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ENPC 4th Edition: Practice Test questions and answers
1. A preschooler has a small laceration that requires 2 stitches. The nurse covers the wound with a bandage knowing that it will comfort the child to have ... [Show More] it covered. What is the developmental reason for this intervention? A.) Preschoolers are magical thinkers and imagine bandages keep their insides from coming out. B.) Preschoolers fear physical disability and believe a bandage will prevent disability. C.) Preschoolers explore orally and will likely chew or suck on the stitches if left uncovered. D.) Preschoolers are concerned with body image and don't want to appear different than peers. A.) Preschoolers are magical thinkers and imagine bandages keep their insides from coming out. Rationale: Preschoolers are magical and illogical thinkers and have difficulty distinguishing fantasy from reality. They have misconceptions about illness, injury, and bodily functions. For example, they perceive that if their skin is cut, they fear their insides will leak out. Covering a wound with a bandage helps them with this fear. 2. 7-month-old presents to the emergency department with a complaint of fever. Assessment reveals a patent airway and slight cyanosis around his lips and nail beds. He is alert and interactive. His vital signs are 38.5 C (101.3F), HR 134, RR 32, BP 78/54 mm Hg, and Spo2 84%. The nurse notes a healed surgical scar on his chest. Based on this assessment, what is the nurse's priority? A.) Administer ibuprofen to treat the fever. B.) Begin oxygen via a nonrebreather mask. C.) Obtain a surgical history. D.) Ask if the Spo2 is normal for him. D.) Ask if the Spo2 is normal for him. Rationale: Children with special healthcare needs may present differently than other children, but these differences may be normal. The surgical scar on the chest is likely from a congenital heart defect repair. The mother's chief complaint is the fever, not the color, pulse oximetry, or the respiratory distress. This may be because these aspects of his assessment are normal. The intact mental status is also a sign that he has adapted to lowers oxygen saturation's. The child's baseline must come from the caregiver before any intervention. 3. An 11-year-old presents to the emergency department with a complaint of hitting his head while playing soccer. The nurse enters the room and performs an across-the-room assessment. He is staring at the wall. He has no increased work of breathing, and his color is pink. Using the pediatric assessment triangle (PAT), what classification will the nurse assign? A.) Well Rationale: In using the PAT, there is not a Well category. A child may appear well and without disruption in any of the three components of the PAT but is still designated sick. All pediatric patients presenting to the emergency department are considered sick simply based on the fact that the caregiver was concerned enough to bring the child to the emergency department (p. 54). B.) Sick Rationale: If there is no disruption in any of the three components of the PAT, a pediatric patient is considered sick. This child has an abnormality in one of the three. He is staring at the wall, which is a disruption in the general appearance component (p. 54). C.) Sicker Rationale: This child has a disruption in one of the three components of the PAT. He is staring at the wall, which is a disruption in the general appearance component. It may be that he is anxious and fearful about the experience, but it could be a result of the head injury. More assessment is required (p. 54). D.) Sickest Rationale: If there are disruptions in two or more of the three components of the PAT, a pediatric patient is considered sickest and needs immediate evaluation and intervention. This child has an abnormality in one of the three components (p. 54). C.) Sicker Rationale: This child has a disruption in one of the three components of the PAT. He is staring at the wall, which is a disruption in the general appearance component. It may be that he is anxious and fearful about the experience, but it could be a result of the head injury. More assessment is required (p. 54). 4. The pediatric prioritization process components include the focused assessment, focused history, acuity rating decision and: A.) the pediatric assessment triangle (PAT). Rationale: The four components of the pediatric prioritization process include the pediatric assessment triangle (PAT), the focused assessment (objective data), the focused history (subjective data), and the assignment of the triage acuity rating. These components ensure enough information is rapidly gathered and used to provide appropriate care and timely interventions for pediatric patients (p. 52). B.) developmental characteristics. Rationale: Developmental characteristics are incorporated into each component of the pediatric prioritization process but do not constitute a separate element (p. 52). C.) head-to-toe assessment. Rationale: The head-to-toe assessment is part of the focused assessment but not a separate element (p. 52). D.) life-saving interventions. Rationale: Life-saving interventions should be performed at any point throughout the prioritization process as life threats are identified (p. 52) A.) The pediatric assessment triangle (PAT). Rationale: The four components of the pediatric prioritization process include the pediatric assessment triangle (PAT), the focused assessment (objective data), the focused history (subjective data), and the assignment of the triage acuity rating. These components ensure enough information is rapidly gathered and used to provide appropriate care and timely interventions for pediatric patients (p. 52). 5. A 2-year-old is brought to the emergency department by her father when he found her face down in the pool. She remains unresponsive and is breathing shallowly and slowly. Her color is pale. What is the priority? A.) Administer 100% oxygen Rationale: The primary assessment in a trauma patient begins with immobilization of the cervical spine while opening the airway. The remainder of the primary assessment interventions including oxygenation is performed after cervical spinal immobilization (p. 64). B.) Immobilize the cervical spine Rationale: Any unresponsive child found in a pool must be assumed to be a trauma patient and with a cervical spinal injury until proven otherwise. The primary assessment in a trauma patient begins with immobilization of the cervical spine while opening the airway. The remainder of the primary assessment interventions, including inserting an airway, oxygenation, and ventilation, is performed after cervical spinal immobilization (p. 64). C.) Begin bag-mask ventilation Rationale: The primary assessment in a trauma patient begins with immobilization of the cervical spine while opening the airway. The remainder of the primary assessment interventions, including ventilation, is performed after cervical spinal immobilization (p. 64). D.) Insert an oral airway Rationale: The primary assessment in a trauma patient begins with immobilization of the cervical spine while opening the airway. The remainder of the primary assessment interventions, including inserting an airway, if needed, is performed after cervical spinal immobilization (p. 64). B.) Immobilize the cervical spine. Rationale: Any unresponsive child found in a pool must be assumed to be a trauma patient and with a cervical spinal injury until proven otherwise. The primary assessment in a trauma patient begins with immobilization of the cervical spine while opening the airway. The remainder of the primary assessment interventions, including inserting an airway, oxygenation, and ventilation, is performed after cervical spinal immobilization (p. 64). 6. A 2-year-old has a suspected cervical spinal injury. In order to ensure neutral spinal alignment, padding should be placed under which area? a. Shoulders Rationale: The younger child has a larger head proportionally to the body and when lying supine is naturally in a position of cervical flexion. Padding under the shoulders or upper torso will bring the cervical spine into neutral alignment. The shoulder should be horizontally aligned with the external auditory meatus (p. 64). b. Head Rationale: Padding under the head will exacerbate this flexion (p. 64). c. Neck Rationale: Padding under the neck will not correct the anatomic flexion (p. 64). d. Waist Rationale: Padding under the waist will not affect the cervical spinal alignment (p. 64). A. Shoulders Rationale: The younger child has a larger head proportionally to the body and when lying supine is naturally in a position of cervical flexion. Padding under the shoulders or upper torso will bring the cervical spine into neutral alignment. The shoulder should be horizontally aligned with the external auditory meatus (p. 64). 7. The nurse is preparing to administer a feeding through a nasogastric feeding tube. The tube position was verified by radiograph after insertion 2 hours ago. What is the best way to verify placement before feeding? a. Instill air and listen over the epigastrium Rationale: The research regarding verification of gastric or feeding tube placement has demonstrated that the standard method of instillation of air and auscultation over the epigastrium for gurgling has been associated with improper placement and adverse outcomes (p. 103). b. Test the pH of the gastric contents Rationale: The research regarding verification of gastric or feeding tube placement has demonstrated that the standard method of instillation of air and auscultation over the epigastrium for gurgling has been associated with improper placement and adverse outcomes. The use of pH testing had been demonstrated to be safer and has been adopted as policy in many institutions (p. 103). c. Observe color of a gastric aspirate sample Rationale: Aspiration of gastric contents is done to perform pH testing, not observation of color (p. 103). d. Repeat the radiograph Rationale: Verification of placement by radiograph is generally done initially, but subsequent verifications are better established by pH testing (p. 103). B.) Test the pH of the gastric contents. Rationale: The research regarding verification of gastric or feeding tube placement has demonstrated that the standard method of instillation of air and auscultation over the epigastrium for gurgling has been associated with improper placement and adverse outcomes. The use of pH testing had been demonstrated to be safer and has been adopted as policy in many institutions (p. 103). 8. What is the best method to rapidly administer a 20 mL/kg bolus of 0.9% normal saline to a pediatric patient weighing 8 kg? a. A 20-mL syringe with a stopcock Rationale: With a 20-mL syringe and a three-way stopcock, the nurse can quickly deliver an appropriate bolus of 0.9% normal saline by drawing up and administering 20 mL once for each kilogram of the pediatric patient's weight or 8 times for this patient (p. 119). b. A syringe pump Rationale: A syringe pump is good for medication administration that needs to infuse over time, but it will take longer than the method using a 20-mL syringe and a stopcock (p. 119). c. A rapid infuser Rationale: Rapid infuser devices are used on patients weighing at least 25 kg and receiving a minimum of 500mL. This patient does not meet either requirement for use (p. 119). d. A pressure bag Rationale: A pressure bag is sometimes quite useful in administering a large amount of fluid; however, the higher pressures generated may result in venous rupture in younger children (p. 119). A.) A 20-mL syringe with a stopcock. Rationale: With a 20-mL syringe and a three-way stopcock, the nurse can quickly deliver an appropriate bolus of 0.9% normal saline by drawing up and administering 20 mL once for each kilogram of the pediatric patient's weight or 8 times for this patient (p. 119). 