ENPC exam with 100% correct answers guaranteed pass A/2024/2025, Exams of Nursing

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A/2024/

1. Pediatric triangle: appearance work of breathing circulation to skin
2. General appearance considerations: Tone Interactiveness: drawn to sounds or people. Wants to play Consolability Look/ Gaze Speech/cr y
3. Work of breathing:: Increased work of breathing evidenced by tachypnea, stri- dor, grunting, retractions, accessory musles, nasal flaring, head bobbing, abnormal positioning
4. Circulation to Skin: Observe

palor mottling cyanosis

5. Sick, Sicker, Sickest: Sick: no disruption of any component of PAT but caregivers are concerned Sicker: one component of PAT is a concern Sickest 2+ concerns of PAT
6. 2 leading causes of altered mental status in kids: hypoxia hypoglycemia
7. Blood pressure norms: Hypotension: Less than 70 + (2 x age in years) Widening pulse pressure = increased ICP Narrowing pulse pressure = hypovolemic shock
8. Crying child: Vigorous = good weak = sick high-pitched = increased ICP "Fussiness" = red flag
9. Respiratory distress indicated by:: increased heart rate skin color changes

incrased work of breathing wheezing diaphoresis abnormal airwa sounds

10. Respiratory failure signs: fatigue and become lethargic hypoxia hypercarbia
11. General airway interventions: Allow child to stay in most comfortable position Give O2 to maintain it above 92% O2 does NOT measure ventilation
12. Croup: 1-3 days of nasal congestion and fever with sudden onset of barky cough Treatment: dexamethasone and nebulized epi Discharge Teaching: oral hydration, get child to cool air or steamy bathroom
13. Asthma interventions: albuterol, duo neb and oral steroid
14. Bronchiolitis/RSV: Assessment: 1-3 days nasal congestion fever, cough, res- piratory distress with wheezing and crackles. Dehydration and tachypnea interventions: nasla suctioning, fluids sever: heated, high flow nasal cannula O

Discharge: lasts 2-3 weeks; nasal suctioning; monitor hydration

15. treating hypoglycemia: obtain glucose for anyone who is not awake and alert treat kids with 2-4ml/kg of D25W
16. When to perform blood glucose test?: When the child is not awake and alert or AMS is suspected
17. Preventing Secondary brain injury in TBI: prevent hypotension and hypoxia
18. cuffed vs uncuffed tube: uncuffed= (age in years/4) + 4 cuffed= (age in years/4) + 3.
19. fluid bolus formula: infant: 10ml/kg kid: 20ml/kg
20. normal vitals: pg 52
21. blood glucose normal ages 5-11: 72-
22. Cardiac Assessment: Trend pulse and pulse pressure palapate upper and lower extremity pulses
23. symptoms of CHF: poor feeding, irritability, fatigue easily with rapid

resp rate, increased work of breathing Ass and Interventions similar to adults

24. Myocarditis Assessment and treatment: Assess: consider in anyone with re- cent viral infection; SOB and crackles; dysrhthmias; heart failure; syncope; elevated

liver enzymes Treat: diuretics; BP support; ECMO; transplant

25. Hypovolemic Shock: Tachycardia, tacypnea; AMS; slight increaes in diastolic pressure Intervention: Stop bleed; give fluids and RBC; balanced therapy; offer pedialyte if not NPO
26. Cardiogenic shock: Intervention: expert consult; supportive care to decrease O2 and metabolism demands; slow fluids; treat hpotension while decreasing after- load; vagal maneuver; vasopressors
27. Obstructive Shock: Assessment: Cardiac tamponade- muffled heart sounds and pulsluss paradoxus; tension pneumo- asymmetrical chest rise and fall Intervention: pericardiocentesis; needle thoracentesis; antigoagulation or surgical intervention; treat ductal dependent lesion
28. Anaphylactic Shock: remove pathogen fluids

epi

29. Neurogenic: spinal motion restriction vasopressors warming measures
30. Septic: Fluids antibiotics vasopressors
31. OLD CARTS: Onset Location Duration Characteristics Aggravating factors Relieving factors Treatment Severity
32. Pain Scale and appropriate ages of use: Numeric- 6- years Visual Analog: 5-

