ENPC Exam 6th ed

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

A. SpO2 of 94 % on room air

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

A. Administer intramuscular epinephrine

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

A. Anaphylaxis

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.

A. Discharge instructions including follow-up contact information.

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

A. Increased diastolic blood pressure

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

A. Insert urinary catheter

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

A. Integumentary

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

A. Intramuscular epinephrine

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.

A. Intraosseous in the patient's medial tibia.

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

A. Magnet

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

A. Necrotizing enterocolitis

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

A. Prepare the patient for hospitalization

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

A. Presence of ataxia

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

A. Pulse oximetry reading of 96%

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

B. Urine

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

B. Administration of nebulized epinephrine

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

B. Button battery

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

B. Constipation

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

B. Hyponatremia

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

B. Identify the type of formula the caregiver uses

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

B. Inhaled beta-agonist

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

B. Inspiratory stridor and coughing

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%

B. LET (lidocaine/epinephrine/tetracaine)

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

B. Urine culture

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

B. Providing frequent updates and re-educating them on the care that is being provided

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

B. Purpuric rash

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

C. Assist with escharotomy

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.

C. Auscultate breath sounds over the epigastrium and lung fields.

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

C. Bilateral midaxillary

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

C. Bronchoscopy

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

C. Low pH level

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

C. Numbers scale

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

C. Place in contact isolation

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

C. Possible pregnancy

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

D. Ketorolac

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

D. Use a nonsteroidal anti-inflammatory for pain control

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

D. Cervical spine radiographs

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.

D. Clothing should not be placed on the floor in order to prevent contamination.

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

D. Constant left shoulder pain

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

D. Ensure safety of the patient and staff

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

D. Needle decompression

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)

D. Oropharyngeal airway (OPA)

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

D. Osteogenesis imperfecta

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

D. Physical and psychological safety.

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

D. Prepare for immediate intubation

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

D. Serum blood glucose

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

D. Sick