ENPC 6th Edition Final Exam Questions With Correct and Verified Answers

ENPC 6th Edition Final Exam Questions With Correct and Verified Answers "A 16-month-old child was an unrestrained front seat passenger in a motor vehicle crash. The chest x-ray reveals multiple rib fractures. These findings suggest what type of injury? A. Minor surface injury. B. Significant underlying injury. C. Significant surface injury. D. Minor underlying injury. - Correct Answer B. Significant underlying injury." "Which piece of information is most important to know prior to transferring a patient to another facility? A. Documentation of the family's health insurance coverage. B. Pertinent family health history. C. Confirmation of acceptance from the receiving hospital. D. Confirmation of a medical diagnosis. - Correct Answer C. Confirmation of acceptance from the receiving hospital." "A 10-year-old child who was struck by a car has a distended, tense abdomen. The child's heart rate is 144 beats/minute, respirations 24 breaths/minute, and blood pressure 120/80 mm Hg. Capillary refill is more than 3 seconds, and skin is pale and cool. The patient's signs and symptoms suggest: A. Obstructive shock. B. Distributive shock. C. Hypovolemic shock. D. Cardiogenic shock. - Correct Answer C. Hypovolemic shock." "A school-aged child is about to receive stitches. To evaluate his understanding of the procedure, you tell him: A. "Young people your age have questions about getting stitches. What are your questions?" B. "Don't cry while you are getting the stitches. Be brave like a man." C. "You will probably receive 10 stitches. Do you have any questions before we restrain you?" D. "Does your cut hurt? Would you like your mommy to hold you?" - Correct Answer A. "Young people your age have questions about getting stitches. What are your questions?"" "What is the preferred sit for intraosseous access in the infant? A. Lateral malleolus B. Iliac crest C. Proximal femur D. Anteromedial tibia - Correct Answer D. Anteromedial tibia" "An important consideration in the assessment of pain for an adolescent patient is that they: A. May deny or minimize their pain when friends visit for fear of losing control. B. Have difficulty localizing or describing the pain. C. Are unable to use the 1 to 10 scale to report their pain. D. Feel that the pain is a punishment for something they did wrong. - Correct Answer A. May deny or minimize their pain when friends visit for fear of losing control." An unresponsive 2-year-old child was found by his mother with a bottle labeled "Elavil 50 mg" by his side. Which piece of information is important to obtain from his mother? A. The size of the medication bottle. B. The expiration date of the medication. C. The number of pills left in the bottle. D. The person for whom the medication was prescribe. - Correct Answer C. The number of pills left in the bottle." "A nurse providing crisis intervention to the family of a seriously ill child can best keep the family informed of the child's condition by: A. Placing them in a secluded room. B. Referring to their child as "the patient". C. Telling the family how they should feel. D. Appointing one staff member to communicate with them. - Correct Answer D. Appointing one staff member to communicate with them." "An 8-month-old infant with pneumonia has severe intercostal and substernal retractions, weak muscle tone, lethargy, and gray skin color. The infant's condition does not improve after bag-mask ventilation. The next step in treatment is most likely to be: A. Administration of epinephrine. B. Supplemental warming measures. C. Rapid sequence intubation. D. Administration of albuterol. - Correct Answer C. Rapid sequence intubation." "Which combination of medications is best to have prepared for a pediatric resuscitation? A. Dopamine and sodium bicarbonate. B. Epinephrine and glucose. C. Naloxone and lidocaine. D. Pentothal and vecuronium. - Correct Answer B. Epinephrine and glucose." "A 20-day-old infant has a 1-week history of not eating well. The infant has a weak cry and is jittery. Which laboratory test is indicated? A. Arterial blood gas. B. Finger-stick glucose. C. Complete blood count with differential. D. Toxicology screen. - Correct Answer B. Finger-stick glucose." "The Pediatric Assessment Triangle is used to: A. Identify all life-threatening conditions that the child presents with. B. Perform a complete head-to-toe assessment on the child. C. Assess the status of the child's airway only upon arrive in the ED. D. Determine the severity of the child's illness or injury using the "across-the-room" assessment. - Correct Answer D. Determine the severity of the