CPEN Practice Questions (2026) — Free Sample Questions with Answers

Answer: C

Respiratory distress: Respiratory distress requires abnormal work of breathing (retractions, flaring, abnormal sounds) with a normal appearance. Work of breathing is normal here.

Respiratory failure: Respiratory failure combines abnormal appearance with abnormal work of breathing. This infant's breathing is quiet and unlabored.

Shock: Correct. Abnormal appearance plus abnormal circulation to skin (mottling, pallor) with normal work of breathing is the PAT pattern for shock, and it calls for immediate resuscitation.

Primary CNS or metabolic dysfunction: This impression applies when only appearance is abnormal. The mottled, pale skin shows that circulation is also abnormal.

PAT patterns: appearance alone = CNS/metabolic; work of breathing alone = distress; appearance + breathing = failure; circulation alone = compensated shock; appearance + circulation = shock (decompensated); all three = cardiopulmonary failure.

Answer: B

0.3 mL: This is only half the ordered dose (15 mcg). It may come from preparing the volume for one nostril only.

0.6 mL: Correct. 1.5 mcg/kg x 20 kg = 30 mcg; 30 mcg / 50 mcg/mL = 0.6 mL, divided between the nostrils (about 0.3 mL each).

1.2 mL: This delivers 60 mcg (3 mcg/kg), double the ordered dose.

3 mL: This would be 150 mcg, a fivefold overdose. It is also far more than the nasal mucosa can absorb (about 0.5 mL or less per nostril).

Dose (mcg) = mcg/kg x kg; volume = dose / concentration. Intranasal doses should be split between nostrils, keeping each side to about 0.5 mL or less.

Answer: D

The child can go home now because the dexamethasone is already fully effective: Dexamethasone takes hours to reach full effect; it does not prevent the early rebound after nebulized epinephrine wears off.

The child must be admitted for 24 hours because epinephrine was needed: Needing racemic epinephrine does not by itself require admission. Many children go home after a period of observation without recurrent stridor at rest.

The child can go home now if a cool-mist humidifier is used overnight: Humidified air has not been shown to improve croup and does not replace observation after epinephrine.

The child needs to be watched for 2 to 3 hours because symptoms can return: Correct. Nebulized epinephrine works quickly but lasts about 2 hours. Observe for 2 to 3 hours after the last dose before discharge to watch for recurrent stridor at rest.

After racemic epinephrine for croup, observe 2 to 3 hours for rebound stridor. Dexamethasone gives the longer-lasting benefit.

Answer: A

Begin positive-pressure ventilation with 21% oxygen: Correct. Apnea or heart rate below 100/min after initial steps calls for positive-pressure ventilation within the first minute of life. Term infants start with 21% oxygen, adjusted to pulse oximetry targets.

Begin chest compressions at a 3:1 ratio with breaths: Compressions start only if the heart rate stays below 60/min after at least 30 seconds of ventilation that moves the chest.

Give blow-by oxygen and continue tactile stimulation: Blow-by oxygen does not ventilate an apneic infant, and continued stimulation delays effective ventilation.

Give IV epinephrine 0.01 mg/kg through a peripheral IV: Epinephrine is reserved for a heart rate below 60/min despite effective ventilation and compressions, ideally via umbilical venous catheter.

Newborn resuscitation centers on ventilation: apnea or HR below 100 → PPV within 60 seconds; HR below 60 after 30 seconds of effective PPV → compressions (3:1) with 100% O2; epinephrine if HR stays below 60.

Answer: D

1,200 mL of D5 0.45% NaCl infused over 24 hours: This is a maintenance-type rate with a hypotonic dextrose fluid; it does not restore circulating volume in septic shock.

100 mL of 0.9% NaCl over 1 hour to avoid overload: 5 mL/kg over an hour is too little and too slow for a child in compensated septic shock.

2,000 mL of isotonic crystalloid as one rapid bolus: 100 mL/kg in one bolus without reassessment risks fluid overload. Fluids are given in 10 to 20 mL/kg aliquots with reassessment between them.

200 to 400 mL isotonic crystalloid fast, then reassess: Correct. Guidelines recommend 10 to 20 mL/kg boluses (200 to 400 mL for 20 kg) of balanced or isotonic crystalloid, reassessing for perfusion and fluid overload after each, up to 40 to 60 mL/kg in the first hour where intensive care is available. Antibiotics within 1 hour.

Pediatric septic shock: 10 to 20 mL/kg isotonic crystalloid boluses with reassessment after each, antibiotics within 1 hour, and vasoactive agents (epinephrine or norepinephrine) if fluid-refractory.

Answer: B

Wait to treat until a parent can give verbal consent: Delaying treatment of a life-threatening emergency to get consent is inappropriate and could be fatal.

Treat right away under the emergency exception to consent: Correct. When a minor has an emergency condition and a parent cannot be reached, treatment proceeds under implied consent (the emergency doctrine). EMTALA also requires screening and stabilization while efforts to reach the parents continue.

Obtain a court order before giving any medication: Court orders are for non-emergent disputes, such as a parent refusing needed care, not for urgent treatment when the parent is unavailable.

Have the school nurse sign consent as the legal guardian: A school nurse is not the child's legal guardian and cannot give informed consent, although school authorization forms may help.

Emergency exception: when delay would endanger a minor's life or health and no guardian is available, consent is implied. Document the emergency and keep trying to reach the parents.