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ENPC Exam Bundle (Graded A)
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ENPC Home Exam 2023 with complete solutions
Tachycardia = an _______ sign of shock - Answer- Early What is a late sign of circulatory compromise in children? - Answer- Hypotension Children can ... [Show More] remain normotensive until about _____ percent of blood volume is lost - Answer- 25% What are two intervention you should always be doing? - Answer- Applying oxygen Checking bedside blood glucose How long should the car seat be rear facing? - Answer- Until at least one year of age _____ model parents behavior with toys - Answer- Toddlers Age 3 to 5: - Answer- Preschoolers Magical and it logical thinkers Take things literally What are common fears of the preschooler? - Answer- Pain Darkness Body mutilation Being alone Ages 5 to 11: - Answer- School age kids Beers include separation from parents, loss of control, and physical disability 11 to 18 years old: - Answer- Body a parent is the most important thing What is one of the critical public health issues in today society? - Answer- Childhood obesity At how many years old can a child start using the faces pain scale? - Answer- Three years old What is there an emphasis on during the prioritization of the patient? - Answer- Safety I focused assessment is what type of information? - Answer- Objective I focused history is what type of information? - Answer- Subjective The pediatric assessment triangle a.k.a. the across the room assessment of a patient looks at what three things? - Answer- General appearance Work of breathing Circulation to the skin How long should the pediatric assessment triangle take? - Answer- About 3 to 5 seconds What does the general appearance section include: - Answer- 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? - Answer- Abnormal airway sounds Coughing Abnormal positioning Retractions/nasal flaring Rate and depth of respirations Circulation to the skin: - Answer- 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? - Answer- Sick Sicker Sickest If all three components of the PAT are stable know what will the patient be ranked as? - Answer- Sick If there is disruption in one of the areas of the PAT what will the patient be ranked? - Answer- Sicker If there is Disruption in two or more components of the PAT what ranking will the patient receive? - Answer- Sickest If a patient is identified as sickest what is indicated? - Answer- Rapid resuscitation And a child what event typically leads to a code? - Answer- Typically a respiratory event leads to a cardiac event What is the priority with any trauma or suspected drama? - Answer- Stabilize the C-spine and stop any bleeding What maneuver is used to open the jaw in a trauma patient? - Answer- Jaw thrust maneuver When is the nasal pharyngeal airway indicated? - Answer- In a semi conscious or conscious patient Where is the nasopharyngeal airway contra indicated? - Answer- In trauma patients What type of airway should be used for a trauma patient? - Answer- 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? - Answer- Prepare to Intubate Less than eight intubate When will you start CPR? - Answer- 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? - Answer- 90 + 2x the age in years How to calculate minimum acceptable SBP: - Answer- 70 + 2x age in years What are you going to use for your history during the assessment? - Answer- CIAMPEDS What should the urinary output be for an infant? - Answer- 2 ml/ kg / hour What should the normal urinary output be for an adolescent - Answer- 1-1.5 ml/kg / hour What is the most common cause of arrest in pediatric patients? - Answer- Respiratory arrest What is the second most common cause of arrest in a pediatric patient? - Answer- 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. - Answer- Shock Anytime a patient presents with Shock what is the first intervention that we should do? - Answer- Place them on oxygen What happens in the body during shock? - Answer- 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? - Answer- Lactated ringer fluid replacement using the Parkland formula. What is seen in early Shock? - Answer- 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? - Answer- Adenosine What are some different types of obstructive shock? - Answer- 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? - Answer- 1 mL per kilo Monitoring should be done for a patient in shock? - Answer- 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? - Answer- The goal is to restore adequate perfusion What is the rate and depth of CPR that should be administered? - Answer- 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? - Answer- 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? - Answer- 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? - Answer- EPI When do you choose atropine for bradycardia and children? - Answer- When you suspect that the bradycardia is vagal in nature What is the number one site choice for an IO? - Answer- The proximal tibia How can you tell that an I/O is infiltrated? - Answer- I feeling underneath of the leg when flushing How long can an I/O same place for? - Answer- For 24 hours or until you get another form of access What are the things that you want to consider pre-intubation? - Answer- Preoxygenation Atropine, this drug