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Quiz Session - Attempts With Random Questions

BCEN CPEN Exam Questions

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1.

What type of spina bifida is characterized by a cyst containing meninges, cerebrospinal fluid (CSF), and a portion of the spinal cord?

  • Myelomeningocele

  • Meningocele

  • Hydrocephalus

  • Anencephaly

Correct answer: Myelomeningocele

A myelomeningocele is a form of spina bifida characterized by a protruding saclike structure containing meninges, spinal fluid, and neural tissue. Myelomeningocele dysfunction ranges from minimal impairment to total paralysis of the lower extremities. Lumbosacral lesions generally result in some hip, knee, or ankle flexion. Sensory involvement is usually symmetric but patchy. Some degree of bowel and bladder dysfunction exists. Arnold-Chiari type II deformity is present in the majority of myelomeningocele cases.

Meningocele is a protruding sac containing only meninges and CSF (not spinal cord tissue). Anencephaly is a serious neural tube defect in which parts of the brain and skull never develop. Almost all anencephalous newborns die shortly after birth. Hydrocephalus is characterized by excess CSF buildup in fluid-containing cavities of the brain, resulting in developmental, physical, and intellectual disabilities.

2.

A 15-year-old male presents to the emergency department (ED) with the sudden onset of severe, unilateral scrotal pain and tenderness, followed by scrotal swelling and edema. The patient denies any urinary symptoms, such as difficulty voiding or discharge. What is the most likely diagnosis?

  • Testicular torsion 

  • Testicular tumor

  • Acute prostatitis 

  • Priapism 

Correct answer: Testicular torsion 

This patient has testicular torsion, one of a few true urological emergencies. It involves twisting of the spermatic cord or testicle causing strangulation of the blood supply to the scrotum. It is most commonly seen in adolescents between 12 and 18 years, suspected to result from a period of rapid growth. The affected testis is usually firm, tender, and often in a horizontal rather than a vertical alignment. The presence of the cremasteric reflex is helpful in ruling out testicular torsion. If the torsion of the affected testicle is not corrected immediately, ischemia and necrosis will ensue. 

Patients with a testicular tumor present with a change in testicular size over time but not necessarily with pain. Scrotal swelling with a testicular mass is firm and nontender. Priapism is also a urological emergency; it is a prolonged, painful erection without scrotal pain or swelling. Acute prostatitis is an inflammation of the prostate gland, which presents with sudden-onset dysuria and general malaise. 

3.

A nurse is caring for a child in the PICU who sustained a femoral fracture. The child becomes suddenly restless, confused, and tachypneic. The nurse suspects the child is experiencing which of the following complications?

  • Fat embolism syndrome (FES)

  • Venous thromboembolism (VTE)

  • Compartment syndrome

  • Rhabdomyolysis

Correct answer: Fat embolism syndrome (FES)

Fat embolism is rare in children and is defined by the presence of fat globules in the pulmonary circulation. FES is most commonly associated with long bone and pelvic fractures or after orthopedic surgery. Affected patients develop a classic triad of hypoxemia, neurologic abnormalities, and a petechial rash.

Pulmonary manifestations are the most common presenting features of FES. Hypoxemia, dyspnea, and tachypnea are the most frequent early findings, and respiratory distress is observed in 90% of cases.

Swelling and severe pain are indicative of compartment syndrome. Muscle cramping and dark urine are symptoms of rhabdomyolysis. VTE is not associated with neurologic and respiratory sequelae unless the thrombus moves into the lungs.

4.

An eight-year-old female is admitted to the emergency department with a diagnosis of type 1 diabetes mellitus and is in diabetic ketoacidosis (DKA). The emergency physician orders intravenous fluids consisting of 0.9% NS (normal saline) and IV insulin to be bolused at 10 units and then given as an insulin drip per hospital policy. The patient has a pH of 7.25, a serum glucose of 350, and a potassium level of 3 mEq/L.

The nurse should implement which of the following interventions at this time?

  • Hold the insulin and notify the physician of the patient's potassium level

  • Hold the fluids and insulin and repeat the laboratory values

  • Start the fluids and administer the insulin bolus and drip as ordered

  • Start the fluids and insulin bolus but hold the insulin drip until the serum glucose level is repeated

Correct answer: Hold the insulin and notify the physician of the patient's potassium level

Cautious rehydration in DKA is imperative to prevent cerebral edema and should be done over 48 hours. Potassium and phosphate replacement is also imperative in DKA; if hyperkalemia is present initially, an ECG should be done, and urine output should be achieved before potassium replacement is initiated.

