ENPC EXAM
ANSWERS
2022-2023
RATED A+
VERIFIED Q & A
1. Which of the following would be an abnormal finding in a patient
... [Show More] with
glomerulonephritis?
Clear 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]