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ENPC Exam Answers 2022-2023 BUNDLE
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ENPC Exam Answers 2022-2023 Rated A+ Verified Q & A
ENPC EXAM ANSWERS 2022-2023 RATED A+ VERIFIED Q & A 1. Which of the following would be an abnormal finding in a patient with glomerulonephritis? C... [Show More] lear urine There is a decrease in urine output for patient's with glomerulonephritis. Urine would be concentrated and dark brown/tea-colored. Decreased energy Hypertension Nausea, vomiting 2. A 3-year-old is brought to the emergency department with a 2-day history of a runny nose, lowgrade 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? Administration of nebulized epinephrine Moderate to severe croup is treated with dexamethasone and nebulized epinephrine. Delivery of humidified oxygen Bag-valve-mask ventilations Suctioning secretions from the oropharynx 3. 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. Dedicate a healthcare team member to be with the family during the procedure. Allowing caregivers to remain with the pediatric patient is more supportive in this situation. Allow family members to serve as interpreters during the procedure Provide access to nondenominational clergy in a quiet area 4. Which of the following patient presentations should increase suspicion of potential child maltreatment? Right radial spiral fracture in a 10-year-old practicing martial arts Bruising to the left ear of a newborn from sleeping on his side Any bruise in a nonexploratory 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. Closed greenstick wrist fracture in a 4 year old who fell off his bicycle Bruises in various stages of healing to the lower extremities of a 2-year-old 5. 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? Aortic Dissection 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. Pericardial Tamponade Blunt Aortic Injury 6. 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? Ecstasy overdose Neuroleptic malignant syndrome These are classic symptoms of neuroleptic malignant syndrome, which is a rare reaction to antipsychotic medications. Serotonin syndrome Nicotine overdose 7. Which of the following patients should be evaluated first? A 3-year-old with a dislodged gastrostomy tube A 12-year-old with left shoulder pain after a handlebar injury 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. A 3-month-old with periods of inconsolable crying 8. 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. Verifying the patient dose during shift report at nursing station Dual confirmation of a hard to read order Confirming patient's attending provider 9. Acute chest syndrome, stroke, and splenic sequestration are complications of which of the following diseases? Mononucleosis Hemophilia Sickle cell anemia These are all complications of sickle cell anemia. Acute rheumatic fever 10. 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? Empowerment, voice and choice 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. Peer support Trustworthiness and transparency 11. 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. Bronchopulmonary Dysplasia Pneumonitis Reactive Airway Disease 12. 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? Ondansetron Midzaolam Succinylcholine Succinylcholine may increase intraocular pressure and should be avoided. Vancomycin 13. 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? Administer lorazepam and a fluid bolus and place on seizure precautions 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. Administer intravenous analgesics, a fluid bolus, and obtain a point of care glucose Call police and child welfare authorities and have security detain parent 14. 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. Breathing and circulation Disability and exposure Circulation and exposure 15. 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? Decreasing preload Decreasing contractility Increasing afterload Increasing heart rate In pediatric patients, tachycardia is the primary compensatory mechanism to increase cardiac output. 16. A toddler has a chemical eye injury. Which of the following is the priority intervention? Consult with ophthalmology within 24 hours 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. Elevate the head of the bed to 30 to 45 degrees. Administration of an ocular antibiotic 17. 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? Discharge to home with follow-up instructions to contact their primary care physician 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. Consult cardiology for appropriate follow-up Repeat a head-to-toe exam to identify any missed traumatic injuries 18. 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. Place the child in a prone position Prepare to administer rectal diazepam Place the child in a supine position 19. 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? Reposition the endotracheal tube 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. Insert an orogastric tube Assess the oropharynx 20. 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? Initiation of abdominal thrusts for removal of fluid from the lungs Insertion of orogastric or nasogastric tube for removal of water and debris from stomach Removal of wet clothing to prevent hypothermia Endotracheal intubation with positive pressure ventilation Airway control and positive pressure ventilation are the priority interventions for this patient. 21. 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? Referring to their child as "the patient". Appointing one staff member to communicate with them. This will help create a solid patientstaff bond and facilitate communication. Placing the family in a secluded room. Telling the family how they should feel. 22. You are discharging a patient to home with a history of depression. Discharge teaching should include which of the following? Handing the family a list of potential behavioral health facilities to call for follow-up. Emphasizing to the family to come back to the hospital for any escalation in behavior rather than calling authorities. 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. Discussion with the family on the importance of keeping all medications stored on the top shelf of a closet. 23. 