ENPC PRE COURSE EXAM
Questions and Answers
1. The caregiver of a 2-month-old infant states the patient has had
trouble breathing for the past two days. Pediatric assessment
triangle (PAT) reveals an age-appropriate general appearance, rapid
breathing with mild distress, and pink skin. Mucous is noted in both
nares.
Which of the following is the best next step?
A. Obtain a history including immunization status
B. Suction nasal passages using a bulb syringe
C. Administer oxygen by nasal cannula with patient in caregiver's arms
D. Respiratory assessment is completed so move to circulatory
Answer B. Suction nasal passages using a bulb syringe
Infants up to four months old are obligate nose breathers and can have respiratory distress when nares
are occluded. Mucous can be gently suctioned using a bulb syringe or suction catheter. A good, thorough
history should always include immunization status for pediatric patients. The nose needs to be clear before
applying oxygen via nasal cannula. Respiratory assessment includes interventions to improve breathing so
you would not move to move to circulation until that is accomplished.
2. The caregiver of a 7-year old reports witnessing a seizure at home,
but no
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16
,seizure history. The patient is post-ictal with a heart rate of 142
beats per minute, respiratory rate of 36 breaths per minute, and blood
pressure of 86/72 mm Hg. Significant burns are noted to the patient's
back and lower extremities. The caregiver states the burns
accidentally occurred three days ago but was afraid to bring the
patient in due to an ongoing child welfare investigation.
Which of the following groups of interventions are the priority for this
patient?
A. Call police and child welfare authorities and have security detain
the care- giver
B. Administer intravenous analgesics and obtain a point of care
glucose
C. Draw a metabolic panel, point of care glucose, and administer a fluid
bolus
D. Administer lorazepam and a fluid bolus and place on seizure
precautions
Answer C. Draw a metabolic panel, point of care glucose, and administer a fluid bolus.
Burn injuries result in fluid and electrolyte shifts leading to hypovolemia and electrolyte imbalances. Early
identification and treatment of electrolyte imbalances can help prevent further seizures. Contacting child
protective services and other authorities can wait. The patient is post-ictal so does not require lorazepam
medication at this time. Pain medication can and should be considered with significant burns, but is not
a priority.
3. A three-year-old is rescued after being submerged in a pool for
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16
, several
minutes. On arrival the patient is responsive to painful stimuli with
shallow respirations, diminished breath sounds, and an occasional
cough. Which of the following interventions is the initial
management priority?
A. Initiation of abdominal thrusts to remove fluid from the lungs
B. Insertion of orogastric to remove of water and debris from stomach
C. Endotracheal intubation to provide positive pressure ventilation
D. Removal of wet clothing to prevent hypothermia
Answer C. Endotracheal intubation to provide positive pressure ventilation.
The primary survey assessment and treatment of deficits are the priority. Airway control and positive pressure
ventilation while preparing for intubation of a child who meets intubation criteria (GCS < 8) should be
performed while also maintaining cervical spine stabilization. The child is responsive only to painful stimuli,
has shallow respirations, and diminished breath sounds. All of these are breathing problems and must be
addressed immediately. Removing wet clothing is necessary, but is not the main priority initially. With
intubation an orogastric tube will be placed and abdominal thrusts are not necessary to remove fluid from
the lungs.
4. Which of the following patients should be evaluated first?
A. A 3-year-old with a dislodged gastrostomy tube
B. An 18-month-old with bilious emesis
C. A 12-year-old with vomiting after a handlebar injury
3/
16
Questions and Answers
1. The caregiver of a 2-month-old infant states the patient has had
trouble breathing for the past two days. Pediatric assessment
triangle (PAT) reveals an age-appropriate general appearance, rapid
breathing with mild distress, and pink skin. Mucous is noted in both
nares.
Which of the following is the best next step?
A. Obtain a history including immunization status
B. Suction nasal passages using a bulb syringe
C. Administer oxygen by nasal cannula with patient in caregiver's arms
D. Respiratory assessment is completed so move to circulatory
Answer B. Suction nasal passages using a bulb syringe
Infants up to four months old are obligate nose breathers and can have respiratory distress when nares
are occluded. Mucous can be gently suctioned using a bulb syringe or suction catheter. A good, thorough
history should always include immunization status for pediatric patients. The nose needs to be clear before
applying oxygen via nasal cannula. Respiratory assessment includes interventions to improve breathing so
you would not move to move to circulation until that is accomplished.
2. The caregiver of a 7-year old reports witnessing a seizure at home,
but no
1/
16
,seizure history. The patient is post-ictal with a heart rate of 142
beats per minute, respiratory rate of 36 breaths per minute, and blood
pressure of 86/72 mm Hg. Significant burns are noted to the patient's
back and lower extremities. The caregiver states the burns
accidentally occurred three days ago but was afraid to bring the
patient in due to an ongoing child welfare investigation.
Which of the following groups of interventions are the priority for this
patient?
A. Call police and child welfare authorities and have security detain
the care- giver
B. Administer intravenous analgesics and obtain a point of care
glucose
C. Draw a metabolic panel, point of care glucose, and administer a fluid
bolus
D. Administer lorazepam and a fluid bolus and place on seizure
precautions
Answer C. Draw a metabolic panel, point of care glucose, and administer a fluid bolus.
Burn injuries result in fluid and electrolyte shifts leading to hypovolemia and electrolyte imbalances. Early
identification and treatment of electrolyte imbalances can help prevent further seizures. Contacting child
protective services and other authorities can wait. The patient is post-ictal so does not require lorazepam
medication at this time. Pain medication can and should be considered with significant burns, but is not
a priority.
3. A three-year-old is rescued after being submerged in a pool for
2/
16
, several
minutes. On arrival the patient is responsive to painful stimuli with
shallow respirations, diminished breath sounds, and an occasional
cough. Which of the following interventions is the initial
management priority?
A. Initiation of abdominal thrusts to remove fluid from the lungs
B. Insertion of orogastric to remove of water and debris from stomach
C. Endotracheal intubation to provide positive pressure ventilation
D. Removal of wet clothing to prevent hypothermia
Answer C. Endotracheal intubation to provide positive pressure ventilation.
The primary survey assessment and treatment of deficits are the priority. Airway control and positive pressure
ventilation while preparing for intubation of a child who meets intubation criteria (GCS < 8) should be
performed while also maintaining cervical spine stabilization. The child is responsive only to painful stimuli,
has shallow respirations, and diminished breath sounds. All of these are breathing problems and must be
addressed immediately. Removing wet clothing is necessary, but is not the main priority initially. With
intubation an orogastric tube will be placed and abdominal thrusts are not necessary to remove fluid from
the lungs.
4. Which of the following patients should be evaluated first?
A. A 3-year-old with a dislodged gastrostomy tube
B. An 18-month-old with bilious emesis
C. A 12-year-old with vomiting after a handlebar injury
3/
16
