CEN Review

An unrestrained driver was involved in a MVC. The driver is responsive upon arrival to the emergency department and complaining of chest pain with a large area of ecchymosis on her anterior chest. The patient is placed on the cardiac monitor. What rhythm is most commonly associated with blunt cardiac trauma? a. sinus tachycardia b. third degree heart block c. sinus bradycardia d. premature ventricular contractions

A. The most common arrhythmia seen in blunt cardiac trauma is sinus tachycardia. Third degree heart block is not a common arrhythmia related to blunt cardiac trauma. Sinus bradycardia may be seen if the patient is decompensating. However, this is not the most common arrhythmia. Patients could display premature ventricular contractions, but they are not the most common.

A patient presents to the emergency department with acute respiratory distress due to heart failure. The patient has audible crackles, tachypnea, tachycardia, and diaphoresis. The patient's vital signs consists of blood pressure 165/95, heart rate of 124, respirations at 32, and a pulse ox of 85% on room air. The patient was placed on oxygen for 5 minutes without improvement. What is the next priority for this patient? a. Bilevel Positive Airway Pressure (BiPaP) b. electrocardiogram (ECG) c. intravenous access with normal saline bolus d. lasix intravenously

A. The patient appears to be in acute respiratory distress and immediate action needs to be taken to address the patient's breathing such as BiPaP. An ECG will be completed once the patient's breathing has been addressed. An IV will be inserted, but the patient should not receive a normal saline bolus as they appear to be in congestive heart failure. Lasix will be given after addressing the patient's breathing.

A patient with angioedema related to smoke inhalation has the following ABG values pH 7.35, CO2 53, HCO3 28. These values show a. compensated respiratory acidosis b. uncompensated respiratory acidosis c. compensated respiratory alkalosis d. uncompensated respiratory alkalosis

A. The patient has a pH on the low end of normal with an elevated CO2 indicating respiratory acidosis. The elevated HCO3 indicates the body is compensating, otherwise the pH would be even lower. It is helpful to remember that CO2 is an acid and HCO3 is an alkaline. The body uses these to balance the pH. If the CO2 gets too high or the HCO3 is too low, the pH drops. If the CO2 gets too low or the HCO3 gets too high, the pH increases.

A 72-year-old female presents to the ED with increasing weakness and confusion. She has a low grade fever, appears in mild respiratory distress with a room air SPO2 of 94%. She is coughing up sputum that is thick and yellow in color. What is the most likely diagnosis? a. pnuemonia b. COPD c. pulmonary edema d. bronchitis

A. The patient most likely has pneumonia based on the presenting symptoms. Pneumonia causes fever, chills, and productive cough with yellow, green, or purulent sputum. Elderly patients can present with weakness or confusion as a result of the underlying infection. COPD and pulmonary edema do not present with fever unless there is an underlying infection, which may be pneumonia. Bronchitis is possible, but the patient is showing signs of an infectious process more consistent with pneumonia.

A 72-year-old patient presents with complaints of a mild fever and productive cough. A chest x-ray reveals a lower left infiltrate. After addressing the ABCs, a priority intervention with this patient is a. prepare for administration of antibiotics b. obtain an ECG c. obtain ABGs d. prepare the patient for admission

A. This patient has a lower left pneumonia based on the chest x-ray interpretation. A priority intervention is to prepare for administration of antibiotics, which must be done within 4 hours of arrival to the ED. An ECG and ABGs may be warranted based on patient presentation and comorbidities, but are not generally a priority for patients with pneumonia. Elderly patients often do require admission, but it is important to ensure antibiotics are started first.

A patient recently underwent a pericardiocentesis. What sign or symptom would indicate the procedure was unsuccessful? a. narrowing pulse pressure b. increased blood pressure c. heart rate of 75 d. increase in urine output

A A narrowed pulse pressure indicates poor heart function such as an unsuccessful pericardiocentesis. Signs and symptoms of cardiac tamponade include hypotension, muffled heart tones, and jugular vein distention. An increase in blood pressure and urine output indicates a successful procedure because there is an increase in blood flow to the heart, kidneys, and the rest of the body. Typically, patients with cardiac tamponade will have a rapid heartbeat greater than 100 bpm to compensate for the hypotension.

A 45-year-old female patient enters into the emergency department with complaints of intermittent chest pain that has happened at rest, during sleep, and with exercise. The patient was diagnosed with Prinzmetal's angina. What question should the nurse ask the patient? a. Do you smoke cigarettes? b. How long have you been exercising? c. Do you have any respiratory conditions? d. Does cold exposure relieve the chest pain?

A Cigarette smoking causes vasoconstriction which can cause vasospasm of the coronary arteries. The length of time exercising and any respiratory conditions does not directly address the causes of Prinzmetal's angina. Cold exposure causes vasoconstriction and would worsen rather than relieve the chest pain.

A patient arrives in the emergency department complaining of chest pain, palpitations, and shortness of breath. The cardiac monitor displays supraventricular tachycardia (SVT). What common signs and symptoms would the nurse anticipate the patient to have? a. dizziness and dyspnea b. hypertension and nausea c. clear mentation and respiratory rate of 16 d. heart rate of 130 and respiratory rate of 28

A Dizziness and dyspnea are classic signs and symptoms of SVT. Patients may be hypertensive and nauseous when they are in SVT, but these are common signs and symptoms. Clear mentation and a respiratory rate of 16 are normal findings. Heart rate of 130 and a respiratory rate of 28 indicate tachycardia and tachypnea. However, the heart rate needs to be above 150 to be classified as SVT.

A patient with a history of Raynaud's disease presents to the emergency department with bilateral hand pain. The patient's hands are cold to the touch and pale, almost cyanotic. Following treatment, what patient education should the nurse provide? a. Make sure your hands remain covered during cold weather b. Apply ice to your hands when they begin to hurt c. You can take cold medications as needed d. You need to take your antibiotics until they are gone

A It is important to help prevent exacerbations of Raynaud's by covering the hands when the weather is cold. If the patient applies ice to the hands, this will cause further vasoconstriction and make the condition worse. Cold medications cause vasoconstriction therefore exacerbating the patient's Raynaud's and should be taken with caution. Raynaud's disease does not require antibiotics.

A patient arrives to the emergency department with complaints of chest pain. On assessment, a pericardial friction rub and diffuse ST elevations are noted. The patient is most likely experiencing what condition? a. Pericarditis b. Non-STEMI c. STEMI d. Pericardial tamponade

A Pericarditis is an inflammation of the pericardial lining. Classic signs and symptoms include pain relieved when leaning forward, pericardial friction rub, and diffuse ST elevations. Non-STEMI signs and symptoms include ST depression or T wave inversions with elevation in cardiac enzymes. STEMI signs and symptoms include ST elevation in two or more leads, without the presence of a pericardial friction rub. Pericardial tamponade is an accumulation of fluid, pus, or blood in the pericardial sac compressing the heart preventing full myocardial expansion. The patient will have muffled heart sounds instead of a pericardial friction rub.

