CEN Online Review 3.0 - Pre Exam

The nurse is giving discharge instructions to a patient with chronic obstructive pulmonary disease-emphysema. Which response indicates the patient understands the instructions?

A."I need to limit my fluids to prevent fluid overload." B."I need to sleep with my feet elevated to prevent swelling." C."I need to get the pneumococcal vaccine." D."I need to avoid snacking between meals." "I need to get the pneumococcal vaccine.": Pneumonia in a patient with emphysema can be devastating. Immunizations, especially to prevent pneumonia, are recommended for all patients with chronic obstructive pulmonary disease.

An older adult patient fell in the bathroom last night and was found on the floor by family this morning. The patient is awake, confused, and has large ecchymotic areas to the right hip, leg, and shoulder. Which of the following clinical manifestation will the nurse anticipate with this patient?

A.Blood clots in the urine B.Dysuria C.Dark brown urine D.Anuria Dark brown urine: Prolonged immobilization is a common cause of rhabdomyolysis. The characteristic sign of rhabdomyolysis is dark brown urine.

An adolescent patient who siphoned gasoline presents with coughing, vomiting, and decreased oxygen saturation. Which delayed sequela is most likely?

A.Dysrhythmias B.Seizure C.Hepatotoxicity D.Chemical pneumonitis Chemical pneumonitis: The relatively low viscosity of gasoline and the potential for aspiration may affect lung surfaces and establish an environment for infection.

Which of the following eye conditions requires bilateral patching of the eyes?

A.Hyphema B.Ruptured globe C.Corneal ulcer D.Keratitis Ruptured globe: Interventions for a ruptured globe include patching both eyes to limit movement.

Which of the following is a priority intervention for acute lithium toxicity?

A.Intravenous fluids with hypertonic solution B.Urine alkalinization C.Hemodialysis D.Activated charcoal Hemodialysis: Hemodialysis is recommended for patients with renal failure due to the kidneys' inability to clear lithium from the body.

What elevated lab value supports the diagnosis of congestive heart failure?

A.Lactic acid B.Troponin C.Creatine kinase D.B-type natriuretic peptide B-type natriuretic peptide: B-type natriuretic peptide (BNP) blood levels become elevated in response to ventricular volume expansion, which occurs in congestive heart failure.

Which of the following diagnoses would be the highest suspicion in a 22-year-old patient with normal vital signs and pleuritic chest pain that worsens with deep breathing and lateral movement?

A.Myocardial infarction B.Myocarditis C.Costochondritis D.Esophageal reflux Costochondritis: Costochondritis is common in young people and presents with unilateral pleuritic pain that is exacerbated by deep breaths and movement.

A mother brings her 3-week-old infant to the ED and states that the child "throws up after eating and is immediately hungry again." This has been going on for over one week. The child is listless, with a capillary refill of greater than 2 seconds. Laboratory results reveal hypokalemia and metabolic alkalosis. Which intervention is the nurse's priority?

A.Oral replacement therapy B.Prepare for a barium enema C.Isotonic crystalloid fluid bolus D.Administer an antiemetic Isotonic crystalloid fluid bolus: This infant has clinical manifestations of and a history that indicates pyloric stenosis. Severe dehydration is likely given the length of time this infant has been vomiting. Intravenous rehydration is necessary, and there may also be an indication for electrolyte replacement.

What type of dysrhythmia is Wolff-Parkinson-White?

A.Supraventricular B.Ventricular C.Junctional D.Heart block Supraventricular: Wolff-Parkinson-White is a form of tachycardia with abnormal impulses that arise above the ventricles.

Which nursing intervention is a priority for a neonate who has just been delivered?

A.Thoroughly dry the neonate B.Suction the mouth and nose C.Measure APGAR score D.Clamp the umbilical cord Thoroughly dry the neonate: Thoroughly drying the neonate immediately begins the warming process, preventing complications.

The nurse is providing discharge instructions for a patient with pelvic inflammatory disease. Which statement made by the patient indicates an understanding of these instructions?

A."Getting pregnant shouldn't be a problem once the infection goes away." B."I'll take the medicine for nausea when I feel sick to my stomach." C."I have an increased risk for ectopic pregnancy in the future." D."I will follow up with my doctor tomorrow." "I have an increased risk for ectopic pregnancy in the future.": The risk of ectopic pregnancy is increased in women with a history of pelvic inflammatory disease as a direct result of damage to the fallopian tube. If the patient is aware of the risk and signs and symptoms of an ectopic pregnancy, she will be able to seek appropriate medical help.

The nurse is providing discharge instructions to a patient with asthma. Which of the following statements indicates understanding from the patient?

A."I should avoid air conditioning if I begin having symptoms." B."I'm going to wash my bed linens once a week in hot water." C."To get a baseline peak expiratory flow, I'll do it right before I use my rescue inhaler." D."My son uses a spacer, but since I'm an adult and can coordinate the inhaler, I don't need one." "I'm going to wash my bed linens once a week in hot water.": Washing bed linens in hot water will remove allergens and decrease possible asthma triggers in the linens.

Which of the following statements made by a patient being discharged after laceration repair with tissue adhesive indicates an understanding of discharge instructions?

A."I should use sunscreen tomorrow when I go outside." B."I'll watch for it to slough off in the next two days." C."I should keep it covered with a bandage." D."I should look for redness or drainage." "I should look for redness or drainage.": Any laceration should be reassessed regularly for signs of infection. Specific instructions regarding manifestations of infections should be provided to the patient.

The nurse is discharging an individual diagnosed with Bell's palsy. They have been prescribed prednisone for the next week. Which of the following statements indicates the patient understands their discharge instructions?

A."I will avoid sleeping on the affected side." B." I nee to instill artificial tears during the day" C."I need to take antibiotics as prescribed." D."I should use a mouth guard at night." " I need to instill artificial tears during the day": With the inflammation of the facial nerve, the patient has an inability to completely close the eye, in addition to decreased lacrimal secretions, leading to drying and/or tearing of the cornea.

A 23-year-old patient with a stable ectopic pregnancy has an order for methotrexate to be administered intramuscularly. Which statement by the nurse indicates knowledge of the medication?

A."I'll instruct the patient to follow up in two weeks." B."I can give this medication because there is only scant vaginal bleeding." C."I'll give this medication because there is fetal cardiac activity." D."I can't administer this medication. I'm pregnant." "I can't administer this medication. I'm pregnant.": Pregnant staff should be given the choice to avoid work activity in an area with increased risk of exposure to chemotherapy agents. Methotrexate should not be handled by pregnant nurses or those of child-bearing age; it is a chemotherapeutic agent that is cytotoxic. Special handling of chemotherapeutic agents must be practiced to prevent exposure.

When providing discharge instructions for a patient diagnosed with gonorrhea, the nurse should include which of the following?

A."If the infection is still active when you go into labor, you may need a C-section." B."Tell all sexual partners to seek evaluation and treatment." C."Abstain from having sexual intercourse for 14 days after treatment has been completed." D."Come back to the emergency department for follow-up treatment." "Tell all sexual partners to seek evaluation and treatment.": To limit the spread of all sexually transmitted infections, patients should inform all sexual partners in order for them to seek evaluation and treatment.

Which of the following statements is most significant when assessing a patient for Guillain-Barré syndrome?

A."My mother says I have been forgetful." B."Both of my legs really hurt at night." C."I've lost control of my bladder a few times." D."My eye twitches a lot lately." "Both of my legs really hurt at night.": In Guillain-Barré syndrome, neuropathy usually begins in lower extremities and ascends in a symmetrical pattern. Pain is usually worse at night.

Which of the following statements by the patient indicates an understanding of the discharge instructions regarding side effects of phenazopyridine?

A."My urine will have an orange discoloration." B."I can continue to take it even if I develop a rash." C."This medication does not have any side effects." D."I may gain weight while taking this medication." "My urine will have an orange discoloration.": A potential effect of phenazopyridine is urine with an orange or red discoloration. This is a normal effect. Darkened urine may also cause stains to underwear, which may or may not be removed by laundering.

You are caring for a patient who was diagnosed with a pulmonary embolism Which of the following statements made by the patient would lead the nurse to conclude that they understands risk factors for pulmonary embolism?

A."While on a long flight, I should get up and walk to stretch my legs every hour." B."Resuming my birth control pills will lower my risk of cancer and my risk of another clot." C."If I drink plenty of water while driving on a long trip, this shouldn't happen again." D."Switching from my regular cigarettes to the electronic ones can reduce my risk." "While on a long flight, I should get up and walk to stretch my legs every hour.": The most common risk factors related to pulmonary embolism are prolonged immobility; increased estrogen from hormone replacement, pregnancy, or oral contraceptive use; injury to the pelvic or lower extremity veins; recent multiple bone fracture or surgery; cigarette smoking; obesity; and history of deep vein thrombosis or pulmonary embolism. Getting up to walk and stretch your legs is one way to avoid immobility leading to stasis, which increases the risk of deep vein thrombosis and pulmonary embolism.

A patient who was successfully defibrillated now has a sinus rhythm of 48 beats/minute on the monitor. The patient remains unresponsive, with absent central pulses. Which of the following interventions is the priority?

A.500 mL isotonic crystalloid fluid bolus B.Resume chest compressions C.Administer intravenous atropine D.Prepare for transcutaneous pacing Resume chest compressions: Pulseless electrical activity (PEA) is a loss of communication between the electrical impulses and mechanical activity of the heart. With PEA there is some electrical activity displayed on a cardiac monitor, which may or may not be organized, but the patient has no detectable pulse. With no pulse, resumption of compressions is the priority.

After an explosion within a residential area, using the START algorithm, which of the following patients would be given a yellow disaster tag?

A.A 54-year-old with RR 24 breaths/minute, alert, palpable radial pulse, and deformity of the right lower leg B.A 37-year-old with RR 38 breaths/minute, metal bar sticking into chest, and subcutaneous emphysema C.An 18-year-old, who is unresponsive, no spontaneous respirations after repositioning the airway D.A 29-year-old ambulatory patient with slight swelling and an abrasion to the forehead A 54-year-old with RR 24 breaths/minute, alert, palpable radial pulse, and deformity of the right lower leg: This patient with a possible lower leg fracture would be in the yellow category, meaning they can wait for care. The delay would not increase the chances of a negative outcome. The red category is for those patients who require care immediately in order to sustain life. The green category is is for those who are the "walking wounded." The black or "expectant" category is for those who are already dead or who are considered to be beyond saving in the current situation.:

A patient presents with complaints of weakness, weight gain, and insomnia. Your assessment findings reveal an awake, alert, and oriented individual with a round moon face, buffalo humpback (back of neck), hirsutism, and prominent purple striae on the trunk. Vital signs are normal. Which of the following scenarios is most consistent with this patient's presentation?

