Free CPN Exam Flashcards

For a child born preterm, use corrected age when appropriate. Check developmental progress, listen to caregiver concerns, and follow up promptly on missed milestones or any loss of skills.

Toddlers are building independence while still needing predictable limits. Offer simple choices and consistent routines. Temporary setbacks can occur with stress, and loss of established developmental skills warrants evaluation.

Preschool children may believe their thoughts or actions caused an illness or procedure. Explain care in concrete, nonblaming language and avoid phrases that sound like punishment.

School-age children want competence and approval. Include them in explanations, let them practice skills when safe, and connect care tasks to returning to school, play, and normal activities.

Adolescents need developmentally appropriate confidentiality, direct communication, and time without caregivers for sensitive questions. Also clarify legal limits when safety concerns require disclosure.

Use a least-to-most invasive approach when possible. Observe before touching, save painful or frightening steps for later, and adapt the order to the child's age, distress, and clinical stability.

Retractions, nasal flaring, grunting, head bobbing, poor feeding, and fatigue can signal respiratory distress. In children, appearance and effort often warn of decline before a single number does.

Assess mucous membranes, tears, urine output, capillary refill, mental status, weight trend, and caregiver report of intake. Infants and young children can decompensate quickly because reserves are limited.

Use self-report when the child can give it, with a scale suited to their developmental level. When self-report is unavailable, use a validated observational tool and ask caregivers about the child's usual pain behaviors.

Identify the child's usual caregivers, health beliefs, language needs, transportation barriers, medication access, and home routines. These factors shape whether a plan is realistic after discharge.

Before giving vaccines, check prior doses, current illness severity, allergy history, immune status, pregnancy status when relevant, and caregiver questions. Use the current schedule rather than memory alone.

Live vaccines require extra screening for significant immunocompromise and pregnancy when applicable. If there is uncertainty, verify eligibility before administration rather than assuming routine timing applies.

Start with listening, acknowledge the concern, give a clear recommendation, and use plain language about benefits and expected reactions. Argument alone rarely improves trust.

Use a bladder width of at least 40% of the mid-upper arm circumference and a length that encircles 80-100% of it. A cuff that is too small can overestimate the pressure.

When a child is behind, verify records and use an official catch-up schedule. Do not restart a series just because time has passed; continue from documented valid doses.

A reliever treats symptoms quickly. An inhaled corticosteroid reduces airway inflammation and future exacerbations. Some children use prescribed ICS-formoterol for both roles. Review frequent symptoms or reliever use with the care team.

A spacer helps inhaled medication reach the lower airway. Teach a tight seal, slow inhalation when age appropriate, and cleaning per device instructions; poor technique can look like treatment failure.

Priorities are airway patency, hydration, feeding tolerance, oxygenation, and caregiver teaching. Nasal suction and frequent reassessment can be more important than routine medications.

Barking cough and inspiratory stridor suggest upper airway involvement. Stridor at rest, severe retractions, altered mental status, or exhaustion are urgent findings.

Caregivers need hands-on training, emergency supplies, suction equipment, and a plan for accidental decannulation or obstruction. Return demonstration is essential before discharge.

For mild to moderate dehydration with vomiting or diarrhea, small frequent amounts of oral rehydration solution are usually preferred when the child can tolerate them. Avoid high-sugar drinks that can worsen diarrhea.

Bilious vomiting, rigid abdomen, bloody stool, severe localized pain, signs of shock, or pain with testicular symptoms require urgent escalation rather than routine reassurance.

Assess stool pattern, withholding behavior, diet, fluid intake, medications, and toileting routines. Long-term success often depends on behavior support as much as medication.

Evaluate growth trend, feeding technique, formula preparation, swallowing, chronic disease signs, family stressors, and food access. Avoid blaming caregivers while gathering objective data.

Teach strict gluten avoidance, label reading, cross-contact prevention, and monitoring for nutritional deficiencies. Symptoms may include GI complaints, poor growth, anemia, or fatigue.

