ENPC Pre Course Exam Questions with
Correct Answers 2025
What is the priority intervention for symptomatic bradycardia in a four-year-old child?
a. IV atropine
b. IV epinephrine
c. bag-mask ventilation
d. transcutaneous pacing - CORRECT ANSWER-C.
Identifying and treating other causes, chest compressions, and epinephrine are interventions for pediatri
c bradycardia with signs of poor perfusion that are not improved by adequate oxygenation and ventilati
on. Atropine and pacing may be considered if there is no response to the other interventions.
Which of the following patients should be evaluated first?
a. 3 yo with dislodged G-tube
b. 18m with bilious emesis
c. 12 you with vomiting after handlebar injury
d. 3m with periods of inconsolable crying - CORRECT ANSWER-B.
The presence of bilious emesis is especially concerning because it may be indicative of an immediately
life-threatening bowel obstruction. A dislodged gastrostomy tube should be reinserted within 4-
6 hours to prevent stoma closure. Vomiting following a handlebarVinjury may be indicative of many po
ssible injuries, but does not take precedence unless other symptoms are present. Infantile colic is descri
bed as inconsolable crying in infants, 2 weeks to 4 months old, for up to 3 hours per day, more than 3
days per week, and lasting for more than 3 weeks.
You need to draw blood from a 2-year-
old. Which of the following is the best approach for this patient?
a. allow them to hold the blood tubes before drawing
b. have them watch a cartoon on an ipad or cellphone
c. give them an explanation of what will happen
d. prepare the equipment in the room so they can see - CORRECT ANSWER-B.
The best approach to a toddler who requires interventions is to provide distractions whenever possible.
They are in the cognitive development phase of "sensorimotor/preoperational" so having the caregiver
present is helpful. You should move from the least invasive to most invasive tasks, and don't let them
watch you prepare since it will increase anxiety.
A 3-month-
old is brought to the emergency department with new onset of fever. You note the child to be pale, tac
hypneic, and tachycardic, with weak distal pulses. Which intervention is the priority for this patient?
a. administer an appropriate dose of an antipyretic
b. infuse rapid 10-20 mL/kg bolus of isotonic crystalloid
c. prepare a broad spectrum antibiotic infusion
d. administer a vasoactive medication - CORRECT ANSWER-B.
This patient most likely has septic shock. An immediate goal is to reverse shock and restore tissue perf
usion with fluids. An antipyretic may be needed based on the temperature and patient symptoms. An a
ntibiotic should be started within an hour, and vasoactive medications may not be needed if fluid resus
citation is successful.
, A 5-year-
old with no health problems presents to the emergency department with a sudden onset of chest pain a
nd shortness of breath. Parents state that the family was involved in a bad car crash two weeks ago. A
thorough assessment and workup has not revealed any abnormalities. Which of the following is the bes
t next step to take?
a. ask about any new bed-wetting or sleep disturbances
b. discharge to home and follow up with PCP
c. repeat a head to toe exam to identify any missed traumatic injuries
d. consult cardiology for appropriate follow-up - CORRECT ANSWER-A.
Physical complaints are not uncommon in children following a traumatic event. Once any physical inju
ries or illnesses have been ruled out, assessment for any behavioral concerns such as anxiety would be
indicated to facilitate appropriate care and follow-
up. The incident occurred two weeks prior, so the likelihood any severe medical issues is low.
The caregiver of a 7-
year old reports witnessing a seizure at home, but no seizure history. The patientVis post-
ictal with a heart rate of 142 beats per minute, respiratory rate of 36 breaths per minute, and blood pre
ssure of 86/72 mm Hg. Significant burns are noted to the patient's back and lower extremities. The car
egiver states the burns accidentally occurred three days ago, but was afraid to bring the patient in due t
o an ongoing child welfare investigation. Which of the following groups of interventions are the priorit
y for this patient?
a. call PD and child welfare and have security detain the caregiver
b. administer IV analgesics and obtain POCT glucose
c. draw metabolic panel, POCT glucose, and administer fluids
d. administer lorazepam and fluids and place of seizure precautions - CORRECT ANSWER-C.
Burn injuries result in fluid and electrolyte shifts leading to hypovolemia and electrolyte imbalances. E
arly identification and treatment of electrolyte imbalances can help prevent further seizures. Contacting
child protective services and other authorities can wait. The patient is post-
ictal so does not require lorazepam medication at this time. Pain medication can and should be conside
red with significant burns, but is not a priority.
A three-year-
old is rescued after being submerged in a pool for several minutes. On arrival the patient is responsive
to painful stimuli with shallow respirations, diminished breath sounds, and an occasional cough. Which
of the following interventions is the initial management priority?
a. initiation of abdominal thrusts to remove fluid from lungs
b. insertion of OG to remove water and debris from stomach
c. ETT intubation to provide PP ventilation
d. removal of wet clothes to prevent hypothermia - CORRECT ANSWER-C.
The primary survey assessment and treatment of deficits are the priority. Airway control and positive p
ressure ventilation while preparing for intubation of a child who meets intubation criteria (GCS < 8) sh
ould be performed while also maintaining cervical spine stabilization. The child is responsive only to p
ainful stimuli, has shallow respirations, and diminished breath sounds. All of these are breathing proble
ms and must be addressed immediately. Removing wet clothing is necessary, but is not the main priori
ty initially. With intubation an orogastric tube will be placed and abdominal thrusts are not necessary t
o remove fluid from the lungs.