9. Immediately after intraosseous insertion the nurse assesses the infusion and notes that the fluid is not dripping. How should the nurse respond? a. Use an infusion pump to deliver the fluids Rationale: Fluids infusing through an intraosseous device do not necessarily run by gravity. The use of an infusion pump is usually required (p. 127). b. Remove the device and insert in another site Rationale: Fluids infusing through an intraosseous device do not necessarily run by gravity. This does not mean it is nonfunctional and removal is not indicated (p. 127). c. Advance the device and reassess the flow Rationale: Advancing the device if it is currently correctly placed may penetrate the far wall of the bone and produce infiltration (p. 127). d. Attempt to aspirate bone marrow Rationale: Aspiration of bone marrow confirms correct placement of an intraosseous device, but lack of return is not a sign of incorrect placement. Bone marrow aspiration is not always possible in some severely dehydrated pediatric patients (p. 127). A.) Use an infusion pump to deliver the fluids Rationale: Fluids infusing through an intraosseous device do not necessarily run by gravity. The use of an infusion pump is usually required (p. 127). 10. A 13-month-old presents to the emergency department with a 2-day history of a low-grade fever, increased work of breathing, and tonight developed a barking cough and inspiratory stridor. What condition does the nurse suspect? a. Epiglottitis Rationale: Epiglottitis has a sudden onset of high fever, sore throat, difficulty swallowing, and muffled voice and quickly progresses to drooling, tripod positioning, and stridor (p. 137). b. Foreign body aspiration Rationale: This patient is the right age for a foreign body aspiration as it is more common in infants and toddlers who explore the world orally, but the gradual onset, low-grade fever, and barking cough indicates an infectious process, specifically croup (p. 137). c. Tracheomalacia Rationale: Tracheomalacia is a chronic condition affecting the upper airway that may be an indication for a tracheostomy, but it is not acute, nor associated with infectious processes (pp. 136, 142-143). d. Croup Rationale: Croup is most commonly seen in children between the ages of 6 and 36 months and has a gradual onset of cold symptoms including a low-grade fever, tachypnea, tachycardia, retractions, and inspiratory stridor. The classic sign is a barking cough that worsens at night (p. 137). D.) Croup Rationale: Croup is most commonly seen in children between the ages of 6 and 36 months and has a gradual onset of cold symptoms including a low-grade fever, tachypnea, tachycardia, retractions, and inspiratory stridor. The classic sign is a barking cough that worsens at night (p. 137). 11. In providing education to a family regarding obtaining baseline peak airway flow for a child with asthma, the nurse will recommend what time of day? a. At bedtime. b. Before exercise c. In the morning. d. After meal. C.) In the morning. Rationale: The recommended time to obtain baseline peak flow readings is first thing in the morning before any administration of bronchodilator therapy (pp. 138, 140). 12. The nurse is planning to begin oral rehydration therapy for a 9-month-old with mild dehydration. She provides the caregivers with a glucose and sodium solution and instructs them to administer small amounts: a. Every 2 to 5 minutes Rationale: Oral rehydration should be attempted in those pediatric patients who can tolerate oral fluids with mild dehydration. Frequent (every 2 to 5 minutes), small sips of a commercially prepared glucose and sodium solution, such as Pedialyte or Infalyte, is the most successful method (p. 149). b. Every 10 to 12 minutes Rationale: Oral rehydration should be attempted in those pediatric patients who can tolerate oral fluids with mild dehydration. Frequent, small sips of a commercially prepared glucose and sodium solution, such as Pedialyte or Infalyte, is the most successful method (p. 149). c. Every 15 minutes Rationale: Oral rehydration should be attempted in those pediatric patients who can tolerate oral fluids with mild dehydration. Frequent, small sips of a commercially prepared glucose and sodium solution, such as Pedialyte or Infalyte, is the most successful method (p. 149). d. Every 30 minutes Rationale: Oral rehydration should be attempted in those pediatric patients who can tolerate oral fluids with mild dehydration. Frequent, small sips of a commercially prepared glucose and sodium solution, such as Pedialyte or Infalyte, is the most successful method (p. 149). A.) Every 2 to 5 minutes. Rationale: Oral rehydration should be attempted in those pediatric patients who can tolerate oral fluids with mild dehydration. Frequent (every 2 to 5 minutes), small sips of a commercially prepared glucose and sodium solution, such as Pedialyte or Infalyte, is the most successful method (p. 149). 13. Caregivers bring in their 3-week-old neonate and describe nonbilious vomiting after every feeding that is becoming more forceful over the past 24 hours. The last time he vomited the vomitus hit a chair 2 feet away. They say he cries, roots, and sucks vigorously on his pacifier right after vomiting as though still hungry. He is not experiencing any diarrhea. What condition is the most likely cause of these signs and symptoms? a. Intussusception Rationale: Intussusception occurs most commonly in males aged 3 to 12 months and manifests with episodic abdominal pain, drawing up of the legs, and vomiting. It is not associated with projectile vomiting (pp. 155-156) b. Volvulus Rationale: Volvulus presents with bilious vomiting, and not projectile (p. 156). c. Gastroenteritis Rationale: Gastroenteritis does present with vomiting but usually includes diarrhea and the vomiting is usually not projectile as seen in pyloric stenosis (p. 151). d. Pyloric stenosis Rationale: Pyloric stenosis is the narrowing of the pylorus, the opening from the stomach into the small intestine. It is most commonly seen in males between 2 and 8 weeks of age. They present with nonbilious vomiting, usually after every feeding, that becomes projectile as the obstruction worsens. With pyloric stenosis the infant remains constantly hungry and will demonstrate hunger behaviors after vomiting. If the diagnosis is delayed, dehydration and signs of hypovolemia may occur (p. 155). D.) Pyloric stenosis Rationale: Pyloric stenosis is the narrowing of the pylorus, the opening from the stomach into the small intestine. It is most commonly seen in males between 2 and 8 weeks of age. They present with nonbilious vomiting, usually after every feeding, that becomes projectile as the obstruction worsens. With pyloric stenosis the infant remains constantly hungry and will demonstrate hunger behaviors after vomiting. If the diagnosis is delayed, dehydration and signs of hypovolemia may occur (p. 155). 14. A neonate is delivered in the emergency department and placed on a radiant warmer. There is no staining of the amniotic fluid. What is the first step in neonatal resuscitation? a. Dry and warm the neonate Rationale: The steps in neonatal resuscitation are 1) dry and warm the patient, 2) maintain airway patency, 3) maintain breathing effectiveness, 4) maintain adequate circulation, 5) obtain vascular access, 6) administer medications, 7) intervene if positive pressure ventilation fails, and 8) volume expansion and vasopressor support. At each step, the neonate is assessed to determine response to care. If the response is absent or inadequate, the steps become more invasive and complex (pp. 187-189). b. Suction the mouth and nose Rationale: The steps in neonatal resuscitation are 1) dry and warm the patient, 2) maintain airway patency, which begins with positioning to open the airway, and suctioning the mouth first and then the nose with a bulb syringe, maintain breathing effectiveness, 4) maintain adequate circulation, 5) obtain vascular access, 6) administer medications, 7) intervene if positive pressure ventilation fails, and 8) volume expansion and vasopressor support. At each step, the neonate is assessed to determine response to care. If the response is absent or inadequate, the steps become more invasive and complex (pp. 187-189). c. Assess for effective breathing Rationale: The steps in neonatal resuscitation are 1) dry and warm the patient, 2) maintain airway patency, 3) maintain breathing effectiveness, which begins with gentle tactile stimulation, then blended oxygen, positive- pressure ventilation and intubation as needed, 4) maintain adequate circulation, 5) obtain vascular access, 6) administer medications, 7) intervene if positive pressure ventilation fails, and 8) volume expansion and vasopressor support. At each step, the neonate is assessed to determine response to care. If the response is absent or inadequate, the steps become more invasive and complex (pp. 187-189). d. Palpate a central pulse rate Rationale: The steps in neonatal resuscitation are 1) dry and warm the patient, 2) maintain airway patency, 3) maintain breathing effectiveness, 4) maintain adequate circulation, which begins with palpating a central pulse, either at the brachial artery or base of the umbilicus and cardiac compressions as needed, 5) obtain vascular access, 6) administer medications, 7) intervene if positive pressure ventilation fails, and 8) volume expansion and vasopressor support. At each step, the neonate is assessed to determine response to care. If the response is absent or inadequate, the steps become more invasive and complex (pp. 187-189). A.) Dry and warm the neonate. Rationale: The steps in neonatal resuscitation are 1) dry and warm the patient, 2) maintain airway patency, 3) maintain breathing effectiveness, 4) maintain adequate circulation, 5) obtain vascular access, 6) administer medications, 7) intervene if positive pressure ventilation fails, and 8) volume expansion and vasopressor support. At each step, the neonate is assessed to determine response to care. If the response is absent or inadequate, the steps become more invasive and complex (pp. 187-189). 15. In discussing the legal care of the adolescent patient, what is a mature minor? a. A minor who lives independently and is legally able to make health decisions Rationale: An emancipated minor is a minor who has been legally declared independent of his or her parent or guardian. Some examples are minors who are married, serve in the military, or are living independently from parents. These minors are considered an adult for healthcare decisions (p. 204). b. A minor who is able to make decisions regarding his or her own sexual or mental health Rationale: In most jurisdictions, adolescents are allowed to make decisions regarding specific health services, including reproductive health, pregnancy-related care, sexual health, drug and alcohol treatment, and mental health (pp. 204-205). c. A minor who is able to make decisions regarding healthcare as a parent of his or her own child Rationale: A minor who is a parent is generally considered an emancipated minor and is able to make decisions regarding his or her child's health (p. 204). d. A minor who lives with a parent or guardian but legally is able to make health decisions Rationale: A mature minor remains in the care and supervision of his or her parent or guardian but has been granted legal permission to make independent health care decisions. The adolescent must be able to understand the risks and benefits of possible treatments. This definition may vary by state or jurisdiction. Know your own local legal definitions (p. 204). D.) A minor who lives with a parent or guardian but legally is able to make health decisions. Rationale: A mature minor remains in the care and supervision of his or her parent or guardian but has been granted legal permission to make independent health care decisions. The adolescent must be able to understand the risks and benefits of possible treatments. This definition may vary by state or jurisdiction. Know your own local legal definitions (p. 204). 