child's illness or injury using the "across-the-room" assessment." "The caregivers of a 6-year-old boy who is brought to the emergency department for abdominal pain should first be asked: A. "Are his immunizations current?" B. "Has anything happened to him at school recently?" C. "What is the reason for the child's visit and how long has he been ill?" D. "Has he been complaining of a sore throat or earache?" - Correct Answer C. "What is the reason for the child's visit and how long has he been ill?"" "A 9-month-old infant is crying loudly through the nursing assessment, and the caregiver is becoming distraught. The nurse should ask the caregiver to: A. Read a story to the infant. B. Offer the infant a pacifier. C. Return when the infant is consoled. D. Ignore the infant's behavior. - Correct Answer B. Offer the infant a pacifier." "During an intubation attempt, the child�s heart rate drops to 40 beats/minute. Which intervention is indicated? A. Ask the physician to stop the intubation attempt and perform bag-mask ventilation. B. Apply cricoid pressure and establish intravenous access. C. Inform the physician of the heart rate and ask the physician to intubate faster. D. Administer blow-by oxygen and begin chest compressions. - Correct Answer A. Ask the physician to stop the intubation attempt and perform bag-mask ventilation." "A 6- week-old infant is pale, has marked substernal retractions, expiratory grunting, and poor muscle tone. The emergency nurse should first: A. Obtain intravenous access. B. Apply a pulse oximeter. C. Prepare a chest x-ray. D. Administer 100% oxygen. - Correct Answer D. Administer 100% oxygen." "The best method to open the airway in an injured child is: A. Placing the head and neck in hyperextension. B. Using the jaw thrust maneuver. C. Placing the head and neck in flexion. D. Using the head tilt maneuver. - Correct Answer B. Using the jaw thrust maneuver." "A 4-year-old child with a history of the flu has a heart rate of 80 beats/minute, respirations of 16 breaths/minute, and capillary refill of more than 3 seconds. The proper sequence for nursing interventions would be: A. Position the airway, administer 100% oxygen, obtain venous access, and administer 20 ml/kg of an isotonic solution. B. Administer 100% oxygen, obtain venous access, administer 0. 1 mg/kg of epinephrine 1:10,000, and prepare for endotracheal intubation. C. Position the airway, provide bag-mask ventilation, provide synchronized cardioversion, and provide supplemental warmth. D. Administer 100% oxygen, prepare for a venous cutdown, administer 20 ml/kg of an isotonic solution, and obtain a chest x-ray. - Correct Answer A. Position the airway, administer 100% oxygen, obtain venous access, and administer 20 ml/kg of an isotonic solution." "A 3-year-old is transported by prehospital personnel after being struck by a car. The parents are en route. The child is screaming and uncooperative. Which is the best approach while conducting the secondary survey? A. Hold the child to comfort him. B. Wait for the parent's arrival. C. Observe for behavioral pain cues. D. Use a doll to demonstrate the examination. - Correct Answer C. Observe for behavioral pain cues." "Which ocular finding is associated with child maltreatment? A. Glaucoma. B. Conjunctivitis. C. Iritis. D. Retinal hemorrhage. - Correct Answer Retinal hemorrhage." "A pregnant 18-year-old woman arrives at the emergency department about ready to deliver a full-term infant. She states that she noticed a large amount of dark green fluid the last time she went to the bathroom. During the delivery, the nurse should prepare to: A. Dry and arm the infant as soon as is it delivered. B. Stimulate and ventilate the infant immediately after delivery. C. Suction the mouth and nose of the infant while on the perineum. D. Administer blow-by oxygen and rub the back immediately after delivery. - Correct Answer Suction the mouth and nose of the infant while on the perineum" "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? - Correct Answer Low pH level" "A teenager presents to the ED for evaluation of pain with deep inspiration. The pain was a sudden onset after running track at school. While obtaining the history, the patient states that they have Marfan Syndrome. What would be a priority triage question based on this information? - Correct Answer "Have you ever had a pneumothorax?"" "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? - Correct Answer Lumbar puncture" "A 6-month-old arrives with swelling to the left thigh. Caregivers deny any traumatic event. Assessment findings include a patient who is active and alert, in the 10th percentile for length, and