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ENA Emergency Nurses
Association
ENPC Emergency Nursing Pediatric Course
ENPC Certification Written Exam &
Pediatric Trauma Scenarios Assessment
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ENPC 4
th
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ENPC ENA Exam Review Emergency Nursing
Pediatric Course Questions and Answers |
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ENPC Certification Written Exam & Pediatric
Trauma Scenarios Assessment
ENPC Emergency Nursing Pediatric Course
Read All Instructions Carefully and Answer All the Questions Correctly Good Luck: - Assess the Pt's level of consciousness/responsiveness - =Answer>> Is the Pt awake/responsive or unconscious Primary Survey - =Answer>> "A" - "E" Position Pt to open airway & keep C-Spine stable - =Answer>> Airway & Alignment (C-Spine) Manually open the airway with the jaw-thrust maneuver to maintain C-Spine stabilization Demonstrates and describes techniques to assess airway patency - Identify at least 3 - =Answer>> Vocalization or abnormal airway sounds Tongue obstruction Loose teeth or foreign objects Blood, drooling, secretions, or vomit Need Writing 📱Help? We've Got You Covered! ✍ 100% NO A I or Plagiarism Guaranteed📱 Click Here To <> Follow Link
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📱Hit Me UP__ Inbox Open 24/7 – 365 …...!!!! 📱 Chat with us here: 📱 Hybridgrades101@gmail.com Testicular torsion - =Answer>> Sudden onset severe unilateral pain. Scrotal swelling and erythema. Surgical emergency Neutropenia - =Answer>> Reverse isolation. Don't get rectal temps! Severe neutrophil less than 500mm Apparent life threatening event - =Answer>> Usually younger than 3 months old Children who walk give IM - =Answer>> Vastus lateralis. Hold with parent cuddling or hugging Neonate thermoregulation - =Answer>> use over the bed radiant warmer with servo control mechanism Hyperbilirubinemia - =Answer>> Check bilirubin level, visible when levels reach 5. Greater than 12 requires immediate intervention Cobedding - =Answer>> Not recommended Cardiac arrest prevention - =Answer>> Work up if there is exertional symptoms, Hx of hypertension or heart murmur or family history of sudden death Bradycardia - =Answer>> Give o2 get vascular access, give epi .01 mg/kg look for causes Tachycardia - =Answer>> Not prefusing well, irritable. Stable or unstable? Vagal maneuvers - =Answer>> Bag of ice on face or groin or rectal temp. Older kids blow into straw Need Writing 📱Help? We've Got You Covered! ✍ 100% NO A I or Plagiarism Guaranteed📱
📱Hit Me UP__ Inbox Open 24/7 – 365 …...!!!! 📱 Chat with us here: 📱 Hybridgrades101@gmail.com Adenosine - =Answer>> .1 mg/kg first .2mg/kg second dose Synchronized cardioversion - =Answer>> 0.5 to 1 joules/kg repeat at 2 joules/kg Long qt - =Answer>> Symptom is syncope Demonstrate and describes required interventions to clear the airway - Identify at least 1 - =Answer>> Suction "Sniffing" Position - place head in a neutral position by placing a towel between shoulder blades Remove foreign objects Nasopharyngeal/Oropharyngeal Airway (OPA) "B" - =Answer>> Breathing & Ventilation Demonstrates and describes techniques to determine effectiveness of breathing - Identify at least 3 - =Answer>> Level of consciousness (LOC) Spontaneous respirations Rate & depth of respirations Decreased/Increased ability Symmetric & equal chest rise and fall Presence & quality of breath sounds Open chest wounds/deformities Skin color Begin or maintain oxygen therapy or assisted ventilations using: ~ 100% oxygen w/ NRB mask ~ Bag-mask with 100% oxygen **Assess effectiveness of ventilation - =Answer>> Equal rise/fall of chest Auscultates breath sounds Need Writing 📱Help? We've Got You Covered! ✍ 100% NO A I or Plagiarism Guaranteed📱
📱Hit Me UP__ Inbox Open 24/7 – 365 …...!!!! 📱 Chat with us here: 📱 Hybridgrades101@gmail.com 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.) Preschoolers are magical thinkers and imagine bandages keep their insides from coming out. Rationale: Preschoolers are magical and illogical thinkers and have difficulty distinguishing fantasy from reality. They have misconceptions about illness, injury, and bodily functions. For example, they perceive that if their skin is cut, they fear their insides will leak out. Covering a wound with a bandage helps them with this fear.