maybe used for patients less than eight years old Prepare for any alternative things that may have to happen such as cric Consider lido What are the complications of intubation? - Answer- Pneumothorax Gastric dissension How will you confirm placement of the ET tube? - Answer- Auscultation CO2 detector Chest x-ray Capnography If an ET tube fails what are alternative airway solutions? - Answer- LMA mask Needle cricothyrotomy _____ A barky seal like cough, worse at night. Low-grade fever. Steeple sign is seen via x-ray. You will want to inform parents to do coolness, take the child outside or open the freezer. Steam from the shower can also help. Administer steroids for inflammation. Give her Seemic Kathy for relief up to two hours, observation is key. - Answer- Croup We should observe a patient that received racemic epi-for at least ____ hours? - Answer- 6 ______ is a true emergency! High fever. Muffled voice. Sore throat. Drooling. Stridor . This is caused by a marvelous influenza B. Often times you will see the thumb sign. For these patients you want to give blow by oxygen as tolerated. Make sure to avoid any invasive procedures until the patient is stabilized, this means no IV or throat exam until the patient's airway is stable. - Answer- Epiglottis pneumonia: - Answer- Maybe viral, bacterial, fungal, or parasitic Give antibiotics Most kids are viral Abdominal pain may be present in lower lobe pneumonia Pertussis: - Answer- Whooping cough Bacterial - contagious Thank you Bashan is 7 to 10 days Usually worse at night Droplet cautions Erythromycin is the anabiotic of choice The most common cause of pediatric dysrhythmias is an unrecognized ____ or _____ - Answer- Respiratory or metabolic compromise A child's cardiac output is how much of that of an adults - Answer- Two times that of an adults What concentration of EPI do you use for CPR? - Answer- 1:10,000 _____ is One of the most common in infants see that can lead to cardiac compromise. Greater than 220 bpm in infants and greater than 180 bpm in children. Absent or hard to see P waves. Rapid onset - Answer- SVT _____ What is indicated for stable SVT dosing is .1 mg per kilogram of adenosine and you want to flush it fast with a 10 mL Saline flush and using the stopcock method. - Answer- Adenosine If SVT becomes unstable what is the method that will be used for treatment - Answer- Synchronize cardioversion. Consider sedation. 0.5 J/Kg. Make sure that machine is in synchronized mood. Refer patient to cardiology. What should always be the first choice for stable SVT? - Answer- Vagal maneuver Aka using ice to the face blowing through an obstructed straw V tach: - Answer- HR >120 Rapid HR with wide QRS complex Tombstone like appearance No p waves Sometimes pulseless Can Turn into v fib V tach with a pulse: - Answer- Consult cardiology 02 EKG Cardioversion I am new at around 150 mcg Pulseless V tach: - Answer- Defibrillator V fib: - Answer- Uncommon [Show Less]
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ENPC Questions Test A 2023 (solved)
Components in the prioritization of pediatric emergency care (4) - Answer- PAT, Focused Assessment (objective information), Focused pediatric Hx(subjective... [Show More] information), assignment of an acuity rating decision Pediatric Assessment Triangle : (3) components - Answer- Appearance. Work of Breathing. Circulation to the skin. This forms the "general impression". If there is an acute disruption in 1 component, child is "sicker". If there is an acute disruption in 2+ components the child is "sickest" PQRST for Pain - Answer- (pg86) Precipitating and palliating factors Quality Radiation Severity, symptoms, and site Time or triggering factors What age is the respiratory system considered fully developed? - Answer- 8 years old 6P's Assessment for Musculoskeletal Trauma - Answer- (pg 283) Pallor : color different from uninjured Pain Pulselessness Parasthesia Paralysis Poikilothermia Burn Transfer Criteria - Answer- 1. Partial thickness >10% of BSA 2. Face, hands, feet, genetalia, perineum or major joints 3. Third degree burns in any age group. 4. Electrical burns, including lightning injury, and chemical burns. 5. Inhalation injury. 6. Burn injury in pt with preexisting medical disorders that could complicate tx. 7. Concomitant trauma (such as fx) in which the burn injury poses the greatest risk of morbidity or mortality. 8. Burned children in hospital wo qualified equipment or personnel to care for them 9. Pt who will require special social, emotional, or rehabilitative intervention. Infants are obligate nose breathers. If nose is obstructed ___________ - Answer- mouth then suction nose Neutropenic pt with a temperature - Answer- Don't take rectal temp. No invasive procedures if not necessary. Nonblanchable Rashes of concern - Answer- Meningocoxcemia Petiachia/Purpura Normal Urine Output for child - Answer- 1 to 2ml / Kg / Hr Oral Rehydration for 9month old with mild dehydration. - Answer- Glucose and sodium solution, every 2 to 5min with 5 to 10ml 6week old infant, no medical hx. eating poorly, vomiting, "hard to wake up", responsive to pain. Anterior fontanel bulging, tachypnic. Diagnostic evaluation expected? - Answer- Skeletal survey Possible shaken baby syndrome Minimal Acceptable BP's - Answer- Newborn = 60 Infant = 70 Child = 70 + (2 x age in yrs) Decompensated