CEN Randomized 150 Question Prep Quiz

Four patients arrive at the front desk of the ED. 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

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 heard. This phenomenon will not occur with a tension pneumothorax or flail chest.

The ED RN suspects central retinal artery occlusion due to what assessment finding? a. sudden painless vision loss b. visual field curtain c. sudden onset of extreme unilateral eye pain d. intraocular pressures of 25 mm Hg

A A unique characteristic of central retinal artery occlusion is sudden painless vision loss. visual field curtain is common in retinal detachment. Sudden extreme unilateral eye pain is most likely to be related to glaucoma. Intraocular pressures of 25 mm Hg is a slightly elevated result and may be related to one of several causes, including uveitis, early glaucoma, or eye trauma.

A 45-year-old male patient presents to triage complaining of sudden onset of big toe pain. On inspection, the triage nurse notes a red, hot, and swollen great toe. Patient denies trauma. The triage nurse suspects the patient has a. gout b. bursitis c. foot fracture d. achilles tendon rupture

A An initial episode of gout is often characterized by spontaneous, intense pain with edema at the metatarsophalangeal joint. Bursitis is often the result of overuse or infection and the common sites are shoulder, elbow, hip, knee, and heel of the foot.

A 45-year-old female patient enters into the ED 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.

Damage control resuscitation for traumatic hypovolemic shock focuses on preventing all of the following complications except a. infection b. blood loss c. coagulopathy d. metabolic acidosis

A Damage control resuscitation does not prevent infection. Infection control measures include hand hygiene and aseptic technique. Administering combined blood products to replenish clotting factors and blood volume and maintaining adequate perfusion are part of damage control resuscitation interventions.

A 45-year-old man arrives by EMS after being "accidentally" stabbed in the chest by his girlfriend an hour earlier. Upon arrival, he is restless and complaints of shortness of breath. He is on a NRB mask with high flow oxygen. VS are T 97.4, P 116, R 32, BP 82/56, SpO2 81%. Decreased breath sounds are auscultated on the left side and a stat chest x-ray confirms a tension pneumothorax. What intervention should occur next? a. a needle thoracostomy b. obtain a type and crossmatch lab c. a chest tube placement d. prepare for surgery

A Immediate decompression of tension pneumothorax is a top priority with the goal of restoring adequate ventilation and perfusion to the lungs. Chest tube placement is the definitive treatment, after decompression to relieve the trapped air. Depending on the amount of internal blood loss and patient symptoms, blood products may be needed after his airway and breathing are stabilized. Surgical intervention may be required following his trauma resuscitation.

The emergency nurse is reviewing discharge instructions with a patient who received sutures to her face. The nurse knows her teaching is effective when the patient states, "If there are no signs or symptoms of infection, I will have my sutures removed in a. 3 to 5 days" b. 5 to 7 days" c. 7 to 10 days" d. 10 to 14 days"

A Sutures to the face, lips, and eyelids should be removed in 3 to 5 days. Sutures to the eyebrow should be removed in 5 to 7 days. Sutures to the back, chest, arms, hands, and thighs should be removed in 7 to 10 days. Sutures to the lower legs and feet should be removed in 10 to 14 days.

Generally, documentation requirements for a patient being discharged from the ED to return to home at a skilled nursing facility include a. discharge instructions including results from medical screening exam b. discharge instructions and EMTALA transfer process c. discharge instructions and updating the medical power of attorney d. discharge instructions and EMS transport documentation

A The hospital should provide documentation validating the results of the patient's medical screening exam, a requirement of the EMTALA law. Discharge instructions meet this requirement.

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 to 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 patient presents with urticarial rash, angioedema, and hoarse voice after consuming crab cakes. His airway is patent, what is the priority of care? a. administer 0.01 mL/kg epinephrine (1 mg/mL concentration) IM to max dose of 0.5 mg b. administer H1/H2 blockers c. administer corticosteroid d. administer oral diphenhydramine

A The patient is displaying symptoms of anaphylaxis.

A patient presents to the ER through triage with a headache. She was seen at urgent care 6 days ago for a sinus infection but now reports "I thought I was all better, but suddenly tonight it is much worse." The patient is febrile at 103.6 and complains of a stiff neck, which is a very painful to move. The triage nurse prioritizes which interventions for this patient? a. IV access, labs, and blood cultures followed by antibiotics b. lumbar puncture and head CT scan, followed by antibiotics c. head CT scan, followed by LP and antibiotics only after CT results d. lumbar puncture, head CT scan with antibiotics after LP results.

A The question asks the nurse to prioritize interventions for a patient with suspected bacterial meningitis.

A young professional woman has delayed pregnancy until timing is more appropriate with her lifestyle. She had a positive pregnancy test at 9 weeks gestation and has seen the NP in her OB's office for her first prenatal visit at 11 weeks gestation. She is currently 12 4/7 weeks gestation and is having spotting of bright red bleeding. Terrified that something is going wrong with the pregnancy, she comes to your ED. She has no pain with the bleeding but did have some menstrual like cramping earlier that has gone away. FHT are 135 bpm. After checking her cervix, it is closed. There is a small amount of darker blood in her vagina but no active bleeding is seen. Patient is suspected of having a. threatened abortion b. inevitable abortion c. missed abortion d. complete abortion

A Threatened abortion: cervix remains closed; inevitable abortion: cervix dilates to 3 cm; missed abortion: no bleeding or cramping are present; complete abortion: some bleeding, mild contractions and product of conception is passed and cervical os is closed. You may confuse the somewhat similar symptoms of threatened abortion and complete abortion but this patient still has FHTs.