16. Which of the following screening statements/questions is most appropriate in assessing an adolescent for dating violence? a. "What triggers for violence have you experienced from your partner?" Rationale: Asking about triggers for violence may be interpreted as the victim doing something to cause the violence and he or she may wish to defend the relationship. This is especially true if the partner has isolated himself or herself from friends and family or if the victim already feels shame or guilt (pp. 214-215). b. "Does your partner feel entitled to sex even if you say 'no'?" Rationale: It may be difficult and unhelpful to ask the adolescent to answer from the perspective of the dating partner (p. 215). c. "Tell me about a time when you've felt unsafe in your relationship." Rationale: Dating violence in the adolescent population requires screening as intimate partner violence is screened in the adult population. Screening should include directive and probing questions to discover violence in a dating relationship. Asking the adolescent to relate a time he or she felt unsafe will help the nurse assess for violence without the accusations or judgment (p. 215). d. "Do you feel if you tried harder to please, your partner will not become violent?" Rationale: Victims of dating violence may feel that if they tried harder, their partners may be less violent, but this is a myth that should not be perpetuated (p. 215). C.) "Tell me about a time when you've felt unsafe in your relationship." Rationale: Dating violence in the adolescent population requires screening as intimate partner violence is screened in the adult population. Screening should include directive and probing questions to discover violence in a dating relationship. Asking the adolescent to relate a time he or she felt unsafe will help the nurse assess for violence without the accusations or judgment (p. 215). 17. Which sign distinguishes compensated shock from decompensated shock in the pediatric patient? a. Peripheral pulses Rationale: Compensatory mechanisms in the pediatric patient are systemic responses to the shock state to prevent hypotension and cardiovascular collapse. These mechanisms include peripheral vasoconstriction to shunt blood to vital organs, which manifests as weakening pulses, delayed capillary refill, and cool, mottled skin (pp. 231-232, 237). b. Blood pressure Rationale: Decompensated shock, also referred to as hypovolemic shock, occurs when the compensatory mechanisms in the pediatric patient, including increasing cardiac output with tachycardia and peripheral vasoconstriction to shunt blood to vital organs, which manifests as weakening pulses, delayed capillary refill, and cool, mottled skin. In pediatric patients, it is at this point that blood pressure drops and decompensated shock occurs (pp. 229, 231). c. Capillary refill Rationale: Compensatory mechanisms in the pediatric patient are systemic responses to the shock state to prevent hypotension and cardiovascular collapse. These mechanisms include peripheral vasoconstriction to shunt blood to vital organs, which manifests as weakening pulses, delayed capillary refill, and cool, mottled skin (pp. 229, 231). d. Level of consciousness Rationale: Changes in level of consciousness occur as cerebral perfusion drops. The signs include anxiety, irritability, restlessness, and lethargy, progressing to unresponsiveness and coma. As loss of consciousness develops, decompensation may be imminent, but the definition of decompensated shock is the onset of hypotension (pp. 229, 230). B.) Blood pressure Rationale: Decompensated shock, also referred to as hypovolemic shock, occurs when the compensatory mechanisms in the pediatric patient, including increasing cardiac output with tachycardia and peripheral vasoconstriction to shunt blood to vital organs, which manifests as weakening pulses, delayed capillary refill, and cool, mottled skin. In pediatric patients, it is at this point that blood pressure drops and decompensated shock occurs (pp. 229, 231). 18. A 5-year-old arrives to the emergency department unconscious with a heart rate of 32 beats/minute, weak, thready pulses, and pale, mottled skin. The team has begun bag-mask ventilation with 100% oxygen and chest compressions with no improvement in the heart rate. An intraosseous line is in place. Which of the following interventions is the priority? a. Administration of atropine Rationale: Atropine is only indicated in pediatric bradycardia if it is the result of vagal nerve stimulation. If the history does not indicate a reason for vagal stimulation, such as vigorous suctioning, the medication of choice is epinephrine (p. 251). b. Transcutaneous pacing Rationale: Transcutaneous pacing may be necessary if there is no response to epinephrine, but it should be given first (p. 251). c. Administration of epinephrine Rationale: For symptomatic bradycardia in the pediatric population, begin with oxygenation and ventilation. If those interventions do not raise the heart rate, the next step is epinephrine, which will increase peripheral vascular resistance and provide improved blood flow to vital organs and increase heart rate and contractility (pp. 250-251). d. Attempt vagal stimulation Rationale: Vagal stimulation is an intervention for supraventricular tachycardia, not bradycardia (p. 253). C.) Administration of epinephrine Rationale: For symptomatic bradycardia in the pediatric population, begin with oxygenation and ventilation. If those interventions do not raise the heart rate, the next step is epinephrine, which will increase peripheral vascular resistance and provide improved blood flow to vital organs and increase heart rate and contractility (pp. 250-251). 19. A 9-month-old infant pulled himself up onto the hearth of a fireplace. While doing so, he fell forward onto the hot glass doors and sustained deep partial thickness burns to the bilateral palmar aspects of both hands. What is the approximate percentage of total body surface area burned? a. 1% Rationale: An estimation of the burn area can be performed by assuming each palmar surface of the patient's hand represents approximately 1% of the total body surface area (p. 274). b. 2% Rationale: An estimation of the burn area can be performed by assuming each palmar surface of the patient's hand represents approximately 1% of the total body surface area. In this case, both hands equal 2% (p. 274). c. 4% Rationale: An estimation of the burn area can be performed by assuming each palmar surface of the patient's hand represents approximately 1% of the total body surface area (p. 274). d. 5% Rationale: An estimation of the burn area can be performed by assuming each palmar surface of the patient's hand represents approximately 1% of the total body surface area (p. 274). b. 2% Rationale: An estimation of the burn area can be performed by assuming each palmar surface of the patient's hand represents approximately 1% of the total body surface area. In this case, both hands equal 2% (p. 274). 20. An ambulance arrives with a 13-year-old pedestrian hit by a car. Identified injuries reported by paramedics include multiple abrasions to the head and face, a large, actively bleeding laceration to the forehead, hip pain with the leg externally rotated, and bruising across the chest and abdomen. The patient is in full spinal immobilization and has two intravenous catheters and a nonrebreather oxygen mask in place. Vital signs are BP 110/70 mm Hg, HR 118 beats/minute, RR 24 breaths/minute, and SpO2 96%. The Glasgow coma scale score is 15. What is the priority? a. Computed tomography Rationale: Although CT scans are an important diagnostic tool and are indicated for this patient for the cervical spine, chest, and abdomen, this test would not be performed until the primary and secondary surveys are completed and any primary or secondary issues are addressed (p. 270). b. Immobilize the femur Rationale: A femur fracture is concerning because of the potential for blood loss. However, the priority for this patient is controlling the obvious bleeding. Obvious external bleeding is controlled in the primary survey and femur immobilization is applied in the secondary survey (p. 283). c. A pressure dressing to the forehead Rationale: Control of active external bleeding is a high priority in order to minimize further hemodynamic instability during the circulation assessment in the primary survey. Younger children can lose relatively large amounts of blood from scalp lacerations (p. 13). d. Focused assessment with sonography for trauma (FAST) Rationale: Sonography may be useful given this patient's evidence of abdominal injuries, but the active bleeding from the forehead laceration is the priority (p. 282). C.) A pressure dressing to the forehead Rationale: Control of active external bleeding is a high priority in order to minimize further hemodynamic instability during the circulation assessment in the primary survey. Younger children can lose relatively large amounts of blood from scalp lacerations (p. 13). 21. A 15-year-old with a history of schizophrenia is taking risperidone (Risperdal) and lithium (Eskalith). She presents with dystonia, akinesia, a shuffling gait, muscle rigidity, and tremors. What does the nurse suspect is the cause of these signs and symptoms? a. Extrapyramidal symptoms Rationale: Extrapyramidal symptoms are an adverse effect caused by antipsychotic medications, including risperidone (Risperdal), aripiprazole (Abilify), quetiapine (Seroquel), olanzapine (Zyprexa), lithium (Eskalith), and valproate (Depakote). Extrapyramidal symptoms are characterized by akinesia, akathisia, dystonia, oculogyric crisis, pseudoparkinsonism or a shuffling gait, drooling, muscle rigidity, tremor, and rabbit syndrome (p. 324). b. Tardive dyskinesia Rationale: Tardive dyskinesia is an effect caused by antipsychotic medications, including risperidone (Risperdal), aripiprazole (Abilify), quetiapine (Seroquel), olanzapine (Zyprexa), lithium (Eskalith), and valproate (Depakote). Tardive dyskinesia presents with tongue protrusion, lip smacking, and involuntary movements of the mouth, fingers and extremities (p. 324). c. Neuroleptic malignant syndrome Rationale: Neuroleptic malignant syndrome is a potentially fatal syndrome caused by antipsychotic medications, including risperidone (Risperdal), aripiprazole (Abilify), quetiapine (Seroquel), olanzapine (Zyprexa), lithium (Eskalith), and valproate (Depakote) and can be precipitated by dehydration. Neuroleptic malignant syndrome presents with high fever, blood pressure instability, tachycardia, agitation, diaphoresis, pallor, muscle rigidity, and altered mental status (p. 324). d. Serotonin syndrome Rationale: Serotonin syndrome is the most serious adverse effect of selective serotonin reuptake inhibitors (SSRIs). Serotonin syndrome is characterized by altered mental status, flushing, diaphoresis, diarrhea, nausea, vomiting, myoclonus, tremors, hyperthermia, and tachycardia (pp. 323-324). A.) Extrapyramidal symptoms Rationale: Extrapyramidal symptoms are an adverse effect caused by antipsychotic medications, including risperidone (Risperdal), aripiprazole (Abilify), quetiapine (Seroquel), olanzapine (Zyprexa), lithium (Eskalith), and valproate (Depakote). Extrapyramidal symptoms are characterized by akinesia, akathisia, dystonia, oculogyric crisis, pseudoparkinsonism or a shuffling gait, drooling, muscle rigidity, tremor, and rabbit syndrome (p. 324). [Show Less]
