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ENPC EXAM PREP ACTUAL QUESTIONS
AND ANSWERS 100% CORRECT
1. Which of the following would be an abnormal finding in a patient with
glomerulonephritis? ANS Clear urine There is a decrease in urine output for patient's with glomerulonephritis. Urine would be concentrated and dark brown/tea-colored.
2. Clear urine There is a decrease in urine output for patient's with glomeru-
lonephritis. Urine would be concentrated and dark brown/tea-colored. ANS Ad- ministration of nebulized epinephrine Moderate to severe croup is treated with dexamethasone and nebulized epinephrine.
3. 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? ANS Allow the extended to family members to serve as interpreters during the procedure.
4. Which of the following patient presentations should increase suspicion of
potential child maltreatment? ANS Bruising to the left ear of a newborn from sleeping on his side Any bruise in a non- exploratory location in children younger than 4 years and any bruising in a child younger than 4 months (TEN-4) are cause for suspicion of abuse
5. Bruising to the left ear of a newborn from sleeping on his side Any bruise in
a non-exploratory location in children younger than 4 years and any bruising in a child younger than 4 months (TEN-4) are cause for suspicion of abuse ANS Commotio cordis Commotio cordis occurs when the chest is struck during the refractory period of the cardiac conduction cycle, resulting in a ventricular dysrhythmia or asystole. This type of injury usually occurs in recreational sports such as baseball or ice hockey
6. 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? ANS Neuroleptic malignant syndrome These are classic symptoms of neuroleptic malignant syndrome, which is a rare reaction to antipsychotic med- ications.
7. Which of the following patients should be evaluated first
ANS An 18-month-old with bilious emesis Bilious emesis in an 18-month-old is always considered an emergent symptom indicative of a life-threatening bowel obstruction.
8. 1. Which of the following tasks can the nurse do to decrease adverse
medication events? ANS Obtain the patient's weight in kilograms This is the preferred measurement for medication calculations for pediatric and adult patients
ing 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? ANS Draw and send a metabolic panel, administer a fluid bolus, and obtain a point of care glucose Significant burns can cause electrolyte imbalances. Electrolyte imbalances may be the cause of the patient's seizure. Electrolyte imbalances need to be identified and treated.
14. In which of the following primary survey components can assessment of
the fontanel provide the most useful information? ANS Circulation and disability A sunken fontanel may indicate dehydration; a bulging fontanel can indicate in- creased intracranial pressure.
15. 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? ANS In- creasing heart rate In pediatric patients, tachycardia is the primary compensatory mechanism to increase cardiac output.
16. A toddler has a chemical eye injury. Which of the following is the priority
intervention? ANS Increasing heart rate In pediatric patients, tachycardia is the pri- mary compensatory mechanism to increase cardiac output.
17. A 5 year-old with no health problems presents to the Emergency Depart-
ment 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? ANS Ask about any new bed-wetting or sleep disturbances Pediatric patients with anxiety and PTSD may present with physical complaints. Assess for other behavioral symptoms to facilitate appropriate care and follow-up.
18. Which of the following is the most appropriate intervention for a child
experiencing a seizure? ANS Prepare to administer intranasal midazolam Midazolam has gained favor because of its ease of use and quick onset of action.
19. An ambulance arrives with a 16-year-old male involved in a dirt bike crash
22. You are discharging a patient to home with a history of depression. Dis-
charge teaching should include which of the following? ANS Ensuring all firearms in the home are locked in a safe place with no access by the patient. Promote injury prevention with caregivers of patients with a history of depression or suicidal ideation by encouraging that all firearms and medications are under lock to prevent overdoses or suicide attempt.
23. A 3-year-old is injured in a motor vehicle collision. Upon arrival at the
emergency department, the child has a diminished level of consciousness, equal bilateral breath sounds, and cool, pale skin. Vital signs are HR 140 beats/minute, RR 36 breaths/minute, and BP 70/40 mm Hg. The child is most likely in which of the following shock states? ANS Hypovolemic shock The mechanism and presentation lead to a suspicion of blood loss.
24. Which of the following is the priority intervention for a pediatric patient
with diabetic ketoacidosis? ANS Insulin infusion A continuous infusion of insulin at 0.05-0.1 unit/kg/hr should be used to decrease blood glucose.
25. Which of the following describes a neonate's normal position?
ANS Flexion with extremities close to the body A neonate's normal position is flexion with extremities close to the body.
