ENPC Test Questions ENPC Test Questions, Exams of Nursing

Download ENPC Test Questions ENPC Test Questions and more Exams Nursing in PDF only on Docsity! ENPC Questions Components in the prioritization of pediatric emergency care (4) - PAT, Focused Assessment (objective information), Focused pediatric Hx(subjective information), assignment of an acuity rating decision Pediatric Assessment Triangle : (3) components - Appearance. Work of Breathing. Circulation to the skin. This forms the "general impression". If there is an acute disruption in 1 component, child is "sicker". If there is an acute disruption in 2+ components the child is "sickest" Pediatric Assessment Triangle : Appearance - Most important. Reflects adequacy of ventilation, oxygenation, brain perfusion, and central nervous system function. Assess for : tone, interactiveness, consolability, look/gaze, and speech/cry. Pediatric Assessment Triangle : Work of Breathing - Breathing easy, even, and unlabored or tripod position, nasal flaring, retractions, supraclavicular retractions Pediatric Assessment Triangle : Circulation to the skin - Mottling or PWD PQRST for Pain - (pg86) Precipitating and palliating factors Quality Radiation Severity, symptoms, and site Time or triggering factors Verbal Report for pain - (pg86) Self-report is the most reliable indicatior of pain; however not all pediatric pt are capable or wiling to verbalize their discomfort. What age is the respiratory system considered fully developed? - 8 years old Most ______ age __to____, are concrete thinkers and interpret words literally. Where as, most _____ age ___ to ___, are magical and illogical thinkers. They often confuse coincidence with causation, and have difficulty distinguising fantasy from reality. - (pg36) Most Toddlers age 1yo to 3yo , are concrete thinkers and interpret words literally. Where as, most Preschoolers age 3yo to 5yo, are magical and illogical thinkers. They often confuse coincidence with causation, and have difficulty distinguising fantasy from reality. Hypotension related to hypovolemia in pediatric trauma patients is a _____ sign and may indicate a loss of ___% to ___% of their circulating blood volume. - (pg262) Late sign. 20% to 25% of circulating blood volume 6P's Assessment for Musculoskeletal Trauma - (pg 283) Pallor : color different from uninjured Pain Pulselessness Parasthesia Child = 70 + (2 x age in yrs) All critically ill patients require _____ level - glucose due to low glycogen stores Altered Mental Status is considered ______ until proven otherwise - decreased cerebral perfusion Decompensated shock in children #1 sign - Hypotension Best place for an IV - Hand(ask if there is a certain side thumb they suck) Scalp if less than 9months. Not in feet if they walk. Tension Pneumothorax Tx - Needle chest decompression 2nd ICS MCL TBI considerations - MD has to say when they can return, not the pt or caregiver. Should be a "gradual return to play" Cardiopulmonary Arrest usually from (2) - Shock Respiratory Distress Bradycardia pharm treatment - Epinephrine (1:10,000), 0.01mg/kg every 3-5min Jump START triage : colors and designation - Determined by ability to ambulate, respirations, perfusion, and mental status. Black (dead or unsalvageable) Red (immediate care) Yellow (delayed care) Green (minor or ambulatory) Jump START triage : breathing - not breathing -> position upper airway, now breathing = red(immediate) -5 rescue breaths wo breathing, no pulse = black(deceased) Jump START triage : Respiratory rate - <15 or >45 = immediate (red) Jump START triage : Pulse - If breathing with resp rate 15-45. No pulse = immediate (red) Jump START triage : AVPU - If breathing, resp rate 15-45, with palpable pulse. AVPU P(inappropriate), posturing or unresponsive = immediate(red) A,V, P(appropriate) = delayed(yellow) A preschooler has a small laceration that required 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 - A 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 (101.3 °F), HR 134, RR 32, BP 78/54 mm Hg, and 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 - 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 B. Sick C. Sicker D. Sickest - The pediatric prioritization process components include the focused assessment, focused history, acuity rating decision and: A. the pediatric assessment triangle (PAT). B. developmental characteristics. C. head-to-toe assessment. 