At triage, a 7-month-old is carried in by her father. From the doorway the nurse sees that she is limp, does not follow the nurse's face, and has nasal flaring with intercostal retractions; her skin color is pink. Based on the Pediatric Assessment Triangle, which interpretation and action are most appropriate?

Respiratory failure; take her directly to the resuscitation room for immediate support

Primary brain dysfunction; obtain a point-of-care glucose before moving her to a room

Compensated shock; place an IV at triage and begin a 20 mL/kg isotonic fluid bolus

Respiratory distress; obtain a complete set of vital signs before assigning an acuity level

A 10-month-old who has had a bidirectional Glenn procedure for single-ventricle heart disease presents with a mild cold. His emergency information form lists his baseline SpO2 as 76-82%. He is feeding well and breathing comfortably with an SpO2 of 79%. Which interpretation is most appropriate?

His saturation matches his documented baseline, so other findings guide care

His saturation is unreliable and must be confirmed with an arterial blood gas first

His saturation shows hypoxemia that requires 100% oxygen by a non-rebreather mask

His saturation should be judged against a standard target of 92% or higher

An 8-month-old with unrepaired tetralogy of Fallot becomes agitated during IV attempts, cries inconsolably, breathes fast and deep, and turns deeply cyanotic with SpO2 falling from 84% to 62%. The murmur has become softer. Which of the following is the priority nursing action?

Bring the knees up to the chest while the caregiver holds and calms the infant

Continue IV attempts so that intravenous morphine can be given as soon as possible

Give oxygen and lay the infant flat and supine on the stretcher to rest quietly

Give a 20 mL/kg bolus of D5W to increase preload and pulmonary blood flow at once

A 6-year-old with a displaced supracondylar humerus fracture was placed in a posterior splint 3 hours ago while awaiting the operating room. Which finding requires immediate intervention?

Severe pain with passive extension of the fingers despite IV morphine

Pain rated 4 out of 10 at the elbow after a dose of ibuprofen

A 2+ radial pulse with capillary refill of 2 seconds in the fingers

Mild finger swelling that decreases when the arm is elevated

A 6-year-old weighing 20 kg has partial- and full-thickness burns over 30% of total body surface area from a house fire. Using 3 mL/kg/%TBSA for 24-hour burn resuscitation, at what hourly rate should lactated Ringer's run during the first 8 hours after the burn, not counting maintenance fluid?

About 113 mL/h of lactated Ringer's for the first 8 hours

About 75 mL/h of lactated Ringer's for the first 8 hours

About 150 mL/h of lactated Ringer's for the first 8 hours

About 225 mL/h of lactated Ringer's for the first 8 hours

A 7-year-old with autism spectrum disorder who communicates with a picture board is brought in for a possible forearm fracture. In the crowded hallway he covers his ears and rocks. Which action is most appropriate?

Ask the caregiver about his communication and calming strategies and find a quiet room

Have the caregiver wait outside so that he can adjust to the members of the care team

Complete the full examination quickly in the hallway before moving him to a room

Apply soft restraints so that he and the staff are protected during the examination

A 13-year-old was stabbed in the left chest just beside the sternum. Two large-bore IVs are in place and a 20 mL/kg crystalloid bolus has been given. The nurse records the following findings. Heart sounds are muffled, neck veins are distended, and breath sounds are equal on both sides. Time HR BP Pulse pressure Arrival 128 104/70 34 15 minutes 142 84/70 14 Which of the following does the nurse anticipate next?

Pericardiocentesis or thoracotomy to relieve pericardial tamponade

A norepinephrine infusion for distributive shock from pain and fear

Needle decompression of the left chest for a tension pneumothorax

Two more 20 mL/kg crystalloid boluses before any blood products

A 12-year-old was struck in the eye by a BB pellet. He has a teardrop-shaped pupil, a 360-degree subconjunctival hemorrhage, and decreased vision. Which action is appropriate?