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 patient presents to the ED with a primary concern of suicidal ideation. He has attempted suicide four times before, overdosing on medications each time. Which of the following statements is not true? a. It is important to realize someone who has overdosed four times in the past is at decreased risk for suicide b. Suicidal "contracts" made with patients have not been shown to decrease suicide c. Firearms are used in the US more than any other means to die by suicide d. Mental illness is a risk factor which is important to consider

A. A past history of suicide attempts is a strong indicator of future suicidal risk.

A 65-year-old patient presents to the ED with a new onset of psychosis. He has no history of mental illness per his and his wife's report. The nurse begins the assessment. All of the following statements are true except a. this is unlikely a new onset of mental illness b. toxicology screen would be important to assess c. sudden cessation of ETOH use could be a factor d. medication such as steroids could be a factor

A. It would be unlikely this presentation would be a new onset of mental illness. If the patient has a history of mental illness, this could be causing the psychosis. Toxicology and medication review could reveal a cause for the psychosis. Cessation of ETOH use could lead to ETOH withdrawal which can present with psychosis.

The acronym SLUDGE as seen in insecticide and organophosphate exposures stands for a. salivation, lacrimation, urination, defecation, gastrointestinal distress, and emesis b. salivation, lacrimation, urination, gastrointestinal distress, and elimination c. salivation, liquidation, urination, defecation, gastrointestinal distress, and emesis d. salivation, lacrimation, urination, defecation, gastritis, and erection

A. The acronym SLUDGE references the words salivation, lacrimation, urination, defecation, gastrointestinal distress, and emesis. These are common symptoms of an exposure to an organophosphate insecticide.

A patient presents with a sore throat that has recently worsened. His voice is muffled, and he complains of a two day history of fever. He has not eaten or drank because of the pain. Upon inspection, the nurse notes his tonsils appear enlarged and purulent. His painful swallowing is a. odynophagia b. trismus c. halitosis d. otalgia

A. Trismus is the inability to open the mouth. Halitosis is foul breath. Otalgia is ear pain and odynophagia is pain upon swallowing. All of these are signs and symptoms of a peritonsillar abscess.

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

B

A woman who is pregnant comes in the ED with irregular contractions that began 2 hours ago and are occurring more frequently. She is 31 2/7 weeks gestation. Baby is active and fetal heart tones are ranging 150 to 155 bpm. Her contractions are palpable and occurring every 10 minutes. What symptom will suggest preterm labor? a. patient feels like she needs to void b. there is evidence of cervical change and dilation c. regular contractions at 5 minutes apart d. patient feels better sitting up

B

You had labs drawn last week for a routine physical. You work in the same system where you had the labs drawn. While at work, you decide to obtain your results a. it is okay to look in the EMR for the results because they're your labs, therefore not a HIPAA concern b. you should go to medical records and sign a release of information to obtain your labs c. you should ask a co-worker to print them for you, which is okay because you gave her verbal consent d. you should get permission from your manager to look up your labs

B

During the course of a procedural sedation, a patient's respiratory rate drops to 10 breaths/minute. The nurse should a. stop the procedure b. assess the patient's vital signs and capnography values c. do nothing. a decreased respiratory rate is normal during sedation d. reposition the patient's airway to ensure patency

B A decreased respiratory rate requires an assessment of the patient and his ventilation status. The procedure should not be stopped if the patient is tolerating a respiratory rate of 10. A respiratory rate of 10 is slightly below normal and should not be ignored. If an obstructed airway is suspected, repositioning the patient's airway is not likely to help increase the respiratory rate.

How does a periapical abscess differ from a periodontal abscess? a. the periapical abscess involves a minimum of two or more dental caries b. the periapical abscess extends beyond the bone c. the periapical abscess may occur around a healthy tooth d. the periapical abscess can occur in the absence of a dental caries

B A periapical abscess involves the dentin, and can extend down into the pulp and nerve roots. Typically, the periapical abscess arises from untreated dental caries. A periodontal abscess occurs when a pocket can form around the tooth creating a reservoir for bacteria and/or other pathogens. The tooth may remain healthy, but the gum tissue around it is inflamed and becomes infected causing a periodontal abscess.

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 back on the endotracheal tube so it rests just above the right main bronchus.

The ED RN is assessing a person bitten on the left hand by a rattlesnake. The RN identifies two fang marks on the hand with some minor edema and bleeding. The patient complains of minor pain, and vital signs are within normal limits. Upon reassessment an hour later, the ED RN finds no change in the patient's assessment. This can best be explained by which phenomenon? a. this patient is immune to snake venom b. a "dry bite" that did not involve envenomation c. not enough time has passed for the snake venom to cause symptoms d. the patient was not bitten by a snake

B Dry bites occur in approximately 20% of pit viper snakebites. Dry bites are characterized by the presence of fang marks without symptoms of envenomation such as pain, edema, or systemic changes such as vital sign abnormalities. It is possible that this patient was not bitten by a snake. The ED RN must take a careful history to determine the accuracy of the patient's description of the snake and if in fact it is poisonous.

