×

Quiz Session - Attempts With Random Questions

BCEN CPEN Exam Questions

Page 2 of 25

21.

A nurse is preparing to administer digoxin to a child with congestive heart failure. What should they do prior to administration?

  • Assess apical pulse rate

  • Auscultate lung sounds

  • Check axillary temperature

  • Review laboratory findings for liver function

Correct answer: Assess apical pulse rate

Digoxin is used for the treatment of mild to moderate heart failure and has inotropic effects from the inhibition of the sodium-potassium pump. The nurse should assess heart rate (HR) prior to dose administration to verify it is greater than 60 beats per minute. In addition, watch for hypokalemia (evidenced by serum levels that fall below 3.5 mEq/L), hypercalcemia (evidenced by serum levels that rise above 10 mg/dL), and hypomagnesia (evidenced by serum levels that fall below 1.4 mEq/L). These may aggravate digoxin cardiotoxicity, even if the digoxin level is normal (therapeutic trough range is 0.5 to 2 ng/mL).

The other choices are not necessary in this case.

22.

You are caring for a newborn who has just been diagnosed with truncus arteriosus and are educating the parents about this condition. Which statement, if made by the mother, demonstrates she understood your teaching about this condition?

  • "My baby's heart shares a single great artery that arises from both ventricles."

  • "My baby has a bluish discoloration of the skin, which is referred to as cyanosis. This is expected with truncus arteriosus and is not concerning."

  • "The left side of my baby's heart is not fully developed."

  • "The positions of the great arteries of my baby's heart are reversed."

Correct answer: "My baby's heart shares a single great artery that arises from both ventricles."

Truncus arteriosus is a congenital heart defect characterized by one great artery arising from both the left and right ventricles (connecting the ventricles), overriding a ventricular septal defect (VSD). A coexisting VSD is present in more than 98% of cases. In a normal heart, there should be two separate arteries (pulmonary artery and aorta) with their own valves, instead of one truncal valve. This condition makes up 1% to 2% of all cardiac defects. Affected infants may present with cyanosis at birth, but this finding varies in intensity according to the amount of pulmonary blood flow.

Hypoplastic left heart syndrome (HLHS) is a congenital heart defect in which the left side of the heart is underdeveloped. Transposition of the great vessels is a congenital heart defect in which the great arteries are reversed (i.e., the pulmonary artery arises from the left ventricle, and the aorta arises from the right ventricle).

23.

A nurse is preparing to admit a child with a new diagnosis of sickle cell disease (SCD). The nurse is obtaining supplies to initiate intravenous (IV) fluid resuscitation and a blood transfusion with packed red blood cells (PRBCs). 

Why are these interventions indicated?

  • To treat dehydration and anemia

  • To reverse hypovolemic shock

  • To reduce pain caused by sickling

  • To reduce kidney damage and correct acidosis

Correct answer: To treat dehydration and anemia

Patient care management in SCD involves both transfusion therapy and IV fluid replacement to treat the dehydration and severe anemia that often accompanies this condition. Fluid resuscitation using crystalloids at 1.5 times the maintenance rate promotes hemodilution by increasing blood flow, thereby decreasing the risk of microvascular occlusion and tissue ischemia. Transfusion therapy is useful in the treatment of symptomatic anemia.

Hypovolemic shock is a concern if splenic sequestration occurs. Pain medication is indicated to reduce pain; hemodilution may slightly decrease pain, but not by much. Renal damage is not a complication of a sickle cell crisis since it affects the spleen, not the kidneys.

24.

What is the most common type of seizure that requires admission to the pediatric intensive care unit (PICU)?

  • Generalized tonic-clonic seizure (GTC)

  • Focal seizure

  • Absence seizure

  • Myoclonic tonic seizure

Correct answer: Generalized tonic-clonic seizure (GTC)

The most common type of seizure requiring ICU admission is GTC status epilepticus (formerly known as grand mal seizure). Status epilepticus is defined as a prolonged seizure or multiple consecutive seizures without regaining consciousness.

Focal seizures start in one part of the brain and may stay local or spread to other areas in the brain. Absence and myoclonic tonic seizures are other types of generalized seizures, originating in the cortical or subcortical areas of the brain and spreading bilaterally.

25.

For the placement of a peripherally inserted central catheter (PICC) in a neonate, the nurse should provide all the following interventions for pain relief, except:

  • Skin-to-skin/kangaroo care

  • Non-nutritive sucking (e.g., pacifier)

  • Swaddling, holding, and rocking

  • Opioid administration

Correct answer: Skin-to-skin/kangaroo care

Evidence-based pain management strategies for PICC line insertion include oral non-nutritive sucking or a sucrose pacifier, swaddling, holding and rocking, topical numbing medications at the site of insertion, such as EMLA cream or amethocaine gel, and opioid administration.

