ENPC 6TH EDITION COURSE EXAM
Questions and Answers
1. A 4-year-old presents with vomiting, lethargy, frequent urination,
weight loss, and dry mucous membranes. Vital signs reveal deep
respirations at 44 breaths per minute, BP of 70/44 mm Hg, and HR
of 144 beats per minute. Which of the following laboratory values
would be most expected in this child?: Hypoglycemia (wrong)
Remediation feedback:
Children can present with new onset diabetes in diabetic ketoacidosis. Manifestations include signs of
dehydration (dry mucous membranes, hypotension, tachycardia), incontinence (polyuria), vomiting,
abdominal pain, Kussmaul respirations (to counter the acidosis), polydipsia, anorexia, and weight loss.
Expected laboratory values would reveal
an acidotic state with a pH level below 7.3, an elevated serum bIcarbonate level, and an elevated blood
glucose level > 200 mg.dL.
2. An 18-month-old is seen for fever, slight circumoral cyanosis, and
wheezing noted on auscultation in the right upper lobe of the lung
field after a choking event 4 days ago. The white blood cell count is
elevated and the patient noted to be tachypneic, tachycardic, agitated,
and has an increased respiratory effort. At the time of the event, the
patient was started on antibiotics with subsequent in- creasing
manifestations instead of improvement. Which of the following would
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16
,be considered to be definitive treatment for the suspected diagnosis?:
Computed tomography (wrong)
Remediation feedback:
Manifestations of a lower airway foreign body include a choking incident with subsequent failure to
improve on antibiotics. Wheezing or decreased lung sounds in one area of the pulmonary system is a
high indicator for a foreign body along with signs of hypoxia such as cyanosis, tachypnea, tachycardia,
increased respiratory effort, agitation or lethargy, and elevated white blood cell counts indicating an
infectious process. The definitive treatment would be a bronchoscopy in order to retrieve the suspected
foreign body instead of diagnostic tests to locate the foreign body itself.
3. A child in cardiopulmonary arrest is receiving chest compressions
and manual ventilations with a bag-mask device. Once return of
spontaneous circulation has been confirmed, which of the following
would be the priority intervention?-
: Establishing a secure airway
4. Parents report their 3-year-old child has developed noisy
breathing. On as- sessment, high-pitched wheezes are audible and
auscultated on inspiration and expiration. What medication would
be appropriate to administer first?: - Humidified oxygen (wrong)
Remediation feedback:
Wheezing is most often identified with asthma in the pediatric population. Initial medication intervention
includes an inhaled short-acting beta agonist.
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16
, 5. A 6-week-old is brought to the emergency department by the
caregivers for poor feeding, listlessness, and fever. Assessment reveals
a crying infant, HR 160 beats/minute, RR 52 breaths/minute, rectal
temperature of 96.0 F (35.5 C), and a bulging anterior fontanel.
Capillary refill is 4 seconds. Based on these findings what is the most
likely diagnostic test the nurse should anticipate?: Lumbar puncture
6. A 12-year-old is being prepped for surgical intervention of acute
appendicitis. Which of the following intravenous medication orders
should the nurse ques- tion?: Hydromorphone (wrong)
Remediation feedback:
Ketorolac is an appropriate medication for moderate to severe pain, however, it should not be used pre-
operatively due to its potential to increase the bleeding risk.
7. A 17-year-old female arrives in the ED with her boyfriend who
states she is pregnant and having vaginal bleeding. The patient is
unsure of the gestational age and has not had any prenatal
treatment. The patient is quiet and lets her boyfriend answer most
of the questions. Which of the following is the most appropriate action
for the nurse to take at this point?: Have the boyfriend leave the room during
the pelvic exam.
8. A 2-year-old arrives at the ED in hypovolemic shock and needs fluids
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16
Questions and Answers
1. A 4-year-old presents with vomiting, lethargy, frequent urination,
weight loss, and dry mucous membranes. Vital signs reveal deep
respirations at 44 breaths per minute, BP of 70/44 mm Hg, and HR
of 144 beats per minute. Which of the following laboratory values
would be most expected in this child?: Hypoglycemia (wrong)
Remediation feedback:
Children can present with new onset diabetes in diabetic ketoacidosis. Manifestations include signs of
dehydration (dry mucous membranes, hypotension, tachycardia), incontinence (polyuria), vomiting,
abdominal pain, Kussmaul respirations (to counter the acidosis), polydipsia, anorexia, and weight loss.
Expected laboratory values would reveal
an acidotic state with a pH level below 7.3, an elevated serum bIcarbonate level, and an elevated blood
glucose level > 200 mg.dL.
2. An 18-month-old is seen for fever, slight circumoral cyanosis, and
wheezing noted on auscultation in the right upper lobe of the lung
field after a choking event 4 days ago. The white blood cell count is
elevated and the patient noted to be tachypneic, tachycardic, agitated,
and has an increased respiratory effort. At the time of the event, the
patient was started on antibiotics with subsequent in- creasing
manifestations instead of improvement. Which of the following would
1/
16
,be considered to be definitive treatment for the suspected diagnosis?:
Computed tomography (wrong)
Remediation feedback:
Manifestations of a lower airway foreign body include a choking incident with subsequent failure to
improve on antibiotics. Wheezing or decreased lung sounds in one area of the pulmonary system is a
high indicator for a foreign body along with signs of hypoxia such as cyanosis, tachypnea, tachycardia,
increased respiratory effort, agitation or lethargy, and elevated white blood cell counts indicating an
infectious process. The definitive treatment would be a bronchoscopy in order to retrieve the suspected
foreign body instead of diagnostic tests to locate the foreign body itself.
3. A child in cardiopulmonary arrest is receiving chest compressions
and manual ventilations with a bag-mask device. Once return of
spontaneous circulation has been confirmed, which of the following
would be the priority intervention?-
: Establishing a secure airway
4. Parents report their 3-year-old child has developed noisy
breathing. On as- sessment, high-pitched wheezes are audible and
auscultated on inspiration and expiration. What medication would
be appropriate to administer first?: - Humidified oxygen (wrong)
Remediation feedback:
Wheezing is most often identified with asthma in the pediatric population. Initial medication intervention
includes an inhaled short-acting beta agonist.
2/
16
, 5. A 6-week-old is brought to the emergency department by the
caregivers for poor feeding, listlessness, and fever. Assessment reveals
a crying infant, HR 160 beats/minute, RR 52 breaths/minute, rectal
temperature of 96.0 F (35.5 C), and a bulging anterior fontanel.
Capillary refill is 4 seconds. Based on these findings what is the most
likely diagnostic test the nurse should anticipate?: Lumbar puncture
6. A 12-year-old is being prepped for surgical intervention of acute
appendicitis. Which of the following intravenous medication orders
should the nurse ques- tion?: Hydromorphone (wrong)
Remediation feedback:
Ketorolac is an appropriate medication for moderate to severe pain, however, it should not be used pre-
operatively due to its potential to increase the bleeding risk.
7. A 17-year-old female arrives in the ED with her boyfriend who
states she is pregnant and having vaginal bleeding. The patient is
unsure of the gestational age and has not had any prenatal
treatment. The patient is quiet and lets her boyfriend answer most
of the questions. Which of the following is the most appropriate action
for the nurse to take at this point?: Have the boyfriend leave the room during
the pelvic exam.
8. A 2-year-old arrives at the ED in hypovolemic shock and needs fluids
3/
16