shock in children #1 sign - Answer- Hypotension TBI considerations - Answer- MD has to say when they can return, not the pt or caregiver. Should be a "gradual return to play" Bradycardia pharm treatment - Answer- Epinephrine (1:10,000), 0.01mg/kg every 3-5min 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 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 - Answer- A. Magical thinkers 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 B. Sick C. Sicker D. Sickest - Answer- B. Sicker 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 B. Head C. Neck D. Waist - Answer- A. Shoulders 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 B. Every 10 to 12 minutes C. Every 15 minutes D. Every 30 minutes - Answer- A. 2-5 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 B. Volvulus C. Gastroenteritis D. Pyloric stenosis - Answer- D. Pyloric Stenosis Which of the following screening statements/questions is most appropriate in assessing an adolescent for dating violence? A. "What triggers violence you've experienced from your partner?" B. "Does your partner feel entitled to sex even if you say 'no'?" C. "Tell me about a time when you've felt unsafe in your relationship." D. "Do you feel if you tried harder to please, your partner will not become violent?" - Answer- C. Tell me Which sign distinguishes compensated shock from decompensated shock in the pediatric patient? A. Peripheral pulses B. Blood pressure C. Capillary refill D. Level of consciousness - Answer- B BP 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 B. Tardive dyskinesia C. Neuroleptic malignant syndrome D. Serotonin syndrome - Answer- A. EPS Two ambulances collide in front of the hospital. The victims include three pediatric victims. Using the JumpSTART triage system, which category assignment will the nurse give to a 2-year-old who is lying on the ground, alert and crying with spontaneous respirations of 36 breaths/minute and present peripheral pulses? A. Green B. Yellow C. Red D. Black - Answer- Yellow 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. - Answer- 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. - Answer- 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. - Answer- 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. - Answer- C. Hypovolemic shock. What is the preferred sit for intraosseous access in the infant? A. Lateral malleolus B. Iliac crest C. Proximal femur D. Proximal tibia - Answer- D. Proximal tibia 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. - Answer- 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. - Answer- B. Epinephrine and 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. - Answer- 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. - Answer- 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. - Answer- 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. - Answer- 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. - Answer- D. Determine the severity of the child's illness or injury using the "across-the-room" assessment. A 6- week-old infant is pale, has marked substernal retractions, expiratory grunting, and poor muscle tone. The emergency nurse should first: A. Obtain IV. B. Apply a pulse ox. C. Prepare a chest x-ray. D. Administer 100% oxygen. - Answer- 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. - Answer- B. Using the jaw thrust maneuver. A 3-year-old is transported by prehospital personn [Show Less]
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ENPC Practice test 2023 (Answered)
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. - Answer- 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? - Answer- 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? - Answer- Sicker The pediatric prioritization process components include the focused assessment, focused history, acuity rating decision and: - Answer- 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? - Answer- 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? - Answer- The shoulders. Test the Ph of the gastric contents. - Answer- 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 - Answer- 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 - Answer- Immediately after intraosseous insertion the nurse assesses the infusion and notes that the fluid is not dripping. How should the nurse respond? Croup - Answer- 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 - Answer- 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 - Answer- 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 - Answer- 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 - Answer- 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 - Answer- 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 - Answer- Which of the following screening statements/questions is most appropirate in asssessing an adolescent for dating violence Blood pressure - Answer- Which sign distinguishes compensated shock from decompensated shock in the pediatric patient? Administration of epinephrine - Answer- 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% - Answer- 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 - Answer- 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 - Answer- 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 - Answer- Which of the following burn injury patterns and history indicates suspected child maltreatment. Skeletal survey - Answer- 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 - Answer- 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 - Answer- 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 Exam Questions and Answers (Graded A)
