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Quiz Session - Attempts With Random Questions

BCEN CPEN Exam Questions

Page 6 of 25

101.

The nurse is caring for a four-year-old female with diagnostic studies confirming pneumococcal meningitis. The child has no known drug allergies. The nurse anticipates administering which of the following antibiotics?

  • Vancomycin and cefotaxime

  • Ampicillin and gentamicin

  • Acyclovir and ceftriaxone

  • Gentamicin and acyclovir

Correct answer: Vancomycin and cefotaxime

Specific antimicrobial therapy for central nervous system (CNS) infections depends on the pathogen suspected or identified, the age of the patient, and any associated complications. In a child older than 1 month, general recommendations often include third-generation cephalosporins (cefotaxime or ceftriaxone) plus vancomycin to cover the emergence of cephalosporin-resistant organisms.

Empiric antimicrobial therapy for neonates has traditionally been ampicillin and gentamicin. With the increasing resistance of Escherichia coli and other gram-negative enterococci to ampicillin, a third-generation cephalosporin often takes the place of gentamicin. Acyclovir is indicated for the treatment of herpes simplex virus encephalitis.

102.

A nurse is caring for a child in the PICU with a head injury and is preparing to administer mannitol to the child. The nurse will know this medication has been effective when the child exhibits which sign?

  • Decreased intracranial pressure (ICP)

  • Decreased urine output

  • Increased urine output

  • Improved level of consciousness (LOC)

Correct answer: Decreased intracranial pressure (ICP)

Mannitol is used to control cerebral swelling and reduce ICP, but it is a controversial therapy for children as it has not been studied with controlled clinical trials in the pediatric population. Its use is reserved for head trauma cases that have not responded to other, more traditional therapy measures.

Mannitol works by producing an osmotic gradient between the intravascular and extravascular compartments, causing the movement of water from the interstitium into the cerebral vasculature, where it can be removed via the kidneys. It also causes compensatory vasoconstriction due to reduced blood viscosity, decreasing total cerebral volume and ICP while maintaining cerebral blood flow.

Therefore, mannitol has been successful if the patient's ICP drops after receiving this drug.

103.

An infant with unrepaired hypoplastic left heart syndrome (HLHS) experiences episodes of hypoxia secondary to oxygen desaturation. Why does desaturation happen in this context?

  • Pulmonary and systemic venous blood mix together

  • Ventricular size is decreased

  • Pulmonary vascular resistance (PVR) is decreased

  • Systemic vascular resistance (SVR) is decreased

Correct answer: Pulmonary and systemic blood mix together

HLHS is the most common type of single-ventricle physiology characterized by various levels of underdevelopment of left heart structures. The left-sided valves may be small or atretic, the left ventricle cavity may be absent or hypoplastic, and the ascending aorta could be tiny to normal-sized. In all cases of HLHS, the left-sided structures fail to form normally and are not large enough to function as systemic ventricles and valves. An atrial septal defect (ASD) may or may not be present, but both a patent ductus arteriosus (PDA) and ASD are obligatory for survival and are considered part of the complex.

Systemic venous blood returns normally to the right atrium (RA) and flows normally from the right side of the heart. Pulmonary venous blood flows across the ASD to the RA because it cannot exit the left side of the heart if mitral atresia is present. Mixing in the RA desaturates the blood, resulting in tachypnea, dyspnea, grunting, cool and poorly perfused extremities, lethargy, and pallor or gray coloring.

PVR is initially elevated, placing the infant at risk for pulmonary over-circulation. A hypoplastic (or absent) left ventricle causes decreased systemic vascular blood flow.

104.

A 10-year-old female is admitted to the emergency department after a motor vehicle collision with left-sided hemiparesis. The patient is going in and out of consciousness. She was unrestrained in the back seat of the car at the time of the collision. Upon further assessment, the nurse notes an inequality of the child's pupils, with the left pupil noticeably larger than the right.

The nurse suspects which of the following?

  • Epidural hematoma

  • Subdural hematoma

  • Cerebral contusion

  • Concussion

Correct answer: Epidural hematoma

An epidural hematoma occurs as blood accumulates in the extradural space as a result of direct trauma near the temporal bone. Infants with epidural hematoma may present with a bulging fontanel, anemia with significant bleeding, or cranial suture separation. Older children display hemiparesis or hemiplegia and anisocoria (an inequality of the pupils, usually greater than a 1 mm difference). Loss of consciousness is common. All ages will generally present with signs of increasing intracranial pressure (ICP) in severe cases.

A concussion is milder and does not cause structural damage to the brain. A subdural hematoma presents with retinal hemorrhage(s) and seizure activity, as blood collects between the dura and arachnoid membranes. Symptoms of cerebral contusion depend on the location of the injury and the amount of cerebral swelling present. Focal seizures are common; loss of consciousness may or may not be present.

