ENPC Pre Course Questions and
Complete Solutions Graded A+
The caregiver of a 2-month-old infant states the patient has had trouble breathing for the past two days.
Pediatric assessment triangle (PAT) reveals an age-appropriate general appearance, rapid breathing with
mild distress, and pink skin. Mucous is noted in both nares. Which of the following is the best next step?
A. Obtain a history including immunization status
B. Suction nasal passages using a bulb syringe
C. Administer oxygen by nasal cannula with patient in caregiver's arms
D. Respiratory assessment is completed so move to circulatory - Answer: B. Suction nasal passages using
a bulb syringe
Infants up to four months old are obligate nose breathers and can have respiratory distress when nares
are occluded. Mucous can be gently suctioned using a bulb syringe or suction catheter. A good,
thorough history should always include immunization status for pediatric patients. The nose needs to be
clear before applying oxygen via nasal cannula. Respiratory assessment includes interventions to
improve breathing so you would not move to move to circulation until that is accomplished.
The caregiver of a 7-year old reports witnessing a seizure at home, but no seizure history. The patient is
post-ictal with a heart rate of 142 beats per minute, respiratory rate of 36 breaths per minute, and
blood pressure of 86/72 mm Hg. Significant burns are noted to the patient's back and lower extremities.
The caregiver states the burns accidentally occurred three days ago but was afraid to bring the patient in
due to an ongoing child welfare investigation. Which of the following groups of interventions are the
priority for this patient?
A. Call police and child welfare authorities and have security detain the caregiver
B. Administer intravenous analgesics and obtain a point of care glucose
C. Draw a metabolic panel, point of care glucose, and administer a fluid bolus
D. Administer lorazepam and a fluid bolus and place on seizure precautions - Answer: C. Draw a
metabolic panel, point of care glucose, and administer a fluid bolus.
, Burn injuries result in fluid and electrolyte shifts leading to hypovolemia and electrolyte imbalances.
Early 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 considered 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 the lungs
B. Insertion of orogastric to remove of water and debris from stomach
C. Endotracheal intubation to provide positive pressure ventilation
D. Removal of wet clothing to prevent hypothermia - Answer: C. Endotracheal intubation to provide
positive pressure ventilation.
The primary survey assessment and treatment of deficits are the priority. Airway control and positive
pressure ventilation while preparing for intubation of a child who meets intubation criteria (GCS < 8)
should be performed while also maintaining cervical spine stabilization. The child is responsive only to
painful stimuli, has shallow respirations, and diminished breath sounds. All of these are breathing
problems and must be addressed immediately. Removing wet clothing is necessary, but is not the main
priority initially. With intubation an orogastric tube will be placed and abdominal thrusts are not
necessary to remove fluid from the lungs.
Which of the following patients should be evaluated first?
A. A 3-year-old with a dislodged gastrostomy tube
B. An 18-month-old with bilious emesis
C. A 12-year-old with vomiting after a handlebar injury
D. A 3-month-old with periods of inconsolable crying - Answer: B. An 18-month-old with bilious emesis
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 handlebar injury may be indicative of many possible
Complete Solutions Graded A+
The caregiver of a 2-month-old infant states the patient has had trouble breathing for the past two days.
Pediatric assessment triangle (PAT) reveals an age-appropriate general appearance, rapid breathing with
mild distress, and pink skin. Mucous is noted in both nares. Which of the following is the best next step?
A. Obtain a history including immunization status
B. Suction nasal passages using a bulb syringe
C. Administer oxygen by nasal cannula with patient in caregiver's arms
D. Respiratory assessment is completed so move to circulatory - Answer: B. Suction nasal passages using
a bulb syringe
Infants up to four months old are obligate nose breathers and can have respiratory distress when nares
are occluded. Mucous can be gently suctioned using a bulb syringe or suction catheter. A good,
thorough history should always include immunization status for pediatric patients. The nose needs to be
clear before applying oxygen via nasal cannula. Respiratory assessment includes interventions to
improve breathing so you would not move to move to circulation until that is accomplished.
The caregiver of a 7-year old reports witnessing a seizure at home, but no seizure history. The patient is
post-ictal with a heart rate of 142 beats per minute, respiratory rate of 36 breaths per minute, and
blood pressure of 86/72 mm Hg. Significant burns are noted to the patient's back and lower extremities.
The caregiver states the burns accidentally occurred three days ago but was afraid to bring the patient in
due to an ongoing child welfare investigation. Which of the following groups of interventions are the
priority for this patient?
A. Call police and child welfare authorities and have security detain the caregiver
B. Administer intravenous analgesics and obtain a point of care glucose
C. Draw a metabolic panel, point of care glucose, and administer a fluid bolus
D. Administer lorazepam and a fluid bolus and place on seizure precautions - Answer: C. Draw a
metabolic panel, point of care glucose, and administer a fluid bolus.
, Burn injuries result in fluid and electrolyte shifts leading to hypovolemia and electrolyte imbalances.
Early 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 considered 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 the lungs
B. Insertion of orogastric to remove of water and debris from stomach
C. Endotracheal intubation to provide positive pressure ventilation
D. Removal of wet clothing to prevent hypothermia - Answer: C. Endotracheal intubation to provide
positive pressure ventilation.
The primary survey assessment and treatment of deficits are the priority. Airway control and positive
pressure ventilation while preparing for intubation of a child who meets intubation criteria (GCS < 8)
should be performed while also maintaining cervical spine stabilization. The child is responsive only to
painful stimuli, has shallow respirations, and diminished breath sounds. All of these are breathing
problems and must be addressed immediately. Removing wet clothing is necessary, but is not the main
priority initially. With intubation an orogastric tube will be placed and abdominal thrusts are not
necessary to remove fluid from the lungs.
Which of the following patients should be evaluated first?
A. A 3-year-old with a dislodged gastrostomy tube
B. An 18-month-old with bilious emesis
C. A 12-year-old with vomiting after a handlebar injury
D. A 3-month-old with periods of inconsolable crying - Answer: B. An 18-month-old with bilious emesis
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 handlebar injury may be indicative of many possible
