ENPC 5th edition Update

ENPC 5th edition Update Ask about any new bed-wetting or sleep disturbances Pediatric patients with anxiety and PTSD may present with physical complaints. Assess for other behavioral symptoms to facilitate appropr ...

ENPC 5th edition Update Ask about any new bed-wetting or sleep disturbances Pediatric patients with anxiety and PTSD may present with physical complaints. Assess for other behavioral symptoms to facilitate appropriate care and follow-up. Correct Answer: A 5 year-old with no health problems presents to the Emergency Department with a sudden onset of chest pain and shortness of breath. Parents state that the family was involved in a bad car crash one week ago. A thorough assessment and workup has not revealed any abnormalities. Which of the following steps is the best next step to take? Ensuring all firearms in the home are locked in a safe place with no access by the patient. Promoting injury prevention with caregivers of patients with a history of depression or suicidal ideation by encouraging that all firearms and medications are under lock to prevent overdoses or suicide attempt. Correct Answer: You are discharging a patient to home with a history of depression. Discharge teaching should include which of the following? Obtain vascular access for rapid fluid administration Rapid vascular access and fluid administration are the priority interventions. Correct Answer: A 2-year old has uniformly demarcated burns to bilateral lower extremities, approximately 30% of the childs total body surface area. The father states he briefly left the room while the child was in the bath and the child apparently played with the faucet. Which of the following interventions has the highest priority? Draw and send a metabolic panel and venous blood gas, administer a fluid bolus, and obtain a point of care glucose Electrolyte imbalances need to be identified and treated to prevent another seizure. Correct Answer: A 7-year-old arrives via ambulance. The patient's mother reports witnessing a seizure at home. The patient has no seizure history. Upon examination, the patient is post-ictal with a heart rate of 142 beats per minute, respiratory rate of 36 breaths per minute, and blood pressure of 86/72 mm Hg. Significant burns are noted to the patient's back and lower extremities. The mother states the burns accidentally occurred 3 days ago, but she was afraid to bring patient in due to an ongoing child welfare investigation. Which of the following are the MOST appropriate immediate interventions? ventilation to address hypoxia is the priority intervention. Correct Answer: What is the priority intervention for symptomatic bradycardia in a four-year-old child? Commotio cordis Comotio Cordis "occurs when chest is struck during the refractory period of the cardiac conduction cycle. This type of injury usually occurs in recreational sports such as baseball or ice hockey." Correct Answer: A 14-year-old high school student who was pitching for his baseball team was hit in the chest by the ball and had a sudden cardiac arrest. Of the following, which is the most likely cause of the cardiac arrest? Focused Assessment: Vital Signs: "As the patient compensates for altered tissue perfusion, the pulse pressure narrows and the heart rate increases" - (need to rewrite either the question or the answers) Widening Pulse pressure - not correct (suppose to be narrow pulse pressure) Bradycardia - not correct Decreasing diastolic blood pressure - late sign Weak peripheral pulses - late sign Correct Answer: A 5-year-old child presents to the emergency department after being hit by a car. She complains of left upper quadrant pain and the focused assessment with sonography for trauma (FAST) exam shows fluid around her spleen. Which of the following findings would be an early indication of ongoing blood loss? Increasing heart rate Pathophysiology: Cardiac Output. In pediatric patients, cardiac out is primarily regulate by increasing heart rate Correct Answer: A 5-year-old patient presents to the emergency department with severe dehydration due to viral gastroenteritis. He has signs of shock due to his hypovolemia. Which of the following physiologic responses to shock has the greatest impact on improving cardiac output in the pediatric patient? Bruising to the left ear of a newborn from sleeping on his side Pg 10- Any bruises in a non exploratory location (especially torso ears, neck) in children younger than 4 Pg 11Any bruising in a child younger than 4 months. Correct Answer: Which of the following patient presentations should increase suspicion of potential child maltreatment? Fifth Disease at 6 months There is an animal vaccine, but not a human vaccine for Fifth Disease. Correct Answer: All of the vaccine administrations listed are appropriate EXCEPT for which of the following? My child can go to daycare since they have been off of Tylenol and fever free for 24 hours. Yes, the patient needs to be afebrile WITHOUT the use of antipyretics to be able to go back to daycare or school. Correct Answer: Which of the following statements indicates the caregiver understands your discharge teaching on influenza? Dedicate a healthcare team member with a qualified interpreter to be with the family during the procedure. Providing the option for family presence with an assigned team member to facilitate communication is most supportive of the family in this situation. Correct Answer: The neurosurgeon has decided to perform an invasive procedure in the emergency department to monitor the intracranial pressure on a 5-year-old patient. The family does not speak English and has identified their religion as Muslim. Which of the following interventions is most supportive of the family? Rubeola On presentation the child starts with cough, nasal inflammation (coryza) and a non-purulent conjunctivitis. After 2-4 days a rash begins as erythematous macules and papules on the face that spreads to the torso and extremities. Correct Answer: A 6 year-old child presents to the emergency department with caregivers who report a cough with nasal congestion and pink-eye that started 2 days ago. They have been treating with an over-the-counter medicine without relief. Today they noticed a raised red rash on the face and papules in the mouth. You suspect which of the following? removal of clothing and decontamination Decontamination of nerve agents requires removal of clothing and flushing the skin with copious amounts of soap and water Correct Answer: A fertilizer silo exploded during a school tour of a working farm. The children are able to manage their own secretions but are all incontinent and salivating with excess tearing. Which of the following is the priority intervention? Succinylcholine Succinylcholine may increase intraocular pressure and should be avoided. Correct Answer: The emergency nurse is caring for a patient with significant facial trauma and a suspected globe rupture. Which of the following medication orders would the nurse question? Copious eye irrigation with an isotonic solution Normal saline or Ringer's lactate solution are both acceptable for irrigation. Irrigate until the pH of the eye returns to normal. The pH of Ringer's lactate is closer to that of human tears and may be more comfortable than normal saline. Correct Answer: A toddler has a chemical eye injury. Which of the following is the priority intervention? (Do not pick acetaminophen) Correct Answer: Which of the following medications is appropriate for treating the fever of a four-year-old with scleral jaundice and elevated aspartate transaminase (AST)? Food allergy These findings are typical of a food allergy. Because allergic reactions are so variable and do not always include classic manifestations, anticipate that any food-induced allergic reaction may unexpectedly progress to life-threatening anaphylaxis. Correct Answer: The parents of a 5-year-old child arrive at the emergency department. The child's lips and face are swollen with hives on the face. The parents report the child ate peanut butter crackers in the last hour. The child has no known allergies. The nurse recognizes the findings are associated with: