ENPC PEDIATRIC EMERGENCY CARE EXAM 6TH
ED 2025/2026 WITH 100% ACCURATE ANSWERS
1. A 3-year-old child is brought to the office by her father. The child has had a
sore throat and fever for the past two days. This morning she was hoarse
and seemed to be having more difficulty breathing. On exam, she appears
to be in distress and has an oral temperature of 100.0 F. Tympanic
membranes are pink but not bulging. Nares are patent without rhinorrhea.
She has a barking cough, stridor at rest, and nasal flaring. Which of the
following treatments is most appropriate in the care of this child?
Discharge home to use cool mist vaporizer
Start broad spectrum antibiotic
Administer parainfluenza vaccine
Admit patient, start humidified oxygen and intermittent racemic
epinephrine
2. Describe the advantages of using LET (lidocaine/epinephrine/tetracaine) for
topical anesthesia in pediatric patients.
LET is less effective than EMLA for pain relief in children.
LET provides effective pain relief and vasoconstriction, which
minimizes bleeding during procedures.
LET has a longer onset time compared to LMX.
LET is not suitable for use in children under 5 years old.
3. Describe the significance of administering intramuscular epinephrine in a
child experiencing stridor after a meal.
Intramuscular epinephrine helps in diagnosing respiratory
,conditions.
, Intramuscular epinephrine is a long-term treatment for allergies.
Intramuscular epinephrine is used to treat infections in children.
Intramuscular epinephrine is crucial as it rapidly reverses airway
swelling and improves breathing in anaphylaxis.
4. In a scenario where a 3-year-old child presents with severe dehydration
and multiple unsuccessful attempts at IV access, what would be the most
appropriate immediate intervention?
Continue attempts at peripheral IV access for 30 minutes.
Establish intraosseous access in the medial tibia.
Administer oral rehydration solutions.
Wait for a pediatric anesthesiologist to place a central line.
5. In a neonate presenting with irritability, weak cry, and hypotonia, which
initial laboratory test is most crucial to perform?
Arterial blood gas
Complete blood count
Urine analysis
Serum glucose level
6. What symptom is most indicative of a potential secondary etiology in a
pediatric patient with headaches?
Presence of ataxia
Pulsating, unilateral pain
Occurrence of photophobia
, Nausea, vomiting
7. A patient who has been involved in a motor-vehicle crash is admitted to the
ED with cool, clammy skin, tachycardia, and hypotension. All of these orders
are written. Which one will the nurse act on first?
Draw blood to type and crossmatch for transfusions.
Administer oxygen at 100% per non-rebreather mask.
Place the patient on continuous cardiac monitor.
Insert two 14-gauge IV catheters.
8. Parents report their 3-year-old child has developed noisy breathing. On
assessment, high-pitched wheezes are audible and auscultated on
inspiration and expiration. What medication would be appropriate to
administer first?
Nebulized magnesium sulfate
Humidified oxygen
Inhaled beta-agonist
Oral steroids
9. A 2-month-old infant is brought to the pediatric emergency department
due to vomiting and diarrhea for 4 days. Assessment findings include
lethargy, poor feeding, sunken fontanel, temperature 100.4 F (38 C), heart
rate 134/min, and respiratory rate 28/min. Which prescription from the
health care provider would be the priority?
Acetaminophen elixir 50 mg by mouth every 6 hours
Intravenous (IV) ampicillin 240 mg every 12 hours
IV normal saline bolus 20 mL/kg over 1 hour
ED 2025/2026 WITH 100% ACCURATE ANSWERS
1. A 3-year-old child is brought to the office by her father. The child has had a
sore throat and fever for the past two days. This morning she was hoarse
and seemed to be having more difficulty breathing. On exam, she appears
to be in distress and has an oral temperature of 100.0 F. Tympanic
membranes are pink but not bulging. Nares are patent without rhinorrhea.
She has a barking cough, stridor at rest, and nasal flaring. Which of the
following treatments is most appropriate in the care of this child?
Discharge home to use cool mist vaporizer
Start broad spectrum antibiotic
Administer parainfluenza vaccine
Admit patient, start humidified oxygen and intermittent racemic
epinephrine
2. Describe the advantages of using LET (lidocaine/epinephrine/tetracaine) for
topical anesthesia in pediatric patients.
LET is less effective than EMLA for pain relief in children.
LET provides effective pain relief and vasoconstriction, which
minimizes bleeding during procedures.
LET has a longer onset time compared to LMX.
LET is not suitable for use in children under 5 years old.
3. Describe the significance of administering intramuscular epinephrine in a
child experiencing stridor after a meal.
Intramuscular epinephrine helps in diagnosing respiratory
,conditions.
, Intramuscular epinephrine is a long-term treatment for allergies.
Intramuscular epinephrine is used to treat infections in children.
Intramuscular epinephrine is crucial as it rapidly reverses airway
swelling and improves breathing in anaphylaxis.
4. In a scenario where a 3-year-old child presents with severe dehydration
and multiple unsuccessful attempts at IV access, what would be the most
appropriate immediate intervention?
Continue attempts at peripheral IV access for 30 minutes.
Establish intraosseous access in the medial tibia.
Administer oral rehydration solutions.
Wait for a pediatric anesthesiologist to place a central line.
5. In a neonate presenting with irritability, weak cry, and hypotonia, which
initial laboratory test is most crucial to perform?
Arterial blood gas
Complete blood count
Urine analysis
Serum glucose level
6. What symptom is most indicative of a potential secondary etiology in a
pediatric patient with headaches?
Presence of ataxia
Pulsating, unilateral pain
Occurrence of photophobia
, Nausea, vomiting
7. A patient who has been involved in a motor-vehicle crash is admitted to the
ED with cool, clammy skin, tachycardia, and hypotension. All of these orders
are written. Which one will the nurse act on first?
Draw blood to type and crossmatch for transfusions.
Administer oxygen at 100% per non-rebreather mask.
Place the patient on continuous cardiac monitor.
Insert two 14-gauge IV catheters.
8. Parents report their 3-year-old child has developed noisy breathing. On
assessment, high-pitched wheezes are audible and auscultated on
inspiration and expiration. What medication would be appropriate to
administer first?
Nebulized magnesium sulfate
Humidified oxygen
Inhaled beta-agonist
Oral steroids
9. A 2-month-old infant is brought to the pediatric emergency department
due to vomiting and diarrhea for 4 days. Assessment findings include
lethargy, poor feeding, sunken fontanel, temperature 100.4 F (38 C), heart
rate 134/min, and respiratory rate 28/min. Which prescription from the
health care provider would be the priority?
Acetaminophen elixir 50 mg by mouth every 6 hours
Intravenous (IV) ampicillin 240 mg every 12 hours
IV normal saline bolus 20 mL/kg over 1 hour