Pediatric triangle - Answer- appearance work of breathing circulation to skin General appearance considerations - Answer- Tone Interactiveness: drawn... [Show More] 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 mandibular fracture test - Answer- have pt bite down on tongue blade attempt to pull tongue blade out if pt unable to continuously bite down --> could indicate mandibular fracture Hyphema interventiosn - Answer- pt on bed rest with HOB at 35-45 degrees cover eye with shield steroids and tranexamic acid Globe injuries - Answer- stabalize object with a shield assess for fluid leaks CT or MRI meds to prevent increase IOP --> prevent vomiting, agitation, pain, antibiotics Gastroenteritis Assessment and Interventions - Answer- Assessment: increased freqency of loose, fould smelling stools, vomiting, fever/headache/malaise; ab cramping Intervention: oral rehydration; 2-5ml of oral rehydration solution every 2-5 minutes; increase if tolerated. Goal 50-100mg/kg over 2-4 hrs; ANTIDIARRHEAL MEDS ARE NT REOMMENDED colic baby comforting suggestions - Answer- 1. Swaddle 2. Side position for digestion (left) 3. sushing sounds 4. swinging 5. Sucking Intussusception assessment and intervention - Answer- Assessment: colicky abdominal pain; child inconsolable; draws legs to chest; bomiting and ab distention with palpable sausage-shapped mass Intervention: air or contrast enema to diagnose and treat --> not with signs of shock; Swallowing items - Answer- -batteries are ideally removed within 2 hours -X-ray/CT/US use to diagnose -keep child NPO Esophageal Atresia/Tracheoesophageal fistula - Answer- Assess: resp distress; drooling, choking episodes; reccurent resp infection Post repiar: GErD; resp. illness, dysphagia; feeding issues diagnosis by trying to insert a OG tube Rhabdomyolysis assessment and interventin - Answer- Classic triad: muscle pain, weakness, dark urine Peds: muscle pain, fever, and fivral prodrome usually caused by infection (under 9yo) Diagnose: CK>1000 Aggressive hydration; treat problem hemolytic uremic syndrome Assessment - Answer- damage to kidenys so they can't filter usually form illness pallor/lethargy hypertension diarrhea (bloody); N/V edema oliguria/anuria w/ hematuria and proteinuria low hemoglobin adn hematocrit levles elevated BUN and creatinine bruising, purpura AMS/seizures HUS interventions - Answer- diagnosis made by triad of anemia, thrombocytopenia, and renal failure DONT give antibiotic IV hydration and electrolyte correction dialysis [Show Less]
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ENPC Exam Prep / Exam Questions with correct Answers
Which of the following would be an abnormal finding in a patient with glomerulonephritis? - Answer- Clear urine There is a decrease in urine output for pat... [Show More] ient'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 th [Show Less]
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ENPC Exam 2023 Questions with Verified Answers
CIAMPEDS - Answer- C - Cheif Complaint I - Immunizations I - Isolation A - Allergies M - Medications P - Past Medical History P - Caregivers impressi... [Show More] on of the pediatric pts condition E - Events surrounding the illness/injury D - Diet D - Diapers S - Symptoms associated with the illness or injury MIVT - Answer- M - Mechanism of injury, including the use of protective devices I - Injuries suspected V - Vital signs in prehospital T - Treatment by prehospital (Under E in CIAMPEDS) Secondary Assessment - Answer- F - Full set of vital signs F - Family presence F - Focused adjuncts G - Give comfort H - History H - Head to Toe I - Inspect the Back Urine Output: Infant - Answer- 2 mL/kg per hour Urine Output: Child - Answer- 1-2 mL/kg per hour Urine Output: Adolescent - Answer- 0.5-1 mL/kg per hour Measuring Urine Output via Diapers - Answer- 1 gram increase in diaper weight = 1 mL of urine Weight Estimation Formula (1-Puberty) - Answer- Wt (kg) = (3 x age in years) + 7 Normal Systolic BP (2 years or older) - Answer- = 90 + (2 x Age in years) Lower Limit Normal Systolic BP (2 years or older) - Answer- = 70 + (2 x Age in years) Normal RR: Infant (1-12 months) - Answer- 30-60 Normal RR: Toddler (1-3 years) - Answer- 24-40 Normal RR: Preschooler (3-5 years) - Answer- 22-34 Normal RR: School-aged (5-11 years) - Answer- 18-30 Normal RR: Adolescent (11-18) - Answer- 12-16 Normal HR: Infant (1-12 months) - Answer- 100-160 Normal HR: Toddler (1-3 years) - Answer- 90-150 Normal HR: Preschooler (3-5 years) - Answer- 80-140 Normal HR: School-aged (5-11 years) - Answer- 70-120 Normal HR: Adolescent (11-18 years) - Answer- 60-100 Systolic BP: Neonate (Term, birth to 28 days) - Answer- > 60 (or strong central pulse) Systolic BP: Child (>10) - Answer- > 90 AVPU scale - Answer- A - Awake and alert V - Responsive to verbal stimuli P - Responsive only to painful stimuli U - Completely unresponsive Primary Assessment - Answer- A - Airway w/ Cervical spine immobilization B - Breathing C - Circulation D - Disability (Brief neurological assessment) E - Exposure and Environmental Control Fluid Bolus - Answer- 20 mL/kg of