ENPC 6th Edition Pre Exam / ENPC 6th Edition Test Questions and Answers 2024

ENPC 6th Edition
Pre Exam / ENPC
6th Edition Test
Questions and
Answers 2024
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.
Which of the following patients should be evaluated first? - CORRECT ANSWER-An 18-month-old with bilious emesis
Rationale
The presence of bilious emesis is especially concerning because it may be indicative of an immediately life-threatening bowel obstruction. A dislodged gastrostomy tube should be reinserted within 4-6 hours to prevent stoma closure. Vomiting following a handlebar injury may be indicative of many possible injuries, but does not take precedence unless other symptoms are present. Infantile colic is described as inconsolable crying in infants, 2 weeks to 4 months old, for up to 3 hours per day, more than 3 days per week, and lasting for more than 3 weeks.
A nurse providing trauma informed care to the family of a seriously ill child should be doing which of the following? - CORRECT ANSWER-Appointing one staff member to stay with the family
Rationale
Caregivers experiencing the crisis of a critically ill child have low attentiveness and increased stress so would benefit from having a member of the healthcare team to stay with them as much as possible and communicate updates on the plan of care. Caregivers should be allowed to stay with their child as much as possible and not placed in a secluded room away for them.
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