- 7-month-old presents to the emergency department with a complaint of fever. Assessment reveals a patent airway and slight cyanosis around his lips and nail beds. He is alert and interactive. His vital signs are 38. C (101.3F), HR 134, RR 32, BP 78/54 mm Hg, and Spo 84%. The nurse notes a healed surgical scar on his chest. Based on this assessment, what is the nurse's priority? A.) Administer ibuprofen to treat the fever. B.) Begin oxygen via a nonrebreather mask. C.) Obtain a surgical history. D.) Ask if the Spo2 is normal for him. - =Answer>> D.) Ask if the Spo2 is normal for him. Rationale: Children with special healthcare needs may present differently than other children, but these differences may be normal. The surgical scar on the chest is likely from a congenital heart defect repair. The Need Writing 📱Help? We've Got You Covered! ✍ 100% NO A I or Plagiarism Guaranteed📱
📱Hit Me UP__ Inbox Open 24/7 – 365 …...!!!! 📱 Chat with us here: 📱 Hybridgrades101@gmail.com mother's chief complaint is the fever, not the color, pulse oximetry, or the respiratory distress. This may be because these aspects of his assessment are normal. The intact mental status is also a sign that he has adapted to lowers oxygen saturation's. The child's baseline must come from the caregiver before any intervention.
- An 11-year-old presents to the emergency department with a complaint of hitting his head while playing soccer. The nurse enters the room and performs an across-the-room assessment. He is staring at the wall. He has no increased work of breathing, and his color is pink. Using the pediatric assessment triangle (PAT), what classification will the nurse assign? A.) Well Rationale: In using the PAT, there is not a Well category. A child may appear well and without disruption in any of the three components of the PAT but is still designated sick. All pediatric patients presenting to the emergency department are considered sick simply based on the fact that the caregiver was concerned enough to bring the child to the emergency department (p. 54). B.) Sick Rationale: If there is no disruption in any of the three components of the PAT, a pediatric patient is considered sick. This child has an abnormality in one of the thre - =Answer>> C.) Sicker Rationale: This child has a disruption in one of the three components of the PAT. He is staring at the wall, which is a disruption in the general appearance component. It may be that he is anxious and fearful about the experience, but it could be a result of the head injury. More assessment is required (p. 54). Need Writing 📱Help? We've Got You Covered! ✍ 100% NO A I or Plagiarism Guaranteed📱
📱Hit Me UP__ Inbox Open 24/7 – 365 …...!!!! 📱 Chat with us here: 📱 Hybridgrades101@gmail.com shallowly and slowly. Her color is pale. What is the priority? A.) Administer 100% oxygen Rationale: The primary assessment in a trauma patient begins with immobilization of the cervical spine while opening the airway. The remainder of the primary assessment interventions including oxygenation is performed after cervical spinal immobilization (p. 64). B.) Immobilize the cervical spine Rationale: Any unresponsive child found in a pool must be assumed to be a trauma patient and with a cervical spinal injury until proven otherwise. The primary assessment in a trauma patient begins with immobilization of the cervical spine while opening the airway. The remainder of the primary assessment interventions, including inserting an airway, oxygenation, and ventilation, is perfor - =Answer>> B.) Immobilize the cervical spine. Rationale: Any unresponsive child found in a pool must be assumed to be a trauma patient and with a cervical spinal injury until proven otherwise. The primary assessment in a trauma patient begins with immobilization of the cervical spine while opening the airway. The remainder of the primary assessment interventions, including inserting an airway, oxygenation, and ventilation, is performed after cervical spinal immobilization (p. 64).