A.A high school wrestler who admits to taking his grandfather's furosemide before a meet B.A patient with insulin-dependent diabetes who took insulin, without eating breakfast. C.A patient with severe chronic asthma who has been on prednisone for several years D.A patient who underwent a thyroidectomy several years ago who recently ran out of medication A patient with severe chronic asthma who has been on prednisone for several years: Iatrogenic changes from long-term glucocorticoid therapy such as prednisone leads to Cushing syndrome, consistent with the signs described.

A patient presents with sensory hallucinations and delusions, disorganized speech, and grossly disordered behavior. Which of the following is the priority intervention for this patient?

A.A suicide risk assessment B.Administration of antipsychotics C.Application of restraints D.Medical clearance Medical clearance: Medical clearance encompasses taking a thorough history and performing a physical examination and laboratory and other diagnostic tests as indicated to exclude underlying organic causes that may be contributing to psychosis.

An awake and alert 26-year-old patient has suspected meningitis. Which of the following assessment findings would support that diagnosis?

A.Abnormal extension B.Nuchal rigidity C.Hyporeflexia D.Negative Brudzinski sign Nuchal rigidity: The classic signs of bacterial meningitis are fever, headache, and neck stiffness (nuchal rigidity) that lead to meningeal irritation. Meningeal irritation is demonstrtated by nuchal rigidity and postive Brudzinski and Kernig signs.

Bilevel positive airway pressure (BiPAP) can be an ideal therapy to use on a respiratory failure patient with which associated assessment finding?

A.Absent gag reflex B.Nasal deformity C.Distended neck veins D.Excessive oral secretions Distended neck veins: Crackles and distended neck veins are symptoms of cardiogenic pulmonary edema. Bilevel positive airway pressure (BiPAP) ventilation is an effective treatment modality for patients with respiratory failure related to chronic pulmonary disease, asthma, and cardiogenic pulmonary edema.

A middle-aged male patient presents with a complaint of fever. He is awake, alert, and in no acute distress. Vital signs are BP 118/58 mm Hg, HR 112 beats/minute, RR 20 breaths/minute, SpO2 95%, and T 38.8°C (101.9°F). Medical history includes human immunodeficiency virus (HIV) and taking antiviral medications. Using a 5-level triage system, this patient would be triaged as which acuity level?

A.Acuity level 4 (nonurgent) B.Acuity level 2 (emergent) C.Acuity level 1 (life-threatening situation) D.Acuity level 3 (urgent) Acuity level 2 (emergent): A patient classifed as level 2 according the Emergency Severity Index (ESI) is considered high risk and should not wait. They are an emergent patient, with a potential threat to life, limb, or function. While in the waiting room, an HIV patient could become worse if exposed to other patients with potential infections.

A patient presents with a sudden onset of nontraumatic eye pain. They describe seeing haloes around lights and experiencing nausea, vomiting, and severe headaches. The nurse's assessment reveals loss of peripheral vision and redness of the affected eye. Which condition does this set of clinical manifestations describe?

A.Acute angle-closure glaucoma B.Keratitis C.Central retinal artery occlusion D.Retinal detachment Acute angle-closure glaucoma: These clinical manifestations are associated with acute angle-closure glaucoma. Narrow-angle closure glaucoma is defined as glaucoma from narrowing/closure of anterior chamber angle (usually due to pupillary block), leading to inadequate drainage of aqueous humor and, ultimately, atrophy/neuropathy of the optic nerve head secondary to increased intraocular pressure (IOP). This is one of the big causes of the red painful eye. This is not something to miss as this is the leading cause of irreversible blindness globally.

A patient brought by emergency medical services presents with aggression, making clear homicidal threats. Which immediate intervention would be the priority for the staff?

A.Administer antipsychotics to patient B.Place patient in one-to-one observation C.Place patient in a seclusion room D.Place patient on restraints Place patient in a seclusion room: For violent and homicidal patients, it is prudent to remove them from the waiting room, from other patients, and place them in a safe environment in order to decrease external stimuli. Once in this private room, the patient can then be undressed and searched for contraband and other dangerous items. Once the patient is deemed safe, the nurse may begin the assessment process with therapeutic interventions, which will include de-escalation techniques as needed.

A patient presents with difficulty swallowing, trismus, fever, muffled voice, and unilateral cervical lymphadenitis. What would be the highest priority of care for this patient?

A.Airway protection B.Pain management C.Preparation for incision and drainage D.Intravenous access for fluid resuscitation Airway protection: This could be peritonsillar abscess or Ludwig's angina. In both cases, the highest priority is protection of the airway. Swelling in both conditions can be so severe as to obstruct the airway.

A patient presents to the ED with dyspnea, suprasternal retractions, and hoarse vocalization after putting out a fire in the basement. Which condition does the nurse suspect is the cause of the symptoms?

A.Angioedema B.Pneumonia C.Asthma exacerbation D.Respiratory distress syndrome Angioedema: Thermal injuries, as in an exposure to a house fire, can cause an upper airway inhalation injury. The patient exhibits symptoms of angioedema, the sudden development of swelling deep in the submucosal or subcutaneous tissue—the larynx and oropharynx in this case. Suprasternal retractions indicate an increased work of breathing. Hoarse vocalization is an indication of vocal cord involvement and potential obstruction. Timely intubation is indicated for this condition.

Which of the following interventions would be appropriate for a patient who has just been diagnosed with renal calculi?

A.Apply ice to the flank area B.Surgical intervention C.Administer antiemetics D.Limit fluid intake Administer antiemetics: Patients with renal calculi tend to present with nausea and vomiting. Antiemetics affect the vomiting center in the brain to decrease nausea and vomiting.

A child presents complaining of difficulty urinating. During triage, the mother begins speaking in Spanish and the adolescent sibling begins to translate for the mother. Which of the following is the most appropriate nursing intervention to complete the patient assessment?

A.Ask a Spanish-speaking bilingual nurse to translate B.Allow the sibling to continue translating C.Access an Internet translation service to type in questions D.Use the hospital phone translation services Use the hospital phone translation services: A professional resource, such as a language phone line or hospital-approved interpreter is the best method for achieving effective and accurate communication. Professional interpreters have been evaluated for skill and fluency and have received additional training in the techniques involved in accurate and culturally appropriate intepretation. Even though the interaction will be on the phone, not in person, the medical interpretation will be more accurate.

For a dark-skinned patient, which technique effectively assesses for early jaundice?

A.Assess the stool for clay discoloration B.Observe for yellow discoloration of the palate C.Blanch the skin over the sternum and assess for yellow discoloration D.Depress the nailbed and observe for yellow discoloration Observe for yellow discoloration of the palate: Jaundice first appears in elastic tissues, such as the palate or sclera. In the dark-skinned patient, it is also easiest to see in these locations.

A patient presents to the emergency department with right-sided facial drooping, right arm weakness, and slurred speech. Which of the following assessments indicate exclusion criteria for receiving tissue plasminogen activator (tPA)?

A.Blood glucose of 180 mg/dL B.BP 190/110 mm Hg C.NIH stroke scale of 6 D.Headache BP 190/110 mm Hg: Elevated blood pressure is an absolute contraindication for tissue plasminogen activator (tPA) administration. If administered to a patient with an elevated blood pressure, it may increase the likelihood of intracerebral hemorrhage. Blood pressure must be less than 185 mm Hg (systolic) and 110 mm Hg (diastolic).

Which of the following is an early sign of increasing intracranial pressure in a patient with a head injury?

A.Bradycardia B.Widening pulse pressure C.Extension of upper extremities with stimuli D.Nausea and vomiting Nausea and vomiting: Headache, nausea, vomiting, altered mental status, and amnesia concerning the event are examples of early signs of increasing intracranial pressure.

A 50-year-old arrives via ambulance after sustaining a knife wound to the right mid-back. The patient has loss of movement on the right side and loss of sensation on the left side of the body. The nurse suspects which type of spinal cord injury?

A.Brown-Séquard syndrome B.Anterior cord syndrome C.Posterior cord syndrome D.Central cord syndrome Brown-Séquard syndrome: Brown-Séquard syndrome is an incomplete spinal cord lesion characterized by ipsilateral paralysis or paresis; loss of pressure, touch, and vibration perception; and contralateral loss of pain and temperature perception.

A patient playing basketball felt a pop in their heel after a jump shot and a sharp pain in the heel upon landing. The patient is unable to stand on the ball of the foot. The nurse suspects which of the following injuries?

A.Calcaneous fracture B.Achilles tendon rupture C.Ankle strain D.Metatarsal fracture Achilles tendon rupture: Causes of an Achilles tendon rupture include sudden forced plantar flexion or unexpected dorsiflexion, direct trauma, and jumping or pushing off. Clinical manifestations include a sharp pain or "pop" in the heel, walking flat-footed, inability to stand on the ball of the foot or to plantar flex the foot.

An adult male presents to the ED complaining of pain to the fingers of his right hand after using rust remover containing hydrofluoric acid earlier in the day. He states the pain began about 30 minutes ago. The distal digits are discolored and painful, but the fingernails are intact. After decontaminating the patient with copious amounts of water, the emergency nurse anticipates application of which treatment to the affected areas?

A.Calcium gluconate gel to the affected areas B.A topical fat emollient to the affected areas C.Calcium chloride gel to the affected areas D.Ice directly to the affected areas Calcium gluconate gel to the affected areas: Calcium gluconate gel is applied to skin having hydrofluoric acid burns because it reacts with the acid to create insoluble (non-toxic) calcium fluoride. Topical fat emollient is used to remove tar/asphalt from the skin. Calcium chloride is not recommended for skin hydrofluoric acid burns as it is corrosive and may result in further damage. Ice should not be applied directly to burned skin as further tissue damage can occur.

A patient is transported to the emergency department via emergency medical services (EMS) with an SpO2 of 87%, hypotension, and seizures after being removed from a confined space in a burning industrial plant that manufactures plastic toys. What type of poisoning does the nurse suspect?

A.Carbon monoxide B.Organophosphate C.Insecticide D.Cyanide Cyanide: Cyanide is a by-product of the combustion of synthetic materials, including plastics, which results in hypoxia, hypotension, and seizures.

A 20-year-old male presents with a sudden onset of pleuritic chest pain, mild dyspnea, and a cough. Assessment reveals a tall, thin patient with tachycardia and diminished breath sounds and subcutaneous emphysema on the right side. Following a plain chest radiograph, the nurse should anticipate which of the following interventions?

