ENPC Test Questions 6th Edition with correct Answers., Exams of Medicine

Download ENPC Test Questions 6th Edition with correct Answers. and more Exams Medicine in PDF only on Docsity! ENPC Test Questions 6th Edition with correct Answers. An unresponsive 2-year-old child was found by his mother with a bottle labeled "Elavil 50 mg" by his side. Which piece of information is important to obtain from his mother? A. The size of the medication bottle. B. The expiration date of the medication. C. The number of pills left in the bottle. D. The person for whom the medication was prescribe. - Correct Answer C. The number of pills left in the bottle. A nurse providing crisis intervention to the family of a seriously ill child can best keep the family informed of the child's condition by: A. Placing them in a secluded room. B. Referring to their child as "the patient". C. Telling the family how they should feel. D. Appointing one staff member to communicate with them. - Correct Answer D. Appointing one staff member to communicate with them. A 16-month-old child was an unrestrained front seat passenger in a motor vehicle crash. The chest x-ray reveals multiple rib fractures. These findings suggest what type of injury? A. Minor surface injury. B. Significant underlying injury. C. Significant surface injury. D. Minor underlying injury. - Correct Answer B. Significant underlying injury. Which piece of information is most important to know prior to transferring a patient to another facility? A. Documentation of the family's health insurance coverage. B. Pertinent family health history. C. Confirmation of acceptance from the receiving hospital. D. Confirmation of a medical diagnosis. - Correct Answer C. Confirmation of acceptance from the receiving hospital. A 10-year-old child who was struck by a car has a distended, tense abdomen. The child's heart rate is 144 beats/minute, respirations 24 breaths/minute, and blood pressure 120/80 mm Hg. Capillary refill is more than 3 seconds, and skin is pale and cool. The patient's signs and symptoms suggest: A. Obstructive shock. B. Distributive shock. C. Hypovolemic shock. D. Cardiogenic shock. - Correct Answer C. Hypovolemic shock. A school-aged child is about to receive stitches. To evaluate his understanding of the procedure, you tell him: A. "Young people your age have questions about getting stitches. What are your questions?" B. "Don't cry while you are getting the stitches. Be brave like a man." C. "You will probably receive 10 stitches. Do you have any questions before we restrain you?" D. "Does your cut hurt? Would you like your mommy to hold you?" - Correct Answer A. "Young people your age have questions about getting stitches. What are your questions?" What is the preferred sit for intraosseous access in the infant? A. Lateral malleolus B. Iliac crest C. Proximal femur D. Anteromedial tibia - Correct Answer D. Anteromedial tibia An important consideration in the assessment of pain for an adolescent patient is that they: A. May deny or minimize their pain when friends visit for fear of losing control. B. Have difficulty localizing or describing the pain. C. Are unable to use the 1 to 10 scale to report their pain. D. Feel that the pain is a punishment for something they did wrong. - Correct Answer A. May deny or minimize their pain when friends visit for fear of losing control. An 8-month-old infant with pneumonia has severe intercostal and substernal retractions, weak muscle tone, lethargy, and gray skin color. B. Offer the infant a pacifier. C. Return when the infant is consoled. D. Ignore the infant's behavior. - Correct Answer B. Offer the infant a pacifier. During an intubation attempt, the child�s heart rate drops to 40 beats/minute. Which intervention is indicated? A. Ask the physician to stop the intubation attempt and perform bag-mask ventilation. B. Apply cricoid pressure and establish intravenous access. C. Inform the physician of the heart rate and ask the physician to intubate faster. D. Administer blow-by oxygen and begin chest compressions. - Correct Answer A. Ask the physician to stop the intubation attempt and perform bag-mask ventilation. A 6- week-old infant is pale, has marked substernal retractions, expiratory grunting, and poor muscle tone. The emergency nurse should first: A. Obtain intravenous access. B. Apply a pulse oximeter. C. Prepare a chest x-ray. D. Administer 100% oxygen. - Correct Answer D. Administer 100% oxygen. The best method to open the airway in an injured child is: A. Placing the head and neck in hyperextension. B. Using the jaw thrust maneuver. C. Placing the head and neck in flexion. D. Using the head tilt maneuver. - Correct Answer B. Using the jaw thrust maneuver. A 4-year-old child with a history of the flu has a heart rate of 80 beats/minute, respirations of 16 breaths/minute, and capillary refill of more than 3 seconds. The proper sequence for nursing interventions would be: A. Position the airway, administer 100% oxygen, obtain venous access, and administer 20 ml/kg of an isotonic solution. B. Administer 100% oxygen, obtain venous access, administer 0. 