has blue-grey sclera. Radiographs reveal a midshaft fracture of the left femur. Which of the following is the most likely cause? - Correct Answer Osteogenesis imperfecta" "Which of the following is considered a "red flag" when triaging a pediatric patient? - Correct Answer A 3-week-old with a temperature of 38.2°C (100.7°F)" "Which intervention should be performed next if tactile stimulation, positioning, drying, and blow-by oxygen administration do not increase a newborn's heart rate? A. Chest compressions. B. Umbilical vein cannulation. C. Endotracheal intubation. D. Bag-mask ventilation. - Correct Answer D. Bag-mask ventilation." "A 10-kg child has deep partial-thickness burns over 35% of the total body surface area. Which evaluation parameter indicates that fluid resuscitation is adequate? A. Heart rate of 160 beats/minute. B. Respiratory rate of 34 breaths/minute. C. Blood pressure of 80/60 mm Hg. D. Urine output of 11 ml/hour. - Correct Answer D. Urine output of 11 ml/hour." "A 7-year-old female sustains a minor head injury and did not lose consciousness. She does not respond to commands and groans in response to questions. Which action will quickly determine if her behavior indicates a serious head injury? A. Review her medical record for pre-existing developmental problems. B. Obtain a head computerized tomography scan. C. Conduct a developmental screening test. D. Ask the parents if her behavior is unusual. - Correct Answer D. Ask the parents if her behavior is unusual." "An 8-month-old child presents with purpura, irritability, and a rectal temperature of 39.4�C (102.9�F). An intervention of high priority is: A. Encouraging the caregiver to hold and comfort the child. B. Monitoring for signs and symptoms of increased intracranial pressure (ICP). C. Collecting urine for toxicology screen. D. Encouraging oral fluids and food. - Correct Answer B. Monitoring for signs and symptoms of increased intracranial pressure (ICP)." "A 4-year-old patient is being assessed for a foreign body in the nose. The child is awake and alert and watching a video on the caregivers phone. Vitals include HR of 110 beats/minute, RR of 26 breaths per minute, BP of 138/90 mm Hg, and T of 37.3oC (99.3oF) orally. Which of the following interventions should the nurse perform next? - Correct Answer The normal systolic blood pressure for a 4 year old is between 89-112 mm Hg. The other vitals are within normal limits for that age. When the clinical picture of the patient does not match the vitals, check to make sure you are using the correctly sized equipment first. A blood pressure cuff that is too small will give a reading that is higher than it actually is." "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? - Correct Answer Providing frequent updates and re-educating them on the care that is being provided" "Caregivers state an 18-month-old child had a harsh, barky cough, low-grade fever, and irritability throughout the night. On assessment this morning, the child appears alert, is interactive, their present cough is quiet, and their temperature is 98.8°F (37.1°C) axillary. Which of the following diagnoses is the highest probablity for this child? - Correct Answer Croup" "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? - Correct Answer Urinary catherization" "Which of the following is a first-line treatment for atopic dermatitis? - Correct Answer Skin hydration therapy" "Which of the following questions reflects the concept of the "teach-back" method? - Correct Answer "Would you repeat those instructions, so I can make sure I was clear?"" "A 15-year-old patient has attempted suicide by overdosing on amitriptyline. The emergency nurse should expect which of the following symptoms? - Correct Answer When assessing patients with a toxic ingestion, if the ABCs are within normal limits you move to Disability. You should check blood sugar for any altered level of consciousness." "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? - Correct Answer Endotracheal intubation" "An 8-year-old male presents to the emergency department with incoherent speech, hallucinations, and violent behavior. What is the priority in caring for this patient? - Correct Answer Ensure safety of the patient and staff" "A caregiver states their 3-year-old child ate some marijuana gummies approximately 3 hours prior to arrival. The PAT reveals the child is pink, difficult to arouse, and work of breathing is normal. What is your initial intervention? - Correct Answer Obtain a full set of vital signs" "A fertilizer silo exploded during a school tour of a working farm. The children are able to manage their own secretions but all