105.

A nurse is caring for a six-month-old infant recovering from a ventricular septal defect (VSD) repair via cardiac catheterization. The nurse must monitor the infant closely for postoperative complications.

Which arrhythmia is the most common complication following this repair?

  • Atrioventricular (AV) heart block

  • Ventricular tachycardia

  • Premature ventricular contractions (PVCs)

  • Junctional rhythm

Correct answer: Atrioventricular (AV) heart block

Potential complications of VSD closure include infection, postoperative bleeding, damage to the valves of the heart (tricuspid, pulmonary, or aortic), pulmonary hypertension with poor cardiac output, AV heart block, residual VSD from unsuccessful closure, and death.

PVCs are common but benign, and ventricular tachycardia is a risk during the procedure but not postoperatively. Junctional rhythm is not common.

106.

A child with diastolic left heart failure (HF) secondary to pediatric cardiomyopathy has developed pulmonary edema. When a nurse performs this patient's head-to-toe assessment, which of the following signs and symptoms would be an expected finding?

  • Tachypnea and tachycardia

  • Machine-like murmur

  • Muffled heart sounds

  • Jaundice

Correct answer: Tachypnea and tachycardia

Cardiomyopathy is myocardial dysfunction associated with mechanical and/or electrical problems with ventricular dilation or hypertrophy. Symptoms of cardiomyopathy reflect the variable degrees of HF. Tachycardia, tachypnea, increased work of breathing, diaphoresis, loss of appetite, feeding intolerance, poor weight gain, abdominal pain, and exercise intolerance are often seen.

A machine-like murmur is not associated with congestive heart failure (CHF). Jaundice is the result of liver dysfunction and, subsequently, elevated bilirubin levels. Muffled heart sounds are indicative of cardiac tamponade.

107.

A nurse is caring for a pediatric patient who begins to manifest signs of compensated shock. Which of the following assessment findings would the nurse anticipate?

  • Cool, clammy skin

  • Jaundice

  • Hypotension

  • Petechiae and ecchymosis

Correct answer: Cool, clammy skin

Compensated shock is characterized by normal systolic blood pressure with clinical evidence of inadequate tissue perfusion. Cool, clammy skin is a response of the sympathetic nervous system causing vasoconstriction as a "fight or flight" mechanism. This is one of several compensatory mechanisms used by the body to maintain adequate oxygen delivery. Other signs of compensated shock include tachycardia, an increase in systemic vascular resistance (SVR), increased contractility of the heart muscle, and increased venous smooth muscle tone (boosting venous return to the heart and augmenting preload).

Jaundice, hypotension, petechiae, and ecchymosis are all signs of decompensated shock, as physiologic attempts to maintain systolic blood pressure, tissue perfusion, and oxygen delivery fail. Jaundice occurs when the liver is no longer able to filter and metabolize waste products, leading to an increase in bilirubin. Clotting factors are activated in uncompensated shock, which causes petechiae and ecchymosis. Hypotension results when perfusion can no longer be maintained.

108.

A pediatric nurse is caring for a 14-year-old male with superficial partial-thickness burns to his lower extremities and is performing a daily dressing change. These types of burns generally do not require surgical intervention and heal in approximately what timeframe?

  • 7 to 10 days

  • 3 to 5 days

  • 10 to 14 days

  • 14 to 21 days

Correct answer: 7 to 10 days

While full-thickness burns require prompt excision and grafting, more superficial burns heal on their own, typically in 7 to 10 days without surgical intervention. Daily dressing changes with gentle cleansing are generally indicated for proper healing and to decrease the risk of infection. 

The nurse must ensure all prior topical creams and ointments are removed entirely before applying a new dressing.

109.

The clinical course of acute tubular necrosis (ATN) can be divided into four phases. Which phase involves cellular injury through the development of uremia?

  • Oliguric phase

  • Initiating phase

  • Diuretic phase

  • Recovery phase

Correct answer: Oliguric phase

The oliguric phase is the time from cell injury to the development of uremia. The duration is usually between 1 and 2 weeks; oliguria is more common in postischemic ATN. The following events characterize the development of severe nephron dysfunction and uremia (or uremic syndrome) during this phase:

  • GFR is significantly decreased.
  • Hypervolemia occurs.
  • BUN and plasma creatinine rise.
  • Electrolyte imbalances occur.
  • Metabolic acidosis is present.

The onset, or initiating phase, is the time from the precipitating event until cell injury occurs (generally hours to days); the diuretic phase is the beginning of recovery characterized by improved urine output, increased urea excretion, and solute excretion lasting 7 to 14 days. Finally, the recovery phase involves the slow restoration of renal function, which can take years.