A patient is newly diagnosed with controlled atrial fibrillation. What intervention would the nurse expect the physician to order? a. anticoagulants b. aspirin c. antithrombotics d. atropine

A The patient is newly diagnosed with controlled atrial fibrillation and should be started on anticoagulants to prevent the development of a thrombosis. Aspirin is not as effective as anticoagulants in preventing a thrombosis. Antithrombotics are recommended for a thrombosis in the coronary arteries or brain it is not recommended for controlled atrial fibrillation. Atropine is recommended for sinus bradycardia and is not recommended for controlled atrial fibrillation.

Four patients arrive at the front desk of the emergency department. Which patient should the RN assess first? a. 68-year-old male with chest pain, diaphoresis, pale skin, and vomiting b. 18-year-old male with chest pain worse upon movement and deep breathing. c. 45-year-old female with abdominal pain, vomiting, and diarrhea d. 53-year-old female with pleuritic chest pain, productive cough, and dyspnea

A The symptoms of the 68-year-old male with chest pain, diaphoresis, and vomiting could indicate he is having an acute myocardial infarction and would be the first patient for the RN to assess. The 53-year-old female with pleuritic chest pain, productive cough, and dyspnea would be important to see, however not as important as the 68-year-old male patient. The 18-year-old female patient with chest pain worsening with deep breathing and movement can wait to be seen.

A patient is diagnosed with an aortic aneurysm. The patient displays the following vital signs: blood pressure 200/98, heart rate 100 bpm, respirations at 24 per minute, temperature of 99.0 F, and pulse ox of 95% on room air. Which vital sign needs immediate attention? a. blood pressure b. heart rate c. respiratory rate d. temperature

A When a patient is diagnosed with an aortic aneurysm, it is imperative to lower blood pressure to prevent dissection. Even thought the heart rate and respiratory rate are elevated, this compensatory mechanism is caused by the aortic aneurysm. The temperature is slightly elevated, but has not effect on an aortic aneurysm.

A patient suffered severe abdominal and chest wall trauma. During the initial assessment, abdominal sounds are auscultated in the lower left chest. The nurse suspects the patient has a. a ruptured diaphragm b. a tension pneumothorax c. a flail chest d. hyper-resonant abdominal sounds

A. A ruptured diaphragm is more likely to occur on the left side of the chest as there are not solid organs (such as the liver) to protect it from blunt or penetrating force. When this occurs, the intestines herniate into the chest cavity, displacing the lungs. Therefore, abdominal sounds may be hear. This phenomenon will not occur with a tension pneumothorax or flail chest.

A patient has been experiencing dizziness, fatigue, and a decreased level of consciousness. The patient's cardiac rhythm displays a P wave of 0.12, QRS <0.12, QT 0.48, and a heart rate of 38. What intervention would the nurse expect the physician to order? a. atropine b. amiodarone c. cardioversion d. defibrillation

A. Atropine is the recommended treatment for symptomatic sinus bradycardia. Amiodarone, cardioversion, and defibrillation are not recommended for treatment of sinus bradycardia.

A 63-year-old patient has evidence of pulmonary edema. Which of the following findings would indicate this pulmonary edema is noncardiogenic in nature? a. chest x-ray shows normal heart size b. BNP level is 650 pg/mL c. bilateral basilar crackles are heard on auscultation d. shortness of breath increases when laying down

A. Cardiogenic pulmonary edema is the result of heart failure; therefore, the finding on x-ray that the heart size is normal would indicate heart failure is not likely the cause. A BNP level of 650 pg/mL is elevated and would indicate heart failure. Assessment findings on patient presentation and auscultation are similar for cardiogenic and noncardiogenic causes of pulmonary edema. For that reason, it is important to do lab and imaging tests to differentiate.

A patient has been having a headache and elevated blood pressure for the past three days. The patient's blood pressure upon arrival is 170/100. The patient has no allergies, takes no medications, and has no medical history. What is the patient's most likely condition? a. essential hypertension b. systolic hypertension c. secondary hypertension d. hypertensive emergency

A. Essential hypertension occurs without evidence of other diseases and with a chronic elevation in blood pressure. Systolic hypertension occurs when the systolic pressure is continually elevated above 140, however the diastolic pressure is less than 90. Secondary hypertension results from diseases or processes occurring within the body. Hypertensive emergency is an accelerated form of hypertension suddenly displaying a systolic pressure greater than 180 and a diastolic pressure greater than 120.

Which of the following tests is NOT helpful in distinguishing non-cardiogenic pulmonary edema from congestive heart failure (CHF)? a. ABGs b. chest x-ray c. CT chest d. BNP

A. Presentation of patients with pulmonary edema is similar whether it is cardiogenic or non-cardiogenic in nature. Radiological and laboratory tests help to distinguish the two. Patients with cardiogenic pulmonary edema, such as CHF will show a widened mediastinum on a chest x-ray and a CT chest. In addition, they will show an elevated BNP level. ABGs are not reliable to distinguish as they may be abnormal due to either cause.

A 32-year-old male patient involved in a motorcycle crash presents with multiple injuries. He was wearing a helmet and does not appear to have any head or facial trauma. He is dyspneic, tachycardic, and tachynpneic with road rash and redness to his anterior chest. Close inspection reveals tracheal deviation to the left with diminished lung sounds on the right. The priority intervention is to a. perform immediate needle decompression to the right 2nd intercostal space b. prepare for immediate endotracheal intubation c. perform immediate needle decompression to the left 2nd intercostal space d. anticipate chest tube insertion

A. Tracheal deviation is the hallmark sign of a tension pneumothorax. It is identified by absent or diminished lung sounds on the affected side and tracheal deviation away from the affected side. Immediate needle decompression is the primary intervention. In this case, the assessment indicates the tension pneumothorax is on the right side. Once needle decompression is successful, additional interventions would include preparing for endotracheal intubation and chest tube insertion.

A 30-year-old female patient presents to the emergency department with complaints of increasing shortness of breath over the last few days and pain over the right side of her chest. In assessing for potential risk factors for pulmonary embolus, all would be of concern except a. she takes birth control pills b. she is a marathon runner c. she smokes one pack of cigarettes a day d. she reports recent travel to Fiji

B Frequent and regular exercise is not a risk factor for pulmonary emboli. Immobility from sedentary behaviors, long travel, or illness does increase the risk due to venous stasis which allows for clot formation. Cigarette smoking damages the vascular lining, which can promote clot formation. Birth control pills elevate hormone levels, which can increase coagulability.

What common signs and symptoms would an RN expect to see in a patient with left-sided congestive heart failure? a. syncope, palpitations, and dyspnea b. tachypnea, dyspnea, and crackles in the lungs c. anorexia, jugular vein distention, and fatigue d. bradycardia, tachypnea, and headache

B Left-sided heart failure signs and symptoms include tachypnea, dyspnea, and crackles in the lungs due to the blood backing up into the lungs causing pulmonary congestion. Anorexia, jugular vein distention, and fatigue are signs and symptoms of right-sided heart failure. Syncope, palpitations, bradycardia and headache are not common in left-sided heart failure.

