200+ Free CPEN Practice Questions

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A 4-year-old child is brought to the emergency department with rapid breathing, visible retractions, and nasal flaring. Using the Pediatric Assessment Triangle (PAT), which component is being assessed?

Circulation to the skin

Work of breathing

Level of consciousness

Muscle tone

to track

2026 Statistics

Key Facts: CPEN Exam

175

Total Questions

BCEN

150 + 25

Scored + Unscored

BCEN

110/150

Passing Score

73.3%

3 hours

Exam Time

BCEN

37%

System-Focused

Largest domain

$380

Exam Fee

BCEN 2026

4 years

Certification Valid

BCEN

The CPEN exam contains 175 items (150 scored + 25 unscored pretest) over 3 hours. The passing standard is 110 correct out of 150 scored items (73.3%). Content covers triage (PAT, ESI), assessment (history, physical, pain), system-focused emergencies (respiratory, cardiac, neuro, GI, GU, ENT, musculoskeletal, integumentary, hematology/oncology, endocrine), special considerations (neonatal, behavioral health, maltreatment, environmental, toxicology, communicable diseases), multi-system issues (sepsis, anaphylaxis, sedation), and professional issues (legal, nursing practice, patient/family considerations).

Sample CPEN Practice Questions

Try these sample questions to test your CPEN exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 200+ question experience with AI tutoring.

1A 4-year-old child is brought to the emergency department with rapid breathing, visible retractions, and nasal flaring. Using the Pediatric Assessment Triangle (PAT), which component is being assessed?

A.Circulation to the skin

B.Work of breathing

C.Level of consciousness

D.Muscle tone

Explanation: The Pediatric Assessment Triangle (PAT) consists of three components: appearance (includes muscle tone, interactiveness, consolability, look/gaze, speech/cry), work of breathing (includes nasal flaring, retractions, positioning, audible sounds), and circulation to the skin (includes pallor, mottling, cyanosis). Nasal flaring and retractions are classic signs of increased work of breathing.

2A 2-month-old infant presents with fever of 38.5°C (101.3°F). The nurse is triaging the patient. Which factor would classify this infant as high risk according to standard pediatric triage protocols?

A.Age under 3 months with fever

B.Temperature above 38.0°C

C.Absence of cough or runny nose

D.Feeding normally at home

Explanation: Infants under 3 months of age with fever (≥38.0°C or 100.4°F) are considered high risk because they have immature immune systems and can deteriorate rapidly. These infants require prompt evaluation, often including septic workup, due to the risk of serious bacterial infections.

3During mass casualty triage using the JumpSTART system, a 5-year-old child is found apneic but resumes breathing after airway positioning. What triage category should be assigned?

A.Immediate (Red)

B.Delayed (Yellow)

C.Minimal (Green)

D.Expectant (Black)

Explanation: In JumpSTART pediatric mass casualty triage, children who are apneic but begin breathing after airway positioning are categorized as Immediate (Red). This is different from adult triage where apneic patients without spontaneous breathing after airway opening are classified as deceased/expectant.

4A parent brings a 6-year-old child to the ED who was exposed to a chemical at a factory. The child has visible powder on clothing and skin irritation. What is the FIRST priority in managing this patient?

A.Obtain vital signs

B.Decontamination

C.Administer antidote

D.Notify poison control

Explanation: Decontamination is the first priority in chemical exposure to prevent continued absorption of the toxic substance and to protect healthcare workers. The patient should be decontaminated before entering the main treatment area to prevent contamination of the facility and staff.

5A 10-year-old patient presents to triage with a rash, fever, and history of recent international travel. Which action should the triage nurse take FIRST?

A.Place patient in an isolation room

B.Administer antipyretics

C.Call the patients pediatrician

D.Begin IV fluid resuscitation

Explanation: A patient with rash, fever, and recent international travel should be immediately isolated due to the risk of communicable diseases such as measles, chickenpox, or other infectious diseases. Isolation precautions must be initiated before further assessment to prevent transmission to other patients and staff.