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. Obstructive shock Cardiogenic shock Distributive shock 24. Which of the following is the priority intervention for a pediatric patient with diabetic ketoacidosis? Subcutaneous insulin Intramuscular insulin Insulin infusion A continuous infusion of insulin at 0.05–0.1 unit/kg/hr should be used to decrease blood glucose. Insulin bolus 25. Which of the following describes a neonate’s normal position? Extension with extremities close to the body Flexion with extremities away from the body Extension with extremities away from the body Flexion with extremities close to the body A neonate’s normal position is flexion with extremities close to the body. 26. 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? Topical application of lidocaine-based cream Application of warm compresses to the affected extremity Placing the extremity at the level of the heart Application of a splint to the affected extremity Splinting is an effective non-pharmacologic intervention to reduce pain associated with fractures. 27. The type of vascular access is appropriate in all of the patient situations given EXCEPT for whichof the following? Intraosseous device insertion for a cardiac emergency Scalp IV for a neonate with a fever 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. Peripheral IV in the forearm pre-surgically in a child 28. 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. Bradycardia Decreasing diastolic blood pressure Weak peripheral pulses 29. 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. Miosis Diuresis Hypotension 30. 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. Nutritional sensitivity Medication sensitivity Latex allergy 31. Which of the following statements demonstrates a nurse's understanding of pediatric submersioninjuries? Laryngospasm; a reflexive response to submersion, prevents fluid from entering the lungs for extended periods of time The negative impact of lactic acid on the renal tubules is evidenced by a decrease in urinary output in the immediate post-submersion phase 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. Hypoxemia and respiratory alkalosis may adversely impact myocardial function 32. 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? Administer oxygen via face mask Reposition the infant 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. Assess breath sounds 33. 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? Secondary survey, vital signs, pain management and effectiveness of therapeutic interventions Primary survey, pain management, Pediatric Glasgow Coma Scale Airway assessment, check pulses, neurological assessment, and pain management 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. 34. Which of the following interventions would the nurse anticipate for a pediatric patient with a feverand a history of a hematologic or oncologic condition? Oral ibuprofen Placement in a negative pressure room Rectal acetaminophen Intravenous antibiotics This patient population is at risk for life-threatening sepsis, and treatment with intravenous antibiotics is indicated. 35. Prioritizing pediatric patients presenting with fever is often difficult. Which of the following patients is at greatest risk of serious illness? A 13-year-old female who reports feeling "run down" for 4 days with an oral temperature of 38.2°C (100.8°F) 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. A 3-month old with no abnormalities based on the Pediatric Assessment Triangle and a rectal temperature of 37.6°C (99.7°F) A 6-month old boy who is alert and pulling at his ear with a rectal temperature of 39.4°C (103°F) 36. Which of the following indicates the need for additional parent/guardian education regarding a UTI? I should encourage my child to drink fluids 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. I should encourage my child to use the bathroom when they feel they need to My child should complete all of their antibiotics 37. 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. D25 D50 D5 38. Which of the following actions by the nurse promotes pediatric patient safety? Silencing alarms on IV pump to promote patient resting Overriding medication guardrails to accommodate pediatric medication doses Securing and covering the IV site to ensure patency and decrease anxiety 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. 39. 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? Diminished tactile sensation to the left lower extremity Tenderness to palpation of left iliac crest Open wound to left lower extremity with no active bleeding 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. 40. 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? Myocarditis Aortic Aneurism Cardiovascular defects associated with Marfan syndrome are mitral valve prolapse, heart failure, and aortic dissection/aneurysm. Rheumatic heart disease Pericarditis 41. A 2-month-old child with intermittent irritability, poor feeding and apneic episodes has a heart rateof 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. Repeat a 20 ml/kg bolus using Lactated Ringers Start packed red blood cells Repeat a 20 ml/kg bolus of normal saline 42. Spinal shock results in which of the following transient conditions? Generalized flaccid paralysis of skeletal muscle Increased perspiration due to disruption of the thermal center 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. Sparing of bowel and bladder function 43. 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? Labor Trafficking Physical Abuse 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. Psychological Abuse 44. 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. Haemophilus influenzae B at 2 months Measles, Mumps, Rubella at 12 months Hepatitis B at birth 45. Which of the following statements indicates the caregiver understands your discharge teaching on influenza? My child can't get influenza again since they have had it once and received the vaccine. My child can interact with others after taking the first dose of antibiotics. 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. My child cannot get influenza if they wash their hands. 46. 