Crystalloid Fluid Bolus for Cardiogenic Shock - Answer- 10 mL/kg of Crystalloid Blood Administration - Answer- 10 mL/kg Estimating ETT tube Depth - Answer- Depth (cm) = Internal tube diameter (mm) x 3 Estimated Uncuffed ETT (1-10 yrs) - Answer- Uncuffed ETT = (Age in years/4) + 4 Estimated Cuffed ETT (1-10 yrs) - Answer- Cuffed = (Age in years/4) + 3.5 Systolic BP: Infant (1-24 mo) - Answer- > 70 (or strong central pulse) Systolic BP: Child (2-10) - Answer- > 70 + (2 x Age in years) Pediatric Assessment Triangle (PAT) - Answer- Appearance (across the room) Work of Breathing Circulation to Skin Adolescent Age Range - Answer- 11-18 years School-Aged Children Age Range - Answer- 5-11 years Preschooler Age Range - Answer- 3-5 years Toddler Age Range - Answer- 1-3 years Infant Age Range - Answer- 1-12 months Neonate Age Range - Answer- Birth-28 days Circulating Blood Volume: Infant - Answer- 90 mL/kg Circulating Blood Volume: Child - Answer- 80 mL/kg Circulating Blood Volume: Adult - Answer- 70 mL/kg Growth - Answer- Increase in weight and BMI that can be plotted on specific growth charts (boys, girls, age) Development - Answer- Gradual and successive increase in abilities and skills on a predetermined path (Developmental Milestones) Normal Infant Reflexes - Answer- Moro, Suck, Root, Startle, Babinski, Grasp, Step Pediatric Parkland Formula - Answer- Fluid resuscitation in burn trauma %TBSA burn x child's wt (kg) x 4 mL = mL to be infused in 1st 24 hours Administer 1/2 total amount in first 8 hours (time starts at injury time) Administer second 1/2 over next 16 hours Maintenance fluids with glucose for kiddos under 5 years Rule of 9's in Pediatric Burns - Answer- Hand 1% Head 18% Front 18% Back 18% Leg 14% Arm 9% [Show Less]
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ENPC-Trauma/Shock Exam Questions and Answers
Major risks for pediatric burns - Answer- 1. Hyperkalemia 2. infection 3. fluid loss Urine output goal for kids with burns - Answer- 0.5-2 ml/kg ... [Show More] Parkland formula for fluids - Answer- TBSA burned x childs wt in kg x 4 = number of mL to be infused in 24 hrs. Give first half in first 8 (start at time of injury) then second 1/2 over the next 16 hours. Cushing Triade - Answer- Assessment used in trauma pts: bradycardia, hypotension alteration of respiratons (suggestive of spinal cord injury) Basillar skull fracture sx - Answer- 1. hemotypanums = diruptions of cranial nerve 7 and 9 2. racoons eyes (echymosis below eyes) 3.Battles sign ( postaurical eccymosis) Normal ICP in children and infants - Answer- 1. infants: 2-6 2. children 3-7 Sx of increased ICP - Answer- slurred speech, lethargy, posturing, seizures, ataxia while crawling, walking etc. Linear skull fracture - Answer- occurs from low energy blunt trauma over service of skull sx: tenderness and swelling over indicated area Basilar skull fracture - Answer- fracture of base of skull (frontal, ethomoid, sphenoids, temporal or occipital) leads to CSF leak and possible infection. Sx of decompansated shock - Answer- widespread edema, tachycardia, DIC, urine in feces, decreased urine output less than 1mg/kg/hr, petichiae in extremities, hypotension, narrow pulse pressure progressing to wide pulse pressure, delayed cap refill. sx of warm shock - Answer- cap refill less than 2 sec, bounding pulses, flushed, hot extremities, normotensive, widespread vasodialtion sx of cold shock - Answer- delayed cap refil greater than 3 sec, bounding pulses, cool extremities, pallor, mottled extremities, wide pulse pressure. Hypovolemic shock increases - Answer- Fluid bolus 20ml/kg, , packed red blood cells, vasoconstictors Cardiogenic shock tx - Answer- Fluid bolus of 5-10 mL NS or LR, assess for sx of fluid overload, obstructive shock - Answer- cardiac tamponode, tension pneumo, PE Types of distribuitive shock - Answer- neurogenic, septic, anaphylactic 25% carboxyhemoglobin - Answer- causes lethargy in children Four indicators of dehydration in pediatric population - Answer- 1. general appearence, absence of tears, dry mucous membranes, cap refil greater than 2 secs. Preferred route fo IO access in pediatrics - Answer- 2 cm below tibial tuberosity on medial aspect of tibia [Show Less]
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ENPC 5th edition Questions with correct Answers
Neonate characteristics: - Answer- Birth to 4 weeks If preterm neonate until original due date plus 28 days Loses 5-10% weight by 3-4th day of life Flex... [Show More] ion normal posture Limited glycogen store Nose breathers Infant characteristics: - Answer- Nose breather until 6months And muscle to breathe Metabolic rate 2x adult (increased need for oxygen and glucose) Toddler characteristics: - Answer- Babinski réflex normal until walking Plantar réflex at 2 years And muscles to breathe Most common cause of bradycardia in peds - Answer- hypoxia When to begin chest compressions in peds - Answer- when HR is below 60bpm Suctioning the neonate - Answer- increases the risk for decreased cerebral blood flow decreased pulmonary oxygenation bradycardia suction mouth then nose Neonate first minute emphasis - Answer- ventilation not intubation Lower glucose levels in Neonate - Answer- associated with potential for brain injury stress of respiratory and circulatory efforts metabolize existing glucose D10 IV for glucose <40mg/dL normal heel