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ENPC 5th Edition Exam Questions &
Answers 100% Correct
1. Ask about any new bed-wetting or sleep disturbances
Pediatric patients with anxiety and PTSD may present with physical com- plaints. Assess for other behavioral symptoms to facilitate appropriate care and follow-up. ANS A 5 year-old with no health problems presents to the Emergency Department with a sudden onset of chest pain and shortness of breath. Parents state that the family was involved in a bad car crash one week ago. A thorough assessment and workup has not revealed any abnormalities. Which of the following steps is the best next step to take?
2. Ensuring all firearms in the home are locked in a safe place with no access
by the patient. Promoting injury prevention with caregivers of patients with a history of depression or suicidal ideation by encouraging that all firearms and med- ications are under lock to prevent overdoses or suicide attempt. ANS You are discharging a patient to home with a history of depression. Discharge teaching should include which of the following?
3. Obtain vascular access for rapid fluid administration
Rapid vascular access and fluid administration are the priority interven- tions. ANS A 2-year old has uniformly demarcated burns to bilateral lower extremities, approximately 30% of the childs total body surface area. The father states he briefly left the room while the child was in the bath and the child apparently played with the faucet. Which of the following interventions has the highest priority?
4. Draw and send a metabolic panel and venous blood gas, administer a fluid
bolus, and obtain a point of care glucose Electrolyte imbalances need to be identified and treated to prevent another seizure. ANS A 7-year-old arrives via ambulance. The patient's mother reports wit- nessing a seizure at home. The patient has no seizure history. Upon examination, the patient is post-ictal with a heart rate of 142 beats per minute, respiratory rate of 36 breaths per minute, and blood pressure of 86/72 mm Hg. Significant burns are noted to the patient's back and lower extremities. The mother states the burns accidentally occurred 3 days ago, but she was afraid to bring patient in due to an ongoing child welfare investigation. Which of the following are the MOST appropriate immediate interventions?
5. ventilation to address hypoxia is the priority intervention.
ANS What is the priority intervention for symptomatic bradycardia in a four-year- old child?
Pathophysiology ANS Cardiac Output. In pediatric patients, cardiac out is pri- marily regulate by increasing heart rate ANS A 5-year-old patient presents to the emergency department with severe dehydration due to viral gastroenteritis. He has signs of shock due to his hypovolemia. Which of the following physiologic responses to shock has the greatest impact on improving cardiac output in the pediatric patient?
9. Bruising to the left ear of a newborn from sleeping on his side
Pg 10- Any bruises in a non exploratory location (especially torso ears, neck) in children younger than 4 Pg 11Any bruising in a child younger than 4 months. ANS Which of the following patient presentations should increase suspicion of potential child maltreatment?
10. Fifth Disease at 6 months
There is an animal vaccine, but not a human vaccine for Fifth Disease. ANS All
of the vaccine administrations listed are appropriate EXCEPT for which of the following?
11. My child can go to daycare since they have been off of Tylenol and fever
free for 24 hours. Yes, the patient needs to be afebrile WITHOUT the use of antipyretics to be able to go back to daycare or school. ANS Which of the following statements indicates the caregiver understands your discharge teaching on influenza?
12. Dedicate a healthcare team member with a qualified interpreter to be with
the family during the procedure. Providing the option for family presence with an assigned team member to facilitate communication is most supportive of the family in this situation. ANS - The neurosurgeon has decided to perform an invasive procedure in the emergency department to monitor the intracranial pressure on a 5-year-old patient. The family does not speak English and has identified their religion as Muslim. Which of the following interventions is most supportive of the family?
13. Rubeola On presentation the child starts with cough, nasal inflammation
(coryza) and a non-purulent conjunctivitis. After 2-4 days a rash begins as erythematous macules and papules on the face that spreads to the torso and extremities. ANS A 6 year-old child presents to the emergency department with caregivers who report a cough with nasal
suspected globe rupture. Which of the following medication orders would the nurse question?
16. Copious eye irrigation with an isotonic solution
Normal saline or Ringer's lactate solution are both acceptable for irrigation. Irrigate until the pH of the eye returns to normal. The pH of Ringer's lactate is closer to that of human tears and may be more comfortable than normal saline. ANS A toddler has a chemical eye injury. Which of the following is the priority intervention?
17. (Do not pick acetaminophen)
ANS Which of the following medications is appro- priate for treating the fever of a four-year-old with scleral jaundice and elevated aspartate transaminase (AST)?
18. Food allergy These findings are typical of a food allergy. Because aller- gic
reactions are so variable and do not always include classic manifesta- tions, anticipate that any food-induced allergic reaction may unexpectedly progress to life-threatening anaphylaxis. ANS The parents of a 5-year-old child arrive at the emergency department. The child's lips and face are swollen with hives on the face. The parents report the child ate peanut butter crackers in the last hour. The child has no known allergies. The nurse recognizes the findings are associated with ANS
19. Appointing one staff member to communicate with them.
This will help create a solid patient-staff bond and facilitate communication- ANS A nurse providing crisis intervention to the family of a seriously ill child can best keep the family informed of the child's condition by doing which of the following?
20. An 18-month-old with bilious emesis
Bilious emesis in an 18-month-old is always considered an emergent symp- tom indicative of a life-threatening bowel obstruction. ANS Which of the following patients should be evaluated first?
