ENPC Exam 6th Edition 62 questions with correct and verified answers. Graded A+

ENPC Exam 6th Edition 62 questions with correct and verified answers. Graded A+ A 5-year-old child presents with hives, swelling of the lips and face, and stridor that developed about an hour after eating lunch. The child has no known allergies. Which of the following is the priority intervention? A. Administer intramuscular epinephrine B. Auscultate bilateral breath sounds C. Insert an intravenous catheter D. Administer inhaled albuterol - Correct answer A. Administer intramuscular epinephrine" "An adolescent is awaiting ICU admission for pneumonia. During reassessment, which of the following findings would be most indicative that respiratory failure is developing? A. SpO2 of 94 % on room air B. Widened pulse pressure C. Extreme lethargy D. Flash capillary refill - Correct answer A. SpO2 of 94 % on room air" "A 3-year-old has a two-day history of runny nose, low-grade fever, and a "barky" cough at night. The child is awake and alert with noted stridor. Pulse oximetry is 96% on room air. Which of the following interventions would be the most appropriated for this child? A. Delivery of humidified oxygen by nasal cannula B. Administration of nebulized epinephrine C. Suctioning secretions from the oropharynx D. Administration of albuterol with a spacer - Correct answer B. Administration of nebulized epinephrine" "A 14-year-old patient had a reduction of a temporomandibular joint dislocation in the ED. Which of the following should be included in the discharge instructions? A. Practice yawning three to four times a day B. Resume eating a regular diet later today C. Apply hot packs to the joint area for pain control D. Use a nonsteroidal anti-inflammatory for pain control - Correct answer D. Use a nonsteroidal anti-inflammatory for pain control" "Which of the following parameters would indicate that appropriate post resuscitation interventions were successfully carried out in the pediatric patient? A. Pulse oximetry reading of 96% B. Temperature of 99.8°F (37.6°C) C. Capillary refill of < 1 second D. Capnography reading of 60 mm Hg - Correct answer A. Pulse oximetry reading of 96%" "An anxious 12-year-old child presents to the emergency department with a sudden onset of nausea, diarrhea, abdominal cramping, flushing, and hypotension. Symptoms started about 60 minutes after lunch. Which of the following conditions is the most likely cause of these symptoms? A. Anaphylaxis B. Renal colic C. Crohn's Disease D. Menarche - Correct answer A. Anaphylaxis" "An 8-year-old trauma patient suddenly develops increased respiratory distress with a rise in heart rate from 112 beats/minute to 142 beats/minute associated with an abrupt hypotensive event. Distention of the jugular veins is noted. Which of the following emergent interventions should be anticipated first? A. High flow oxygen B. Drug assisted intubation C. Chest tube insertion D. Needle decompression - Correct answer D. Needle decompression" "A 4-week-old infant born prematurely is brought to the emergency department due to the rapid onset of abdominal distention, vomiting, bloody stools, and exhibiting signs of shock. Based on these findings, what condition should the nurse suspect? A. Necrotizing enterocolitis B. Pyloric stenosis C. Megacolon D. Congenital diaphragmatic hernia - Correct answer A. Necrotizing enterocolitis" "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? A. Hypoglycemia B. Severe anemia C. Low pH level D. Elevated serum bicarbonate - Correct answer C. Low pH level" "Which of the following pathologic processes would most likely be attributed to a primary diagnosis of cystic fibrosis? A. Hypernatremia B. Constipation C. Obesity D. Epiglottitis - Correct answer B. Constipation" "Which of the following is the highest priority intervention for a well-appearing 2-month-old with a fever? A. Lumbar puncture B. Urine culture C. Intravenous fluid bolus D. Chest radiograph - Correct answer B. Urine culture" "The caregivers of a 6-year-old report the child developed a cough with nasal congestion and "pink-eye" that started two days ago. Today they noticed a raised, red rash on the face, and grey papules in the mouth. Which of the following is the priority intervention for this patient? A. Obtain a nasopharyngeal swab B. Place in airborne isolation C. Place in contact isolation D. Obtain a fingerstick glucose - Correct answer C. Place in contact isolation" "A 14-year-old patient with Down syndrome presents with an abnormal gait, head tilted to the left, decreased sensation to the extremities, and urinary incontinence. The patient has no history of trauma. Which of the following diagnostics is the priority for this patient? A. Lumbar spine magnetic resonance imaging B. Complete neurologic exam C. Urinalysis by straight catheterization D. Cervical spine radiographs - Correct answer D. Cervical spine radiographs" "A 7-year-old is being seen for new onset of headaches. Which of the following manifestations would most likely rule out the potential of a primary etiology? A. Presence of ataxia B. Pulsating, unilateral pain C. Occurrence of photophobia D. Nausea, vomiting - Correct answer A. Presence of ataxia" "A 3-week old is brought to the emergency department with a history of fussiness, spitting up, crying, and watery stools. Assessment reveals an alert child with moist