ENPC 6TH EDITION - SET 1 EXAM QUESTIONS
WITH ANSWERS AND EXPLANATIONS
1. A teen is somnolent with pinpoint pupils and a respiratory rate of 5/min after suspected opioid exposure.
What should the nurse prioritize?
A. Administer a benzodiazepine to reduce sedation
B. Wait for a toxicology screen before treatment
C. Give activated charcoal before supporting breathing
D. Support ventilation and administer naloxone as indicated
Correct Answer: D. Support ventilation and administer naloxone as indicated
Rationale: Opioid toxicity threatens ventilation. Airway and breathing support are immediate priorities, and
naloxone can rapidly reverse opioid-induced respiratory depression.
2. A child with severe hemophilia falls from a bicycle and strikes the head. The child is awake with a mild
headache and no external bleeding. Which action is most appropriate?
A. Treat the event as potentially serious internal bleeding and arrange urgent factor replacement/evaluation per
the child's plan
B. Discharge because there is no visible bleeding
C. Give aspirin for the headache
D. Wait for neurologic deterioration before notifying the hemophilia team
Correct Answer: A. Treat the event as potentially serious internal bleeding and arrange urgent factor
replacement/evaluation per the child's plan
Rationale: Children with hemophilia can develop life-threatening intracranial bleeding after apparently minor
trauma. Early factor replacement and evaluation are preferred rather than waiting for obvious neurologic decline.
3. A 6-year-old arrives confused and diaphoretic after being found difficult to arouse. Which rapid bedside
test should be obtained early because it identifies a reversible cause of altered mental status?
A. Bone age radiograph
B. Point-of-care blood glucose
C. Skin allergy testing
D. Serum vitamin D level
Correct Answer: B. Point-of-care blood glucose
Rationale: Hypoglycemia is a rapidly reversible cause of altered mental status and seizures. A bedside glucose
check is fast and should be part of the early evaluation.
4. A 7-year-old has a narrow-complex tachycardia at 210/min with an abrupt onset. The child is alert, has a
palpable pulse, and has no hypotension or signs of shock. What is the best initial action?
A. Attempt an age-appropriate vagal maneuver while preparing for adenosine
B. Start chest compressions because the heart rate is above 200/min
C. Begin unsynchronized defibrillation immediately
D. Give atropine before obtaining vascular access
Correct Answer: A. Attempt an age-appropriate vagal maneuver while preparing for adenosine
Rationale: A stable child with probable supraventricular tachycardia can undergo vagal maneuvers first, with
rapid IV/IO adenosine if the rhythm persists. Cardioversion is reserved for cardiopulmonary compromise or
refractory cases.
5. A caregiver reports that a 2-year-old may have swallowed a button battery 30 minutes ago. The child is
drooling but breathing without stridor. What is the priority?
A. Arrange immediate emergency evaluation to locate the battery and expedite removal if it is in the esophagus
B. Wait for abdominal pain before obtaining imaging
C. Give activated charcoal and observe at home for stool passage
D. Induce vomiting to recover the battery before it travels farther
Correct Answer: A. Arrange immediate emergency evaluation to locate the battery and expedite removal if it is
in the esophagus
Rationale: A button battery lodged in the esophagus can cause severe tissue injury within hours. Immediate
evaluation and removal are priorities; vomiting should not be induced and charcoal does not treat this exposure.
6. A 9-year-old after blunt chest trauma develops severe respiratory distress, hypotension, distended neck
veins, and absent breath sounds on the left. Which intervention is most urgent?
A. A fluid challenge as the only initial treatment
, B. Portable chest radiography before any intervention
C. Nebulized albuterol followed by reassessment
D. Immediate decompression of a suspected tension pneumothorax
Correct Answer: D. Immediate decompression of a suspected tension pneumothorax
Rationale: This pattern is classic for obstructive shock from tension pneumothorax. Treatment should not wait
for imaging when the clinical diagnosis is evident; immediate decompression is lifesaving.
7. A 19-day-old infant has a rectal temperature of 38.2 C (100.8 F), decreased feeding, and irritability.
Which response is most appropriate?
A. Treat the infant as high risk for serious infection and begin prompt age-appropriate sepsis evaluation and
management
B. Assume the fever is vaccine related and arrange routine follow-up
C. Observe without laboratory evaluation if the infant can be consoled
D. Discharge after acetaminophen lowers the temperature
Correct Answer: A. Treat the infant as high risk for serious infection and begin prompt age-appropriate sepsis
evaluation and management
Rationale: Young febrile infants can deteriorate rapidly and may have serious bacterial infection despite subtle
findings. An infant this age with fever requires prompt evaluation and management rather than routine outpatient
observation.
