ENPC 6th Edition Course Exam

During a diaper change on a 4-month-old infant, the nurse measures the infant's urinary output. After subtracting the weight of a dry diaper, the wet diaper weighs 22 grams. What is the infant's estimated urinary output?

22 mL

Which of the following is considered a "red flag" when triaging a pediatric patient?

A 5-year-old with a temperature of 40.1°C (104.2°F) (wrong) Remediation feedback: Any temperature greater than 38°C (100.4°F) in a neonate is a significant red flag and should be treated as neonatal sepsis.

Which of the following is appropriate administration of N-acetylcysteine (NAC) for an acetaminophen overdose?

A bolus infusion of 150 mg/kg NAC should be administered.

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?

Administer intramuscular epinephrine

A 3-year-old is brought by caregivers with generalized tonic-clonic activity, unresponsiveness, and drooling that began 6 minutes prior to arrival. Which of the following interventions would be most appropriate for this event?

Administer intranasal midazolam

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?

Assist with chest tube insertion (wrong) Remediation feedback: Urinary catheters are contraindicated for placement if pelvic injury is suspected or blood is noted at the urinary meatus. Scrotal or perineal discolorations with edema to the areas is also a contraindication for this adjunct.

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?

Barking cough (wrong) Remediation feedback Triage begins when the child is initially visualized using the pediatric assessment triangle. Appearance, work of breathing, and circulation to the skin are components that guide the prioritization of the child's care. The presence of a purpuric rash necessitates the infant to be placed in isolation immediately as this is a symptom of possible meningitis.

The nurse is reevaluating the effectiveness of interventions for a 4-year-old child with a suspected tension pneumothorax. Which assessment finding indicates the interventions were effective?

Bilateral chest wall rise with assisted ventilations.

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?

Bilateral midaxillary

A 5-year-old arrives in the ED with a 4 day history of vomiting. Vital signs: HR 136 beats/minute, RR 36 breaths/minute, BP 92/56 mm Hg, T 38oC (100.4oF), and pulse oximetry 93% on room air. The child is pale with warm, dry skin and a capillary refill of 3 seconds. A fluid bolus is completed. Which of the following reassessment findings indicate that a second fluid bolus is necessary?

Blood pressure of 92/78 mm Hg

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?

Button battery

A 2-year-old arrives with a 2-day history of vomiting and diarrhea. The patient has a fever of 38.4oC (101.2°F), resting HR of 152 beats/minute, RR of 34 breaths/minute, and blood pressure of 94/ 56 mm Hg. Assessment reveals a capillary refill time of > 5 seconds. Which of the following would be most indicative of the need for intravenous rehydration therapy for this patient?

Capillary refill

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?

Cervical spine radiographs

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?

Computed tomography (wrong) Remediation feedback: Manifestations of a lower airway foreign body include a choking incident with subsequent failure to improve on antibiotics. Wheezing or decreased lung sounds in one area of the pulmonary system is a high indicator for a foreign body along with signs of hypoxia such as cyanosis, tachypnea, tachycardia, increased respiratory effort, agitation or lethargy, and elevated white blood cell counts indicating an infectious process. The definitive treatment would be a bronchoscopy in order to retrieve the suspected foreign body instead of diagnostic tests to locate the foreign body itself.

Which of the following pathologic processes would most likely be attributed to a primary diagnosis of cystic fibrosis?

Constipation

Which of the following is a family-centered care concept ?

Cultural backgrounds are assessed and incorporated into the plan of care.

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?

Drug assisted intubation (wrong) Remediation feedback: Tension pneumothorax is a complication of trauma associated with an original pneumothorax. Air in the pleural space increases and compresses the heart and great vessels creating a type of obstructive shock. A hallmark sign, tracheal deviation, can be difficult to see in the pediatric patient. Needle decompression is emergently necessary to release the air and allow expansion of the lung again.

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?

Ehlers-Danlos syndrome (wrong) Remediation feedback: Osteogenesis imperfecta is a genetic disorder that includes short stature, blue-grey color to the sclera, discolored teeth, and laxity of the ligaments. Such patients are susceptible to fractures, especially of the midshaft of long bones. These patients are often mistaken for victims of child maltreatment.

A 13-year -old male presents to the triage desk complaining of nausea and vomiting. The patient looks distressed and pale. He complains of spasming pain in his right scrotum which has now become constant and more severe. Which of the following assessment findings would the nurse expect with this patient?

Elevated right testicle

An 8-year-old pedestrian is thrown onto the hood of a moving vehicle striking the windshield. On arrival to the ED. the patient is minimally responsive with active bleeding from the nose and mouth. The patient is vomiting. Which of the following interventions would most likely be considered?

Endotracheal intubation

An 8-month-old arrives with a 12-hour history of intermittent abdominal pain, non-bilious vomiting, and a low grade fever. On assessment the child is intermittently inconsolable followed by periods of normal activity. A sausage-shaped mass is noted during palpation of the abdomen. The nurse should prepare for which of the following?

Enema with air

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?

Ensure safety of the patient and staff

You are discharging a patient home who has a history of depression. Discharge teaching should include which of the following?

Ensuring all firearms in the home are locked up with no access available by the patient.

A child in cardiopulmonary arrest is receiving chest compressions and manual ventilations with a bag-mask device. Once return of spontaneous circulation has been confirmed, which of the following would be the priority intervention?

Establishing a secure airway

A 17-year-old female arrives in the ED with her boyfriend who states she is pregnant and having vaginal bleeding. The patient is unsure of the gestational age and has not had any prenatal treatment. The patient is quiet and lets her boyfriend answer most of the questions. Which of the following is the most appropriate action for the nurse to take at this point?