Kangaroo care is not recommended for PICC line insertion.

26.

A child in hemorrhagic shock will experience a drastic decrease in intravascular volume. This decrease leads to all the following, except: 

  • Decreased serum lactate

  • Decreased serum creatinine 

  • Anaerobic metabolism 

  • Decreased central venous pressure (CVP) 

Correct answer: Decreased serum lactate

During hemorrhagic shock, there is less intravascular volume, leading to decreased oxygen flow to the cells, anaerobic metabolism, and lactic acidosis (increased, not decreased, serum lactate). Serum creatinine is decreased, and CVP is also decreased with a low circulating volume secondary to hemorrhagic shock.

A decreased serum lactate (lactic acid) is an indicator that cells are receiving adequate oxygen flow and that volume replacement therapy is effective (i.e., circulating volume is increasing).

27.

A nurse is caring for a 12-year-old trauma patient in the PICU. The patient sustained multiple fractures as a result of a motor vehicle accident, including a closed fracture of the left femur, which has been cast. The nurse includes monitoring for complications of the femoral fracture in the daily plan of care.

Which of the following signs and/or symptoms would likely indicate the formation of fat emboli?

  • Hypoxia and petechial rash

  • Swelling and severe pain in the cast leg

  • Fever and tachycardia

  • Dark, reddish-brown urine and extreme muscle cramping

Correct answer: Hypoxia and petechial rash

Although rare, fat embolism syndrome (FES) is a dangerous complication of fractures and is more commonly seen in closed versus open fractures of the long bones and pelvis of major trauma victims. It can also be a complication of orthopedic surgery. It is postulated to be the result of a disruption to blood supply caused by fat globules that enter the venous channels at the fracture site, leading to embolization.

FES may manifest within 12 hours post-injury or surgery with symptoms peaking within 48 to 72 hours. Although this syndrome can be difficult to diagnose, respiratory distress symptoms manifest in up to 90% of cases. Other common symptoms include a petechial rash seen on the anterior torso, axillary regions, and conjunctiva (usually appears 3-5 days after the onset of symptoms) and altered mental status (particularly confusion).

Swelling and severe pain are indicative of compartment syndrome. Fever and tachycardia could signal osteomyelitis. Muscle cramping and dark urine are symptoms of rhabdomyolysis.

28.

Guidelines for assessing pain in an infant include all the following, except:

  • Assess and document pain only when obtaining vital signs

  • Assess pain after each potentially painful clinical intervention

  • Use standardized pain assessments with evidence of validity, reliability, and clinical utility

  • Reevaluate pain after interventions to assess their efficacy

Correct answer: Assess and document pain only when obtaining vital signs

Pain should be documented and assessed with vital signs every four to six hours or as indicated by pain scores and/or the infant's clinical condition. The other choices are accurate guidelines for assessing pain.

29.

What blood type is known as the "universal donor"?

  • Type O

  • Type AB

  • Type A

  • Type B

Correct answer: Type O

For blood transfusions, the donor's blood and the recipient's blood must be tested for compatibility. If the blood is not compatible, a life-threatening transfusion reaction can occur.

The universal red blood cell donor is type O negative; O-negative unmatched blood may be given to patients with an urgent, life-threatening need for a blood transfusion. Type AB positive is known as the universal recipient. All other blood types must be tested for compatibility before administering.

30.

A child presents to the emergency department after being bitten by a snake with signs and symptoms indicative of acute rhabdomyolysis, including myalgia, myoglobinuria, and weakness.

Which of the following laboratory tests is the most sensitive finding and is diagnostic for this condition?

  • Creatine phosphokinase (CPK)

  • Serum creatinine

  • Blood urea nitrogen (BUN)

  • Urinary albumin

Correct answer: Creatine phosphokinase (CPK)

Rhabdomyolysis is a syndrome characterized by muscle necrosis and the release of intracellular muscle constituents, including myoglobin, potassium, phosphorus, and enzymes into circulation. Rhabdomyolysis may be caused by severe trauma and crush injuries, as well as metabolic myopathies, hypoxia/ischemia, certain licit and illicit drugs, congestive heart failure, malignant hyperthermia, and snake bites.

Clinical features are typically sufficient to recognize this condition, including weakness, pain, tenderness, swelling, tea-colored urine, kidney dysfunction, fever, and leukocytosis. It can be recognized clinically by urinalysis with a dipstick that is strongly positive for heme and urine sediment with few or no red cells.

A more sensitive and diagnostic finding is an elevated CPK. Creatinine kinase peaks at 12 to 36 hours after muscle injury, and acute rhabdomyolysis is seen with levels exceeding 5,000 IU/L.

31.

An 18-month-old male is brought to the emergency department by his mother with a sudden onset of choking, gagging, and coughing. The patient is afebrile and has a pulse of 125/min and a respiratory rate of 42/min. The nurse auscultates decreased breath sounds over the right lower lung field.