are incontinent and salivating, with excess tearing. Which of the following is the priority intervention? - Correct Answer Removal of clothing and decontamination" "The nurse is triaging an infant brought to the emergency department by their caregiver. Which finding by the nurse leads the infant to be placed in isolation? - Correct Answer Purpuric rash" "A 5-year-old patient presents with severe dehydration and signs of shock due to viral gastroenteritis. Which of the following physiologic responses by this patient will have the greatest impact on improving their cardiac output? - Correct Answer Pediatric patients have strong compensatory mechanisms that attempt to counteract the cardiovascular effects of hypovolemic shock. In children, the heart rate increases to increase preload and cardiac output. Systemic vasoconstriction from epinephrine and norepinephrine release increases afterload." "A 3-year-old has a two-day history of runny nose, low-grade fever, and a "barky" cough at night. The child is awake and alert with noted stridor. Pulse oximetry is 96% on room air. Which of the following interventions would be the most appropriated for this child? - Correct Answer Administration of nebulized epinephrine" "A 15-year-old presents alone requesting care. Which of the following chief complaints would most likely be considered legal or appropriate to treat without parental consent? - Correct Answer Local and state laws must be followed but generally speaking, pregnancy issues can be treated without parental consent if the minor refuses contact with their family. Other issues that may be treated without parental consent include contraceptive needs, mental health issues, prenatal care, sexually transmitted diseases, and substance use request for help. Minors may be considered "emancipated" if they are living on their own, pregnant or already a parent, in the military, or married. Laws vary and must be followed in each locale." "A 5-year-old presents with sudden onset nausea, vomiting, abdominal cramping, hives, and hypotension after eating lunch. Which of the following is the priority intervention? - Correct Answer Intramuscular epinephrine" "A 3-year-old child who was found in a pool unresponsive has return of spontaneous circulation (ROSC) after prolonged resuscitation. Intubation was performed in the field. Upon arrival to the ED, which intervention is of highest priority? - Correct Answer Auscultate breath sounds over the epigastrium and lung fields." "You are discharging a patient home who has a history of depression. Discharge teaching should include which of the following? - Correct Answer Ensuring all firearms in the home are locked up with no access available by the patient." "A 12-year-old restrained, back -seat passenger involved in a motor vehicle crash is noted to have hypotension, tachycardia, and contusions and discoloration across the lap area. On exam a splenic rupture is suspected. Which of the following diagnoses should be suspected as a companion injury with these findings and associated mechanism of injury? - Correct Answer A Chance fracture (fracture of the lumbar spine) is often associated with belted passengers. Injuries associated with the "seatbelt sign" are small bowel, abdominal vasculature, ureteral, and splenic and liver injuries." "A 12-year-old complains of a severe headache for the past 8 hours. Which of the following past history disease processes would be considered a "red flag" and warrant immediate evaluation for this patient? - Correct Answer Sickle cell disease" "A school-aged child arrives in the emergency department with a 2-day history of vomiting. The child is cool and pale, with weak pulses, elevated heart rate, and capillary refill of 4 to 5 seconds. Which of the following is the priority intervention for the child? - Correct Answer Initiate a fluid bolus" "During your primary assessment of a 3-year-old, the child is pale, with a respiratory rate of 70 breaths/minute, costal retractions, poor air movement, and a pulse oximetry reading of 89%. What is the priority intervention for this patient? - Correct Answer Administer oxygen per protocol" "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? - Correct Answer Administer intramuscular epinephrine" "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? - Correct Answer Enema with air" "Which of the following is a family-centered care concept ? - Correct Answer Cultural backgrounds are assessed and incorporated into the plan of care." "Which of the following parameters would indicate that appropriate post resuscitation interventions were successfully carried out in the pediatric patient? - Correct