When insulin is given, it helps move the potassium back into the cell, which will cause potassium blood levels to fall. Therefore, insulin therapy should only be initiated if the patient's potassium level is normal (3.5-5 mEq/L). Since this patient's potassium level is low, the nurse should hold the insulin and notify the doctor of the patient's current hypokalemic status. It is acceptable for the nurse to initiate fluid resuscitation.

5.

What is the most common type of Salter-Harris fracture, occurring frequently in children over 10 years of age?

  • Type II

  • Type I

  • Type III

  • Type IV

Correct answer: Type II

Salter-Harris fractures are usually caused by traumatic injuries and involve injury to the growth plate (physeal fracture). Wrist and hand injuries are usually "Salter" type fractures involving the physis. "SALTER" is a mnemonic referring to the fracture line and its relationship to the growth plate:

  • S (type I fracture): Straight across; disrupt the physis
  • A (type II fracture): Above the growth plate; involves a break from the growth plate up into the metaphysis (at an angle), with the periosteum usually remaining intact; this is the most common pediatric physeal fracture, occurring frequently in children over 10 years of age
  • L (type III fracture): Lower or beLow: intra-articular fractures through the epiphysis that extend across the physis
  • T (type IV fracture): Two or Through; cross the epiphysis, physis, and metaphysis
  • ER: (type V fracture): ERasure of growth plate or CRush; compression injuries to the physis

6.

You are triaging a 12-year-old male with an asthma exacerbation. The child has had 3 visits to the emergency department (ED) and 2 admissions in the last 6 months. What should you do?

  • Assess the child's and the family's knowledge of asthma triggers 

  • Review the pathophysiology of asthma with the child and his family

  • Place a consultation with the social worker to assess for potential neglect 

  • Inform your nurse manager of the child's recent readmissions for further direction 

Correct answer: Assess the child's and the family's knowledge of asthma triggers 

Medical non-compliance can result in frequent readmission and possible chronic disease complications. You should first assess the child's and his family's knowledge of disease triggers, their perception of the severity of the disease, and their level of social support. Based on this assessment, you should then reach out to your nurse manager and/or social worker for assistance with resource availability to rule out financial, transportation, or other barriers to receiving adequate treatment. 

Reviewing the pathophysiology of asthma with the patient and his family may help with the facilitation of learning, but it will not help you determine the knowledge deficits and/or barriers to treatment. If you suspect neglect, the appropriate notifications must be made, but an assessment must occur first. 

7.

Functions of surfactant include all the following, except:

  • Vasodilating the pulmonary vasculature

  • Preventing lung collapse during exhalation

  • Optimizing lung compliance

  • Defending against microorganisms

Correct answer: Vasodilating the pulmonary vasculature

Surfactant is a substance produced by type II alveolar epithelial cells in the lungs, consisting of proteins and lipids. It prevents alveolar collapse at end exhalation, lessens the work of breathing, optimizes lung compliance and surface area for gas exchange and ventilation-perfusion (V/Q) matching, protects the lung epithelium, and facilitates the clearance of foreign substances. It also prevents capillary leakage of fluid into the alveoli and defends against microorganisms.

Premature infants have decreased levels of surfactant, which leads to respiratory distress syndrome (RDS). This often necessitates the administration of exogenous surfactant replacement therapy to increase lung compliance. Surfactant is not a vasodilator.

8.

A child with a femur fracture reports calf pain in the unaffected leg. After supporting the airway and breathing, what is your next intervention?

  • Assess neurovascular status 

  • Massage the calf

  • Apply ice to the leg

  • Elevate the extremity 

Correct answer: Assess neurovascular status 

These assessment findings are consistent with deep vein thrombosis (DVT), which puts the child at risk for pulmonary embolism. A neurovascular assessment is necessary to assess for color, sensation, and pulse to intervene rapidly. Management involves hemodynamic support and immediate heparinization. 

Massaging the calf is not indicated as it could dislodge a potential DVT. Applying ice is not indicated if the leg is cool to the touch. Although elevating the extremity is indicated, it is not the next intervention. 

9.

Which of the following represents the highest level of evidence on which to base nursing practice?

  • Systematic reviews of randomized controlled trials (RCTs)

  • Cohort studies

  • Case-control studies

  • Evidence syntheses

Correct answer: Systematic reviews of randomized controlled trials (RCTs)

Systematic reviews of RCTs or meta-analyses are regarded as the strongest level of evidence. However, evidence from descriptive and qualitative studies also should be factored into clinical decisions.

10.

A nurse educates an infant's family about the significant complications of a ventriculoperitoneal (VP) shunt. All the following manifestations would be important for the family to report immediately to the nursing staff, except:

  • An increase in temperature to 99 degrees F (37.2 degrees C)

  • Swelling, redness, or drainage along the pathway of the shunt tube

  • Poor feeding

  • Bulging soft spot when the baby is sitting quietly

Correct answer: An increase in temperature to 99 degrees F (37.2 degrees C)

A VP shunt is indicated for acute and chronic hydrocephalus.

