ENPC 6th Edition Course Exam
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? -
(correct Answer) - Hypoglycemia (wrong)
Remediation feedback:
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.
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? - (correct 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 would be a bronchoscopy in order to retrieve the suspected
foreign body instead of diagnostic tests to locate the foreign body itself.
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? - (correct Answer) - Establishing a secure airway
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? - (correct 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.
, 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 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? - (correct Answer) -
Lumbar puncture
A 12-year-old is being prepped for surgical intervention of acute appendicitis. Which of the following
intravenous medication orders should the nurse question? - (correct 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.
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? - (correct Answer) - Have the boyfriend leave the
room during the pelvic exam.
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? - (correct Answer) - Intraosseous in the patient's medial tibia.
A child with an electrical injury is seen 1 hour post event. Which of the following types of specimen
samples would provide visual information regarding a potential complication of this injury? - (correct
Answer) - Sputum (wrong)
Remediation feedback:
Electrical injuries, though they may appear to be small, can produce large amounts of damage internally,
including muscle damage. Myoglobin is excreted in the urine and is evidenced by dark, red-tinged urine.
Parents with an infant requiring multiple laboratory tests, radiographic studies, and invasive procedures
appear to be distressed and withdrawn. Which of the following interventions would best ensure a sense
of comfort and control for these parents? - (correct Answer) - Providing frequent updates and re-
educating them on the care that is being provided
When taking vital signs on a stable infant, which of the following should be done first? - (correct Answer)
- Respiratory rate
A laceration on a toddler's arm is prepared for suturing. Which of the following preparations for topical
anesthesia would be the best choice for this procedure? - (correct Answer) - LET
(lidocaine/epinephrine/tetracaine)
Which of the following is appropriate administration of N-acetylcysteine (NAC) for an acetaminophen
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? -
(correct Answer) - Hypoglycemia (wrong)
Remediation feedback:
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.
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? - (correct 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 would be a bronchoscopy in order to retrieve the suspected
foreign body instead of diagnostic tests to locate the foreign body itself.
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? - (correct Answer) - Establishing a secure airway
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? - (correct 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.
, 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 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? - (correct Answer) -
Lumbar puncture
A 12-year-old is being prepped for surgical intervention of acute appendicitis. Which of the following
intravenous medication orders should the nurse question? - (correct 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.
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? - (correct Answer) - Have the boyfriend leave the
room during the pelvic exam.
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? - (correct Answer) - Intraosseous in the patient's medial tibia.
A child with an electrical injury is seen 1 hour post event. Which of the following types of specimen
samples would provide visual information regarding a potential complication of this injury? - (correct
Answer) - Sputum (wrong)
Remediation feedback:
Electrical injuries, though they may appear to be small, can produce large amounts of damage internally,
including muscle damage. Myoglobin is excreted in the urine and is evidenced by dark, red-tinged urine.
Parents with an infant requiring multiple laboratory tests, radiographic studies, and invasive procedures
appear to be distressed and withdrawn. Which of the following interventions would best ensure a sense
of comfort and control for these parents? - (correct Answer) - Providing frequent updates and re-
educating them on the care that is being provided
When taking vital signs on a stable infant, which of the following should be done first? - (correct Answer)
- Respiratory rate
A laceration on a toddler's arm is prepared for suturing. Which of the following preparations for topical
anesthesia would be the best choice for this procedure? - (correct Answer) - LET
(lidocaine/epinephrine/tetracaine)
Which of the following is appropriate administration of N-acetylcysteine (NAC) for an acetaminophen