A patient diagnosed with a deep vein thrombosis (DVT) suddenly becomes short of breath, tachycardic, tachypneic, and restless. What complication does the nurse suspect? a. acute myocardial infarction b. pulmonary embolism c. pericardial tamponade d. congestive heart failure

B Patients with DVTs are at high risk for pulmonary embolism. Sudden onset of shortness of breath, tachycardia, tachypnea, and restlessness are manifestations of pulmonary embolism. Acute myocardial infarction, pericardial tamponade, and congestive heart failure are not a complication of DVT.

A patient was found pulseless and apneic. Cardiopulmonary resuscitation was begun and a cardiac/defibrillator was applied. The patient's rhythm is asystole. What treatment would the nurse expect the physician to order? a. atropine b. epinephrine c. amiodarone d. defibrillation

B The American Heart Association recommends epinephrine as the medication to treat asystole. Atropine does not show any benefit to patients in asystole. Amiodarone is recommended for ventricular tachycardia and fibrillation and is not recommended for asystole. Adenosine is recommended for supraventricular tachycardia and not recommended for asystole.

A patient enters the emergency department in cardiopulmonary arrest. The patient was intubated prior to arrival. The nurse auscultates the chest and hears breath sounds on the right side only. What intervention would the nurse expect the physician to order first? a. arterial blood gases b. chest x-ray c. CT scan d. electrocardiogram

B The patient is intubated prior to arrival and one of the causes of absent breath sounds is displacement. The ET tube could be placed in the right mainstem bronchus. The physician would order a chest x-ray to verify placement of the endotracheal tube. If the endotracheal tube is in the correct place, an arterial blood gas may be ordered, but this is not the priority. A patient in cardiopulmonary arrest is unstable to go to CT scan. An electrocardiogram may be obtained if the patient has any electrical activity on the cardiac monitor, but this is not the priority.

A patient arrives in the emergency department after being involved in a motor vehicle crash (MVC). The patient struck the steering wheel with her chest. The patient is diagnosed with blunt chest trauma and pericardial effusion and then becomes unresponsive and hypotensive. What is the priority intervention? a. continue to monitor the patient b. pericardiocentesis c. administer Dopamine intravenously d. needle-chest decompression

B The patient is unstable and needs immediate intervention such as a pericardiocentesis. If the RN simply continues to monitor the patient, the patient will become worse. Administering Dopamine intravenously may be needed, but it is not the priority intervention. The patient is not displaying signs or symptoms related to tension pneumothorax in which needle-chest decompression would the be recommended intervention.

A patient enters the emergency department with midsternal chest pain, nausea, and diaphoresis. the patient states the pain has increased in intensity over the last hour. An ECG was obtained and ST depression is noted. The patient has an elevation in cardiac enzymes. The patient is most likely experiencing? a. stable angina b. unstable angina c. NSTEMI d. STEMI

C In NSTEMI, the patient has elevation in cardiac enzymes with ST depression on the ECG. Stable angina does not have ST depression or elevation in cardiac enzymes. Unstable angina may have similar signs and symptoms, but patients do not have any elevation in cardiac enzymes. STEMI is classified as an elevation in cardiac enzymes along with ST elevation on the ECG.

A patient is diagnosed with infective endocarditis in the emergency department. What signs and symptoms will the patient display? a. chest pain, dyspnea, and cough b. syncope, bradycardia, and fever c. fever, dyspnea, and anorexia d. back pain, lethargy, and bradycardia

C Patients with infective endocarditis have fever, dyspnea, and anorexia due to the infectious process in the body. The patient with infective endocarditis does have dyspnea, but not a cough. The patient may have chest pain, but is not as common as fever and dyspnea. Patients with infective endocarditis have fevers and tachycardia, not bradycardia or syncope. While patients with infective endocarditis may be lethargic, back pain, and bradycardia are uncommon.

A patient complains of having two syncopal episodes at home. The patient is placed on the cardiac monitor and becomes unresponsive. the RN notices a third different episode of 10 to 20 second pauses on the cardiac monitor. What intervention will the RN expect the patient to receive? a. intravenous fluids b. beta-blocker medication c. pacemaker d. CT of the head

C The patient is experiencing a sinus pause/arrest and requires a pacemaker as the SA node is not consistently generating an impulse. Intravenous fluids will not improve the sinus pause/arrest rhythm that caused the patient's syncope. Beta-blockers commonly cause sinus pause/arrest and therefore should not administer to the patient. The patient has an electrical conduction disorder and a CT of head is not a recommended intervention for sinus pause/arrest.

A 62-year-old female is in the ED for shortness of breath and has vital signs of p-114; r-28; BP-96/54; SpO2 89% on room air, which increases to 93% on 2 liters oxygen by nasal cannula. ABG results are returned with a pH of 7.47, PaCO2 of 32 mm Hg., HCO3 of 24 mEq/liter. What do these results indicate? a. metabolic alkalosis b. respiratory acidosis c. respiratory alkalosis d. her ABGs are within normal limits

C The patient's pH is elevated, the PaCO2 is low, and the HCO3 is normal. The elevated pH indicates alkalosis. The decreased PaCO2 and normal HCO3 level indicates a respiratory component that is not being compensated for. These results, combined with the assessment, indicate the patient is in non-compensated respiratory alkalosis. Respiratory alkalosis can result from any condition causing hyperventilation, including fever and sepsis.

A chest tube is placed in a patient to evaluate blood from a hemothorax following a significant chest trauma. An emergency thoracotomy is indicated when a. there is greater than 750mL of initial blood return b. there is no blood return, but increasing dyspnea c. blood return is greater than 200 mL per hour for 4 hours d. a second chest tube needs to be placed

C. Emergency thoracotomy would not be required for an initial blood return of 750 mL. It is required if chest tube insertion results in greater than 1500 mL of blood return initially, or greater than 200 mL per hour for 4 consecutive hours. Autotransfusion-returning the shed blood, may be another intervention to consider. If there is no blood return, placement of the chest tube should be questioned, especially with increasing dyspnea, but an emergency thoracotomy would not be warranted. The need for a second chest tube, particularly if it is on the opposite side, does not require immediate thoracotomy unless there is significant blood loss.

A 22-year-old patient was rescued from a house fire. Upon arrival to the ED, the patient is alert and talking. Which assessment findings may indicate the need for immediate endotracheal intubation? a. SpO2 of 88% on room air b. carboxyhemoglobin level of 6% c. second degree burns noted to the anterior neck d. wheezing and crackles noted in all lung fields

C. Endotracheal intubation should be immediately considered if the patient has facial, neck, or perioral burns. A decreased SpO2 of 88% should be closely monitored, but without other signs of respiratory distress, this finding alone would not indicate the need for immediate endotracheal intubation. Carboxyhemoglobin levels of 6% may be normal in a patient that is a smoker. A patient with significant carbon monoxide exposure would have levels greater than 10%. Wheezing and crackles may be present in a patient with exposure to smoke and should be monitored for other signs of respiratory distress.

