CPN Sample Questions & Answers

American Academy of Pediatrics (AAP) safe sleep guidelines recommend placing infants supine (on the back) on a firm, flat, non-inclined sleep surface for every sleep period. Elevating the head of a crib or using inclined sleep positioners is ineffective in reducing gastroesophageal reflux and significantly increases the risk that the infant will slide into a chin-to-chest posture or roll onto the stomach, causing positional asphyxiation. In the supine position, the trachea lies anatomically superior to the esophagus, protecting against aspiration.

School-age children who have outgrown the weight or height limit of their forward-facing 5-point harness seat must use a belt-positioning booster seat in the rear seat until the vehicle seat belt fits properly—typically when the child reaches 145 cm (4 ft 9 in) tall between 8 and 12 years of age. Proper fit requires the shoulder belt to cross the middle of the chest and shoulder and the lap belt to lie low across the upper thighs rather than the abdomen.

Evidence-based firearm injury prevention requires that if firearms are kept in the home, they must be stored unloaded in a locked gun safe or lockbox, with the ammunition locked in a separate location. Simply hiding a firearm on a high closet shelf or educating young children not to touch guns is insufficient to prevent unintentional pediatric firearm injuries.

High-dose intravenous immune globulin (IVIG 2 g/kg) provides high levels of circulating passive maternal/donor antibodies that persist for months and interfere with the active replication required for parenteral live attenuated viral vaccines (MMR and varicella) to generate an endogenous immune response. Therefore, MMR and varicella vaccinations must be deferred for 11 months following a 2 g/kg IVIG dose. Inactivated toxoid/subunit vaccines such as DTaP are not meaningfully inhibited by circulating passive antibodies and should be administered on schedule.

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.

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.

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.