Answer Pulse oximetry reading of 96%" "A 5-year-old presents with decreased level of consciousness and a wide complex and rapid rate on the electrocardiogram. Which of the following characteristics would indicate ventricular tachycardia as opposed to other tachydysrhythmias? - Correct Answer Heart rate between 120 to 200 beats/minute" "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? - Correct Answer Performing a suicide risk assessment" "Which of the following is the priority intervention for the nurse caring for an immunocompromised pediatric patient with a fever? - Correct Answer Placement in a negative pressure room" "A parent brings in a 4-month-old infant reporting seizure-like activity at home. The parent denies a fever and reports that the infant is otherwise healthy. Which of the following is most important for the nurse to inquire about? - Correct Answer The ratio of formula to water used when mixing a bottle" "A 6-year-old involved in a boating crash is awaiting admission for surgical repair of a fractured ankle. Which of the following manifestations during reassessments would cause the greatest concern for possible intra-abdominal trauma? - Correct Answer Diagnosis of intra-abdominal injury in a child can be challenging. Distracting injuries, pain, and anxiety can alter their ability to assist in pinpointing these types of injuries post-trauma. Intra-abdominal injuries can present with abdominal pain, but other important findings are shoulder pain, due to irritation of the phrenic nerve from the presence of blood or fluid in the peritoneal cavity, or umbilical or flank ecchymosis." "A child with an electrical injury is seen 1 hour post event. Which of the following specimen samples would provide visual information regarding a potential complication of this injury? - Correct Answer 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." "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? - Correct Answer Insert urinary catheter" "A child with an injury to the lower cervical spine with spinal cord involvement would most likely demonstrate which of the following findings during assessment? - Correct Answer Decreased respiratory effort" "A 2-year-old arrives with parents stating the child may have ingested a button battery. The patient initially choked and coughed and is now drooling with bloody sputum. Which of the following is the priority intervention? - Correct Answer Children who have ingested button batteries are at risk for multiple potential complications. The leaking battery fluids and electrical charge can cause ulcerations and necrosis and can lead to bleeding and airway compromise. For symptomatic patients, the child should be NPO and admitted for potential endoscopic removal. Children with esophageal burns should be hospitalized. Honey is recommended only for asymptomatic patients." "The neurosurgeon has decided to perform an invasive procedure in the emergency department to monitor the intracranial pressure on a 5-year-old patient. The family does not speak the local language. Which of the following interventions is most supportive of the family during the procedure? - Correct Answer Presenting the option for family presence with an assigned team member to facilitate communication and the presence of an interpreter is most supportive of the family." "A 6-year-old child weighing 20 kg (44.1 lb) arrives in full arrest following an electrocution event. CPR is in progress after defibrillation for ventricular fibrillation. What is the intravenous dose of epinephrine for this patient? - Correct Answer 0.2 mg" "An 8-year-old arrives following a bicycle crash with swelling and bleeding from the right side of his face, deformities to the jawline, nasal swelling, and epistaxis. He is unresponsive with snoring respirations and an absent gag reflex. Which of the following airway adjuncts would be most appropriate for this patient? - Correct Answer Oropharyngeal airway (OPA)" "A 3 year-old patient presents following frequent emesis and diarrhea over the past 12 hours. Which of the following assessment findings indicate that the patient' body is compensating for the fluid loss? - Correct Answer Increased diastolic blood pressure" "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? - Correct Answer Bronchoscopy" "A 14-year-old patient with Down syndrome presents with an abnormal gait, head tilted to the left, decreased sensation to the extremities, and urinary incontinence. The patient has no history of trauma. Which of the following diagnostics is the priority for this patient? - Correct Answer Cervical spine radiographs" "After a seizure at home, a 9-month-old infant