During illness, families should monitor glucose more often, check ketones as instructed, maintain hydration, and continue basal insulin unless the diabetes team gives different instructions.

Shakiness, sweating, hunger, irritability, confusion, or seizure can indicate low glucose. Give fast-acting carbohydrate per the child's plan when swallowing is safe and recheck in 15 minutes. If swallowing is unsafe, follow the glucagon and emergency plan.

Vomiting, abdominal pain, dehydration, fruity breath, deep breathing, and altered mental status suggest possible DKA. This is an emergency because acidosis and fluid shifts can worsen rapidly.

Children with adrenal insufficiency may need stress-dose steroids during significant illness, injury, or surgery. Families should know when to call, when to give emergency medication, and when to seek urgent care.

Assess growth pattern, pubertal staging, medication history, chronic illness, nutrition, psychosocial impact, and family history. Early or delayed findings should be interpreted in the full clinical context.

Protect the child from injury, position to maintain airway when possible, time the seizure, and avoid placing anything in the mouth. Afterward, assess breathing, neurologic status, and recovery pattern.

Concerning findings include worsening headache, vomiting, altered mental status, abnormal pupils, bulging fontanelle in an infant, declining level of consciousness, or new neurologic deficits.

Suspect meningitis with fever and neck stiffness, severe headache, or altered alertness. Infants may have poor feeding, lethargy, or irritability. Escalate promptly and follow organism-specific precautions, including droplet precautions for suspected meningococcal disease.

Escalate worsening headache, repeated vomiting, confusion, or new neurologic signs urgently. After the first 1-2 days of relative rest, most children can resume light activity and return to school with support. Sports require a separate, supervised progression.

Loss of previously acquired language, motor, social, or self-care skills is more concerning than slow progress alone. It warrants careful history, screening, and provider follow-up.

Place the infant on their back on a firm, flat, noninclined surface with no loose bedding or soft objects. Use a separate infant sleep surface in the caregiver's room and avoid overheating and smoke exposure.

Store medications, vitamins, cannabis products, and household chemicals locked and out of sight. Remind families that child-resistant packaging is not childproof.

Keep the child rear-facing to the seat's limits, then use a forward-facing harness and tether to its limits before a booster. Use the booster until the seat belt fits properly, and keep the child in the back seat through age 12.

Provide close, constant adult supervision, within arm's reach for young children and weak swimmers. Use four-sided pool fencing, empty tubs and buckets after use, and use properly fitted life jackets when indicated.

Injuries inconsistent with the history, patterned marks, repeated delays in care, concerning caregiver behavior, or disclosures from the child require objective documentation and action under reporting laws.

Ask the child or caregiver to explain or demonstrate the plan in their own words. If they miss a step, explain it another way and check understanding again.

Review name, purpose, dose, route, schedule, measuring device, missed-dose plan, side effects to report, and storage. Demonstration is important for inhalers, injections, and liquid dosing.

Readiness includes clinical stability, caregiver understanding, supplies, follow-up, medication access, transportation, and clear return precautions. A correct written plan is not enough if the family cannot carry it out.

Ask about family preferences, decision makers, language needs, and health beliefs. Use qualified interpreters for clinical communication instead of relying on children or untrained family members.

Assess school attendance, activity restrictions, access to medication, staff readiness for emergencies, and communication with caregivers. Ask the child about concerns such as stigma or missed class time.

Advocacy means speaking up for the child's safety, developmental needs, family voice, and access to care. It includes escalating concerns when the plan does not fit the child's condition or context.

When abuse or neglect is suspected, the nurse follows mandated reporting law and facility policy. The nurse does not need to prove abuse before reporting a reasonable concern.

Match the task to state law, facility policy, the patient's condition, the delegatee's competence, and available supervision. The RN remains accountable for the delegation decision and retains tasks that require nursing judgment.

Use current evidence, clinical expertise, patient and family preferences, and available resources to guide care. Question routines that persist only because they are familiar.

Quality improvement looks for system patterns behind errors, delays, and variation. Reporting near misses and adverse events helps improve processes rather than assign blame.