Faces: 4- FLACC- nonverbal

33. Evaluation of child maltreatment: ask open ended questions use direct quotes

34. Sex trafficing risk factors: limited education runaway/homeless/foster care hx of abuse livining poverty family dysfunction disability substance abuse LBGT low self-esteem, depression, social isolation
35. Human trafficang Assessment screening: hx: pt doesn;t have ID; doesn't know home address; vague hx of illness; person accompanying is unwilling to leave pt. persistent/untreated STI trauma to vagina/rectum jaw/neck pain hyper startle reflex

expensive items, clothing, hotel keys

36. Increased ICP triad: widening pulse pressure bradycardia bulging fontenel respiratory disress
37. Febrile seizure: Temp greater than 100.4 usually occurs after 24 hour onset if occurs after that 24 hr period consider meningitis give antipyretic to promote comfort and oral intake. Does not prevent seizures Avoid ice baths
38. Seizure Inteventions: turn pt on side provide safe environment check bedside glucose manage fever as a cause or a result if seizure lasts longer than 5 minutes consider benzos give antiboitcs for infection hyponatremia =3% sodium chloride

39. Seizure medication: 5 min: midazolam=intranasal, IM, IV 5-10 min: 2nd dose or phenytoin 15-30 min: phenobarbital, reassess airway, consider intubation

40. When should the parent cal 911 in for a seizing child?: child stops breathing parent cannot feel a pulse seizure lasts more tahn 5 minutes child has more than 1 seizure before fully awake
41. VP shunt issues assessment: changes in resp rate: apnea or irregular changes in BP: widening pulse pressure Changes in HR: bradycardia fever or signs of shock redness/edema
42. Hydrocephalus interventions: accurate head circumference for monitoring elevate HOB 30 degrees and maintian head allignment Give meds: anyipyretics, analgesic, antibiotics, meds to decrease ICP
43. Difference between stroke and bells palsy: Pt will be unable to raise an eyebrow or wrinkle the forehead on the affected size w/ bells palsy stroke usually only involves the lower face
44. Stroke interetnions: maintain

glucose control BP meds: aspirin; anticonvulsants; antigocagulants (embolism)

45. Symptoms of TBI (concusion) are organized into what four catagories?: - Thininking and remembering physical emotional/ mood sleep

46. Secondary impact syndrome: 2nd brain injury before the first one is healed. Brain cannot auto regulate CPP Causes massive brain edema and herniation
47. proper infnat/toddler head positioning with spinal percautions: place padding under shoulders of infant to achieve neutral alignment have parent directly above pt so pt is not turning head reverse trandeleburg to reduce anxiety
48. Neurogenic Shock: Injury above T6 results in bradycardia, hypotension, and vasodilation, thermoregulatory instability
49. Spinal shock: flaccid muscle tone below thei njury and decreased

sensation at and below the level of injury

50. kids who do not need a spine board: compliant child absence of distracting injury

absence of alcohol GCS 15 absence of spine tenderness/neurologic findings

51. Orbital fracture interventions: topical vasoconstrictor to stop bloody nose avoid blowing nose analgesic s ice elevate HOB
52. LeFort I: Edema of maxillary area lip laceraiton or fractured teeth edema maloccluiosn
53. Le Fort II: massive facisal edema nasal swelling with obvious fracture or deformity maloccluison CSF rhinorrhea
54. Lefort III: massive facial edema ecchymosis mobility and depression of zygomatic

bones diplopia from nerve entrapment ma,occluison CSF rhinorrhea

55. midface and nasal fracture interventions: maintain airway delay surgery until swelling decreases avoid straining bending over heavy lifting blowing nose sleep with head of bed elevated for 3 nights
56. mandibular fracture test: have pt bite down on tongue blade attempt to pull tongue blade out if pt unable to continuously bite down --> could indicate mandibular fracture
57. Hyphema interventiosn: pt on bed rest with HOB at 35- degrees cover eye with shield

steroids and tranexamic acid

58. Globe injuries: stabalize object with a shield assess for fluid leaks CT or MRI meds to prevent increase IOP --> prevent vomiting, agitation, pain, antibiotics
59. Gastroenteritis Assessment and Interventions: Assessment: increased fre- qency of loose, fould smelling stools, vomiting, fever/headache/malaise; ab cramp- ing Intervention: oral rehydration; 2-5ml of oral rehydration solution every 2-5 minutes; increase if tolerated. Goal 50-100mg/kg over 2-4 hrs; ANTIDIARRHEAL MEDS ARE NT REOMMENDED
60. colic baby comforting suggestions: 1. Swaddle 2.Side position for digestion (left) 3.sushing sounds 4.swinging 5.Sucking