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 B. Every 10 to 12 minutes C. Every 15 minutes D. Every 30 minutes - 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 B. Volvulus C. Gastroenteritis D. Pyloric stenosis - A neonate is delivered in the emergency department and placed on a radiant warmer. There is no staining of the amniotic fluid. What is the first step in neonatal resuscitation? A. Dry and warm the neonate B. Suction the mouth and nose C. Assess for effective breathing D. Palpate a central pulse rate - In discussing the legal care of the adolescent patient, what is a mature minor? A. A minor who lives independently and is legally able to make health decisions B. A minor who is able to make decisions regarding his or her own sexual or mental health C. A minor who is able to make decisions regarding health care as a parent of his or her own child D. A minor who lives with a parent or guardian but legally is able to make health decisions - Which of the following screening statements/questions is most appropriate in assessing an adolescent for dating violence? A. "What triggers violence you've experienced from your partner?" B. "Does your partner feel entitled to sex even if you say 'no'?" C. "Tell me about a time when you've felt unsafe in your relationship." D. "Do you feel if you tried harder to please, your partner will not become violent?" - Which sign distinguishes compensated shock from decompensated shock in the pediatric patient? A. Peripheral pulses B. Blood pressure C. Capillary refill D. Level of consciousness - A 5-year-old arrives to the emergency department unconscious with a heart rate of 32 beats/minute, weak, thready pulses, and pale, mottled skin. The team has begun bag-mask ventilation with 100% oxygen and chest compressions with no improvement in the heart rate. An intraosseous line is in place. Which of the following interventions is the priority? A. Administration of atropine B. Transcutaneous pacing C. Administration of epinephrine D. Attempt vagal stimulation - A 9-month-old infant pulled himself up onto the hearth of a fireplace. While doing so, he fell forward onto the hot glass doors and sustained deep partial thickness burns to the bilateral palmar aspects of both hands. What is the approximate percentage of total body surface area burned? A. 1% B. 2% C. 4% D. 5% - 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 B. Immobilize the femur C. A pressure dressing to the forehead D. Focused assessment with sonography for trauma (FAST) - A 15-year-old with a history of schizophrenia is taking risperidone (Risperdal) and lithium (Eskalith). She presents with dystonia, akinesia, a shuffling gait, muscle rigidity, and tremors. What does the nurse suspect is the cause of these signs and symptoms? A. Extrapyramidal symptoms B. Tardive dyskinesia C. Neuroleptic malignant syndrome D. Serotonin syndrome - Which of the following burn injury patterns and history indicates suspected child maltreatment? 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. - 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. - 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?" - 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 - 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. - 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. The infant's condition does not improve after bag-mask ventilation. The next step in treatment is most likely to be: A. Administration of epinephrine. B. Supplemental warming measures. C. Rapid sequence intubation. D. Administration of albuterol. - C. Rapid sequence intubation. Which combination of medications is best to have prepared for a pediatric resuscitation? A. Dopamine and sodium bicarbonate. B. Epinephrine and glucose. C. Naloxone and lidocaine. D. Pentothal and vecuronium. - B. Epinephrine and glucose. A 20-day-old infant has a 1-week history of not eating well. The infant has a weak cry and is jittery. Which laboratory test is indicated? A. Arterial blood gas. B. Finger-stick glucose. C. Complete blood count with differential. D. Toxicology screen. - B. Finger-stick glucose. Which intervention should be performed next if tactile stimulation, positioning, drying, and blow-by oxygen administration do not increase a newborn's heart rate? A. Chest compressions. B. Umbilical vein cannulation. C. Endotracheal intubation. D. Bag-mask ventilation. - D. Bag-mask ventilation. A 10-kg child has deep partial-thickness burns over 35% of the total body surface area. Which evaluation parameter indicates that fluid resuscitation is adequate? A. Heart rate of 160 beats/minute. B. Respiratory rate of 34 breaths/minute. C. Blood pressure of 80/60 mm Hg. D. Urine output of 11 ml/hour. - D. Urine output of 11 ml/hour. A 7-year-old female sustains a minor head injury and did not lose consciousness. She does not respond to commands and groans in response to questions. Which action will quickly determine if her behavior indicates a serious head injury? A. Review her medical record for pre-existing developmental problems. B. Obtain a head computerized tomography scan. C. Conduct a developmental screening test. D. Ask the parents if her behavior is unusual. - D. Ask the parents if her behavior is unusual. 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. - 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. - C. Observe for behavioral pain cues. Which ocular finding is associated with child maltreatment? A. Glaucoma. B. Conjunctivitis. C. Iritis. D. Retinal hemorrhage. - D. 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. - C. Suction the mouth and nose of the infant while on the perineum.