ENPC 6th Edition Exam Study Guide (Latest 2026)
1. A 2-year-old child is brought to the emergency department with
stridor, drooling, and a high fever. The child is sitting forward in a
"tripod" position. Which of the following is the priority nursing
intervention?
A) Prepare for immediate nasotracheal intubation
B) Visualize the posterior pharynx using a tongue blade to confirm the
diagnosis
C) Keep the child calm and allow them to remain in the parent's lap
while preparing for airway management
D) Administer nebulized racemic epinephrine immediately
Answer: C) Keep the child calm and allow them to remain in the
parent's lap while preparing for airway management
Rationale: The clinical presentation is classic for epiglottitis. Agitation
can worsen airway obstruction, leading to complete occlusion. The child
should be kept calm in a position of comfort (usually a parent's lap).
Visualizing the throat with a tongue blade is strictly contraindicated as it
can precipitate laryngospasm and complete airway obstruction. The
airway must be secured in a controlled environment (usually the OR),
but keeping the child calm is the immediate priority.
2. A nurse is assessing a 4-month-old infant with a suspected diagnosis
of bronchiolitis caused by RSV. Which of the following findings would be
most concerning and indicate impending respiratory failure?
,A) Bilateral wheezing and nasal flaring
B) A respiratory rate of 60 breaths/min and mild substernal retractions
C) Grunting, severe retractions, and a capillary refill of 4 seconds
D) Copious nasal secretions and a sporadic cough
Answer: C) Grunting, severe retractions, and a capillary refill of 4
seconds
Rationale: Grunting is a sign of severe respiratory distress attempting to
maintain alveolar recruitment (auto-PEEP). Severe retractions indicate
significant increased work of breathing. A capillary refill of 4 seconds
indicates systemic hypoperfusion, often secondary to respiratory fatigue
and impending cardiopulmonary failure.
3. The Pediatric Assessment Triangle (PAT) consists of three
components. Which of the following accurately lists these components?
A) Appearance, Work of Breathing, Circulation to the skin
B) Airway, Breathing, Circulation
C) Level of consciousness, Respiratory rate, Heart rate
D) Muscle tone, Pupil response, Blood pressure
Answer: A) Appearance, Work of breathing, Circulation to the skin
Rationale: The PAT is an rapid, across-the-room, hands-off assessment.
Appearance (muscle tone, interactiveness, consolability, look/gaze,
cry/speech) evaluates neurologic status. Work of breathing evaluates
respiratory effort. Circulation to skin evaluates perfusion.
,4. A 3-year-old is brought to the ED after ingesting an unknown amount
of mother's iron pills. The child is vomiting and having bloody diarrhea.
Which of the following medications should the nurse anticipate
administering?
A) Naloxone (Narcan)
B) Flumazenil (Romazicon)
C) Deferoxamine (Desferal)
D) Acetylcysteine (Mucomyst)
Answer: C) Deferoxamine (Desferal)
Rationale: Iron toxicity causes gastrointestinal bleeding, shock, and
hepatotoxicity. Deferoxamine is the specific chelating agent used to
treat severe iron poisoning by binding to iron and allowing it to be
excreted in the urine (often turning urine a "vin rose" color).
5. An 8-month-old infant is brought to the ED unresponsive. The parents
state the infant was fine 2 hours ago. Assessment reveals a lethargic
infant with a palpable anterior fontanelle that is bulging. Which of the
following is the most likely diagnosis?
A) Bacterial meningitis
B) Severe dehydration
C) Intussusception
D) Hypovolemic shock
, Answer: A) Bacterial meningitis
Rationale: A sudden decline in mental status accompanied by a bulging
fontanelle is a classic sign of increased intracranial pressure (ICP), highly
suspicious for bacterial meningitis. Dehydration would cause a sunken
fontanelle. Intussusception presents with colicky abdominal pain and
currant jelly stools.
6. A 14-year-old is brought to the ED after a near-drowning incident in
cold water. The patient is apneic and pulseless. Which of the following
best explains the physiological benefit of cold water submersion in this
scenario?
A) Cold water increases systemic vascular resistance, improving
perfusion.
B) Cold water induces the diving reflex, shunting blood to the brain and
heart, and decreases metabolic demand.
C) Cold water prevents aspiration of gastric contents.
D) Cold water causes peripheral vasoconstriction, preventing
hypothermia.
Answer: B) Cold water induces the diving reflex, shunting blood to the
brain and heart, and decreases metabolic demand.
Rationale: The mammalian diving reflex, triggered by cold water on the
face, causes bradycardia and peripheral vasoconstriction, shunting
oxygenated blood to the brain and heart. Hypothermia also lowers the
brain's metabolic oxygen demand. This combination can prolong the
window for successful resuscitation without neurologic deficit.
