ULTIMATE ENPC
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
