ENPC 6TH EDITION PRE EXAM
CORRECT 100%
A 14-year-old patient sustained a displaced fracture of the radius and ulna after falling
from a bicycle. Which of the following pain control interventions is most likely to result in
improvement in symptoms related to pain? - ANSWERApplying a splint to the affected
extremity
Rationale
Splinting is an effective non-pharmacologic intervention to reduce pain associated with
fractures. This will also help to minimize complications. Topical creams and elevation of
the extremity will not help with pain control. The application of ice in an appropriate
manner can help, but not warmth which would be contraindicated in the early stages of
the injury.
Assessment of the fontanelle provides the most useful information for which two
components of the primary survey? - ANSWERCirculation and disability
Rationale
A sunken fontanelle is a red flag for circulation assessment in pediatric triage and may
indicate dehydration . A bulging fontanel is a red flag for disability assessment in
pediatric triage and can indicate increased intracranial pressure.
A 6-month-old is seen for a recurrent respiratory infection. During the assessment, the
mother adds that the patient's stools seem to be fatty or "greasy". Which of the following
disease processes would be a primary concern for this child? - ANSWERCystic fibrosis
Rationale
In patients with cystic fibrosis, thick mucus inhibits the release of pancreatic enzymes
necessary for digestion. This results in impaired absorption and the inability to utilize
ingested fats. These fats are excreted in the stools and can present as "fatty" or
"greasy". Combined with the recurrent upper respiratory infections for an infant, cystic
fibrosis should be ruled out. The other three disease processes frequently present with
respiratory issues but fatty stools would not normally be seen.
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? - ANSWERDextrose 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 indicates the need for additional caregiver education regarding a
urinary tract infection? - ANSWERMy 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.
You need to draw blood from a 2-year-old. Which of the following is the best approach
for this patient? - ANSWERHave them watch a cartoon on an I-pad or cell phone
Rationale
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.
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? - ANSWERSuction nasal
passages using a bulb syringe
Rationale
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.
An ambulance arrives with a 16-year-old male involved in a dirt bike crash who was
intubated prior to arrival. Which of the following is the priority assessment or
intervention? - ANSWERAssess endotracheal tube placement
Rationale
If a patient arrives with an artificial airway (endotracheal tube or tracheostomy) in place,
assess its placement, patency, and the oral airway (in that order) before moving to the
next step of the primary survey. The oropharynx should be checked for fluids or objects
such as broken teeth. Inserting a gastric tube in an intubated patient and starting a
second large caliber IV line should also be done, but they don't take priority over airway.
CORRECT 100%
A 14-year-old patient sustained a displaced fracture of the radius and ulna after falling
from a bicycle. Which of the following pain control interventions is most likely to result in
improvement in symptoms related to pain? - ANSWERApplying a splint to the affected
extremity
Rationale
Splinting is an effective non-pharmacologic intervention to reduce pain associated with
fractures. This will also help to minimize complications. Topical creams and elevation of
the extremity will not help with pain control. The application of ice in an appropriate
manner can help, but not warmth which would be contraindicated in the early stages of
the injury.
Assessment of the fontanelle provides the most useful information for which two
components of the primary survey? - ANSWERCirculation and disability
Rationale
A sunken fontanelle is a red flag for circulation assessment in pediatric triage and may
indicate dehydration . A bulging fontanel is a red flag for disability assessment in
pediatric triage and can indicate increased intracranial pressure.
A 6-month-old is seen for a recurrent respiratory infection. During the assessment, the
mother adds that the patient's stools seem to be fatty or "greasy". Which of the following
disease processes would be a primary concern for this child? - ANSWERCystic fibrosis
Rationale
In patients with cystic fibrosis, thick mucus inhibits the release of pancreatic enzymes
necessary for digestion. This results in impaired absorption and the inability to utilize
ingested fats. These fats are excreted in the stools and can present as "fatty" or
"greasy". Combined with the recurrent upper respiratory infections for an infant, cystic
fibrosis should be ruled out. The other three disease processes frequently present with
respiratory issues but fatty stools would not normally be seen.
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? - ANSWERDextrose 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 indicates the need for additional caregiver education regarding a
urinary tract infection? - ANSWERMy 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.
You need to draw blood from a 2-year-old. Which of the following is the best approach
for this patient? - ANSWERHave them watch a cartoon on an I-pad or cell phone
Rationale
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.
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? - ANSWERSuction nasal
passages using a bulb syringe
Rationale
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.
An ambulance arrives with a 16-year-old male involved in a dirt bike crash who was
intubated prior to arrival. Which of the following is the priority assessment or
intervention? - ANSWERAssess endotracheal tube placement
Rationale
If a patient arrives with an artificial airway (endotracheal tube or tracheostomy) in place,
assess its placement, patency, and the oral airway (in that order) before moving to the
next step of the primary survey. The oropharynx should be checked for fluids or objects
such as broken teeth. Inserting a gastric tube in an intubated patient and starting a
second large caliber IV line should also be done, but they don't take priority over airway.
