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 chil...
ULTIMATE ENPC
Questions and Answers
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 definitive treatment for the suspected diagnosis? 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? 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? Ketorolac
,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? 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)
Which of the following is appropriate administration of N-acetylcysteine (NAC) for an
acetaminophen overdose? A bolus infusion of 150 mg/kg NAC should be administered.
A 2-year-old is seen with a 3-day history of irritability, vomiting, and the presence of foul-
smelling urine. The child is hypotensive and tachycardic. Which of the following methods for
obtaining a urine sample is most appropriate in this circumstance? Urinary catherization
You are discharging a patient home who has a history of depression. Discharge teaching should
include which of the following? Ensuring all firearms in the home are locked up with no
access available by the patient.
A 2-year-old arrives with a 2-day history of vomiting and diarrhea. The patient has a fever of
38.4oC (101.2°F), resting HR of 152 beats/minute, RR of 34 breaths/minute, and blood pressure
, of 94/ 56 mm Hg. Assessment reveals a capillary refill time of > 5 seconds. Which of the
following would be most indicative of the need for intravenous rehydration therapy for this
patient? Capillary refill
An 8-month-old arrives with a 12-hour history of intermittent abdominal pain, non-bilious
vomiting, and a low grade fever. On assessment the child is intermittently inconsolable followed
by periods of normal activity. A sausage-shaped mass is noted during palpation of the abdomen.
The nurse should prepare for which of the following? Enema with air
A 13-year -old male presents to the triage desk complaining of nausea and vomiting. The patient
looks distressed and pale. He complains of spasming pain in his right scrotum which has now
become constant and more severe. Which of the following assessment findings would the nurse
expect with this patient? Elevated right testicle
An 8-year-old trauma patient suddenly develops increased respiratory distress with a rise in heart
rate from 112 beats/minute to 142 beats/minute associated with an abrupt hypotensive event.
Distention of the jugular veins is noted. Which of the following emergent interventions should be
anticipated first? Needle decompression is emergently necessary to release the air and
allow expansion of the lung again.
An 8-year-old pedestrian is thrown onto the hood of a moving vehicle striking the windshield.
On arrival to the ED. the patient is minimally responsive with active bleeding from the nose and
mouth. The patient is vomiting. Which of the following interventions would most likely be
considered? Endotracheal intubation
The nurse is reevaluating the effectiveness of interventions for a 4-year-old child with a
suspected tension pneumothorax. Which assessment finding indicates the interventions were
effective? Bilateral chest wall rise with assisted ventilations.
A 3-year-old is brought by caregivers with generalized tonic-clonic activity, unresponsiveness,
and drooling that began 6 minutes prior to arrival. Which of the following interventions would be
most appropriate for this event? Administer intranasal midazolam
A 6-month-old arrives with swelling to the left thigh. Caregivers deny any traumatic event.
Assessment findings include a patient who is active and alert, in the 10th percentile for length,
and has blue-grey sclera. Radiographs reveal a midshaft fracture of the left femur. Which of the
following is the most likely cause? Osteogenesis imperfecta
A 14-year-old patient had a reduction of a temporomandibular joint dislocation in the ED. Which
of the following should be included in the discharge instructions? Cold or warm, not hot,
compresses are recommended along with nonsteroidal anti-inflammatory medications for pain
control.
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