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Practice test ENPC questions and answers with complete top solutions
A preschooler has a small laceration that required 2 stitches. The nurse covers the wound with a bandage knowing that it will comfort the child to have it ... [Show More] covered. What is the developmental reason for this intervention. Preschoolers are magical thinkers and imagine bandages keep their insides from coming out. A 7-month old presents to the ED with a complaint of fever. Assessment reveals a patent airway and a slight cyanosis around his lips and nail beds. He is alert and interactive. His vital signs are 38.5 (101.3), HR 134, RR 32, BP 78/54 mm Hg, and SPO2 of 84%. The nurse notes a healed surgical scar on his chest.Based on this assessment, what is the nurse's priority? As if the SPO2 is normal for him. An 11-year-old presents to the ED with a complaint of hitting his head while playing soccer. The nurse enters the room and performs an across the room assessment. He is starting at the wall. He has no increased work of breathing and his color is pink. Using the PAT what classification will the nurse assign? Sicker The pediatric prioritization process components include the focused assessment, focused history, acuity rating decision and: The pediatric assessment triangle (PAT) A 2-year-old is brought to the ED by her father when he found her face down in the pool. She remains unresponsive and is breathing shallowly and slowly. Her color is pale. What is the priority? Immobilize the cervical spine A 2-year-old has a suspected cervical spinal injury. In order to ensure neutral spinal alignment, padding should be placed under which area? The shoulders. Test the Ph of the gastric contents. The nurse is preparing to administer a feeding through an NG tube. The tube position was verified by radiograph after insertion 2 hours ago. What is the best way to verify placement before feeding? A 20-ml syringe with a stopcock What is the best method to rapidly administer a 20 ml/kg bolus of 0.9% normal saline to a pediatric patient weighing 8 kg. Use an infusion pump to deliver fluids Immediately after intraosseous insertion the nurse assesses the infusion and notes that the fluid is not dripping. How should the nurse respond? Croup A 13-month old presents to the ED with a 2-day history of a low-grade fever, increased work of breathing, and tonight developed a barky cough and inspiratory stridor. What condition does the nurse suspect. in the morning In providing education to a family regarding obtaining baseline peak airway flow for a child with asthma, the nurse will recommend what time of the day Every 2 to 5 minutes The nurse is planning to begin oral rehydration therapy for a 9-month old with mild dehydration. She provides the caregivers witha glucose and solution and instructs them to administer small amounts. Pyloric stenosis Caregivers being in their 3-week-old neonate and describe nonbilous vomiting after each feeding that is becoming more forceful over the past 24 hours.The last time he vomited the vomitus hit a chair 2 feet away. They say he cries, and sucks vigourrously on his pacifier right after vomiting as through still hungry. He is not experiencing any diarrhea. What condition is the most liekly cause of these signs and symptoms. Dry and warm the neonate A neonate is delivered in the ED and placed on a radiant warmer. There is no staining of the amniotic fluid. What is the first step in neonatal resucitation. A minor who lives with a parent or guardian but legally is able to make health decisions In dicussing the legal care of the adolescent patient, what is a mature minor? Tell me about a time when you've felt unsafe in your relationship Which of the following screening statements/questions is most appropirate in asssessing an adolescent for dating violence Blood pressure Which sign distinguishes compensated shock from decompensated shock in the pediatric patient? Administration of epinephrine A 5-year-old arrives to the ED unconscious with a heart rate of 32 beats/minute, weak, thready pulses, and pale mottled skin. The team has begun bag-mask ventilation with 100% oxygen and chest compressions with no improvement in the heart rate. An intraosseous line is in place. Which of the following interventions is the priority. 2% A 19-month old infant pulled himself up onto the hearth of a fireplace. While doing so, he fell forward onto the hot glass doors and sustained deep partial thickness burns to the bilateral palmar aspects f both hands. What is the approximate percentage of total body surface area burned? A pressure dressing to the forehead An ambulance arrives with a 13-year-old pedestrian hit by a car. Identified injuries reported by paramedics include multiple abrasions to the head and face, a large, actively bleeding laceration to the forehead, hip pain with the leg externally rotated, and bruising across the chest and abdomen. The patient is in full spinal immobilization and has 2 IV catheters and a nonrebreather oxygen mask in place. Vital signs are BP 110/70, HR 118, RR 24, SPO296%. Glasgow coma scale score is 15. What is the priority? Extrapyramidal symptoms A 15-year-old with a history of schizophrenia is taking risperidone and lithium. She presents with dystonia, akinesia, a shuffling gait, muscle rigidity, and tremors. What does the nurse suspect is the cause of these signs and symptoms? A deep partial thickness sharply demarcated burn on the buttocks of a toddler, reportedly from the child turning on the hot water while in the tub Which of the following burn injury patterns and history indicates suspected child maltreatment. Skeletal survey A mother presents to the ER with a 6-week old infant iwth no medical issues after a normal delivery, until yesterday. Mom states that he has been eating properly, vomiting and that hes hard to wake up. The infant is responsive only to painful stimuli. The anterior fontanel is bulging. He is mildly tachycardic, but otherwise vital signs are normal. What diagnostic evaluation will the nurse expect for thhis infant. One who is not sleeping because of dreams of the incident A malfunctioning oxygen tank explodes near a child's bed in the ED resulting in an extensive burn injury to the child. Four nurses participate in the child's immediate care. Which nurse requires intervention after this critical incident. Yellow Two ambulances collide in front of the hospital. The victims include 3 pediatric victims. Using the Jumpstart triage system, which category assessment will the nurse give to a 2-year-old who is lying on the groun, alert and crying with spontenous respirations of 36 breaths per minute and present peripheral pulses? [Show Less]
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ENPC Home Exam questions and answers graded A+
Tachycardia = an _______ sign of shock Early What is a late sign of circulatory compromise in children? Hypotension Children can remain nor... [Show More] motensive until about _____ percent of blood volume is lost 25% What are two intervention you should always be doing? Applying oxygen Checking bedside blood glucose How long should the car seat be rear facing? Until at least one year of age _____ model parents behavior with toys Toddlers Age 3 to 5: Preschoolers Magical and it logical thinkers Take things literally What are common fears of the preschooler? Pain Darkness Body mutilation Being alone Ages 5 to 11: School age kids Beers include separation from parents, loss of control, and physical disability 11 to 18 years old: Body a parent is the most important thing What is one of the critical public health issues in today society? Childhood obesity At how many years old can a child start using the faces pain scale? Three years old What is there an emphasis on during the prioritization of the patient? Safety I focused assessment is what type of information? Objective I focused history is what type of information? Subjective The pediatric assessment triangle a.k.a. the across the room assessment of a patient looks at what three things? General appearance Work of breathing Circulation to the skin How long should the pediatric assessment triangle take? About 3 to 5 seconds What does the general appearance section include: Interaction Muscle tone Consolabilty Look or gaze Speech or cry Work of breathing— a good indicator of oxygenation and ventilation. What should you look for in this assessment? Abnormal airway sounds Coughing Abnormal positioning Retractions/nasal flaring Rate and depth of respirations Circulation to the skin: Skin reflects perfusion status Inspect the color of central areas such as lips and mucous membranes Assessed for pallor, molting, or cyanosis Is the patient flushed or diaphoretic What are the three patient categories for the pediatric assessment triangle? Sick Sicker Sickest If all three components of the PAT are stable know what will the patient be ranked as? Sick If there is disruption in one of the areas of the PAT what will the patient be ranked? Sicker If there is Disruption in two or more components of the PAT what ranking will the patient receive? Sickest If a patient is identified as sickest what is indicated? Rapid resuscitation And a child what event typically leads to a code? Typically a respiratory event leads to a cardiac event What is the priority with any trauma or suspected drama? Stabilize the C-spine and stop any bleeding What maneuver is used to open the jaw in a trauma patient? Jaw thrust maneuver When is the nasal pharyngeal airway indicated? In a semi conscious or conscious patient Where is the nasopharyngeal airway contra indicated? In trauma patients What type of airway should be used for a trauma patient? Oral pharyngeal airways and be prepared for intubation with RSI if oral pharyngeal airway is unsuccessful After you have bagged the patient, the patients oxygen saturations and respiratory effort including respiratory rate have not improved, what is your next step? Prepare to Intubate Less than eight intubate When will you start CPR? When the heart rate is less than 60 bpm and the patient is symptomatic you should start CPR How do you calculate the normal systolic blood pressure for a child? 90 + 2x the age in years How to calculate minimum acceptable SBP: 70 + 2x age in years What are you going to use for your history during the assessment? CIAMPEDS What should the urinary output be for an infant? 