The priority in the assessment of a patient with homicidal ideation is a. ensuring the individual that they are targeting is informed b. assessing for immediate danger c. developing a plan to ensure the patient and others are safe d. calling the police to inform them of the risk

B During the assessment phase, the RN should ensure immediate safety is ensured.

A patient is brought into the ED 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 RN 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 presents to the ED following collapse at a distance running event. The emergency nurse immediately suspects a heat-related emergency. What signs and symptoms would the nurse expect to see with heat stroke as opposed to heat exhaustion? a. core temperature 102.5, warm skin, profuse perspiration, and altered mental status b. core temperature 104.5, hot skin, lack of perspiration, and altered level of consciousness c. headache, pale skin, and profuse perspiration d. muscle cramps, mild tachycardia, headache, and lack of perspiration

B Heat stroke is a medical emergency and is differentiated from heat exhaustion by a core temperature of greater than 104.0 and the lack of perspiration.

The ED RN knows to anticipate transfer to the OR for the following patient injury a. puncture wound to the hand b. paint gun injection to the hand c. ligament tear in the knee d. stage 1 pressure ulcer

B High-pressure injuries such as paint gun injections are serious, and immediate surgical intervention is required to drain the paint or oil and to preserve tissue.

Which of the following would not be an indicator of potential abuse? a. elderly dementia patient with patterned bruising b. toddler who has bruising in various stages of healing c. husband refuses to let the nurse interview his wife alone d. stories of a child's injuries change

B It is not unusual for toddlers at the cruising age to have bruising from falls.

One key characteristic of panic attacks which is often most difficult for patients is a. embarrassment over the attacks b. fear of recurrent attacks c. associated nausea d. that they are not taken seriously

B Panic attacks are associated with a fear of reoccurrence. This fear may be debilitating to patients. The panic attacks may be associated with a wide range of physiological systems and sometimes social impact such as embarrassment. Panic attacks are often taken seriously due to the associated physical symptomology.

A patient collapses in the ED parking lot and appears to be in acute distress. The parking lot is located 75 yards from the ED entrance. The triage RN should a. call 911 to pick up the patient b. bring the patient in for stabilization treatment c. do nothing since the patient is outside d. call security to determine what is going on out there

B The patient is on hospital property and within 250 yards of the entrance; therefore EMTALA law applies to this patient.

A seventh-month old girl is brought into the ED 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 100.9, rhinorrhea, and tachycardia. Otherwise the child has clear lung sounds and appears well hydrated. The ED RN 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 patient arrives in the ED after being involved in a 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.

A 68-year-old arrives via EMS with complaints of shortness of breath. Symptoms started about 3 hours prior to arrival. According to the patient's wife, he had flu-like symptoms for the past three days. He has no other significant past medical history. Upon arrival, he is on oxygen at 4 liters via NC. VS are T 96.2, P 98, RR 24, BP 110/62, SpO2 93% on RA. According to his presentation, what condition would the nurse suspect? a. pulmonary embolism (PE) b. sepsis c. ARDS d. DIC

B This patient has a suspected infection, and sepsis is often diagnosed in the presence of a suspected or actual infection along with some of the following signs and symptoms: some of the diagnostic criteria of fever greater than 100.9, or hypothermia (core temp less than 96.8), heart rate greater than 90 per minute, tachypnea, AMS, significant edema, hyperglycemia (>140 in the absence of diabetes).

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 750 mL 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 female patient presents to the ED with severe diarrhea, fatigue, and weight loss. The ED RN performs a history and assessment. Which historical finding suggests the patient may have giardiasis? a. patient works in a meat processing plant b. patient traveled to New Mexico recently c. patient works in a day care center d. patient is a vegan

C Giardiasis is a parasitic disease causing severe diarrhea, fatigue, fever, and weight loss. Those traveling outside the US, day care workers, children, and individuals with poor dietary habits are most at risk for ingesting the giardiasis parasite.

A patient presents with a maculopapular rash on his trunk, fever, fatigue, and diarrhea. He states, he is an IV drug user sex worker. What is the likely cause of his symptoms? a. measles b. MRSA c. HIV d. Herpes Zoster virus

C Given his history and symptoms, he likely has primary HIV infection.

A triage nurse would anticipate a diagnosis of shingles with a patient presenting with complaints of a. painful, bilateral flank pain b. a generalized, urtucarial rash; with a history of exposure to chicken pox c. a painful, itchy rash appearing with tiny blisters along a unilateral dermatome of the trunk d. a generalized, pruritic rash that appears to have small blisters

C Herpes Zoster, also known as shingles, is characterized by a maculopapular rash, which is very painful and itchy, and commonly appears on the trunk and follows a unilateral dermatome.

