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Emergency Nursing Pediatric Course (ENPC)
COMPREHENSIVE EXAM ALL 550 QUESTIONS AND
CORRECT DETAILED SOLUTIONS WITH RATIONALES
LATEST UPDATED VERSION JUST RELEASED
RECENTLY
Question: An 18-month-old is seen for fever, slight circumoral cyanosis, and wheezing noted on
auscultation in the right upper lobe of the lung field after a choking event 4 days ago. The white
blood cell count is elevated and the patient noted to be tachypneic, tachycardic, agitated, and
has an increased respiratory effort. At the time of the event, the patient was started on
antibiotics with subsequent increasing manifestations instead of improvement. Which of the
following would be considered to be definitive treatment for the suspected diagnosis? -
ANSWER✔✔Computed tomography (wrong)
Remediation feedback:
Manifestations of a lower airway foreign body include a choking incident with subsequent
failure to improve on antibiotics. Wheezing or decreased lung sounds in one area of the
pulmonary system is a high indicator for a foreign body along with signs of hypoxia such as
cyanosis, tachypnea, tachycardia, increased respiratory effort, agitation or lethargy, and
elevated white blood cell counts indicating an infectious process. The definitive treatment
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would be a bronchoscopy in order to retrieve the suspected foreign body instead of diagnostic
tests to locate the foreign body itself.
Question: A child in cardiopulmonary arrest is receiving chest compressions and manual
ventilations with a bag-mask device. Once return of spontaneous circulation has been
confirmed, which of the following would be the priority intervention? - ANSWER✔✔Establishing
a secure airway
Question: 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? - ANSWER✔✔Humidified oxygen (wrong)
Remediation feedback:
Wheezing is most often identified with asthma in the pediatric population. Initial medication
intervention includes an inhaled short-acting beta agonist.
Question: A 6-week-old is brought to the emergency department by the caregivers for poor
feeding, listlessness, and fever. Assessment reveals a crying infant, HR 160 beats/minute, RR 52
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breaths/minute, rectal temperature of 96.0 F (35.5 C), 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? - ANSWER✔✔Lumbar puncture
Question: A 12-year-old is being prepped for surgical intervention of acute appendicitis. Which
of the following intravenous medication orders should the nurse question? -
ANSWER✔✔Hydromorphone (wrong)
Remediation feedback:
Ketorolac is an appropriate medication for moderate to severe pain, however, it should not be
used pre-operatively due to its potential to increase the bleeding risk.
Q:A 4-year-old presents with vomiting, lethargy, frequent urination, weight loss, and dry
mucous membranes. Vital signs reveal deep respirations at 44 breaths per minute, BP of 70/44
mm Hg, and HR of 144 beats per minute. Which of the following laboratory values would be
most expected in this child? - ANSWER✔✔Hypoglycemia (wrong)
Remediation feedback:
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Children can present with new onset diabetes in diabetic ketoacidosis. Manifestations include
signs of dehydration ( dry mucous membranes, hypotension, tachycardia), incontinence
(polyuria), vomiting, abdominal pain, Kussmaul respirations (to counter the acidosis), polydipsia,
anorexia, and weight loss. Expected laboratory values would reveal an acidotic state with a pH
level below 7.3, an elevated serum bIcarbonate level, and an elevated blood glucose level > 200
mg.dL.
Question: A 17-year-old female arrives in the ED with her boyfriend who states she is pregnant
and having vaginal bleeding. The patient is unsure of the gestational age and has not had any
prenatal treatment. The patient is quiet and lets her boyfriend answer most of the questions.
Which of the following is the most appropriate action for the nurse to take at this point? -
ANSWER✔✔Have the boyfriend leave the room during the pelvic exam.
Question: A 2-year-old arrives at the ED in hypovolemic shock and needs fluids immediately.
After several attempts, your team has been unsuccessful at establishing vascular access. Of the
following, which is the next best option for establishing access quickly? -
ANSWER✔✔Intraosseous in the patient's medial tibia.
