ENPC (Emergency Nursing Pediatric Course) 2025/2026 – Overview
Comprehensive Review Structure (Total: 200 Questions)
Section 1 – Initial Assessment & Triage (Q1–40)
Section 2 – Respiratory & Airway Emergencies (Q41–80)
Section 3 – Circulatory, Shock, & Cardiac Emergencies (Q81–120)
Section 4 – Neurologic, Trauma, & Multisystem Emergencies (Q121–160)
Section 5 – Special Considerations & Psychosocial Care (Q161–200)
Section 1: Initial Assessment & Triage (Q1–40)
1. The Pediatric Assessment Triangle (PAT) immediately evaluates which three
domains at first glance?
A. Airway, Breathing, Circulation
B. Appearance, Vitals, Skin perfusion
C. Appearance, Work of Breathing, Circulation to Skin (CORRECT)
D. Neurologic status, Temperature, Glucose
Rationale:
The PAT is a rapid, hands-off tool used in seconds to identify a child in distress. It focuses on
appearance (tone, interactiveness, consolability), work of breathing (retractions, nasal flaring),
and circulation to the skin (pallor, mottling). Abnormalities in any domain trigger immediate
further assessment and intervention while guiding triage priority.
2. Which sign on the PAT most strongly suggests impending respiratory failure?
A. Mild tachypnea
B. Head bobbing or severe retractions (CORRECT)
C. Warm, flushed skin
D. Normal speech for age
,Rationale:
Head bobbing and severe accessory muscle use are late, high-risk signs in children indicating
the respiratory pump is failing. Unlike mild tachypnea, these signs suggest exhaustion and
imminent hypoventilation; immediate airway/oxygenation support and urgent escalation are
required.
3. In triage, the highest priority (resuscitation) category is assigned to a child
who is:
A. Ambulatory with fever
B. Unresponsive with no respirations (CORRECT)
C. Alert with localized pain
D. Stable with minor laceration
Rationale:
Triage is about rapid risk sorting. An unresponsive child with absent respirations needs
immediate lifesaving interventions (airway, breathing, circulation) and is triaged to
resuscitation/rescue priority. Other complaints are lower priority and can wait for assessment.
4. During primary survey (ABCDE), what is assessed immediately after airway
control?
A. Disability (neurologic)
B. Breathing (respiratory effort and oxygenation) (CORRECT)
C. Exposure
D. Full vitals
Rationale:
The ABCs are sequential: after ensuring the airway is open/protected, focus on Breathing —
observing effort, chest rise, breath sounds, and oxygenation. This identifies respiratory
compromise that needs immediate support (oxygen, ventilation, suction, or advanced airway).
5. A child with tachycardia, delayed capillary refill, and cool extremities but
normal blood pressure most likely has:
A. Compensated shock (CORRECT)
B. Dehydration without shock
C. Neurogenic shock
D. Hypothermia
,Rationale:
Children maintain blood pressure until late in shock by increasing systemic vascular resistance
and heart rate. Tachycardia, prolonged capillary refill, and cool extremities reflect poor
perfusion despite normal BP — classic compensated shock that requires urgent
fluid/resuscitative measures.
6. Which device is best for rapid, noninvasive continuous oxygen saturation
monitoring in triage?
A. Stethoscope
B. Blood pressure cuff
C. Pulse oximeter (CORRECT)
D. ETCO₂ capnograph
Rationale:
A pulse oximeter provides fast, continuous, noninvasive SpO₂ and pulse rate information at
triage. It helps identify hypoxemia not evident clinically. ETCO₂ is useful once ventilatory
support is in place but is not the first-line triage monitor.
7. The triage nurse notes a child with stridor at rest, drooling, and high fever.
The most appropriate immediate action is:
A. Obtain a chest x-ray
B. Prepare for immediate airway support and ENT consult (CORRECT)
C. Give oral antibiotics and discharge
D. Apply cool mist and observe
Rationale:
Stridor with drooling and systemic signs suggests severe upper airway obstruction (e.g.,
epiglottitis) and risk for rapid decompensation. Do not attempt throat exam or delay — prepare
airway equipment, oxygen, and emergency ENT/anesthesia support.
8. Which of the following is the most reliable early indicator of deterioration in a
pediatric patient?
A. Blood pressure drop
B. Slight fever
C. Change in mental status or level of responsiveness (CORRECT)
D. Mild cough
, Rationale:
Children often maintain vitals until decompensation. Altered mental status, irritability, or
decreased responsiveness signals inadequate cerebral perfusion or hypoxia — an early and
urgent red flag requiring immediate assessment and intervention.
9. A 2-year-old with asthma presents to triage. What initial measure should be
given immediately if in moderate distress?
A. Oral steroids only
B. Scheduled nebulizer later
C. Administer inhaled short-acting beta agonist (SABA) via spacer or nebulizer
(CORRECT)
D. IV magnesium sulfate
Rationale:
For acute asthma exacerbation, inhaled SABA (albuterol) is first-line to relieve bronchospasm.
Delivery via spacer or nebulizer provides prompt bronchodilation. Steroids are important but not
the immediate rescue; advanced therapies follow if inadequate response.
10. The STOP-BANG-like question for pediatric triage that helps detect severe
dehydration is:
A. Does the child have a cough?
B. Has the child had significantly reduced urine output and poor oral intake? (CORRECT)
C. Is the child vaccinated?
D. Does the child have a history of asthma?
Rationale:
Oliguria and poor oral intake are key markers of dehydration severity in children. Assessing
urine output and feeding behavior provides practical information for fluid needs and triage
urgency.