2 ml/ kg / hour What should the normal urinary output be for an adolescent 1-1.5 ml/kg / hour What is the most common cause of arrest in pediatric patients? Respiratory arrest What is the second most common cause of arrest in a pediatric patient? Shock _____ is the inadequate delivery of oxygen and nutrients necessary for normal tissue and cellular function. It is the in balance between supply and demand at the cellular level. Shock Anytime a patient presents with Shock what is the first intervention that we should do? Place them on oxygen What happens in the body during shock? Plasma leakage/fluid shifts. This results in puffy kids. DIC, inflammatory responses, intracellular acidosis, ards, and MODS are also seen in shock What type of fluid should you give a patient with hypovolemic shock due to Burns? Lactated ringer fluid replacement using the Parkland formula. What is seen in early Shock? In early Shock or warm Shock there is flash cab refill. Look for bounding pulses fever and flushed skin What medication is used to correct SVT? Adenosine What are some different types of obstructive shock? Pneumothorax - you will want to do needle aspiration that the second intercostal space in the midclavicular line and you want to always place a chest tube after PDA - start this patient on prostaglandins. Do not give this patient any Motrin as it can help the PDA to close. Tampa nod - you need to pull the fluid off surrounding the heart PE Congenital heart disease What is the urine output that we I would like to maintain when a patient is in shock? 1 mL per kilo Monitoring should be done for a patient in shock? Cardiac monitoring Pulse ox Capnography 12 lead EKG Chest x-ray CT for any trauma Echo Coags, CBC, electrolytes, type and cross, lactate, arterial blood gas, urinalysis, blood and urine culture, and always check glucose What is the goal with septic shock? The goal is to restore adequate perfusion What is the rate and depth of CPR that should be administered? The rate of CPR should be 100 to 120 compressions per minute The death should be 1.5 to 2 inches and then 2 to 2.5 depth allow for recoil What will you give to correct hypoglycemia and in a neonate? Give D 10- 2cc per kilo can be given over one minute What will you give to the patient that is two years or older with hypoglycemia? You can give D 25. Either 2 to 4 mL per kilo can be given What is the drug of choice for children with bradycardia? EPI When do you choose atropine for bradycardia and children? When you suspect that the bradycardia is vagal in nature What is the number one site choice for an IO? The proximal tibia [Show Less]
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ENPC Exam Prep / Exam Questions |100% correct answers, latest updated
Which of the following would be an abnormal finding in a patient with glomerulonephritis? Clear urine There is a decrease in urine output for patient's wi... [Show More] th glomerulonephritis. Urine would be concentrated and dark brown/tea-colored. Clear urine There is a decrease in urine output for patient's with glomerulonephritis. Urine would be concentrated and dark brown/tea-colored. Administration of nebulized epinephrine Moderate to severe croup is treated with dexamethasone and nebulized epinephrine. The neurosurgeon has decided to perform an invasive procedure in the emergency department to monitor the intracranial pressure on a 5-year-old patient. The family does not speak English and has identified their religion as Muslim. Which of the following interventions is most supportive of the family? Allow the extended to family members to serve as interpreters during the procedure. Which of the following patient presentations should increase suspicion of potential child maltreatment? Bruising to the left ear of a newborn from sleeping on his side Any bruise in a non-exploratory location in children younger than 4 years and any bruising in a child younger than 4 months (TEN-4) are cause for suspicion of abuse Bruising to the left ear of a newborn from sleeping on his side Any bruise in a non-exploratory location in children younger than 4 years and any bruising in a child younger than 4 months (TEN-4) are cause for suspicion of abuse Commotio cordis Commotio cordis occurs when the chest is struck during the refractory period of the cardiac conduction cycle, resulting in a ventricular dysrhythmia or asystole. This type of injury usually occurs in recreational sports such as baseball or ice hockey A 12-year-old who was recently started on anti-psychotic medication for schizophrenia is brought to the emergency department with severe muscle rigidity and hyperthermia. These symptoms are most likely caused by which of the following? Neuroleptic malignant syndrome These are classic symptoms of neuroleptic malignant syndrome, which is a rare reaction to antipsychotic medications. Which of the following patients should be evaluated first An 18-month-old with bilious emesis Bilious emesis in an 18-month-old is always considered an emergent symptom indicative of a life-threatening bowel obstruction. 1. Which of the following tasks can the nurse do to decrease adverse medication events? Obtain the patient's weight in kilograms This is the preferred measurement for medication calculations for pediatric and adult patients Acute chest syndrome, stroke, and splenic sequestration are complications of which of the following diseases? Sickle cell anemia These are all complications of sickle cell anemia. During the assessment of a 16-year-old male patient, the ED nurse identifies him as a potential sex trafficking victim. The trauma informed approach to care emphasizes certain principles in caring for these types of patients. Which of the following care principles has the highest priority? Physical and psychological safety Create an environment where patients feel safe, both physically and psychologically. Increase awareness of the patient's interpersonal interactions with others to screen for risk of harm. Prioritize the patient being in a safe location A 6-month-old is brought to the emergency department for a recurrent respiratory infection. When gathering a history from the caregiver, the emergency nurse learns that, in addition to the respiratory symptoms, the infant has had fatty stools. The emergency nurse should be concerned about which of the following disease processes? Cystic Fibrosis Pancreatic insufficiency leads to fat malabsorption, which results in the fatty stools seen with cystic fibrosis. The emergency nurse is caring for a patient with significant facial trauma and a suspected globe rupture. Which of the following medication orders would the nurse question? Succinylcholine Succinylcholine may increase intraocular pressure and should be avoided. A 7-year-old arrives via ambulance. The patient's mother reports witnessing a seizure at home. The patient has no seizure history. Upon examination, 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 mother states the burns accidentally occurred 3 days ago, but she was afraid to bring patient in due to an ongoing child welfare investigation. Which of the following are the MOST appropriate immediate interventions? Draw and send a metabolic panel, administer a fluid bolus, and obtain a point of care glucose Significant burns can cause electrolyte imbalances. Electrolyte imbalances may be the cause of the patient's seizure. Electrolyte imbalances need to be identified and treated. In which of the following primary survey components can assessment of the fontanel provide the most useful information? Circulation and disability A sunken fontanel may indicate dehydration; a bulging fontanel can indicate increased intracranial pressure. A 5-year-old patient presents to the emergency department with severe dehydration due to viral gastroenteritis. He has signs of shock due to his hypovolemia. Which of the following physiologic responses to shock has the greatest impact on improving cardiac output in the pediatric patient? Increasing heart rate In pediatric patients, tachycardia is the primary compensatory mechanism to increase cardiac output. A toddler has a chemical eye injury. Which of the following is the priority intervention? Increasing heart rate In pediatric patients, tachycardia is the primary compensatory mechanism to increase cardiac output. A 5 year-old with no health problems presents to the Emergency Department with a sudden onset of chest pain and shortness of breath. Parents state that the family was involved in a bad car crash one week ago. A thorough assessment and workup has not revealed any abnormalities. Which of the following steps is the best next step to take? Ask about any new bed-wetting or sleep disturbances Pediatric patients with anxiety and PTSD may present with physical complaints. Assess for other behavioral symptoms to facilitate appropriate care and follow-up. Which of the following is the most appropriate intervention for a child experiencing a seizure? Prepare to administer intranasal midazolam Midazolam has gained favor because of its ease of use and quick onset of action. An ambulance arrives with a 16-year-old male involved in a dirt bike crash who was intubated prior to arrival. Which of the following is the priority assessment or intervention? Assess the endotracheal tube placement and patency If a patient arrives with an artificial airway (endotracheal tube or tracheostomy) in place, assess its placement, tube patency, and the oral airway (in that order) before moving to the next step of the primary survey. A three-year-old is rescued after being submerged in a residential pool for several minutes. On arrival at the Emergency Department he is responsive to painful stimuli, has shallow respirations with diminished breath sounds throughout, and has an occasional cough. What is the initial management priority? Endotracheal intubation with positive pressure ventilation Airway control and positive pressure ventilation are the priority interventions for this patient. A nurse providing crisis intervention to the family of a seriously ill child can best keep the family informed of the child's condition by doing which of the following? Appointing one staff member to communicate with them. This will help create a solid patient-staff bond and facilitate communication. You are discharging a patient to home with a history of depression. Discharge teaching should include which of the following? Ensuring all firearms in the home are locked in a safe place with no access by the patient. Promote injury prevention with caregivers of patients with a history of depression or suicidal ideation by encouraging that all firearms and medications are under lock to prevent overdoses or suicide attempt. A 3-year-old is injured in a motor vehicle collision. Upon arrival at the emergency department, the child has a diminished level of consciousness, equal bilateral breath sounds, and cool, pale skin. Vital signs are HR 140 beats/minute, RR 36 breaths/minute, and BP 70/40 mm Hg. The child is most likely in which of the following shock states? Hypovolemic shock The mechanism and presentation lead to a suspicion of blood loss. Which of the following is the priority intervention for a pediatric patient with diabetic ketoacidosis? Insulin infusion A continuous infusion of insulin at 0.05-0.1 unit/kg/hr should be used to decrease blood glucose. Which of the following describes a neonate's normal position? Flexion with extremities close to the body A neonate's normal position is flexion with extremities close to the body. The emergency nurse is caring for a 14-year-old patient who sustained a displaced fracture of the radius and ulna after falling from a bicycle. Which of the following pain interventions is most likely to result in improvement in symptoms? Application of a splint to the affected extremity Splinting is an effective non-pharmacologic intervention to reduce pain associated with fractures. The type of vascular access is appropriate in all of the patient situations given EXCEPT for which of the following? Peripherally inserted central catheter line for one time fluid bolus