ENPC 6th Edition Exam Emergency
Nursing Pediatric Course Official Practice
Exam Actual Exam 2026/2027 with Detailed
Rationales | Complete Exam-Style Questions
| Pass Guaranteed – A+ Graded
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SECTION 1: PEDIATRIC ASSESSMENT & TRIAGE Q1 – Q10
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Question 1 of 50
An 18-month-old toddler arrives in respiratory distress after choking on a grape. The child is
conscious, coughing weakly, and has stridor. Which is the priority nursing intervention?
A. Perform a blind finger sweep to remove the obstructing object.
B. Administer high-flow oxygen via non-rebreather mask and prepare for rapid sequence
intubation.
C. Encourage the child to continue coughing while positioning the child upright and preparing
for back blows if the cough becomes ineffective. ✓ CORRECT
D. Immediately deliver five back blows followed by five chest thrusts without assessing the
effectiveness of the cough.
Correct Answer: C
Rationale: A weak cough with stridor indicates a partial airway obstruction, and the child
should be allowed to continue coughing as long as they are conscious, as this is the most
effective means of clearing the airway. A blind finger sweep risks pushing the object deeper
or causing airway injury, and back blows are reserved for infants or unconscious patients with
complete obstruction. High-flow oxygen is appropriate but does not address the mechanical
obstruction, which remains the immediate life threat.
Question 2 of 50
A 2-year-old toddler arrives via private vehicle with a forehead laceration after falling from a
couch. The child is crying but consolable by the parent, has a 2 cm clean forehead laceration,
and vital signs are within normal limits. Using the Emergency Severity Index (ESI), which
triage level is most appropriate?
,A. ESI Level 4 ✓ CORRECT
B. ESI Level 1
C. ESI Level 2
D. ESI Level 3
Correct Answer: A
Rationale: A stable toddler with a minor laceration requiring simple closure is appropriately
triaged as ESI Level 4, as the child is stable and resources needed are limited. ESI Level 1 is
reserved for patients requiring immediate lifesaving intervention, which this child does not
need. ESI Level 3 typically involves multiple resources or complex lacerations, while this
presentation is straightforward and low-acuity.
Question 3 of 50
A school-age child is brought to the ED with fever and lethargy. The nurse knows that
understanding age-specific vital signs is essential. For a 6-year-old child, which respiratory
rate would be considered within normal limits?
A. 32 breaths per minute
B. 22 breaths per minute ✓ CORRECT
C. 16 breaths per minute
D. 40 breaths per minute
Correct Answer: B
Rationale: The normal respiratory rate for a 6-year-old child ranges from 18 to 25 breaths per
minute, making 22 breaths per minute appropriate. A rate of 32 breaths per minute is
tachypneic for this age group and may indicate respiratory distress, while 16 breaths per
minute is bradypneic and concerning for respiratory fatigue or neurologic compromise. ENPC
emphasizes that respiratory rate is the most sensitive early indicator of respiratory distress
in children.
Question 4 of 50
An emergency nurse is preparing to assess a 3-year-old child who fell at preschool and is
now holding the parent's leg and avoiding eye contact. Which approach best facilitates a
developmentally appropriate assessment?
A. Immediately perform the physical examination starting with the head and moving
systematically to the toes.
B. Ask the parent to restrain the child so the nurse can auscultate the heart and lungs without
interruption.
C. Begin the examination with the mouth and throat since these are often the most
distressing parts and should be done first.
, D. Start with the least invasive assessments, such as observing the child's gait and
auscultating the heart while the child sits on the parent's lap. ✓ CORRECT
Correct Answer: D
Rationale: A 3-year-old child is in the autonomy versus shame and doubt stage, so beginning
with non-threatening assessments while the child remains on the parent's lap respects
developmental needs and builds trust. Starting with the head-to-toe approach or restraining
the child increases anxiety and may compromise the accuracy of the assessment. The mouth
and throat should be examined last as they are the most invasive and distressing for a
preschooler.
Question 5 of 50
During the secondary survey of a 7-year-old who was struck by a car, the nurse notes bruising
across the lower abdomen in a linear pattern. The child is hemodynamically stable. Which is
the priority nursing action?
A. Apply a cervical collar and prepare for spinal immobilization.
B. Assess for abdominal tenderness, rigidity, and signs of intra-abdominal injury such as the
seat belt sign. ✓ CORRECT
C. Administer IV morphine at 0.1 mg/kg to manage pain before continuing the examination.
D. Obtain a detailed history from the parents regarding the child's past medical history and
allergies.
Correct Answer: B
Rationale: A linear abdominal bruising pattern consistent with a seat belt sign raises high
suspicion for intra-abdominal injury, including bowel perforation or mesenteric injury, and
requires immediate focused abdominal assessment. While cervical collar application is
important, the primary survey has already been completed and the child is stable, so the
secondary survey finding takes priority. Pain medication should not be administered until the
extent of injuries is fully assessed, as it may mask clinical deterioration.
Question 6 of 50
A 4-year-old child with a fractured forearm is crying and states, "It hurts a lot." The nurse
attempts to quantify the pain using a developmentally appropriate tool. Which assessment
method is most appropriate for this child?
A. The Faces Pain Scale-Revised, asking the child to point to the face that best shows how
much pain they feel. ✓ CORRECT
B. The Numeric Rating Scale from 0 to 10, asking the child to verbally state a number
representing their pain.
C. The Neonatal Infant Pain Scale, observing the child's facial expression, cry, and breathing
patterns.