- A 2-year-old has a suspected cervical spinal injury. In order to ensure neutral spinal alignment, padding should be placed under which area? a. Shoulders Rationale: The younger child has a larger head proportionally to the body and when lying supine is naturally in a position of cervical flexion. Padding under the shoulders or upper torso will bring the cervical Need Writing 📱Help? We've Got You Covered! ✍ 100% NO A I or Plagiarism Guaranteed📱
📱Hit Me UP__ Inbox Open 24/7 – 365 …...!!!! 📱 Chat with us here: 📱 Hybridgrades101@gmail.com spine into neutral alignment. The shoulder should be horizontally aligned with the external auditory meatus (p. 64). b. Head Rationale: Padding under the head will exacerbate this flexion (p. 64). c. Neck Rationale: Padding under the neck will not correct the anatomic flexion (p. 64). d. Waist Rationale: Padding under the waist will not affect the cervical spinal alignment (p. 64). - =Answer>> A. Shoulders Rationale: The younger child has a larger head proportionally to the body and when lying supine is naturally in a position of cervical flexion. Padding under the shoulders or upper torso will bring the cervical spine into neutral alignment. The shoulder should be horizontally aligned with the external auditory meatus (p. 64).
- The nurse is preparing to administer a feeding through a nasogastric feeding tube. The tube position was verified by radiograph after insertion 2 hours ago. What is the best way to verify placement before feeding? a. Instill air and listen over the epigastrium Rationale: The research regarding verification of gastric or feeding tube placement has demonstrated that the standard method of instillation of air and auscultation over the epigastrium for gurgling has been associated with improper placement and adverse outcomes (p. 103). b. Test the pH of the gastric contents Rationale: The research regarding verification of gastric or feeding tube placement has demonstrated that the Need Writing 📱Help? We've Got You Covered! ✍ 100% NO A I or Plagiarism Guaranteed📱
📱Hit Me UP__ Inbox Open 24/7 – 365 …...!!!! 📱 Chat with us here: 📱 Hybridgrades101@gmail.com Rationale: A pressure bag is sometimes quite useful in administering a large amount of flui - =Answer>> A.) A 20-mL syringe with a stopcock. Rationale: With a 20-mL syringe and a three-way stopcock, the nurse can quickly deliver an appropriate bolus of 0.9% normal saline by drawing up and administering 20 mL once for each kilogram of the pediatric patient's weight or 8 times for this patient (p. 119).
- Immediately after intraosseous insertion the nurse assesses the infusion and notes that the fluid is not dripping. How should the nurse respond? a. Use an infusion pump to deliver the fluids Rationale: Fluids infusing through an intraosseous device do not necessarily run by gravity. The use of an infusion pump is usually required (p. 127). b. Remove the device and insert in another site Rationale: Fluids infusing through an intraosseous device do not necessarily run by gravity. This does not mean it is nonfunctional and removal is not indicated (p. 127). c. Advance the device and reassess the flow Rationale: Advancing the device if it is currently correctly placed may penetrate the far wall of the bone and produce infiltration (p. 127). d. Attempt to aspirate bone marrow Rationale: Aspiration of bone marrow confirms correct placement of an intraosseous device, but lack of return is not a sign of incorrect placemen - =Answer>> A.) Use an infusion pump to deliver the fluids Rationale: Fluids infusing through an intraosseous device do not necessarily run by gravity. The use of an infusion pump is usually required (p. 127). Need Writing 📱Help? We've Got You Covered! ✍ 100% NO A I or Plagiarism Guaranteed📱
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- A 13-month-old presents to the emergency department with a 2-day history of a low-grade fever, increased work of breathing, and tonight developed a barking cough and inspiratory stridor. What condition does the nurse suspect? a. Epiglottitis Rationale: Epiglottitis has a sudden onset of high fever, sore throat, difficulty swallowing, and muffled voice and quickly progresses to drooling, tripod positioning, and stridor (p. 137). b. Foreign body aspiration Rationale: This patient is the right age for a foreign body aspiration as it is more common in infants and toddlers who explore the world orally, but the gradual onset, low-grade fever, and barking cough indicates an infectious process, specifically croup (p. 137). c. Tracheomalacia Rationale: Tracheomalacia is a chronic condition affecting the upper airway that may be an indication for a tracheostomy, but it is not acute, nor associated with infectious processes - =Answer>> D.) Croup Rationale: Croup is most commonly seen in children between the ages of 6 and 36 months and has a gradual onset of cold symptoms including a low-grade fever, tachypnea, tachycardia, retractions, and inspiratory stridor. The classic sign is a barking cough that worsens at night (p. 137).