This vascular access is most appropriate for long term medication administration and multiple blood draws. A 5-year-old child presents to the emergency department after being hit by a car. She 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? Widening pulse pressure Narrowing pulse pressure and increasing heart rate are early indications of ongoing blood loss. A 15-year-old patient has attempted suicide by overdosing on amitriptyline. The emergency nurse should expect which of the following symptoms? Dysrhythmias QRS prolongation and ventricular dysrhythmias are symptoms of cyclic antidepressant overdose. The parents of a 5-year-old child arrive at the emergency department. The child's lips and face are swollen with hives on the face. The parents report the child ate peanut butter crackers in the last hour. The child has no known allergies. The nurse recognizes the findings are associated with: Food allergy This a clinical manifestation seen in food allergies. Which of the following statements demonstrates a nurse's understanding of pediatric submersion injuries? The best indicator of survival after submersion is the duration of time of submersion The duration of submersion is the best predictor of survival after drowning. In general, shorter times correlate to better outcomes. A 2-month-old infant is brought to the emergency department. The mother states he has had trouble breathing for the past two days. The PAT reveals an age-appropriate general appearance, rapid breathing with mild distress, and pink skin. Mucous is noted to both nares. Which of the following is the best next step? Suction the nares with a bulb syringe Infants are preferential nose breathers and can have respiratory distress when the nares are occluded. Suctioning the nares is the priority intervention to open the airway. During the tertiary survey, the emergency nurse should continue to conduct reevaluations of the Pediatric Assessment Triangle (PAT), abnormal findings, and which of the following other assessment components? Primary survey, vital signs, pain management, and effectiveness of therapeutic interventions The additional components of the reevaluation in the tertiary survey include the primary survey, vital signs, pain management, and effectiveness of therapeutic interventions. Which of the following interventions would the nurse anticipate for a pediatric patient with a fever and a history of a hematologic or oncologic condition? Intravenous antibiotics This patient population is at risk for life-threatening sepsis, and treatment with intravenous antibiotics is indicated. Prioritizing pediatric patients presenting with fever is often difficult. Which of the following patients is at greatest risk of serious illness? A 7-year old boy with a history of sickle cell anemia and an oral temperature of 38.3°C (101°F) Children with chronic illnesses such as sickle cell disease are at greatest risk for life-threatening fever-related illnesses. Which of the following indicates the need for additional parent/guardian education regarding a UTI? My child will grow out of their frequent urinary tract infections UTIs are not a normal occurrence in children and may require additional investigation and follow up. A 4-day-old who is brought to the emergency department with the parental complaint of "not acting right" is found to be hypoglycemic. The appropriate glucose concentration to administer to this neonate is which of the following? D10 D10 is the preferred concentration for neonates to protect their fragile vasculature. Which of the following actions by the nurse promotes pediatric patient safety? Preparing medications in a distraction-free area To decrease errors, the nurse should be focused and systematic in verifying patient identification, medication order, route, time, and dose. A 16-year-old trauma patient is noted to have external rotation and shortening of the left lower extremity and pain with palpation of the pelvis after being ejected from a motorcycle. Which of the following assessment findings is most concerning for a potentially life-threatening condition? Bony crepitus and instability with gentle anteroposterior compression of the iliac crests Bony crepitus and instability to palpation of the pelvis are common findings in patients with unstable pelvic fractures. Unstable pelvic fractures may be associated with injury to major blood vessels and contribute to hypovolemic shock. A 10-year-old patient was recently diagnosed with Marfan syndrome. The emergency nurse understands that this patient may be at risk for developing which of the following conditions? Aortic Aneurism Cardiovascular defects associated with Marfan syndrome are mitral valve prolapse, heart failure, and aortic dissection/aneurysm. A 2-month-old child with intermittent irritability, poor feeding and apneic episodes has a heart rate of 188 and an irregular respiratory rate. After three 0.9% sodium chloride fluid boluses at 20 ml/kg each with only minimal clinical improvement, what treatment should the emergency nurse anticipate next? Start a vasopressor infusion A child in septic shock who is not responding to fluid resuscitation likely needs vasopressors to compensate for the vasodilation caused by the septic shock state. Spinal shock results in which of the following transient conditions? Pain at the site of injury and hyperesthesia above the level of the injury Spinal cord shock results in pain at the site of injury and hyperesthesia above the level of the injury. A 14-year-old patient presents to the emergency department with her aunt after being assaulted. The patient has multiple bruises inconsistent with the assault history and seems guarded with her answers. A urine test is positive for pregnancy although the patient denies being sexually active. The aunt repeatedly asks when they will be discharged. The ED nurse recognizes these finding as red flags for which of the following? Sex Trafficking Red flags for sex trafficking include multiple bruises, unwanted or unintended pregnancy and being withdrawn or anxious in the presence of the caregiver. All of the vaccine administrations listed are appropriate EXCEPT for which of the following? Fifth Disease at 6 months There is an animal vaccine but not a human vaccine for fifth disease. Which of the following statements indicates the caregiver understands your discharge teaching on influenza? My child can go to daycare since they have been off of Tylenol and fever free for 24 hours. Yes, the patient needs to be afebrile WITHOUT the use of antipyretics to be able to go back to daycare or school. A fertilizer silo exploded during a school tour of a working farm. The children are able to manage their own secretions but are all incontinent and salivating with excess tearing. Which of the followiing is the priority intervention? Removal of clothing and decontamination Decontamination of nerve agents requires removal of clothing and flushing the skin with copious amounts of soap and water. A 2-year old has uniformly demarcated burns to bilateral lower extremities, approximately 30% of the child's total body surface area. The father states he briefly left the room while the child was in the bath and the child apparently played with the faucet. Which of the following interventions has the highest priority? Obtain vascular access for analgesic and fluid administration Rapid vascular access and fluid administration are the priority interventions. Which of the following findings would be most concerning for a secondary headache? Pain with flexion of the neck Nuchal rigidity is associated with meningeal irritation and meningitis, which would be considered a more serious secondary headache condition. A 6 year-old child presents to the emergency department with caregivers who report a cough with nasal congestion and "pink-eye" that started 2 days ago. They have been treating with an over-the-counter medicine without relief. Today they noticed a raised red rash on the face and papules in the mouth. You suspect which of the following? Rubeola Rubeola presents with a cough, nasal inflammation (coryza), and non-purulent conjunctivitis. A rash begins as erythematous macules and papules on the hairline and face that spreads downward. [Show Less]
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ENPC Test Questions with complete answers 100% correct
An unresponsive 2-year-old child was found by his mother with a bottle labeled "Elavil 50 mg" by his side. Which piece of information is important to obtai... [Show More] n from his mother? A. The size of the medication bottle. B. The expiration date of the medication. C. The number of pills left in the bottle. D. The person for whom the medication was prescribe. C. The number of pills left in the bottle. A nurse providing crisis intervention to the family of a seriously ill child can best keep the family informed of the child's condition by: A. Placing them in a secluded room. B. Referring to their child as "the patient". C. Telling the family how they should feel. D. Appointing one staff member to communicate with them. D. Appointing one staff member to communicate with them. A 16-month-old child was an unrestrained front seat passenger in a motor vehicle crash. The chest x-ray reveals multiple rib fractures. These findings suggest what type of injury? A. Minor surface injury. B. Significant underlying injury. C. Significant surface injury. D. Minor underlying injury. B. Significant underlying injury. Which piece of information is most important to know prior to transferring a patient to another facility? A. Documentation of the family's health insurance coverage. B. Pertinent family health history. C. Confirmation of acceptance from the receiving hospital. D. Confirmation of a medical diagnosis. C. Confirmation of acceptance from the receiving hospital. A 10-year-old child who was struck by a car has a distended, tense abdomen. The child's heart rate is 144 beats/minute, respirations 24 breaths/minute, and blood pressure 120/80 mm Hg. Capillary refill is more than 3 seconds, and skin is pale and cool. The patient's signs and symptoms suggest: A. Obstructive shock. B. Distributive shock. C. Hypovolemic shock. D. Cardiogenic shock. C. Hypovolemic shock. A school-aged child is about to receive stitches. To evaluate his understanding of the procedure, you tell him: A. "Young people your age have questions about getting stitches. What are your questions?" B. "Don't cry while you are getting the stitches. Be brave like a man." C. "You will probably receive 10 stitches. Do you have any questions before we restrain you?" D. "Does your cut hurt? Would you like your mommy to hold you?" A. "Young people your age have questions about getting stitches. What are your questions?" What is the preferred sit for intraosseous access in the infant? A. Lateral malleolus B. Iliac crest C. Proximal femur D. Anteromedial tibia D. Anteromedial tibia An important consideration in the assessment of pain for an adolescent patient is that they: A. May deny or minimize their pain when friends visit for fear of losing control. B. Have difficulty localizing or describing the pain. C. Are unable to use the 1 to 10 scale to report their pain. D. Feel that the pain is a punishment for something they did wrong. A. May deny or minimize their pain when friends visit for fear of losing control. An 8-month-old infant with pneumonia has severe intercostal and substernal retractions, weak muscle tone, lethargy, and gray skin color. The infant's condition does not improve after bag-mask ventilation. The next step in treatment is