While shopping, Jane notices a dull headache beginning. Jane is 35 weeks pregnancy and has noticed additional swelling and heartburn over the past two weeks. Upon arrival to the ED, Jane begins to have a seizure. The nurse knows to expect what treatment to be ordered a. oxytocin b. D50 c. magnesium sulfate d. phenytoin

C In a pregnant patient experiencing seizures, preeclampsia should be suspected. Magnesium sulfate reduces seizure activity through an unknown mechanism, but has been shown to be more effective than other seizure medications, such as phenytoin. Oxytocin and D50 are not indicated at this time.

A patient presents to the ED with hypertension, left side weakness, and an inability to speak. The patient appears frustrated and anxious but is able to follow commands. The ER RN 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 process 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.

The ED RN is discharging an otherwise healthy 75-year-old male patient diagnosed with cystitis. He is prescribed Bactrim and Pyridium. All of the following statements demonstrate his understanding of his discharge instructions except a. "I need to drink at least 8 glasses of water a day" b. "I need to take all of my Bactrim as it is prescribed" c. "If my urine turns a rusty orange color I should come back here" d. "I need to follow up with my doctor next week"

C Pyridium may be prescribed for dysuria and urinary frequency and can turn the urine orange or a reddish orange color.

When assessing a patient's history to analyze risk factors for epistaxis, the nurse would want to inquire about a. recent travel b. family history of heart disease c. herbal supplements d. diet restrictions

C Specific herbal supplements such as ginseng contain anticoagulation properties that can increase the risk for epistaxis.

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 comination

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.

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 aspriation. A chest x-ray is helpful in confirming tube placement, but will not reduce the risk of aspiration.

A patient experiences point tenderness at McBurney's point during an abdominal assessment. What other findings may coincide with this symptom? a. history of chronic intermittent pain b. hematochezia c. elevated WBC d. pain radiates to the right shoulder

C. McBurney's point is located midway between the umbilicus and the anterior superior iliac crest in the RLQ. If point tenderness is localized at this point, it may be an indication of an acute appendicitis. An elevated WBC, in the presence of other suspecting symptoms, has a greater diagnostic value for appendicitis. Acute pain is associated with appendicitis. The risk of perforation increases if symptoms are present more than 48 hours. Hematochezia is bright red or maroon rectal bleeding and is suggestive of a lower GI bleeding or a massive upper GI bleed. Pain radiating to the right shoulder can be symptomatic for acute cholecystitis

A 45-year-old man arrives by EMS after being stabbed in the chest an hour earlier. Upon arrival, he is restless and complains of shortness of breath. He is on a NRB with high flow oxygen. VS are T 97.4, P 116, RR 32, BP 82/56, SpO2 81%. Diminished breath sounds are auscultated on his left side and tracheal deviation is noted toward his right side. What type of injury and shock are suspected? a. pericardial tamponade (obstructive shock) b. pericardial tamponade (distributive shock) c. tension pneumothorax (obstructive shock) d. tension pneumothorax (distributive shock)

C. Obstructive shock is a classification of shock when blood flow is decreased. The hypoperfusion is caused by a pathological obstruction as seen with a tension pneumothorax, pericardial tamponade and pulmonary embolus.

A patient arrives with a splint to his upper extremity. He reports 10/10 pain despite analgesia administration and burning sensation to his arm. The most likely cause of his unrelieved pain is a. a torn ligament b. a history of narcotic dependency c. compartment syndrome d. blood loss

C. Pain out of proportion to the injury which is not relieved by usual measures is a cardinal sign of compartment syndrome. Torn ligaments do not generally cause consistent, unrelieved pain, especially if they have been appropriately immobilized. Blood loss would not necessarily cause an increase in pain. Although the patient may have a history of narcotic dependency, he also has a fracture and all organic causes of his symptoms should be evaluated before this diagnosis is made.

The most common presentation for a patient with bipolar in a manic state is a. suicidal ideation b. depressed mood and irritability c. elevated mood and psychomotor agitation d. both depressed mood and elevated mood

C. Patients who are experiencing a bipolar manic state often present with an elevated mood frequently accompanied by irritability and psychomotor agitation. Bipolar disorder does convey an increased risk for suicide but the risk is greater during the depressive episodes of bipolar. Episodes of bipolar include mania or hypomania and depression. In the manic state, someone would not have a depressed mood.

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 appear 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 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.

The primary purpose of triage is to a. ensure the patient is properly registered with his legal name b. get patients to a physician immediately c. prioritize patients needing immediate treatment over those who can wait d. assess the patient to determine resources needed when he is placed in a room

C. The primary purpose of triage is to sort the patients to determine who will see the provider first.

An ED RN enters a patient's room to collect a patient history. The patient's chief complaint is "hearing voices" and has a history of psychosis. Currently, he is quiet and calm. To ensure safety, the nurse should a. turn the tv on to provide a distraction for the patient b. offer a meal to the patient if he answers all of the questions c. confirm an escape route by positioning between the door and the patient d. place the patient in 4-point restraints

C

The ED RN is in the hall when they hear screaming from a room down the hall. The nurse responds and finds a patient's wife yelling and screaming. She is standing in the corner, appears red in the face, and is breathing rapidly. Her husband is hiding under the covers. The nurse attempts to de-escalate the situation. The first action of the nurse is to a. approach the patient with arms extended b. yell at the patient's wife to calm herself or security will be called c. manage personal reactions d. ask for PRN lorazepam to calm the wife

C

While palpating the abdomen of a patient, the ED RN observes rebound tenderness. Rebound tenderness raises the possibility for all of the conditions except a. appendicitis b. a perforated colon c. constipation d. cholecystitis

C Although rebound tenderness does not have 100% sensitivity for appendicitis, peritonitis (a perforated colon) or cystitis, patients presenting with any of these conditions may have rebound tenderness noted during physical assessment. Some of the common symptoms associated with constipation are abdominal discomfort, bloating, and straining during bowel evacuation.