mucous membranes. Which of the following should be the priority? A. Medicate with ondansetron for emesis B. Identify the type of formula the caregiver uses C. Obtain a stool specimen for culture D. Initiate intravenous access with 0.9% sodium chloride - Correct answer B. Identify the type of formula the caregiver uses" "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? A. EMLA (lidocaine 2.5% and prilocaine 2.5%) B. LET (lidocaine/epinephrine/tetracaine) C. LMX (lidocaine 4%) D. Tetracaine 4% - Correct answer B. LET (lidocaine/epinephrine/tetracaine)" "A 6-month-old arrives with swelling to the left thigh. Caregivers deny any traumatic event. Assessment findings include a patient who is active and alert, in the 10th percentile for length, and has blue-grey sclera. Radiographs reveal a midshaft fracture of the left femur. Which of the following is the most likely cause? A. Osteomyelitis B. Physical maltreatment C. Ehlers-Danlos syndrome D. Osteogenesis imperfecta - Correct answer D. Osteogenesis imperfecta" "A 3 year-old patient presents following frequent emesis and diarrhea over the past 12 hours. Which of the following assessment findings indicate that the patient' body is compensating for the fluid loss? A. Increased diastolic blood pressure B. Bounding peripheral pulses C. Prolonged capillary refill D. Increased urine output - Correct answer A. Increased diastolic blood pressure" "A 6-year-old involved in a boating crash is awaiting admission for surgical repair of a fractured ankle. Which of the following manifestations during reassessments would cause the greatest concern for possible intra-abdominal trauma? A. Chest pain with deep inspiration B. Thoracic spine pain with palpation C. Intermittent shortness of breath D. Constant left shoulder pain - Correct answer D. Constant left shoulder pain" "During the assessment of a 16-year-old patient, the ED nurse identifies them as a potential sex trafficking victim. Which of the following trauma-informed care principles has the highest priority for this patient? A. Empowerment, voice, and choice B. Peer support C. Trustworthiness and transparency D. Physical and psychological safety - Correct answer D. Physical and psychological safety." "A 6-year-old involved in a boating crash is awaiting admission for surgical repair of a fractured ankle. Which of the following manifestations during reassessments would cause the greatest concern for possible intra-abdominal trauma? A. Chest pain with deep inspiration B. Thoracic spine pain with palpation C. Intermittent shortness of breath D. Constant left shoulder pain - Correct answer D. Constant left shoulder pain" "A caregiver reports their one-month-old has had a yellowish color to their eyes and skin over the last two weeks. If left untreated, which body system can this affect? A. Integumentary B. Renal C. Gastrointestinal D. Neurological - Correct answer A. Integumentary" "A neonate presents to the emergency department with irritability, weak cry, and hypotonia. Which of the following is a priority intervention? A. Prostaglandin infusion B. Toxin screening C. Head compterized tomography scan D. Serum blood glucose - Correct answer D. Serum blood glucose" "An 8-year-old arrives post bicycle crash with swelling and bleeding from the right side of his face, deformities to the jawline, nasal swelling, and epistaxis. He is unresponsive with snoring respirations and an absent gag reflex. Which of the following airway adjuncts would be most appropriate for this patient? A. Nasopharyngeal airway (NPA) B. Head tilt - chin lift maneuver C. Elevate the head of the bed D. Oropharyngeal airway (OPA) - Correct answer D. Oropharyngeal airway (OPA)" "A 3-year-old is assessed for the presence of increasing amounts of serosanguineous drainage from his left nares over the past 6 hours. Which of the following foreign bodies is the most likely etiology? A. Magnet B. Button battery C. Dried bean D. Fishing weight - Correct answer A. Magnet" "A caregiver presents to the emergency department with an 18-month-old and reports the child is not using their left arm after playing a game with an older sibling. The child is alert and curious, with regular, even respirations, and skin color is appropriate. Using the Pediatric Assessment Triangle (PAT), how would you categorize this patient? A. Sicker B. Sickest C. Stable D. Sick - Correct answer D. Sick" "An 8-year-old male presents to the emergency department with incoherent speech, hallucinations, and violent behavior. What is the priority in caring for this patient? A. Administer antipsychotic medications B. Evaluate laboratory values C. Allow family and friend visitation D. Ensure safety of the patient and staff - Correct answer D. Ensure safety of the patient and staff" "A 2-year-old child is seen with acute respiratory distress after playing alone. Caregiver statements indicate the child was found playing with irregular, ½ - ¾ inch sized pieces of a game. Which of the following assessment findings would most likely be expected for this situation? A. Audible wheezing and retractions B. Inspiratory stridor and coughing C. Grunting respirations and tachypnea D. Quiet tachypnea and coarse crackles - Correct answer B. Inspiratory stridor and coughing" "A 15-year-old presents alone requesting care. Which of the following chief complaints would most likely be considered legal or appropriate