CPEN-Triage Practice Test Exam GRADED A+ with Actual
Questions & Answers 2023/2024
Pediatric Assessment Triangle correct answers appearance, work of breathing, circulation to skin
Characteristics of apperance correct answers "sick" vs "not sick", age appropriate behavior, know dev't
baseline
define critical, emergent, urgent, non-urgent correct answers Critical-requires immediate care or
intervention; Emergent-requires care or intervention w/in 10 mins; Urgent-requires care w/in 1 hour
Non-urgent-does not require care
Factors that affect triage assessment correct answers dev't stage, common illness/injury, risk factors of
abuse, compensatory mechanisms, potential for rapid deterioration, parental concerns & perceptions,
child communication, portability of child, alternative treatments, lack of primary care
Triage Red Flags correct answers Apnea, choking, drooling; stridor, grunting, inc use of acc muscles; RR
>60; HR <60 or >200; AMS, LOC, or listless, Temp >40; severe pain; cyanosis; tachycardia & bradycardia,
petechiae, purpura; new onset seizure acitvity, injuries not matching mechanism
Triage history correct answers C-Chief complaint
I-Immunizations or isolation
A-Allergies to food, meds, latex
M-Medications
P-Past med, surg, behavioral health hx
E-Events surrounding illness
D-Diet & diapers
S-Symptoms w/ this illness
Triage interventions correct answers isolaton, protocols (labs, xrays, meds), pt disposition,
documentation
Describe symptoms of heat cramps correct answers involves large muscle groups (esp quads &
hamstrings). Sudden, painful muscle spasm, normal to slightly inc body temp, normal mental status.
Nursing interventions for heat cramps correct answers move to cool environment, oral fluid
replacement, IV 20ml/kg NSS
Symptoms of heat exhaustion correct answers Results from exposure to high temps, excessive sweating,
& insufficient fluid &/or salt replacement. Fatigue, HA/N/V, diarrhea & muscle cramps, hypotension, mild
changes in MS, moist skin & profuse sweating
Treatment of heat exhaustion correct answers cool environment, oral or IV fluids, spray water over body
to inc evaporation, use pan to inc convective heat loss