most likely to be: A. Administration of epinephrine. B. Supplemental warming measures. C. Rapid sequence intubation. D. Administration of albuterol. C. Rapid sequence intubation. Which combination of medications is best to have prepared for a pediatric resuscitation? A. Dopamine and sodium bicarbonate. B. Epinephrine and glucose. C. Naloxone and lidocaine. D. Pentothal and vecuronium. B. Epinephrine and glucose. A 20-day-old infant has a 1-week history of not eating well. The infant has a weak cry and is jittery. Which laboratory test is indicated? A. Arterial blood gas. B. Finger-stick glucose. C. Complete blood count with differential. D. Toxicology screen. B. Finger-stick glucose. Which intervention should be performed next if tactile stimulation, positioning, drying, and blow-by oxygen administration do not increase a newborn's heart rate? A. Chest compressions. B. Umbilical vein cannulation. C. Endotracheal intubation. D. Bag-mask ventilation. D. Bag-mask ventilation. A 10-kg child has deep partial-thickness burns over 35% of the total body surface area. Which evaluation parameter indicates that fluid resuscitation is adequate? A. Heart rate of 160 beats/minute. B. Respiratory rate of 34 breaths/minute. C. Blood pressure of 80/60 mm Hg. D. Urine output of 11 ml/hour. D. Urine output of 11 ml/hour. A 7-year-old female sustains a minor head injury and did not lose consciousness. She does not respond to commands and groans in response to questions. Which action will quickly determine if her behavior indicates a serious head injury? A. Review her medical record for pre-existing developmental problems. B. Obtain a head computerized tomography scan. C. Conduct a developmental screening test. D. Ask the parents if her behavior is unusual. D. Ask the parents if her behavior is unusual. An 8-month-old child presents with purpura, irritability, and a rectal temperature of 39.4�C (102.9�F). An intervention of high priority is: A. Encouraging the caregiver to hold and comfort the child. B. Monitoring for signs and symptoms of increased intracranial pressure (ICP). C. Collecting urine for toxicology screen. D. Encouraging oral fluids and food. B. Monitoring for signs and symptoms of increased intracranial pressure (ICP). The Pediatric Assessment Triangle is used to: A. Identify all life-threatening conditions that the child presents with. B. Perform a complete head-to-toe assessment on the child. C. Assess the status of the child's airway only upon arrive in the ED. D. Determine the severity of the child's illness or injury using the "across-the-room" assessment. D. Determine the severity of the child's illness or injury using the "across-the-room" assessment. The caregivers of a 6-year-old boy who is brought to the emergency department for abdominal pain should first be asked: A. "Are his immunizations current?" B. "Has anything happened to him at school recently?" C. "What is the reason for the child's visit and how long has he been ill?" D. "Has he been complaining of a sore throat or earache?" C. "What is the reason for the child's visit and how long has he been ill?" A 9-month-old infant is crying loudly through the nursing assessment, and the caregiver is becoming distraught. The nurse should ask the caregiver to: A. Read a story to the infant. B. Offer the infant a pacifier. C. Return when the infant is consoled. D. Ignore the infant's behavior. B. Offer the infant a pacifier. During an intubation attempt, the child�s heart rate drops to 40 beats/minute. Which intervention is indicated? A. Ask the physician to stop the intubation attempt and perform bag-mask ventilation. B. Apply cricoid pressure and establish intravenous access. C. Inform the physician of the heart rate and ask the physician to intubate faster. D. Administer blow-by oxygen and begin chest compressions. A. Ask the physician to stop the intubation attempt and perform bag-mask ventilation. A 6- week-old infant is pale, has marked substernal retractions, expiratory grunting, and poor muscle tone. The emergency nurse should first: A. Obtain intravenous access. B. Apply a pulse oximeter. C. Prepare a chest x-ray. D. Administer 100% oxygen. D. Administer 100% oxygen. The best method to open the airway in an injured child is: A. Placing the head and neck in hyperextension. B. Using the jaw thrust maneuver. C. Placing the head and neck in flexion. D. Using the head tilt maneuver. B. Using the jaw thrust maneuver. A 4-year-old child with a history of the flu has a heart rate of 80 beats/minute, respirations of 16 breaths/minute, and capillary refill of more than 3 seconds. The proper sequence for nursing interventions would be: A. Position the airway, administer 100% oxygen, obtain venous access, and administer 20 ml/kg of an isotonic solution. B. Administer 100% oxygen, obtain venous access, administer 0. 1 mg/kg of epinephrine 1:10,000, and prepare for endotracheal intubation. C. Position the airway, provide bag-mask ventilation, provide synchronized cardioversion, and provide supplemental warmth. D. Administer 100% oxygen, prepare for a venous cutdown, administer 20 ml/kg of an isotonic solution, and obtain a chest x-ray. A. Position the airway, administer 100% oxygen, obtain venous access, and administer 20 ml/kg of an isotonic solution. A 3-year-old is transported by prehospital personnel after being struck by a car. The parents are en route. The child is screaming and uncooperative. Which is the best approach while conducting the secondary survey? A. Hold the child to comfort him. B. Wait for the parent's arrival. C. Observe for behavioral pain cues. D. Use a doll to demonstrate the examination. C. Observe for behavioral pain cues. Which ocular finding is associated with child maltreatment? A. Glaucoma. B. Conjunctivitis. C. Iritis. D. Retinal hemorrhage. D. Retinal hemorrhage. A pregnant 18-year-old woman arrives at the emergency department about ready to deliver a full-term infant. She states that she noticed a large amount of dark green fluid the last time she went to the bathroom. During the delivery, the nurse should prepare to: A. Dry and arm the infant as soon as is it delivered. B. Stimulate and ventilate the infant immediately after delivery. C. Suction the mouth and nose of the infant while on the perineum. D. Administer blow-by oxygen and rub the back immediately after delivery. C. Suction the mouth and nose of the infant while on the perineum. 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ENPC 5th edition questions and answers 100% correct
Ask about any new bed-wetting or sleep disturbances Pediatric patients with anxiety and PTSD may present with physical complaints. Assess for other beha... [Show More] vioral symptoms to facilitate appropriate care and follow-up. A 5 year-old with no health problems presents to the Emergency Department with a sudden onset of chest pain and shortness of breath. Parents state that the family was involved in a bad car crash one week ago. A thorough assessment and workup has not revealed any abnormalities. Which of the following steps is the best next step to take? Ensuring all firearms in the home are locked in a safe place with no access by the patient. Promoting injury prevention with caregivers of patients with a history of depression or suicidal ideation by encouraging that all firearms and medications are under lock to prevent overdoses or suicide attempt. You are discharging a patient to home with a history of depression. Discharge teaching should include which of the following? Obtain vascular access for rapid fluid administration Rapid vascular access and fluid administration are the priority interventions. A 2-year old has uniformly demarcated burns to bilateral lower extremities, approximately 30% of the childs total body surface area. The father states he briefly left the room while the child was in the bath and the child apparently played with the faucet. Which of the following interventions has the highest priority? Draw and send a metabolic panel and venous blood gas, administer a fluid bolus, and obtain a point of care glucose Electrolyte imbalances need to be identified and treated to prevent another seizure. A 7-year-old arrives via ambulance. The patient's mother reports witnessing a seizure at home. The patient has no seizure history. Upon examination, 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 mother states the burns accidentally occurred 3 days ago, but she was afraid to bring patient in due to an ongoing child welfare investigation. Which of the following are the MOST appropriate immediate interventions? ventilation to address hypoxia is the priority intervention. What is the priority intervention for symptomatic bradycardia in a four-year-old child? Commotio cordis Comotio Cordis "occurs when chest is struck during the refractory period of the cardiac conduction cycle. This type of injury usually occurs in recreational sports such as baseball or ice hockey." A 14-year-old high school student who was pitching for his baseball team was hit in the chest by the ball and had a sudden cardiac arrest. Of the following, which is the most likely cause of the cardiac arrest? Focused Assessment: Vital Signs: "As the patient compensates for altered tissue perfusion, the pulse pressure narrows and the heart rate increases" - (need to rewrite either the question or the answers) Widening Pulse pressure - not correct (suppose to be narrow pulse pressure) Bradycardia - not correct Decreasing diastolic blood pressure - late sign Weak peripheral pulses - late sign A 5-year-old child presents to the emergency department after being hit by a car. She 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? Increasing heart rate Pathophysiology: Cardiac Output. In pediatric patients, cardiac out is primarily regulate by increasing heart rate A 5-year-old patient presents to the emergency department with severe dehydration due to viral gastroenteritis. He has signs of shock due to his hypovolemia. Which of the following physiologic responses to shock has the greatest impact on improving cardiac output in the pediatric patient? Bruising to the left ear of a newborn from sleeping on his side Pg 10- Any bruises in a non exploratory location (especially torso ears, neck) in children younger than 4 Pg 11Any bruising in a child younger than 4 months. Which of the following patient presentations should increase suspicion of potential child maltreatment? Fifth Disease at 6 months There is an animal vaccine, but not a human vaccine for Fifth Disease. All of the vaccine administrations listed are appropriate EXCEPT for which of the following? My child can go to daycare since they have been off of Tylenol and fever free for 24 hours. Yes, the patient needs to be afebrile WITHOUT the use of antipyretics to be able to go back to daycare or school. Which of the following statements indicates the caregiver understands your discharge teaching on influenza? Dedicate a healthcare team member with a qualified interpreter to be with the family during the procedure. Providing the option for family presence with an assigned team member to facilitate communication is most supportive of the family in this situation. The neurosurgeon has decided to perform an invasive procedure in the emergency department to monitor the intracranial pressure on a 5-year-old patient. The family does not speak English and has identified their religion as Muslim. Which of the following interventions is most supportive of the family? Rubeola On presentation the child starts with cough, nasal inflammation (coryza) and a non-purulent conjunctivitis. After 