1. A 2-year-old child is brought to the emergency department with
stridor, drooling, and a high fever. The child is sitting forward in a
"tripod" position. Which of the following is the priority nursing
intervention?
A) Prepare for immediate nasotracheal intubation
B) Visualize the posterior pharynx using a tongue blade to confirm the
diagnosis
C) Keep the child calm and allow them to remain in the parent's lap
while preparing for airway management
D) Administer nebulized racemic epinephrine immediately
Answer: C) Keep the child calm and allow them to remain in the
parent's lap while preparing for airway management
Rationale: The clinical presentation is classic for epiglottitis. Agitation
can worsen airway obstruction, leading to complete occlusion. The child
should be kept calm in a position of comfort (usually a parent's lap).
Visualizing the throat with a tongue blade is strictly contraindicated as it
can precipitate laryngospasm and complete airway obstruction. The
airway must be secured in a controlled environment (usually the OR),
but keeping the child calm is the immediate priority.
2. A nurse is assessing a 4-month-old infant with a suspected diagnosis
of bronchiolitis caused by RSV. Which of the following findings would be
most concerning and indicate impending respiratory failure?
,A) Bilateral wheezing and nasal flaring
B) A respiratory rate of 60 breaths/min and mild substernal retractions
C) Grunting, severe retractions, and a capillary refill of 4 seconds
D) Copious nasal secretions and a sporadic cough
Answer: C) Grunting, severe retractions, and a capillary refill of 4
seconds
Rationale: Grunting is a sign of severe respiratory distress attempting to
maintain alveolar recruitment (auto-PEEP). Severe retractions indicate
significant increased work of breathing. A capillary refill of 4 seconds
indicates systemic hypoperfusion, often secondary to respiratory fatigue
and impending cardiopulmonary failure.
3. The Pediatric Assessment Triangle (PAT) consists of three
components. Which of the following accurately lists these components?
A) Appearance, Work of Breathing, Circulation to the skin
B) Airway, Breathing, Circulation
C) Level of consciousness, Respiratory rate, Heart rate
D) Muscle tone, Pupil response, Blood pressure
Answer: A) Appearance, Work of breathing, Circulation to the skin
Rationale: The PAT is an rapid, across-the-room, hands-off assessment.
Appearance (muscle tone, interactiveness, consolability, look/gaze,
cry/speech) evaluates neurologic status. Work of breathing evaluates
respiratory effort. Circulation to skin evaluates perfusion.
,4. A 3-year-old is brought to the ED after ingesting an unknown amount
of mother's iron pills. The child is vomiting and having bloody diarrhea.
Which of the following medications should the nurse anticipate
administering?
A) Naloxone (Narcan)
B) Flumazenil (Romazicon)
C) Deferoxamine (Desferal)
D) Acetylcysteine (Mucomyst)
Answer: C) Deferoxamine (Desferal)
Rationale: Iron toxicity causes gastrointestinal bleeding, shock, and
hepatotoxicity. Deferoxamine is the specific chelating agent used to
treat severe iron poisoning by binding to iron and allowing it to be
excreted in the urine (often turning urine a "vin rose" color).
5. An 8-month-old infant is brought to the ED unresponsive. The parents
state the infant was fine 2 hours ago. Assessment reveals a lethargic
infant with a palpable anterior fontanelle that is bulging. Which of the
following is the most likely diagnosis?
A) Bacterial meningitis
B) Severe dehydration
C) Intussusception
D) Hypovolemic shock
, Answer: A) Bacterial meningitis
Rationale: A sudden decline in mental status accompanied by a bulging
fontanelle is a classic sign of increased intracranial pressure (ICP), highly
suspicious for bacterial meningitis. Dehydration would cause a sunken
fontanelle. Intussusception presents with colicky abdominal pain and
currant jelly stools.
6. A 14-year-old is brought to the ED after a near-drowning incident in
cold water. The patient is apneic and pulseless. Which of the following
best explains the physiological benefit of cold water submersion in this
scenario?
A) Cold water increases systemic vascular resistance, improving
perfusion.
B) Cold water induces the diving reflex, shunting blood to the brain and
heart, and decreases metabolic demand.
C) Cold water prevents aspiration of gastric contents.
D) Cold water causes peripheral vasoconstriction, preventing
hypothermia.
Answer: B) Cold water induces the diving reflex, shunting blood to the
brain and heart, and decreases metabolic demand.
Rationale: The mammalian diving reflex, triggered by cold water on the
face, causes bradycardia and peripheral vasoconstriction, shunting
oxygenated blood to the brain and heart. Hypothermia also lowers the
brain's metabolic oxygen demand. This combination can prolong the
window for successful resuscitation without neurologic deficit.
