CPEN Basic Exam 2 — Questions and Answers
Question 1: A 4-year-old presents with stridor at rest, drooling, and preference for the tripod position. Which condition is the MOST likely diagnosis?
- Croup (laryngotracheobronchitis)
- Epiglottitis (Correct answer)
- Foreign body aspiration
- Bacterial tracheitis
Correct answer: Epiglottitis
Epiglottitis classically presents with the 'three Ds'—drooling, dysphagia, distress—plus tripod positioning and toxic appearance.
Question 2: During a pediatric resuscitation, you calculate the correct endotracheal tube size for a 6-year-old. Using the formula (Age/4) + 4, which size is correct?
- 5.5 mm uncuffed
- 5.5 mm cuffed (Correct answer)
- 6.5 mm cuffed
- 4.5 mm uncuffed
Correct answer: 5.5 mm cuffed
The formula (6/4) + 4 = 5.5 mm; cuffed tubes are now acceptable in children over 1 year of age per current PALS guidelines.
Question 3: A 2-year-old with a 3-day history of diarrhea has sunken eyes, dry mucous membranes, and decreased skin turgor. His weight is 12 kg. What is the FIRST priority intervention?
- Obtain IV access and give a 20 mL/kg NS bolus (Correct answer)
- Administer oral rehydration therapy immediately
- Order an abdominal X-ray
- Place an NG tube for tube feeding
Correct answer: Obtain IV access and give a 20 mL/kg NS bolus
Signs of moderate-to-severe dehydration require prompt IV fluid resuscitation with a 20 mL/kg isotonic saline bolus.
Question 4: Which pain assessment tool is MOST appropriate for a non-verbal 18-month-old?
- Numeric Rating Scale (NRS)
- Wong-Baker FACES Scale
- FLACC Scale (Correct answer)
- Visual Analog Scale (VAS)
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 5: A 10-year-old is brought in after a generalized tonic-clonic seizure lasting 8 minutes that has stopped. He is now postictal. Which intervention is MOST appropriate at this time?
- Administer lorazepam IV immediately
- Place in a lateral recovery position and monitor airway (Correct answer)
- Perform an immediate lumbar puncture
- Restrain the patient to prevent injury
Correct answer: Place in a lateral recovery position and monitor airway
A postictal child who has stopped seizing should be placed laterally to protect the airway and prevent aspiration while being monitored.
Question 6: An 8-month-old presents with bilious vomiting, inconsolable crying, and a 'currant jelly' stool. Which diagnosis should be IMMEDIATELY suspected?
- Intussusception (Correct answer)
- Pyloric stenosis
- Hirschsprung disease
- Mesenteric adenitis
Correct answer: Intussusception
Bilious vomiting, intermittent colicky pain, and currant jelly stool are the classic triad of intussusception, a surgical emergency.
Question 7: When administering activated charcoal to a pediatric patient, which condition is an ABSOLUTE contraindication?
- Acetaminophen overdose
- Salicylate ingestion
- Unprotected airway or altered mental status (Correct answer)
- Tricyclic antidepressant ingestion
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.
CPEN Basic Exam 2
A 4-year-old presents with stridor at rest, drooling, and preference for the tripod position.
Which condition is the MOST likely diagnosis?