A.Chest tube insertion B.Computerized tomography of the chest C.Needle decompression D.Intravenous antibiotic administration Chest tube insertion: This patient has symptoms of a spontaneous pneumothorax, which occurs without a history of trauma and is common in young, tall, thin males or smokers with chronic pulmonary disease. Insertion of a chest tube to decompress the pneumothorax is indicated for moderate to severe symptoms following a plain chest radiograph.

An adult patient arrives via emergency medical services following a car versus tree MVC. Vitals signs include BP 92/48 mm Hg, HR 128 beats/min, RR 34 breaths/min, and SpO2 91% with supplemental oxygen via a nonrebreather. Assessment reveals labored breathing, cyanosis, absent breath sounds on the right, and jugular vein distension. Which of the following is the priority intervention?

A.Chest tube insertion B.Intubation C.Pericardiocentesis D.Needle decompression Needle decompression: Dyspnea, labored respirations, jugular venous distention, and decreased or absent breath sounds are the most common signs and symptoms associated with tension pneumothorax. Needle decompression should be performed prior to other interventions such as radiographs or chest tube insertion.

A 42-year-old female patient presents to the emergency department with complaints of right upper quadrant cramping pain that radiates to the right scapula and shoulder areas. She also complains of "being bloated" and "passing gas." Which of the following is the most likely cause of the patient's symptoms?

A.Cholecystitis B.Hepatitis C.Pancreatitis D.Diverticulitis Cholecystitis: Presenting signs for cholecystitis include right upper quadrant pain that radiates to the right scapula or shoulder, guarding or rigidity of the abdomen on palpation, bloating, fever, chills, jaundice, or dark urine.

A 35-year-old man presents with complaints of stomach pain that comes and goes. This has gone on for the past two weeks. It is relieved with antacids and he feels better after eating. The patient has similar pain about two years ago. It stopped after a month, so he never sought care. What is the most likely cause of this patient's symptoms?

A.Cholecystitis B.Pancreatitis C.Duodenal ulcer D.Stress ulcer Duodenal ulcer: A patient presenting with duodenal ulcer is often between the ages of 20 and 45. There is pain before eating that is often relieved by antacids or eating. Duodenal ulcers heal spontaneously but may recur frequently.

A patient presents with sudden onset of shortness of breath, cough, and mild chest pain. Past medical history includes heart failure and recent treatment for pneumonia. Considering the patient's history, the nurse anticipates a workup for which respiratory problem?

A.Chronic bronchitis B.Pleural effusion C.Pulmonary embolism D.Pulmonary contusion Pleural effusion: Pleural effusion is the collection of fluid in the pleural space, causing dyspnea, hemoptysis, cough, and pain. Patients presenting with pleural effusion have a history of heart failure, pneumonia, and/or malignant disease. This patient's history is consistent with having a pleural effusion.

A patient presents with an amputated thumb after an incident with a power saw. Which of the following interventions is appropriate for the amputated part in preparation for transport for replantation?

A.Cleanse with iodine B.Irrigate with distilled water C.Wrap in saline-soaked gauze D.Place the part in iced saline Wrap in saline-soaked gauze: Care of the amputated part includes brushing off any gross contamination, wrapping in saline soaked gauze, placeing in a sealed plastic bag or container, and placing the sealed container on crushed ice/water. Label the container with the injured person's name.

A 68-year-old woman presents with a chief complaint of fatigue and exhaustion. She states she nearly passed out that morning and just has no energy. She states she's nauseous but thinks it is because she is a little dizzy from almost passing out. She is overweight and has a history of smoking for 40 years but quit 5 years ago. The nurse's assessment reveals mild tachypnea and diaphoresis. What will be the priority diagnostic assessment for this patient?

A.Coagulation panel B.Depression screening C.Complete blood count with differential D.Electrocardiogram Electrocardiogram: Women will often present with atypical and vague signs of myocardial infarction. In this case, it may not be an MI, but ruling it out is important. The first step in doing so is a 12-lead electrocardiogram.

A patient presents with chest pain. The nurse performs a 12-lead electrocardiogram that reveals a Q wave that is 0.05 seconds and has a depth that is 30% the height of the R wave that follows. What does the nurse suspect?

A.Congenital heart defect B.An old infarction C.An acute infarction D.Ischemia An old infarction: An abnormal or pathologic Q wave is at least 0.04 seconds in duration and at least 25% the height of the R wave that follows and may be an indication of an old myocardial infarction.

A patient presents with a positive purified protein derivative (PPD) test that was administered two days ago and their sputum specimen was negative. The patient has no other symptoms. Which isolation precautions will the nurse initiate?

A.Contact B.Standard C.Airborne D.Droplet Standard: Patients who have a positive skin test require futher testing such as a sputum specimen to determine if the TB is latent or active. This patient has asymptomatic tuberculosis (TB) or latent TB and is not contagious, therefore, they only require standard precautions.

A patient who has sustained a severe electrical injury arrives in the ED. Vitals include HR 108 beats /minute, RR 20 breaths/minute, BP 98/60 mmHg, and SaO2 94% without supplemental oxygen. Which of the following interventions is the priority?

A.Continuous cardiac monitoring B.Carboxyhemoglobin level C.Urine myoglobin test D.2 mL/kg crystalloid fluid resuscitation Continuous cardiac monitoring: Electrical injuries may result in severe or fatal arrhythmias so every patient should get an electrocardiogram and continuous cardiac monitoring.

A patient is brought to the ED following a motor vehicle collision in which they were ejected from the vehicle. The patient has obvious bruising on the sternum, muffled heart sounds, jugular venous distention, and low blood pressure. This group of clinical manifestations is also known as which of the following?

A.Cushing's triad B.Kehr's sign C.Beck's triad D.Kussmaul's sign Beck's triad: Beck's triad is a set of three clinical manifestations associated with pericardial tamponade. The signs are distended jugular veins, muffled heart tones, and hypotension.

A patient presents with disorientation to time, place and person; memory impairment; and personality changes, all of which have been occuring for the past six days. Which of the following behavioral health emerngencies best describes the patient's symptoms?

A.Dementia B.Schizophrenia C.Depression D.Delirium Delirium: Delirium has similar clinical manifestations to dementia. The distinguishing factor between the two is the onset of symptoms. Delirium has a rapid onset, typically hours to days, whereas dementia has a gradual onset, typically weeks to months. This patient had symptoms for six days, denoting a rapid onset.

A patient being prepared for emergency surgery is unable to sign the consent form due to the administration of pain medication. Which of the following documents provides consent by another individual for this procedure?

A.Durable power of attorney for finance B.Living will C.Do not resuscitate order D.Durable power of attorney for healthcare Durable power of attorney for healthcare: When a durable power of attorney for a healthcare designee has not been arranged or is unavailable in an emergency situation, the next of kin or legal guardian can sign for the patient.

An unconscious trauma patient presents following a fall off a roof. Following clearance of the cervical spine, the patient's eyes remain midline when the head is briskly turned to the side. This is an indication of which of the following conditions?

A.Dysfunction of the brainstem B.An intact brain stem C.Dysfunction of the diencephalon D.An intact diencephalon Dysfunction of the brainstem: A positive occulocephalic reflex is when the you briskly rotate the head one direction and the eyes deviate in the opposite direction. This indicates an intact brainstem. If the eyes remain midline when the head is turned, this is a negative reflex and indicates severe dysfunction of the brainstem. This test is only done on unconsious patients after the cervical spine has been cleared. The brainstem contains the reticular activating system, which is responsible for arousal and contains the primary cardiorespiratory center and ascending and descending nerve pathways.

The emergency nurse is caring for an 11-month-old child found face down in a bucket of water who was unresponsive and apneic. The child received rescue breaths, had rapid return of respirations, and is now awake and alert with normal vital signs. The nurse should anticipate which of the following?

A.Early endotracheal intubation for preservation of airway B.Prophylactic anticonvulsant medication C.Close observation for a minimum of 8 hours D.Radiographic imaging of the patient's spine Close observation for a minimum of 8 hours: All patients who have experienced a submersion event significant enough to lead to a cessation of breathing but are asymptomatic on arrival to the ED should be observed for worsening clinical status for a minimum of 8 and up to 24 hours.

Caregivers bring their 2-year-old son to the ED with suspected foreign body ingestion. He was found playing with a box of buttons. Vital signs are BP 92/54 mm Hg, HR 134 beats/minute, RR 24 breaths/minute, T 37.0°C (98.6°F), and SpO2 99% without supplemental oxygen. There are no retractions or increased work of breathing, but he does cough with inspiration. He is able to talk. His breath sounds are diminished, with expiratory wheezing on the right. The left breath sounds are clear. Which intervention will the nurse prepare for?

A.Endoscopic removal B.Heimlich maneuver C.Manual removal D.Direct laryngoscopy with forceps Endoscopic removal: Endoscopic removal or bronchoscopy is indicated for bronchial obstructions. These foreign objects are too far down for the Heimlich or to be seen and accessed directly. With no increased work of breathing and adequate oxygenation, the obstruction is partial. With unilateral wheezing and diminished breath sounds on the affected side, the object is likely in the right mainstem bronchus.

An unresponsive patient arrives via emergency medical services. Assessment reveals involuntary movements on the right side of body. Symptoms continue despite midazolam having been administered in the field. What is the priority intervention for this patient?

A.Endotracheal intubation B.Airway protection C.Computed tomography scan D.Repeat intravenous midazolam Airway protection: This patient is unresponsive and requires airway protection to prevent obstruction. Ensure that the airway is clear of obstruction, blood, or secretions.

A patient with multiple trauma including rib fractures, a small, simple pneumothorax, and fractures of the tibia and fibula is being transferred by helicopter to another facility for provision of a higher level of care. Which of the following actions should take place prior to transport by this mode?

A.Ensure that fluids are infusing by gravity B.Chest tube is placed C.Air splint is applied properly D.Insert a urinary catheter Chest tube is placed: A chest tube is placed for patients with a pneumothorax that are to be transported by rotor wing helicopter because the cabin is not pressurized, which will cause the pneumothorax to expand, leading to respiratory distress.

What is the best way to promote a successful family presence practice?

A.Ensure that social services leads the practice B.Allow only immediate family to be present C.Secure administrative support D.Make it a facility requirement Secure administrative support: Once a clear and concise policy, procedure, or standard of care has been approved, administrative support is recommended to ensure that the practice is a success. Monitoring of the practice and its outcomes will provide evidence of its effectiveness.

A patient presents to the emergency department with superficial reddened welts to the hands and upper extremities incurred after placing his hands and arms into the jellyfish tank at the local zoo. After irrigating the wounds with normal saline and removing the tentacles with forceps, application of of which of the following will provide the best pain management?