What should be done expediently in intubated patients to prevent aspiration? a. obtaining a chest x-ray b. elevating the head of the bed c. gastric tube placement d. providing IV sedation

C. Gastric tube placement should be performed immediately following endotracheal intubation to decompress the stomach and reduce the risk of aspiration. A chest x-ray is helpful in confirming tube placement, but will not reduce the risk of aspiration. Elevating the head of the bed is helpful to reduce aspiration and ventilator-associated pneumonia (VAP), but can be performed prior to intubation. Sedating intubated patients helps to reduce the risk of dislodgement and discomfort to the patient.

A patient presents to the emergency department with hypertension, left side weakness, and an inability to speak. The patient appears frustrated and anxious but is able to follow commands. The emergency nurse understands the patient has likely had a stroke in what area of the brain? a. Huntington's area: located in the left parietal lobe b. Cushing's area: located in the right limbic lobe c. Broca's area: located in the dominant frontal lobe d. Wernicke's area: located in the right temporal lobe

C. Interruption of blood flow to Broca's area affects the motor component of speech. The patient is able to understand and follow commands so the patient can still processes speech. Inability to understand commands would indicate a receptive aphasia secondary to damage in Wernicke's area. Huntington and Cushing's area do not exist as anatomical features of the brain.

Patient teaching for patients with COPD should include all of the following except a. encourage adequate fluid intake b. limit the use of antihistamines, antitussives, and decongestants c. avoid exercise as it may exacerbate symptoms d. encourage small, frequent meals

C. It is important to encourage exercise as it helps to increase energy and decrease shortness of breath. COPD patients should drink plenty of fluids to help thin secretions; limit the use of medications that have a dehydrating effect; and eat small meals frequently to minimize abdominal distension that can reduce lung capacity.

An emergency nurse knows it is important to never fully occlude an open pneumothorax or clamp a chest tube because occlusion would a. Put the patient at increased risk for infection b. Cause a pleural effusion c. Cause a tension pneumothorax d. irritate the diaphragm

C. Occlusion of a chest wound or clamping the chest tube prevents air and/or fluid from escaping the chest, which can lead to a tension pneumothorax. Although a chest tube can predispose the patient to an infection, such as an empyema, clamping it or occluding a wound would not increase that risk, nor irritate the diaphragm. A pleural effusion would not result from these actions either.

A patient with respiratory distress is placed on capnography. The following wave forms would be anticipated with COPD? a. flat and extended b. tall and narrow c. "shark fin" shaped d. curved

C. Patients with COPD and asthma exacerbations will have a wave form that appears like a "shark fin" as the CO2 is slow to escape during exhalation due to alveolar trapping. This waveform usually correlates with a higher CO2 level. ABG assessment is a good correlation tool with capnography. A flat and wider waveform may indicate little ventilation and perfusion occurring (lower CO2 level). Other abnormal waveforms require assessing the patient's breathing pattern, rate, and depth of respirations. If the patient is mechanically ventilated or receiving supplemental oxygen, assuring that the tubing and circuitry are connected and working properly.

A 46-year-old patient is diagnosed with pertussis and is being discharged. Further teaching is needed when the patient states a. "I will need to make sure my family also takes the prescribed antibiotics" b. "I should get the Tdap vaccination every 10 years" c. "The antibiotics will help me to feel better in a few days" d. "I can expect to have this cough for 2 to 3 months"

C. Pertussis is an infection that more often affects adolescents and adults as immunization duration decreases. Antibiotic use does not shorten the course of the illness, which typically lasts 2 to 3 months, but will reduce the spread to others. Those in close contact should also complete a course of antibiotics to reduce the spread of the illness. It is important to teach patients the importance of vaccination every 10 years to ensure immunity.

Pulsus paradoxus may be noted on a patient with a. pulmonary contusion b. flail chest c. severe asthma exacerbation d. pneumothorax

C. Pulsus paradoxus is a condition in which the systolic blood pressure changes significantly on inspiration. There are several cardiac etiologies of this phenomenon. Respiratory etiologies include severe asthma and COPD exacerbation. This phenomenon is observed when the systolic BP decreases greater than 20 mm Hg during expiration.

A patient enters the emergency department complaining of a racing heart, palpitations, and shortness of breath with an onset 30 minutes prior to arrival. The nurse places the patient on the cardiac monitor and notes that the heart rate is 190 bpm. What cardiac rhythm would the nurse expect to see? a. Normal sinus rhythm b. sinus tachycardia c. supraventricular tachycardia d. ventricular fibrillation

C. Supraventricular tachycardia is defined as a heart rate greater than 150, narrow complex, and regular rhythm. The signs and symptoms correlate with supraventricular tachycardia. Sinus tachycardia is a heart rate between 100 to 150. Normal sinus rhythm. is a heart rate between 60 to 100. Ventricular fibrillation has no heart rate and the patient would be unresponsive.

Upon entering a room with a patient complaining of a headache, the patient is found to be pacing the room and refusing to lie on the bed. The patient complains of sharp pain behind the right eye. The right eye is swollen and drooping with tear production noted. What medication is considered to be most effective for this type of headache? a. hydromorphone IV with a NS bolus b. proparacaine drops to the affected eye c. high flow oxygen through a NRB d. Compazine/Benadryl/Toradol combination

C. The unilateral pain behind the right eye, inability to sit still, and agitation are indicative of a cluster headache. High flow oxygen is the preferred treatment for cluster headaches. Compazine/Benadryl/Toradol combination is the treatment for a migraine headache, which involve bilateral pain, nausea, and photophobia. Opioids are not usually the first line treatment for suspected cluster headaches, and proparacaine eye drops would not be indicated.

A patient complains of dizziness/lightheadedness, palpitations, and dyspnea for the last two weeks. An electrocardiogram is performed with the following findings: irregular rate, unmeasurable PR interval, QRS<0.12, QT interval 0.36. The nurse would interpret this cardiac rhythm to be? a. sinus pause/arrest b. normal sinus rhythm with premature ventricular contractions c. atrial fibrillation d. ventricular fibrillation

C An irregular rhythm with no measurable PR interval is characteristic of atrial fibrillation. Sinus pause/arrest is an irregular rhythm, but the PR interval is measurable. The patient is missing one or several beats. Normal sinus rhythm with premature ventricular contractions is an irregular rhythm, but the PR interval is measurable in the normal beats and usually within normal limits (0.12 to 0.20). Ventricular fibrillation is a chaotic rhythm that is irregular, but there is not heartbeat, no PR interval, no QRS segment, and no QT interval.