A 41-year-old male patient presents to the ED after an exposure to an organophosphate insecticide. After decontamination, he is experiencing profuse salivation and is urinating and defecating frequently. The ER RN anticipates which medication will be ordered? a. an antiemetic and antidiarrheal medication b. IV atropine c. IV atropine and IV pralidoxime (2-PAM) d. epinephrine and diphenhydramine

C Atropine and pralidoxime are the agents used to treat an organophosphate exposure. Atropine works by reducing symptoms (SLUDGE) while pralidoxime works by binding the organophosphate, which is considered curative. IV atropine alone will not eliminate the organophosphate from the nerve synapse; it will only reduce the symptoms of SLUDGE. Epinephrine and diphenhydramine are not indicated, and antiemetics are antidiarrheals are not priority for this patient.

A patient arrives to the ED complaining of left shoulder pain. The shoulder is swollen with obvious deformity. The patient is unable to raise the left arm or bring it across the chest. The emergency nurse suspects a(n) a. radial fracture b. rotator cuff injury c. shoulder dislocation d. arthritic shoulder

C Dislocations present with deformity and limited range of motion. Arthritis is a chronic condition, not an acute process. Rotator cuff injuries result in pain with movement but no significant restriction on range of motion or swelling. Radial fracture should not affect a patient's ability to perform shoulder range of motion.

The ED RN knows discharge teaching was effective when a patient with gout reports a. "Alcohol doesn't effect my risk for gout attacks" b. "Weight reduction will increase my gout attacks" c. "I should drink plenty of water to reduce my risk of gout attacks" d. "I should eat more purine-rich foods to prevent uric acid build up"

C Drinking plenty of water is linked to fewer gout attacks.

A 53-year-old patient presents to the ED by EMS with a chief complaint of nausea and dizziness with headache. EMS started an IV and gave a 500 mL NS bolus and 4mg of Zofran prior to arrival. VS are P 70, RR 20, BP 169/59, SPO2 99% RA. The patient states his main complaint is his headache, which has been going on for a few days but is now much worse. He also states he's been "bumping into things, lately and I might need my glasses checked." Eyes are reactive, but the left pupil is 2 mm larger than the right. On exam the ED RN notes no unilateral deficits. The priority is to a. obtain labs, ECG, and a full set of vitals b. notify the emergency provider with anticipating an order for a stat non-contrast head CT c. obtain a visual acuity exam and collect a detailed medical history d. apply high flow oxygen via NRB

B This patient has symptoms of a posterior stroke, which can often be missed because they do not present with unilateral weakness. Headache with nausea and visual disturbance coupled with the difference in pupil size (anisocoria) should raise the nurse's concern of a cerebrovascular accident.

A 17-year-old male presents to the ED with complaints of weakness. He is tachypneic, tachycardia, and hypotensive. A glucometer check in the waiting room reveals a glucose reading of 406. The triage nurse anticipates which immediate action? a. transport to ED treatment area b. assess airway c. establish IV d. administer insulin

B This patient is presenting with symptoms of hypovolemic shock, possibly a nonhemorrhagic origin such as DKA. Although he would need all of the above interventions, a patent airway is the top priority.

A critically injured trauma patient arrives in the ED following ejection from the car that he was driving. He was unresponsive, hypotensive, and intubated at the scene. During transport via medical helicopter, he received 2 units of crystalloids, 2 units of packed red blood cells, 1 unit of fresh frozen plasma, and Tranexamic Acid (TXA) IV. Current vital signs are T 97.8, P 128, RR 16 (assisted), BP 80/48. The ED RN anticipates the one of the following lab tests is needed for guiding blood product administration a. hematocrit and hemoglobin b. INR c. thromboelastography d. platelet count

C. Thromboelastography (TEG) provides a visual graphic about the clotting process. The graphic provides information about specific clotting factors that are deficient and can guide administration of blood components. The other lab tests do not provide complete information about any coagulopathy.

A 41-year-old female patient presents to the ED with a suspected infection. The patient develops fever, tachycardia, rigors and hypotension. Her vital signs are T 102.6, P 118, RR 20, BP 84/52, SpO2 92% on RA. The following lab test is a sensitive marker for decreased tissue perfusion? a. procalcitonin b. INR c. lactate level d. ABG

C. When a patient with a suspected or known infection develops sepsis with possible deterioration to septic shock, a serum lactate is a sensitive indicator for tissue hypoxia.