What is the next step in the evaluation of this child?

  • Plain neck and chest radiographs

  • Lateral soft tissue radiograph of the neck

  • Finger sweep

  • Indirect laryngoscopy

Correct answer: Plain neck and chest radiographs

Foreign-body aspiration is a common cause of accidental death in infants and children. The initial episode is frequently associated with choking and coughing. Examination findings may be normal or nonspecific, such as decreased air entry, wheezing, rhonchi, or inspiratory stridor. The right bronchus is more often the site of the foreign body than the left, so decreased breath sounds may be heard over the right lung field.

After a thorough history and physical exam, plain neck and chest radiographs should be obtained. Approximately 10% of aspirated foreign bodies are radiopaque, making the diagnosis a simple one. Unfortunately, the majority of foreign bodies are not obvious, and changes are seen secondary to obstruction of the airway by the object. Anteroposterior and lateral views of the neck and chest may show signs of a partially obliterated tracheobronchial air column.

However, chest radiography alone does not diagnose the condition; a final diagnosis is only achieved at the time of bronchoscopic evaluation.

32.

A 16-year-old female with a history of depression and multiple suicide attempts recently started on a new dose of isocarboxazid (Marplan; monoamine oxidase [MAO] inhibitor). Her mother found her agitated, diaphoretic, and shaking, and she admitted to taking dextromethorphan earlier that day to "feel high." En route to the emergency department (ED), paramedics reported that she had a seizure.

You suspect she is experiencing serotonin syndrome. What is the most definitive effective therapy for her condition?

  • Cyproheptadine

  • Benzodiazepines

  • Haloperidol

  • Naloxone

Correct answer: Cyproheptadine

Serotonin syndrome is a potentially life-threatening condition that can lead to multiorgan failure within hours if not recognized. It is caused by elevated serotonin levels in the central and peripheral nervous systems after large overdoses, especially with an overdose of more than one drug. It may also occur idiosyncratically. Potential exam findings of autonomic dysfunction include diaphoresis, tachycardia, nausea and vomiting, and mydriasis. Patients often present with agitation, confusion, anxiety, lethargy, seizures, and coma.

Cyproheptadine is a serotonin and histamine antagonist with anticholinergic and sedative effects. Antiserotonin and antihistamine drugs appear to compete with serotonin and histamine, respectively, for receptor sites.

33.

An infant diagnosed with an atrial septal defect (ASD) presents with a grade IV systolic ejection murmur that is heard well in all positions. Which of the following is characteristic of this type of murmur?

  • A palpable thrill

  • Increased blood flow through the aortic valve

  • Murmur heard throughout systole

  • Murmur heard when the stethoscope is partly off the chest

Correct answer: A palpable thrill

Systolic ejection murmurs are heard between S1 and S2 (early, mid, or late) when blood flows through the semilunar valves; the intensity increases, then decreases (known as crescendo-decrescendo). In ASD, blood is shunted from the higher-pressure left side of the heart to the lower-pressure right side, resulting in RV volume and pressure overload with RA and RV dilation.

Auscultation reveals a systolic ejection murmur at the LSB from increased blood flowing through the pulmonic valve (not the aortic valve). The murmur is wide and fixed with a split S2. A diastolic murmur may also be present from the large volume flowing across the tricuspid valve.

Murmurs are graded from a barely audible (using a stethoscope) grade I murmur to a grade VI murmur (which is so loud it can be heard without a stethoscope). A grade IV murmur is heard well in all positions using a stethoscope, and a palpable thrill is present. Grade V murmurs can be heard with the stethoscope partly off the chest. Murmurs heard throughout systole are referred to as holosystolic murmurs.

34.

Which of the four main types of cerebral aneurysms is commonly located in the basilar arteries of the brain?

  • Fusiform (giant) aneurysm

  • Saccular (berry) aneurysm

  • Mycotic aneurysm

  • Traumatic aneurysm

Correct answer: Fusiform (giant) aneurysm

There are four main types of aneurysms:

  • Saccular (berry) aneurysms are rare in children and are responsible for most subarachnoid hemorrhages (SAHs). They grow slowly over time, usually rupturing between the third and sixth decades of life.
  • Fusiform (giant) aneurysms consist of enlargement or dilatation of the entire circumference of the involved vessel that may be due to atherosclerotic changes; they are commonly found in basilar arteries or the terminal ends of internal carotids.
  • Mycotic aneurysms usually result from infected bacterial emboli due to infective endocarditis; they are relatively common in children compared to adults.
  • Traumatic aneurysms are characterized by the weakening of the arterial wall from nonpenetrating head trauma (i.e., bone fracture or traumatic brain injury). They are rare in childhood.

35.

Which of the following diuretic agents, indicated in the management of pediatric heart failure (HF), has a common side effect of hyperkalemia?