A patient arrives to the emergency department after a minor MVC reporting chest pain. The nurse would suspect treatment interventions for blunt cardiac trauma, as opposed to STEMI care, due to which initial findings? a. ST segment changes, peaked T-waves, and increased Troponin-I b. ST segment changes, T-wave inversion, and increased Troponin-I c. ST segment changes, T-wave inversion, and normal Troponin-I d. ST segment changes, T-wave flattening, and normal Troponin-I

C Blunt trauma causes ST segment changes, T-wave inversion and normal Troponin levels. Peaked T-waves are common in hyperkalemia while flattened T-waves may be due to hypokalemia or coronary ischemia. Increased Troponin levels are more likely to be seen in STEMI than blunt cardiac trauma.

A patient has a history of hypertension and hyperlipidemia and states that he developed sudden onset of upper back pain with dyspnea. The patient's blood pressure was 160/80 upon arrival with a heart rate of 104. A contrast CT scan was completed and an ascending aortic aneurysm was noted. What is the first priority to be completed for this patient? a. administer intravenous fluids b. administer an antihypertensive c. administer a beta-blocker d. administer analgesics

B To prevent aortic dissection, it is important to decrease the blood pressure keeping the systolic between 100 to 120 mm Hg. Adding intravenous fluids would further increase the vascular volume and increase the blood pressure. Administering a beta-blocker to reduce myocardial contractility and analgesics for the pain are necessary, but they are not the first priority.

A patient complains of chest pain unrelieved with rest. The ECG shows T wave inversion, but no elevation in his troponin level. Based on the signs and symptoms, the patient is most likely experiencing? a. stable angina b. unstable angina c. Non-STEMI d. STEMI

B Unstable angina is defined as continued chest pain remaining after cessation of activity or chest pain relieved by nitroglycerin and without elevation in cardiac enzymes. Stable angina is characterized by chest pain relieved with cessation of the activity. Non-STEMI is defined as chest pain often with T wave inversion and/or ST segment depression and elevation in the cardiac enzymes. STEMI is characterized by chest pain with ST elevation and elevation in the cardiac enzymes.

A focused assessment with sonography in trauma (FAST) exam is the preferred radiological exam in trauma because it a. requires minimal training to perform b. can be done quickly at bedside to identify internal trauma c. is more definitive than other radiological exams d. is less expensive than other tests

B. A FAST exam can be performed at the bedside and requires a skilled provider to perform the test. This ultrasound screening test is helpful in identifying blood (internal bleeding), such as a hemothorax. Although there are other radiological exams that provide clearer pictures, such as CT. The FAST exam is beneficial as it can be done rapidly and does not require moving the patient to another locaiton.

A seven-month-old girl is brought into the emergency department by her mother. The mother states the little girl was fine at daycare today, but tonight she found the toddler "jerking her arms and legs with her eyes rolled back in her head." The child is warm to the touch with a rectal temp of 100.9F, rhinorrhea, and tachycardia. Otherwise the child has clear lung sounds and appears well hydrated. The ED nurse reassures the patient's mother by telling her a. there was nothing the mother could do to prevent the illness b. two-thirds of patients will never experience a second episode c. anti-seizure medications are very effective these days d. a CT scan is non-invasive and will reveal any brain damage

B. The patient is presenting with a febrile seizure. CT scans and anti-seizure medications are not appropriate for this patient since febrile seizures rarely cause permanent damage to the brain, and often do not recur.

A 25-year-old female patient was involved in a head on collision with significant chest wall trauma. A tracheobronchial injury is suspected when a. there is a contusion noted to the upper chest b. the patient is unable to speak c. the chest tube insertion fails to evacuate subcutaneous emphysema d. the patient has increasing dyspnea

C. Tracheobronchial injuries are often the result of rapid deceleration. They should be suspected when chest tube insertion fails to evacuate subcutaneous emphysema. Contusions to the chest wall and increasing dyspnea can be indicative of many injuries and is therefore not specific to tracheobronchial injuries. The inability to speak would be indicative of a laryngeal injury.

A 64-year-old female patient presents with a significantly swollen tongue and lips. She is extremely anxious and is drooling. The emergency nurse positions the patient and opens the airway with a jaw thrust. The priority intervention for this patient is a. insert an oral airway b. prepare for cricothyrotomy c. apply oxygen via non-rebreather mask d. obtain SpO2 measurement

B. The patient is showing symptoms of airway obstruction associated with angioedema. Insertion of an oral airway is dangerous as it could cause further swelling and completely obstruct the airway. It is important to anticipate immediate intubation and prepare for cricothyrotomy as insertion of an endotracheal tube may not be possible. Patients with an airway obstruction often have extreme anxiety and placement of a non-rebreather mask may worsen it. Although SpO2 measurement is helpful and may be done simultaneously with other interventions, the priority is airway securement.

The emergency nurse knows that discharge instructions for a patient with asthma is effective when he states a. "I should return to the ED if I need a refill of my inhaler" b. "I will get better results from the medicine if I use a spacer with my inhaler" c. "I should avoid exercise to prevent asthma attacks" d. "It would help if I switched to light cigarettes"

B. The use a spacer improves the amount of medication that reaches the lungs. Patients should follow up with their primary physician to improve continuity of care, and coordinate any necessary referrals. Exercise is important to strengthen the lungs and can actually reduce the frequency of attacks. Smoking of any kind is not recommended as it can instigate asthma attacks and leads to irreversible lung damage.

A 2-year-old patient presents to the emergency department (ED) with a fever, barky cough, stridor, and retractions. Initially, the most beneficial treatment is a. a nebulizer with B2 adrenergic agonists and anticholinergic b. cool, humidified oxygen c. an antipyretic d. high flow oxygen

B. This child is showing symptoms of croup causing respiratory distress. Oxygen is needed to manage the hypoxemia. Cool, humidified oxygen keeps the airway moist and prevents drying, which can help symptoms. In this case, a nebulizer with racemic epinephrine would be the first line drug along with corticosteroids. An antipyretic will help lower the fever, but it is not the initial intervention.

A 22-year-old male arrives to the ED following an all terrain vehicle (ATV accident. What initial assessment finding requires the most immediate intervention? a. abrasions across the chest b. respiratory rate of 26 c. complaints of pain to palpation across lower rib border d. trachea deviated to the left

D. A deviated trachea indicates a tension pneumothorax. This requires immediate intervention with needle decompression to prevent further respiratory compromise. Abrasions to the chest indicate trauma, as would pain to the lower rib border, but those findings alone do not require the most immediate intervention. Tachypnea can indicate chest injury, but can also be elevated due to pain or anxiety.

A patient with ST-segment elevation in all ECG leads begins to rapidly decompensate with worsening vital signs. The emergency nurse knows to prepare for a. IV diuretics b. Repeat ECG c. IV beta-blocker d. pericardiocentesis

D. Diffuse ST-segment elevation is indicative of pericarditis. Significant vital sign decompensation may be an indication of cardiac compression requiring removal of fluid from around the heart. While diuretics may also be ordered, a pericardiocentesis would provide the most rapid relief of symptoms. A repeat ECG would not help with diagnosis or treatment and IV beta-blocker medications would not relieve the cause of the symptoms.