A.Fat emollient B.Pressure bandage C.Topical antihistamines D.Acetic acid Acetic acid: Application of acetic acid (vinegar) may deactivate the cause of the stinging pain from certain species of jellyfish.

Which heart block is associated with a lengthening PR interval until a QRS complex is dropped?

A.First degree B.Second degree type II C.Third degree D.Second degree type I Second degree type I: also known as Wenckebach, is characterized by a lengthening PR interval until a QRS is dropped.

You are caring for a 68 year-old patient with a history of hypertension who was diagnosed with a myocardial infarction. Assessment reveals crackles in the lungs and vitals of BP 90/57 mm Hg, HR 112 beats/minute, RR 28 breaths/minute, T 36.5oC (97.8oF) and SpO2 of 93% with supplemental oxygen. The patient is slightly confused, dyspneic and has cool extremities. Which of the following would be the priority intervention for this patient?

A.Fluid bolus B.Epinephrine infusion C.Dopamine infusion D.Furosemide IV push Dopamine infusion: This patient is exhibiting signs and symptoms of cardiogenic shock such as altered mental status, hypotension, pulmonary congestion, and cool extremities. Myocardial ischemia or infarction are common causes of cardiogenic shock. The goal of treatment is to restore cardiac output and prevent the progression of end-organ damage, so initiating a vasopressor such as dopamine to improve mycardial contractility and cardiac output.

Distributive shock is best characterized by which of the following patient presentations?

A.Following a motor vehicle collision, a 20-year-old female has decreased sensation below the nipple line. Vital signs are BP 80/50 mm Hg, HR 54 beats/min, RR 10 breaths/min, T 36.7°C (98.2°F), and SpO2 93% on 15 L/min via nonrebreather mask. B.Following a motor vehicle collision, a 45-year-old male suffered massive blood loss from a partially amputated leg. Vital signs are BP 90/48 mm Hg, HR 120 beats/min, RR 24 breaths/min, T 36.7°C (98.2°F), and SpO2 96% without supplemental oxygen. C.A 36-year-old female with fatigue for two days presents with the following vital signs: BP 89/45 mm Hg, HR 190 beats/min, RR 26 breaths/min, T 36.7°C (98.2°F), and SpO2 88% with 15 L/min via nonrebreather mask. D.A 20-year-old male presents with sudden onset of shortness of breath. Breath sounds are markedly decreased on the left, and his trachea is deviated to the right. His vital signs are BP 104/70 mm Hg, HR 96 beats/min, RR 22 breaths/min, T 36.7°C (98.2°F), and SpO2 97% without supplemental oxygen. Following a motor vehicle collision, a 20-year-old female has decreased sensation below the nipple line. Vital signs are BP 80/50 mm Hg, HR 54 beats/min, RR 10 breaths/min, T 36.7°C (98.2°F), and SpO2 93% on 15 L/min via nonrebreather mask.: Types of distributive shock are neurogenic, anaphylactic, and septic. Neurogenic shock is caused by high thoracic or cervical spinal cord injury and is characterized by bradycardia, bradypnea, and hypotension due to the loss of the effects of the sympathetic nervous system, leaving the parasympathetic nervous system unopposed.

An 11-month-old patient presents to the ED with grunting, nasal flaring, copious nasal secretions, mild intercostal retractions, and expiratory wheezing. Vital signs include BP 78/54 mm Hg, HR 148 beats/minute, RR 74 breaths/minute, T 37.8°C (100.0°F), and SpO2 93% without supplemental oxygen. Which intervention will be the nurse's highest priority?

A.Give a bolus of normal saline B.Prepare for intubation C.Administer antibiotics D.Suction the nares Suction the nares: This patient is in respiratory distress, with clinical signs and symptoms of bronchiolitis. The highest priority is to clear the airway for which, in this case, suctioning the nares is necessary.

A patient reports testicular swelling that he believes is due to physical activity. On physical exam, he is orthopneic, has dyspnea on exertion with a respiratory rate of 28 breaths/minute, and has 3+ pitting edema of bilateral lower extremities, scrotum, and abdomen. These findings are most consistent with which of the following conditions?

A.Heart failure B.Epididymitis C.Obesity D.Lymphedema Heart failure: Heart failure leads to interstitial and intravascular fluid overload due to inefficient cardiac pump function, decreased cardiac output, and activation of the sympathetic nervous system response. Left ventricular failure causes pulmonary edema, which commonly causes symptoms such as dyspnea with exertion and orthopnea. Right ventricular failure leads to peripheral edema, jugular venous distention, hepatomegaly, and ascites.

A patient arrives at the ED after getting a hand caught in a machine, peeling the skin away and exposing underlying structures. Which of the following injury titles is best represented by this injury?

A.Hematoma B.Avulsion C.Laceration D.Abrasion Avulsion: An avulsion is an injury that involves full-thickness skin loss with exposure of underlying structures where approximation of wound edges is not possible and the peeling of the skin from underlying tissues compromises the blood supply. A degloving injury is a type of severe avulsion.

Administration of activated charcoal is indicated for which of the following overdoses?

A.Hydrofluoric acid B.Carbamazepine C.Ferrous sulfate D.Lithium Carbamazepine: Activated charcoal is indicated for extended-release drugs: carbamazepine, dapsone, quinine, theophylline, and enteric-coated drugs.

Diabetes insipidus is frequently seen in patients with intracranial (pituitary) tumors. What medication would you anticipate administering to such a patient to correct symptoms?

A.Hypertonic saline B.Methylprednisolone C.Desmopressin D.Furosemide Desmopressin: Diabetes insipidus is a disease where the ability of the kidney to reabsorb free water is compromised resulting in polyuria. It can be central (also called neurogenic), due to inadequate ADH secretion, or renal (also called nephrogenic), when ADH secretion is normal or increased but the v2R receptors of the kidney's collecting duct cells do not respond appropriately to ADH. Desmopressin replaces the missing anti-diuretic hormone (ADH) and decreases urination.

Which best describes achievement of high quality cardiopulmonary resuscitation in a neonate?

A.Hyperventilating the neonate to improve oxygenation B.Rotating those performing chest compressions every four minutes C.Beginning resuscitation with 100% oxygen D.Performing chest compressions with minimal interruptions Performing chest compressions with minimal interruptions: High quality CPR is the foundation of basic and advanced life support for the management of cardiac arrest. Pushing hard and fast, letting the chest recoil, and minimizing interruptions are all components of high quality CPR.

A patient arrives with an impaired gag reflex and difficulty with phonation following a traumatic brain injury. Compression of which cranial nerves is most likely responsible for these symptoms?

A.Hypoglossal B.Facial C.Trigeminal D.Vagus Vagus: Cranial nerve X, the vagus nerve, is responsible for swallowing, the gag reflex, and phonation, which is the ability to produce sounds.

A patient presents with multiple bee stings. The acute inflammatory and immune response is due to what type of mediated immune reaction?

A.IgA B.IgE C.IgG D.IgM IgE: Immunoglobulin E (IgE) is responsible for Type 1 allergic responses.

A homeless patient is transported to the emergency department by emergency medical services (EMS) in the middle of winter, complaining of numbness and tingling to his distal fingers and toes, which are now white with a waxy appearance. What is an appropriate method for rewarming?

A.Immerse the affected areas in circulating warm water B.Turn the temperature up in the room C.Infusion of warm intravenous solutions D.Massage the affected areas until warm Immerse the affected areas in circulating warm water: This patient is experiencing paresthesia and color changes after environmental exposure, indicating frostbite. Appropriate treatment for frostbite is throughly immersing the affected areas in circulating warm water (37°C to 39°C [98.6°F to 102.2°F]) for 15 to 30 minutes.

A teenager arrives in the ED with complaints of pain, swelling, and deformity of the left elbow after falling on an externally rotated arm while playing basketball. Radial pulse is palpable, and there is severe pain with movement of the elbow. Which of the following interventions is the initial priority?

A.Immobilize the elbow B.Administer an analgesic C.Obtain an elbow radiograph D.Apply ice to the elbow Immobilize the elbow: This patient has a probable dislocation of the elbow joint. The arm should be immobilzed in a position of comfort since movement makes the pain worse and can cause more damage. Application of ice, administration of pain medication, and obtaining an x-ray are all appropriate, but should be done after immobilization.

The disease most commonly associated with the catarrhal, paroxysmal, and convalescent stages is best treated with which classification of medications?

A.Immune globulin B.Steroids C.Antiretroviral therapy D.Macrolide antibiotics Macrolide antibiotics: The disease most commonly associated with the catarrhal, paroxysmal, and convalescent stages is pertussis. Pertussis is best treated with macrolide antibiotics.

A patient is placed in a treatment room. The nurse explains the plan of care and the patient holds his arm out in preparation for blood specimen collection and intravenous line insertion. Which type of consent for treatment is this?

A.Implied B.Involuntary C.Informed D.Express Express: Express consent is given by patient, legal guardian, or family member for general/low-risk care and procedures. Examples of express consent include a patient who registers in the ED and signs consent for treatment or a patient who holds out an arm when approached by a nurse for phlebotomy.

Which is the most appropriate intervention in the management of seasonal affective disorder?

A.Increasing caffeine intake B.Vitamin D supplements C.Moving to a warmer climate D.Use tanning beds Vitamin D supplements: Vitamin D3 is produced in skin that is exposed to ultraviolet B radiation from sunlight. Inadequate exposure to sunlight, such as during winter months, causes decreased production of vitamin D3, which may lead to signs of depression.

A 12-year-old complains of difficulty breathing, swollen eyes and lips, and hives after eating a peanut butter cookie. Epinephrine was administered. Coughing spasms and wheezing were noted on reassessment. Which medication should be administered next for this patient?

A.Inhaled beta 2 agonist B.Corticosteroid C.Antihistamine D.Anticholinergic Inhaled beta 2 agonist: First-line treatment for anaphylactic shock is administration of epinephrine. Inhaled albuterol (metered dose inhaler or nebulizer) may be used for bronchospasm not responding to epinephrine. This would be the next class of medications to administer to prevent airway compromise. Primary attention is directed at the stabilization of the patient's airway, breathing, and circulation.

Which of the following nursing interventions is most effective in screening for homicidal ideation?

A.Inquire about the patient's interaction with family members and friends B.Ask the patient about plans to carry out violence and any prohibiting factors C.Observe the patient for threatening statements, movements, or actions D.Be aware of any threatening feelings experienced while interacting with the patient Ask the patient about plans to carry out violence and any prohibiting factors: An open, direct approach enables the discussion to occur in a reassuring, nonthreatening manner. This may make the patient more likely to be honest about thoughts and feelings.

