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BCEN CPENFree Certified Pediatric Emergency Nurse practice test
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A 10-year-old boy reaches the ED reporting intense pain across his upper-mid abdomen that shoots toward his back, plus vomiting, nausea, and fever. Inspecting him, the nurse spots a bluish tint running along both sides of his trunk. What is this flank discoloration called?
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Q1. A 10-year-old boy reaches the ED reporting intense pain across his upper-mid abdomen that shoots toward his back, plus vomiting, nausea, and fever. Inspecting him, the nurse spots a bluish tint running along both sides of his trunk. What is this flank discoloration called?
Correct answer: C. Turner's sign
Pediatric acute pancreatitis classically brings epigastric pain, nausea and vomiting, fever, and appetite-driven weight loss. Since the gland lies behind the peritoneum, the discomfort often spreads toward the back and sides and worsens with movement or eating. Should bleeding accompany the inflammation, bruising can surface over the sides, called Turner's sign, or ring the navel, called Cullen's sign; either marks hemorrhagic disease.
Q2. An adolescent boy, age 15, says severe pain and tenderness struck one side of his scrotum without warning, with swelling and edema following. He reports no trouble urinating and no discharge. Which diagnosis best fits?
Correct answer: B. Testicular torsion
These features indicate testicular torsion, a genuine urologic emergency where the spermatic cord twists and chokes off circulation to the affected side. Boys roughly 12 to 18 are struck most, likely tied to growth spurts. The involved testis usually feels firm and tender and sits horizontally instead of vertically, and an intact cremasteric reflex helps argue against the condition; delayed correction lets ischemia advance to necrosis. Contrast this with a tumor, which yields a firm, painless mass enlarging gradually; priapism, a lasting painful erection with no scrotal swelling; and prostatitis, which triggers sudden dysuria alongside malaise.
Q3. Applying the Hunt and Hess classification, clinicians assign a grade of 3 to a child's subarachnoid hemorrhage (SAH). What clinical picture matches that grade?
Correct answer: B. The child is drowsy and confused, with a mild focal neurologic deficit
This scale links a patient's presenting symptoms in SAH to expected outcomes, guiding treatment decisions, and rising grades track with rising mortality. Grade 1 means minimal findings: a mild headache with slight neck stiffness. Grade 2 adds a worse headache and stiffness but no deficit other than a cranial nerve palsy. Grade 3, the answer here, brings sleepiness, confusion, and a slight focal deficit. Grade 4 involves stupor plus notable hemiparesis, and grade 5 signifies coma with decerebrate posturing.
Q4. During hemorrhagic shock a child loses a large share of intravascular volume, setting off several consequences. Which listed change would NOT be expected?
Correct answer: A. Decreased serum lactate
When circulating volume falls in hemorrhagic shock, oxygen reaching the cells drops and metabolism turns anaerobic, generating lactic acidosis; consequently lactate rises rather than declines. Both CVP and serum creatinine fall as circulating volume shrinks. A dropping lactate would in fact reassure the team that cells are again well oxygenated and that fluid replacement is succeeding, which is why decreased lactate is the exception among these findings.
Q5. The nurse monitors a child in the PICU who is on propranolol (Inderal) to control hypertension. Which finding would most alarm the nurse as a potential drug complication?
Correct answer: B. Audible expiratory wheezes
Being a beta-blocker, propranolol blunts sympathetic stimulation of the heart and treats hypertension, various arrhythmias including tachyarrhythmias, and myocardial infarction. Wheezing heard on exhalation raises concern for bronchospasm, a dangerous reaction to the drug. Clinicians should also watch for laryngospasm, slowed heart rate, low blood pressure, and marrow suppression.
Q6. Blunt force to a child's temporal region produces a skull fracture, and the child arrives at the ED. Staffing triage, which intracranial bleed should you most suspect?
Correct answer: B. Epidural hematoma (EDH)
Fracturing the temporal bone can rupture the middle meningeal vessels, so the resulting extradural collection tends to sit in the temporal area, making epidural bleeds the top suspect. A hallmark is a lucid stretch of minutes to days before consciousness falls, accompanied by same-side pupil dilation and opposite-side weakness as blood pools. Subdural bleeds show vaguer clues instead, such as irritability, lethargy, and drowsiness, with seizures more likely under age three and rising pressure from torn bridging veins. Contusion findings vary by location, severity, and edema, whereas SAH tends to spark seizures or a fast surge in intracranial pressure.
Q7. A child being worked up in the ED has a peritonsillar abscess. Which finding would you NOT anticipate with this condition?
Correct answer: C. Cough
This abscess is a pus pocket beside the tonsil that can menace the airway and spread into deep tissue unless caught early. Expect fever, foul breath, painful and difficult swallowing, drooling, a muffled 'hot potato' voice, throat pain that travels to the ear, a uvula pushed away from the lesion, bulging of the palate on the involved side, tender neck nodes, and red tonsils bearing exudate. Coughing, however, does not belong to this presentation.
Q8. The ED nurse assesses a child whose spinal cord has been injured. Which paired findings suggest early neurogenic shock is setting in?
Correct answer: B. Hypotension and bradycardia
Neurogenic shock, a distributive type, misroutes blood so organs and tissues go underperfused, and its usual triggers are head and cord trauma. Sweeping loss of vascular tone provokes deep vasodilation and falling pressure, while the sympathetic system cannot lift the rate, so output and oxygen delivery decline. As preload and afterload both drop, pressure sinks, pulse pressure broadens, and the heart slows. Severe bradycardia may need atropine, and vasopressors can lift the pressure by driving vasoconstriction.
Q9. A child with suspected aortic stenosis (AS) undergoes a full workup in the pediatric ICU. Estimated valvular gradients indicate obstruction severity, yet the reading can be falsely low under which circumstance?
Correct answer: A. A low cardiac output (CO)
AS involves a malformed aortic valve that blocks ejection from the left ventricle; the valve is often bicuspid, carrying one fused commissure and an off-center opening, and it frequently travels with defects such as PDA, VSD, or coarctation. Although the gradient estimates how tight the stenosis is, low cardiac output can distort that estimate, because diminished flow across the valve yields an artificially small gradient.
Q10. A child with multiple traumatic injuries is brought into the ED. Once the airway is secured, which assessment comes next?
Correct answer: C. Respiratory assessment
The multiply injured child is worked through a primary survey and then a secondary one, tackling life-threatening problems first. The ABCD framework structures the primary survey: A secures airway patency with cervical spine protection; B evaluates breathing, meaning respiratory character, breath sounds, and skin or mucous-membrane color; C manages circulation, finding and halting bleeding while checking pulse, pressure, and capillary refill; and D screens the neurologic status of consciousness and pupils. Breathing thus follows immediately once the airway is handled.
Exam facts and objectives sourced from the official BCEN (Board of Certification for Emergency Nursing) certification page. Last reviewed June 2026.
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