When considering airway options for patients with COPD, Noninvasive positive pressure ventilation (NPPV) such as BiPaP is beneficial because it a. can be used on patients that are unconscious b. creates negative pressure within the lungs c. is easily tolerated by most patients d. can reduce the need for intubation and improve outcomes

D. NPPV, such as BiPaP maintains continuous positive pressure in to maintain open alveoli. It should only be used on alert and cooperative patients. The tight mask seal can be uncomfortable and is not always tolerated by patients. However, it can improve outcomes by reducing the need for intubation and decrease duration of hospitalizaiton.

Pertussis is most commonly found in the following age group a. less than 2 years b. 2 years to 5 years c. 5 years to 15 years d. over 15 years

D. Pertussis is most likely to affect adolescents and adults as the vaccination immunity diminishes. The Tdap vaccine protects against tetanus and pertussis and should be given to adults at least every 10 years to protect against illness.

Which of the following types of shock can occur from a tension pneumothorax? a. hypovolemic b. cardiogenic c. distributive d. obstructive

D. Tension pneumothorax causes a mediastinal shift away from the affected side. This compresses the heart and great vessels decreasing cardiac output. Despite the cardiac implications, it is considered obstructive shock as the cause of origin is non-cardiac. Hypovolemic shock is caused by excessive blood or fluid loss; cardiogenic shock is caused by decreased cardiac function/failure related to cardiac injury/illness; distributive shock is caused by ineffective vascular tone such as with anaphylaxis or sepsis.

A patient with extreme anxiety and hyperventilation has the following ABG values pH 7.48, CO2 27, HCO3 25. These values show a. compensated respiratory acidosis b. uncompensated respiratory acidosis c. compensated respiratory alkalosis d. uncompensated respiratory alkalosis

D. The patient has an elevated pH and a decreased CO2 which indicates respiratory alkalosis. The HCO3 is within normal range, so the body is not compensating.

A 35-year-old female presents with dyspnea and tachycardia. Her history includes use of birth control pills, cigarette smoking, and a severe iodine allergy. In addition to a D-dimer test, the nurse would anticipate an order for a. a chest x-ray b. an ECG c. a CT scan d. a ventilation/perfusion scan

D. This patient has risk factors for a pulmonary embolus (PE), which are difficult to diagnose with a chest x-ray. An ECG may be ordered to rule out other causes for her symptoms, but would not definitively diagnose a PE. A CT scan is the most reliable test, but is contraindicated because of her iodine allergy. In this case, a ventilation/perfusion scan would be the preferred alternative.

Ventricular tachycardia commonly leads to what rhythm? a. third degree heart block b. pulseless electrical activity (PEA) c. supraventricular tachycardia d. ventricular fibrillation

D. Ventricular tachycardia commonly leads to ventricular fibrillation. Ventricular tachycardia does not commonly lead to third degree heart block, pulseless electrical activity (PEA), and supraventricular tachycardia.

In pulsus paradoxus, the pulse during inspiration can be a. palpated by not auscultated b. auscultated but not palpated c. auscultated and visualized on telemetry d. auscultated but not visualized on telemetry

B. Pulsus paradoxus occurs during conditions such as cardiac tamponade and pericarditis in which the myocardium is able to conduct electricity and contract, but may not have enough force to create cardiac output strong enough for a palpable pulse, especially at the radial artery.

Treatments for RSV include all of the following except a. racemic epinephrine b. antibiotic administration c. corticosteroids d. B2 agonists and anticholinergics

B. RSV is a virus; therefore antibiotics would not be indicated. Treatment for RSV includes racemic epinephrine, B agonists, and anticholinergics to open the bronchioles. Corticosteroids are used to reduce pulmonary inflammation in children over 24 months of age.

When using egophony as part of your assessment, an "ah" sound is heard through auscultation, at the left lower lung field, this is indicative of a. inhalation injury b. pulmonary emboli c. pleural effusion d. tension pneumothorax

C. Egophony is noted over areas where fluids are present, as with a pleural effusion. It is not noted over areas of air, such as with tension pneumothorax. Egophony would not be noted with inhalation injuries or pulmonary emboli as independent clinical findings.

Your patient has been diagnosed with pulmonary edema. He is alert and talking, but has difficulty maintaining a SpO2 greater than 90% with oxygen by nasal cannula. The most effective airway management for this patient is a. non-rebreather mask at 10 LPM b. NPPV (BiPaP) c. bag mask device with 100% oxygen d. endotracheal intubation and mechanical ventillation

B. Although oxygen support is necessary, a non-rebreather mask will not maintain positive pressure, which is necessary to prevent respiratory fatigue and possible failure. Non-invasive pressure support ventilation, such as BiPaP maintains positive pressure in the airway, which prevents the alveoli from collapsing, increases patient comfort, and may prevent acute respiratory failure. A bag-valve mask device, followed by endotracheal intubation and mechanical ventilation would be indicated if the patient demonstrated signs of progressive hypoxemia, such as altered mental status.

Which of the following findings would be of concern immediately following endotracheal intubation? a. the color on the exhaled CO2, indicator is yellow b. upon auscultation, sounds are heard over the epigastrium c. bilateral chest rise and fall is noted with ventilation d. chest x-ray shows the tip of the endotracheal tube just above the right main bronchus

B. Auscultation of the epigastrium should be performed immediately following endotracheal intubation. Sounds heard over the epigastrium with the absence of chest rise and fall indicates intubation of the esophagus. The next step should be auscultation of the lungs, with bilateral breath sounds indicating proper placement. Evaluation of the color on the CO2 indicator should reveal a change from purple to yellow. Finally, a chest x-ray should be performed to confirm placement of the endotracheal tube. Because the right main bronchus is superior to the left, it is more common to enter. This would be indicated by diminished lung sounds on the left. To resolve, gently pull pack on the endotracheal tube so it rests just above the right main bronchus.

A patient is brought into the emergency department by EMS. EMS states the patient's car was hit on the driver's side by another vehicle. The patient's head shattered the side window and there is a laceration on the left side of the skull. EMS states the patient was unconscious at the scene but was alert and talking on the way in. He complained of a severe headache and had weakened grips on the right side. Upon arrival, however, the patient has again lost consciousness and has a left fixed and dilated pupil. The ED nurse suspects the patient has a. a subdural bleed b. an epidural bleed c. a diffuse axonal injury d. a concussion

B. Epidural bleeds are associated with trauma and often have a lucid period prior to rapid deterioration. Because the bleeding is arterial, usually from the middle meningeal artery, with a hematoma developing between the skull and tough covering of the brain. Injury side pupil dilation and opposite side motor weakness is consistent with this type of injury.

