NENA EMERGENCY NURSING PEDIATRIC (ENP) CERTIFICATION EXAM – QUESTIONS AND ANSWERS | VERIFIED
AND WELL DETAILED ANSWERS | PLUS RATIONALES | GUARANTEED PASS | LATEST EXAM UPDATE
Core Domains:
• Triage and Initial Assessment
• Resuscitation and Stabilization
• Medical-Surgical Emergencies
• Trauma Emergencies
• Toxicological and Environmental Emergencies
• Behavioral and Psychosocial Emergencies
• Child Maltreatment and Neglect
• Legal, Ethical, and Regulatory Issues
• Professional Standards and Leadership
Introduction
This comprehensive assessment is designed to prepare the emergency nurse for the NENA Emergency Nursing Pediatric
(ENP) Certification Exam. It evaluates both foundational knowledge and advanced clinical reasoning across a wide
spectrum of pediatric emergencies. The exam utilizes a rigorous multiple-choice format, integrated with realistic,
scenario-based questions that challenge the candidate to apply evidence-based practice in high-acuity situations.
Beyond recalling facts, this test measures the ability to synthesize information, prioritize interventions, and exercise
sound clinical judgment in complex and often dynamic environments. Emphasis is placed on the unique physiological
and psychological needs of the pediatric patient, from infancy through adolescence, ensuring the nurse is equipped to
provide safe, competent, and compassionate care.
SECTION ONE: QUESTIONS 1 – 100
,1. A 4-year-old child presents with a barking cough, stridor, and moderate subcostal retractions. The triage nurse
notes the child is sitting upright and drooling. What is the priority intervention?
A. Prepare for immediate intubation.
B. Administer racemic epinephrine via nebulizer.
C. Obtain a lateral neck radiograph.
D. Transport the child to the operating room for an airway assessment.
🟢A
🔴 Explanation: The presentation of stridor, drooling, and a tripod position in a child is highly concerning for
epiglottitis, a life-threatening airway emergency. The priority is to prepare for definitive airway management, as
these patients can deteriorate rapidly. Interventions like nebulized medications or radiographs can cause agitation
and airway compromise and should be deferred until the airway is secure.
2. A 2-month-old infant is brought in with a fever of 102.2°F (39°C), poor feeding, and lethargy. The infant
appears ill. Which diagnostic test is the most critical to obtain immediately?
A. Complete blood count and differential.
B. Blood culture.
C. Urinalysis and culture.
D. Cerebrospinal fluid (CSF) analysis via lumbar puncture.
🟢D
🔴 Explanation: In a febrile infant less than 60 days old who appears ill, the risk of serious bacterial infection,
including meningitis, is high. A lumbar puncture to obtain CSF for analysis is the most critical test to diagnose or rule
out meningitis, which requires prompt and specific antibiotic therapy. Other tests are important but are secondary to
the definitive diagnosis of central nervous system infection.
,3. A 7-year-old child is in status epilepticus. The nurse has administered a weight-appropriate dose of midazolam
intranasally with no response after 5 minutes. What is the next appropriate pharmacological intervention?
A. Administer a second dose of intranasal midazolam.
B. Administer diazepam rectally.
C. Administer intravenous lorazepam.
D. Administer intravenous levetiracetam.
🟢C
🔴 Explanation: The standard of care for status epilepticus is a stepwise approach. After a first-line benzodiazepine
(e.g., midazolam, diazepam) fails, the next step is intravenous administration of a second benzodiazepine, such as
lorazepam. This provides a more reliable and rapid onset of action than rectal or additional intranasal routes.
Levetiracetam is considered a second-line agent after benzodiazepine failure.
4. A 10-year-old child has a known allergy to amoxicillin. The physician orders cefuroxime for a bacterial
infection. What is the nurse's priority action?
A. Administer the medication as ordered.
B. Administer the medication with a lower dose.
C. Hold the medication and verify the order with the physician.
D. Request an order for an antihistamine to be given with the antibiotic.
🟢C
🔴 Explanation: There is a risk of cross-reactivity between penicillins and cephalosporins. While the risk is lower with
newer cephalosporins like cefuroxime, the potential for a hypersensitivity reaction exists. The nurse must verify the
order with the physician, who may determine the benefit outweighs the risk, or may choose an alternative antibiotic.
Administering without verification or pre-medicating is inappropriate and unsafe.
, 5. A 3-year-old child is brought to the ED after ingesting an unknown amount of a liquid found under the sink.
The child is asymptomatic. A poison control specialist recommends activated charcoal. What is the most
important nursing action before administering the charcoal?
A. Confirm the child's weight.
B. Assess the child's ability to maintain their airway.
C. Mix the charcoal with a flavored drink.
D. Administer an antiemetic.
🟢B
🔴 Explanation: The primary contraindication to administering activated charcoal is a compromised or unprotected
airway. The risk of aspiration of the charcoal preparation is significant. Ensuring the child has a patent airway and a
strong gag reflex is the most critical safety assessment. Weight is important for dosing but secondary to airway
assessment. Mixing with a drink can improve palatability but is not the priority.
6. Which of the following clinical findings is most suggestive of increased intracranial pressure in a 6-month-old
infant?
