ENPC 6TH EDITION
LATEST 2024 EXAM (
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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? - ANSHypoglycemia (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? -
ANSComputed tomography (wrong)
Remediation feedback:
Manifestations of a lower airway foreign body include a choking incident with subsequent failure
to improve on antibiotics. Wheezing or decreased lung sounds in one area of the pulmonary
system is a high indicator for a foreign body along with signs of hypoxia such as cyanosis,
tachypnea, tachycardia, increased respiratory effort, agitation or lethargy, and elevated white
blood cell counts indicating an infectious process. 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? - ANSEstablishing 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? - ANSHumidified oxygen (wrong)
Remediation feedback:
Wheezing is most often identified with asthma in the pediatric population. 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? - ANSLumbar 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? - ANSHydromorphone
(wrong)
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? - ANSHave the
boyfriend leave the room during the pelvic exam.
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