6A triage nurse is assessing a 3-year-old using the Emergency Severity Index (ESI). The child has stridor at rest, is drooling, and appears anxious. What ESI level should be assigned?

A.ESI Level 1 (requires immediate life-saving intervention)

B.ESI Level 2 (high-risk situation)

C.ESI Level 3 (multiple resources needed)

D.ESI Level 4 (one resource needed)

Explanation: Stridor at rest with drooling and anxiety in a child suggests possible epiglottitis or severe upper airway obstruction, which is a high-acuity, life-threatening condition requiring immediate intervention. This meets ESI Level 1 criteria for a patient requiring immediate life-saving intervention.

7A 9-month-old infant is brought to the ED after a fall. Which assessment finding would be MOST concerning for non-accidental trauma?

A.Small bruise on the forehead

B.Symmetric bruising on both shins

C.Bruising on the buttocks and lower back

D.Scraped knee from crawling

Explanation: Bruising on the buttocks, lower back, ears, or neck in a non-ambulatory infant is highly suspicious for non-accidental trauma (child abuse). Infants who are not yet mobile should not have bruises in these areas. This requires further investigation and mandatory reporting.

8When obtaining a pain assessment on a 4-year-old child, which tool would be MOST appropriate?

A.Numeric Rating Scale (0-10)

B.FLACC Scale (Face, Legs, Activity, Cry, Consolability)

C.Visual Analog Scale

D.CRIES Scale

Explanation: The FLACC Scale is appropriate for children aged 2 months to 7 years who may not be able to reliably use a numeric scale. It assesses five categories: Face, Legs, Activity, Cry, and Consolability. Each category is scored 0-2, with a maximum score of 10.

9During a primary survey of a pediatric trauma patient, the nurse notes absent breath sounds on the left side with tracheal deviation to the right. What is the priority intervention?

A.Insert a chest tube on the left side

B.Perform immediate needle decompression on the left side

C.Administer supplemental oxygen

D.Obtain a chest X-ray

Explanation: Absent breath sounds with tracheal deviation away from the affected side indicates a tension pneumothorax, which is a life-threatening emergency requiring immediate needle decompression. This should be done in the second intercostal space at the midclavicular line on the affected side before obtaining imaging.

10A 2-year-old child weighs 12 kg. The provider orders a fluid bolus of 20 mL/kg for dehydration. How many milliliters should the nurse administer?

A.120 mL

B.200 mL

C.240 mL

D.400 mL

Explanation: To calculate the fluid bolus: 20 mL/kg × 12 kg = 240 mL. The standard pediatric fluid bolus for dehydration is 20 mL/kg of isotonic crystalloid (normal saline or lactated Ringer's), which may be repeated as needed based on the patient's response.

About the CPEN Exam

The CPEN certification validates specialized knowledge and skills in pediatric emergency nursing. The exam covers six domains: Triage Process, Assessment, System-Focused Emergencies, Special Considerations, Multi-System Considerations, and Professional Issues. Content integrates 15 key concepts including family-centered care, pain management, patient safety, and evidence-based practice.

Questions

175 scored questions

Time Limit

3 hours

Passing Score

110/150 (73.3%)

Exam Fee

$380 (BCEN (Board of Certification for Emergency Nursing))

CPEN Exam Content Outline

13%

Triage Process

Emergency intake using Pediatric Assessment Triangle (PAT), ESI triage acuity, immunization status, isolation concerns, behavioral status, cultural considerations, emergency preparedness including mass casualty and decontamination

17%

Assessment

History taking including family dynamics, primary and secondary surveys, developmental milestones, pain assessment and management (pharmacologic and non-pharmacologic), vital signs interpretation with age-specific normals, general assessment techniques

