ENPC 4th Edition: Practice Test Exam Questions And Answers, Exams of Medicine

Download ENPC 4th Edition: Practice Test Exam Questions And Answers and more Exams Medicine in PDF only on Docsity! ENPC 4th Edition: Practice Test Exam Questions And Answers 1. A preschooler has a small laceration that requires 2 stitches. The nurse covers the wound with a bandage knowing that it will comfort the child to have it covered. What is the developmental reason for this intervention? 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. - correct 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. 2. 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 38.5 C (101.3F), HR 134, RR 32, BP 78/54 mm Hg, and ENPC 4th Edition: Practice Test Exam Questions And Answers Spo2 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. - correct 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 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. 3. 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 ENPC 4th Edition: Practice Test Exam Questions And Answers 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 - correct 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). 6. 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. ENPC 4th Edition: Practice Test Exam Questions And Answers 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). 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). - correct 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). 7. 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 ENPC 4th Edition: Practice Test Exam Questions And Answers 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 standard method of instillation of air and auscultation over the epigastrium for gurgling has been associated with improper placement and adverse outcomes. The use of pH testing had been demonstrated to be safer and has been adopted as policy - correct answer ✅B.) Test the pH of the gastric contents. 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. The use of pH testing had been demonstrated to be safer and has been adopted as policy in many institutions (p. 103). 8. What is the best method to rapidly administer a 20 mL/kg bolus of 0.9% normal saline to a pediatric patient weighing 8 kg? 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 ENPC 4th Edition: Practice Test Exam Questions And Answers 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 - correct 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). 11. 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. ENPC 4th Edition: Practice Test Exam Questions And Answers d. After meal. - correct answer ✅C.) In the morning. Rationale: The recommended time to obtain baseline peak flow readings is first thing in the morning before any administration of bronchodilator therapy (pp. 138, 140). 12. The nurse is planning to begin oral rehydration therapy for a 9- month-old with mild dehydration. She provides the caregivers with a glucose and sodium solution and instructs them to administer small amounts: a. Every 2 to 5 minutes Rationale: Oral rehydration should be attempted in those pediatric patients who can tolerate oral fluids with mild dehydration. Frequent (every 2 to 5 minutes), small sips of a commercially prepared glucose and sodium solution, such as Pedialyte or Infalyte, is the most successful method (p. 149). b. Every 10 to 12 minutes Rationale: Oral rehydration should be attempted in those pediatric patients who can tolerate oral fluids with mild dehydration. Frequent, small sips of a commercially prepared glucose and sodium solution, such as Pedialyte or Infalyte, is the most successful method (p. 149). c. Every 15 minutes ENPC 4th Edition: Practice Test Exam Questions And Answers Rationale: Oral rehydration should be attempted in those pediatric patien - correct answer ✅A.) Every 2 to 5 minutes. Rationale: Oral rehydration should be attempted in those pediatric patients who can tolerate oral fluids with mild dehydration. Frequent (every 2 to 5 minutes), small sips of a commercially prepared glucose and sodium solution, such as Pedialyte or Infalyte, is the most successful method (p. 149). 13. 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). ENPC 4th Edition: Practice Test Exam Questions And Answers b. A minor who is able to make decisions regarding his or her own sexual or mental health Rationale: In most jurisdictions, adolescents are allowed to make decisions regarding specific health services, including reproductive health, pregnancy-related care, sexual health, drug and alcohol treatment, and mental health (pp. 204-205). c. A minor who is able to make decisions regarding healthcare as a parent of his or her own child Rationale: A minor who is a parent is - correct answer ✅D.) A minor who lives with a parent or guardian but legally is able to make health decisions. Rationale: A mature minor remains in the care and supervision of his or her parent or guardian but has been granted legal permission to make independent health care decisions. The adolescent must be able to understand the risks and benefits of possible treatments. This definition may vary by state or jurisdiction. Know your own local legal definitions (p. 204). 