ENPC Exam Prep / Exam Questions: 5th
Edition ENPC, Open Book Expert
Strategies, Review of (50) Key Practice
Questions and Verified Detailed
Answers; for Gu aranteed Success
1. A 5-year-old with no health problems presents to the ED with sudden
chest pain and shortness of breath. Parents state the family was in a
bad car crash one week ago. A thorough workup reveals no
abnormalities. What is the best next step?
• A) Reassure the parents and discharge the patient.
• B) Consult a pediatric cardiologist.
• C) Order a chest x-ray to rule out a pneumothorax.
• D) Ask about any new bed-wetting or sleep disturbances.
Rationale: Children experiencing anxiety or PTSD following a traumatic
event may manifest with somatic complaints like chest pain and
shortness of breath. Asking about behavioral changes (e.g., sleep
disturbances, bed-wetting) helps facilitate appropriate psychosocial
support and follow-up care.
2. A 2-year-old has uniform, sharply demarcated burns to both lower
extremities, covering approximately 30% of their TBSA. The father
states he briefly left the room and the child played with the hot water
faucet in the bath. Which intervention has the highest priority?
, • A) Apply silver sulfadiazine cream to the burns.
• B) Contact child protective services.
• C) Give oral acetaminophen for pain.
• D) Obtain vascular access for rapid fluid administration.
Rationale: This patient has a major burn (>10% TBSA in a child) and is at
high risk for hypovolemic shock. Rapid vascular access and fluid
resuscitation (per the Parkland formula) is the priority intervention to
restore intravascular volume and prevent shock.
3. A 14-year-old was hit in the chest by a baseball while pitching and
had a sudden cardiac arrest. What is the most likely cause?
• A) Commotio cordis
• B) Hypertrophic cardiomyopathy
• C) Aortic dissection
• D) Tension pneumothorax
Rationale: Commotio cordis occurs when a blunt, non-penetrating blow
to the chest (e.g., from a baseball) strikes during the refractory period of
the cardiac cycle, triggering ventricular fibrillation and sudden cardiac
arrest.
4. What is the priority intervention for a 4-year-old child with
symptomatic bradycardia?
• A) Administer atropine.
• B) Start transcutaneous pacing.
• C) Begin chest compressions.
• D) Provide ventilation to address hypoxia.
Rationale: In pediatric patients, bradycardia is most often a result of
hypoxemia. The priority intervention is to support oxygenation and
ventilation. Other interventions like chest compressions or medications
are secondary if the bradycardia persists despite adequate oxygenation.
,5. Which of the following is an early sign of circulatory compromise
(shock) in a child?
• A) Tachycardia
• B) Hypotension
• C) Bradycardia
• D) Decreased level of consciousness
Rationale: Tachycardia is an early compensatory mechanism to maintain
cardiac output in the setting of decreased stroke volume. Hypotension is
a late and ominous sign in children, indicating decompensated shock.
6. A neonate presents with central cyanosis. The most accurate place
to assess for this is:
• A) Fingers and toes
• B) The palms and soles
• C) Around the mouth and nose
• D) The tongue and oral mucous membranes
Rationale: Central cyanosis reflects low arterial oxygen saturation and is
best assessed by examining the tongue, lips, and oral mucous
membranes. Acrocyanosis (bluish discoloration of hands and feet) is
often a normal finding in newborns.
7. When caring for an intubated child, you note the heart rate has
dropped from 130 to 60 bpm. After checking the pulse oximeter and
blood pressure, what is the most appropriate immediate action?
• A) Administer a dose of epinephrine.
• B) Check the endotracheal tube placement.
• C) Begin chest compressions.
• D) Re-check the heart rate in 30 seconds.
, Rationale: According to PALS guidelines, chest compressions should be
initiated for a heart rate < 60 bpm with signs of poor perfusion (e.g.,
hypotension) despite adequate oxygenation and ventilation.
8. You are discharging a patient with a history of depression. Which of
the following should be included in the discharge teaching regarding
injury prevention?
• A) Ensuring the patient gets at least 8 hours of sleep a night.
• B) Encouraging the patient to exercise daily.
• C) Ensuring all firearms in the home are locked in a safe place
with no access by the patient.
• D) Advising the patient to avoid all social media.
Rationale: Promoting injury prevention is critical for patients with
depression or suicidal ideation. Caregivers should be encouraged to lock
all firearms and medications to prevent overdoses or suicide attempts.
9. A 5-year-old child is brought to the ED after being hit by a car. She
complains of left upper quadrant (LUQ) pain, and a FAST exam shows
fluid around her spleen. Which finding would be an early indication of
ongoing blood loss?
• A) Hypotension
• B) Widening pulse pressure
• C) Bradycardia
• D) Increasing heart rate
Rationale: In the early stages of hemorrhagic shock, the body
compensates by increasing the heart rate to maintain cardiac output.
Hypotension is a late sign of decompensated shock in children.
10. A 7-year-old arrives via ambulance after a witnessed seizure at
home. They are post-ictal, HR 142 bpm, RR 36, BP 86/72 mmHg.