Environmental factors contributing to reducing the risk for violence include all of the following except a. use of metal detectors b. training for staff in de-escalation techniques c. rooms free of potential weapons d. limiting access for non-patients

B. The training of staff in de-escalation would not be considered an environmental factor reducing the risk for violence. It is important to keep rooms free of items that could be used as weapons and to maintain an easy exit at all times.

A patient has a history of hypertension and hyperlipidemia and states that he developed sudden onset of upper back pain and 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 patient is being treated in the ED for a Jimson weed exposure. Upon arrival, ED staff called the poison control center help line. Three hours later, the poison control center calls for an update. To comply with HIPAA laws, the nurse a. cannot release any information b. can share information about the overdose c. should ask the charge nurse what to do d. should have the provider speak with the poison control center

B. When initially called about the patient's case, the poison control center became a consultant on the case and is thereby part of the patient's treatment team. Therefore, HIPAA laws provide for sharing relevant information with the poison control center.

An ill-appearing 50-year-old male arrives at the ED via EMS. His chief complaint is abdominal pain, vomiting, and fever of 101 for the past 12 hours. His abdominal pain is diffuse with muscle rigidity upon palpation of his abdomen. Past medical history is noncontributory except for a screening colonoscopy 24 hours earlier. This patient may be experiencing the following condition a. appendicitis b. diverticulitis c. perforated ulcer d. peritonitis

D A perforation may have occurred from the colonoscopy causing spillage of bowel contents into the peritoneal cavity. If left untreated, sepsis will ensue. His history of having a recent colonoscopy would raise the index of suspicion for a perforated colon. Typically pain from appendicitis becomes localized in the RLQ and pain from diverticulitis becomes localized in the LLQ. Although a ruptured appendix or perforated ulcer can cause diffuse abdominal pain with peritonitis, his history of a recent colonoscopy coincides with the potential cause of his peritonitis.

You enter the room of a 2-year-old child who arrived in cardiac arrest after being hit by a car. Trauma resuscitation efforts are discontinued 90 minutes later and the child is pronounced dead. The grieving parents remain with their child. One of the most important nursing interventions is a. assist with funeral arrangements b. remind them the death was not their fault c. call the corner/medical examiner and organ donation service d. support their bereavement and provide a quiet calm area for them

D.

A 51-year-old patient has come to the ED with fever, sore throat and hoarseness for the past 4 days. Today, he felt like he was "choking" in his airway. He has been diagnosed with Ludwig's angina. The nurse's first priority is assuring the following is available a. cardiac monitoring b. IV antibiotics c. IV hydration d. cricothyrotomy tray

D. A patient with Ludwig's angina has a great risk for airway obstruction due to the edema within the submandibular space, an area that does not provide needed expansion to accommodate swelling without minimizing or occluding the airway. Often these patients are taking directly to the OR with plans for intubation with preparation for a tracheostomy, if needed. Cardiac and pulse oximetry monitoring are indicated as well as IV antibiotics and fluids; however, with the first priority of "airway," an emergency surgical airway kit within reach will prevent a delay if an emergency airway is needed.

The ED RN is caring for a patient contaminated with gamma radiation particles. The ED RN understands what principle for ensuring healthcare team safety by minimizing exposure? a. gamma radiation has little or no risk with exposure b. decontamination will keep the nurse and staff safe c. distance and shielding from the patient d. time, distance, and shielding

D. The principle of time, distance, and shielding is the preferred method to minimize exposure to ionizing radiation. By minimizing time near the source of radiation, the amount of ionizing radiation absorbed is reduced. Distance from a source of ionizing radiation also minimizes exposure. The use of shielding such as lead aprons and thyroid shields can provide the most benefit. Respiratory protection is also warranted in order to prevent inhalation of a radioactive substance.

Following discharge instructions for a patient with Uveitis, the ED RN knows instructions are understood when the patient says a. "I'll just go home and read a book" b. "I'll rest and catch up on my favorite TV show" c. "I'll just go relax on the beach" d. "It's going to be hard to stay away from my computer"

D. Treatment for uveitis includes eye rest in dark environments. Eye rest includes time away from television and other "screens" and reading so verbalization of the need to reduce computer usage indicates understanding. Reading and watching TV creates stress on the eye and time at the beach increases exposure to bright lights.

The ED RN is reviewing abscess treatment discharge instructions with a patient. The nurse knows the teaching is effective when the patient states a. i will soak the wound every night so the packing stays moist b. i will take my antibiotics until the swelling goes down c. i will return to my doctor tomorrow to have the wound closed with sutures d. increased swelling and redness are a signs of infection, which I should have re-evaluated

D

Three young children in the same family are diagnosed with chicken pox. Discharge instructions noted for this family include all of the information except a. chicken pox is caused by the varicella zoster virus and is very contagious b. the rash which develops, is pruritic in nature c. a person may develop a mild fever and is contagious from 1 to 2 days before the outbreak of the chicken pox rash d. there is no risk of exposure to immunocompromised individuals

D

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.