Place a rigid eye shield without pressure and give an antiemetic

Apply a firm pressure patch to control intraocular bleeding

Measure the intraocular pressure with a handheld tonometer

Irrigate the eye and instill antibiotic ointment into the fornix

A 9-year-old weighing 30 kg was bitten on the lower leg by a rattlesnake 30 minutes ago. Swelling and pain are spreading above the ankle. Which of the following is the most appropriate nursing action?

Mark the leading edge of swelling and measure the leg circumference every 15-30 minutes

Wrap the entire leg firmly in a compression bandage to limit the spread of venom through the body

Apply ice packs to the bite and a tight tourniquet just above the swollen area

Incise the fang marks and apply suction to draw out as much venom as possible

CPEN Exam

Free CPEN Practice Questions

10 sample questions for the CPEN Exam, with the correct answer and an explanation for each. No account needed. Try each one before you open the answer.

Sections covered on the exam: Professional Issues, Triage Process and Emergency Preparedness, Pain Assessment and Management, Respiratory Emergencies, Hematologic, Oncologic, Endocrine, and Metabolic Emergencies, Gastrointestinal, Genitourinary, and Obstetric Emergencies, Maxillofacial, Ocular, ENT, Musculoskeletal, and Integumentary Emergencies, Pediatric Assessment.