26. 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?
ANS Application of a splint to the affected extremity Splinting is an effective non- pharmacologic intervention to reduce pain associated with fractures.
27. The type of vascular access is appropriate in all of the patient situa- tions
given EXCEPT for which of the following? ANS Peripherally inserted central catheter line for one time fluid bolus This vascular access is most appropriate for long term medication administration and multiple blood draws.
28. A 5-year-old child presents to the emergency department after being hit
by a car. She 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? ANS Widening pulse pressure Narrowing pulse pressure and increasing heart rate are early indications of ongoing blood loss.
29. A 15-year-old patient has attempted suicide by overdosing on amitripty-
line. The emergency nurse should expect which of the following symptoms?- ANS Dysrhythmias QRS prolongation and ventricular dysrhythmias are symptoms of cyclic antidepressant overdose.
therapeutic interventions.
34. Which of the following interventions would the nurse anticipate for a
pediatric patient with a fever and a history of a hematologic or oncologic condition? ANS Intravenous antibiotics This patient population is at risk for life-threat- ening sepsis, and treatment with intravenous antibiotics is indicated.
35. Prioritizing pediatric patients presenting with fever is often difficult.
Which of the following patients is at greatest risk of serious illness? ANS A 7-year old boy with a history of sickle cell anemia and an oral temperature of 38.3°C (101°F) Children with chronic illnesses such as sickle cell disease are at greatest risk for life-threatening fever-related illnesses.
36. Which of the following indicates the need for additional parent/guardian
education regarding a UTI? ANS My child will grow out of their frequent urinary tract infections UTIs are not a normal occurrence in children and may require additional investigation and follow up.
37. A 4-day-old who is brought to the emergency department with the parental
complaint of "not acting right" is found to be hypoglycemic. The appropriate glucose concentration to administer to this neonate is which of the following? ANS D10 D10 is the preferred concentration for neonates to protect their fragile vasculature.
38. Which of the following actions by the nurse promotes pediatric patient
safety? ANS 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.
39. A 16-year-old trauma patient is noted to have external rotation and short-
ening 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? ANS Bony crepitus and instability with gentle anteroposterior compression of the iliac crests 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.
40. A 10-year-old patient was recently diagnosed with Marfan syndrome. The
emergency nurse understands that this patient may be at risk for developing which of the following conditions? ANS Aortic Aneurism Cardiovascular defects associated with Marfan syndrome are mitral valve prolapse, heart failure, and aortic dissection/aneurysm.
41. A 2-month-old child with intermittent irritability, poor feeding and apneic
aunt repeatedly asks when they will be discharged. The ED nurse recognizes these finding as red flags for which of the following? ANS Sex Trafficking Red flags for sex trafficking include multiple bruises, unwanted or unintended pregnancy and being withdrawn or anxious in the presence of the caregiver.
44. All of the vaccine administrations listed are appropriate EXCEPT for
which of the following? ANS Fifth Disease at 6 months There is an animal vaccine but not a human vaccine for fifth disease.
45. Which of the following statements indicates the caregiver understands
your discharge teaching on influenza? ANS 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.
46. A fertilizer silo exploded during a school tour of a working farm. The
children are able to manage their own secretions but are all incontinent and salivating with excess tearing. Which of the followiing is the priority interven- tion? ANS Removal of clothing and decontamination Decontamination of nerve agents requires removal of clothing and flushing the skin with copious amounts of soap and water.
47. A 2-year old has uniformly demarcated burns to bilateral lower extrem-
ities, approximately 30% of the child's 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? ANS Obtain vascular access for analgesic and fluid administra- tion Rapid vascular access and fluid administration are the priority interventions.
48. Which of the following findings would be most concerning for a sec- ondary
headache? ANS Pain with flexion of the neck Nuchal rigidity is associated with meningeal irritation and meningitis, which would be considered a more serious secondary headache condition.
49. A 6 year-old child presents to the emergency department with caregivers
who report a cough with nasal congestion and "pink-eye" that started 2 days ago. They have been treating with an over-the-counter medicine without relief. Today they noticed a raised red rash on the face and papules in the mouth. You suspect which of the following? ANS Rubeola Rubeola presents with a cough, nasal inflammation (coryza), and non- purulent conjunctivitis. A rash begins as erythematous macules and papules on the hairline and face that spreads downward.
