ENPC Pre Course Exam Study Questions
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Answers
1. Which of the following patients should be evaluated first?
a. A 3-year-old with a dislodged gastrostomy tube
b. An 18-month-old with bilious emesis
c. A 12-year-old with vomiting after a handlebar injury
d. A 3-month-old with periods of inconsolable crying - ANSWER b. 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.
2. 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?
a. Applying a topical lidocaine-based cream
b. Elevating the extremity to the level of the heart
c. Placing warm compresses on the affected extremity
, d. Applying a splint to the affected extremity - ANSWER d. 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.
3. 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?
a. Cystic fibrosis
b. Bronchopulmonary dysplasia
c. Pneumonitis
d. Down syndrome - ANSWER a. 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.
4. Which of the following is a known cause of pediatric seizures?
a. Benzodiazepine overdose
b. Supraventricular tachycardia
, c. Overdiluted formula
d. Congenital heart disease - ANSWER c. Overdiluted formula
Rationale: Water overload is a well-documented etiology of hyponatremia in
infants, which can be caused by excess dilution of formula. Hyponatremia is a
known cause of seizures. Benzodiazepine overdose is more likely to result is
respiratory depression and coma. CHD and SVT are not readily known to cause
seizures.
5. Which of the following indicates the need for additional caregiver education
regarding a urinary tract infection?
a. I should encourage my child to drink extra fluids.
b. I need to make a follow-up appointment with child's physician.
c. My child will grow out of their frequent urinary tract infections.
d. My child should complete all of their antibiotic medication. -
ANSWER c. 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.
6. 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?
a. Assess the oropharynx
, b. Assess endotracheal tube placement
c. Insert an orogastric tube
d. Insert a second intravenous access - ANSWER b. 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.
7. 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?
a. Initiation of abdominal thrusts to remove fluid from the lungs
b. Insertion of orogastric to remove of water and debris from stomach
c. Endotracheal intubation to provide positive pressure ventilation
d. Removal of wet clothing to prevent hypothermia - ANSWER c.
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 lungs.
with 100% Correct Answers Already
Answers
1. Which of the following patients should be evaluated first?
a. A 3-year-old with a dislodged gastrostomy tube
b. An 18-month-old with bilious emesis
c. A 12-year-old with vomiting after a handlebar injury
d. A 3-month-old with periods of inconsolable crying - ANSWER b. 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.
2. 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?
a. Applying a topical lidocaine-based cream
b. Elevating the extremity to the level of the heart
c. Placing warm compresses on the affected extremity
, d. Applying a splint to the affected extremity - ANSWER d. 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.
3. 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?
a. Cystic fibrosis
b. Bronchopulmonary dysplasia
c. Pneumonitis
d. Down syndrome - ANSWER a. 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.
4. Which of the following is a known cause of pediatric seizures?
a. Benzodiazepine overdose
b. Supraventricular tachycardia
, c. Overdiluted formula
d. Congenital heart disease - ANSWER c. Overdiluted formula
Rationale: Water overload is a well-documented etiology of hyponatremia in
infants, which can be caused by excess dilution of formula. Hyponatremia is a
known cause of seizures. Benzodiazepine overdose is more likely to result is
respiratory depression and coma. CHD and SVT are not readily known to cause
seizures.
5. Which of the following indicates the need for additional caregiver education
regarding a urinary tract infection?
a. I should encourage my child to drink extra fluids.
b. I need to make a follow-up appointment with child's physician.
c. My child will grow out of their frequent urinary tract infections.
d. My child should complete all of their antibiotic medication. -
ANSWER c. 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.
6. 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?
a. Assess the oropharynx
, b. Assess endotracheal tube placement
c. Insert an orogastric tube
d. Insert a second intravenous access - ANSWER b. 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.
7. 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?
a. Initiation of abdominal thrusts to remove fluid from the lungs
b. Insertion of orogastric to remove of water and debris from stomach
c. Endotracheal intubation to provide positive pressure ventilation
d. Removal of wet clothing to prevent hypothermia - ANSWER c.
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 lungs.
