ENPC 5th edition
Which of the following vital signs is most consistent with an adolescent in neurogenic shock after a spinal cord injury?
Pulse 50 beats/ minute, BP 80/30 mm Hg Neurogenic shock patients have bradycardia and hypotension with a widened pulse pressure due to vasodilation.
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?
Appointing one staff member to communicate with them. This will help create a solid patient-staff bond and facilitate communication
A 6-month-old is brought to the emergency department for a recurrent respiratory infection. When gathering a history from the caregiver, the emergency nurse learns that, in addition to the respiratory symptoms, the infant has had fatty stools. The emergency nurse should be concerned about which of the following disease processes?
Cystic Fibrosis In CF, the mucus can block pancreatic ducts, which does not allow full absorption of fats/proteins, leading to greasy/fatty stools.
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?
Endotracheal intubation with positive pressure ventilation Airway control and positive pressure ventilation are the appropriate interventions for this patient.
Which of the following is the most appropriate intervention for a child experiencing a seizure?
Prepare to administer intranasal midazolam Midazolam has gained favor because of its ease of use and quick onset of action
Which of the following is the priority intervention for a pediatric patient with diabetic ketoacidosis?
Insulin infusion A continuous infusion of insulin at 0.050.1 unit/kg/hr should be used to decrease blood glucose.
Spinal shock results in which of the following transient conditions?
pain at the site of injury and hyperesthesia above the level of injury (Symptoms of spinal cord shock)
What is the priority intervention for symptomatic bradycardia in a four-year-old child?
ventilation to address hypoxia is the priority intervention.
Which of the following medications is appropriate for treating the fever of a four-year-old with scleral jaundice and elevated aspartate transaminase (AST)?
(Do not pick acetaminophen)
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?
Application of a splint to the affected extremity Splinting is an effective non-pharmacologic intervention to reduce pain associated with fractures.
A 3-year-old is brought to the emergency department with a 2-day history of a runny nose, low-grade fever, and a "barky" cough at night. The caregiver tells the emergency department nurse the coughing is getting worse. The child is awake and alert, with stridor. The nurse should anticipate which of the following?
Administration of nebulized epinephrine Moderate to severe croup is treated with dexamethasone and nebulized epinephrine
Which of the following patients should be evaluated first?
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.
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?
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.
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?
Assess the endotracheal tube placement and patency If a patient arrives with an artificial airway (endotracheal tube or tracheostomy) 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)
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?
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.
Which of the following patient presentations should increase suspicion of potential child maltreatment?
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.
In which of the following primary survey components can assessment of the fontanel provide the most useful information?
Circulation and disability A sunken fontanel may indicate dehydration; a bulging fontanel can indicate increased intracranial pressure.
Which of the following would be an abnormal finding in a patient with glomerulonephritis?
Clear urine Normal finding: There is a decrease in urine output for patient's with glomerulonephritis. Urine would be concentrated and dark brown/tea-colored
A 14-year-old high school student who was pitching for his baseball team was hit in the chest by the ball and had a sudden cardiac arrest. Of the following, which is the most likely cause of the cardiac arrest?
Commotio cordis Comotio Cordis "occurs when chest is struck during the refractory period of the cardiac conduction cycle. This type of injury usually occurs in recreational sports such as baseball or ice hockey."
A toddler has a chemical eye injury. Which of the following is the priority intervention?
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.
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?
D10 D10 is the preferred concentration for neonates to protect their fragile vasculature.
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?
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.
Which of the following statements about the assessment and management of pediatric hypovolemia is accurate?
Delayed capillary refill is one indication to administer a fluid bolus Other indications include tachycardia, dry mucous membranes, altered mental status, and cool skin.
A 7-year-old arrives via ambulance. The patient's mother reports witnessing 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?
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.
A 15-year-old patient has attempted suicide by overdosing on amitriptyline. The emergency nurse should expect which of the following symptoms?
Dysrhythmias QRS prolongation and ventricular dysrhythmias are symptoms of cyclic antidepressant overdose.
You are discharging a patient to home with a history of depression. Discharge teaching should include which of the following?
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 medications are under lock to prevent overdoses or suicide attempt.
All of the vaccine administrations listed are appropriate EXCEPT for which of the following?
Fifth Disease at 6 months There is an animal vaccine, but not a human vaccine for Fifth Disease.
Which of the following describes a neonates normal position?
Flexion with extremities close to the body A neonates normal position is flexion with extremities close to the body
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?
Focused Assessment: Vital Signs: "As the patient compensates for altered tissue perfusion, the pulse pressure narrows and the heart rate increases" - (need to rewrite either the question or the answers) Widening Pulse pressure - not correct (suppose to be narrow pulse pressure) Bradycardia - not correct Decreasing diastolic blood pressure - late sign Weak peripheral pulses - late sign
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:
Food allergy These findings are typical of a food allergy. Because allergic reactions are so variable and do not always include classic manifestations, anticipate that any food-induced allergic reaction may unexpectedly progress to life-threatening anaphylaxis.
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?
Intravenous antibiotics This patient population is at risk for life-threatening sepsis, and treatment with intravenous antibiotics is indicated.
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?
Increasing heart rate Pathophysiology: Cardiac Output. In pediatric patients, cardiac out is primarily regulate by increasing heart rate
Which of the following statements indicates the caregiver understands your discharge teaching on influenza?
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.
Which of the following indicates the need for additional parent/guardian education regarding a UTI?
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
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?
Neuroleptic malignant syndrome These are classic symptoms of neuroleptic malignant syndrome, which is a rare reaction to antipsychotic medications.
Which of the following tasks can the nurse do to decrease adverse medication events?
Obtain the patient's weight in kilograms This is the preferred measurement for medication calculations for pediatric and adult patients.
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?
Obtain vascular access for rapid fluid administration Rapid vascular access and fluid administration are the priority interventions.
The type of vascular access is appropriate in all of the patient situations given EXCEPT for which of the following?
Peripherally inserted central catheter line for one time fluid bolus This is most appropriate for long term medication administration and multiple blood draws
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?
Physical and psychological safety Create an environment where patients feel safe, both physically and psychologically. Increase awareness of the patients interpersonal interactions with others to screen for risk of harm. Prioritize the patient being in a safe location.
Which of the following actions by the nurse promotes pediatric patient safety?
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.
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?
Primary survey, vital signs, pain management, and effectiveness of therapeutic 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)
According to the American Academy of Pediatrics guidelines, which of the follwing describes how a neonate riding in a car should be positioned?
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.
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?
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.
A 14-year-old patient presents to the emergency department with her aunt after being assaulted. The patient has multiple bruises inconsistent with the assault history and seems guarded with her answers. A urine test is positive for pregnancy although the patient denies being sexually active. The aunt repeatedly asks when they will be discharged. The ED nurse recognizes these finding as red flags for which of the following?
Sex Trafficking Red Flags for sex trafficking may include multiple bruises, unwanted or unintended pregnancy, being withdrawn and guarded.
Acute chest syndrome, stroke, and splenic sequestration are complications of which of the following diseases?
Sickle cell anemia These are all typical complications of sickle cell anemia
The emergency nurse is caring for a patient with significant facial trauma and a suspected globe rupture. Which of the following medication orders would the nurse question?
Succinylcholine Succinylcholine may increase intraocular pressure and should be avoided.
Which of the following statements demonstrates a nurse's understanding of pediatric submersion injuries?
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.
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?
Using a bulb syringe suction nasal passages 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. (p6)
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 following is the priority intervention?
removal of clothing and decontamination Decontamination of nerve agents requires removal of clothing and flushing the skin with copious amounts of soap and water