11. The primary reason children go into cardiac arrest is:
A. Primary arrhythmia
B. Massive myocardial infarction
C. Progressive respiratory failure or shock (CORRECT)
D. Electrolyte imbalance only
Comprehensive Review Structure (Total: 200 Questions)
Section 1 – Initial Assessment & Triage (Q1–40)
Section 2 – Respiratory & Airway Emergencies (Q41–80)
Section 3 – Circulatory, Shock, & Cardiac Emergencies (Q81–120)
Section 4 – Neurologic, Trauma, & Multisystem Emergencies (Q121–160)
Section 5 – Special Considerations & Psychosocial Care (Q161–200)
Section 1: Initial Assessment & Triage (Q1–40)
1. The Pediatric Assessment Triangle (PAT) immediately evaluates which three
domains at first glance?
A. Airway, Breathing, Circulation
B. Appearance, Vitals, Skin perfusion
C. Appearance, Work of Breathing, Circulation to Skin (CORRECT)
D. Neurologic status, Temperature, Glucose
Rationale:
The PAT is a rapid, hands-off tool used in seconds to identify a child in distress. It focuses on
appearance (tone, interactiveness, consolability), work of breathing (retractions, nasal flaring),
and circulation to the skin (pallor, mottling). Abnormalities in any domain trigger immediate
further assessment and intervention while guiding triage priority.
2. Which sign on the PAT most strongly suggests impending respiratory failure?
A. Mild tachypnea
B. Head bobbing or severe retractions (CORRECT)
C. Warm, flushed skin
D. Normal speech for age
,Rationale:
Head bobbing and severe accessory muscle use are late, high-risk signs in children indicating
the respiratory pump is failing. Unlike mild tachypnea, these signs suggest exhaustion and
imminent hypoventilation; immediate airway/oxygenation support and urgent escalation are
required.
3. In triage, the highest priority (resuscitation) category is assigned to a child
who is:
A. Ambulatory with fever
B. Unresponsive with no respirations (CORRECT)
C. Alert with localized pain
D. Stable with minor laceration
Rationale:
Triage is about rapid risk sorting. An unresponsive child with absent respirations needs
immediate lifesaving interventions (airway, breathing, circulation) and is triaged to
resuscitation/rescue priority. Other complaints are lower priority and can wait for assessment.
4. During primary survey (ABCDE), what is assessed immediately after airway
control?
A. Disability (neurologic)
B. Breathing (respiratory effort and oxygenation) (CORRECT)
C. Exposure
D. Full vitals
Rationale:
The ABCs are sequential: after ensuring the airway is open/protected, focus on Breathing —
observing effort, chest rise, breath sounds, and oxygenation. This identifies respiratory
compromise that needs immediate support (oxygen, ventilation, suction, or advanced airway).
5. A child with tachycardia, delayed capillary refill, and cool extremities but
normal blood pressure most likely has:
A. Compensated shock (CORRECT)
B. Dehydration without shock
C. Neurogenic shock
D. Hypothermia
,Rationale:
Children maintain blood pressure until late in shock by increasing systemic vascular resistance
and heart rate. Tachycardia, prolonged capillary refill, and cool extremities reflect poor
perfusion despite normal BP — classic compensated shock that requires urgent
fluid/resuscitative measures.
6. Which device is best for rapid, noninvasive continuous oxygen saturation
monitoring in triage?
A. Stethoscope
B. Blood pressure cuff
C. Pulse oximeter (CORRECT)
D. ETCO₂ capnograph
Rationale:
A pulse oximeter provides fast, continuous, noninvasive SpO₂ and pulse rate information at
triage. It helps identify hypoxemia not evident clinically. ETCO₂ is useful once ventilatory
support is in place but is not the first-line triage monitor.
7. The triage nurse notes a child with stridor at rest, drooling, and high fever.
The most appropriate immediate action is:
A. Obtain a chest x-ray
B. Prepare for immediate airway support and ENT consult (CORRECT)
C. Give oral antibiotics and discharge
D. Apply cool mist and observe
Rationale:
Stridor with drooling and systemic signs suggests severe upper airway obstruction (e.g.,
epiglottitis) and risk for rapid decompensation. Do not attempt throat exam or delay — prepare
airway equipment, oxygen, and emergency ENT/anesthesia support.
8. Which of the following is the most reliable early indicator of deterioration in a
pediatric patient?
A. Blood pressure drop
B. Slight fever
C. Change in mental status or level of responsiveness (CORRECT)
D. Mild cough
, Rationale:
Children often maintain vitals until decompensation. Altered mental status, irritability, or
decreased responsiveness signals inadequate cerebral perfusion or hypoxia — an early and
urgent red flag requiring immediate assessment and intervention.
9. A 2-year-old with asthma presents to triage. What initial measure should be
given immediately if in moderate distress?
A. Oral steroids only
B. Scheduled nebulizer later
C. Administer inhaled short-acting beta agonist (SABA) via spacer or nebulizer
(CORRECT)
D. IV magnesium sulfate
Rationale:
For acute asthma exacerbation, inhaled SABA (albuterol) is first-line to relieve bronchospasm.
Delivery via spacer or nebulizer provides prompt bronchodilation. Steroids are important but not
the immediate rescue; advanced therapies follow if inadequate response.
10. The STOP-BANG-like question for pediatric triage that helps detect severe
dehydration is:
A. Does the child have a cough?
B. Has the child had significantly reduced urine output and poor oral intake? (CORRECT)
C. Is the child vaccinated?
D. Does the child have a history of asthma?
Rationale:
Oliguria and poor oral intake are key markers of dehydration severity in children. Assessing
urine output and feeding behavior provides practical information for fluid needs and triage
urgency.
11. The primary reason children go into cardiac arrest is:
A. Primary arrhythmia
B. Massive myocardial infarction
C. Progressive respiratory failure or shock (CORRECT)
D. Electrolyte imbalance only