The caregiver of a 2-month-
old infant states the patient has had trouble breathing for the past two days. Pediatric assessment triang
le (PAT) reveals an age-
appropriate general appearance, rapid breathing with mild distress, and pink skin. Mucous is noted in b
Correct Answers 2025
What is the priority intervention for symptomatic bradycardia in a four-year-old child?
a. IV atropine
b. IV epinephrine
c. bag-mask ventilation
d. transcutaneous pacing - CORRECT ANSWER-C.
Identifying and treating other causes, chest compressions, and epinephrine are interventions for pediatri
c bradycardia with signs of poor perfusion that are not improved by adequate oxygenation and ventilati
on. Atropine and pacing may be considered if there is no response to the other interventions.
Which of the following patients should be evaluated first?
a. 3 yo with dislodged G-tube
b. 18m with bilious emesis
c. 12 you with vomiting after handlebar injury
d. 3m with periods of inconsolable crying - CORRECT ANSWER-B.
The presence of bilious emesis is especially concerning because it may be indicative of an immediately
life-threatening bowel obstruction. A dislodged gastrostomy tube should be reinserted within 4-
6 hours to prevent stoma closure. Vomiting following a handlebarVinjury may be indicative of many po
ssible injuries, but does not take precedence unless other symptoms are present. Infantile colic is descri
bed as inconsolable crying in infants, 2 weeks to 4 months old, for up to 3 hours per day, more than 3
days per week, and lasting for more than 3 weeks.
You need to draw blood from a 2-year-
old. Which of the following is the best approach for this patient?
a. allow them to hold the blood tubes before drawing
b. have them watch a cartoon on an ipad or cellphone
c. give them an explanation of what will happen
d. prepare the equipment in the room so they can see - CORRECT ANSWER-B.
The best approach to a toddler who requires interventions is to provide distractions whenever possible.
They are in the cognitive development phase of "sensorimotor/preoperational" so having the caregiver
present is helpful. You should move from the least invasive to most invasive tasks, and don't let them
watch you prepare since it will increase anxiety.
A 3-month-
old is brought to the emergency department with new onset of fever. You note the child to be pale, tac
hypneic, and tachycardic, with weak distal pulses. Which intervention is the priority for this patient?
a. administer an appropriate dose of an antipyretic
b. infuse rapid 10-20 mL/kg bolus of isotonic crystalloid
c. prepare a broad spectrum antibiotic infusion
d. administer a vasoactive medication - CORRECT ANSWER-B.
This patient most likely has septic shock. An immediate goal is to reverse shock and restore tissue perf
usion with fluids. An antipyretic may be needed based on the temperature and patient symptoms. An a
ntibiotic should be started within an hour, and vasoactive medications may not be needed if fluid resus
citation is successful.
, A 5-year-
old with no health problems presents to the emergency department with a sudden onset of chest pain a
nd shortness of breath. Parents state that the family was involved in a bad car crash two weeks ago. A
thorough assessment and workup has not revealed any abnormalities. Which of the following is the bes
t next step to take?
a. ask about any new bed-wetting or sleep disturbances
b. discharge to home and follow up with PCP
c. repeat a head to toe exam to identify any missed traumatic injuries
d. consult cardiology for appropriate follow-up - CORRECT ANSWER-A.
Physical complaints are not uncommon in children following a traumatic event. Once any physical inju
ries or illnesses have been ruled out, assessment for any behavioral concerns such as anxiety would be
indicated to facilitate appropriate care and follow-
up. The incident occurred two weeks prior, so the likelihood any severe medical issues is low.
The caregiver of a 7-
year old reports witnessing a seizure at home, but no seizure history. The patientVis post-
ictal with a heart rate of 142 beats per minute, respiratory rate of 36 breaths per minute, and blood pre
ssure of 86/72 mm Hg. Significant burns are noted to the patient's back and lower extremities. The car
egiver states the burns accidentally occurred three days ago, but was afraid to bring the patient in due t
o an ongoing child welfare investigation. Which of the following groups of interventions are the priorit
y for this patient?
a. call PD and child welfare and have security detain the caregiver
b. administer IV analgesics and obtain POCT glucose
c. draw metabolic panel, POCT glucose, and administer fluids
d. administer lorazepam and fluids and place of seizure precautions - CORRECT ANSWER-C.
Burn injuries result in fluid and electrolyte shifts leading to hypovolemia and electrolyte imbalances. E
arly identification and treatment of electrolyte imbalances can help prevent further seizures. Contacting
child protective services and other authorities can wait. The patient is post-
ictal so does not require lorazepam medication at this time. Pain medication can and should be conside
red with significant burns, but is not a priority.
A three-year-
old is rescued after being submerged in a pool for several minutes. On arrival the patient is responsive
to painful stimuli with shallow respirations, diminished breath sounds, and an occasional cough. Which
of the following interventions is the initial management priority?
a. initiation of abdominal thrusts to remove fluid from lungs
b. insertion of OG to remove water and debris from stomach
c. ETT intubation to provide PP ventilation
d. removal of wet clothes to prevent hypothermia - CORRECT ANSWER-C.
The primary survey assessment and treatment of deficits are the priority. Airway control and positive p
ressure ventilation while preparing for intubation of a child who meets intubation criteria (GCS < 8) sh
ould be performed while also maintaining cervical spine stabilization. The child is responsive only to p
ainful stimuli, has shallow respirations, and diminished breath sounds. All of these are breathing proble
ms and must be addressed immediately. Removing wet clothing is necessary, but is not the main priori
ty initially. With intubation an orogastric tube will be placed and abdominal thrusts are not necessary t
o remove fluid from the lungs.
The caregiver of a 2-month-
old infant states the patient has had trouble breathing for the past two days. Pediatric assessment triang
le (PAT) reveals an age-
appropriate general appearance, rapid breathing with mild distress, and pink skin. Mucous is noted in b