Emergency Nursing Pediatric Course (ENPC)
COMPREHENSIVE EXAM ALL 550 QUESTIONS AND
CORRECT DETAILED SOLUTIONS WITH RATIONALES
LATEST UPDATED VERSION JUST RELEASED
RECENTLY
Question: An 18-month-old is seen for fever, slight circumoral cyanosis, and wheezing noted on
auscultation in the right upper lobe of the lung field after a choking event 4 days ago. The white
blood cell count is elevated and the patient noted to be tachypneic, tachycardic, agitated, and
has an increased respiratory effort. At the time of the event, the patient was started on
antibiotics with subsequent increasing manifestations instead of improvement. Which of the
following would be considered to be definitive treatment for the suspected diagnosis? -
ANSWER✔✔Computed tomography (wrong)
Remediation feedback:
Manifestations of a lower airway foreign body include a choking incident with subsequent
failure to improve on antibiotics. Wheezing or decreased lung sounds in one area of the
pulmonary system is a high indicator for a foreign body along with signs of hypoxia such as
cyanosis, tachypnea, tachycardia, increased respiratory effort, agitation or lethargy, and
elevated white blood cell counts indicating an infectious process. The definitive treatment
, Page 2 of 197
would be a bronchoscopy in order to retrieve the suspected foreign body instead of diagnostic
tests to locate the foreign body itself.
Question: A child in cardiopulmonary arrest is receiving chest compressions and manual
ventilations with a bag-mask device. Once return of spontaneous circulation has been
confirmed, which of the following would be the priority intervention? - ANSWER✔✔Establishing
a secure airway
Question: 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? - ANSWER✔✔Humidified oxygen (wrong)
Remediation feedback:
Wheezing is most often identified with asthma in the pediatric population. Initial medication
intervention includes an inhaled short-acting beta agonist.
Question: A 6-week-old is brought to the emergency department by the caregivers for poor
feeding, listlessness, and fever. Assessment reveals a crying infant, HR 160 beats/minute, RR 52
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breaths/minute, rectal temperature of 96.0 F (35.5 C), 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? - ANSWER✔✔Lumbar puncture
Question: A 12-year-old is being prepped for surgical intervention of acute appendicitis. Which
of the following intravenous medication orders should the nurse question? -
ANSWER✔✔Hydromorphone (wrong)
Remediation feedback:
Ketorolac is an appropriate medication for moderate to severe pain, however, it should not be
used pre-operatively due to its potential to increase the bleeding risk.
Q:A 4-year-old presents with vomiting, lethargy, frequent urination, weight loss, and dry
mucous membranes. Vital signs reveal deep respirations at 44 breaths per minute, BP of 70/44
mm Hg, and HR of 144 beats per minute. Which of the following laboratory values would be
most expected in this child? - ANSWER✔✔Hypoglycemia (wrong)
Remediation feedback:
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Children can present with new onset diabetes in diabetic ketoacidosis. Manifestations include
signs of dehydration ( dry mucous membranes, hypotension, tachycardia), incontinence
(polyuria), vomiting, abdominal pain, Kussmaul respirations (to counter the acidosis), polydipsia,
anorexia, and weight loss. Expected laboratory values would reveal an acidotic state with a pH
level below 7.3, an elevated serum bIcarbonate level, and an elevated blood glucose level > 200
mg.dL.
Question: A 17-year-old female arrives in the ED with her boyfriend who states she is pregnant
and having vaginal bleeding. The patient is unsure of the gestational age and has not had any
prenatal treatment. The patient is quiet and lets her boyfriend answer most of the questions.
Which of the following is the most appropriate action for the nurse to take at this point? -
ANSWER✔✔Have the boyfriend leave the room during the pelvic exam.
Question: A 2-year-old arrives at the ED in hypovolemic shock and needs fluids immediately.
After several attempts, your team has been unsuccessful at establishing vascular access. Of the
following, which is the next best option for establishing access quickly? -
ANSWER✔✔Intraosseous in the patient's medial tibia.