  • Spironolactone

  • Furosemide

  • Chlorothiazide

  • Butemadine

Correct answer: Spironolactone

Spironolactone is a potassium-sparing diuretic. Therefore, it can increase potassium levels, causing hyperkalemia as a potential side effect. It is not a strong diuretic but can be used in the treatment of HF.

Furosemide (Lasix), chlorothiazide, and butemadine (Bumex) are all diuretic agents that have the potential for hypokalemia.

36.

You are triaging a 12-month-old patient for suspected acute bronchitis in the emergency department (ED). What is the predominant symptom associated with acute bronchitis?

  • Cough

  • Increased purulent sputum production

  • Wheezing

  • Nasal flaring, grunting, and/or retractions

Correct answer: Cough

Acute bronchitis is a self-limiting respiratory infection characterized by a dry, brassy cough, with or without sputum production. Cough is always the predominant symptom and may last up to three weeks. It is often the result of a virus such as parainfluenza, respiratory syncytial virus (RSV), or rhinovirus. Very few cases (less than 10%) are bacterial in nature, though a secondary bacterial infection can develop due to weakened tissue. The diagnosis is made after ruling out other causes of cough.

Pneumonia presents with nasal flaring, grunting, retractions, tachypnea, and tachycardia. Wheezing is more common in viral pneumonia than in bacterial pneumonia.

37.

A two-year-old male is brought to the emergency department by his mother with a sudden onset of choking, gagging, and coughing. The patient has a pulse of 125/min and a respiratory rate of 34/min. The nurse auscultates decreased breath sounds over the right upper lung field.

What other immediate physical finding correlates with a diagnosis of partial laryngeal foreign body obstruction?

  • Inspiratory stridor

  • Fever

  • Aphonia

  • Crackles

Correct answer: Inspiratory stridor

Foreign body aspiration is a common cause of accidental death in infants and children. The initial episode is frequently associated with choking and coughing. Examination findings may be normal or nonspecific, such as decreased air entry, wheezing, rhonchi, or inspiratory stridor. The right bronchus is more often the site of the foreign body than the left, and thus decreased breath sounds may be heard over the right lung field.

Patients who present with laryngeal foreign bodies develop stridor, dyspnea, cyanosis, coughing, and voice change (not an inability to speak). Patients with bronchial foreign bodies manifest with cough, asymmetric breath sounds, wheezing, and dyspnea.

A fever may develop later (not immediately) if the partial obstruction is not resolved. Cyanosis will get progressively worse if the larynx becomes completely blocked or if the child aspirates the foreign body deeper into the lungs. Crackles are not heard in a partial foreign body obstruction.

38.

A child suspected of having aortic stenosis (AS) is admitted to the PICU for a full diagnostic workup. Estimations of valvular gradients are used to determine the severity of the defect but may be falsely low if the patient has which condition?

  • A low cardiac output (CO)

  • A high cardiac output (CO)

  • Compromised left ventricular (LV) function

  • Associated cardiac lesions

Correct answer: A low cardiac output (CO)

AS is characterized by malformation of the aortic valve, which obstructs an ejection of blood from the LV. Associated cardiac lesions are common (PDA, VSD, or coarctation). The aortic valve is usually bicuspid with a single, fused commissure and an eccentrically placed orifice.

Valvular gradients can give some estimation of the degree of stenosis. This number may be misleading in instances of low CO in which output across the valve is already diminished, producing a falsely low gradient reading.

39.

What is an example of a threat from natural causes?

  • Pandemic flu

  • Workplace violence

  • Hazardous material release

  • Power grid failure

Correct answer: Pandemic flu

Potential threats requiring an emergency management (EM) plan and response include threats from natural causes, human-induced threats, and terrorist threats. Natural and human-induced disasters occur around the world on a frequent basis. In the past 15 years, terrorism has unfortunately become an increasingly real threat to the citizens of the United States. 

Threats from natural causes include pandemic flu, hurricanes, floods, fire, tornadoes, and ice storms. Workplace violence (including assaults, threats, or any other acts of violence), releasing hazardous materials, and power grid failures are all considered to be human-induced threats.

40.

How does exogenous surfactant administration improve lung function in an infant with immature lungs?

  • It decreases surface tension within the alveoli

  • It increases opening pressure

  • It inhibits alveolar fluid clearance

  • It decreases lung compliance

Correct answer: It decreases surface tension within the alveoli

Premature infants and infants with immature lungs 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.

In the lungs, surface tension forces tend to cause the alveoli to collapse. Surfactant reduces the tension at the air-fluid interface in each alveolus, allowing the alveoli to remain open and thereby increasing lung compliance, providing alveolar stability, and decreasing opening pressure. Surfactant also enhances alveolar fluid clearance, decreases precapillary tone, and protects the epithelial cell surface.

×