A patient has just been diagnosed with endocarditis. While in the ED preparing for surgery for valvular repair, which of the following interventions will the nurse expect to perform?

A.Insert a urinary catheter B.Insert a gastric tube C.Initiate nitroprusside infusion D.Administer intravenous antibiotics Administer intravenous antibiotics: Endocarditis is a bacterial infection of the cardiac muscle. Antibiotics are a priority.

A 20-year-old male arrives in the ED following a motorcycle crash. Upon assessment, blood is observed at the urinary meatus. What is the most appropriate intervention for this patient?

A.Insert an indwelling urinary catheter B.Infuse isotonic crystalloid boluses to increase urinary output C.Collect a urine specimen for analysis D.Obtain a surgical consult Obtain a surgical consult: Patients with indications of bladder or urethral trauma, as evidenced by blood at the urinary meatus, require consultation with and evaluation by a surgeon.

A 36 weeks pregnant woman who had fallen from a balcony was brought in with no pulse and is not breathing. Chest compressions are in progress. What is priority for this patient?

A.Inserting two large caliber intravenous lines B.Placing the patient in the left lateral position C.Continue maternal resuscitation D.Obtaining fetal cardiac activity Continue maternal resuscitation: Vigorous maternal resuscitation provides the fetus with the best chance of survival.

A patient presents and states "It feels like I have something in my eye, but I can't see anything in it." Which eye injury is this most likely to represent?

A.Iritis B.Viral keratitis C.Hyphema D.Corneal abrasion Corneal abrasion: The common complaint from a patient with a corneal abrasion is the feeling of foreign body sensation in the eye and photophobia.. It is often a scratch from a foreign object that may or may not still be in the eye.

A 40-year-old man presents with oliguria over the past two days. He said he has been working in his yard and not drinking enough fluids. He has a previous history of benign prostatic hypertrophy (BPH) and kidney stones. Labs reveal elevated BUN and creatinine. Which type of renal injury might his symptoms represent?

A.Ischemic (acute) tubular necrosis B.Intrinsic C.Prerenal D.Postrenal Postrenal: Postrenal kidney injury is caused by obstruction of the urinary tract. Nephrolithiasis (kidney stone disease) can cause post-renal acute kidney injury (AKI) via obstruction of urinary outflow, often associated with rapid deterioration in renal function. Irreversible kidney damage can result if urinary drainage is not corrected in a timely fashion.

A 56-year-old patient presents with vague complaints of fatigue, shortness of breath, and bloating. Assessment reveals pitting edema of the hands and feet, abdominal distention, and prominent neck veins. Which of the following is a priority intervention for this patient?

A.Isotonic crystalloid fluid bolus B.Semi-Fowler's position C.Dobutamine infusion D.Urinary catheter Dopamine infusion: Right-sided heart failure results in blood backing up into the systemic venous system, causing peripheral edema, ascites, or abdominal distention, and jugular venous distention. Dobutamine is a positive inotrope that will increase stroke volume and cardiac output

Which of the following complications has the highest limb-threat potential following a puncture wound to the bottom of the foot?

A.Joint effusion B.Osteoarthritis C.Osteomyelitis D.Hemorrhage Osteomyelitis: The highest risk complication from a puncture wound is osteomyelitis from infectious agents being directly implanted into the tissues. This can then progress to a serious and potentially limb-threatening infection.

A licensed provider orders a medication that is listed as an allergy for the patient. The nurse mistakenly administers the medication. Which of the following ethical principles did this nurse breach?

A.Justice B.Nonmaleficence C.Beneficence D.Autonomy Nonmaleficence: Nonmaleficence is a duty to do no harm and not risk harm to others. Knowing that the patient had an allergy to the ordered medication, it should not have been administered. This action put the patient at risk for an anaphylactic reaction, which could cause harm.

Which of the following actions is appropriate in maintaining chain of custody for a patient involved in a forensic situation?

A.Keep the evidence at the nurse's work station until released to law enforcement B.Sign and date the tamper-resistant tape in front of law enforcement C.Limit the number of people with access to the evidence D.Carry the evidence with them until released to law enforcement Limit the number of people with access to the evidence: Keeping the number of people involved with chain of custody to a minimum limits the risk of contamination of the evidence and potential loss of abilty to prosecute the case. The person obtaining the evidence should place the signed and sealed box in an appropriate lock box that has only one key and which is carried by the nurse until it is turned over to law enforcement. Documentation that the nurse obtaining the evidence placed the evidence in the lock box and carryied the one key is vital to the successful delivery of that evidence during the court case.

A patient presents with ear pain, nausea, "room spinning" vertigo, and tinnitus, limiting their activities of daily living. On discharge, the patient receives a prescription for corticosteroids and antiemetics and is told to make sure they stay well hydrated. Which condition might this patient be exhibiting?

A.Labyrinthitis B.Ruptured tympanic membrane C.Ménière disease D.Otitis media Labyrinthitis: Labyrinthitis is an inner ear condition with clinical manifestations that include ear pain, nausea, vomiting, vertigo, and tinnitus. Labyrinthitis is treated with hydration, bed rest, corticosteroids, and antiemetics. Antibiotics are give only for a bacterial infection.

A 3-year-old presents with bruises on the left thigh, back, and feet and bleeding of gums over the last week. Laboratory values include slightly low hemoglobin and hematocrit, a low platelet count, and normal white blood cell count. Which disorder most describes the patient's signs and symptoms?

A.Leukemia B.Thrombocytosis C.Disseminated intravascular coagulopathy D.Idiopathic thrombocytopenia purpura Idiopathic thrombocytopenia purpura: A complete blood count with an isolated low platelet count is indicative of idiopathic thrombocytopenia purpura (ITP). With active bleeding noted, a low hemoglobin and hematocrit may also be noted. White blood cell count should be normal in ITP.

An adult presents to the emergency department complaining of a low-grade fever, malaise, pain in the joints, and headache for the past week. The patient reports hiking in wooded areas during a recent vacation in the Northeast United States. Upon physical assessment, a circular, flat, red rash with central clearing is noted to the left scapular area and local tenderness upon palpation of the left axillary lymph node. After confirmatory diagnosis, the emergency nurse anticipates which course of pharmacologic treatment?

A.Levofloxacin B.Doxycycline C.Ceftriaxone D.Praziquantel Doxycycline: This presentation is consistent with Lyme disease, which is treated with oral doxycycline in the early stages of the disease.

A male patient arrives following a motor vehicle collision. Emergency medical services report vital signs: HR 92 beats/min, RR 20 breaths/min, BP 128/74 mm Hg, SpO2 96% with a nonrebreather at 15 L/min. They state that the airbag malfunctioned and he hit the steering wheel. The nurse assesses the patient and finds bruising to the sternum, muffled heart tones, and the following vital signs: HR 102 beats/min, RR 18 breaths/min, BP 122/94 mm Hg, SpO2 92%. What pathophysiologic process does the nurse recognize?

A.Low pulse pressure B.Decrease in afterload C.High pulse pressure D.Cushing triad Low pulse pressure: The mechanism and clinical manifestations are indications of a probable pericardial tamponade. The other sign associated with pericardial tamponade is a low or narrowing pulse pressure. As the pericardium fills with blood, the heart loses its ability to pump.

Elevation of the head of the bed but not the affected extremity, ambulation as tolerated, and thrombolytic therapy are interventions for which type of peripheral vascular disease?

A.Lymphedema B.Peripheral artery disease C.Superficial thrombophlebitis D.Peripheral venous disease Peripheral artery disease: In peripheral artery disease, arterial blood flow is decreased, and elevation of the extremity can worsen perfusion.

An infant with a history of hydrocephalus presents with a bulging anterior fontanel, vomiting, poor feeding, and irritability. The patient has a slight tachycardia and is afebrile. What condition do these clinical manifestations most likely represent?

A.Malrotation with volvulus B.Pyloric stenosis C.Ventriculoperitoneal shunt malfunction D.Meningococcemia Ventriculoperitoneal shunt malfunction: Any patient with a history of hydrocephalus who presents with altered mental status is assumed to have a ventriculoperitoneal shunt malfunction until ruled out with a radiographic shunt series. Vomiting and the bulging fontanel may be signs of increasing intracranial pressure in an infant. Poor feeding and irritability may be signs of altered mental status.

A patient arrives with severe, sudden-onset chest pain. He states he used cocaine earlier that day and is taking a beta blocker for hypertension. Which abnormal assessment finding will the nurse expect?

A.Metabolic alkalosis B.Hypoglycemia C.BP 196/110 mm Hg D.HR 48 beats/min BP 196/110 mm Hg: Cocaine use can result in unopposed alpha activity in patients taking beta blockers, which can result in hypertension

A patient presents to the ED with complaints of right arm weakness and difficulty speaking. Symptoms started about 40 minutes ago and are now improving. The patients states this happened yesterday too but went away. What is the most likely cause of these symptoms?

A.Migraine headache B.Ischemic stroke C.Bell's palsy D.Transient ischemic attack Transient ischemic attack: Transient ischemic attacks are characterized by neurologic dysfunction, similar to a stroke that is self-limiting in duration. They are not benign and may precede a stroke.

A 68-year-old patient presents to the emergency department with a complaint of increasing confusion and headache over the past several days after tripping and hitting their head. What type of brain injury is suspected?

A.Mild traumatic brain injury B.Epidural hematoma C.Subdural hematoma D.Basilar skull fracture Subdural hematoma: Subdural hematoma is a collection of blood between the dura mater and the subarachnoid layer of the meninges, usually caused by trauma. It is classified based on the onset of clinical signs and symptoms: acute (within 48 hours), subacute (2 to 14 days), and chronic (more than 14 days). The gradual onset suggests this patient is experiencing a subacute subdural hematoma.

A patient with vaginal bleeding and cramping tells the nurse, "I passed clots at home. I think I lost my baby." Pelvic examination reveals that the cervical os is open. Which type of spontaneous abortion most likely occurred?

A.Missed abortion B.Septic abortion C.Inevitable abortion D.Threatened abortion Inevitable abortion: An inevitable abortion occurs when the cervical os has opened and membranes have ruptured. The patient experiences vaginal bleeding and lower abdominal cramping.

One finding during a hazard vulnerability analysis (HVA) for a rural ED was that the electrical system was antiquated and could not handle power outages with generator backup. This issue was acknowledged and a plan was initiated to ensure that necessary upgrades were instituted. To which of the following phases of disaster preparedness is this action related?

