CPEN Exam 3 — Questions and Answers
Question 1: A 4-year-old presents with a 3-day history of fever, rash starting on the trunk, and vesicular lesions in various stages. The nurse recognizes this as varicella and knows which complication is most concerning?
- Bacterial superinfection of skin lesions (Correct answer)
- Febrile seizure
- Dehydration from oral lesions
- Otitis media
Correct answer: Bacterial superinfection of skin lesions
Secondary bacterial superinfection, most commonly with Staphylococcus aureus or Group A Streptococcus, is the most common serious complication of varicella.
Question 2: When calculating a weight-based medication dose for a pediatric patient whose actual weight is unknown, the nurse should use which method as the first choice?
- Parental estimate of weight
- A length-based resuscitation tape (e.g., Broselow) (Correct answer)
- Age-based formula (e.g., weight = 2 × [age + 4])
- Previous medical records
Correct answer: A length-based resuscitation tape (e.g., Broselow)
A length-based resuscitation tape such as the Broselow tape provides the most accurate weight estimation and corresponding equipment sizes and drug doses.
Question 3: A 10-year-old with sickle cell disease presents with severe chest pain, fever, and hypoxia. Which condition should the nurse prioritize?
- Pneumonia
- Acute chest syndrome (Correct answer)
- Pulmonary embolism
- Myocarditis
Correct answer: Acute chest syndrome
Acute chest syndrome is a life-threatening vaso-occlusive complication of sickle cell disease presenting with chest pain, fever, and hypoxia, requiring immediate intervention.
Question 4: A 7-year-old is brought in after ingesting an unknown number of acetaminophen tablets 2 hours ago. Which antidote should be prepared for administration?
- Flumazenil
- Naloxone
- N-acetylcysteine (Correct answer)
- Activated charcoal alone
Correct answer: N-acetylcysteine
N-acetylcysteine (NAC) is the specific antidote for acetaminophen toxicity and is most effective when given within 8 hours of ingestion.
Question 5: During a pediatric trauma assessment, the nurse notes the child has a GCS of 8 and is deteriorating. What is the priority action?
- Obtain a CT scan of the head immediately
- Prepare for rapid sequence intubation (Correct answer)
- Administer hypertonic saline
- Insert an ICP monitor
Correct answer: Prepare for rapid sequence intubation
A GCS of 8 or below indicates the need for definitive airway management, and rapid sequence intubation should be prepared to protect the airway.
Question 6: A 2-year-old is brought to the ED with burns on both palms from touching a hot stove. Using the Rule of Nines modified for children, what percentage of BSA does this represent?
- 1% (Correct answer)
- 2.5%
- 4.5%
- 9%
Correct answer: 1%
Each palm (including fingers) represents approximately 1% of total body surface area in a child, so both palms together equal about 2%, but a single palm is 1%.
Question 7: A neonate presents with bilious vomiting and abdominal distension. The nurse should suspect which surgical emergency?
- Pyloric stenosis
- Midgut volvulus with malrotation (Correct answer)
- Intussusception
- Hirschsprung disease
Correct answer: Midgut volvulus with malrotation
Bilious vomiting in a neonate is a surgical emergency until proven otherwise; midgut volvulus with malrotation can cause bowel ischemia and requires immediate surgical consultation.
CPEN Exam 3
A 4-year-old presents with a 3-day history of fever, rash starting on the trunk, and vesicular lesions in various stages.
The nurse recognizes this as varicella and knows which complication is most concerning?