- In providing education to a family regarding obtaining baseline peak airway flow for a child with asthma, the nurse will recommend what time of day? a. At bedtime. b. Before exercise c. In the morning. d. After meal. - =Answer>> C.) In the morning. Need Writing 📱Help? We've Got You Covered! ✍ 100% NO A I or Plagiarism Guaranteed📱
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- Caregivers bring in their 3-week-old neonate and describe nonbilious vomiting after every feeding that is becoming more forceful over the past 24 hours. The last time he vomited the vomitus hit a chair 2 feet away. They say he cries, roots, and sucks vigorously on his pacifier right after vomiting as though still hungry. He is not experiencing any diarrhea. What condition is the most likely cause of these signs and symptoms? a. Intussusception Rationale: Intussusception occurs most commonly in males aged 3 to 12 months and manifests with episodic abdominal pain, drawing up of the legs, and vomiting. It is not associated with projectile vomiting (pp. 155-156) b. Volvulus Rationale: Volvulus presents with bilious vomiting, and not projectile (p. 156). c. Gastroenteritis Rationale: Gastroenteritis does present with vomiting but usually includes diarrhea and the vomiting is usually not projectile as seen in pyloric s - =Answer>> D.) Pyloric stenosis Rationale: Pyloric stenosis is the narrowing of the pylorus, the opening from the stomach into the small intestine. It is most commonly seen in males between 2 and 8 weeks of age. They present with nonbilious vomiting, usually after every feeding, that becomes projectile as the obstruction worsens. With pyloric stenosis the infant remains constantly hungry and will demonstrate hunger behaviors after vomiting. If the diagnosis is delayed, dehydration and signs of hypovolemia may occur (p. 155).
- A neonate is delivered in the emergency department and placed on a radiant warmer. There is no staining of the amniotic fluid. What is the first step in neonatal resuscitation? Need Writing 📱Help? We've Got You Covered! ✍ 100% NO A I or Plagiarism Guaranteed📱
📱Hit Me UP__ Inbox Open 24/7 – 365 …...!!!! 📱 Chat with us here: 📱 Hybridgrades101@gmail.com a. Dry and warm the neonate Rationale: The steps in neonatal resuscitation are 1) dry and warm the patient, 2) maintain airway patency,
- maintain breathing effectiveness, 4) maintain adequate circulation, 5) obtain vascular access, 6) administer medications, 7) intervene if positive pressure ventilation fails, and 8) volume expansion and vasopressor support. At each step, the neonate is assessed to determine response to care. If the response is absent or inadequate, the steps become more invasive and complex (pp. 187-189). b. Suction the mouth and nose Rationale: The steps in neonatal resuscitation are 1) dry and warm the patient, 2) maintain airway patency, which begins with positioning to open the airway, and suctioning the mouth first - =Answer>> A.) Dry and warm the neonate. Rationale: The steps in neonatal resuscitation are 1) dry and warm the patient, 2) maintain airway patency,
- maintain breathing effectiveness, 4) maintain adequate circulation, 5) obtain vascular access, 6) administer medications, 7) intervene if positive pressure ventilation fails, and 8) volume expansion and vasopressor support. At each step, the neonate is assessed to determine response to care. If the response is absent or inadequate, the steps become more invasive and complex (pp. 187-189).