A patient enters the emergency department with pain, edema, and ulcer formation on the left lower leg. The patient states the edema has become worse over the past couple of days and the patient noticed skin discoloration on the left lower leg. What condition is most likely? a. varicose veins b. chronic venous insufficiency c. deep vein thrombosis d. Raynaud's disease

B. The patient is displaying signs and symptoms of chronic venous insufficiency. Varicose veins signs and symptoms consist of pain, edema, and dilated veins, not ulcer formation. Deep vein thrombosis signs and symptoms consist of unilateral swelling, skin is warm to touch, and pain in the lower extremity. However, ulcer formation is not a typical sign or symptom. Raynaud's disease is an intense vasospasm of the arteries in the fingers and toes, not in the lower extremities.

A 62-year-old patient is brought to the emergency department by his son. The patient has been complaining of severe headache for the past day, dizziness, shortness of breath, blurred vision and "...not feeling right." He denies chest pain or extremity weakness. His daily medications consist of Wellbutrin for depression and Captopril. The patient admitted he stopped taking Captopril about one week ago when the prescription "ran out," and he was "...coughing more." A 12 lead ECG shows sinus rhythm without ST segment or T wave abnormalities. Vital signs: temp 98.6F, pulse 88, respirations 22, BP 240/126, pulse oximetry 92% on room air. The nurse anticipates that any one of the following medications would be ordered right away except a. nicardipine b. benazepril (lotensin) c. labetalol d. nitroprusside

B. Hypertensive emergencies can cause or worsen organ damage and immediate controlled treatment is imperative. Benazepril is an ACE inhibitor class of antihypertensive medications and is only available in oral doses. The other three antihypertensive medications can be administered IV. IV antihypertensive medications are indicated for hypertension emergencies as they can be titrated safely and reduce blood pressure more effectively. Patients are typically instructed to report a persistent cough while taking an ace-inhibitor, such as Captopril, as this can be one of the side effects. Nicardipine is a calcium channel blocker. Labetalol is an alpha/beta-adrenergic blocker and nitroprusside is a potent peripheral vasodilator.

A 55-year-old male presents to the emergency department with chest pain. He has a history of Type 2 diabetes and hypertension that has been well controlled with medication. He has no other past medical problems or history of chest pain. The medications he takes are hydrochlorothiazide and sildenafil (Viagra). Pulse is 98, respirations are 20, BP is 174/92 and pulse oximetry is 95% on room air. The following medication should not be administered while taking sildenafil a. morphine b. isosorbide c. esmolol d. fentanyl

B. Isosorbide is an antianginal nitrate. Nitrates are contraindicated with phosphodiesterase 5 (PDE5) inhibitor class of drugs, such as sildenafil. The PDE5 class of pharmacological agents are prescribed for erectile dysfunction and if nitrates are administered while on this, cardiovascular collapse can occur. Esmolol is a beta-adrenergic blocker and often administered for hypertension. Morphine and Fentanyl are both opioids and given to patients with chest pain.

Which of the following findings indicate a patient with an asthma exacerbation is not improving? a. Peak flow levels are 75% of predicted b. lung sounds are diminished throughout and without wheezing c. there is audible end expiratory wheezing noted d. SpO2 measurements have improved

B. Lack of wheezing with diminished breath sounds indicates severe obstruction of air flow and requires immediate intervention. Evaluations that show improvement of symptoms include an improved peak flow greater than 70% of predicted, improvement of SpO2 measurements, and a transition from wheezing on inspiration and expiration to end expiration only.

A patient developed chest pain, palpitations, dyspnea, and lightheadedness 2 days ago. The patient is currently on a beta-blocker for hypertension with a blood pressure of 140/74. The patient is placed on the cardiac monitor, which displays a second-degree heart block type II. What intervention would the physician order for treatment? a. give epinephrine IV b. discontinue the beta-blocker c. continue to monitor the patient d. give a calcium channel blocker

B. One of the causes of a second degree heart block type II is beta-blockade. Removing the beta-blocker from the patient's medication regimen may help reestablish the previous cardiac rhythm. Epinephrine is recommended for patients who are hypotensive. This patient has normal blood pressure. Continuing to monitor the patient does not address the patient's change in cardiac rhythm, signs, or symptoms. It would not be recommended to give a calcium channel blocker, which may further worsen the second degree heart block type II.

The nurse caring for a patient with chest pain notices Osler Nodes on the patient's fingertips and knows to expect an order for a. aspirin b. antibiotics c. calcium d. diuretics

B. Osler nodes are a sign of bacterial endocarditis, which requires treatment with antibiotic medications. Aspirin, calcium, and diuretics would not be a recommended treatment for bacterial endocarditis.

The emergency nurse knows the patient understands discharge homecare instructions for treatment and monitoring of a small )<10%) pneumothorax when the patient states a. "I'm glad I can go home; I am flying to Hawaii in two days" b. "I'm glad I can keep practicing my snorkeling in the local pool" c. "I need to come back in two days to have a tube placed in the side of my chest" d. "If I cut back on my smoking, this will never happen again"

B. Patients discharged with a small pneumothorax should be counseled not to fly or dive but surface snorkeling will be safe as long as the patient is warned not to free dive while snorkeling. The patient would only require chest tube if the pneumothorax increases in size and the patient starts having symptoms of shortness of breath. Smoking will increase risk but reduction will not eliminate risk of recurrence.

All of the following physical assessment findings are common with COPD except a. leaning forward on outstretched arms b. decreased resonance to percussion over the chest c. accessory muscle use of neck and shoulders d. barrel shaped chest

B. Physical assessment finding for patients with COPD commonly include sitting in positions to decrease dyspnea, accessory muscle use, pursed lip breathing, barrel-shaped chest, and prolonged expiration. Hypoxemia and dyspnea worsening with exertion is expected with COPD. Decreased resonance to percussion over the chest would be a finding consistent with fluid in the lungs, not specific to COPD.

A patient with a history of T6 cord injury presents with a headache, high blood pressure, nasal congestion, and appears flushed and diaphoretic. The first action would be to a. start two large bore IVs and initiate a fluid bolus b. give IV Mannitol 0.9 mg/kg with 10% of the total dose as a bolus followed by an infusion of the rest over the next 60 minutes c. check the patient's indwelling urinary catheter for kinks d. obtain a 12 lead ECG

C This patient appears to be suffering from autonomic dysreflexia, a dangerous complication of spinal cord injuries that can be triggered by something as simple as a distended bladder. Of the given answers, unkinking the catheter tubing is the only intervention that would remove a stimulus that could trigger autonomic dysreflexia.

A patient who has been diagnosed with a NSTEMI is going for a diagnostic cardiac catherization and possible revascularization. He is receiving a heparin infusion. The emergency nurse would anticipate the following action a. administer an oral dose of Dabigatran b. Stop the heparin infusion until the procedure is completed c. administer an oral dose of Clopidogrel d. Administer IV hydropmorphone for his increased pain

C. Clopidogrel inhibits platelet aggregation by binding to the adenosine diphosphate P2Y12 receptor on platelets. This binding action inhibits the ADP-mediated formation of the glycoprotein GPIIb/IIIa complex activation that is necessary for platelet aggregation. Impeding platelet aggregation augments reperfusion. Heparin is not usually stopped for reperfusion therapy. Morphine decreases myocardial oxygen demand and is the first opioid analgesic of choice unless contraindicated for the patient.