is awake and interacting appropriately. Vital signs on arrival are HR 150 beats/minutes, RR 36 breaths/minute (unlabored), BP 80/52 mm Hg, SaO2 97% without supplemental oxygen, and T 102.7°F (39.3°C) rectally. During re-evaluation 2 hours after arrival, which of the following assessments would indicate appropriate measures were taken in treating this child? - Correct Answer Temperature 37.7°C (99.9°F)" "During a diaper change on a 4-month-old infant, the nurse measures the infant's urinary output. After subtracting the weight of a dry diaper, the wet diaper weighs 22 grams. What is the infant's estimated urinary output? - Correct Answer 22 mL" "Which patient reflects an EMTALA compliant transfer? - Correct Answer A post-ictal patient with status epilepticus being transferred to a higher level of care with an accepting physician. All records are copied." "A child presents with a history of poor oral intake. The patient is pale, lethargic, and has shallow, rapid respirations. Central pulses are weak and capillary refill time is four seconds. Which of the following interventions has the highest priority? - Correct Answer Initiate an intravenous fluid bolus" "A child was found unresponsive under the monkey bars during recess and arrives with the following assessment: eyes open only with supraorbital pressure stimulus, no verbal response is elicited, and withdraws arms and legs when a swab is inserted in the nose. Which of the following is the priority intervention for this child? - Correct Answer Prepare for immediate intubation" "Which of the following pathologic processes would most likely be attributed to a primary diagnosis of cystic fibrosis? - Correct Answer Constipation" "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? - Correct Answer Administer intranasal midazolam" "A 4-week-old infant born prematurely is brought to the emergency department due to the rapid onset of abdominal distention, vomiting, bloody stools, and exhibiting signs of shock. Based on these findings, what condition should the nurse suspect? - Correct Answer Necrotizing enterocolitis" "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? - Correct Answer LET (lidocaine/epinephrine/tetracaine)" "EMS is transporting a 12-year-old restrained passenger involved in a high-speed motor vehicle collision. The patient complains of increasing dyspnea. Breath sounds are clear and equal, and heart sounds are difficult to auscultate. Vitals include HR 132 beats/minute, RR 36 breaths/minute, and BP 80/55 mm Hg. Which of the following is the priority intervention? - Correct Answer Pericardiocentesis" "What is the first step in the care of the newly born infant? - Correct Answer Warm, dry, and stimulate" "Which of the following is the highest priority intervention for a well-appearing 2-month-old with a fever? - Correct Answer Urine culture" "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? - Correct Answer Establishing a secure airway" "A 5-year-old arrives in the ED with a 4 day history of vomiting. Vital signs: HR 136 beats/minute, RR 36 breaths/minute, BP 92/56 mm Hg, T 38oC (100.4oF), and pulse oximetry 93% on room air. The child is pale with warm, dry skin and a capillary refill of 3 seconds. A fluid bolus is completed. Which of the following reassessment findings indicate that a second fluid bolus is necessary? - Correct Answer Blood pressure of 92/78 mm Hg" "A 14-year-old patient presents to the emergency department with her aunt after being assaulted. The patient has multiple bruises inconsistent with the assault history and seems guarded with her answers. A urine test is positive for pregnancy, although the patient denies being sexually active. The aunt repeatedly asks when they will be discharged. The ED nurse recognizes these finding as red flags for which of the following? - Correct Answer Sex trafficking" "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? - Correct Answer Have the boyfriend leave the room during the pelvic exam." "Which of the following is the recommended method of insulin administration for a pediatric patient with diabetic ketoacidosis? - Correct Answer Insulin infusion" "When taking vital signs on a stable infant, which of the following should be done first? - Correct Answer Respiratory rate" "A 12-year-old female patient arrives awake and alert with an acute onset of abdominal pain on the right side, nausea, vomiting, and vaginal spotting. On palpation, the pain is localized to the right side and there is tenderness to the breasts. Which of the following laboratory tests is the priority for this patient? - Correct Answer Human chorionic gonadotropin" "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? - Correct