ENPC 6th Edition Course Exam
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? - ANS 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.
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 increasing manifestations instead of improvement. Which of the
following would be considered to be definitive treatment for the suspected diagnosis? - ANS
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.
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? - ANS Establishing a secure airway
Parents report their 3-year-old child has developed noisy breathing. On assessment,
high-pitched wheezes are audible and auscultated on inspiration and expiration. What
medication would be appropriate to administer first? - ANS 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.
, 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? - ANS Lumbar puncture
A 12-year-old is being prepped for surgical intervention of acute appendicitis. Which of the
following intravenous medication orders should the nurse question? - ANS 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.
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? - ANS
Have the boyfriend leave the room during the pelvic exam.
A 2-year-old arrives at the ED in hypovolemic shock and needs fluids immediately. After
several attempts, your team has been unsuccessful at establishing vascular access. Of the
following, which is the next best option for establishing access quickly? - ANS Intraosseous in
the patient's medial tibia.
A child with an electrical injury is seen 1 hour post event. Which of the following types of
specimen samples would provide visual information regarding a potential complication of this
injury? - ANS Sputum (wrong)
Remediation feedback:
Electrical injuries, though they may appear to be small, can produce large amounts of damage
internally, including muscle damage. Myoglobin is excreted in the urine and is evidenced by
dark, red-tinged urine.
Parents with an infant requiring multiple laboratory tests, radiographic studies, and invasive
procedures appear to be distressed and withdrawn. Which of the following interventions would
best ensure a sense of comfort and control for these parents? - ANS Providing frequent
updates and re-educating them on the care that is being provided
When taking vital signs on a stable infant, which of the following should be done first? - ANS
Respiratory rate
, A laceration on a toddler's arm is prepared for suturing. Which of the following preparations for
topical anesthesia would be the best choice for this procedure? - ANS LET
(lidocaine/epinephrine/tetracaine)
Which of the following is appropriate administration of N-acetylcysteine (NAC) for an
acetaminophen overdose? - ANS A bolus infusion of 150 mg/kg NAC should be administered.
A 10-year-old arrives at the ED post motor vehicle crash. The following assessment is noted:
hypotension, tachycardia, absent breath sounds from the left chest with an increased respiratory
rate, pain on palpation of the pelvis, tinge of blood noted at the urinary meatus, moderate active
bleeding from a laceration to left thigh, pulse oximetry of 86% without supplemental oxygen,
deformity to the left upper leg, and a Glasgow Coma Score of 7. Which of the following orders
will prompt the nurse to have a discussion with the provider before initiating? - ANS Assist with
chest tube insertion (wrong)
Remediation feedback:
Urinary catheters are contraindicated for placement if pelvic injury is suspected or blood is noted
at the urinary meatus. Scrotal or perineal discolorations with edema to the areas is also a
contraindication for this adjunct.
A 2-year-old is seen with a 3-day history of irritability, vomiting, and the presence of
foul-smelling urine. The child is hypotensive and tachycardic. Which of the following methods for
obtaining a urine sample is most appropriate in this circumstance? - ANS Urinary catherization
A child with bipolar disorder is brought to the emergency department for increasing irritability,
agitation, pressured speech, and a decreased need for sleep. What should be included in the
plan of care for this child? - ANS Performing a suicide risk assessment
You are discharging a patient home who has a history of depression. Discharge teaching
should include which of the following? - ANS Ensuring all firearms in the home are locked up
with no access available by the patient.
A 5-year-old child presents with hives, swelling of the lips and face, and stridor that developed
about an hour after eating lunch. The child has no known allergies. Which of the following is the
priority intervention? - ANS Administer intramuscular epinephrine
Which of the following pathologic processes would most likely be attributed to a primary
diagnosis of cystic fibrosis? - ANS Constipation
A 2-year-old arrives with a 2-day history of vomiting and diarrhea. The patient has a fever of
38.4oC (101.2°F), resting HR of 152 beats/minute, RR of 34 breaths/minute, and blood pressure
of 94/ 56 mm Hg. Assessment reveals a capillary refill time of > 5 seconds. Which of the
following would be most indicative of the need for intravenous rehydration therapy for this
patient? - ANS Capillary refill
, Which of the following is a family-centered care concept ? - ANS Cultural backgrounds are
assessed and incorporated into the plan of care.
An 8-month-old arrives with a 12-hour history of intermittent abdominal pain, non-bilious
vomiting, and a low grade fever. On assessment the child is intermittently inconsolable followed
by periods of normal activity. A sausage-shaped mass is noted during palpation of the abdomen.
The nurse should prepare for which of the following? - ANS Enema with air
A caregiver presents to the emergency department with an 18-month-old and reports the child
is not using their left arm after playing a game with an older sibling. The child is alert and
curious, with regular, even respirations, and skin color is appropriate. Using the Pediatric
Assessment Triangle (PAT), how would you categorize this patient? - ANS Sick
A 13-year -old male presents to the triage desk complaining of nausea and vomiting. The
patient looks distressed and pale. He complains of spasming pain in his right scrotum which has
now become constant and more severe. Which of the following assessment findings would the
nurse expect with this patient? - ANS Elevated right testicle
An 8-year-old trauma patient suddenly develops increased respiratory distress with a rise in
heart rate from 112 beats/minute to 142 beats/minute associated with an abrupt hypotensive
event. Distention of the jugular veins is noted. Which of the following emergent interventions
should be anticipated first? - ANS Drug assisted intubation (wrong)
Remediation feedback:
Tension pneumothorax is a complication of trauma associated with an original pneumothorax.
Air in the pleural space increases and compresses the heart and great vessels creating a type
of obstructive shock. A hallmark sign, tracheal deviation, can be difficult to see in the pediatric
patient. Needle decompression is emergently necessary to release the air and allow expansion
of the lung again.
An 8-year-old pedestrian is thrown onto the hood of a moving vehicle striking the windshield.
On arrival to the ED. the patient is minimally responsive with active bleeding from the nose and
mouth. The patient is vomiting. Which of the following interventions would most likely be
considered? - ANS Endotracheal intubation
The nurse is reevaluating the effectiveness of interventions for a 4-year-old child with a
suspected tension pneumothorax. Which assessment finding indicates the interventions were
effective? - ANS Bilateral chest wall rise with assisted ventilations.
A 3-year-old is brought by caregivers with generalized tonic-clonic activity, unresponsiveness,
and drooling that began 6 minutes prior to arrival. Which of the following interventions would be
most appropriate for this event? - ANS Administer intranasal midazolam
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? - ANS 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.
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 increasing manifestations instead of improvement. Which of the
following would be considered to be definitive treatment for the suspected diagnosis? - ANS
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.
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? - ANS Establishing a secure airway
Parents report their 3-year-old child has developed noisy breathing. On assessment,
high-pitched wheezes are audible and auscultated on inspiration and expiration. What
medication would be appropriate to administer first? - ANS 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.
, 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? - ANS Lumbar puncture
A 12-year-old is being prepped for surgical intervention of acute appendicitis. Which of the
following intravenous medication orders should the nurse question? - ANS 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.
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? - ANS
Have the boyfriend leave the room during the pelvic exam.
A 2-year-old arrives at the ED in hypovolemic shock and needs fluids immediately. After
several attempts, your team has been unsuccessful at establishing vascular access. Of the
following, which is the next best option for establishing access quickly? - ANS Intraosseous in
the patient's medial tibia.
A child with an electrical injury is seen 1 hour post event. Which of the following types of
specimen samples would provide visual information regarding a potential complication of this
injury? - ANS Sputum (wrong)
Remediation feedback:
Electrical injuries, though they may appear to be small, can produce large amounts of damage
internally, including muscle damage. Myoglobin is excreted in the urine and is evidenced by
dark, red-tinged urine.
Parents with an infant requiring multiple laboratory tests, radiographic studies, and invasive
procedures appear to be distressed and withdrawn. Which of the following interventions would
best ensure a sense of comfort and control for these parents? - ANS Providing frequent
updates and re-educating them on the care that is being provided
When taking vital signs on a stable infant, which of the following should be done first? - ANS
Respiratory rate
, A laceration on a toddler's arm is prepared for suturing. Which of the following preparations for
topical anesthesia would be the best choice for this procedure? - ANS LET
(lidocaine/epinephrine/tetracaine)
Which of the following is appropriate administration of N-acetylcysteine (NAC) for an
acetaminophen overdose? - ANS A bolus infusion of 150 mg/kg NAC should be administered.
A 10-year-old arrives at the ED post motor vehicle crash. The following assessment is noted:
hypotension, tachycardia, absent breath sounds from the left chest with an increased respiratory
rate, pain on palpation of the pelvis, tinge of blood noted at the urinary meatus, moderate active
bleeding from a laceration to left thigh, pulse oximetry of 86% without supplemental oxygen,
deformity to the left upper leg, and a Glasgow Coma Score of 7. Which of the following orders
will prompt the nurse to have a discussion with the provider before initiating? - ANS Assist with
chest tube insertion (wrong)
Remediation feedback:
Urinary catheters are contraindicated for placement if pelvic injury is suspected or blood is noted
at the urinary meatus. Scrotal or perineal discolorations with edema to the areas is also a
contraindication for this adjunct.
A 2-year-old is seen with a 3-day history of irritability, vomiting, and the presence of
foul-smelling urine. The child is hypotensive and tachycardic. Which of the following methods for
obtaining a urine sample is most appropriate in this circumstance? - ANS Urinary catherization
A child with bipolar disorder is brought to the emergency department for increasing irritability,
agitation, pressured speech, and a decreased need for sleep. What should be included in the
plan of care for this child? - ANS Performing a suicide risk assessment
You are discharging a patient home who has a history of depression. Discharge teaching
should include which of the following? - ANS Ensuring all firearms in the home are locked up
with no access available by the patient.
A 5-year-old child presents with hives, swelling of the lips and face, and stridor that developed
about an hour after eating lunch. The child has no known allergies. Which of the following is the
priority intervention? - ANS Administer intramuscular epinephrine
Which of the following pathologic processes would most likely be attributed to a primary
diagnosis of cystic fibrosis? - ANS Constipation
A 2-year-old arrives with a 2-day history of vomiting and diarrhea. The patient has a fever of
38.4oC (101.2°F), resting HR of 152 beats/minute, RR of 34 breaths/minute, and blood pressure
of 94/ 56 mm Hg. Assessment reveals a capillary refill time of > 5 seconds. Which of the
following would be most indicative of the need for intravenous rehydration therapy for this
patient? - ANS Capillary refill
, Which of the following is a family-centered care concept ? - ANS Cultural backgrounds are
assessed and incorporated into the plan of care.
An 8-month-old arrives with a 12-hour history of intermittent abdominal pain, non-bilious
vomiting, and a low grade fever. On assessment the child is intermittently inconsolable followed
by periods of normal activity. A sausage-shaped mass is noted during palpation of the abdomen.
The nurse should prepare for which of the following? - ANS Enema with air
A caregiver presents to the emergency department with an 18-month-old and reports the child
is not using their left arm after playing a game with an older sibling. The child is alert and
curious, with regular, even respirations, and skin color is appropriate. Using the Pediatric
Assessment Triangle (PAT), how would you categorize this patient? - ANS Sick
A 13-year -old male presents to the triage desk complaining of nausea and vomiting. The
patient looks distressed and pale. He complains of spasming pain in his right scrotum which has
now become constant and more severe. Which of the following assessment findings would the
nurse expect with this patient? - ANS Elevated right testicle
An 8-year-old trauma patient suddenly develops increased respiratory distress with a rise in
heart rate from 112 beats/minute to 142 beats/minute associated with an abrupt hypotensive
event. Distention of the jugular veins is noted. Which of the following emergent interventions
should be anticipated first? - ANS Drug assisted intubation (wrong)
Remediation feedback:
Tension pneumothorax is a complication of trauma associated with an original pneumothorax.
Air in the pleural space increases and compresses the heart and great vessels creating a type
of obstructive shock. A hallmark sign, tracheal deviation, can be difficult to see in the pediatric
patient. Needle decompression is emergently necessary to release the air and allow expansion
of the lung again.
An 8-year-old pedestrian is thrown onto the hood of a moving vehicle striking the windshield.
On arrival to the ED. the patient is minimally responsive with active bleeding from the nose and
mouth. The patient is vomiting. Which of the following interventions would most likely be
considered? - ANS Endotracheal intubation
The nurse is reevaluating the effectiveness of interventions for a 4-year-old child with a
suspected tension pneumothorax. Which assessment finding indicates the interventions were
effective? - ANS Bilateral chest wall rise with assisted ventilations.
A 3-year-old is brought by caregivers with generalized tonic-clonic activity, unresponsiveness,
and drooling that began 6 minutes prior to arrival. Which of the following interventions would be
most appropriate for this event? - ANS Administer intranasal midazolam