stick at birth 30 mg/dL normal heel stick at 24h 45 mg/dL Neonatal CHD - Answer- compare pulse ox from right hand to either foot (difference >3% suggest dx) considered in infant presenting with respiratory distress or shock (with absence of fever) s/s include shock, cyanosis, tachypnea, or pulmonary edema Neonatal cyanosis - Answer- look inside the mouth at gum line for purple/blue color of tongue and gums - central look for hands and feet to change color - peripheral Respiratory Distress in peds patient - Answer- characterized by increased respiratory rate increased heart rate skin color changes increased WOB (grunting, nasal flaring, head bobbing, accessory muscle use) wheezing diaphoresis abnormal upper airway (sounds such as stridor) change in mentation (irritable or agitated) Laryngotracheobronchitis (Croup) - Answer- viral illness that account 90% peds stridor inflammation, exudates and edema of larynx l/d narrowing of upper airway tx with dexamethasone and racemic epi (nebulized epinephrine) tx with antipyretics for fever Pertussis (whooping cough) - Answer- acute bacterial infection of the respiratory tract that is highly contagious characterized by spasmodic, hacking cough followed by whooping noise upon breath intake tx with erythromycin, azithromycin, clarithromycin or trimethoprim-sulfamethoxazole cystic fibrosis (CF) - Answer- genetic condition r/t exocrine dysfunction result in thick mucous production persistent productive cough, hyperinflated lungs, diminished pulmonary function and increased susceptibility to ch. bacterial resp infections tx with abx, steroids for asthma-like s/s, brochodilator followed by nebulized hypertonic saline and dornase alfa Pneumothorax - Answer- simple - when air enters pleural space (monitor) large - s/s hypotension, distended neck veins, pale and diaphoretic skin, decreased or absence BS on affected side, hyper-resonance to percussion (Chest tube) spontaneous - no known trauma or injury (most cases is ruptured bleb) Heart Failure in peds - Answer- inadequate CO r/t ventricle unable to either fill with blood or eject blood can be result of sepsis, renal dx, inflammatory conditions, dysrythmias, muscular dystrophy, chemotherapy or blunt chest traumas tx by position of comfort, record weight daily, BB, avoid vasodilators and caution of diuretics Cardiomyopathy in peds - Answer- left ventricular hypertrophy (thickened muscle wall) dilated cardiomyopathy (left ventricular enlarged and weakened) cause include coronary artery dx, HTN, obesity, drug tox and kawasaki dx tx by position of comfort, record weight daily, BB, avoid vasodilators and caution of diuretics Myocarditis - Answer- inflammation of the heart muscle that has significant mortality and morbidity in peds viral, bacterial, toxic and autoimmune etiologies s/s include fever, malaise (general unwell) and myalgia (soreness/achiness in muscles); SHOB at rest and crackles on auscultation; dysrhytmias; HF; elevated enxymes; syncope Percarditis - Answer- inflammation of pericardial sac of heart infectious (viral/bacterial) or dug (PCN, phenytoin), post cardiac surg, metabolic or immune mediated tx NSAIDS and possible pericardiocentesis Marfan Syndrome - Answer- inherited autosomal dominant dx connective tissue dx s/s - thin, tall with long extremities, flat feet, pectus excavatum (caved-in chest) or pectus carinatum (protruding "pigeon" chest) tx with BB or angiotensin-receptor blocker Kawaski Disease - Answer- vasculitis of unknown cause may be r/t infection (viral/bacterial) L/T coronary artery aneurysms, progressive stenosis, ischemic heart disease, myocardial infarction, HG or sudden cardiac death Reversible causes of peds cardiac arrest - Answer- Hypovolemia hypoxia hydrogen ion (acid-base illness) hypokalemia/hyperkalemia (glucose also) hypothermia tension pneumothorax tamponade (cardiac) toxins/tablets thrombosis (PE, MI) hypovolemic shock - Answer- decreased intravascular volume fluid volume loss - n/v/d, UO, hemorrhage, burns, and fluid shift into third space most common shock in children distributive shock - Answer- characterized by vasodilation and maldistribution of blood volume anaphylactic - allergen exposure and histamine release cause vasodilation septic - endotoxin release cause increased vascular permebility and vasodilation neurogenic - SCI, spinal anesthesia or nervous system damage cause loss of sympathetic tone and vasodilation obstructive shock - Answer- obstruction that decreases the heart's ability to pump blood or venous return of the heart cause include pericardial tamponade, tension pneumothorax, CHD and PE cadiogenic shock - Answer- characterized by decreased cardiac contractility and output secondary to abnormal pump function or pump failure cause by myocardial injury (myocarditis or trauma), CHD or dysrhythmias Compensated shock (Stage I) - Answer- tachycardia, mild tachypnea, slightly delayed cap refil, and subtle changes ****** [Show Less]
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ENPC Study Set 1 with complete solutions
