ENPC 6th Edition Pre Exam 20
Questions and Answers with
Rationales 2025
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? -
**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? -
**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? -
**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? -
**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? -
**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? -
**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? -
**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? -
**Assess endotracheal tube placement
Rationale
Questions and Answers with
Rationales 2025
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? -
**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? -
**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? -
**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? -
**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? -
**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? -
**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? -
**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? -
**Assess endotracheal tube placement
Rationale