If the infant's temperature increases to 99 degrees F, it does not have to be reported immediately but should be monitored closely. A temperature of 101 degrees F (38.3 degrees C) or higher should be immediately reported to nursing staff.

Parents should be informed that swelling, redness, or drainage along the shunt tubing pathway, lethargy or irritability, poor feeding, and a bulging soft spot when the baby is quietly sitting are also reportable symptoms that could indicate an infection or a shunt malfunction (e.g., obstruction). Other complications of the VP shunt include bowel perforation, ascites, and ileus.

11.

After pulling a cup of hot tea off the kitchen table, a three-year-old child is admitted for second-degree burns on approximately 20% of his body. The nurse should expect an order to initiate fluid resuscitation with which of the following?

  • Lactated Ringer's (LR) solution

  • Dextrose 5% in water (D5W)

  • Dextrose 10% in water (D10W)

  • Dextrose 5% in normal saline (D5NS)

Correct answer: Lactated Ringer's (LR) solution

For a pediatric patient who sustains burns that appear to be bigger than 15% of the total body surface area (TBSA) and deep (second-degree or third-degree burns), the nurse should begin fluid resuscitation for the first 24 hours postburn injury. Lactated Ringer's (LR) or NS are appropriate choices for resuscitation fluid.

Maintenance fluids, if indicated, may include dextrose. These augment the initial fluid resuscitation using LR or NS.

12.

A nurse is caring for a child with acute pericarditis. Which assessment finding would prompt the nurse to contact the physician immediately?

  • Muffled heart sounds

  • Chest pain that is worse in supine positioning

  • Pericardial friction rub

  • Shortened PR interval

Correct answer: Muffled heart sounds

Acute pericarditis is inflammation of the pericardium characterized by pericarditic chest pain, pericardial friction rub, and serial ECG changes, which may show ST elevation or depression, an inverted T wave, a prolonged PR interval (not shortened), diminished QRS and T-wave voltage, or arrhythmias.

Muffled heart sounds may indicate cardiac tamponade, which is a serious complication of acute pericarditis and is considered a medical emergency. Because of this, the nurse should immediately contact the physician.

Chest pain and pericardial friction rub are both expected symptoms of acute pericarditis. While the nurse should closely monitor these elements, they would not immediately indicate a potential emergency.

13.

What is the difference between physiologic and pathologic jaundice?

  • Pathologic jaundice appears within the first 24 hours after birth

  • Physiologic jaundice usually results in hepatosplenomegaly

  • The risk of physiologic jaundice increases with decreasing gestational age

  • Pathologic jaundice begins in the head and progresses down the body

Correct answer: Pathologic jaundice appears within the first 24 hours after birth

Pathologic jaundice appears within the first 24 hours after birth for a normal full-term newborn. The clinical course of nonpathologic (or physiologic) jaundice is characterized by a progressive increase in transcutaneous serum bilirubin (TSB) concentration up to a mean peak of 5 to 7 mg/dL between 3 and 4 days after birth. Levels usually normalize by 2 weeks of age; no hepatosplenomegaly is present in physiologic jaundice.

Physiologic jaundice is transient hyperbilirubinemia that is frequently observed in otherwise completely healthy newborns. It often begins in the head/face and progresses down the body.

Jaundice within the first 24 hours after birth is pathologic. The risk of pathologic jaundice increases with decreasing gestational age, for infants born before 38 weeks of gestation who are receiving human milk, and for ill neonates.

14.

A child presents to the emergency department (ED) with a peritonsillar abscess. Which of the following findings would not be indicative of this condition?

  • Cough

  • Halitosis

  • Fever

  • Dysphagia

Correct answer: Cough

A peritonsillar abscess is a collection of purulent material (pus) around the tonsils that may lead to a deep tissue infection and airway patency complications if not diagnosed early and quickly. Signs and symptoms include deviation of the uvula toward the unaffected side, drooling and dysphagia, fever, halitosis (bad breath), muffled voice ("hot potato voice"), pain in the throat that radiates to the ear, swollen soft palate on the affected side, cervical lymphadenitis, and erythematic tonsils with exudates. 

A cough is not a symptom of a peritonsillar abscess.

15.

What is the primary risk factor in the development of rheumatic fever?