Answer Intraosseous in the patient's medial tibia." "When caring for a potential crime victim, what evidence collection principle is imperative? - Correct Answer Clothing should not be placed on the floor in order to prevent contamination." "A nurse begins making multiple errors in clinical decisions regarding the care of patients in the pediatric emergency department. The nurse has worked many consecutive shifts caring for severely ill and injured children and mentioned to a co-worker that they are not sleeping and feel anxious about coming to work. What condition may this nurse be experiencing? - Correct Answer Vicarious traumatization or secondary traumatic stress (STS) can result from repeated exposure to traumatized or suffering patients without always knowing the outcomes. The fast-paced ED often requires the team to continue caring for patients without stopping to discuss a traumatic event." "A toddler arrives in a post-ictal state. Parents describe seizure-like activity and state they gave acetaminophen earlier in the day due to fussiness. Which of the following statements by the parents would be most concerning? - Correct Answer "He also had a seizure about 2 in the morning."" "A pediatric resuscitation has ended with the death of the child. Coroner notification has not been made yet. In dealing with the family of this child, how can the nurse facilitate their grieving process until legally required notification has been made? - Correct Answer Provide simple, straightforward information" "A 3-week old is brought to the emergency department with a history of fussiness, spitting up, crying, and watery stools. Assessment reveals an alert child with moist mucous membranes. Which of the following should be the priority? - Correct Answer Identify the type of feeding the caregiver uses" "The caregivers of a 6-year-old report the child developed a cough with nasal congestion and "pink-eye" that started two days ago. Today they noticed a raised, red rash on the face, and grey papules in the mouth. Which of the following is the priority intervention for this patient? - Correct Answer Rubeola (measles) often presents with a high fever, cough, coryza (nasal congestion), non-purulent conjunctivitis, and Koplick spots-white or gray papules on the mucous membranes. It is a highly contagious viral illness, and patients should have standard and airborne precautions initiated immediately upon suspicion to prevent the spread." "A parent presents to the emergency department carrying her 12-week-old infant. The PAT reveals an infant who is quiet and opens eyes with stimulation, whose breathing is regular and even, and whose skin is pale, with a scattered vesicular rash. What is the priority intervention for this infant? - Correct Answer Obtain a full set of vital signs" "A neonate presents to the emergency department with irritability, weak cry, and hypotonia. Which of the following is a priority intervention? - Correct Answer Serum blood glucose" "A 3-year-old is assessed for the presence of increasing amounts of serosanguineous drainage from his left nares over the past 6 hours. Which of the following foreign bodies is the most likely etiology? - Correct Answer Button battery" "A term infant is delivered in the emergency department. Which assessment finding is most concerning? - Correct Answer Central cyanosis" "An infant presents to the emergency department with difficulty breathing. The patient is pale and respirations appear rapid and shallow. Which location on the torso is the most effective site for assessing bilateral breath sounds? - Correct Answer Bilateral midaxillary" "An anxious 12-year-old child presents to the emergency department with a sudden onset of nausea, diarrhea, abdominal cramping, flushing, and hypotension. Symptoms started about 60 minutes after lunch. Which of the following conditions is the most likely cause of these symptoms? - Correct Answer Anaphylaxis" "A child has a nondisplaced fracture of the radius that has been splinted, with a sling in place and NSAIDs given for pain. Prior to discharge home with follow-up at a pediatric facility, what actions must be completed? - Correct Answer Discharge instructions including follow-up contact information." "A 7-year-old is being seen for new onset of headaches. Which of the following manifestations would most likely rule out the potential of a primary etiology? - Correct Answer The presence of ataxia with an associated headache would indicate a secondary etiology. Other red flags for secondary etiologies include age under 5 years, altered levels of consciousness, associated sickle cell