1 mg/kg of epinephrine 1:10,000, and prepare for endotracheal intubation. C. Position the airway, provide bag-mask ventilation, provide synchronized cardioversion, and provide supplemental warmth. D. Administer 100% oxygen, prepare for a venous cutdown, administer 20 ml/kg of an isotonic solution, and obtain a chest x-ray. - Correct Answer A. Position the airway, administer 100% oxygen, obtain venous access, and administer 20 ml/kg of an isotonic solution. A 3-year-old is transported by prehospital personnel after being struck by a car. The parents are en route. The child is screaming and uncooperative. Which is the best approach while conducting the secondary survey? A. Hold the child to comfort him. B. Wait for the parent's arrival. C. Observe for behavioral pain cues. D. Use a doll to demonstrate the examination. - Correct Answer C. Observe for behavioral pain cues. Which ocular finding is associated with child maltreatment? A. Glaucoma. B. Conjunctivitis. C. Iritis. D. Retinal hemorrhage. - Correct Answer Retinal hemorrhage. A pregnant 18-year-old woman arrives at the emergency department about ready to deliver a full-term infant. She states that she noticed a large amount of dark green fluid the last time she went to the bathroom. During the delivery, the nurse should prepare to: A. Dry and arm the infant as soon as is it delivered. B. Stimulate and ventilate the infant immediately after delivery. C. Suction the mouth and nose of the infant while on the perineum. D. Administer blow-by oxygen and rub the back immediately after delivery. - Correct Answer Suction the mouth and nose of the infant while on the perineum 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? - Correct Answer Low pH level A teenager presents to the ED for evaluation of pain with deep inspiration. The pain was a sudden onset after running track at school. While obtaining the history, the patient states that they have Marfan Syndrome. What would be a priority triage question based on this information? - Correct Answer "Have you ever had a pneumothorax?" 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? - Correct Answer Lumbar puncture 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? - Correct Answer Osteogenesis imperfecta Which of the following is considered a "red flag" when triaging a pediatric patient? - Correct Answer A 3-week-old with a temperature of 38.2°C (100.7°F) A 4-year-old patient is being assessed for a foreign body in the nose. The child is awake and alert and watching a video on the caregivers phone. Vitals include HR of 110 beats/minute, RR of 26 breaths per minute, BP of 138/90 mm Hg, and T of 37.3oC (99.3oF) orally. Which of the following interventions should the nurse perform next? - Correct Answer The normal systolic blood pressure for a 4 year old is between 89-112 mm Hg. The other vitals are within normal limits for that age. When the clinical picture of the patient does not match the vitals, check to make sure you are using the correctly sized equipment first. A blood pressure cuff that is too small will give a reading that is higher than it actually is. 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? - Correct Answer Providing frequent updates and re-educating them on the care that is being provided Caregivers state an 18-month-old child had a harsh, barky cough, low- grade fever, and irritability throughout the night. On assessment this salivating, with excess tearing. Which of the following is the priority intervention? - Correct Answer Removal of clothing and decontamination The nurse is triaging an infant brought to the emergency department by their caregiver. Which finding by the nurse leads the infant to be placed in isolation? - Correct Answer Purpuric rash A 5-year-old patient presents with severe dehydration and signs of shock due to viral gastroenteritis. Which of the following physiologic responses by this patient will have the greatest impact on improving their cardiac output? - Correct Answer Pediatric patients have strong compensatory mechanisms that attempt to counteract the cardiovascular effects of hypovolemic shock. In children, the heart rate increases to increase preload and cardiac output. Systemic vasoconstriction from epinephrine and norepinephrine release increases afterload. A 3-year-old has a two-day history of runny nose, low-grade fever, and a "barky" cough at night. The child is awake and alert with noted stridor. Pulse oximetry is 96% on room air. Which of the following interventions would be the most appropriated for this child? - Correct Answer Administration of nebulized epinephrine A 15-year-old presents alone requesting care. Which of the following chief complaints would most likely be considered legal or appropriate to treat without parental consent? - Correct Answer Local and state laws must be followed but generally speaking, pregnancy issues can be treated without parental consent if the minor refuses contact with their family. Other issues that may be treated without parental consent include contraceptive needs, mental health issues, prenatal care, sexually transmitted diseases, and substance use request for help. Minors may be considered "emancipated" if they are living on their own, pregnant or already a parent, in the military, or married. Laws vary and must be followed in each locale. A 5-year-old presents with sudden onset nausea, vomiting, abdominal cramping, hives, and hypotension after eating lunch. Which of the following is the priority intervention? - Correct Answer Intramuscular epinephrine A 3-year-old child who was found in a pool unresponsive has return of spontaneous circulation (ROSC) after prolonged resuscitation. Intubation was performed in the field. Upon arrival to the ED, which intervention is of highest priority? - Correct Answer Auscultate breath sounds over the epigastrium and lung fields. You are discharging a patient home who has a history of depression. Discharge teaching should include which of the following? - Correct Answer Ensuring all firearms in the home are locked up with no access available by the patient. A 12-year-old