8. A child with a ventriculoperitoneal shunt develops repeated vomiting, worsening headache, and
increasing sleepiness. What complication should the nurse suspect?
A. Expected symptoms after normal shunt function
B. Isolated peripheral neuropathy
C. Shunt malfunction with increased intracranial pressure
D. Simple viral gastroenteritis as the most likely explanation
Correct Answer: C. Shunt malfunction with increased intracranial pressure
Rationale: Headache, vomiting, and altered level of consciousness in a child with a VP shunt are concerning for
obstruction or malfunction causing increased intracranial pressure and require urgent evaluation.
9. A 3-week-old infant has green bilious emesis and abdominal distention. Which response is most
appropriate?
A. Offer small frequent feeds and arrange follow-up next week
B. Treat the presentation as a possible intestinal obstruction or malrotation with volvulus requiring urgent surgical
evaluation
C. Give an antidiarrheal medication and observe
D. Reassure the caregiver that bilious emesis is typical reflux
Correct Answer: B. Treat the presentation as a possible intestinal obstruction or malrotation with volvulus
requiring urgent surgical evaluation
Rationale: Bilious emesis in a young infant is a surgical red flag. Malrotation with midgut volvulus can
compromise bowel perfusion and requires urgent evaluation.
10. When positioning an unconscious young child with a proportionally large occiput for airway
management, what is often needed to maintain a neutral airway position?
A. Maximum neck flexion toward the chest
B. Extreme neck extension
C. A thick pillow directly under the occiput
D. Padding under the shoulders or torso rather than under the head
Correct Answer: D. Padding under the shoulders or torso rather than under the head
Rationale: The large pediatric occiput can flex the neck when the child lies supine. A small shoulder or torso roll
can help align the airway in a neutral position.
11. A 14-year-old boy has sudden severe unilateral scrotal pain, vomiting, and a high-riding tender testis.
What is the priority?
A. Ice application and discharge if pain decreases
B. Urgent surgical evaluation for testicular torsion
C. Routine outpatient ultrasound next week
D. Empiric treatment for a urinary tract infection only
Correct Answer: B. Urgent surgical evaluation for testicular torsion
WITH ANSWERS AND EXPLANATIONS
1. A teen is somnolent with pinpoint pupils and a respiratory rate of 5/min after suspected opioid exposure.
What should the nurse prioritize?
A. Administer a benzodiazepine to reduce sedation
B. Wait for a toxicology screen before treatment
C. Give activated charcoal before supporting breathing
D. Support ventilation and administer naloxone as indicated
Correct Answer: D. Support ventilation and administer naloxone as indicated
Rationale: Opioid toxicity threatens ventilation. Airway and breathing support are immediate priorities, and
naloxone can rapidly reverse opioid-induced respiratory depression.
2. A child with severe hemophilia falls from a bicycle and strikes the head. The child is awake with a mild
headache and no external bleeding. Which action is most appropriate?
A. Treat the event as potentially serious internal bleeding and arrange urgent factor replacement/evaluation per
the child's plan
B. Discharge because there is no visible bleeding
C. Give aspirin for the headache
D. Wait for neurologic deterioration before notifying the hemophilia team
Correct Answer: A. Treat the event as potentially serious internal bleeding and arrange urgent factor
replacement/evaluation per the child's plan
Rationale: Children with hemophilia can develop life-threatening intracranial bleeding after apparently minor
trauma. Early factor replacement and evaluation are preferred rather than waiting for obvious neurologic decline.
3. A 6-year-old arrives confused and diaphoretic after being found difficult to arouse. Which rapid bedside
test should be obtained early because it identifies a reversible cause of altered mental status?
A. Bone age radiograph
B. Point-of-care blood glucose
C. Skin allergy testing
D. Serum vitamin D level
Correct Answer: B. Point-of-care blood glucose
Rationale: Hypoglycemia is a rapidly reversible cause of altered mental status and seizures. A bedside glucose
check is fast and should be part of the early evaluation.
4. A 7-year-old has a narrow-complex tachycardia at 210/min with an abrupt onset. The child is alert, has a
palpable pulse, and has no hypotension or signs of shock. What is the best initial action?