disease, ventriculoperitoneal shunt, fever, increase in head circumference, seizure, sudden onset, and trauma related events. Migraines and tension headache are the two most common primary headaches." "A caregiver reports their one-month-old has had a yellowish color to their eyes and skin over the last two weeks. If left untreated, which body system can this affect? - Correct Answer Neurological" "A six-week-old infant presents to the emergency department with seizures. The infant is afebrile with a normal glucose level ,and caregivers report no signs of illness other than formula intolerance, which they treated by adding extra water to the formula. The nurse would expect to find which of the following laboratory abnormalities? - Correct Answer Hyponatremia" "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? - Correct Answer Bilateral chest wall rise with assisted ventilations." "Immediately following birth, a full-term neonate is not breathing and has a heart rate of 45 beats/minute. The neonate has been warmed, dried, stimulated, and suctioned without improvement. What the next step in resuscitation? - Correct Answer The initial steps in neonatal resuscitation are to warm, dry, stimulate, open the airway, and suction. If the neonate is not breathing or is gasping, or if the neonate is breathing but the heart rate is below 100 beats/minute after these initial steps, initiate positive pressure ventilation (PPV) at 21% oxygen and 40-60 breaths per minute." "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? - Correct Answer Elevated right testicle" "A 12-year-old involved in a house fire has full thickness, circumferential burns to bilateral lower extremities. Fluid resuscitation is in progress on arrival at the ED. On assessment the left pedal and posterior tibialis pulses are absent, with delayed capillary refill. Which of the following is the priority intervention? - Correct Answer Assist with escharotomy" "A 10-year-old playing baseball is hit in the chest with a ball. He immediately demonstrates loss of consciousness with no pulses. Which of the following is the priority intervention? - Correct Answer Utilize AED/defibrillator" "A 2-year-old child is seen with acute respiratory distress after playing alone. Caregiver statements indicate the child was found playing with irregular, ½ - ¾ inch sized pieces of a game. Which of the following assessment findings would most likely be expected for this situation? - Correct Answer Inspiratory stridor and coughing" "Which of the following physiological changes in an infant increase the chances of drowning? - Correct Answer Weak neck muscles" "The triage nurse is assessing a 14 year old male who was brought in by ambulance. The patient reports he was playing his video games at home when he had a sudden onset of groin pain that was so severe he became nauseated and vomited. Further assessment reveals a swollen scrotum. What is the priority intervention for this patient? - Correct Answer Preparing the patient for ultrasound" "An alteration in a child's interaction with their environment (appearance) can indicate a significant underlying problem. Which of the following mnemonics is most helpful in assessing the appearance of a child when applying the PAT? - Correct Answer TICLS" "A 3 year-old patient presents following frequent emesis and diarrhea over the past 12 hours. Which of the following assessment findings indicate that the patient' body is compensating for the fluid loss? - Correct Answer Increased diastolic blood pressure" "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? - Correct Answer Low pH level" "During the assessment of a 16-year-old patient, the ED nurse identifies them as a potential sex trafficking victim. Which of the following trauma-informed care principles has the highest priority for this patient? - Correct Answer Physical and psychological safety" "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? - Correct Answer Needle decompression" "A 12-year-old is being prepped for surgical intervention of acute appendicitis. Which of the following intravenous medication orders should the nurse question? - Correct Answer Ketorolac" "A 13-year-old is experiencing a sudden onset of testicular pain, swelling, and vomiting. The cremasteric reflex is absent. Which of the following diagnoses is of highest suspicion in this situation? - Correct Answer Testicular torsion" "A child recovering from procedural sedation is sleeping deeply and snoring loudly. The pulse oximetry reading is 92% without supplemental oxygen. Which of the following interventions would be the priority for this patient? - Correct Answer Reposition the airway"