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? Rapid administration of atropine Establishing patient identification Removal of clothing and decontamination Decontamination of nerve agents requires removal of clothing and flushing the skin with copious amounts of soap and water. Providing supportive treatment 47. A 2-year old has uniformly demarcated burns to bilateral lower extremities, approximately 30% ofthe 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? Cover burns with moist sterile sheets Contact child welfare to report suspicious burn Calculate and administer resuscitation and maintenance fluids. Obtain vascular access for analgesic and fluid administration Rapid vascular access and fluid administration are the priority interventions. 48. Which of the following findings would be most concerning for a secondary headache? Pain described as throbbing and severe 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. Nausea and vomiting Unilateral headache with aura 49. 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? Varicella 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. Erythema Infectiosum Hand, foot, and mouth disease 50. According to the American Academy of Pedatrics guidelines, which of the following describes how a neonate riding in a car should be positioned? Forward facing in a convertible car seat Rear facing in a convertible car seat until at least the age of 2 Rear facing in a high back booster with a five point restraint system Rear facing in a convertible car seat until the age of 1 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. [Show Less]
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ENPC Exam Questions And Answers(5th Edition ENPC Exam Questions, Open Book) (2022 -2023)
ENPC Exam Prep / Exam Questions and Answers (5th Edition ENPC Exam Questions, Open Book)2022/2023 Which of the following would be an abnormal finding in... [Show More] a patient with glomerulonephritis? - Answer Clear urine There is a decrease in urine output for patient's with 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. - Answer 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? - Answer 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? - Answer 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 - Answer 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? - Answer 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 - Answer 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? - Answer 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? - Answer 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? - Answer 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? - Answer 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? - Answer 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? - Answer 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? - Answer 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? - Answer 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? - Answer 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? - Answer 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? - Answer 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? - Answer 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? - Answer 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? - Answer 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? - Answer 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? - Answer 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? - Answer 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? - Answer 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? - Answer 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? - Answer 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? - Answer 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? - Answer 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: - Answer Food allergy This a clinical manifestation seen in food allergies. Which of the following statements demonstrates a nurse's understanding of pediatric submersion injuries? - Answer 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? - Answer 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? - Answer 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? - Answer 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? - Answer 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? - Answer 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? - Answer 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? - Answer 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? - Answer 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? - Answer 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? - Answer 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. [Show Less]
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ENPC 2022 Study Guide With Complete And Rated 100- Correct Solutions
ENPC 2022 Study Guide With Complete And Rated 100% Correct Solutions Pediatric triangle - Answer appearance work of breathing circulation to skin G... [Show More] eneral appearance considerations - Answer Tone Interactiveness: drawn to sounds or people. Wants to play Consolability Look/Gaze Speech/cry Work of breathing: - Answer Increased work of breathing evidenced by tachypnea, stridor, grunting, retractions, accessory musles, nasal flaring, head bobbing, abnormal positioning Circulation to Skin - Answer Observe palor mottling cyanosis Sick, Sicker, Sickest - Answer Sick: no disruption of any component of PAT but caregivers are concerned Sicker: one component of PAT is a concern Sickest 2+ concerns of PAT 2 leading causes of altered mental status in kids - Answer hypoxia hypoglycemia Blood pressure norms - Answer Hypotension: Less than 70 + (2 x age in years) Widening pulse pressure = increased ICP Narrowing pulse pressure = hypovolemic shock Crying child - Answer Vigorous = good weak = sick high-pitched = increased ICP "Fussiness" = red flag Respiratory distress indicated by: - Answer increased heart rate skin color changes incrased work of breathing wheezing diaphoresis abnormal airwa sounds Respiratory failure signs - Answer fatigue and become lethargic hypoxia hypercarbia General airway interventions - Answer Allow child to stay in most comfortable position Give O2 to maintain it above 92% O2 does NOT measure ventilation Croup - Answer 1-3 days of nasal congestion and fever with sudden onset of barky cough Treatment: dexamethasone and nebulized epi Discharge Teaching: oral hydration, get child to cool air or steamy bathroom Asthma