ENPC 2025 Emergency Nursing Pediatric Course Full Exam Guide |
Verified Test Questions, Rationales, Trauma & Medical Scenarios,
Triage, Pediatric Assessment Triangle | Study Material for ENA
Certification | Updated & Accurate Content
A 4-day-old who is brought to the emergency department with the parental complaint of "not acting right" is
found to be hypoglycemic. What is the appropriate glucose concentration to administer to this neonate?
A.Dextrose 5%
B.Dextrose 10%
C.Dextrose 25%
D.Dextrose 50%
B
Dextrose 10% is the preferred concentration for neonates with hypoglycemia to protect their fragile vasculature
while providing needed glucose. Dextrose 5% is not used to treat hypoglycemia in children. Dextrose 25% is
used for children above the age of 5 years. Dextrose 50% is not recommended for use in pediatrics unless it is
diluted.
Assessment of the fontanelle provides the most useful information for which two components of the primary
survey?
A.Circulation and disability
B.Breathing and circulation
C.Disability and exposure
D.Circulation and exposure
A
A sunken fontanelle is a red flag for circulation assessment in pediatric triage and may indicate dehydration . A
bulging fontanel is a red flag for disability assessment in pediatric triage and can indicate increased intracranial
pressure.
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.
C
A nurse providing trauma informed care to the family of a seriously ill child should be doing which of the
following?
A.Placing the family in a quiet, secluded room
B.Referring to their child as "the patient"
C.Making sure the family does not stay at the bedside.
D.Appointing one staff member to stay with the family
,D
Caregivers experiencing the crisis of a critically ill child have low attentiveness and increased stress so would
benefit from having a member of the healthcare team to stay with them as much as possible and communicate
updates on the plan of care. Caregivers should be allowed to stay with their child as much as possible and not
placed in a secluded room away for them.
The caregiver of a 7-year old reports witnessing a seizure at home, but no seizure history. 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 caregiver states the
burns accidentally occurred three days ago, but was afraid to bring the patient in due to an ongoing child
welfare investigation.Which of the following groups of interventions are the priority for this patient?
A.Call police and child welfare authorities and have security detain the caregiver
B.Administer intravenous analgesics and obtain a point of care glucose
C.Draw a metabolic panel, point of care glucose, and administer a fluid bolus
D.Administer lorazepam and a fluid bolus and place on seizure precautions
C
Burn injuries result in fluid and electrolyte shifts leading to hypovolemia and electrolyte imbalances. Early
identification and treatment of electrolyte imbalances can help prevent further seizures. Contacting child
protective services and other authorities can wait. The patient is post-ictal so does not require lorazepam
medication at this time. Pain medication can and should be considered with significant burns, but is not a
priority.
What is the priority intervention for symptomatic bradycardia in a four-year-old child?
A.Administer intravenous atropine
B.Administer intravenous epinephrine
C.Initiate bag-mask ventilation
D.Initiate transcutaneous pacing
C
\
Identifying and treating other causes, chest compressions, and epinephrine are interventions for pediatric
bradycardia with signs of poor perfusion that are not improved by adequate oxygenation and ventilation.
Atropine and pacing may be considered if there is no response to the other interventions.
A 5-year-old child presents to the emergency department after being hit by a car. The patient 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?
A.Widening pulse pressure
B.Bradycardia
C.Decreasing diastolic blood pressure
D.Weak peripheral pulses
D
,Early signs of hypovolemic shock include tachycardia and delayed capillary refill. The nurse may note a strong
central pulse but weaker peripheral pulses, indicating the child is compensating by shunting blood to their core.
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
B
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.
inconsolable crying
rule of 3s:
crying more than 3 hours per day, more than three days per week, for longer than three weeks
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
C
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
abdomen.
A 3-month-old is brought to the emergency department with new onset of fever. You note the child to be pale,
tachypneic, and tachycardic, with weak distal pulses. Which intervention is the priority for this patient?
A.Administer an appropriate dose of an antipyretic
B.Infuse a rapid 10-20 mL/kg bolus of an isotonic crystalloid
C.Prepare a broad spectrum antibiotic infusion
D.Administer a vasoactive medication
, B
This patient most likely has septic shock. An immediate goal is to reverse shock and restore tissue perfusion
with fluids. An antipyretic may be needed based on the temperature and patient symptoms. An antibiotic should
be started within an hour, and vasoactive medications may not be needed if fluid resuscitation is successfu
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
A
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.
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
D
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.
Which of the following is a known cause of pediatric seizures?
A.Benzodiazepine overdose
B.Supraventricular tachycardia
C.Overdiluted formula
D.Congenital heart disease
C
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.