A. A sunken, depressed anterior fontanel.
B. A tense, bulging anterior fontanel.
C. A head circumference below the 5th percentile.
D. A closed posterior fontanel.
🟢B
🔴 Explanation: In infants, the anterior fontanel is an indicator of intracranial pressure. A tense or bulging fontanel,
especially when the infant is quiet and upright, is a classic sign of increased ICP. A sunken fontanel indicates
AND WELL DETAILED ANSWERS | PLUS RATIONALES | GUARANTEED PASS | LATEST EXAM UPDATE
Core Domains:
• Triage and Initial Assessment
• Resuscitation and Stabilization
• Medical-Surgical Emergencies
• Trauma Emergencies
• Toxicological and Environmental Emergencies
• Behavioral and Psychosocial Emergencies
• Child Maltreatment and Neglect
• Legal, Ethical, and Regulatory Issues
• Professional Standards and Leadership
Introduction
This comprehensive assessment is designed to prepare the emergency nurse for the NENA Emergency Nursing Pediatric
(ENP) Certification Exam. It evaluates both foundational knowledge and advanced clinical reasoning across a wide
spectrum of pediatric emergencies. The exam utilizes a rigorous multiple-choice format, integrated with realistic,
scenario-based questions that challenge the candidate to apply evidence-based practice in high-acuity situations.
Beyond recalling facts, this test measures the ability to synthesize information, prioritize interventions, and exercise
sound clinical judgment in complex and often dynamic environments. Emphasis is placed on the unique physiological
and psychological needs of the pediatric patient, from infancy through adolescence, ensuring the nurse is equipped to
provide safe, competent, and compassionate care.
SECTION ONE: QUESTIONS 1 – 100
,1. A 4-year-old child presents with a barking cough, stridor, and moderate subcostal retractions. The triage nurse
notes the child is sitting upright and drooling. What is the priority intervention?
A. Prepare for immediate intubation.
B. Administer racemic epinephrine via nebulizer.
C. Obtain a lateral neck radiograph.
D. Transport the child to the operating room for an airway assessment.
🟢A
🔴 Explanation: The presentation of stridor, drooling, and a tripod position in a child is highly concerning for
epiglottitis, a life-threatening airway emergency. The priority is to prepare for definitive airway management, as
these patients can deteriorate rapidly. Interventions like nebulized medications or radiographs can cause agitation
and airway compromise and should be deferred until the airway is secure.
2. A 2-month-old infant is brought in with a fever of 102.2°F (39°C), poor feeding, and lethargy. The infant
appears ill. Which diagnostic test is the most critical to obtain immediately?
A. Complete blood count and differential.
B. Blood culture.
C. Urinalysis and culture.
D. Cerebrospinal fluid (CSF) analysis via lumbar puncture.
🟢D
🔴 Explanation: In a febrile infant less than 60 days old who appears ill, the risk of serious bacterial infection,
including meningitis, is high. A lumbar puncture to obtain CSF for analysis is the most critical test to diagnose or rule
out meningitis, which requires prompt and specific antibiotic therapy. Other tests are important but are secondary to
the definitive diagnosis of central nervous system infection.
,3. A 7-year-old child is in status epilepticus. The nurse has administered a weight-appropriate dose of midazolam
intranasally with no response after 5 minutes. What is the next appropriate pharmacological intervention?
A. Administer a second dose of intranasal midazolam.
B. Administer diazepam rectally.
C. Administer intravenous lorazepam.
D. Administer intravenous levetiracetam.
🟢C
🔴 Explanation: The standard of care for status epilepticus is a stepwise approach. After a first-line benzodiazepine
(e.g., midazolam, diazepam) fails, the next step is intravenous administration of a second benzodiazepine, such as
lorazepam. This provides a more reliable and rapid onset of action than rectal or additional intranasal routes.
Levetiracetam is considered a second-line agent after benzodiazepine failure.
4. A 10-year-old child has a known allergy to amoxicillin. The physician orders cefuroxime for a bacterial
infection. What is the nurse's priority action?
A. Administer the medication as ordered.
B. Administer the medication with a lower dose.
C. Hold the medication and verify the order with the physician.
D. Request an order for an antihistamine to be given with the antibiotic.
🟢C
🔴 Explanation: There is a risk of cross-reactivity between penicillins and cephalosporins. While the risk is lower with
newer cephalosporins like cefuroxime, the potential for a hypersensitivity reaction exists. The nurse must verify the
order with the physician, who may determine the benefit outweighs the risk, or may choose an alternative antibiotic.
Administering without verification or pre-medicating is inappropriate and unsafe.
, 5. A 3-year-old child is brought to the ED after ingesting an unknown amount of a liquid found under the sink.
The child is asymptomatic. A poison control specialist recommends activated charcoal. What is the most
important nursing action before administering the charcoal?
A. Confirm the child's weight.
B. Assess the child's ability to maintain their airway.
C. Mix the charcoal with a flavored drink.
D. Administer an antiemetic.
🟢B
🔴 Explanation: The primary contraindication to administering activated charcoal is a compromised or unprotected
airway. The risk of aspiration of the charcoal preparation is significant. Ensuring the child has a patent airway and a
strong gag reflex is the most critical safety assessment. Weight is important for dosing but secondary to airway
assessment. Mixing with a drink can improve palatability but is not the priority.
6. Which of the following clinical findings is most suggestive of increased intracranial pressure in a 6-month-old
infant?
A. A sunken, depressed anterior fontanel.
B. A tense, bulging anterior fontanel.
C. A head circumference below the 5th percentile.
D. A closed posterior fontanel.
🟢B
🔴 Explanation: In infants, the anterior fontanel is an indicator of intracranial pressure. A tense or bulging fontanel,
especially when the infant is quiet and upright, is a classic sign of increased ICP. A sunken fontanel indicates
