ENPC 6th Edition —Exam
ENPC 6th Edition
Emergency Nursing Pediatric Course — Test
Questions and Answers| Latest Update
1. When using the Pediatric Assessment Triangle (PAT), which three
components does the nurse evaluate?
A. Airway, breathing, circulation
B. Appearance, work of breathing, circulation to skin
C. Vital signs, level of consciousness, skin color
D. Respiratory rate, heart rate, blood pressure
Answer: B
Rationale: The Pediatric Assessment Triangle is a rapid, hands-off visual
assessment tool consisting of three components: appearance (tone,
interactiveness, consolability, look/gaze, speech/cry), work of breathing, and
circulation to skin (color). It takes seconds to perform and helps the nurse form
a general impression before touching the child.
2. During the primary assessment of a pediatric trauma patient, which sequence
should the nurse follow?
A. Disability, airway, breathing, circulation, exposure
B. Airway with cervical spine stabilization, breathing, circulation, disability,
exposure
C. Breathing, airway, circulation, exposure, disability
D. Circulation, airway, breathing, disability, exposure
Answer: B
Page 1 of 44
, ENPC 6th Edition —Exam
Rationale: The primary assessment in ENPC follows the standard trauma
sequence: Airway (with cervical spine protection), Breathing, Circulation,
Disability (neurologic status), and Exposure/Environmental control (ABCDE),
ensuring life-threatening conditions are identified and treated in priority order.
3. A toddler presents limp with poor muscle tone, is not making eye contact,
and is not consolable by the caregiver. Using the PAT, this appearance finding
indicates:
A. A normal well-appearing child
B. A significantly abnormal appearance suggesting a serious underlying
problem requiring immediate intervention
C. Mild dehydration only
D. Normal toddler stranger anxiety
Answer: B
Rationale: Abnormal findings in the 'appearance' side of the PAT (using the
mnemonic TICLS: Tone, Interactiveness, Consolability, Look/gaze, Speech/cry)
— such as poor tone, lack of eye contact, and inconsolability — indicate
abnormal brain oxygenation, perfusion, or metabolic function, signaling a
potentially serious illness or injury requiring immediate action.
4. During the secondary assessment using the mnemonic 'SAMPLE,' the 'M'
stands for:
A. Mechanism of injury
B. Medications the child currently takes
C. Mental status
D. Medical history of the family
Answer: B
Rationale: SAMPLE history is a structured tool for obtaining a focused history:
Signs/symptoms, Allergies, Medications, Past medical history, Last oral intake,
and Events leading to the injury/illness. 'M' specifically refers to current
medications, including over-the-counter drugs and supplements.
Page 2 of 44
, ENPC 6th Edition —Exam
5. A nurse assesses a child's work of breathing as part of the PAT and notes
nasal flaring, retractions, and grunting. This finding suggests:
A. Normal respiratory effort for age
B. Increased work of breathing indicating respiratory distress
C. Adequate oxygenation with no concern
D. A behavioral response with no physiologic significance
Answer: B
Rationale: Nasal flaring, retractions (subcostal, intercostal, suprasternal), and
grunting are signs of increased work of breathing, indicating the child is
compensating for inadequate oxygenation/ventilation and needs prompt
respiratory assessment and intervention.
6. When assessing circulation to skin as part of the PAT, the nurse notes the
infant's skin is mottled and pale with delayed capillary refill. This most likely
indicates:
A. Normal newborn skin changes
B. Adequate perfusion
C. Poor perfusion, possibly from shock
D. Only a thermoregulation issue with no clinical significance
Answer: C
Rationale: Mottling, pallor, and delayed capillary refill (>2 seconds) reflect
poor peripheral perfusion, which can indicate early compensated shock as the
body shunts blood away from the periphery to preserve perfusion to vital
organs.
7. A nurse is performing a rapid cardiopulmonary assessment on an infant.
Which finding indicates the HIGHEST priority for intervention?
A. Respiratory rate of 40/min with mild retractions
B. Heart rate of 200/min with poor perfusion and altered mental status
C. Temperature of 100.9°F (38.3°C)
D. Mild nasal congestion
Answer: B
Page 3 of 44
, ENPC 6th Edition —Exam
Rationale: A heart rate of 200/min in an infant combined with poor perfusion
and altered mental status indicates decompensation and possible shock or a
dangerous tachyarrhythmia, requiring immediate intervention. This takes
priority over mild respiratory findings, low-grade fever, or congestion.
8. During disability assessment (the 'D' in the primary assessment), the nurse
should use which tool to rapidly assess a child's level of consciousness?
A. Glasgow Coma Scale or the AVPU scale (Alert, Voice, Pain, Unresponsive)
B. APGAR score
C. FLACC pain scale
D. Braden scale
Answer: A
Rationale: The AVPU scale (Alert, responds to Voice, responds to Pain,
Unresponsive) provides a rapid method to assess level of consciousness during
the primary assessment; the Glasgow Coma Scale (pediatric-adapted) provides
a more detailed neurologic assessment. FLACC assesses pain, and the Braden
scale assesses pressure injury risk.
9. When exposing a pediatric trauma patient for the 'E' in the primary
assessment, the nurse's priority is to:
A. Fully undress the child and leave them exposed for extended examination
without regard to temperature
B. Remove clothing to inspect for injuries while preventing hypothermia
through warming measures
C. Avoid exposing the child at all to prevent psychological distress
D. Only expose the chest, ignoring the extremities
Answer: B
Rationale: Exposure allows the nurse to fully inspect for injuries, but children
are at high risk for hypothermia due to their larger body surface area to mass
ratio, so the nurse must balance thorough inspection with immediate
rewarming measures (warm blankets, overhead warmers) to prevent heat loss.