- In discussing the legal care of the adolescent patient, what is a mature minor? a. A minor who lives independently and is legally able to make health decisions Rationale: An emancipated minor is a minor who has been legally declared independent of his or her parent or guardian. Some examples are minors who are married, serve in the military, or are living Need Writing 📱Help? We've Got You Covered! ✍ 100% NO A I or Plagiarism Guaranteed📱
📱Hit Me UP__ Inbox Open 24/7 – 365 …...!!!! 📱 Chat with us here: 📱 Hybridgrades101@gmail.com Rationale: It may be difficult and unhelpful to ask the adolescent to answer from the perspective of the dating partner (p. 215). c. "Tell me about a time when you've felt unsafe in your relationship." Rationale: Dating violence in the adolescent population requires screening as intimate partner violence is screened in the adult population. - =Answer>> C.) "Tell me about a time when you've felt unsafe in your relationship." Rationale: Dating violence in the adolescent population requires screening as intimate partner violence is screened in the adult population. Screening should include directive and probing questions to discover violence in a dating relationship. Asking the adolescent to relate a time he or she felt unsafe will help the nurse assess for violence without the accusations or judgment (p. 215).
- Which sign distinguishes compensated shock from decompensated shock in the pediatric patient? a. Peripheral pulses Rationale: Compensatory mechanisms in the pediatric patient are systemic responses to the shock state to prevent hypotension and cardiovascular collapse. These mechanisms include peripheral vasoconstriction to shunt blood to vital organs, which manifests as weakening pulses, delayed capillary refill, and cool, mottled skin (pp. 231-232, 237). b. Blood pressure Rationale: Decompensated shock, also referred to as hypovolemic shock, occurs when the compensatory mechanisms in the pediatric patient, including increasing cardiac output with tachycardia and peripheral vasoconstriction to shunt blood to vital Need Writing 📱Help? We've Got You Covered! ✍ 100% NO A I or Plagiarism Guaranteed📱
📱Hit Me UP__ Inbox Open 24/7 – 365 …...!!!! 📱 Chat with us here: 📱 Hybridgrades101@gmail.com organs, which manifests as weakening pulses, delayed capillary refill, and cool, mottled skin. In pediatric patients, it is at this point that blood pressure drops and decompensated shock occurs (pp. 22 - =Answer>> B.) Blood pressure Rationale: Decompensated shock, also referred to as hypovolemic shock, occurs when the compensatory mechanisms in the pediatric patient, including increasing cardiac output with tachycardia and peripheral vasoconstriction to shunt blood to vital organs, which manifests as weakening pulses, delayed capillary refill, and cool, mottled skin. In pediatric patients, it is at this point that blood pressure drops and decompensated shock occurs (pp. 229, 231).
- A 5-year-old arrives to the emergency department unconscious with a heart rate of 32 beats/minute, weak, thready pulses, and pale, mottled skin. The team has begun bag-mask ventilation with 100% oxygen and chest compressions with no improvement in the heart rate. An intraosseous line is in place. Which of the following interventions is the priority? a. Administration of atropine Rationale: Atropine is only indicated in pediatric bradycardia if it is the result of vagal nerve stimulation. If the history does not indicate a reason for vagal stimulation, such as vigorous suctioning, the medication of choice is epinephrine (p. 251). b. Transcutaneous pacing Rationale: Transcutaneous pacing may be necessary if there is no response to epinephrine, but it should be given first (p. 251). c. Administration of epinephrine Rationale: For symptomatic bradycardia in the pediatric population, begin with oxygenation and ventila - =Answer>> C.) Administration of epinephrine Need Writing 📱Help? We've Got You Covered! ✍ 100% NO A I or Plagiarism Guaranteed📱
