ENPC 6th Edition by Emergency Nurses
Association (ENA) Exam Prep 2025-2026:
Ultimate Practice Questions and
Rationales for a First-Attempt Pass
A 10-year-old arrives at the ED post motor vehicle crash.
Assessment reveals a distended, tense abdomen. Heart rate is 144
beats/minute, respiratory rate is 24 breaths/minute, and blood
pressure is 120/80 mm Hg. Capillary refill is more than 3 seconds,
and skin is pale and cool. The patient's signs and symptoms
suggest:
A. Obstructive shock.
B. Distributive shock.
C. Hypovolemic shock.
D. Cardiogenic shock.
Correct Answer: C. Hypovolemic shock.
Rationale: The patient's presentation—tachycardia, delayed
capillary refill, cool and pale skin, and a tense, distended abdomen
following trauma—is a classic presentation of hypovolemic
shock. The abdominal distention indicates likely intra-abdominal
bleeding, leading to a loss of circulating volume. In hypovolemic
shock, the body compensates by increasing the heart rate
(tachycardia) and constricting peripheral blood vessels, which
explains the delayed capillary refill and cool/pale skin. Importantly,
,blood pressure is often a late sign and can remain normal, as seen
here, even in compensated shock.
Question 2
A nurse providing crisis intervention to the family of a seriously ill
child can best keep the family informed by:
A. Placing them in a secluded room.
B. Referring to their child as "the patient."
C. Telling the family how they should feel.
D. Appointing one staff member to communicate with them.
Correct Answer: D. Appointing one staff member to
communicate with them.
Rationale: In a crisis, clear and consistent communication is
paramount for families. Assigning a single, consistent liaison (such
as a designated nurse or social worker) prevents conflicting
information, reduces the family's anxiety, and ensures they have a
reliable source to turn to for updates and questions. This
designated person is the family's constant point of contact,
providing personalized support and information.
Question 3
A 4-year-old is brought in with symptoms of vomiting, lethargy,
frequent urination, weight loss, and dry mucous membranes. Vital
,signs reveal deep respirations at 44 breaths/minute, BP of 70/44
mm Hg, and HR of 144 beats/minute. Which lab finding would be
most expected in this child?
A. Low blood sugar
B. Blood pH less than 7.3
C. Normal serum bicarbonate
D. Blood glucose under 200 mg/dL
Correct Answer: B. Blood pH less than 7.3.
Rationale: This child is presenting with classic signs of new-onset
diabetes mellitus with diabetic ketoacidosis (DKA). The deep,
rapid breathing (Kussmaul respirations) is the body's attempt to
"blow off" carbon dioxide to compensate for a metabolic acidosis.
The expected lab values include an elevated blood glucose
(typically >200 mg/dL) and, most importantly, evidence of that
acidosis, such as a blood pH < 7.3 and a low serum bicarbonate.
Section 2: Respiratory Emergencies
Question 4
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 at rest. Pulse oximetry is 96% on room air.
Which of the following interventions would be most appropriate?
, A. Delivery of humidified oxygen.
B. Administration of nebulized epinephrine.
C. Suctioning secretions from the oropharynx.
D. Administration of albuterol with a spacer.
Correct Answer: B. Administration of nebulized epinephrine.
Rationale: The history and presentation are classic for moderate
to severe croup (laryngotracheobronchitis). The hallmark
symptoms are a "barky" (seal-like) cough and stridor, which is an
audible inspiratory wheeze indicating upper airway obstruction.
For a child with stridor at rest, nebulized epinephrine is the first-
line pharmacological treatment. It works rapidly to reduce airway
edema and improve breathing.
Question 5
A 6-week-old infant is brought to the emergency department by
the caregivers for poor feeding, listlessness (lethargy), and fever.
Assessment reveals a crying infant, HR 160 beats/minute, RR 52
breaths/minute, 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?
A. Chest X-ray
B. Urinalysis
C. Head CT
D. Lumbar puncture
Correct Answer: D. Lumbar puncture.