A. Attempt an age-appropriate vagal maneuver while preparing for adenosine
B. Start chest compressions because the heart rate is above 200/min
C. Begin unsynchronized defibrillation immediately
D. Give atropine before obtaining vascular access
Correct Answer: A. Attempt an age-appropriate vagal maneuver while preparing for adenosine
Rationale: A stable child with probable supraventricular tachycardia can undergo vagal maneuvers first, with
rapid IV/IO adenosine if the rhythm persists. Cardioversion is reserved for cardiopulmonary compromise or
refractory cases.
5. A caregiver reports that a 2-year-old may have swallowed a button battery 30 minutes ago. The child is
drooling but breathing without stridor. What is the priority?
A. Arrange immediate emergency evaluation to locate the battery and expedite removal if it is in the esophagus
B. Wait for abdominal pain before obtaining imaging
C. Give activated charcoal and observe at home for stool passage
D. Induce vomiting to recover the battery before it travels farther
Correct Answer: A. Arrange immediate emergency evaluation to locate the battery and expedite removal if it is
in the esophagus
Rationale: A button battery lodged in the esophagus can cause severe tissue injury within hours. Immediate
evaluation and removal are priorities; vomiting should not be induced and charcoal does not treat this exposure.
6. A 9-year-old after blunt chest trauma develops severe respiratory distress, hypotension, distended neck
veins, and absent breath sounds on the left. Which intervention is most urgent?
A. A fluid challenge as the only initial treatment
, B. Portable chest radiography before any intervention
C. Nebulized albuterol followed by reassessment
D. Immediate decompression of a suspected tension pneumothorax
Correct Answer: D. Immediate decompression of a suspected tension pneumothorax
Rationale: This pattern is classic for obstructive shock from tension pneumothorax. Treatment should not wait
for imaging when the clinical diagnosis is evident; immediate decompression is lifesaving.
7. A 19-day-old infant has a rectal temperature of 38.2 C (100.8 F), decreased feeding, and irritability.
Which response is most appropriate?
A. Treat the infant as high risk for serious infection and begin prompt age-appropriate sepsis evaluation and
management
B. Assume the fever is vaccine related and arrange routine follow-up
C. Observe without laboratory evaluation if the infant can be consoled
D. Discharge after acetaminophen lowers the temperature
Correct Answer: A. Treat the infant as high risk for serious infection and begin prompt age-appropriate sepsis
evaluation and management
Rationale: Young febrile infants can deteriorate rapidly and may have serious bacterial infection despite subtle
findings. An infant this age with fever requires prompt evaluation and management rather than routine outpatient
observation.
8. A child with a ventriculoperitoneal shunt develops repeated vomiting, worsening headache, and
increasing sleepiness. What complication should the nurse suspect?
A. Expected symptoms after normal shunt function
B. Isolated peripheral neuropathy
C. Shunt malfunction with increased intracranial pressure
D. Simple viral gastroenteritis as the most likely explanation
Correct Answer: C. Shunt malfunction with increased intracranial pressure
Rationale: Headache, vomiting, and altered level of consciousness in a child with a VP shunt are concerning for
obstruction or malfunction causing increased intracranial pressure and require urgent evaluation.
9. A 3-week-old infant has green bilious emesis and abdominal distention. Which response is most
appropriate?
A. Offer small frequent feeds and arrange follow-up next week
B. Treat the presentation as a possible intestinal obstruction or malrotation with volvulus requiring urgent surgical
evaluation
C. Give an antidiarrheal medication and observe
D. Reassure the caregiver that bilious emesis is typical reflux
Correct Answer: B. Treat the presentation as a possible intestinal obstruction or malrotation with volvulus
requiring urgent surgical evaluation
Rationale: Bilious emesis in a young infant is a surgical red flag. Malrotation with midgut volvulus can
compromise bowel perfusion and requires urgent evaluation.
10. When positioning an unconscious young child with a proportionally large occiput for airway
management, what is often needed to maintain a neutral airway position?
A. Maximum neck flexion toward the chest
B. Extreme neck extension
C. A thick pillow directly under the occiput
D. Padding under the shoulders or torso rather than under the head
Correct Answer: D. Padding under the shoulders or torso rather than under the head
Rationale: The large pediatric occiput can flex the neck when the child lies supine. A small shoulder or torso roll
can help align the airway in a neutral position.
11. A 14-year-old boy has sudden severe unilateral scrotal pain, vomiting, and a high-riding tender testis.
What is the priority?
A. Ice application and discharge if pain decreases
B. Urgent surgical evaluation for testicular torsion
C. Routine outpatient ultrasound next week
D. Empiric treatment for a urinary tract infection only
Correct Answer: B. Urgent surgical evaluation for testicular torsion