37%

System-Focused Emergencies

Respiratory (asthma, bronchiolitis, croup, epiglottitis, pneumonia, foreign body), Cardiovascular (shock, SVT, cardiac arrest, congenital heart defects), Neurological (seizures, meningitis, TBI, hydrocephalus shunt), GI (foreign body, gastroenteritis, appendicitis, intussusception), GU/OB (UTI, torsion, pregnancy emergencies), ENT/Ocular (epistaxis, dental trauma, eye injuries), Musculoskeletal/Integumentary (fractures, growth plate injuries, burns, cellulitis), Hematology/Oncology (sickle cell, anemia), Endocrine/Metabolic (DKA, hypoglycemia, electrolyte imbalances)

17%

Special Considerations

Neonatal emergencies (jaundice, sepsis, RDS), Behavioral health (suicide ideation, eating disorders), Maltreatment recognition (physical abuse, sexual abuse, human trafficking), Environmental emergencies (heat stroke, hypothermia, drowning, bites), Toxicology (acetaminophen, iron, lead), Communicable diseases and immunizations

Multi-System Considerations

Submersion injuries, sepsis recognition and management, anaphylaxis assessment and treatment, post-resuscitative care, procedural sedation monitoring and complications

Professional Issues

Legal issues (consent, minor rights, EMTALA, HIPAA), nursing practice standards, mandatory reporting requirements, medication administration safety, vasoactive medications, forensic evidence collection, death notification, grief support, compassion fatigue, discharge planning, family-centered care principles

How to Pass the CPEN Exam

What You Need to Know

Passing score: 110/150 (73.3%)
Exam length: 175 questions
Time limit: 3 hours
Exam fee: $380

Keys to Passing

Complete 500+ practice questions
Score 80%+ consistently before scheduling
Focus on highest-weighted sections
Use our AI tutor for tough concepts

CPEN Study Tips from Top Performers

1Master the Pediatric Assessment Triangle (PAT) for rapid triage of pediatric patients

2Know age-specific vital signs and developmental milestones for accurate assessment

3Study respiratory emergencies thoroughly - they are the most common pediatric emergency

4Understand pediatric shock recognition and fluid resuscitation (20 mL/kg boluses)

5Learn seizure types and management including status epilepticus protocols

6Review common pediatric dysrhythmias including SVT and treatment (adenosine, synchronized cardioversion)

7Understand fever management guidelines and when to pursue sepsis workup

8Study pain assessment tools by age group (FLACC, Faces, Numeric)

9Know the signs of child maltreatment and mandatory reporting requirements

10Review legal issues specific to pediatrics including consent and minor rights

11Understand neonatal emergencies including hyperbilirubinemia and newborn resuscitation

Frequently Asked Questions

What is the CPEN exam?

The CPEN (Certified Pediatric Emergency Nurse) is a specialty certification offered by BCEN (Board of Certification for Emergency Nursing) that validates expertise in pediatric emergency nursing. It covers triage, assessment, and management of pediatric emergencies across all body systems.

How many questions are on the CPEN exam?

The CPEN exam contains 175 total items: 150 scored questions and 25 unscored pretest questions. You have 3 hours to complete the exam.

What score do I need to pass CPEN?

BCEN lists the CPEN passing standard as 110 correct out of 150 scored items, which is approximately 73.3%.

What are the CPEN eligibility requirements?

To sit for the CPEN exam, you must hold a current unrestricted RN license in the US or Canada. BCEN recommends 2 years of pediatric emergency nursing experience before testing, though it is not strictly required.

How much does CPEN certification cost?

The CPEN exam fee is $380 for non-members. BCEN/ENA members may receive discounted rates.

How long is CPEN certification valid?

CPEN certification is valid for 4 years. Recertification can be achieved through continuing education hours (100 contact hours in pediatric emergency nursing) or by retaking the examination.

What content areas does CPEN cover?

The CPEN exam covers six domains: Triage Process (13%), Assessment (17%), System-Focused Emergencies (37%), Special Considerations (17%), Multi-System Considerations (8%), and Professional Issues (8%).