Significant burns are noted to the back and lower extremities. The
Edition ENPC, Open Book Expert
Strategies, Review of (50) Key Practice
Questions and Verified Detailed
Answers; for Gu aranteed Success
1. A 5-year-old with no health problems presents to the ED with sudden
chest pain and shortness of breath. Parents state the family was in a
bad car crash one week ago. A thorough workup reveals no
abnormalities. What is the best next step?
• A) Reassure the parents and discharge the patient.
• B) Consult a pediatric cardiologist.
• C) Order a chest x-ray to rule out a pneumothorax.
• D) Ask about any new bed-wetting or sleep disturbances.
Rationale: Children experiencing anxiety or PTSD following a traumatic
event may manifest with somatic complaints like chest pain and
shortness of breath. Asking about behavioral changes (e.g., sleep
disturbances, bed-wetting) helps facilitate appropriate psychosocial
support and follow-up care.
2. A 2-year-old has uniform, sharply demarcated burns to both lower
extremities, covering approximately 30% of their TBSA. The father
states he briefly left the room and the child played with the hot water
faucet in the bath. Which intervention has the highest priority?
, • A) Apply silver sulfadiazine cream to the burns.
• B) Contact child protective services.
• C) Give oral acetaminophen for pain.
• D) Obtain vascular access for rapid fluid administration.
Rationale: This patient has a major burn (>10% TBSA in a child) and is at
high risk for hypovolemic shock. Rapid vascular access and fluid
resuscitation (per the Parkland formula) is the priority intervention to
restore intravascular volume and prevent shock.
3. A 14-year-old was hit in the chest by a baseball while pitching and
had a sudden cardiac arrest. What is the most likely cause?
• A) Commotio cordis
• B) Hypertrophic cardiomyopathy
• C) Aortic dissection
• D) Tension pneumothorax
Rationale: Commotio cordis occurs when a blunt, non-penetrating blow
to the chest (e.g., from a baseball) strikes during the refractory period of
the cardiac cycle, triggering ventricular fibrillation and sudden cardiac
arrest.
4. What is the priority intervention for a 4-year-old child with
symptomatic bradycardia?
• A) Administer atropine.
• B) Start transcutaneous pacing.
• C) Begin chest compressions.
• D) Provide ventilation to address hypoxia.
Rationale: In pediatric patients, bradycardia is most often a result of
hypoxemia. The priority intervention is to support oxygenation and
ventilation. Other interventions like chest compressions or medications
are secondary if the bradycardia persists despite adequate oxygenation.
,5. Which of the following is an early sign of circulatory compromise
(shock) in a child?
• A) Tachycardia
• B) Hypotension
• C) Bradycardia
• D) Decreased level of consciousness
Rationale: Tachycardia is an early compensatory mechanism to maintain
cardiac output in the setting of decreased stroke volume. Hypotension is
a late and ominous sign in children, indicating decompensated shock.
6. A neonate presents with central cyanosis. The most accurate place
to assess for this is:
• A) Fingers and toes
• B) The palms and soles
• C) Around the mouth and nose
• D) The tongue and oral mucous membranes
Rationale: Central cyanosis reflects low arterial oxygen saturation and is
best assessed by examining the tongue, lips, and oral mucous
membranes. Acrocyanosis (bluish discoloration of hands and feet) is
often a normal finding in newborns.
7. When caring for an intubated child, you note the heart rate has
dropped from 130 to 60 bpm. After checking the pulse oximeter and
blood pressure, what is the most appropriate immediate action?
• A) Administer a dose of epinephrine.
• B) Check the endotracheal tube placement.
• C) Begin chest compressions.
• D) Re-check the heart rate in 30 seconds.
, Rationale: According to PALS guidelines, chest compressions should be
initiated for a heart rate < 60 bpm with signs of poor perfusion (e.g.,
hypotension) despite adequate oxygenation and ventilation.
8. You are discharging a patient with a history of depression. Which of
the following should be included in the discharge teaching regarding
injury prevention?
• A) Ensuring the patient gets at least 8 hours of sleep a night.
• B) Encouraging the patient to exercise daily.
• C) Ensuring all firearms in the home are locked in a safe place
with no access by the patient.
• D) Advising the patient to avoid all social media.
Rationale: Promoting injury prevention is critical for patients with
depression or suicidal ideation. Caregivers should be encouraged to lock
all firearms and medications to prevent overdoses or suicide attempts.
9. A 5-year-old child is brought to the ED after being hit by a car. She
complains of left upper quadrant (LUQ) pain, and a FAST exam shows
fluid around her spleen. Which finding would be an early indication of
ongoing blood loss?
• A) Hypotension
• B) Widening pulse pressure
• C) Bradycardia
• D) Increasing heart rate
Rationale: In the early stages of hemorrhagic shock, the body
compensates by increasing the heart rate to maintain cardiac output.
Hypotension is a late sign of decompensated shock in children.
10. A 7-year-old arrives via ambulance after a witnessed seizure at
home. They are post-ictal, HR 142 bpm, RR 36, BP 86/72 mmHg.
Significant burns are noted to the back and lower extremities. The