to treat without parental consent? A. Lower back pain B. Itching rash to arms C. Possible pregnancy D. Dental pain - Correct answer C. Possible pregnancy" "An 11-year-old child presents with right arm pain after falling off a bicycle. The child is tearful and holding his right arm. What pain scale would be the most appropriate to use when assessing this child's pain? A. Faces scale B. FLACC scale C. Numbers scale D. NIPS scale - Correct answer C. Numbers scale" "A 10-year-old arrives at the ED post motor vehicle crash. The following assessment is noted: hypotension, tachycardia, absent breath sounds from the left chest with an increased respiratory rate, pain on palpation of the pelvis, tinge of blood noted at the urinary meatus, moderate active bleeding from a laceration to left thigh, pulse oximetry of 86% without supplemental oxygen, deformity to the left upper leg, and a Glasgow Coma Score of 7. Which of the following orders will prompt the nurse to have a discussion with the provider before initiating? A. Insert urinary catheter B. Prepare for intubation C. Assist with chest tube insertion D. Place orogastric tube - Correct answer A. Insert urinary catheter" "A six-week-old infant presents to the emergency department with seizures. The infant is afebrile with a normal glucose level ,and caregivers report no signs of illness other than formula intolerance, which they treated by adding extra water to the formula. The nurse would expect to find which of the following laboratory abnormalities? A. Hypokalemia B. Hyponatremia C. Hyperkalemia D. Hypernatremia - Correct answer B. Hyponatremia" "A 12-year-old involved in a house fire has full thickness, circumferential burns to bilateral lower extremities. Fluid resuscitation is in progress on arrival at the ED. On assessment the left pedal and posterior tibialis pulses are absent, with delayed capillary refill. Which of the following is the priority intervention? A. Application of compression dressings B. Elevation of left lower extremity C. Assist with escharotomy D. Preparation for thrombectomy - Correct answer C. Assist with escharotomy" "A 2-year-old arrives with parents stating the child may have ingested a button battery. The patient initially choked and coughed and is now drooling with bloody sputum. Which of the following is the priority intervention? A. Prepare the patient for hospitalization B. Administer 5 -10 ml of honey orally C. Discharge with specific return instructions D. Offer the child sips of water intermittently - Correct answer A. Prepare the patient for hospitalization" "When caring for a potential crime victim, what evidence collection principle is imperative? A. Evidence collection is prioritized over nursing assessment. B. Suspicious clothing should be placed in separate, clean, clearly marked plastic bags. C. Clothing should always be cut along seam lines to preserve evidence. D. Clothing should not be placed on the floor in order to prevent contamination. - Correct answer D. Clothing should not be placed on the floor in order to prevent contamination." "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? A. Serum B. Urine C. Stool D. Sputum - Correct answer B. Urine" "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? A. Intraosseous in the patient's medial tibia. B. Peripherally inserted central catheter C. Assisting with central line placement. D. Intraosseous in the patient's scapula. - Correct answer A. Intraosseous in the patient's medial tibia." "A child has a nondisplaced fracture of the radius that has been splinted, with a sling in place and NSAIDs given for pain. Prior to discharge home with follow-up at a pediatric facility, what actions must be completed? A. Discharge instructions including follow-up contact information. B. Ensure the receiving facility has space and qualified personnel. C. Certify that medical benefits of discharge outweigh risks. D. Complete doctor-to-doctor communication with receiving facility. - Correct answer A. Discharge instructions including follow-up contact information." "The nurse is triaging an infant brought to the emergency department by their caregiver. Which finding by the nurse leads the infant to be placed in isolation? A. Barking cough B. Purpuric rash C. High-pitched cry D. Mottled skin - Correct answer B. Purpuric rash" "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? A. Taking the child to the radiographic studies while the parents rest in the room B. Providing frequent updates and re-educating them on the care that is being provided C. Ensuring adequate lighting and keeping the door closed to provide privacy D. Answering questions only when the parents ask them in order to reduce information overload - Correct answer B. Providing frequent updates and re-educating them on the care that is being provided" "An infant presents to the emergency department with difficulty breathing. The patient is pale and respirations appear rapid and shallow. Which location on the torso is the most effective site for assessing bilateral breath sounds? A. Bilateral posterior back B. Over the epigastrium C. Bilateral midaxillary D. Bilateral anterior chest - Correct answer C. Bilateral midaxillary" "A child was found unresponsive under the monkey bars during recess and arrives with the following assessment: eyes open only with supraorbital pressure stimulus, no verbal response is