A patient has just been in a traumatic MVC in which a passenger is killed. The patient does not appear injured, but is visibly distressed. The ED RN enters the room and understands the patient may have all of the following characteristics of a situational crisis except a. the nurse may need to take control of the situation b. reactions can differ based on individuals c. culture can often play a role in the way someone responds to situational crisis d. people with preexisting mental health diagnosis react better to crisis situations

D

You are working the evening shift and are concerned several of the patients in the ED currently are at risk for violence. You know the patient with the highest risk for violence is a. an 88-year-old male who is confused and is using a loud voice to get his point across b. a 40-year-old woman coming in on the ambulance who has been violent in the ambulance c. a 24-year-old male who is intoxicated and has a laceration to his foot d. a 23-year-old patient with a diagnosis of schizophrenia who has hallucinations

B. Although each of these patients present with risk factors, the best predictor of violent behavior is a history of violent behavior. The woman who is violent in the ambulance has demonstrated recent violence and is at the highest risk. The 88-yar-old male demonstrates risks of being male, confusion, and using a loud voice, which may indicate an escalation of behaviors. An intoxicated male in his twenties demonstrates a risk for violence related to the intoxication and being male. A patient with schizophrenia who has hallucinations may be at risk if the hallucinations are causing paranoia. In this case, we do not know the content of the hallucinations.

A patient presents to the ED following a near drowning in a nearby lake. The patient is receiving high-flow oxygen and is maintaining his airway. The nurse notes coarse lung sounds throughout all lung fields. What is the emergency nurse most concerned about with initial treatment in a near drowning? a. sepsis due to inhalation of dirty water b. aspiration pneumonia and hypothermia c. physical trauma due to the violent nature of near drowning d. hyperthermia

B. Aspiration pneumonia and hypothermia are both likely in near drowning episodes, and each should be considered in any submersion event. Bacterial pneumonia is a concern as well, although much later. Near-drowning patients are at risk for hypothermia. Sepsis is not a threat in this present scenario. A near drowning is not typically associated with traumatic injuries, although more information may be collected after initial treatment.

A 28-year-old male patient is being discharged from the emergency department following a diagnosis of epididymitis. The ED nurse knows the patient understands his discharge instructions when he makes the following statement a. i may not ever be able to have kids b. i need to wear support, like a jock strap, when i am up walking c. i can keep running in preparation for the marathon i'm in next month d. my antibiotic is only needed if the pain doesn't get better

B. Epididymitis can be from a sexually transmitted infection. Other causes can be from urological procedures such as a cystoscopy. Pain is a hallmark of the illness, and elevating and supporting the penis especially during physical activity decreases the pain. Often, the patient may be advised not to resume vigorous physical activity until they have followed up with their primary care physician or urologist. Infertility typically is not related to epididymitis. Antibiotics may be prescribed if a STD is suspected, and the patient should complete the entire course of antibiotics.

Eye drops are administered into the a. lacrimal sac b. conjunctival sac c. cornea d. Canal of Schlemm

B. Eye drops are administered into the conjunctival sac by using the index finger to place gentle traction under the eye OR using the index finger and thumb to gently pinch the tissue under the eye to create a pocket between the lower eyelid and the sclera of the globe.

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.

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.

A mother drives her 6-year-old son, with a peanut allergy, to the ED after he developed urticaria. The child weighs 20 kg. The ED RN observes edema around his lips and hears inspiratory wheezes when auscultating lung sounds. The next action should be a. establish an IV and administer a 400 mL 0.9 NS fluid bolus b. apply a cardiac monitor and continuous pulse oximetry c. administer 0.15 mL epinephrine IM (1 mg/mL concentration of epinephrine) d. administer 0.015 mL epinephrine IM (0.1 mg/mL concentration of epinephrine)

C This child's allergic reaction is deteriorating to symptoms of anaphylaxis. He is developing angioedema, and his lung sounds have wheezing. Epinephrine is the most important treatment for suspected anaphylaxis. The correct concentration for epinephrine, when administered IM, is 1 mg/mL (or 1:1,000). The correct concentration is 0.1 mg/mL when epinephrine is administered IV (or 1:10,000). Cardiac monitoring and pulse oximetry are indicated but can immediately follow administration of epinephrine. IV establishment and a fluid bolus (20 mL/kg) may be indicated if the child's symptoms continue and anaphylactic shock is suspected.

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 2 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.

An adult patient involved in a car fire enters the ED. Once stabilized, the ED RN determines that the patient has burns to the anterior chest, left anterior arm, and right posterior leg. Using the rule of nines the ED RN estimates the total surface burn area as a. 18% b. 27% c. 32% d. 36%

C Using the rule of nines, the anterior chest scores at 18%, the anterior and posterior arms are each 4.5%, and the anterior and posterior legs count for 9% each. The total surface area for the patient described above is 31.5% and has been rounded to 32%.

A patient recently brought to the ED is demonstrating a clinical picture of cardiogenic shock following an acute MI. The ED RN anticipates observing all of the following signs with this patient except a. elevated brain natriuretic peptide (BNP) b. S3 heart sound c. bradycardia d. hepatomegaly

C With cardiogenic shock, tachycardia usually is part of the clinical picture as the heart attempts to increase cardiac output and tissue perfusion. One of the hallmarks of cardiogenic shock is heart failure and the signs and symptoms that accompany this. An elevated BNP, S3 heart sound and hepatomegaly are all indicative of heart failure.

