ENPC 6TH EDITION 2026 LATEST
UPDATE!!!
A 5-year-old child presents to the emergency department after being hit by a car. The
patient complains of left upper quadrant pain, and the focused assessment with
sonography for trauma (FAST) exam shows fluid around her spleen. Which of the
following findings would be an early indication of ongoing blood loss?
A.Widening pulse pressure
B.Bradycardia
C.Decreasing diastolic blood pressure
D.Weak peripheral pulses - ANSWERD.Weak peripheral pulses
Rationale:
Early signs of hypovolemic shock include tachycardia and delayed capillary refill. The
nurse may note a strong central pulse but weaker peripheral pulses, indicating the child
is compensating by shunting blood to their core.
Which of the following indicates the need for additional caregiver education regarding a
urinary tract infection?
A.I should encourage my child to drink extra fluids.
B.I need to make a follow-up appointment with child's physician.
C.My child will grow out of their frequent urinary tract infections.
D.My child should complete all of their antibiotic medication - ANSWERC.My child will
grow out of their frequent urinary tract infections.
Rationale
Urinary tract infections are not a normal occurrence in children and are not something
children will "grow out of." Additional investigation and follow-up are needed when a
child has frequent urinary tract infections. Drinking extra fluids should be encouraged.
Patients should always finish the complete course of antibiotics to eliminate the
infection. And follow-up should be done to make sure the infection has been eliminated.
A 4-day-old who is brought to the emergency department with the parental complaint of
"not acting right" is found to be hypoglycemic. What is the appropriate glucose
concentration to administer to this neonate?
A.Dextrose 5%
B.Dextrose 10%
C.Dextrose 25%
D.Dextrose 50% - ANSWERB.Dextrose 10%
Rationale
Dextrose 10% is the preferred concentration for neonates with hypoglycemia to protect
their fragile vasculature while providing needed glucose. Dextrose 5% is not used to
treat hypoglycemia in children. Dextrose 25% is used for children above the age of 5
years. Dextrose 50% is not recommended for use in pediatrics unless it is diluted.
, Which of the following patient presentations should increase suspicion of potential child
maltreatment?
A.Closed greenstick wrist fracture in a 4-year-old child who fell off his bicycle
B.Bruises in various stages of healing to the lower extremities of a 2-year-old child
C.Right radial spiral fracture in a 10 year old practicing martial arts
D.Bruising to the left ear of a newborn from sleeping on his side - ANSWERD.Bruising
to the left ear of a newborn from sleeping on his side
Rationale
Any bruises in a non-exploratory location (especially torso, ears, and neck) in children
younger than 4 years old and ANY bruising in a child younger than 4 months old is
suspicious for child maltreatment. Bruises to the lower extremities of a 2-year-old who is
learning to walk on their own is not uncommon. Greenstick fractures are a more
common fracture is children due to the immaturity of their bone structure. Martial arts
includes many moves that could produce a spiral fracture.
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 - ANSWERB.An 18-month-old with
bilious emesis
Rationale
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 injuries, but does not take precedence unless
other symptoms are present. Infantile colic is described 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.
A 3-month-old is brought to the emergency department with new onset of fever. You
note the child to be pale, tachypneic, and tachycardic, with weak distal pulses. Which
intervention is the priority for this patient?
A.Administer an appropriate dose of an antipyretic
B.Infuse a rapid 10-20 mL/kg bolus of an isotonic crystalloid
C.Prepare a broad spectrum antibiotic infusion
D.Administer a vasoactive medication - ANSWERB.Infuse a rapid 10-20 mL/kg bolus of
an isotonic crystalloid
Rationale
This patient most likely has septic shock. An immediate goal is to reverse shock and
restore tissue perfusion with fluids. An antipyretic may be needed based on the
temperature and patient symptoms. An antibiotic should be started within an hour, and
vasoactive medications may not be needed if fluid resuscitation is successful.
UPDATE!!!
A 5-year-old child presents to the emergency department after being hit by a car. The
patient complains of left upper quadrant pain, and the focused assessment with
sonography for trauma (FAST) exam shows fluid around her spleen. Which of the
following findings would be an early indication of ongoing blood loss?
A.Widening pulse pressure
B.Bradycardia
C.Decreasing diastolic blood pressure
D.Weak peripheral pulses - ANSWERD.Weak peripheral pulses
Rationale:
Early signs of hypovolemic shock include tachycardia and delayed capillary refill. The
nurse may note a strong central pulse but weaker peripheral pulses, indicating the child
is compensating by shunting blood to their core.
Which of the following indicates the need for additional caregiver education regarding a
urinary tract infection?
A.I should encourage my child to drink extra fluids.
B.I need to make a follow-up appointment with child's physician.
C.My child will grow out of their frequent urinary tract infections.
D.My child should complete all of their antibiotic medication - ANSWERC.My child will
grow out of their frequent urinary tract infections.
Rationale
Urinary tract infections are not a normal occurrence in children and are not something
children will "grow out of." Additional investigation and follow-up are needed when a
child has frequent urinary tract infections. Drinking extra fluids should be encouraged.
Patients should always finish the complete course of antibiotics to eliminate the
infection. And follow-up should be done to make sure the infection has been eliminated.
A 4-day-old who is brought to the emergency department with the parental complaint of
"not acting right" is found to be hypoglycemic. What is the appropriate glucose
concentration to administer to this neonate?
A.Dextrose 5%
B.Dextrose 10%
C.Dextrose 25%
D.Dextrose 50% - ANSWERB.Dextrose 10%
Rationale
Dextrose 10% is the preferred concentration for neonates with hypoglycemia to protect
their fragile vasculature while providing needed glucose. Dextrose 5% is not used to
treat hypoglycemia in children. Dextrose 25% is used for children above the age of 5
years. Dextrose 50% is not recommended for use in pediatrics unless it is diluted.
, Which of the following patient presentations should increase suspicion of potential child
maltreatment?
A.Closed greenstick wrist fracture in a 4-year-old child who fell off his bicycle
B.Bruises in various stages of healing to the lower extremities of a 2-year-old child
C.Right radial spiral fracture in a 10 year old practicing martial arts
D.Bruising to the left ear of a newborn from sleeping on his side - ANSWERD.Bruising
to the left ear of a newborn from sleeping on his side
Rationale
Any bruises in a non-exploratory location (especially torso, ears, and neck) in children
younger than 4 years old and ANY bruising in a child younger than 4 months old is
suspicious for child maltreatment. Bruises to the lower extremities of a 2-year-old who is
learning to walk on their own is not uncommon. Greenstick fractures are a more
common fracture is children due to the immaturity of their bone structure. Martial arts
includes many moves that could produce a spiral fracture.
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 - ANSWERB.An 18-month-old with
bilious emesis
Rationale
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 injuries, but does not take precedence unless
other symptoms are present. Infantile colic is described 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.
A 3-month-old is brought to the emergency department with new onset of fever. You
note the child to be pale, tachypneic, and tachycardic, with weak distal pulses. Which
intervention is the priority for this patient?
A.Administer an appropriate dose of an antipyretic
B.Infuse a rapid 10-20 mL/kg bolus of an isotonic crystalloid
C.Prepare a broad spectrum antibiotic infusion
D.Administer a vasoactive medication - ANSWERB.Infuse a rapid 10-20 mL/kg bolus of
an isotonic crystalloid
Rationale
This patient most likely has septic shock. An immediate goal is to reverse shock and
restore tissue perfusion with fluids. An antipyretic may be needed based on the
temperature and patient symptoms. An antibiotic should be started within an hour, and
vasoactive medications may not be needed if fluid resuscitation is successful.