110.

You are preparing for a child's admission en route to the emergency department (ED) via ambulance with suspected hemolytic anemia. You expect which of the following examination findings upon admission?

  • Jaundice and dark urine

  • Systolic murmur and diaphoresis

  • Tachycardia and hypotension

  • Shortness of breath and pallor

Correct answer: Jaundice and dark urine

Pediatric anemia most frequently occurs as the result of a decrease in red blood cell (RBC) production, an increase in RBC destruction, a combination of the two, or blood loss. Hemolytic anemia presents with jaundiced skin and icteric sclera, hemoglobinuria (causing urine to be dark), hepatomegaly, splenomegaly, a flow murmur, and fatigue.

Hypotension is a late sign of shock that is associated with blood loss. Though pallor is associated with anemia, shortness of breath is associated with a nutritional deficiency or bone marrow failure, leading to decreased RBC production. Diaphoresis is not associated with hemolytic anemia.

111.

Which of the following laboratory data is clinically significant for the diagnosis of syndrome of inappropriate antidiuretic hormone (SIADH) in a child?

  • Decreased serum osmolality

  • Decreased urine osmolality

  • Increased serum sodium

  • Decreased blood urea nitrogen (BUN)

Correct answer: Decreased serum osmolality

SIADH is a common disorder in pediatric critical care and is characterized by excess ADH (i.e., the release of ADH is not able to be suppressed), resulting in hyponatremia and impaired water excretion. When the body senses a rising osmolality, ADH is released to cause water retention or volume expansion. In this syndrome, excess ADH acts on the renal collecting ducts to become more permeable to water, causing dilutional hyponatremia (decreased serum sodium) and a hypoosmolar state (reduced serum osmolality).

In addition to hyponatremia and hypo-osmolality, a relative increase in the concentration of urine occurs with high specific gravity and increased urine osmolality (above 100 mOsmol/kg) because of ADH's effect on the renal tubules, resulting in increased water reabsorption by the kidneys.

112.

You are triaging a patient with suspected meningitis. Which of the following assessment findings is most ominous? 

  • Change in level of consciousness 

  • A severe headache 

  • A petechial rash 

  • Neck stiffness with vomiting

Correct answer: Change in level of consciousness

When meningitis leads to changes in the level of consciousness (LOC), it indicates that the meningitis is quite severe. 

A severe headache is common with meningitis. A petechial rash indicates that meningitis is bacterial in origin, meaning that it is more severe than viral meningitis. A petechial rash, however, is not as severe a symptom as changes in LOC. Neck stiffness and vomiting are both symptoms of meningitis, but they are not as serious as altered LOC.

113.

During a mass casualty event, which of the following patient considerations is least likely to be important while providing care?

  • Alleviating pain and suffering 

  • Determining likelihood of survival 

  • Determining severity of the injury 

  • Ensuring necessary resources are available to treat injured patients 

Correct answer: Alleviating pain and suffering

During a mass casualty event, alleviating pain and suffering becomes secondary to saving the greatest number of lives possible. The patient's likelihood of survival, the severity of the injury, and the resources required to save them are all important considerations that affect the ability to save the greatest number of lives possible.

Pain management is not the top priority when providing care in the case of a mass casualty event.

114.

All the following are appropriate diagnostic studies for a child with suspected heart failure (HF), except:

  • Holter monitoring

  • Electrocardiogram and echocardiogram

  • Cardiac catheterization

  • Brain natriuretic peptide (BNP) levels

Correct answer: Holter monitoring

Heart failure is a condition in which the heart is unable to provide adequate cardiac output (CO) or regional blood flow to meet the circulatory and metabolic requirements of the body. A history and a physical examination are often performed first, providing lots of clues to both the etiology and severity (based on presenting signs and symptoms) of HF. Diagnostic tests include chest X-ray, ECG and echocardiogram, PA catheter placement and/or cardiac catheterization, SVO2 measurements, laboratory studies including BNP levels, and cardiac MRI.

Holter monitoring provides a 24-hour record of ECG activity (heart rate and rhythm). It is used to document arrhythmias and/or conduction disorders at rest and under stress, as well as the frequency of their occurrence. It does not aid in the diagnosis of HF.

115.

An infant with a diagnosis of Wolff-Parkinson-White syndrome (WPW) is likely to have which associated congenital heart defect?

  • Ebstein's anomaly

  • Atrial septal defect (ASD)

  • Ventricular septal defect (VSD)

  • Truncus arteriosus

Correct answer: Ebstein's anomaly

Ebstein's anomaly is the downward displacement of the posterior and septal leaflets of the tricuspid valve with an atrialized portion of the right ventricle; it is the congenital lesion most strongly associated with WPW syndrome.

