ENPC 6th Edition Course Exam 2024

A 4-year-old presents with vomiting, lethargy, frequent urination, weight loss, and dry mucous membranes. Vital signs reveal deep respirations at 44 breaths per minute, BP of 70/44 mm Hg, and HR of 144 beats per minute. Which of the following laboratory values would be most expected in this child? - Hypoglycemia (wrong) Remediation feedback: Children can present with new onset diabetes in diabetic ketoacidosis. Manifestations include signs of dehydration ( dry mucous membranes, hypotension, tachycardia), incontinence (polyuria), vomiting, abdominal pain, Kussmaul respirations (to counter the acidosis), polydipsia, anorexia, and weight loss. Expected laboratory values would reveal an acidotic state with a pH level below 7.3, an elevated serum bIcarbonate level, and an elevated blood glucose level 200 mg.dL. An 18-month-old is seen for fever, slight circumoral cyanosis, and wheezing noted on auscultation in the right upper lobe of the lung field after a choking event 4 days ago. The white blood cell count is elevated and the patient noted to be tachypneic, tachycardic, agitated, and has an increased respiratory effort. At the time of the event, the patient was started on antibiotics with subsequent increasing manifestations instead of improvement. Which of the following would be considered to be def - Computed tomography (wrong) Remediation feedback: Manifestations of a lower airway foreign body include a choking incident with subsequent failure to improve on antibiotics. Wheezing or decreased lung sounds in one area of the pulmonary system is a high indicator for a foreign body along with signs of hypoxia such as cyanosis, tachypnea, tachycardia, increased respiratory effort, agitation or lethargy, and elevated white blood cell counts indicating an infectious process. The definitive treatment would be a bronchoscopy in order to retrieve the suspected foreign body instead of diagnostic tests to locate the foreign body itself. A child in cardiopulmonary arrest is receiving chest compressions and manual ventilations with a bag-mask device. Once return of spontaneous circulation has been confirmed, which of the following would be the priority intervention? - Establishing a secure airway Parents report their 3-year-old child has developed noisy breathing. On assessment, high-pitched wheezes are audible and auscultated on inspiration and expiration. What medication would be appropriate to administer first? - Humidified oxygen (wrong) Remediation feedback: Wheezing is most often identified with asthma in the pediatric population. Initial medication intervention includes an inhaled short-acting beta agonist. A 6-week-old is brought to the emergency department by the caregivers for poor feeding, listlessness, and fever. Assessment reveals a crying infant, HR 160 beats/minute, RR 52 breaths/minute, rectal temperature of 96.0 F (35.5 C), and a bulging anterior fontanel. Capillary refill is 4 seconds. Based on these findings what is the most likely diagnostic test the nurse should anticipate? - Lumbar puncture A 12-year-old is being prepped for surgical intervention of acute appendicitis. Which of the following intravenous medication orders should the nurse question? - Hydromorphone (wrong) Remediation feedback: Ketorolac is an appropriate medication for moderate to severe pain, however, it should not be used pre-operatively due to its potential to increase the bleeding risk. A 17-year-old female arrives in the ED with her boyfriend who states she is pregnant and having vaginal bleeding. The patient is unsure of the gestational age and has not had any prenatal treatment. The patient is quiet and lets her boyfriend answer most of the questions. Which of the following is the most appropriate action for the nurse to take at this point? - Have the boyfriend leave the room during the pelvic exam. A 2-year-old arrives at the ED in hypovolemic shock and needs fluids immediately. After several attempts, your team has been unsuccessful at establishing vascular access. Of the following, which is the next best option for establishing access quickly? - Intraosseous in the patient's medial tibia. A child with an electrical injury is seen 1 hour post event. Which of the following types of specimen samples would provide visual information regarding a potential complication of this injury? - Sputum (wrong) Remediation feedback: Electrical injuries, though they may appear to be small, can produce large amounts of damage internally, including muscle damage. Myoglobin is excreted in the urine and is evidenced by dark, red-tinged urine. Parents with an infant requiring multiple laboratory tests, radiographic studies, and invasive procedures appear to be distressed and withdrawn. Which of the following interventions would best ensure a sense of comfort and control for these parents? - Providing frequent updates and re-educating them on the care that is being provided When taking vital signs on a stable infant, which of the following should be done first? - Respiratory rate A laceration on a toddler's arm is prepared for suturing. Which of the following preparations for topical anesthesia would be the best choice for this procedure? - LET (lidocaine/epinephrine/tetracaine