2-4 days a rash begins as erythematous macules and papules on the face that spreads to the torso and extremities. A 6 year-old child presents to the emergency department with caregivers who report a cough with nasal congestion and pink-eye that started 2 days ago. They have been treating with an over-the-counter medicine without relief. Today they noticed a raised red rash on the face and papules in the mouth. You suspect which of the following? removal of clothing and decontamination Decontamination of nerve agents requires removal of clothing and flushing the skin with copious amounts of soap and water A fertilizer silo exploded during a school tour of a working farm. The children are able to manage their own secretions but are all incontinent and salivating with excess tearing. Which of the following is the priority intervention? Succinylcholine Succinylcholine may increase intraocular pressure and should be avoided. The emergency nurse is caring for a patient with significant facial trauma and a suspected globe rupture. Which of the following medication orders would the nurse question? Copious eye irrigation with an isotonic solution Normal saline or Ringer's lactate solution are both acceptable for irrigation. Irrigate until the pH of the eye returns to normal. The pH of Ringer's lactate is closer to that of human tears and may be more comfortable than normal saline. A toddler has a chemical eye injury. Which of the following is the priority intervention? (Do not pick acetaminophen) Which of the following medications is appropriate for treating the fever of a four-year-old with scleral jaundice and elevated aspartate transaminase (AST)? Food allergy These findings are typical of a food allergy. Because allergic reactions are so variable and do not always include classic manifestations, anticipate that any food-induced allergic reaction may unexpectedly progress to life-threatening anaphylaxis. The parents of a 5-year-old child arrive at the emergency department. The child's lips and face are swollen with hives on the face. The parents report the child ate peanut butter crackers in the last hour. The child has no known allergies. The nurse recognizes the findings are associated with: Appointing one staff member to communicate with them. This will help create a solid patient-staff bond and facilitate communication A nurse providing crisis intervention to the family of a seriously ill child can best keep the family informed of the child's condition by doing which of the following? An 18-month-old with bilious emesis Bilious emesis in an 18-month-old is always considered an emergent symptom indicative of a life-threatening bowel obstruction. Which of the following patients should be evaluated first? Clear urine Normal finding: There is a decrease in urine output for patient's with glomerulonephritis. Urine would be concentrated and dark brown/tea-colored Which of the following would be an abnormal finding in a patient with glomerulonephritis? My child will grow out of their frequent urinary tract infections UTIs are not a normal occurrence in children and may require additional investigation and follow up Which of the following indicates the need for additional parent/guardian education regarding a UTI? Intravenous antibiotics This patient population is at risk for life-threatening sepsis, and treatment with intravenous antibiotics is indicated. Which of the following interventions would the nurse anticipate for a pediatric patient with a fever and a history of a hematologic or oncologic condition? Sickle cell anemia These are all typical complications of sickle cell anemia Acute chest syndrome, stroke, and splenic sequestration are complications of which of the following diseases? Sex Trafficking Red Flags for sex trafficking may include multiple bruises, unwanted or unintended pregnancy, being withdrawn and guarded. A 14-year-old patient presents to the emergency department with her aunt after being assaulted. The patient has multiple bruises inconsistent with the assault history and seems guarded with her answers. A urine test is positive for pregnancy although the patient denies being sexually active. The aunt repeatedly asks when they will be discharged. The ED nurse recognizes these finding as red flags for which of the following? Physical and psychological safety Create an environment where patients feel safe, both physically and psychologically. Increase awareness of the patients interpersonal interactions with others to screen for risk of harm. Prioritize the patient being in a safe location. During the assessment of a 16-year-old male patient, the ED nurse identifies him as a potential sex trafficking victim. The trauma informed approach to care emphasizes certain principles in caring for these types of patients. Which of the following care principles has the highest priority? Primary survey, vital signs, pain management, and effectiveness of therapeutic interventions The additional three components of the reevaluation in the Tertiary Survey includes primary survey, vital signs and pain management, effectiveness of therapeutic interventions. (p 38) During the tertiary survey, the emergency nurse should continue to conduct reevaluations of the Pediatric Assessment Triangle (PAT), abnormal findings, and which of the following other assessment components? Assess the endotracheal tube placement and patency If a patient arrives with an artificial airway (endotracheal tube or tracheostomy) in place, assess its placement, tube patency and then the oral airway (in that order) before moving to the next step of the primary survey. (p 4) An ambulance arrives with a 16-year-old male involved in a dirt bike crash who was intubated prior to arrival. Which of the following is the priority assessment or intervention? Circulation and disability A sunken fontanel may indicate dehydration; a bulging fontanel can indicate increased intracranial pressure. In which of the following primary survey components can assessment of the fontanel provide the most useful information? Preparing medications in a distraction-free area To decrease errors, the nurse should be focused and systematic in verifying patient identification, medication order, route, time, and dose. Which of the following actions by the nurse promotes pediatric patient safety? Obtain the patient's weight in kilograms This is the preferred measurement for medication calculations for pediatric and adult patients. Which of the following tasks can the nurse do to decrease adverse medication events? Insulin infusion A continuous infusion of insulin at 0.050.1 unit/kg/hr should be used to decrease blood glucose. Which of the following is the priority intervention for a pediatric patient with diabetic ketoacidosis? D10 D10 is the preferred concentration for neonates to protect their fragile vasculature. A 4-day-old who is brought to the emergency department with the parental complaint of "not acting right" is found to be hypoglycemic. The appropriate glucose concentration to administer to this neonate is which of the following? Bony crepitus and instability with gentle anteroposterior compression Bony crepitus and instability to palpation of the pelvis are common findings in patients with unstable pelvic fractures. Unstable pelvic fractures may be associated with injury to major blood vessels and contribute to hypovolemic shock. A 16-year-old is noted to have external rotation and shortening of the left lower extremity and pain with palpation of the pelvis after being ejected from a motorcycle. Which of the following assessment findings is most concerning for a potentially life-threatening condition? ... Which of the following is a known cause of pediatric seizures? Prepare to administer intranasal midazolam Midazolam has gained favor because of its ease of use and quick onset of action Which of the following is the most appropriate intervention for a child experiencing a seizure? Application of a splint to the affected extremity Splinting is an effective non-pharmacologic intervention to reduce pain associated with fractures. The emergency nurse is caring for a 14-year-old patient who sustained a displaced fracture of the radius and ulna after falling from a bicycle. Which of the following pain interventions is most likely to result in improvement in symptoms? Rear facing in a convertible carseat until at least the age of 2 The safest mode of transport for the neonate is rear facing until the age of 2 when the neck ligaments are stronger to support the head. According to the American Academy of Pediatrics guidelines, which of the follwing describes how a neonate riding in a car should be positioned? Flexion with extremities close to the body A neonates normal position is flexion with extremities close to the body Which of the following describes a neonates normal position? Cystic Fibrosis In CF, the mucus can block pancreatic ducts, which does not allow full absorption of fats/proteins, leading to greasy/fatty stools. A 6-month-old is brought to the emergency department for a recurrent respiratory infection. When gathering a history from the caregiver, the emergency nurse learns that, in addition to the respiratory symptoms, the infant has had fatty stools. The emergency nurse should be concerned about which of the following disease processes? Administration of nebulized epinephrine Moderate to severe croup is treated with dexamethasone and nebulized epinephrine A 3-year-old is brought to the emergency department with a 2-day history of a runny nose, low-grade fever, and a "barky" cough at night. The caregiver tells the emergency department nurse the coughing is getting worse. The child is awake and alert, with stridor. The nurse should anticipate which of the following? Delayed capillary refill is one indication to administer a fluid bolus Other indications include tachycardia, dry mucous membranes, altered mental status, and cool skin. Which of the following statements about the assessment and management of pediatric hypovolemia is accurate? Pulse 50 beats/ minute, BP 80/30 mm Hg Neurogenic shock patients have bradycardia and hypotension with a widened pulse pressure due to vasodilation. Which of the following vital signs is most consistent with an adolescent in neurogenic shock after a spinal cord injury? pain at the site of injury and hyperesthesia above the level of injury (Symptoms of spinal cord shock) Spinal shock results in which of the following transient conditions? Endotracheal intubation with positive pressure ventilation Airway control and positive pressure ventilation are the appropriate interventions for this patient. A three-year-old is rescued after being submerged in a residential pool for several minutes. On arrival at the Emergency Department he is responsive to painful stimuli, has shallow respiration's with diminished breath sounds throughout, and has an occasional cough. What is the initial management priority? The best indicator of survival after submersion is the duration (Length) of time of submersion. The duration of submersion is the best predictor of survival after drowning. In general, shorter times correlate to better outcomes. Which of the following statements demonstrates a nurse's understanding of pediatric submersion injuries? Dysrhythmias QRS prolongation and ventricular dysrhythmias are symptoms of cyclic antidepressant overdose. A 15-year-old patient has attempted suicide by overdosing on amitriptyline. The emergency nurse should expect which of the following symptoms? [Show Less]
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