ENPC EXAM 2024/ NEW EDITION 2024-2025 WITH
CORRECT DETAILED AND VERIFIED ANSWERS WITH
RATIONALES/ALREADY GRADED A+
A 14-year-old patient sustained a displaced fracture of the radius and ulna after
falling from a bicycle. Which of the following pain control interventions is most
likely to result in improvement in symptoms related to pain?
Applying a splint to the affected extremity
Rationale
Splinting is an effective non-pharmacologic intervention to reduce pain associated
with fractures. This will also help to minimize complications. Topical creams and
elevation ofthe extremity will not help with pain control. The application of ice in
an appropriate manner can help, but not warmth which would be contraindicated
in the early stages of the injury.
Assessment of the fontanelle provides the most useful information for which two
components of the primary survey?
Circulation and disability
Rationale
A sunken fontanelle is a red flag for circulation assessment in pediatric triage
and mayindicate dehydration . A bulging fontanel is a red flag for disability
assessment in pediatric triage and can indicate increased intracranial pressure.
A 6-month-old is seen for a recurrent respiratory infection. During the
assessment, the mother adds that the patient's stools seem to be fatty or
"greasy". Which of the following disease processes would be a primary concern
for this child?
Cystic fibrosis
,Rationale
In patients with cystic fibrosis, thick mucus inhibits the release of pancreatic
enzymes necessary for digestion. This results in impaired absorption and the
inability to utilize ingested fats. These fats are excreted in the stools and can
present as "fatty" or "greasy". Combined with the recurrent upper respiratory
infections for an infant, cystic fibrosis should be ruled out. The other three
disease processes frequently present withrespiratory issues but fatty stools
would not normally be seen.
A 4-day-old who is brought to the emergency department with the parental
complaint of "not acting right" is found to be hypoglycemic. What is the
appropriate glucose concentration to administer to this neonate?
Dextrose
10%
Rationale
Dextrose 10% is the preferred concentration for neonates with hypoglycemia to
protect their fragile vasculature while providing needed glucose. Dextrose 5% is
not used to treat hypoglycemia in children. Dextrose 25% is used for children
above the age of 5 years. Dextrose 50% is not recommended for use in pediatrics
unless it is diluted.
Which of the following indicates the need for additional caregiver education
regarding a urinary tract infection?
My child will grow out of their frequent urinary tract infections.
,Rationale
Urinary tract infections are not a normal occurrence in children and are not
something children will "grow out of." Additional investigation and follow-up are
needed when a child has frequent urinary tract infections. Drinking extra fluids
should be encouraged. Patients should always finish the complete course of
antibiotics to eliminate the infection. And follow-up should be done to make sure
the infection has been eliminated.
You need to draw blood from a 2-year-old. Which of the following is the best
approach for this patient?
Have them watch a cartoon on an I-pad or cell phone
Rationale
The best approach to a toddler who requires interventions is to provide
distractions whenever possible. They are in the cognitive development phase of
"sensorimotor/preoperational" so having the caregiver present is helpful. You
shouldmove from the least invasive to most invasive tasks, and don't let them
watch you prepare since it will increase anxiety.
The caregiver of a 2-month-old infant states the patient has had trouble breathing
for the past two days. Pediatric assessment triangle (PAT) reveals an age-
appropriate general appearance, rapid breathing with mild distress, and pink skin.
Mucous is noted in both nares. Which of the following is the best next step?
Suction nasal passages using a bulb syringe
Rationale
, Infants up to four months old are obligate nose breathers and can have
respiratory distress when nares are occluded. Mucous can be gently suctioned
using a bulb syringe or suction catheter. A good, thorough history should always
include immunization status for pediatric patients. The nose needs to be clear
before applying oxygen via nasal cannula. Respiratory assessment includes
interventions to improve breathing so you would not move to move to circulation
until that is accomplished.
An ambulance arrives with a 16-year-old male involved in a dirt bike crash who
was intubated prior to arrival. Which of the following is the priority assessment or
intervention?
Assess endotracheal tube placement
Rationale
If a patient arrives with an artificial airway (endotracheal tube or tracheostomy) in
place,assess its placement, patency, and the oral airway (in that order) before
moving to the next step of the primary survey. The oropharynx should be
checked for fluids or objects
such as broken teeth. Inserting a gastric tube in an intubated patient and starting a
second large caliber IV line should also be done, but they don't take priority over
airway.
Which of the following patients should be evaluated first?
An 18-month-old with bilious emesis
Rationale
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