Have the boyfriend leave the room during the pelvic exam.

A 12-year-old female patient arrives awake and alert with an acute onset of abdominal pain on the right side, nausea, vomiting, and vaginal spotting. On palpation, the pain is localized to the right side and there is tenderness to the breasts. Which of the following laboratory tests is the priority for this patient?

Human chorionic gonadotropin

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?

Humidified oxygen (wrong) Remediation feedback: Wheezing is most often identified with asthma in the pediatric population. Initial medication intervention includes an inhaled short-acting beta agonist.

A 5-year-old patient presents with severe dehydration and signs of shock due to viral gastroenteritis. Which of the following physiologic responses by this patient will have the greatest impact on improving their cardiac output?

Increased heart rate

A 12-year-old is being prepped for surgical intervention of acute appendicitis. Which of the following intravenous medication orders should the nurse question?

Hydromorphone (wrong) Remediation feedback: Ketorolac is an appropriate medication for moderate to severe pain, however, it should not be used pre-operatively due to its potential to increase the bleeding risk.

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?

Hypoglycemia (wrong) Remediation feedback: Children can present with new onset diabetes in diabetic ketoacidosis. Manifestations include signs of dehydration ( dry mucous membranes, hypotension, tachycardia), incontinence (polyuria), vomiting, abdominal pain, Kussmaul respirations (to counter the acidosis), polydipsia, anorexia, and weight loss. Expected laboratory values would reveal an acidotic state with a pH level below 7.3, an elevated serum bIcarbonate level, and an elevated blood glucose level > 200 mg.dL.

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?

Identify the type of formula the caregiver uses

A child presents with a history of poor oral intake. The patient is pale, lethargic, and has shallow, rapid respirations. Central pulses are weak and capillary refill time is four seconds. Which of the following interventions has the highest priority?

Initiate an intravenous fluid bolus

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?

Intraosseous in the patient's medial tibia.

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?

LET (lidocaine/epinephrine/tetracaine)

A 6-week-old is brought to the emergency department by the caregivers for poor feeding, listlessness, and fever. Assessment reveals a crying infant, HR 160 beats/minute, RR 52 breaths/minute, rectal temperature of 96.0 F (35.5 C), and a bulging anterior fontanel. Capillary refill is 4 seconds. Based on these findings what is the most likely diagnostic test the nurse should anticipate?

Lumbar puncture

A 12-year-old presents to the emergency department with a severe headache. The mother reports that the child has been experiencing headaches and has had multiple seizures for the past several months. The child was seen by their primary doctor and prescribed an anti-seizure medication, but the prescription was not filled because "the doctor just wants money." This is an example of what type of neglect?

Medical

A child with bipolar disorder is brought to the emergency department for increasing irritability, agitation, pressured speech, and a decreased need for sleep. What should be included in the plan of care for this child?

Performing a suicide risk assessment

EMS is transporting a 12-year-old restrained passenger involved in a high-speed motor vehicle collision. The patient complains of increasing dyspnea. Breath sounds are clear and equal, and heart sounds are difficult to auscultate. Vitals include HR 132 beats/minute, RR 36 breaths/minute, and BP 80/55 mm Hg. Which of the following is the priority intervention?

Pericardiocentesis

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?

Practice yawning three to four times a day (wrong) Remediation feedback: Patients with temporomandibular joint dislocation should avoid activities that involve extreme jaw joint opening. Cold or warm, not hot, compresses are recommended along with nonsteroidal anti-inflammatory medications for pain control.

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?

Prolonged capillary refill (wrong) Remediation feedback: In the early compensated phase of shock attributed to fluid volume loss, the diastolic pressure will increase due to vasoconstriction (increasing systemic vascular resistance) as a compensatory mechanism causing a narrowed pulse pressure. A normal systolic pressure is maintained during this phase. Other manifestations of early shock states are tachycardia, normal capillary refill, decreased urine output, mild irritability, tachypnea, and weak peripheral pulses.

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?

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

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?

Pulsating, unilateral pain (wrong) Remediation feedback: Urinary catheters are contraindicated for placement if pelvic injury is suspected or blood is noted at the urinary meatus. Scrotal or perineal discolorations with edema to the areas is also a contraindication for this adjunct.

When taking vital signs on a stable infant, which of the following should be done first?

Respiratory rate

A neonate presents to the emergency department with irritability, weak cry, and hypotonia. Which of the following is a priority intervention?

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?

Sick

Which of the following is a first-line treatment for atopic dermatitis?

Skin hydration therapy

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?

Sputum (wrong) Remediation feedback: Electrical injuries, though they may appear to be small, can produce large amounts of damage internally, including muscle damage. Myoglobin is excreted in the urine and is evidenced by dark, red-tinged urine.

After a seizure at home, a 9-month-old infant is awake and interacting appropriately. Vital signs on arrival are HR 150 beats/minutes, RR 36 breaths/minute (unlabored), BP 80/52 mm Hg, SaO2 97% without supplemental oxygen, and T 102.7°F (39.3°C) rectally. During re-evaluation 2 hours after arrival, which of the following assessments would indicate appropriate measures were taken in treating this child?

Temperature 37.7°C (99.9°F)

A 2-year-old is seen with a 3-day history of irritability, vomiting, and the presence of foul-smelling urine. The child is hypotensive and tachycardic. Which of the following methods for obtaining a urine sample is most appropriate in this circumstance?

Urinary catherization

A 10-year-old playing baseball is hit in the chest with a ball. He immediately demonstrates loss of consciousness with no pulses. Which of the following is the priority intervention?

Utilize AED/defibrillator