Association (ENA) Exam Prep 2025-2026:
Ultimate Practice Questions and
Rationales for a First-Attempt Pass
A 10-year-old arrives at the ED post motor vehicle crash.
Assessment reveals a distended, tense abdomen. Heart rate is 144
beats/minute, respiratory rate is 24 breaths/minute, and blood
pressure is 120/80 mm Hg. Capillary refill is more than 3 seconds,
and skin is pale and cool. The patient's signs and symptoms
suggest:
A. Obstructive shock.
B. Distributive shock.
C. Hypovolemic shock.
D. Cardiogenic shock.
Correct Answer: C. Hypovolemic shock.
Rationale: The patient's presentation—tachycardia, delayed
capillary refill, cool and pale skin, and a tense, distended abdomen
following trauma—is a classic presentation of hypovolemic
shock. The abdominal distention indicates likely intra-abdominal
bleeding, leading to a loss of circulating volume. In hypovolemic
shock, the body compensates by increasing the heart rate
(tachycardia) and constricting peripheral blood vessels, which
explains the delayed capillary refill and cool/pale skin. Importantly,
,blood pressure is often a late sign and can remain normal, as seen
here, even in compensated shock.
Question 2
A nurse providing crisis intervention to the family of a seriously ill
child can best keep the family informed by:
A. Placing them in a secluded room.
B. Referring to their child as "the patient."
C. Telling the family how they should feel.
D. Appointing one staff member to communicate with them.
Correct Answer: D. Appointing one staff member to
communicate with them.
Rationale: In a crisis, clear and consistent communication is
paramount for families. Assigning a single, consistent liaison (such
as a designated nurse or social worker) prevents conflicting
information, reduces the family's anxiety, and ensures they have a
reliable source to turn to for updates and questions. This
designated person is the family's constant point of contact,
providing personalized support and information.
Question 3
A 4-year-old is brought in with symptoms of vomiting, lethargy,
frequent urination, weight loss, and dry mucous membranes. Vital
,signs reveal deep respirations at 44 breaths/minute, BP of 70/44
mm Hg, and HR of 144 beats/minute. Which lab finding would be
most expected in this child?
A. Low blood sugar
B. Blood pH less than 7.3
C. Normal serum bicarbonate
D. Blood glucose under 200 mg/dL
Correct Answer: B. Blood pH less than 7.3.
Rationale: This child is presenting with classic signs of new-onset
diabetes mellitus with diabetic ketoacidosis (DKA). The deep,
rapid breathing (Kussmaul respirations) is the body's attempt to
"blow off" carbon dioxide to compensate for a metabolic acidosis.
The expected lab values include an elevated blood glucose
(typically >200 mg/dL) and, most importantly, evidence of that
acidosis, such as a blood pH < 7.3 and a low serum bicarbonate.
Section 2: Respiratory Emergencies
Question 4
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 at rest. Pulse oximetry is 96% on room air.
Which of the following interventions would be most appropriate?
, A. Delivery of humidified oxygen.
B. Administration of nebulized epinephrine.
C. Suctioning secretions from the oropharynx.
D. Administration of albuterol with a spacer.
Correct Answer: B. Administration of nebulized epinephrine.
Rationale: The history and presentation are classic for moderate
to severe croup (laryngotracheobronchitis). The hallmark
symptoms are a "barky" (seal-like) cough and stridor, which is an
audible inspiratory wheeze indicating upper airway obstruction.
For a child with stridor at rest, nebulized epinephrine is the first-
line pharmacological treatment. It works rapidly to reduce airway
edema and improve breathing.
Question 5
A 6-week-old infant is brought to the emergency department by
the caregivers for poor feeding, listlessness (lethargy), and fever.
Assessment reveals a crying infant, HR 160 beats/minute, RR 52
breaths/minute, 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?
A. Chest X-ray
B. Urinalysis
C. Head CT
D. Lumbar puncture
Correct Answer: D. Lumbar puncture.