elicited, and withdraws arms and legs when a swab is inserted in the nose. Which of the following is the priority intervention for this child? A. Infuse a bolus of crystalloid solution B. Expose the child's body for full exam C. Log roll to assess posterior aspect D. Prepare for immediate intubation - Correct answer D. Prepare for immediate intubation" "A 5-year-old presents with sudden onset nausea, vomiting, abdominal cramping, hives, and hypotension after eating lunch. Which of the following is the priority intervention? A. Intramuscular epinephrine B. Inhaled albuterol C. Oral diphenhydramine D. Intravenous ondansetron - Correct answer A. Intramuscular epinephrine" "A 12-year-old is being prepped for surgical intervention of acute appendicitis. Which of the following intravenous medication orders should the nurse question? A. Morphine B. Acetaminophen C. Hydromorphone D. Ketorolac - Correct answer D. Ketorolac" "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? A. Computed tomography B. Magnetic resonance imaging C. Bronchoscopy D. Ultrasound - Correct answer C. Bronchoscopy" "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? A. Humidified oxygen B. Inhaled beta-agonist C. Oral steroids D. Nebulized magnesium sulfate - Correct answer B. Inhaled beta-agonist" "A 3-year-old child who was found in a pool unresponsive has return of spontaneous circulation (ROSC) after prolonged resuscitation. Intubation was performed in the field. Upon arrival to the ED, which intervention is of highest priority? A. Administer sedation as ordered. B. Utilize a length-based resuscitation tape to determine the approximate weight. C. Auscultate breath sounds over the epigastrium and lung fields. D. Obtain a bedside blood glucose reading. - Correct answer C. Auscultate breath sounds over the epigastrium and lung fields." "A 3-year-old is assessed for the presence of increasing amounts of serosanguineous drainage from his left nares over the past 6 hours. Which of the following foreign bodies is the most likely etiology? A. Magnet B. Button battery C. Dried bean D. Fishing weight - Correct answer B. Button battery" 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? - Correct answer Applying 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? - Correct answer Circulation 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? - Correct answer Cystic 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? - Correct answer 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 indicates the need for additional caregiver education regarding a urinary tract infection? - Correct answer 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." "You need to draw blood from a 2-year-old. Which of the following is the best approach for this patient? - Correct answer Have 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? - Correct answer Suction 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? - Correct answer Assess 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." "What is the priority intervention for symptomatic bradycardia in a four-year-old child? - Correct answer Initiate bag-mask ventilation Rationale Identifying and treating other causes, chest compressions, and epinephrine are interventions for pediatric bradycardia with signs of poor perfusion that are not improved by adequate oxygenation and ventilation. Atropine and pacing may be considered if there is no response to the other interventions." "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? - Correct answer Endotracheal intubation to provide positive pressure ventilation Rationale 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 abdomen." "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? - Correct answer 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." "For the infant, what duration of time is consider apneic? - Correct answer 20 seconds Rationale The respiratory rate, depth, and regularity all continue to change the first year of life, making respiratory assessments different than those of older children. Infants breathe faster and less regularly, with apnea not considered as such until 20 seconds without a breath or associated with other physiologic effects such as bradycardia." "A 9 month pregnant woman presents to the emergency department and delivers a term neonate vaginally. The neonate is dried and stimulated and the mouth and nose are suctioned using a bulb syringe. After repositioning the head, the neonate remains limp and apneic and the HR is 80 beats/minute. What is the priority intervention? - Correct answer Initiate positive pressure ventilation Rationale Immediately after delivery all neonates should be warmed, stimulated, and have their mouth then nose suctioned using a bulb syringe. Following this, if the neonate is not breathing or is gasping and/or has a heart rate of less than 100 beats per minute positive pressure ventilation at 21% FiO2 at a rate of 40-60 breaths per minute should be immediately initiated. The heart rate should be assessed after 15 seconds of PPV and if not improving additional measures should be taken (MRSOPA). Vascular access is not always needed but can be worked on by another team member while airway and breathing interventions are being completed." "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? - Correct answer 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."