restrained, back -seat passenger involved in a motor vehicle crash is noted to have hypotension, tachycardia, and contusions and discoloration across the lap area. On exam a splenic rupture is suspected. Which of the following diagnoses should be suspected as a companion injury with these findings and associated mechanism of injury? - Correct Answer A Chance fracture (fracture of the lumbar spine) is often associated with belted passengers. Injuries associated with the "seatbelt sign" are small bowel, abdominal vasculature, ureteral, and splenic and liver injuries. A 12-year-old complains of a severe headache for the past 8 hours. Which of the following past history disease processes would be considered a "red flag" and warrant immediate evaluation for this patient? - Correct Answer Sickle cell disease A school-aged child arrives in the emergency department with a 2-day history of vomiting. The child is cool and pale, with weak pulses, elevated heart rate, and capillary refill of 4 to 5 seconds. Which of the following is the priority intervention for the child? - Correct Answer Initiate a fluid bolus During your primary assessment of a 3-year-old, the child is pale, with a respiratory rate of 70 breaths/minute, costal retractions, poor air movement, and a pulse oximetry reading of 89%. What is the priority intervention for this patient? - Correct Answer Administer oxygen per protocol A 5-year-old child presents with hives, swelling of the lips and face, and stridor that developed about an hour after eating lunch. The child has no known allergies. Which of the following is the priority intervention? - Correct Answer Administer intramuscular epinephrine 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? - Correct Answer Enema with air Which of the following is a family-centered care concept ? - Correct Answer Cultural backgrounds are assessed and incorporated into the plan of care. Which of the following parameters would indicate that appropriate post resuscitation interventions were successfully carried out in the pediatric patient? - Correct Answer Pulse oximetry reading of 96% A 5-year-old presents with decreased level of consciousness and a wide complex and rapid rate on the electrocardiogram. Which of the following characteristics would indicate ventricular tachycardia as opposed to other tachydysrhythmias? - Correct Answer Heart rate between 120 to 200 beats/minute A child with bipolar disorder is brought to the emergency department for increasing irritability, agitation, pressured speech, and a decreased need for sleep. What should be included in the plan of care for this child? - Correct Answer Performing a suicide risk assessment Which of the following is the priority intervention for the nurse caring for an immunocompromised pediatric patient with a fever? - Correct Answer Placement in a negative pressure room A parent brings in a 4-month-old infant reporting seizure-like activity at home. The parent denies a fever and reports that the infant is otherwise healthy. Which of the following is most important for the nurse to inquire about? - Correct Answer The ratio of formula to water used when mixing a bottle A 6-year-old involved in a boating crash is awaiting admission for surgical repair of a fractured ankle. Which of the following manifestations during reassessments would cause the greatest concern for possible intra- abdominal trauma? - Correct Answer Diagnosis of intra-abdominal injury in a child can be challenging. Distracting injuries, pain, and anxiety can alter their ability to assist in pinpointing these types of injuries post-trauma. appropriate measures were taken in treating this child? - Correct Answer Temperature 37.7°C (99.9°F) During a diaper change on a 4-month-old infant, the nurse measures the infant's urinary output. After subtracting the weight of a dry diaper, the wet diaper weighs 22 grams. What is the infant's estimated urinary output? - Correct Answer 22 mL Which patient reflects an EMTALA compliant transfer? - Correct Answer A post-ictal patient with status epilepticus being transferred to a higher level of care with an accepting physician. All records are copied. A child presents with a history of poor oral intake. The patient is pale, lethargic, and has shallow, rapid respirations. Central pulses are weak and capillary refill time is four seconds. Which of the following interventions has the highest priority? - Correct Answer Initiate an intravenous fluid bolus A child was found unresponsive under the monkey bars during recess and arrives with the following assessment: eyes open only with supraorbital pressure stimulus, no verbal response is elicited, and withdraws arms and legs when a swab is inserted in the nose. Which of the following is the priority intervention for this child? - Correct Answer Prepare for immediate intubation Which of the following pathologic processes would most likely be attributed to a primary diagnosis of cystic fibrosis? - Correct Answer Constipation 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? - Correct Answer Administer intranasal midazolam A 4-week-old infant born prematurely is brought to the emergency department due to the rapid onset of abdominal distention, vomiting, bloody stools, and exhibiting signs of shock. Based on these findings, what condition should the nurse suspect? - Correct Answer Necrotizing enterocolitis 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? - Correct Answer LET (lidocaine/epinephrine/tetracaine) EMS is transporting a 12-year-old restrained passenger involved in a high- speed motor vehicle collision. The