21. Clear urine
Normal finding ANS There is a decrease in urine output for patient's with glomeru- lonephritis. Urine would be concentrated and dark brown/tea-colored ANS Which of the following would be an abnormal finding in a patient with glomerulonephritis?
22. My child will grow out of their frequent urinary tract infections
26. Physical and psychological safety
Create an environment where patients feel safe, both physically and psy- chologically. Increase awareness of the patients interpersonal interactions with others to screen for risk of harm. Prioritize the patient being in a safe location. ANS During the assessment of a 16-year-old male patient, the ED nurse identifies him as a potential sex trafficking victim. The trauma informed approach to care emphasizes certain principles in caring for these types of patients. Which of the following care principles has the highest priority?
27. Primary survey, vital signs, pain management, and effectiveness of ther-
apeutic interventions The additional three components of the reevaluation in the Tertiary Survey includes primary survey, vital signs and pain management, effectiveness of therapeutic interventions. (p 38) ANS During the tertiary survey, the emergency
nurse should continue to conduct reevaluations of the Pediatric Assessment Triangle (PAT), abnormal findings, and which of the following other assessment components?
28. Assess the endotracheal tube placement and patency
If a patient arrives with an artificial airway (endotracheal tube or tracheosto- my) in place, assess its placement, tube patency and then the oral airway (in that order) before moving to the next step of the primary survey. (p 4) ANS 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?
29. Circulation and disability
A sunken fontanel may indicate dehydration; a bulging fontanel can indicate increased intracranial pressure. ANS In which of the following primary survey com- ponents can assessment of the fontanel provide the most useful information?
30. Preparing medications in a distraction-free area
To decrease errors, the nurse should be focused and systematic in verifying patient identification, medication order, route, time, and dose. ANS Which of the following actions by the nurse promotes pediatric patient safety?
31. Obtain the patient's weight in kilograms
This is the preferred measurement for medication calculations for pediatric
34. Bony crepitus and instability with gentle anteroposterior compression
Bony crepitus and instability to palpation of the pelvis are common findings in patients with unstable pelvic fractures. Unstable pelvic fractures may be associated with injury to major blood vessels and contribute to hypovolemic shock. ANS A 16-year-old is noted to have external rotation and shortening of the left lower extremity and pain with palpation of the pelvis after being ejected from a motorcycle. Which of the following assessment findings is most concerning for a potentially life- threatening condition?
35. Which of the following is a known cause of pediatric seizures?
Prepare to administer intranasal midazolam Midazolam has gained favor because of its ease of use and quick onset of action ANS Which of the following is the most appropriate intervention for a child experiencing a seizure?
36. Application of a splint to the affected extremity
Splinting is an effective non-pharmacologic intervention to reduce pain as- sociated with fractures. ANS The emergency nurse is caring for a 14-year-old patient who sustained a displaced fracture of the radius and ulna after falling from a bicycle. Which of the following pain interventions is most likely to result in improvement in symptoms?
37. Rear facing in a convertible carseat until at least the age of 2
The safest mode of transport for the neonate is rear facing until the age of 2 when the neck ligaments are stronger to support the head. ANS According to the American Academy of Pediatrics guidelines, which of the follwing describes how a neonate riding in a car should be positioned?
38. Flexion with extremities close to the body
A neonates normal position is flexion with extremities close to the body ANS - Which of the following describes a neonates normal position?
39. Cystic Fibrosis
In CF, the mucus can block pancreatic ducts, which does not allow full absorption of fats/proteins, leading to greasy/fatty stools. ANS A 6-month-old is brought to the emergency department for a recurrent respiratory infection. When
(Symptoms of spinal cord shock) ANS Spinal shock results in which of the following transient conditions?
44. Endotracheal intubation with positive pressure ventilation
Airway control and positive pressure ventilation are the appropriate inter- ventions for this patient. ANS A three-year-old is rescued after being submerged in a residential pool for several minutes. On arrival at the Emergency Department he is responsive to painful stimuli, has shallow respiration's with diminished breath sounds throughout, and has an occasional cough. What is the initial management priority?
45. The best indicator of survival after submersion is the duration (Length)
of time of submersion. The duration of submersion is the best predictor of survival after drowning. In general, shorter times correlate to better outcomes. ANS Which of the follow-
ing statements demonstrates a nurse's understanding of pediatric submersion injuries?
46. Dysrhythmias
QRS prolongation and ventricular dysrhythmias are symptoms of cyclic antidepressant overdose. ANS A 15-year-old patient has attempted suicide by over- dosing on amitriptyline. The emergency nurse should expect which of the following symptoms?
47. Neuroleptic malignant syndrome These are classic symptoms of neu-
roleptic malignant syndrome, which is a rare reaction to antipsychotic med- ications. ANS A 12-year-old who was recently started on anti-psychotic medication for schizophrenia is brought to the emergency department with severe muscle rigidity and hyperthermia. These symptoms are most likely caused by which of the following?
48. Using a bulb syringe suction nasal passages
Infants up to four months old are obligate nose breathers and can have res- piratory distress when nares are occluded. Mucous can be gently suctioned using a bulb syringe or suction catheter. (p6) ANS A 2-month-old infant is brought to the emergency department. The mother states he has had trouble breathing for the past two days. The PAT reveals an age-appropriate general appearance, rapid breathing with mild distress, and pink skin. Mucous is noted to both nares. Which of the following is the best next step?
49. Peripherally inserted central catheter line for one time fluid bolus
