Free CPN sample questions

Correct answer: Brush the teeth twice daily with a soft toothbrush using a rice-grain-sized smear of fluoridated toothpaste and establish a dental home by 12 months of age.

To prevent early childhood caries, oral hygiene with a soft toothbrush and a rice-grain-sized smear of fluoridated toothpaste should begin upon eruption of the first primary tooth (transitioning to a pea-sized amount at age 3 years). A dental home should be established within 6 months of the first tooth eruption and no later than 12 months of age. Additionally, caregivers should avoid putting the infant to bed with a bottle containing milk or juice and transition from a bottle to an open cup around 12 months.

Correct answer: Utilize the Revised FLACC (r-FLACC) scale, partnering with the primary caregiver to document the child's individualized baseline behaviors and idiosyncratic pain cues.

Pain assessment tools must match the child's developmental and cognitive capabilities rather than chronological age alone. For a nonverbal child with severe cognitive impairment and baseline motor spasticity, the Revised FLACC (r-FLACC) scale or Non-Communicating Children's Pain Checklist is the tool of choice because it allows the nurse and caregiver to incorporate individualized pain behaviors (such as specific vocalizations, breath-holding, or alterations in baseline spasticity). Physiological parameters like vital signs are non-specific and can change due to fever, hypovolemia, or anxiety. flowchart TD Start([Pediatric Pain Assessment]) --> CheckVerbal{Can child reliably self-report?} CheckVerbal -->|Yes, Age 3-7 yrs| Faces[Wong-Baker FACES or Oucher Scale] CheckVerbal -->|Yes, Age >= 8 yrs| NRS[Numeric Rating Scale 0-10] CheckVerbal -->|No, Nonverbal / Preverbal| CheckCog{Cognitive or Motor Impairment?} CheckCog -->|No, Infant < 1 mo| NIPS[NIPS / CRIES Scale] CheckCog -->|No, 2 mos - 7 yrs| FLACC[Standard FLACC Scale] CheckCog -->|Yes, Neurodevelopmental Disability| rFLACC[Revised FLACC r-FLACC with Caregiver Input]

Correct answer: True

Children frequently use quiet play, television watching, or withdrawal into sleep as behavioral coping and distraction mechanisms when experiencing ongoing pain, or they may fall asleep from sheer physiological exhaustion. Therefore, sleep or quiet play does not prove the absence of pain, and the nurse should still value a developmentally appropriate self-report tool like the Wong-Baker FACES scale when the child is awake.

Correct answer: The rising ETCO2 paired with a 'silent chest,' worsening tachycardia, and lethargy indicates severe airway obstruction, respiratory muscle exhaustion, and impending respiratory arrest.

In early status asthmaticus, tachypnea causes hyperventilation and hypocapnia (low ETCO2 of 29 mmHg). As bronchospasm, mucosal edema, and mucus plugging worsen, airflow becomes so restricted that wheezing is no longer generated ('silent chest') and the child's respiratory muscles fatigue, causing the respiratory rate to drop. The rapid rise in ETCO2 to 56 mmHg (hypercapnia) alongside lethargy and severe tachycardia signals decompensated respiratory failure and impending arrest, even when supplemental oxygen masks hypoxemia by maintaining an SpO2 of 93%.

Correct answer: Late decompensation of intracranial compliance (Cushing triad) with cranial nerve III compression and impending cerebral herniation.

The progression from irritability and headache (early signs of increased intracranial pressure) to obtundation, ipsilateral pupillary dilation (cranial nerve III compression), and Cushing triad—characterized by widening pulse pressure (systolic hypertension of 144/52 mmHg), reflex bradycardia (54/min), and irregular Cheyne-Stokes respirations—is a late, life-threatening sign of exhausted intracranial compliance and impending brainstem/uncal herniation. In contrast, neurogenic shock presents with hypotension combined with bradycardia.

Correct answer: The infant is in compensated hypovolemic shock, maintaining a normal systolic blood pressure through intense sympathetic tachycardia and peripheral vasoconstriction.

Pediatric patients have robust vascular tone and cardiac rate reserve, enabling them to maintain a normal blood pressure in the presence of losing up to 25% to 30% of their intravascular blood volume. Marked tachycardia (190/min), delayed capillary refill (4 seconds), cool mottled skin, weak peripheral pulses, and lethargy with a preserved systolic blood pressure (84/56 mmHg) define compensated hypovolemic shock. Hypotension is a late, pre-arrest sign of decompensated shock in infants and children.