  • A recent group A beta-hemolytic streptococcal (GABHS) infection

  • A history of a congenital heart defect

  • A recent diagnosis of erythema marginatum

  • Recent travel outside of the United States

Correct answer: A recent group A beta-hemolytic streptococcal (GABHS) infection

Rheumatic fever is an inflammatory disorder of the heart, blood vessels, and joints. A partially treated or untreated GABHS infection, otherwise known as "strep throat," can lead to rheumatic fever, as this is the most common type of bacteria causing acute rheumatic fever. With rheumatic fever, a child has an abnormal immune response to a "strep throat" infection, which causes widespread inflammation. This can lead to long-term cardiac damage, which is known as rheumatic heart disease.

Erythema marginatum is a major manifestation of acute rheumatic fever and involves a rash characterized by pink, raised, small irregular macules that are nonpruritic and appear on the trunk and limbs (not the face).

16.

A nurse is reviewing the laboratory values of a child under their care and notes a sodium level of 125 mE/L. The nurse expects this finding to result from which of the following conditions?

  • Syndrome of inappropriate antidiuretic hormone (SIADH)

  • Type 1 diabetes mellitus (T1DM)

  • Diabetes insipidus (DI)

  • Severe dehydration

Correct answer: Syndrome of inappropriate antidiuretic hormone (SIADH)

SIADH is often seen in pediatric critical care and is the result of excess ADH; it occurs when ADH release is not able to be suppressed, leading to hyponatremia (serum sodium levels below 135 mEq/L) and impaired water secretion.

T1DM does not cause hyponatremia. Hypernatremia (serum sodium levels greater than 145 mEq/L) is associated with severe dehydration and DI.

17.

Which of the following laboratory tests best correlates with a diagnosis of hyperthyroidism?

  • Decreased serum thyroid-stimulating hormone (TSH) levels

  • Decreased serum triiodothyronine (T3) levels

  • Decreased serum thyroxine (T4) levels

  • Decreased serum free thyroxine (free T4) levels

Correct answer: Decreased serum thyroid-stimulating hormone (TSH) levels

Hyperthyroidism is caused by high levels of thyroid hormones and results in a hypermetabolic state with weight loss, tachycardia, hypertension, wide pulse pressure, irritability with restlessness, diarrhea, and tremor. The most common type in childhood is Graves' disease, which occurs most frequently in early-adolescent females following an infection.

Expect the patient with hyperthyroidism to show the following results on a serum thyroid panel: elevated T3, elevated T4, elevated free T4, and decreased TSH levels. The high levels of T3 and T4 suppress the production of TSH in this condition.

18.

Pediatric acute respiratory distress syndrome (PARDS) is characterized by which of the following?

  • Increased airway resistance

  • Increased lung compliance

  • Increased chest wall compliance

  • Decreased airway resistance

Correct answer: Increased airway resistance

ARDS in children is different than ARDS in adults. Pediatric ARDS occurs when fluid fills the lungs due to an infection or injury, causing increased airway resistance. This prevents air from filling the lungs efficiently and deprives the body of oxygen.

When lungs are inflamed and filled with fluid, they become stiff and are unable to expand properly when breathing (i.e., decreased lung and chest wall compliance). Oxygen saturation levels decline rapidly, and other organs are at risk of failure. These patients need ventilatory support and management to allow the lungs to heal.

19.

What is the most common type of localized infection preceding or occurring from sepsis in a neonate?

  • Meningitis

  • Myocarditis

  • Hepatitis

  • Gastroenteritis

Correct answer: Meningitis

Infants with meningitis usually have nonspecific or vague symptoms (e.g., lethargy, irritability, poor feeding, seizures, apnea, or vomiting). The presentation of symptoms may evolve over a few days or more acutely, occurring over a few hours.

Meningitis occurs in up to 15 percent of neonates with bacteremia (the presence of viable bacteria in the circulating blood) and is most commonly a localized infection.

20.

In what phase of Kawasaki disease will a child manifest red lips, tongue, palms, and soles?

  • Acute phase

  • Subacute phase

  • Convalescent phase

  • Refractory phase

Correct answer: Acute phase

Kawasaki disease is the systemic inflammation of the blood vessels in the body (vasculitis). Early fever and multisystem vasculitis (particularly in the coronary arteries) are followed by pancarditis with inflammation of the conduction system, myocardium, pericardium, and endocardium. The cause of this disease is unknown. However, it may be due to an exaggerated immune response to an infection in a susceptible child.

There are three phases of this disease: the acute phase, the subacute phase, and the convalescent phase. The acute phase (days 1-10) presents with a high fever, conjunctivitis, indurative edema, diffuse red-purple discoloration of the palms/soles, a strawberry tongue, reddened fissured lips, skin rash, and cervical lymph node enlargement.

The refractory phase is a stage of shock and is not associated with Kawasaki disease.

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