interventions - Answer albuterol, duo neb and oral steroid Bronchiolitis/RSV - Answer Assessment: 1-3 days nasal congestion fever, cough, respiratory distress with wheezing and crackles. Dehydration and tachypnea interventions: nasla suctioning, fluids sever: heated, high flow nasal cannula O2 Discharge: lasts 2-3 weeks; nasal suctioning; monitor hydration treating hypoglycemia - Answer obtain glucose for anyone who is not awake and alert treat kids with 2-4ml/kg of D25W When to perform blood glucose test? - Answer When the child is not awake and alert or AMS is suspected Preventing Secondary brain injury in TBI - Answer prevent hypotension and hypoxia cuffed vs uncuffed tube - Answer uncuffed= (age in years/4) + 4 cuffed= (age in years/4) + 3.5 fluid bolus formula - Answer infant: 10ml/kg kid: 20ml/kg normal vitals - Answer pg 52 blood glucose normal ages 5-11 - Answer 72-140 Cardiac Assessment - Answer Trend pulse and pulse pressure palapate upper and lower extremity pulses symptoms of CHF - Answer poor feeding, irritability, fatigue easily with rapid resp rate, increased work of breathing Ass and Interventions similar to adults Myocarditis Assessment and treatment - Answer Assess: consider in anyone with recent viral infection; SOB and crackles; dysrhthmias; heart failure; syncope; elevated liver enzymes Treat: diuretics; BP support; ECMO; transplant Hypovolemic Shock - Answer Tachycardia, tacypnea; AMS; slight increaes in diastolic pressure Intervention: Stop bleed; give fluids and RBC; balanced therapy; offer pedialyte if not NPO Cardiogenic shock - Answer Intervention: expert consult; supportive care to decrease O2 and metabolism demands; slow fluids; treat hpotension while decreasing afterload; vagal maneuver; vasopressors Obstructive Shock - Answer Assessment: Cardiac tamponade- muffled heart sounds and pulsluss paradoxus; tension pneumo- asymmetrical chest rise and fall Intervention: pericardiocentesis; needle thoracentesis; antigoagulation or surgical intervention; treat ductal dependent lesion Anaphylactic Shock - Answer remove pathogen fluids epi Neurogenic - Answer spinal motion restriction vasopressors warming measures Septic - Answer Fluids antibiotics vasopressors OLD CARTS - Answer Onset Location Duration Characteristics Aggravating factors Relieving factors Treatment Severity Pain Scale and appropriate ages of use - Answer Numeric- 6-17 years Visual Analog: 5-17 Faces: 4-12 FLACC- nonverbal Evaluation of child maltreatment - Answer ask open ended questions use direct quotes Sex trafficing risk factors - Answer limited education runaway/homeless/foster care hx of abuse livining poverty family dysfunction disability substance abuse LBGT low self-esteem, depression, social isolation Human trafficang Assessment screening - Answer hx: pt doesn;t have ID; doesn't know home address; vague hx of illness; person accompanying is unwilling to leave pt. persistent/untreated STI trauma to vagina/rectum jaw/neck pain hyper startle reflex expensive items, clothing, hotel keys Increased ICP triad - Answer widening pulse pressure bradycardia bulging fontenel respiratory disress Febrile seizure - Answer Temp greater than 100.4 usually occurs after 24 hour onset if occurs after that 24 hr period consider meningitis give antipyretic to promote comfort and oral intake. Does not prevent seizures Avoid ice baths Seizure Inteventions - Answer turn pt on side provide safe environment check bedside glucose manage fever as a cause or a result if seizure lasts longer than 5 minutes consider benzos give antiboitcs for infection hyponatremia =3% sodium chloride Seizure medication - Answer 5 min: midazolam=intranasal, IM, IV 5-10 min: 2nd dose or phenytoin 15-30 min: phenobarbital, reassess airway, consider intubation When should the parent cal 911 in for a seizing child? - Answer child stops breathing parent cannot feel a pulse seizure lasts more tahn 5 minutes child has more than 1 seizure before fully awake VP shunt issues assessment - Answer changes in resp rate: apnea or irregular changes in BP: widening pulse pressure Changes in HR: bradycardia fever or signs of shock redness/edema Hydrocephalus interventions - Answer accurate head circumference for monitoring elevate HOB 30 degrees and maintian head allignment Give meds: anyipyretics, analgesic, antibiotics, meds to decrease ICP Difference between stroke and bells palsy - Answer Pt will be unable to raise an eyebrow or wrinkle the forehead on the affected size w/ bells palsy stroke usually only involves the lower face Stroke interetnions - Answer maintain glucose control BP meds: aspirin; anticonvulsants; antigocagulants (embolism) Symptoms of TBI (concusion) are organized into what four catagories? - Answer Thininking and remembering physical emotional/mood sleep Secondary impact syndrome - Answer 2nd brain injury before the first one is healed. Brain cannot auto regulate CPP Causes massive brain edema and herniation proper infnat/toddler head positioning with spinal percautions - Answer place padding under shoulders of infant to achieve neutral alignment have parent directly above pt so pt is not turning head reverse trandeleburg to reduce anxiety Neurogenic Shock - Answer Injury above T6 results in bradycardia, hypotension, and vasodilation, thermoregulatory instability Spinal shock - Answer flaccid muscle tone below thei njury and decreased sensation at and below the level of injury kids who do not need a spine board - Answer compliant child absence of distracting injury absence of alcohol GCS 15 absence of spine tenderness/neurologic findings Orbital fracture interventions - Answer topical vasoconstrictor to stop bloody nose avoid blowing nose analgesics ice elevate HOB LeFort I - Answer Edema of maxillary area lip laceraiton or fractured teeth edema maloccluiosn Le Fort II - Answer massive facisal edema nasal swelling with obvious fracture or deformity maloccluison CSF rhinorrhea Lefort III - Answer massive facial edema ecchymosis mobility and depression of zygomatic bones diplopia from nerve entrapment ma,occluison CSF rhinorrhea midface and nasal fracture interventions - Answer maintain airway delay surgery until swelling decreases avoid straining bending over heavy lifting blowing nose sleep with head of bed elevated for 3 nights [Show Less]
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