16. Which of the following screening statements/questions is most appropriate in assessing an adolescent for dating violence? a. "What triggers for violence have you experienced from your partner?" Rationale: Asking about triggers for violence may be interpreted as the victim doing something to cause the violence and he or she may wish to ENPC 4th Edition: Practice Test Exam Questions And Answers defend the relationship. This is especially true if the partner has isolated himself or herself from friends and family or if the victim already feels shame or guilt (pp. 214-215). b. "Does your partner feel entitled to sex even if you say 'no'?" 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. - correct 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). 17. Which sign distinguishes compensated shock from decompensated shock in the pediatric patient? a. Peripheral pulses ENPC 4th Edition: Practice Test Exam Questions And Answers 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 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 - correct 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). 18. A 5-year-old arrives to the emergency department unconscious with a heart rate of 32 beats/minute, weak, thready pulses, and pale, ENPC 4th Edition: Practice Test Exam Questions And Answers 20. An ambulance arrives with a 13-year-old pedestrian hit by a car. Identified injuries reported by paramedics include multiple abrasions to the head and face, a large, actively bleeding laceration to the forehead, hip pain with the leg externally rotated, and bruising across the chest and abdomen. The patient is in full spinal immobilization and has two intravenous catheters and a nonrebreather oxygen mask in place. Vital signs are BP 110/70 mm Hg, HR 118 beats/minute, RR 24 breaths/minute, and SpO2 96%. The Glasgow coma scale score is 15. What is the priority? a. Computed tomography Rationale: Although CT scans are an important diagnostic tool and are indicated for this patient for the cervical spine, chest, and abdomen, this test would not be performed until the primary and secondary surveys are completed and any primary or secondary issues are addressed (p. 270). b. Immobilize the femur Rationale: A femur fractu - correct answer ✅C.) A pressure dressing to the forehead Rationale: Control of active external bleeding is a high priority in order to minimize further hemodynamic instability during the circulation assessment in the primary survey. Younger children can lose relatively large amounts of blood from scalp lacerations (p. 13). 21. A 15-year-old with a history of schizophrenia is taking risperidone (Risperdal) and lithium (Eskalith). She presents with dystonia, akinesia, ENPC 4th Edition: Practice Test Exam Questions And Answers a shuffling gait, muscle rigidity, and tremors. What does the nurse suspect is the cause of these signs and symptoms? a. Extrapyramidal symptoms Rationale: Extrapyramidal symptoms are an adverse effect caused by antipsychotic medications, including risperidone (Risperdal), aripiprazole (Abilify), quetiapine (Seroquel), olanzapine (Zyprexa), lithium (Eskalith), and valproate (Depakote). Extrapyramidal symptoms are characterized by akinesia, akathisia, dystonia, oculogyric crisis, pseudoparkinsonism or a shuffling gait, drooling, muscle rigidity, tremor, and rabbit syndrome (p. 324). b. Tardive dyskinesia Rationale: Tardive dyskinesia is an effect caused by antipsychotic medications, including risperidone (Risperdal), aripiprazole (Abilify), quetiapine (Seroquel), olanzapine - correct answer ✅A.) Extrapyramidal symptoms Rationale: Extrapyramidal symptoms are an adverse effect caused by antipsychotic medications, including risperidone (Risperdal), aripiprazole (Abilify), quetiapine (Seroquel), olanzapine (Zyprexa), lithium (Eskalith), and valproate (Depakote). Extrapyramidal symptoms are characterized by akinesia, akathisia, dystonia, oculogyric crisis, pseudoparkinsonism or a shuffling gait, drooling, muscle rigidity, tremor, and rabbit syndrome (p. 324). 22. Which of the following burn injury patterns and history indicates suspected child maltreatment? ENPC 4th Edition: Practice Test Exam Questions And Answers a. A 5-cm (2-inch) linear, superficial partial-thickness burn with irregular edges on the leg of a preschooler, reportedly from bumping into a curling iron left on a low table Rationale: Although inflicted injury should be considered in all pediatric burns, this is a plausible history for this burn in a child who is ambulatory. Burns from irons are particularly suspicious if they are deep and have sharp edges, such as would be seen with prolonged contact with the iron in a single position. The irregular edges are more likely to be associated with accidental injury (p. 351). b. A deep partial-thickness, sharply demarcated burn on the buttocks of a toddler, reportedly from the child turning on the hot water in the bath Rationale: Forced submersion in scalding water tends to produce burns that are deep and sharply demarca - correct answer ✅B.) A deep partial-thickness, sharply demarcated burn on the buttocks of a toddler, reportedly from the child turning on the hot water in the bath. Rationale: Forced submersion in scalding water tends to produce burns that are deep and sharply demarcated. There may also be areas that were spared from contact, such as skin folds, as the child was held down. Unintentional scald burns in toddlers falling or getting into a hot bath will have irregular edges and splash marks as they attempt to get out of the water (p. 351). 23. A mother presents to the emergency department with a 6-week-old infant with no medical issues after a normal delivery, until yesterday.