A patient reports that while playing racquetball he felt a pop followed by severe pain radiating from his heel to the back of his leg and an inability to walk. The ER RN should further assess for signs of a. ankle sprain b. calcaneus fracture c. achilles tendon rupture d. deep vein thrombosis

C. Achilles tendon rupture is common in stop-start sports like racquetball and can cause pain from the heel into the leg and an inability to ambulate. Calcaneus fracture and ankle sprains do not include. Pain radiating into the back of the leg with a "pop." Deep vein thrombosis does not have an acute onset (pop) with pain radiating from the heel to the leg and does not significantly affect a patient's ability to walk.

Afterload is increased by a. increased preload b. decreased preload c. increased systemic vascular resistance d. decreased systemic vascular resistance

C. Afterload is the amount of "load" or resistance that the heart must beat against to generate a cardiac output, like trying to open a door against the wind. The resistance to the blood flow within the systemic circulation is referred to as systemic vascular resistance (SVR). SVR is increased in conditions such as vasoconstriction and aortic valve stenosis. SVR is decreased in vasodilation. Many antihypertensives decrease SVR. Preload is the filling pressures of the atria and ventricles at end diastole. Preload is influenced by many variables such as circulating blood volume and myocardial contractility.

An adult patient who is the suspected victim of domestic abuse is being treated in your ED. You know you are required to a. make a mandatory report to your state agency b. call the local law enforcement agency for patient protection c. allow the patient to determine reporting plan d. flag the patient's chart for care management follow-up

C. An adult patient who does not also qualify as a "vulnerable" patient, such as frail elderly or developmentally disabled, may choose to report abuse and may also choose not to report abuse. An emergency nurse reporting the situation to law enforcement or other state agency could be violating the patient's privacy rights, as protected by HIPAA laws. Care management may not be needed for this patient.

A 31-year-old female arrives to the ED after being stung by a bee and she "deathly" allergic to bee stings. She does not carry her epinephrine autoinjector with her. After stabilization, she responds to treatment. After a period of observation, she is ready for discharge. Part of discharge teaching should include a. the importance of calling 911 b. the instructions about where to obtain a first aid kit c. education about administering a nebulizer treatment d. instructions about availability and use of an epinephrine autoinjector

D

For a patient with a chemical burn to the eye, the emergency nurse knows that the priority intervention is to a. baseline visual acuity b. ophthalmology consult c. warm compress to the eye d. irrigation with copious amounts Ringer's Lacate

D

A 38-year-old male presents to the ED 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 RN 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 patient complaining of dry, itchy eyes and difficulty removing contact lenses placed 2 days ago is best treated by a. gentle suction using a manufactured contact lens removal device b. antibiotic drops to treat corneal abrasions c. measurement of intraocular pressures d. gentle flushing of the eyes

D Gentle flushing of an eye dry from extended contact wear is intended to rehydrate tissue and the contact lens. The purpose is not to remove the lens by forceful flushing, but rather to hydrate the tissue and lens to the point that typical removal is possible.

The ED RN encounters a patient who has a hydrofluoric acid exposure to the right hand and fingers. The ED RN recognizes hydrofluoric acid as an acid leading to what type of emergency? a. full-thickness chemical burn blistering b. bradycardia c. anaphylaxis d. bone damage and severe pain

D Hydrofluoric acid easily passes through the skin and exchanges its fluoride ion with calcium. This causes bone destruction and severe pain as a result. Generally, hydrofluoric acid does not cause a significant skin burn, although it might create erythema in the area. The application of calcium to the skin acts to withdraw the hydrofluoric acid from the tissue, which spares bone destruction. Blistering is not typically seen with hydrofluoric acid exposure. Anaphylaxis and bradycardia are not common with hydrofluoric acid exposure.

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 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.

The most common site for anterior epistaxis is the a. sphenopalatine arteries b. submental region c. sphenoid sinus region d. Kiesselbach's plexus

D The sphenopalatine artery is often the source for a posterior bleed with epistaxis. Posterior epistaxis is less common, about 10-15% of all incidences but has a greater risk for bleeding and/or airway complications. The submental area is the area below the chin and is commonly an area where Ludwig's angina can extend. The sphenoid sinus is located at the base of the skull and the top of the pharynx.

A 17-year-old male patient is being discharged from the ED. He had presented with abdominal pain in his right and left lower quadrants. Bedsides mild nausea and some tenderness with palpation in his lower abdomen, he has no other symptoms. His CBC, ultrasound, and CT scan results were negative for any findings. The ED RN's discharge instructions should include a. avoid greasy foods and consider an OTC proton pump inhibitor, such as Omeprazole b. increase your fiber intake and drink 6-8 glasses of water per day to relieve you constipation c. if symptoms continue or new ones develop, rest and follow-up with your primary care provider in 3 days d. if pain persists and/or worsens or a fever or vomiting appear, return to the ED

D This patient did not appear acutely ill; however, his symptoms could be in the early stage for appendicitis or small bowel obstruction. Given his age, there is a greater likelihood for an early appendicitis that could progress. Discharge instructions, both written and verbal, should emphasize returning for medical care should an acute infectious process, such as appendicitis, evolve.

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 norepinpherine, 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 arrives to the ED 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

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 tow 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.