A patient complains of severe thoracic back pain radiating to the chest starting 2 hours prior to arrival. The patient has a history of hypertension and the initial blood pressure is 220/128. What condition does the nurse suspect? a. hypertensive crisis b. congestive heart failure c. acute arterial occlusion d. dissecting aortic aneurysm

D The patient is displaying signs and symptoms of a dissecting aortic aneurysm. When a patient is diagnosed with an aortic aneurysm, it is imperative to lower blood pressure to prevent dissection. The patient is hypertensive due to the body compensating for decreased cardiac output. The patient is not suffering from a hypertensive crisis. Congestive heart failure patients may be hypertensive due to fluid overload, but patients do not typically have severe thoracic back pain. Acute arterial occlusion signs and symptoms are pulseless, pallor, pain, paresthesia, and paralysis in the extremities, not in the thoracic region.

A patient complains of chest pain, dyspnea, and dizziness for two hours prior to arrival. The patient is placed on the cardiac monitor. The patient's heart rate is 30 and the ECG shows asynchronous but regular P-to-P and R-to-R intervals. The patient is experiencing which of the following dysrhythmias? a. normal sinus rhythm with first degree AV block b. second degree AV block type 1 c. second degree AV block type 2 d. third degree heart block

D The patient symptoms of chest pain, dyspnea, and dizziness combined with the ECG findings indicate a third degree heart block. Normal sinus rhythm with first degree AV block is a prolonged PR interval and the heart rate is 60 to 100. The second degree AV block type 1 has a PR interval that varies with a QRS segment being dropped. The second degree AV block type 2 PR interval is not prolonged, but the QRS segment is dropped.

An 82-year-old female patient arrives via EMS following a low-speed collision. She was driving and the sole occupant in the car. She reports that suddenly she lost control and the car slid off the road hitting a parked car. Airway and breathing are intact and vital signs are stable. She is alert and oriented to person, place and time. She has a left-ankle deformity; otherwise, no obvious signs of injury. She complains of chest pain but denies any shortness of breath. The cardiac monitor shows ST-elevation in lead II, and a stat 12 lead ECG shows ST-elevation in leads II, III and AVF. What other information is needed to help determine the origin of her chest pain? a. Do you have any medication allergies? b. What medications do you take? c. Does the chest pain hurt worse with movement? d. Did the pain begin before you lost control of driving?

D. All the above questions are needed information; however, her present signs of ST-segment elevation are suggesting that she is having an inferior-wall MI. The onset of her chest pain may help indicate if the crash is causing her chest pain (and possible I) or if the chest pain precipitated her losing control of her car leading to the crash.

Which of the following patients is NOT at risk for aspiration? a. a 72-year-old male with increasing weakness and confusion b. a 24-year-old trauma victim that is intubated c. a 42-year-old female with a history of Multiple Sclerosis d. a 58-year-old male with history of Bell's Palsy

D. Although symptoms mimic those of a TIA or stroke, Bell's Palsy affects the seventh cranial nerve and is limited to the face, therefore does not impair the swallowing mechanism. Advanced age, neurological disorders, such as Multiple Sclerosis, and endotracheal intubation are risk factors for aspiration.

A 38-year-old male presents to the emergency department complaining of weakness and numbness of the lower extremities. He had a fever with "the flu" a few weeks ago, but no other medical history. He states the numbness started in his feet but has now progressed to the level of his hips and he is so weak he can barely stand. Exam shows depressed deep tendon reflexes and symmetrical weakness of the lower extremities. The ED nurse anticipates this patient will need a. admission to the ICU on an insulin infusion b. ultrasound cardiovascular exam of bilateral lower extremities for arterial occlusion c. lumbar puncture to rule out meningitis d. admission to the ICU and mechanical ventilation

D. Ascending symmetrical weakness and numbness with loss of deep tendon reflexes indicates Guillain-Barre Syndrome. One quarter of all patients with Guillain-Barre require mechanical ventilation due to respiratory failure as the syndrome progresses to breathing muscles. The patient's history does not suggest he has hyperglycemia and would need an insulin infusion. He is not exhibiting signs of arterial occlusion in the lower extremities or signs associated with meningitis.

A 34-year-old male being treated for an acute asthma exacerbation is showing improvement after treatment. However, he is tachycardic and complaining of dry mouth. His pupils appear dilated. This is likely a side effect of a. albuterol b. prednisone c. magnesium sulfate d. atropine sulfate

D. Atropine sulfate is an anticholinergic, a parasympatholytic causing dilated pupils, decreased salivation, and tachycardia. Anticholinergics also dilate the bronchi and stimulate the release of epinephrine and norepinephrine, which is why medications such as atropine may be beneficial in reactive airway diseases. Albuterol is a B2 adrenergic agonist, a sympathomimetic that causes skeletal muscle tremors, anxiety, tachycardia, headache, palpitations, and hypertension. Prednisone can cause hyperglycemia, and magnesium sulfate can cause irregular heartbeat, hypotension, or muscle weakness.

A patient presents to the emergency department with back pain and right lower leg pain. The nurse performs an assessment and discovers the right leg is pale and pulseless. The patient reports intense pain, paresthesia, and paralysis in the right leg. The patient is diagnosed with acute arterial occlusion. What would be the patient's priority intervention? a. give the patient morphine for the pain b. apply ice to the right leg c. elevate the right leg d. administration of tissue plasminogen activator (tPA)

D. Blood flow needs to be immediately restored to the right leg and tPA or an embolectomy will restore the blood flow. Morphine is important, but will not restore the blood flow to the right leg. Applying ice to the right leg will cause vasoconstriction worsening the patient's condition. Elevating the right leg will not repair the obstruction of blood flow and could potentially worsen the condition.

A patient was found at home in cardiac arrest. The patient regained a pulse during EMS treatment. CPR is in progress as the patient enters the emergency department. After two minutes of CPR, a rhythm check reveals asystole. What are the recommended interventions for asystole? a. defibrillation and epinephrine b. CPR and atropine c. defibrillation and atropine d. CPR and epinephrine

D. CPR and epinephrine are the recommended interventions for asystole. Atropine is not recommended to treat asystole as there is no evidence of benefit for the patient. Defibrillation is not recommended because there is no electrical current with asystole.

A patient has the following cardiac rhythm: inverted or missing P waves, narrow QRS segments, QT interval of 0.44, and a heart rate of 44 bpm. What is the rhythm? a. atrial fibrillation b. sinus bradycardia c. idioventricular rhythm d. junctional rhythm

D. Classic junctional rhythms have no P wave or an inverted P wave, narrowed QRS segment, and a heart rate between 40 to 60. Atrial fibrillation has no discernable P waves, a narrowed QRS segment, and heart rate between 60 to 100 or greater than 100. Idioventricular rhythm has no P wave, wide and bizarre QRS segment, and heart rate between 30 to 40.