Question 1 · Professional Issues
At triage, a 7-month-old is carried in by her father. From the doorway the nurse sees that she is limp, does not follow the nurse's face, and has nasal flaring with intercostal retractions; her skin color is pink. Based on the Pediatric Assessment Triangle, which interpretation and action are most appropriate?
- A.Primary brain dysfunction; obtain a point-of-care glucose before moving her to a room
- B.Compensated shock; place an IV at triage and begin a 20 mL/kg isotonic fluid bolus
- C.Respiratory failure; take her directly to the resuscitation room for immediate support
- D.Respiratory distress; obtain a complete set of vital signs before assigning an acuity level
Show answer and explanation
Answer: C. Respiratory failure; take her directly to the resuscitation room for immediate support
Abnormal appearance (limp, not tracking) combined with increased work of breathing and normal skin color indicates respiratory failure, which needs immediate intervention (ESI 1). Respiratory distress alone would come with a normal appearance, and vital signs should never delay moving a child in failure to the resuscitation area. Circulation to the skin is normal, so shock is not the leading problem.
Question 2 · Triage Process and Emergency Preparedness
A 10-month-old who has had a bidirectional Glenn procedure for single-ventricle heart disease presents with a mild cold. His emergency information form lists his baseline SpO2 as 76-82%. He is feeding well and breathing comfortably with an SpO2 of 79%. Which interpretation is most appropriate?
- A.His saturation is unreliable and must be confirmed with an arterial blood gas first
- B.His saturation matches his documented baseline, so other findings guide care
- C.His saturation shows hypoxemia that requires 100% oxygen by a non-rebreather mask
- D.His saturation should be judged against a standard target of 92% or higher
Show answer and explanation
Answer: B. His saturation matches his documented baseline, so other findings guide care
The emergency information form gives the child's baseline values and care plan; an SpO2 of 79% is within this child's usual range, so the nurse focuses on change from baseline, work of breathing, perfusion, and feeding. Applying standard targets or giving high-flow oxygen to reach normal saturations can be inappropriate in single-ventricle physiology.
Question 3 · Hematologic, Oncologic, Endocrine, and Metabolic Emergencies
An 8-month-old with unrepaired tetralogy of Fallot becomes agitated during IV attempts, cries inconsolably, breathes fast and deep, and turns deeply cyanotic with SpO2 falling from 84% to 62%. The murmur has become softer. Which of the following is the priority nursing action?
- A.Bring the knees up to the chest while the caregiver holds and calms the infant
- B.Continue IV attempts so that intravenous morphine can be given as soon as possible
- C.Give oxygen and lay the infant flat and supine on the stretcher to rest quietly
- D.Give a 20 mL/kg bolus of D5W to increase preload and pulmonary blood flow at once
Show answer and explanation
Answer: A. Bring the knees up to the chest while the caregiver holds and calms the infant
This is a hypercyanotic (tet) spell, and the softer murmur means less blood is crossing the narrowed right ventricular outflow tract. Knee-chest positioning in a calm caregiver's arms raises systemic vascular resistance and pushes blood to the lungs; oxygen, intranasal or IM morphine, isotonic fluid, and phenylephrine follow if needed. Continued painful IV attempts worsen the spell, and D5W is not an appropriate bolus fluid.
Question 4 · Maxillofacial, Ocular, ENT, Musculoskeletal, and Integumentary Emergencies
A 6-year-old with a displaced supracondylar humerus fracture was placed in a posterior splint 3 hours ago while awaiting the operating room. Which finding requires immediate intervention?
- A.Pain rated 4 out of 10 at the elbow after a dose of ibuprofen
- B.Severe pain with passive extension of the fingers despite IV morphine
- C.A 2+ radial pulse with capillary refill of 2 seconds in the fingers
- D.Mild finger swelling that decreases when the arm is elevated
Show answer and explanation
Answer: B. Severe pain with passive extension of the fingers despite IV morphine
Pain with passive stretch that is out of proportion and escalating despite opioids is the earliest reliable sign of compartment syndrome, which can cause Volkmann ischemic contracture; pulses are often preserved until late. The nurse should loosen the splint, keep the arm at heart level, and notify orthopedics for emergent decompression. A normal pulse, swelling that responds to elevation, and moderate pain after an analgesic are expected findings.
Question 5 · Gastrointestinal, Genitourinary, and Obstetric Emergencies
A 6-year-old weighing 20 kg has partial- and full-thickness burns over 30% of total body surface area from a house fire. Using 3 mL/kg/%TBSA for 24-hour burn resuscitation, at what hourly rate should lactated Ringer's run during the first 8 hours after the burn, not counting maintenance fluid?
- A.About 113 mL/h of lactated Ringer's for the first 8 hours
- B.About 75 mL/h of lactated Ringer's for the first 8 hours
- C.About 150 mL/h of lactated Ringer's for the first 8 hours
- D.About 225 mL/h of lactated Ringer's for the first 8 hours
Show answer and explanation
Answer: A. About 113 mL/h of lactated Ringer's for the first 8 hours
The 24-hour volume is 3 x 20 kg x 30 = 1,800 mL; half (900 mL) is given in the first 8 hours from the time of the burn, so 900 / 8 = 112.5, about 113 mL/h. A small child also needs maintenance fluid containing dextrose (60 mL/h for 20 kg by the 4-2-1 rule), and the rate is titrated to a urine output of about 1 mL/kg/h (20 mL/h).