patient complains of increasing dyspnea. Breath sounds are clear and equal, and heart sounds are difficult to auscultate. Vitals include HR 132 beats/minute, RR 36 breaths/minute, and BP 80/55 mm Hg. Which of the following is the priority intervention? - Correct Answer Pericardiocentesis What is the first step in the care of the newly born infant? - Correct Answer Warm, dry, and stimulate Which of the following is the highest priority intervention for a well- appearing 2-month-old with a fever? - Correct Answer Urine culture 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? - Correct Answer Establishing a secure airway A 5-year-old arrives in the ED with a 4 day history of vomiting. Vital signs: HR 136 beats/minute, RR 36 breaths/minute, BP 92/56 mm Hg, T 38oC (100.4oF), and pulse oximetry 93% on room air. The child is pale with warm, dry skin and a capillary refill of 3 seconds. A fluid bolus is completed. Which of the following reassessment findings indicate that a second fluid bolus is necessary? - Correct Answer Blood pressure of 92/78 mm Hg A 14-year-old patient presents to the emergency department with her aunt after being assaulted. The patient has multiple bruises inconsistent with the assault history and seems guarded with her answers. A urine test is positive for pregnancy, although the patient denies being sexually active. The aunt repeatedly asks when they will be discharged. The ED nurse recognizes these finding as red flags for which of the following? - Correct Answer Sex trafficking 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? - Correct Answer Have the boyfriend leave the room during the pelvic exam. Which of the following is the recommended method of insulin administration for a pediatric patient with diabetic ketoacidosis? - Correct Answer Insulin infusion When taking vital signs on a stable infant, which of the following should be done first? - Correct Answer Respiratory rate A 12-year-old female patient arrives awake and alert with an acute onset of abdominal pain on the right side, nausea, vomiting, and vaginal spotting. On palpation, the pain is localized to the right side and there is tenderness to the breasts. Which of the following laboratory tests is the priority for this patient? - Correct Answer Human chorionic gonadotropin 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? - Correct Answer Intraosseous in the patient's medial tibia. When caring for a potential crime victim, what evidence collection principle is imperative? - Correct Answer Clothing should not be placed on the floor in order to prevent contamination. A nurse begins making multiple errors in clinical decisions regarding the care of patients in the pediatric emergency department. The nurse has worked many consecutive shifts caring for severely ill and injured children and mentioned to a co-worker that they are not sleeping and feel anxious about coming to work. What condition may this nurse be experiencing? - Correct Answer Vicarious traumatization or secondary traumatic stress (STS) can result from repeated exposure to traumatized or suffering patients without always knowing the outcomes. The fast-paced ED often requires the team to continue caring for patients without stopping to discuss a traumatic event. A 12-year-old is being prepped for surgical intervention of acute appendicitis. Which of the following intravenous medication orders should the nurse question? - Correct Answer Ketorolac A 13-year-old is experiencing a sudden onset of testicular pain, swelling, and vomiting. The cremasteric reflex is absent. Which of the following diagnoses is of highest suspicion in this situation? - Correct Answer Testicular torsion A child recovering from procedural sedation is sleeping deeply and snoring loudly. The pulse oximetry reading is 92% without supplemental oxygen. Which of the following interventions would be the priority for this patient? - Correct Answer Reposition the airway A 10-year-old playing baseball is hit in the chest with a ball. He immediately demonstrates loss of consciousness with no pulses. Which of the following is the priority intervention? - Correct Answer Utilize AED/defibrillator A 2-year-old child is seen with acute respiratory distress after playing alone. Caregiver statements indicate the child was found playing with irregular, ½ - ¾ inch sized pieces of a game. Which of the following assessment findings would most likely be expected for this situation? - Correct Answer Inspiratory stridor and coughing Which of the following physiological changes in an infant increase the chances of drowning? - Correct Answer Weak neck muscles The triage nurse is assessing a 14 year old male who was brought in by ambulance. The patient reports he was playing his video games at home when he had a sudden onset of groin pain that was so severe he became nauseated and vomited. Further assessment reveals a swollen scrotum. What is the priority intervention for this patient? - Correct Answer Preparing the patient for ultrasound An alteration in a child's interaction with their environment (appearance) can indicate a significant underlying problem. Which of the following mnemonics is most helpful in assessing the appearance of a child when applying the PAT? - Correct Answer TICLS A 3 year-old patient presents following frequent emesis and diarrhea over the past 12 hours. Which of the following assessment findings indicate that the patient' body is compensating for the fluid loss? - Correct Answer Increased diastolic blood pressure 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? - Correct Answer Low pH level