61. Intussusception assessment and intervention: Assessment: colicky abdom- inal pain; child inconsolable; draws legs to chest; bomiting and ab distention with palpable sausage-shapped mass Intervention: air or contrast enema to diagnose and treat --> not with signs of shock;
62. Swallowing items: -batteries are ideally removed within 2 hours -X-ray/CT/US use to diagnose -keep child NPO
63. Esophageal Atresia/Tracheoesophageal fistula: Assess: resp distress; drool- ing, choking episodes; reccurent resp infection Post repiar: GErD; resp. illness, dysphagia; feeding issues diagnosis by trying to insert a OG tube
64. Rhabdomyolysis assessment and interventin: Classic triad: muscle pain, weakness, dark urine Peds: muscle pain, fever, and fivral prodrome usually caused by infection (under 9yo)

Diagnose: CK> Aggressive hydration; treat problem

65. hemolytic uremic syndrome Assessment: damage to kidenys so they can't filter usually form illness pallor/lethargy

hypertension diarrhea (bloody); N/V edema oliguria/anuria w/ hematuria and proteinuria low hemoglobin adn hematocrit levles elevated BUN and creatinine bruising, purpura AMS/seizures

66. HUS interventions: diagnosis made by triad of anemia, thrombocytopenia, and renal failure DONT give antibiotic IV hydration and electrolyte correction dialysis blood/platelet transfusion antihypertensives

67. Long bone fracture assessment: pain reluctance to use extremity deformity/shortening/rotation bony crepitus edema tenderness on palpation delayed cap refill, cool skin six Ps
68. long bone fracture intervention: extenal hemorrhage control monitor for fat emboli splint deformities -- use temp first pain managment immobilize injured extremity and joints above and below circulation is impaired = impaired alignment prepare for possible closed reduction
69. amputation interventions: use tourniquet for external hemorrhage if uncon- trolled by direct pressure

resus and stabilize consider splinting pain management antibiotic and tetnus

70. care for amputated limb: avoid excessive handling gently rinse with steril saline to remove dirt wrap in moist gauze and place in plastic bag place bag on ice
71. interventions for compartment syndrome: limb at level of heart loosen or remove any bandage or splints fasciotomy
72. septic arthritis assessment: 1 joint less than 3 mo: irritability, poor feeding, cellulitis, discomfort with diaper change, pseudoparalysis/fever older kids: fever/malaise/anorexia

swelling, tenderness, and warmth of the affected joints limp or refusal to bear wt and decreased ROM

73. Juvenile idiopathic arthritis assessment: fever spikes about same time each day transient rash for a few hors morning stiffness and after inactivity edematous joints hepatosplenomegaly anemia and elevated WBC count\pleural and pericardial effusions
74. juvenile idiopathic arthritis interventions: NSAIDs and steroid use psychological counseling academic counseling PT OT warm baths and heating pads
75. Interventions for frost bite: immediate rewarming over 15-30 minutes remove constricting, damp clothing and replace it with warm blankets avoid rubbing or causing frictin

blood blisters are left intact; fluid extracted from clear blisters splint affected part

76. Hair tournequet assessment and intervetion: crying w/out associated fever or appearance of some loca reaction by redness and swelling treat pain tpoical antibiotic if skin breakdown wound care to open areas observation for return of circulation
77. Burn intervetnions: Stop burning process- remove clots, jewelry, diapers; cover with dry sheet; cool burns with room0eimp water prevent exposure: done PPE; brush off as much powder as possible clean minor burns with soap and water wound care as indicated: leave blisters intact; pain meds before debridement fluid replacement: 3mlxkg/% burn; use LR