Emergency Nursing Pediatric Course (ENPC) 2026 Provider Practice Exam – Comprehensive 6th Edition Study Guide for Success!

When evaluating a child with a fractured ankle, the presence of constant left shoulder pain can be indicative of potential intra-abdominal trauma, specifically from referred pain associated with injuries to the diaphragm or spleen. This phenomenon occurs because the diaphragm and certain other thoracic or abdominal structures can share nerve pathways. When the spleen is injured, it can lead to referred pain in the left shoulder, often referred to as Kehr's sign.

In the context of intra-abdominal trauma, consistent pain can signal that the injury may be more extensive than initially apparent, necessitating prompt and thorough evaluation to rule out any significant internal injuries. If abdominal organs are compromised, this will require immediate medical intervention, making the identification of such symptoms crucial in pediatric emergency care.

The other symptoms presented, while potentially concerning in their own right, do not specifically point to intra-abdominal trauma as strongly as left shoulder pain does in this scenario. For instance, chest pain with deep inspiration might suggest a respiratory issue or thoracic injury, thoracic spine pain with palpation might indicate a spinal or muscular injury, and intermittent shortness of breath could be associated with several other factors, none of which are as directly connected to intra-abdominal trauma. Therefore, constant left shoulder pain stands out