ENPC UPDATED ACTUAL EXAM QUESTIONS
AND CORRECT ANSWERS FULL SOLUTION
GRADED A+
◉ A 4-year-old presents with vomiting, lethargy, frequent urination,
weight loss, and dry mucous membranes. Vital signs reveal deep
respirations at 44 breaths per minute, BP of 70/44 mm Hg, and HR of
144 beats per minute. Which of the following laboratory values would
be most expected in this child? Answer: Hypoglycemia (wrong)
Remediation feedback:
Children can present with new onset diabetes in diabetic ketoacidosis.
Manifestations include signs of dehydration ( dry mucous membranes,
hypotension, tachycardia), incontinence (polyuria), vomiting,
abdominal pain, Kussmaul respirations (to counter the acidosis),
polydipsia, anorexia, and weight loss. Expected laboratory values
would reveal an acidotic state with a pH level below 7.3, an elevated
serum bIcarbonate level, and an elevated blood glucose level > 200
mg.dL.
◉ An 18-month-old is seen for fever, slight circumoral cyanosis, and
wheezing noted on auscultation in the right upper lobe of the lung
field after a choking event 4 days ago. The white blood cell count is
elevated and the patient noted to be tachypneic, tachycardic, agitated,
and has an increased respiratory effort. At the time of the event, the
patient was started on antibiotics with subsequent increasing
manifestations instead of improvement. Which of the following would
,be considered to be definitive treatment for the suspected diagnosis?
Answer: The definitive treatment would be a bronchoscopy in order to
retrieve the suspected foreign body instead of diagnostic tests to
locate the foreign body itself.
◉ A child in cardiopulmonary arrest is receiving chest compressions
and manual ventilations with a bag-mask device. Once return of
spontaneous circulation has been confirmed, which of the following
would be the priority intervention? Answer: Establishing a secure
airway
◉ Parents report their 3-year-old child has developed noisy breathing.
On assessment, high-pitched wheezes are audible and auscultated on
inspiration and expiration. What medication would be appropriate to
administer first? Answer: initial medication intervention includes an
inhaled short-acting beta agonist.
◉ A 6-week-old is brought to the emergency department by the
caregivers for poor feeding, listlessness, and fever. Assessment
reveals a crying infant, HR 160 beats/minute, RR 52 breaths/minute,
rectal temperature of 96.0 F (35.5 C), and a bulging anterior fontanel.
Capillary refill is 4 seconds. Based on these findings what is the most
likely diagnostic test the nurse should anticipate? Answer: Lumbar
puncture
◉ A 12-year-old is being prepped for surgical intervention of acute
appendicitis. Which of the following intravenous medication orders
should the nurse question? Answer: Ketorolac
,Remediation feedback:
Ketorolac is an appropriate medication for moderate to severe pain,
however, it should not be used pre-operatively due to its potential to
increase the bleeding risk.
◉ A 17-year-old female arrives in the ED with her boyfriend who
states she is pregnant and having vaginal bleeding. The patient is
unsure of the gestational age and has not had any prenatal treatment.
The patient is quiet and lets her boyfriend answer most of the
questions. Which of the following is the most appropriate action for
the nurse to take at this point? Answer: Have the boyfriend leave the
room during the pelvic exam.
◉ A 2-year-old arrives at the ED in hypovolemic shock and needs
fluids immediately. After several attempts, your team has been
unsuccessful at establishing vascular access. Of the following, which
is the next best option for establishing access quickly? Answer:
Intraosseous in the patient's medial tibia.
◉ A child with an electrical injury is seen 1 hour post event. Which of
the following types of specimen samples would provide visual
information regarding a potential complication of this injury? Answer:
Myoglobin is excreted in the urine and is evidenced by dark, red-
tinged urine.
◉ Parents with an infant requiring multiple laboratory tests,
radiographic studies, and invasive procedures appear to be distressed
and withdrawn. Which of the following interventions would best
ensure a sense of comfort and control for these parents? Answer:
, Providing frequent updates and re-educating them on the care that is
being provided
◉ When taking vital signs on a stable infant, which of the following
should be done first? Answer: Respiratory rate
◉ A laceration on a toddler's arm is prepared for suturing. Which of
the following preparations for topical anesthesia would be the best
choice for this procedure? Answer: LET
(lidocaine/epinephrine/tetracaine)
◉ Which of the following is appropriate administration of N-
acetylcysteine (NAC) for an acetaminophen overdose? Answer: A
bolus infusion of 150 mg/kg NAC should be administered.
◉ A 2-year-old is seen with a 3-day history of irritability, vomiting,
and the presence of foul-smelling urine. The child is hypotensive and
tachycardic. Which of the following methods for obtaining a urine
sample is most appropriate in this circumstance? Answer: Urinary
catherization
◉ You are discharging a patient home who has a history of
depression. Discharge teaching should include which of the
following? Answer: Ensuring all firearms in the home are locked up
with no access available by the patient.
◉ A 2-year-old arrives with a 2-day history of vomiting and diarrhea.
The patient has a fever of 38.4oC (101.2°F), resting HR of 152
AND CORRECT ANSWERS FULL SOLUTION
GRADED A+
◉ A 4-year-old presents with vomiting, lethargy, frequent urination,
weight loss, and dry mucous membranes. Vital signs reveal deep
respirations at 44 breaths per minute, BP of 70/44 mm Hg, and HR of
144 beats per minute. Which of the following laboratory values would
be most expected in this child? Answer: Hypoglycemia (wrong)
Remediation feedback:
Children can present with new onset diabetes in diabetic ketoacidosis.
Manifestations include signs of dehydration ( dry mucous membranes,
hypotension, tachycardia), incontinence (polyuria), vomiting,
abdominal pain, Kussmaul respirations (to counter the acidosis),
polydipsia, anorexia, and weight loss. Expected laboratory values
would reveal an acidotic state with a pH level below 7.3, an elevated
serum bIcarbonate level, and an elevated blood glucose level > 200
mg.dL.
◉ An 18-month-old is seen for fever, slight circumoral cyanosis, and
wheezing noted on auscultation in the right upper lobe of the lung
field after a choking event 4 days ago. The white blood cell count is
elevated and the patient noted to be tachypneic, tachycardic, agitated,
and has an increased respiratory effort. At the time of the event, the
patient was started on antibiotics with subsequent increasing
manifestations instead of improvement. Which of the following would
,be considered to be definitive treatment for the suspected diagnosis?
Answer: The definitive treatment would be a bronchoscopy in order to
retrieve the suspected foreign body instead of diagnostic tests to
locate the foreign body itself.
◉ A child in cardiopulmonary arrest is receiving chest compressions
and manual ventilations with a bag-mask device. Once return of
spontaneous circulation has been confirmed, which of the following
would be the priority intervention? Answer: Establishing a secure
airway
◉ Parents report their 3-year-old child has developed noisy breathing.
On assessment, high-pitched wheezes are audible and auscultated on
inspiration and expiration. What medication would be appropriate to
administer first? Answer: initial medication intervention includes an
inhaled short-acting beta agonist.
◉ A 6-week-old is brought to the emergency department by the
caregivers for poor feeding, listlessness, and fever. Assessment
reveals a crying infant, HR 160 beats/minute, RR 52 breaths/minute,
rectal temperature of 96.0 F (35.5 C), and a bulging anterior fontanel.
Capillary refill is 4 seconds. Based on these findings what is the most
likely diagnostic test the nurse should anticipate? Answer: Lumbar
puncture
◉ A 12-year-old is being prepped for surgical intervention of acute
appendicitis. Which of the following intravenous medication orders
should the nurse question? Answer: Ketorolac
,Remediation feedback:
Ketorolac is an appropriate medication for moderate to severe pain,
however, it should not be used pre-operatively due to its potential to
increase the bleeding risk.
◉ A 17-year-old female arrives in the ED with her boyfriend who
states she is pregnant and having vaginal bleeding. The patient is
unsure of the gestational age and has not had any prenatal treatment.
The patient is quiet and lets her boyfriend answer most of the
questions. Which of the following is the most appropriate action for
the nurse to take at this point? Answer: Have the boyfriend leave the
room during the pelvic exam.
◉ A 2-year-old arrives at the ED in hypovolemic shock and needs
fluids immediately. After several attempts, your team has been
unsuccessful at establishing vascular access. Of the following, which
is the next best option for establishing access quickly? Answer:
Intraosseous in the patient's medial tibia.
◉ A child with an electrical injury is seen 1 hour post event. Which of
the following types of specimen samples would provide visual
information regarding a potential complication of this injury? Answer:
Myoglobin is excreted in the urine and is evidenced by dark, red-
tinged urine.
◉ Parents with an infant requiring multiple laboratory tests,
radiographic studies, and invasive procedures appear to be distressed
and withdrawn. Which of the following interventions would best
ensure a sense of comfort and control for these parents? Answer:
, Providing frequent updates and re-educating them on the care that is
being provided
◉ When taking vital signs on a stable infant, which of the following
should be done first? Answer: Respiratory rate
◉ A laceration on a toddler's arm is prepared for suturing. Which of
the following preparations for topical anesthesia would be the best
choice for this procedure? Answer: LET
(lidocaine/epinephrine/tetracaine)
◉ Which of the following is appropriate administration of N-
acetylcysteine (NAC) for an acetaminophen overdose? Answer: A
bolus infusion of 150 mg/kg NAC should be administered.
◉ A 2-year-old is seen with a 3-day history of irritability, vomiting,
and the presence of foul-smelling urine. The child is hypotensive and
tachycardic. Which of the following methods for obtaining a urine
sample is most appropriate in this circumstance? Answer: Urinary
catherization
◉ You are discharging a patient home who has a history of
depression. Discharge teaching should include which of the
following? Answer: Ensuring all firearms in the home are locked up
with no access available by the patient.
◉ A 2-year-old arrives with a 2-day history of vomiting and diarrhea.
The patient has a fever of 38.4oC (101.2°F), resting HR of 152