Components in the prioritization of pediatric emergency care (4) - Answer- PAT, Focused Assessment (objective information), Focused pediatric Hx(subjective... [Show More] information), assignment of an acuity rating decision Pediatric Assessment Triangle : (3) components - Answer- Appearance. Work of Breathing. Circulation to the skin. This forms the "general impression". If there is an acute disruption in 1 component, child is "sicker". If there is an acute disruption in 2+ components the child is "sickest" Pediatric Assessment Triangle : Appearance - Answer- Most important. Reflects adequacy of ventilation, oxygenation, brain perfusion, and central nervous system function. Assess for : tone, interactiveness, consolability, look/gaze, and speech/cry. Pediatric Assessment Triangle : Work of Breathing - Answer- Breathing easy, even, and unlabored or tripod position, nasal flaring, retractions, supraclavicular retractions Pediatric Assessment Triangle : Circulation to the skin - Answer- Mottling or PWD PQRST for Pain - Answer- (pg86) Precipitating and palliating factors Quality Radiation Severity, symptoms, and site Time or triggering factors Verbal Report for pain - Answer- (pg86) Self-report is the most reliable indicatior of pain; however not all pediatric pt are capable or wiling to verbalize their discomfort. What age is the respiratory system considered fully developed? - Answer- 8 years old Most ______ age __to____, are concrete thinkers and interpret words literally. Where as, most _____ age ___ to ___, are magical and illogical thinkers. They often confuse coincidence with causation, and have difficulty distinguising fantasy from reality. - Answer- (pg36) Most Toddlers age 1yo to 3yo , are concrete thinkers and interpret words literally. Where as, most Preschoolers age 3yo to 5yo, are magical and illogical thinkers. They often confuse coincidence with causation, and have difficulty distinguising fantasy from reality. Hypotension related to hypovolemia in pediatric trauma patients is a _____ sign and may indicate a loss of ___% to ___% of their circulating blood volume. - Answer- (pg262) Late sign. 20% to 25% of circulating blood volume 6P's Assessment for Musculoskeletal Trauma - Answer- (pg 283) Pallor : color different from uninjured Pain Pulselessness Parasthesia Paralysis Poikilothermia Burn Transfer Criteria - Answer- 1. Partial thickness >10% of BSA 2. Face, hands, feet, genetalia, perineum or major joints 3. Third degree burns in any age group. 4. Electrical burns, including lightning injury, and chemical burns. 5. Inhalation injury. 6. Burn injury in pt with preexisting medical disorders that could complicate tx. 7. Concomitant trauma (such as fx) in which the burn injury poses the greatest risk of morbidity or mortality. 8. Burned children in hospital wo qualified equipment or personnel to care for them 9. Pt who will require special social, emotional, or rehabilitative intervention. If live interpreter not available for 15mins use ________ - Answer- Language line interpreter Infants are obligate nose breathers. If nose is obstructed ___________ - Answer- suction nose Opiod antidote - Answer- Narcan Benzo antidote - Answer- Romazicon Neutropenic pt with a temperature - Answer- Don't take rectal temp. No invasive procedures if not necessary. Nonblanchable Rashes of concern - Answer- Meningocoxcemia Petiachia/Purpura Bicycle accident concerns - Answer- Did pt strike handle bars? Possible abdominal injury Ribs are more horizontal and provide less protection. Normal Urine Output for child - Answer- 1 to 2ml / Kg / Hr Differences of child vs adult : BSA, blood volume, glycogen storage, metabolic rate - Answer- Children have : increased BSA(predispose to temp dysregulation), decreased circulation blood volume(predispose to hypovolemia), decreased glycogen storage(predisoposed to hypoglycemia), Increased metabolic rate. Oral Rehydration for 9month old with mild dehydration. - Answer- Glucose and sodium solution, every 2 to 5min with 5 to 10ml 6week old infant, no medical hx. eating poorly, vomiting, "hard to wake up", responsive to pain. Anterior fontanel bulging, tachypnic. Diagnostic evaluation expected? - Answer- Skeletal survey Possible shaken baby syndrome Minimal Acceptable BP's - Answer- Newborn = 60 Infant = 70 Child = 70 + (2 x age in yrs) All critically ill patients require _____ level - Answer- glucose due to low glycogen stores Altered Mental Status is considered ______ until proven otherwise - Answer- decreased cerebral perfusion Decompensated shock in children #1 sign - Answer- Hypotension Best place for an IV - Answer- Hand(ask if there is a certain side thumb they suck) Scalp if less than 9months. Not in feet if they walk. Tension Pneumothorax Tx - Answer- Needle chest decompression 2nd ICS MCL TBI considerations - Answer- MD has to say when they can return, not the pt or caregiver. Should be a "gradual return to play" Cardiopulmonary Arrest usually from (2) - Answer- Shock Respiratory Distress Bradycardia pharm treatment - Answer- Epinephrine (1:10,000), 0.01mg/kg every 3-5min [Show Less]
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ENPC – Assessment Exam Questions and Answers 2023