Nursing Pediatric Course Official Practice
Exam Actual Exam 2026/2027 with Detailed
Rationales | Complete Exam-Style Questions
| Pass Guaranteed – A+ Graded
══════════════════════════════════════
SECTION 1: PEDIATRIC ASSESSMENT & TRIAGE Q1 – Q10
══════════════════════════════════════
Question 1 of 50
An 18-month-old toddler arrives in respiratory distress after choking on a grape. The child is
conscious, coughing weakly, and has stridor. Which is the priority nursing intervention?
A. Perform a blind finger sweep to remove the obstructing object.
B. Administer high-flow oxygen via non-rebreather mask and prepare for rapid sequence
intubation.
C. Encourage the child to continue coughing while positioning the child upright and preparing
for back blows if the cough becomes ineffective. ✓ CORRECT
D. Immediately deliver five back blows followed by five chest thrusts without assessing the
effectiveness of the cough.
Correct Answer: C
Rationale: A weak cough with stridor indicates a partial airway obstruction, and the child
should be allowed to continue coughing as long as they are conscious, as this is the most
effective means of clearing the airway. A blind finger sweep risks pushing the object deeper
or causing airway injury, and back blows are reserved for infants or unconscious patients with
complete obstruction. High-flow oxygen is appropriate but does not address the mechanical
obstruction, which remains the immediate life threat.
Question 2 of 50
A 2-year-old toddler arrives via private vehicle with a forehead laceration after falling from a
couch. The child is crying but consolable by the parent, has a 2 cm clean forehead laceration,
and vital signs are within normal limits. Using the Emergency Severity Index (ESI), which
triage level is most appropriate?
,A. ESI Level 4 ✓ CORRECT
B. ESI Level 1
C. ESI Level 2
D. ESI Level 3
Correct Answer: A
Rationale: A stable toddler with a minor laceration requiring simple closure is appropriately
triaged as ESI Level 4, as the child is stable and resources needed are limited. ESI Level 1 is
reserved for patients requiring immediate lifesaving intervention, which this child does not
need. ESI Level 3 typically involves multiple resources or complex lacerations, while this
presentation is straightforward and low-acuity.
Question 3 of 50
A school-age child is brought to the ED with fever and lethargy. The nurse knows that
understanding age-specific vital signs is essential. For a 6-year-old child, which respiratory
rate would be considered within normal limits?
A. 32 breaths per minute
B. 22 breaths per minute ✓ CORRECT
C. 16 breaths per minute
D. 40 breaths per minute
Correct Answer: B
Rationale: The normal respiratory rate for a 6-year-old child ranges from 18 to 25 breaths per
minute, making 22 breaths per minute appropriate. A rate of 32 breaths per minute is
tachypneic for this age group and may indicate respiratory distress, while 16 breaths per
minute is bradypneic and concerning for respiratory fatigue or neurologic compromise. ENPC
emphasizes that respiratory rate is the most sensitive early indicator of respiratory distress
in children.
Question 4 of 50
An emergency nurse is preparing to assess a 3-year-old child who fell at preschool and is
now holding the parent's leg and avoiding eye contact. Which approach best facilitates a
developmentally appropriate assessment?
A. Immediately perform the physical examination starting with the head and moving
systematically to the toes.
B. Ask the parent to restrain the child so the nurse can auscultate the heart and lungs without
interruption.
C. Begin the examination with the mouth and throat since these are often the most
distressing parts and should be done first.
, D. Start with the least invasive assessments, such as observing the child's gait and
auscultating the heart while the child sits on the parent's lap. ✓ CORRECT
Correct Answer: D
Rationale: A 3-year-old child is in the autonomy versus shame and doubt stage, so beginning
with non-threatening assessments while the child remains on the parent's lap respects
developmental needs and builds trust. Starting with the head-to-toe approach or restraining
the child increases anxiety and may compromise the accuracy of the assessment. The mouth
and throat should be examined last as they are the most invasive and distressing for a
preschooler.
Question 5 of 50
During the secondary survey of a 7-year-old who was struck by a car, the nurse notes bruising
across the lower abdomen in a linear pattern. The child is hemodynamically stable. Which is
the priority nursing action?
A. Apply a cervical collar and prepare for spinal immobilization.
B. Assess for abdominal tenderness, rigidity, and signs of intra-abdominal injury such as the
seat belt sign. ✓ CORRECT
C. Administer IV morphine at 0.1 mg/kg to manage pain before continuing the examination.
D. Obtain a detailed history from the parents regarding the child's past medical history and
allergies.
Correct Answer: B
Rationale: A linear abdominal bruising pattern consistent with a seat belt sign raises high
suspicion for intra-abdominal injury, including bowel perforation or mesenteric injury, and
requires immediate focused abdominal assessment. While cervical collar application is
important, the primary survey has already been completed and the child is stable, so the
secondary survey finding takes priority. Pain medication should not be administered until the
extent of injuries is fully assessed, as it may mask clinical deterioration.
Question 6 of 50
A 4-year-old child with a fractured forearm is crying and states, "It hurts a lot." The nurse
attempts to quantify the pain using a developmentally appropriate tool. Which assessment
method is most appropriate for this child?
A. The Faces Pain Scale-Revised, asking the child to point to the face that best shows how
much pain they feel. ✓ CORRECT
B. The Numeric Rating Scale from 0 to 10, asking the child to verbally state a number
representing their pain.
C. The Neonatal Infant Pain Scale, observing the child's facial expression, cry, and breathing
patterns.