Verified Test Questions, Rationales, Trauma & Medical Scenarios,
Triage, Pediatric Assessment Triangle | Study Material for ENA
Certification | Updated & Accurate Content
A 4-day-old who is brought to the emergency department with the parental complaint of "not acting right" is
found to be hypoglycemic. What is the appropriate glucose concentration to administer to this neonate?
A.Dextrose 5%
B.Dextrose 10%
C.Dextrose 25%
D.Dextrose 50%
B
Dextrose 10% is the preferred concentration for neonates with hypoglycemia to protect their fragile vasculature
while providing needed glucose. Dextrose 5% is not used to treat hypoglycemia in children. Dextrose 25% is
used for children above the age of 5 years. Dextrose 50% is not recommended for use in pediatrics unless it is
diluted.
Assessment of the fontanelle provides the most useful information for which two components of the primary
survey?
A.Circulation and disability
B.Breathing and circulation
C.Disability and exposure
D.Circulation and exposure
A
A sunken fontanelle is a red flag for circulation assessment in pediatric triage and may indicate dehydration . A
bulging fontanel is a red flag for disability assessment in pediatric triage and can indicate increased intracranial
pressure.
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.
C
A nurse providing trauma informed care to the family of a seriously ill child should be doing which of the
following?
A.Placing the family in a quiet, secluded room
B.Referring to their child as "the patient"
C.Making sure the family does not stay at the bedside.
D.Appointing one staff member to stay with the family
,D
Caregivers experiencing the crisis of a critically ill child have low attentiveness and increased stress so would
benefit from having a member of the healthcare team to stay with them as much as possible and communicate
updates on the plan of care. Caregivers should be allowed to stay with their child as much as possible and not
placed in a secluded room away for them.
The caregiver of a 7-year old reports witnessing a seizure at home, but no seizure history. 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 caregiver states the
burns accidentally occurred three days ago, but was afraid to bring the patient in due to an ongoing child
welfare investigation.Which of the following groups of interventions are the priority for this patient?
A.Call police and child welfare authorities and have security detain the caregiver
B.Administer intravenous analgesics and obtain a point of care glucose
C.Draw a metabolic panel, point of care glucose, and administer a fluid bolus
D.Administer lorazepam and a fluid bolus and place on seizure precautions
C
Burn injuries result in fluid and electrolyte shifts leading to hypovolemia and electrolyte imbalances. Early
identification and treatment of electrolyte imbalances can help prevent further seizures. Contacting child
protective services and other authorities can wait. The patient is post-ictal so does not require lorazepam
medication at this time. Pain medication can and should be considered with significant burns, but is not a
priority.
What is the priority intervention for symptomatic bradycardia in a four-year-old child?
A.Administer intravenous atropine
B.Administer intravenous epinephrine
C.Initiate bag-mask ventilation
D.Initiate transcutaneous pacing
C
\
Identifying and treating other causes, chest compressions, and epinephrine are interventions for pediatric
bradycardia with signs of poor perfusion that are not improved by adequate oxygenation and ventilation.
Atropine and pacing may be considered if there is no response to the other interventions.
A 5-year-old child presents to the emergency department after being hit by a car. The patient 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?
A.Widening pulse pressure
B.Bradycardia
C.Decreasing diastolic blood pressure
D.Weak peripheral pulses
D
,Early signs of hypovolemic shock include tachycardia and delayed capillary refill. The nurse may note a strong
central pulse but weaker peripheral pulses, indicating the child is compensating by shunting blood to their core.
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
B
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.
inconsolable crying
rule of 3s:
crying more than 3 hours per day, more than three days per week, for longer than three weeks
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
C
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
abdomen.
A 3-month-old is brought to the emergency department with new onset of fever. You note the child to be pale,
tachypneic, and tachycardic, with weak distal pulses. Which intervention is the priority for this patient?
A.Administer an appropriate dose of an antipyretic
B.Infuse a rapid 10-20 mL/kg bolus of an isotonic crystalloid
C.Prepare a broad spectrum antibiotic infusion
D.Administer a vasoactive medication
, B
This patient most likely has septic shock. An immediate goal is to reverse shock and restore tissue perfusion
with fluids. An antipyretic may be needed based on the temperature and patient symptoms. An antibiotic should
be started within an hour, and vasoactive medications may not be needed if fluid resuscitation is successfu
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
A
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.
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
D
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.
Which of the following is a known cause of pediatric seizures?
A.Benzodiazepine overdose
B.Supraventricular tachycardia
C.Overdiluted formula
D.Congenital heart disease
C
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.