As many as 20 percent of these patients have one or more accessory pathways; the majority are located in the right free wall and right posteroseptal spaces.

116.

In an infant with a diagnosed truncus arteriosus, which other heart defect is often present?

  • Ventricular septal defect (VSD)

  • Atrial septal defect (ASD)

  • Patent ductus arteriosus (PDA)

  • Pulmonary stenosis (PS)

Correct answer: Ventricular septal defect (VSD)

Truncus arteriosus comprises approximately 1% to 2% of all congenital cardiac defects and is characterized by a single great artery (along with one truncal valve) that connects the right and left ventricles. This structure carries blood to both the lungs and the body. In a normal heart, two separate arteries (the pulmonary artery and the aorta) exist with their own valves. The pulmonary artery carries blood from the right side of the heart to the lungs, while the aorta carries blood from the left side of the heart to the body.

A coexisting VSD is present in more than 98% of cases. The VSD will be near the truncus arteriousus; it will allow blood to mix in the right and left ventricles and enter the truncus artery.

117.

What is the difference between heat stroke and heat exhaustion?

  • Heat stroke is typically a problem with the body's thermoregulation system, whereas heat exhaustion is related to fluid and electrolyte loss

  • Heat stroke is thought to be less life-threatening than heat exhaustion

  • Heat exhaustion generally occurs when the body temperature reaches 99.5-100.5 °F, whereas heat stroke occurs at temperatures of 100.5 °F and above

  • Heat exhaustion occurs more often in the very young, whereas heat stroke occurs more often in the elderly

Correct answer: Heat stroke is typically a problem with the body's thermoregulation system, whereas heat exhaustion is related to fluid and electrolyte loss

Body temperatures may fluctuate, but there is no specific temperature at which these illnesses are diagnosed. Heat exhaustion is a milder illness than heat stroke. With heat exhaustion, core body temperature is generally found to be normal or elevated (98.6-104 °F). Treatment consists of vigorous rehydration. Children experiencing heat exhaustion should be moved to a cooler environment, and measures to cool the body (e.g., ice packs to the neck or axillae, cool towels, fanning) should be used. 

Heat stroke is an acute medical emergency caused by an extreme buildup of body heat with core body temperatures usually greater than 104 °F (40 °C). Heat stroke is more serious than heat exhaustion; it is life-threatening with a mortality rate of around 10% despite good medical management. 

Both young children and the elderly are susceptible to heat stroke and heat exhaustion.

118.

An eight-year-old patient has been prescribed omeprazole (Prilosec) to take over a four-week treatment period. The nurse will know that the patient is receiving an optimal dosage and the therapy is beneficial if the patient no longer experiences which of the following symptoms?

  • Heartburn

  • Flatulence

  • Constipation

  • Diarrhea

Correct answer: Heartburn

Omeprazole is a proton pump inhibitor (PPI) and is used for the short-term treatment (4-8 weeks) of severe erosive esophagitis, severe gastroesophageal reflux disease (GERD), and duodenal ulcer disease associated with H. pylori. It inhibits hydrochloric acid secretions at the cellular level and treats heartburn in cases of severe GERD. Therefore, the medication regimen is successful if the patient experiences a decrease in or absence of heartburn.

Omeprazole does not treat flatulence, constipation, or diarrhea.

119.

Your colleague explains that female pediatric patients are more sensitive to pain than male pediatric patients. Which of the following is true regarding this statement?

  • This statement is based on incorrect stereotypes

  • This statement is supported by research that is now considered outdated

  • This statement is the reverse of what is correct

  • This statement is correct but should be rephrased in a way that better reflects gender equity

Correct answer: This statement is based on incorrect stereotypes

Despite an increase in the emphasis on pain management in children over the last several years, some misconceptions about children and pain persist. Sensitivity to pain is not influenced by gender. This statement is incorrect and is not supported by past or current empirical research; it incorrectly propagates unsupported gender stereotypes.

120.

Which important drug should all seizing patients receive?

  • Oxygen

  • Lorazepam

  • Phenobarbital

  • Levetiracetam

Correct answer: Oxygen

The management goals for a child with a seizure are to stop both clinical and electrographic seizure activity emergently; prevent injury; and maintain the patient's airway, breathing, and circulation. While benzodiazepines (lorazepam, midazolam, and diazepam) are used in the initial therapy phase based on age, oxygen should be administered to all seizing patients despite a normal pulse oximetry reading, as seizure activity always decreases perfusion to the brain.

Phenobarbital and levetiracetam are indicated as the second therapy, after first-line treatments fail to stop the seizing.

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