A.Mitigation B.Preparedness C.Response D.Recovery Mitigation: Mitigation is the phase of disaster preparedness in which specific risks inherent to the particular area are studied to determine appropriate actions to take place to lessen the effects of the potential disaster. These risks are identified by performing an HVA.

An 8-year-old boy with a history of sickle cell disease presents with sudden right knee pain that he rates at 8 out of 10. He has had no recent injury. There is no redness or swelling at the site. The knee is tender to light palpation and is not warm to touch. The nurse anticipates the use of which pharmacological agent?

A.Morphine B.Meperidine C.Acetaminophen D.Ibuprofen Morphine: Patients presenting to an emergency department for pain related to sickle cell crisis will usually rate their pain as severe and feel they can no longer manage it at home. Vaso-occlusive crisis (VOC) is the most common ED presentation of sickle cell disease. Microvascular occlusion (the cardinal pathophysiologic cause of acute pain) leads to ischemia and hypoxia. Early and aggressive pain management is a priority. An opioid analgesic such as morphine is indicated for sickle cell pain crisis. Its peak effect occurs within 20 minutes, and its duration is 3 to 5 hours.

A patient presents with an unsteady gait, weakness, double vision, and diminished sensation in the face and arms. These findings are most likely associated with what neurological condition?

A.Myasthenia gravis B.Amyotrophic lateral sclerosis C.Multiple sclerosis D.Parkinson's disease Multiple sclerosis: Multiple sclerosis is an autoimmune disorder that results in demyelination of the axon. Clinical manifestations include changes in sensation of the arms, legs, and face, complete or partial vision loss, double vision, generalized weakness, and an unsteady gait with loss of balance.

A patient presents with chest pain after spending the past three days gardening. He denies shortness of breath. Deep breathing worsens the pain and assessment reveals clear bilateral breath sounds and tenderness to palpation along the left sternal border. The 12-lead ECG and cardiac enzymes are within normal limits. Which of the following interventions is the most likely treatment for this condition?

A.Nitroglycerin and aspirin B.Antibiotic therapy C.Corticosteroids D.Ibuprofen and heat Ibuprofen and heat: These clinical manifestations are associated with costochondritis. Treatment for costochondritis includes analgesia and application of heat to the site of pain.

Which of the following interventions is a priority for a patient with a retinal detachment?

A.Nothing to eat or drink B.Warm compresses C.Immediate irrigation D.Antibiotic therapy Nothing to eat or drink: Interventions for a patient with a retinal detachment include ophthalmology referral, preparation for surgical intervention, and absolute bedrest. Since surgery is the treatment for this issue, the patient should have no fluids or food until intervention. No pressure should be placed on the globe until seen by a specialist. If trauma was involved, a metallic eye shield could be used to protect it.

An 84-year-old presents from a nursing home with a decreased level of consciousness and vital signs of BP 78/48 mm Hg, HR 60 beats/minute, RR 28 breaths/minute, T 35.3°C (95.6°F), and SpO2 92% without supplemental oxygen. Which type of shock do these clinical manifestations represent?

A.Obstructive B.Septic C.Anaphylactic D.Hypovolemic Septic: The patient's vital signs indicate septic shock. Geriatric patients with sepsis can present with fever or hypothermia, a decreased level of consciousness, and respiratory alkalosis. While the patient is not tachycardic, he is on metoprolol, a beta-blocker, which can mask the expected tachycardia

An 83-year-old woman presents via EMS with a two-day history of vomiting and diarrhea and is not responding to verbal stimuli. Both lower extremities appear cool and clammy. Her vital signs are BP 85/45 mm Hg, HR 138 beats/minute, RR 28 breaths/minute, and SpO2 96% on 15 L per minute on a non-rebreather mask. Which type of shock is displayed in this patient's presentation?

A.Obstructive shock B.Uncompensated shock C.Compensated shock D.Cardiogenic Uncompensated shock: This patient is experiencing uncompensated shock. Tissue hypoperfusion and vasoconstriction cause the clinical manifestations exhibited such as decreased blood pressure, narrowed pulse pressure, cool/clammy extremities, increased respiratory rate, and dysrhythmias.

A 3-year-old is brought in by caregivers with a history of intermittent episodes of abdominal pain where the child screams, vomits, and flexes their knees up to the chest. On exam, there is no tenderness or guarding in the abdomen, but a sausage-shaped mass is palpated in the right abdomen. Blood is noted in the stool. The nurse should prepare for which intervention?

A.Oil-retention enema B.Plain radiographs of the abdomen C.Computerized tomography of the abdomen D.Barium enema Barium enema: This patient is exhibiting signs of intussusception, which include episodes of acute, colicky abdominal pain in which the child screams and flexes knees up towards the chest. The child usually vomits, and you may feel a "sausage-shaped" mass in the right upper quadrant. Rectal blood or "currant jelly" stools (blood and mucus in the stools) may be present. The appropriate intervention for a child with a probable intussusception and no signs of bowel perforation/peritonitis is a contrast or air enema, which usually reduces the mass.

A 74-year-old presents to the ED with a history of chronic bronchitis and complaints of dyspnea and shortness of breath. The patient is cyanotic, and the nurse applies oxygen at 2L with a nasal cannula. Which of the following reassessment findings will be most concerning to the nurse?

A.PaCO2 of 65 mm Hg B.Pulse oximetry of 89% C.PaO2 of 68 mm Hg D.ETCO2 of 45 mm Hg PaCO2 of 65 mm Hg: The patient experiencing an exacerbation of COPD requires oxygen and continuous monitoring of respiratory status. Arterial blood gases should be obtained 30 minutes after initiation of the oxygen to identify acidosis and monitor progress. A PaCO2 reading above 60 mm Hg or above the patient's baseline is indicative of respiratory failure.

Which of the following clinical presentations is most consistent with a patient who has pancreatitis?

A.Pain with palpation of the right subcostal area during inspiration B.Diffuse cramping abdominal pain C.Epigastric pain that radiates to the back D.Dull, constant umbilical pain Epigastric pain that radiates to the back: Pancreatitis pain is located in the epigastrium and is described as dull and steady. Because of the pancreas' retroperitoneal location, pain may radiate through the abdomen to the back.

A 16-year-old male is brought to the ED by his coach. The patient was playing football in moderately cold weather one hour prior to arrival and felt a sudden onset of severe pain in the left groin area. This is suggestive of which genitourinary emergency?

A.Paraphimosis B.Testicular torsion C.Priapism D.Acute epididymitis Testicular torsion: Testicular torsion is a urological emergency and may be caused by a congenital abnormality, undescended testicle, cold weather, or vigorous physical activity. It can also occur during sleep. The onset is sudden in nature. Pain occurs unilaterally and is severe. Tenderness, swelling, and erythema are observed during assessment.

An order is placed for a procalcitonin level. What condition might produce an elevated procalcitonin level?

A.Parathyroid disease B.Hyperosmolar hyperglycemic syndrome (HHS) C.Tuberculosis D.Sepsis Sepsis: Procalcitonin is a peptide precursor of the hormone calcitonin. It rises in response to a proinflammatory stimulus, especially one of bacterial origin. It is part of the standard sepsis workup.

A patient presents following an incident with an acid splash to the eye. They report severe eye pain, being unable to open their eye, with constant tearing. What is the nurse's first priority?

A.Patch the affected eye B.Irrigation C.Visual acuity testing D.Test the eye for pH Irrigation: With any chemical burn to the eye, the first priority is irrigation until the eye pH tests between 7.0 and 7.5. This may take an hour or longer.

Which of the following situations would be considered a red flag for the suspicion and identification of human trafficking?

A.Patient does not know their address B.History of frequent urinary tract infections C.Allows use of a professional medical interpreter D.Patient carries their legal identification card Patient does not know their address: Individuals, both male and female, who are involved with human trafficking will most likely not be aware of what city they are in or know their current address. This is a common issue related to the practice of human trafficking. Both males and females are trafficked, whether for sexual reasons or labor related issues.

A patient complains of feeling guilty and sad, decreased appetite, and sleep disturbances for the past three weeks. Which is a priority intervention for this patient?

A.Performing a suicide risk assessment B.Placing the patient in a low stimulus area C.Administering antidepressants or anxiolytics D.Providing a discharge referral for support services Performing a suicide risk assessment: An assessment for risk of harming self or others is the priority for this patient to determine whether they are having thoughts of suicide. Protection should be immediately provided to ensure this patient's safety from harm.

A patient arrives with complaints of chest discomfort, poor appetite, fatigue, and difficulty sleeping due to shortness of breath. Patient states they have had to sleep propped up on pillows for the last two nights. On exam, jugular venous distention, hepatomegaly, and bilateral lower extremity edema are noted. Which of the following conditions is the most likely cause of these symptoms?

A.Pericarditis B.Right-sided heart failure C.Left-sided heart failure D.Endocarditis Right-sided heart failure: This patient has signs and symptoms of right-sided heart failure. Impaired function of the right ventricles causes reduced stroke volume leading to a back-up of fluid into the venous system. Increased retention of sodium and water as a compensatory mechanism leads to systemic venous hypertension. These are evidenced by chest discomfort, paroxysmal nocturnal dyspnea, peripheral edema, and hepatomegaly.

A 56-year-old female presents to the emergency department with complaints of abdominal pain for five days. The patient was involved in a motor vehicle crash but did not feel that she needed to come to the emergency department. Upon examination, the patient has no active bowel sounds and the abdomen is rigid. Which of the following is the most likely cause of the patient's symptoms.

A.Peritonitis B.Diverticulitis C.Intestinal obstruction D.Esophageal obstruction Peritonitis: A patient with peritonitis presents with a rigid abdomen, fever, and diminished or absent bowel sounds. This is the result of contaminated fluid leaking into the peritoneum following abdominal trauma.

A family of five presents to the ED with complaints of fever, muscle pain, and unexplained bruising ongoing for seven days. After completing the screening, the nurse notes that the family recently traveled to Sierra Leone. What is the highest priority intervention the triage nurse needs to perform?

A.Place the family in a private waiting area B.Leave the family in the waiting room C.Evacuate the waiting room D.Inform those waiting that Ebola has been detected Place the family in a private waiting area: It is important for EDs to have plans in place both to identify and contain communicable diseases using symptom surveillance. In triage, the nurse can recognize clusters of similar symptoms presenting more quickly than usual or that may occur in those patients who are outside of the generally expected age distribution. Patients should be placed in a private waiting area and the notification should be made to infection prevention to alert them to the suspected exposure. This allows time for the activation of a plan to prevent any further exposures.

