watched, could have fallen off a deck and again not be considered NAT.
A 10-year-old who was playing soccer arrives complaining of right shoulder pain. A diagnosis of a clavicle fracture is made. The nurse understands the discharge instructions are effective when the patient states A. "I will use a heat pack four times a day." B. "I will be able to play soccer next week." C. "I need to take my pain medication every time it is due." D. "I will wear my sling every day until the doctor says I don't have to."
D. The sling should be worn until a physician deems it appropriate to discontinue. Ice should be used, not heat. Activity should be restricted until healing is complete as patients with a clavicle fracture can develop a hemothorax or pneumothorax. Pain medication should be taken as needed and not on scheduled basis.
A 16-year-old presents after running a cross country match. The patient is extremely fatigued with muscle pain and reports nausea and dark urine. The nurse should expect a diagnosis of A. hydronephrosis. B. pyelonephritis. C. glomerulonephritis. D. rhabdomyolysis.
D. The symptoms of fatigue, muscle pain, nausea and dark urine are indicative of rhabdomyolysis. Muscle pain and dark urine help to differentiate this diagnosis from the others listed.
A toddler presents with 6 days of fever, irritability, and a rash. The nurse notes an enlarged reddened tongue and cracked lips. Which of the following orders should the nurse anticipate? A. soft tissue neck imaging B. abdominal ultrasound C. head CT D. echocardiogram
D. These symptoms are consistent with Kawasaki's disease. Cardiovascular manifestations are the major complication in the pediatric population.
Which of the following is the PRIORITY intervention for a 2 day old with jaundice? A. Prepare for exchange transfusion. B. Give the neonate nothing by mouth. C. Expose the neonate's skin to sunlight. D. Prepare for phototherapy.
D. When production of bilirubin exceeds the neonate capacity to conjugate, plasma levels begin to rise. Free bilirubin can cross the blood-brain-barrier and cause kernicterus, which is acute bilirubin encephalopathy. The clinical symptoms are lethargy or irritability, hypotonia, and posturing. Long term effects if no immediate intervention could include hearing loss and intellectual deficits.
Which of the following is the BEST method to assess adequacy of ventilation during procedural sedation? A. breath sounds B. oxygen saturation C. respiratory rate D. capnography value
D. capnography is used to determine adequacy of ventilation. Oxygen saturation provides the percentage of hemoglobin carrying oxygen. Hypoventilation is detected more rapidly by capnography than by auscultation of breath sounds, oxygen saturation or respiratory rate.