Question 6 · Professional Issues
A 3-year-old with 2 days of vomiting sits quietly but alertly on her father's lap and watches the nurse. She has no retractions or abnormal airway sounds. Her skin is pale and her legs are mottled. Using the Pediatric Assessment Triangle, which interpretation is most accurate?
- A.Compensated shock
- B.Respiratory distress
- C.Primary brain dysfunction
- D.Cardiopulmonary failure
Show answer and explanation
Answer: A. Compensated shock
Normal appearance and normal work of breathing with abnormal circulation to the skin (pallor, mottling) indicates compensated shock, here likely hypovolemic. Cardiopulmonary failure would include abnormal appearance and work of breathing, and primary brain dysfunction would show abnormal appearance with normal breathing and circulation.
Question 7 · Triage Process and Emergency Preparedness
A 7-year-old with autism spectrum disorder who communicates with a picture board is brought in for a possible forearm fracture. In the crowded hallway he covers his ears and rocks. Which action is most appropriate?
- A.Have the caregiver wait outside so that he can adjust to the members of the care team
- B.Complete the full examination quickly in the hallway before moving him to a room
- C.Ask the caregiver about his communication and calming strategies and find a quiet room
- D.Apply soft restraints so that he and the staff are protected during the examination
Show answer and explanation
Answer: C. Ask the caregiver about his communication and calming strategies and find a quiet room
Children with autism are often overwhelmed by noise, light, and crowds; moving to a quiet, low-stimulation space and using the caregiver's knowledge of his communication tools and calming routines reduces distress. Restraint is a last resort, and separating him from his caregiver or examining in a noisy hallway worsens sensory overload.
Question 8 · Hematologic, Oncologic, Endocrine, and Metabolic Emergencies
A 13-year-old was stabbed in the left chest just beside the sternum. Two large-bore IVs are in place and a 20 mL/kg crystalloid bolus has been given. The nurse records the following findings. Heart sounds are muffled, neck veins are distended, and breath sounds are equal on both sides.
Time HR BP Pulse pressure
Arrival 128 104/70 34
15 minutes 142 84/70 14
Which of the following does the nurse anticipate next?
- A.Pericardiocentesis or thoracotomy to relieve pericardial tamponade
- B.A norepinephrine infusion for distributive shock from pain and fear
- C.Needle decompression of the left chest for a tension pneumothorax
- D.Two more 20 mL/kg crystalloid boluses before any blood products
Show answer and explanation
Answer: A. Pericardiocentesis or thoracotomy to relieve pericardial tamponade
Hypotension, distended neck veins, and muffled heart sounds (Beck's triad) with a narrowing pulse pressure after a penetrating precordial wound indicate cardiac tamponade, an obstructive shock. Relief of the tamponade by pericardiocentesis or surgery is definitive. Equal breath sounds argue against tension pneumothorax, and more crystalloid or vasopressors do not fix the obstruction.
Question 9 · Maxillofacial, Ocular, ENT, Musculoskeletal, and Integumentary Emergencies
A 12-year-old was struck in the eye by a BB pellet. He has a teardrop-shaped pupil, a 360-degree subconjunctival hemorrhage, and decreased vision. Which action is appropriate?
- A.Apply a firm pressure patch to control intraocular bleeding
- B.Measure the intraocular pressure with a handheld tonometer
- C.Place a rigid eye shield without pressure and give an antiemetic
- D.Irrigate the eye and instill antibiotic ointment into the fornix
Show answer and explanation
Answer: C. Place a rigid eye shield without pressure and give an antiemetic
A peaked or teardrop pupil with circumferential subconjunctival hemorrhage after a projectile injury suggests an open globe. Anything that raises intraocular pressure can extrude ocular contents, so the eye is protected with a rigid shield resting on the bony orbit, and vomiting, crying, and straining are prevented while the child stays NPO with the head elevated. Tonometry, pressure patches, irrigation, and topical ointments are all contraindicated.
Question 10 · Gastrointestinal, Genitourinary, and Obstetric Emergencies
A 9-year-old weighing 30 kg was bitten on the lower leg by a rattlesnake 30 minutes ago. Swelling and pain are spreading above the ankle. Which of the following is the most appropriate nursing action?
- A.Mark the leading edge of swelling and measure the leg circumference every 15-30 minutes
- B.Wrap the entire leg firmly in a compression bandage to limit the spread of venom through the body
- C.Apply ice packs to the bite and a tight tourniquet just above the swollen area
- D.Incise the fang marks and apply suction to draw out as much venom as possible
Show answer and explanation
Answer: A. Mark the leading edge of swelling and measure the leg circumference every 15-30 minutes
Pit viper envenomation is monitored by marking the advancing edge of swelling and measuring circumference serially, along with coagulation studies and platelets, to guide antivenom dosing; the limb is immobilized in a neutral position. Tourniquets, ice, compression wraps, incision, and suction all increase local tissue damage without reducing systemic toxicity.

Time	HR	BP	Pulse pressure
Arrival	128	104/70	34
15 minutes	142	84/70	14

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