Page 4 of 44
ENPC 6th Edition
Emergency Nursing Pediatric Course — Test
Questions and Answers| Latest Update
1. When using the Pediatric Assessment Triangle (PAT), which three
components does the nurse evaluate?
A. Airway, breathing, circulation
B. Appearance, work of breathing, circulation to skin
C. Vital signs, level of consciousness, skin color
D. Respiratory rate, heart rate, blood pressure
Answer: B
Rationale: The Pediatric Assessment Triangle is a rapid, hands-off visual
assessment tool consisting of three components: appearance (tone,
interactiveness, consolability, look/gaze, speech/cry), work of breathing, and
circulation to skin (color). It takes seconds to perform and helps the nurse form
a general impression before touching the child.
2. During the primary assessment of a pediatric trauma patient, which sequence
should the nurse follow?
A. Disability, airway, breathing, circulation, exposure
B. Airway with cervical spine stabilization, breathing, circulation, disability,
exposure
C. Breathing, airway, circulation, exposure, disability
D. Circulation, airway, breathing, disability, exposure
Answer: B
Page 1 of 44
, ENPC 6th Edition —Exam
Rationale: The primary assessment in ENPC follows the standard trauma
sequence: Airway (with cervical spine protection), Breathing, Circulation,
Disability (neurologic status), and Exposure/Environmental control (ABCDE),
ensuring life-threatening conditions are identified and treated in priority order.
3. A toddler presents limp with poor muscle tone, is not making eye contact,
and is not consolable by the caregiver. Using the PAT, this appearance finding
indicates:
A. A normal well-appearing child
B. A significantly abnormal appearance suggesting a serious underlying
problem requiring immediate intervention
C. Mild dehydration only
D. Normal toddler stranger anxiety
Answer: B
Rationale: Abnormal findings in the 'appearance' side of the PAT (using the
mnemonic TICLS: Tone, Interactiveness, Consolability, Look/gaze, Speech/cry)
— such as poor tone, lack of eye contact, and inconsolability — indicate
abnormal brain oxygenation, perfusion, or metabolic function, signaling a
potentially serious illness or injury requiring immediate action.
4. During the secondary assessment using the mnemonic 'SAMPLE,' the 'M'
stands for:
A. Mechanism of injury
B. Medications the child currently takes
C. Mental status
D. Medical history of the family
Answer: B
Rationale: SAMPLE history is a structured tool for obtaining a focused history:
Signs/symptoms, Allergies, Medications, Past medical history, Last oral intake,
and Events leading to the injury/illness. 'M' specifically refers to current
medications, including over-the-counter drugs and supplements.
Page 2 of 44
, ENPC 6th Edition —Exam
5. A nurse assesses a child's work of breathing as part of the PAT and notes
nasal flaring, retractions, and grunting. This finding suggests:
A. Normal respiratory effort for age
B. Increased work of breathing indicating respiratory distress
C. Adequate oxygenation with no concern
D. A behavioral response with no physiologic significance
Answer: B
Rationale: Nasal flaring, retractions (subcostal, intercostal, suprasternal), and
grunting are signs of increased work of breathing, indicating the child is
compensating for inadequate oxygenation/ventilation and needs prompt
respiratory assessment and intervention.
6. When assessing circulation to skin as part of the PAT, the nurse notes the
infant's skin is mottled and pale with delayed capillary refill. This most likely
indicates:
A. Normal newborn skin changes
B. Adequate perfusion
C. Poor perfusion, possibly from shock
D. Only a thermoregulation issue with no clinical significance
Answer: C
Rationale: Mottling, pallor, and delayed capillary refill (>2 seconds) reflect
poor peripheral perfusion, which can indicate early compensated shock as the
body shunts blood away from the periphery to preserve perfusion to vital
organs.
7. A nurse is performing a rapid cardiopulmonary assessment on an infant.
Which finding indicates the HIGHEST priority for intervention?
A. Respiratory rate of 40/min with mild retractions
B. Heart rate of 200/min with poor perfusion and altered mental status
C. Temperature of 100.9°F (38.3°C)
D. Mild nasal congestion
Answer: B
Page 3 of 44
, ENPC 6th Edition —Exam
Rationale: A heart rate of 200/min in an infant combined with poor perfusion
and altered mental status indicates decompensation and possible shock or a
dangerous tachyarrhythmia, requiring immediate intervention. This takes
priority over mild respiratory findings, low-grade fever, or congestion.
8. During disability assessment (the 'D' in the primary assessment), the nurse
should use which tool to rapidly assess a child's level of consciousness?
A. Glasgow Coma Scale or the AVPU scale (Alert, Voice, Pain, Unresponsive)
B. APGAR score
C. FLACC pain scale
D. Braden scale
Answer: A
Rationale: The AVPU scale (Alert, responds to Voice, responds to Pain,
Unresponsive) provides a rapid method to assess level of consciousness during
the primary assessment; the Glasgow Coma Scale (pediatric-adapted) provides
a more detailed neurologic assessment. FLACC assesses pain, and the Braden
scale assesses pressure injury risk.
9. When exposing a pediatric trauma patient for the 'E' in the primary
assessment, the nurse's priority is to:
A. Fully undress the child and leave them exposed for extended examination
without regard to temperature
B. Remove clothing to inspect for injuries while preventing hypothermia
through warming measures
C. Avoid exposing the child at all to prevent psychological distress
D. Only expose the chest, ignoring the extremities
Answer: B
Rationale: Exposure allows the nurse to fully inspect for injuries, but children
are at high risk for hypothermia due to their larger body surface area to mass
ratio, so the nurse must balance thorough inspection with immediate
rewarming measures (warm blankets, overhead warmers) to prevent heat loss.
Page 4 of 44