Inconsolable neonate - Answer- hypoxia Preschooler 3-5yrs likes - Answer- Nightlights + Bandaids 4 Components of the Pediatric Prioritization Process... [Show More] - Answer- 1. PAT 2. Focused Hx 3. Focused Assessment 4. Assignment of an acuity rating Pain scale - nonverbal - Answer- Flacc Pain Scale - 4-7 yrs - Answer- Faces Pain Scale 8 yrs+ - Answer- Numerical 0-10 scale PAT Components - Answer- General appearance Work of breathing Circulation 0 = Sick 1 = Sicker 2+ = Sickest Airway Assessments - Answer- Tongue Obstruction Loose Teeth Vomit Secretions Blood Edema Airway Interventions - Answer- Re-position the head to a neural position Open airway - chin lift, jaw thrust Suction secretions - avoiding vagal stimulation Not conscious - consider inserting orophargyngeal airway Breathing Assessment - Answer- Do I have spontaneous respirations? What is the rate and depth of respiratons? Do I have symmetric chest rise and fall? Breath sounds present, what is their quality? What is the work of breathing - do I have nasal flaring, retractions, accessory muscle use? Interventions breathing - Answer- Maintain a position of comfort Provide supplemental O2 Not breathing adequately - provide bag mask ventilation AND reassess for the effectiveness of breathing Prepare for endotracheal intubation/RSI Assessment of tube placement, insert gastric tube to reduce abd distention Breathing assessment - Answer- Do I have spontaneous respiration? Do I have equal chest rise and fall? What is the rate and depth of respiration? What is the work of breathing - is there any nasal flaring, retractions, head bobbing? Circulation assessment - Answer- Central and peripheral pulse rate and quality Skin color and temperature Capillary refill JVD and tracheal position - trauma Circulation interventions - Answer- CPR/ALS Control obvious bleeding Obtain IV access Adminster 20ml/kg fluid bolus and reassessment of circulatory assessment Administer blood or blood productions Disability assessment - Answer- AVPU - awake/alert, verbal, responds to pain, does not respond/unconscious Pupils equal round reactive to light E - Answer- Exposure and Environmental Control Exposure and Environmental Control Assessment and Interventions - Answer- Look for obvious skin abnormalities Sources of heat loss Apply warm blankets Provide overhead warming light warm IV fluids/warmed humidified O2 F - Answer- Full set of vital signs Family presence Focused adjuncts Full set of vital signs - Answer- HR, RR, BP, SpO2, Temp, Weight (kg) Family - Answer- Identification of family members and their relationship with the child Needs of the family Assign a healthcare professional to liaison with family/provide family support Facilitate family involvement Focused Adjuncts - Answer- Dynamic cardiopulomonary monitor BGL Gastric tube Urinary cath Blood samples to lab G - Answer- Give Comfort Measures Give Comfort Measures - Answer- Assessment of pain Facilitate family presence to support the child Initiate pain management measures - anaglesics, splints, dressings, ice H - Answer- Head to Toe Assessment Head to Toe Assessment - Answer- Inspection Palpation Auscultation techniques for s/s of illness or injury such as rashes, lesions, petechiae, ecchymosis, tenderness Reassessment of airway, breathing, and circulatory status H - Answer- History MIVT - Answer- Mechanism of Injury Injuries Vital signs prior to arrival Treatments CIA M Peds - Answer- C - c/o I - immunizations/exposure to infectious disease A - allergies M - medications P - PMH E - events preceding - onset of illness, treatments prior to arrival D - diapers/diet - last PO intake S - s/s History - Answer- MIVT CIA M Peds Focused Hx Social Hx Family Hx Refer to social services I - Answer- Inspect posterior surfaces Inspect posterior surfaces - Answer- inspect and palpate posterior surfaces log roll to maintain airway and spinal alignment Normal BP formula - Answer- 90 + (2 x age in years) Min Sys BP - Answer- 70 + (2 x age in years) What is the most reliable indicator for pain? - Answer- Self-reporting tools Flacc - Answer- Faces Legs Activity Crying Consolable Croup Intervention - Answer- cool mist/O2 Epiglottis s/s - Answer- High Fever Sudden Onset Muffled Drooling Stridor Keep caregiver with the patient! Decrease stress. RSV - Answer- Low grade fever Foreign body - Answer- remain with caregiver to decrease stress bronchiolitits - Answer- Lots of secretions - need for suctioning RSV is a cause Apnea What is considered a fever? - Answer- 100.4 F (rectally) Fever interventions - Answer- UA BGL CSF Sepsis work up Dehydration interventions - Answer- 20ml/kg bolus PO intake 5ml every 2-5 minutes monitor weight monitor I/O Gastroenteritis - Answer- S/S - Vomiting + diarrhea Contagious - wash hands, teach handwashing @ Risk for dehydration Rubella - German measles - Answer- RINK maculopapular rash with downward progression from the face usually resolving in three days No fever Rubella - Measles - Answer- Fever Red macular popular rash - begins on face and progresses downward High Fever Chickenpox - Answer- pruitirc rash lesions in all stages begins centrally - spreads to face and extremities DKA Fluids - Answer- Administer at a slow rate to prevent increased ICP Intussusception - Answer- currant-jelly stool severe pain male infant 3 months to 12 months dx - CT scan of abd tx - contrast enema Absent cremasteric reflex - normal UA - Answer- Testicular torsion Neonate birth interventions - Answer- Observe Warm Dry Stimulate gently Marks on self, marks on door - Answer- Chocking game Hypovolemic Shock - Answer- Volume problem Causes - V/D, trauma, burns Loss of preload Increased HR Low BP Cardiogenic Shock - Answer- Decreased cardiac output Causes - cardiomyopathies - Answer- [Show Less]
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