A 58-year-old male arrives at the ED following a motor vehicle collision. Assessment reveals bony crepitus and bruising over the left chest with paradoxical chest wall movement. He complains that it is difficult to breathe and his chest hurts. His vital signs are BP 118/60 mm Hg, HR 110 beats/min, RR 32 breaths/min and shallow, T 37°C (98.6°F), SpO2 90% with 15 L/min via nonrebreather mask. The nurse will prepare for which priority intervention?

A.Portable chest radiograph B.12-lead electrocardiogram C.Chest tube insertion D.Intubation with positive end-expiratory pressure Intubation with positive end-expiratory pressure: This patient has signs of a flail chest. Because of the pain and paradoxical chest wall movement, adequate ventilation is difficult. Intubation and mechanical ventilation with positive end-expiratory pressure will limit the risk of hypoventilation and development of pneumonia.

When treating acute respiratory distress syndrome (ARDS), which of the following interventions will the nurse expect to help maintain open alveoli?

A.Positive end-expiratory pressure with ventilation B.High tidal volumes with ventilation C.Aggressive fluid resuscitation D.High-flow oxygen via nasal cannula Positive end-expiratory pressure with ventilation: Positive end-expiratory pressure is one ventilatory strategy that helps maintain open alveoli that collapse in ARDS.

A 28-year-old female presents with complaints of trembling, sudden onset of dizziness, fear of dying, and hot flashes. Which disorder is the patient exhibiting?

A.Post-traumatic stress disorder B.Panic attack C.Acute stress disorder D.Generalized anxiety disorder Panic attack: Panic attack symptoms include four or more of the following: palpitations, sweating, trembling or shaking, dizziness, unsteadiness, lightheadedness, fear of losing control, fear of dying, and chills or hot flashes. These symptoms develop quickly and peak within 10 minutes of onset.

A patient has vancomycin-resistant Enterococcus (VRE) in the urine. What type of transmission-based precautions should be used while caring for the patient?

A.Protective B.Contact C.Droplet D.Airborne Contact: Contact precautions are used to prevent transmission of infection in situations where the infectious agent is spread through contact with the patient or the patient's environment. Examples of infections requiring contact precautions include but are not limited to noroviruses, Clostridium difficile, and vancomycin-resistant enterococci (VRE).

A 22-year-old with a history of leukemia and who just underwent chemotherapy two weeks ago now presents with upper respiratory symptoms, nausea, vomiting and a low-grade fever. What is the priority nursing intrvention for this patient?

A.Protective isolation B.Ondansetron oral dissolving tablet C.Intravenous fluid bolus D.Intravenous morphine Protective isolation: This patient is presenting with a high risk of immunosuppression and the first priority, from the choices listed, is protective isolation precautions.

A patient presents with sudden onset of chest pain. The electrocardiogram reveals ST-segment elevation in diffuse leads and no reciprocal changes. The patient feels better sitting forward. Which is the most likely condition this patient is experiencing?

A.Pulmonary embolism B.Endocarditis C.Unstable angina D.Pericarditis Pericarditis: Patients with pericarditis will generally present with sudden onset of chest pain that is exacerbated by inspiration, activity, and lying supine. It is relieved by leaning forward or sitting up. The 12-lead ECG shows diffuse ST elevation, with absent reciprocal changes and tall, peaked T waves, and PR depression in lead II.

Which of the following research methodologies would be most appropriate for assessing and understanding the emotional states and experiences of fatigued nurses?

A.Quantitative study B.Cohort study C.Randomized controlled trials D.Qualitative study Qualitative study: The study described is a qualitative study. This type of study is an inductive process involving observations and interviews, where rich dedscription and interpretation rather than numbers are used to give meaning to experiences. Interaction between the researcher and the subject is characteristic of this type of study.

A patient presents to the emergency department complaining of flu-like symptoms, malaise, and fever for three days after being bitten by a bat. The patient received rabies prophylaxis one year ago. Which of the following medications does the nurse anticipate being administered?

A.Rabies immunoglobulin B.Broad spectrum antibiotic C.Rabies vaccine D.Corticosteroids Rabies vaccine: This patient is exhibiting early symptoms of rabies exposure. For patients who have received rabies post-exposure prophylaxis in the past and have another exposure, only the rabies vaccine should be given.

A 32-year-old patient is brought to the emergency department by emergency medical services with a complaint of coughing for the past two weeks. The patient is now complaining of severe epigastric pain and is violently retching and vomiting blood. The patient has a history of alcohol abuse and bulimia. Which type of gastrointestinal disorder is the most likely cause of these symptoms?

A.Reflux esophagitis B.Mallory-Weiss syndrome C.Pancreatitis D.Gastric ulcer Mallory-Weiss syndrome: Mallory-Weiss syndrome is characterized by small tears in the junction of the esophagus and stomach caused by violent retching and vomiting. A history of alcohol consumption, aspirin use, heavy lifting, coughing, and bulimia lead to this syndrome.

A 32-year-old female patient with complaints of abdominal pain rated at 10 out of of 10 on a numeric rating scale is awaiting a computed tomography (CT) scan of the abdomen. The provider wants to hold analgesia until a definitive diagnosis is reached. Which of the following actions should occur by the nurse advocating for this patient?

A.Request an order for an opioid B.Request an order for a nonopioid C.Have the patient use distraction techniques D.Have the patient use deep breathing Request an order for an opioid: With a rating of 10 out of 10 on the numeric rating scale, this patient should receive pain control while testing is occurring. This is severe pain and an opioid is indicated. The myth that definitive diagnoses are necessary for abdominal pain prior to pain control has been present for many years and has been refuted in the literature. Pain control should not be withheld in this situation.

The level of alertness and attention displayed by a patient with a diffuse axonal injury is determined by which structure of the neurological system?

A.Reticular activating system B.Brainstem C.Frontal lobe D.Limbic system Reticular activating system: The reticular activating system is a set of connecting nuclei in the brain responsible for regulating wakefulness and sleep-wake transitions.

A patient presents with pain to his eye. On assessment, the eye is red, tearing, and the pupil is slightly irregular. The patient describes increased pain upon palpation. The patient also has severe photophobia and decreased visual acuity. Which of the following ocular emergencies is associated with these assessment findings?

A.Retinal detachment B.Hyphema C.Foreign body D.Iritis Iritis: Iritis is inflammation of the uveal tract of the eye. Clinical manifestations include pain upon palpation, blurred vision, severe photophobia, tearing, redness around the outer ring of the iris, and an irregular pupil. It can occur with trauma or in inflammatory or infectious situations. It is also associated with immune disease processes such as rheumatoid arthritis, lupus, ankylosing spondylitis, or syphilis.

A patient is brought to the ED after a car he was working on fell and trapped his leg. The skin of the extremity is tight and pale. He reports the pain is 10 on a scale of 0-10. He has full range of motion and a palpable pedal pulse to the affected leg. Which intervention will the nurse perform first?

A.Send the patient for limb radiographs B.Position the extremity at the level of the heart C.Splint the extremity in a neutral position D.Assist with compartment pressure monitoring Position the extremity at the level of the heart: These signs and symptoms are associated with compartment syndrome. The interventions for compartment syndrome include positioning the extremity at the level of the heart. Elevation above the heart may worsen arterial flow and perfusion.

A patient arrives with complaints of shortness of breath and a history of asthma. The assessment reveals mild tachypnea, biphasic (expiratory and inspiratory) wheezing, and use of accessory muscles. Peak expiratory flow is 68% of personal best. What is the severity of this asthma exacerbation?

A.Severe B.Moderate C.Slight D.Mild Moderate: Moderate exacerbation is indicated by a peak expiratory flow of 61% to 79%.

A patient with preeclampsia is receiving a magnesium sulfate infusion. Which assessment finding indicates magnesium toxicity?

A.Shortness of breath B.Hyperactive patellar reflexes C.Elevated liver function tests D.Decreased urinary output Shortness of breath: Signs of magnesium toxicity include shortness of breath, hypoxia, loss of patellar reflexes, CNS depression, and nausea.

A 16-year-old presents with severe left upper quadrant abdominal pain after an over-the-handlebars bicycle collision. Vital signs are BP 100/60 mm Hg, HR 100 beats/min, RR 30 breaths/min, T 37.0°C (98.6°F), and SpO2 89% without supplemental oxygen. There is bruising over the left upper quadrant of the abdomen. Auscultation reveals diminished breath sounds on the left, accompanied by gurgling. Based on this history and assessment, the nurse suspects which injury?

A.Small bowel rupture B.Ruptured diaphragm C.Flail chest D.Hepatic injury Ruptured diaphragm: The signs and symptoms described here, in particular the gurgling heard over the left lung fields, indicate the presence of bowel sounds in the thoracic cavity. Gurgling over the lung fields occurs with diaphragmatic rupture.

A 28-year-old female patient presents with shortness of breath, dizziness, and diaphoresis. Her vital signs are BP 118/74 mm Hg, HR 122 beats/minute, RR 26 breaths/minute, T 37.7°C (99.9°F), and SpO2 92% without supplemental oxygen. Her health history includes fractures of the left tibia and fibula from a motor vehicle collision three weeks ago. Surgical fixation was required. Her only current medications are an oral contraceptive and intermittent ibuprofen for pain. Assessment of the casted left leg reveals that the toes are swollen. With this information, which diagnostic testing will the nurse expect as the highest priority?

A.Sputum cultures B.Plain chest radiograph C.Chest computed tomography D.Radiograph of the left leg Chest computed tomography: Her history and clinical manifestations indicate she is at risk for a pulmonary embolism (PE). The risk factors include recent surgery and estrogen use. Clinical manifestations include tachycardia, tachypnea, sudden onset shortness of breath, syncope, diaphoresis, fever, unilateral lower extremity swelling, and decreased oxygen saturation. Assessments or diagnostics for patients with a suspected PE may include a D-dimer test, which is useful if the suspicion is low. If the suspicion is high, as in this case, a spiral computed tomography scan of the chest will provide the diagnosis of a PE. A ventilation/perfusion (VQ) scan would also be diagnostic for a PE.

A patient presents to the ED with chest pain described as a squeezing sensation that came on while exercising and lasted approximately 4 minutes. The nurse assesses the pain and determines that rest relieves the pain. Which of the following conditions is the most likely cause?

A.Stable angina B.Unstable angina C.Prinzmetal angina D.Ludwig angina Stable angina: Anginal chest pain that lasts less than 5 minutes and is relieved by rest is stable angina. Sometimes medication may be used if the pain persisits.

A patient arrives in the ED with severe unilateral, pulsating head pain along with nausea, vomiting, and photophobia, all of which have been getting worse over the last four hours. The patient has a history of similar headaches, but their at home remedies are not working. The ED nurse anticipates an order for which of the following medications?

A.Sumatriptan B.Fentanyl C.Hydromorphone D.Secobarbital Sumatriptan: This patient is exhibiting symptoms of a severe migraine. Patients usually seek treatment in the ED when home remedies and medications are ineffective. Sumatriptan, commonly known as Imitrx, is a first line treatment for migraines and can be given via the intranasal, oral, or subcutaneous routes. Other medications that are used initially are antiemetics, ergotamine, and ketorolac.

Which of the following interventions should be anticipated with a pinhole wound on the hand from a high pressure paint gun?

A.Surgical exploration and debridement B.Application of a topical antibiotic C.Soaking the wound in betadine D.Application of ice packs to the wound Surgical exploration and debridement: High pressure grease or paint gun injuries can be limb threatening. The paint or grease has most likely been injected into the extremity. Such wounds require intravenous antibiotics, tetanus immunization, and surgical exploration and debridement to remove necrotic tissue. They are at high risk for anaerobic infection.

In compensated shock, what physiological response increases serum sodium?

A.Sympathetic nervous system (SNS) response B.Intracellular fluid shift C.Renin-angiotensin-aldosterone system (RAAS) D.Altered capillary permeability Renin-angiotensin-aldosterone system (RAAS): Activation of the renin-angiotensin-aldosterone system causes increased excretion of potassium to maintain homeostasis as sodium is retained, increasing water retention and thus increasing blood pressure and cardiac output.

Each week a community hospital emergency department employs key performance indicators (KPIs) to identify opportunities to enhance customer and staff satisfaction. This type of activity is a component of what?

A.Symptom surveillance B.Patient confidentiality C.Quality improvement D.Risk management Quality improvement: Quality improvement is a formal approach to the analysis of performance and systematic efforts to improve it. Emergency nurses evaluate the quality and effectiveness of emergency nursing practice and are continually looking to improve the care for emergency patients.

A patient arrives unresponsive with CPR in progress. The patient has no pulse, and cardiopulmonary monitoring indicates ventricular tachycardia. What will the nurse anticipate as the next intervention?

A.Synchronized cardioversion B.Administer epinephrine intravenously C.Administer amiodarone intravenously D.Defibrillation Defibrillation: Ventricular tachycardia without a pulse is treated as ventricular fibrillation, which requires early defibrillation.

A 67-year-old male patient presents with sudden-onset, sharp, stabbing pain in his chest, flank, and back. He states he's taken ibuprofen and sublingual nitroglycerin prescribed for his angina with no relief. Assessment reveals he is slurring his words, there is a facial droop, and his grip strength is weaker on the right. Vital signs are BP 108/86 mm Hg, HR 96 beats/minute, RR 18 breaths/minute, T 37.0°C (98.6°F), SpO2 91% without supplemental oxygen. What assessment can the nurse do to further determine the cause of these signs and symptoms?

A.Take a blood pressure on the other arm B.Send blood to the laboratory for toxicology C.Perform an assessment for stroke D.Send blood to the laboratory for cardiac enzymes Take a blood pressure on the other arm: Sudden, sharp, stabbing pain in the chest, flank, and back that is unrelieved by analgesia and nitroglycerin can be a sign of an aortic dissection. If the dissection is in the ascending aorta, there may also be signs of stroke. Another manifestation of this condition is a difference of 20 mm Hg in systolic blood pressure between the left and right arms.

A 30-year-old patient presents to the emergency department with excruciating pain on the right side of the head. It has been coming and going all day. The right eye is reddened and skin is flushed. What type of headache is this patient experiencing?

A.Tension B.Traumatic C.Cluster D.Migraine Cluster: Cluster headaches are attacks of severe or very severe, episodic, strictly unilateral pain that last from 15 to 180 minutes and are associated with conjunctival injection, tearing, nasal congestion, runny nose, forehead and facial sweating, pupil constriction, eyelid drooping, and edema.

The nurse is reviewing laboratory results for a patient who presents with hyperglycemia. Which of the following statements about the difference between diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome is true?

A.The patient with hyperosmolar hyperglycemic syndrome presents with a more significant acidosis than the patient with diabetic ketoacidosis. B.The patient with diabetic ketoacidosis presents with moderate-large amounts of ketones in the urine, while the patient with hyperosmolar hyperglycemic syndrome may have absent or small amounts of ketones present. C.The patient with diabetic ketoacidosis presents with a significantly higher blood glucose level than the patient with hyperosmolar hyperglycemic syndrome. D.The patient with hyperosmolar hyperglycemic syndrome presents with a lower blood urea nitrogen level than the patient with diabetic ketoacidosis. The patient with diabetic ketoacidosis presents with moderate-large amounts of ketones in the urine, while the patient with hyperosmolar hyperglycemic syndrome may have absent or small amounts of ketones present.: Diabetic ketoacidosis (DKA) is a more common presentation in patients with type 1 diabetes mellitus, while hyperosmolar hyperglycemic syndrome (HHS) is more common in older individuals with type 2 diabetes mellitus. The hallmark of DKA is the presence of moderate to large amounts of ketones in the urine and the development of acidosis. Ketones can occur at low amounts in the urine with no acidosis present in HHS. In DKA, hyperglycemia is usually > 250 mg/dL and not as high as in HHS, which frequently presents with blood glucose levels greater than 600 mg/dL.

A patient arrives by emergency medical services who is unresponsive, pale, and has involuntary movement of the head and right side of the body. Symptoms continue despite midazolam having been administered in the field. Which medication should be administered next?

A.Thiamine B.Fosphenytoin C.Phenobarbital D.Lorazepam Lorazepam: Lorazepam is a benzodiazepine and an anticonvulsant indicated for use in patients with status epilepticus.

An adult patient complains of a papular, scaly, itchy rash that is most prominent in the webbing of the fingers, groin, and axilla. Permethrin cream has been prescribed. How will the nurse instruct the patient to apply the cream?

A.To affected areas once per day for three days B.From head-to-toe only if the rash persists beyond a week C.From head-to-toe, with a second application one week later D.To affected areas as needed for itching From head-to-toe, with a second application one week later: This presentation is consistent with scabies, for which permethrin cream should be applied from head-to-toe with two applications, one week apart.

A patient who has deep, full-thickness circumferential thermal burns to the chest and abdomen, as well as burns of varying depth to the upper extremities, has been transferred to your emergency department from a rural community hospital. Ventilating the intubated patient via bag-mask device is becoming increasingly difficult and chest rise with ventilation is poor. The emergency nurse anticipates which intervention?

A.Tracheostomy B.Cricothyroidotomy C.Escharotomy D.Fasciotomy Escharotomy: Circumferential (or near-circumferential) deep burns to the thorax can decrease chest wall compliance, which may be manifested while ventilating the patient. These burns are treated with a chest-wall escharotomy in the anterior axillary line bilaterally, with possible escharotomy incisions extending to the abdomen and connected by a transverse incision along the costal margin.

Which of these is a violation of the emergency medical treatment and active labor act (EMTALA)?

A.Transferring a patient and sending the medical records electronically B.Transferring a patient to a facility where the charge nurse is the accepting professional C.Providing a medical screening examination three hours after arrival at the emergency department D.Transferring an unstable patient to a facility that will provide a higher level of care Transferring a patient to a facility where the charge nurse is the accepting professional: Documentation that the receiving facility has space, qualified personnel, and a physician who has accepted the patient is required before the patient can be transferred. The charge nurse should be aware of the transfer, but the receiving facility must have an accepting physician to be compliant with EMTALA.

Which complication is associated with orbital wall fractures?

A.Trismus B.Mastoiditis C.Globe entrapment D.Numbness of the upper teeth Globe entrapment: A common complication associated with orbital wall fracture is the entrapment of the inferior rectus muscle called ocular or globe entrapment.

A 15-year-old female presents to the emergency department with crampy, lower left quadrant abdominal pain that has lasted for four hours prior to arrival. She also is having frequent, severe, bloody diarrhea. What is the most likely cause of her symptoms?

A.Ulcerative colitis B.Diverticulitis C.Crohn's disease D.Appendicitis Ulcerative colitis: Clinical manifestations of ulcerative colitis include abdominal cramping, typically in the left lower quadrant, nausea, vomiting, and diarrhea (5 to 25 stools per day) with blood, mucus, and pus.

A 21-year-old female presents with pelvic pain. Which diagnosis warrants a priority nursing assessment for the possible cause of pain?

A.Urinary tract infection B.Ectopic pregnancy C.Ruptured ovarian cyst D.Kidney stones Ectopic pregnancy: All women of child-bearing age presenting with pelvic pain or bleeding are examined for ectopic pregnancy, which must be suspected until proven otherwise.y:

A 37-year-old female writhing in pain presents with vaginal bleeding for the past 6 days and soaking 5 sanitary pads every 2 hours. Which diagnosis most likely caused the heavy bleeding?

A.Uterine fibroids B.Mittelschmerz C.Pelvic inflammatory disease D.Bartholin cyst Uterine fibroids: Uterine fibroids are muscular tumors that grow in the wall of the uterus. They cause pain and heavy menstrual bleeding.

A pediatric patient presents with their parents after having passed out at home. Parents report the patent has been vomiting with diarrhea for the last few days. Vital signs on arrival are BP 70/40 mm Hg, HR 132 beats/minute, RR 24 breaths/minute, T 36.9°C (98.4°F), and SpO2 97% without supplemental oxygen. The new nurse is about to infuse a fluid bolus of D5W. How do you explain appropriate fluid resuscitation?

A.Vomiting and diarrhea require the use of D5/ .45% sodium chloride at 10 mL/kg B.The patient appears to be in septic shock so fluid resuscitation is at a rate of 10 mL/kg C.The appropriate fluid for hypotension is isotonic crystalloid, not D5W, at a rate of 20 mL/kg D.A pediatric patient requires D5W, which is given as a 20 mL/kg bolus. The appropriate fluid for hypotension is isotonic crystalloid, not D5W, at a rate of 20 mL/kg: Dextrose is not appropriate for fluid resuscitation as it is quickly metabolized, becoming hypotonic and thus not contributing to expanding intravascular volume. Isotonic crystalloid solutions, such as 0.9% sodium chloride or Ringer's lactate are used for fluid resuscitation for volume losses from vomiting and diarrhea. D5W also contributes to hyperglycemia, which has been demonstrated to lead to poor outcomes.

Which inherited bleeding disorder is the most common?

A.von Willebrand disease B.Classic hemophilia C.Christmas disease D.Rosenthal syndrome von Willebrand disease: von Willebrand disease is the most common inherited bleeding disorder.