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CEN Study Questions

What injury is most commonly associated with blunt chest trauma? Rib fracture The ribs are the structures most commonly injured in the chest in blunt chest trauma.
Which of the following is an expected outcome in a patient with a suspected pericardial tamponade undergoing a pericardiocentesis? Jugular venous distention (JVD) is a sign of increased intrathoracic pressure, which can be caused by cardiac tamponade. After a pericardiocentesis, intrathoracic pressure should return to normal and JVD is not an expected finding.
A patient with acute coronary syndrome has an allergy to aspirin. Which antiplatelet drug should initially be given to this patient? Clopidogrel (Plavix) Aspirin prevents platelet aggregation but when a patient has an allergy to aspirin clopidogrel (Plavix) is the preferred subsitute for aspirin.
Which of the following interventions is most appropriate for a patient who has a HR of 36 beats/minute, BP of 70/30mmHg, and a decreased capillary refill time? Transcutaneous pacing Transcutaneous pacing (TCP) is the treatment of choice when a patient has a symptomatic bradycardia with signs of poor perfusion.
Which of the following intravenous medications is indicated for a patient who will be sent to the cardiac catheterization lab with a non-ST-segment elevation myocardial infarction (non-STEMI)? Eptifibatide (Integrilin) is a Glycoprotein IIbIIIa inhibitor and is indicated as a pharmacological agent to inhibit platelet aggregation. The development of a thrombus, which is the mechanism for non-STEMI, is the build-up or aggregation of platelets.
A 3-year-old patient has been vomiting for three days and presents with hypotension, narrow complex tachycardia, decreased capillary refill time, and decreased responsiveness. To help with treatment decisions, the nurse would initially obtain: The (Broselow tape) is a reference that allows caregivers to estimate body weight based on a child's crown-to-heel length. It is used to determine drug doses, fluid resuscitation, and sizes of supplies used on pediatric patients.
Current national standards for "door to balloon" time for percutaneous coronary interventions (PTCI) are: These times are the current national standards (note: individual institution standards may be a shorter time frame) for how quickly the patient should be in the cardiac catheterization lab (after emergency department arrival) and undergoing PTCI.
The electrocardiogram of a patient found unresponsive shows prolonged PR, QRS, and QT intervals. The QT-interval prolongation and characteristic J (Osborne) waves are suggestive of which of the following? In hypothermia the electrocardiogram may show prolonged PR, QRS, and QT intervals, and atrial or ventricular dysrhythmias. The length and height of the respective QT-interval prolongation are characteristic J (Osborne) waves.
Which of the following hollow organs is most prone to injury by blunt trauma to the abdomen? The position of the small bowel makes it the most frequently injured hollow organ. The small intestine becomes crushed, and possibly ruptured, as it is forced towards the vertebral column during traumatic blunt injuries.
Following nasogastric tube insertion, which of the following potential complications is the most serious? Hypoxia, cyanosis, or respiratory arrest as a result of inadvertent intubation of the trachea would be the most serious complication.
Which of the following medication classes would be most beneficial in the treatment of cholecystitis? Narcotic analgesics are recommended for pain control in cholecystitis.
A nurse would expect all of the following treatments for a patient diagnosed with renal calculi EXCEPT: It is NOT indicated to restrict fluid administration. Although it is common to deliver increased intravenous fluids, this has not been shown to decrease duration or intensity of ureteral obstruction of renal calculi.
A driver approaches the emergency department blowing the horn and waving for help. A pregnant female is in the passenger seat with an umbilical cord protruding from the vagina. After placing the patient on a gurney, which action is most appropriate? Compression of the cord can reduce or eliminate blood flow to the unborn fetus. The knee-chest position may help position the fetus off the cord.
The tetanus, diphtheria, and pertussis vaccine recommended by CDC Advisory Committee on Immunization Practices (ACIP) for children under seven years of age is: DtaP (Daptacel) is the pediatric formulation that contains tetanus, diphtheria, and pertussis vaccine. Hint: Upper case "D" is for pediatric formulation and lower case "d" is for adult formulations.
The most important risk factor in terms of incidence in the general population for the development of herpes zoster (shingles) is: There is an association between age and increasing zoster incidence. The herpes zoster vaccine (Zostavax) is recommended for persons 60 years of age and older. Approximately 50% of persons who live to age 85 years will have experienced a zoster event.
After multiple patients arrive with complaints of progressive symmetric muscle weakness, which begins in the trunk and descends to the extremities the nurse should suspect which of the following: Progressive symmetric muscle weakness beginning at the trunk and descending to the extremities are classic signs of botulism. Numbers of unrelated patients with similar complaints should signal the possibility of a bio-terrorist attack.
Which of the following is TRUE regarding the management of cervical spine fractures with skeletal traction? Skeletal traction is contraindicated in atlanto-occipital dislocations.
The MOST common cause of an epidural hematoma is a(n)? An epidural hematoma is a collection of blood between the skull and the dura mater. It is usually the result of a temporal skull fracture that crosses and lacerates the middle meningeal artery.
The range for normal intracranial pressure (ICP) is: The normal range for ICP is between 1-15mmHg.
A patient with a complete spinal cord lesion at the level of C4 would exhibit which of the following? Injuries in the cervical region will affect the use of both upper and lower extremities resulting in quadriplegia.
An axial loading type injury to the vertebral column is most likely caused by a: The direct force transmitted along the length of the vertebral column caused by a diving injury results in an axial loading injury.
An elderly patient with a dirty finger laceration has never received a tetanus shot. Which medications should be administered? If a patient is not adequately immunized, they must initially receive tetanus immune globulin and tetanus diphtheria injections followed by a second tetanus and diphtheria injection at 4 weeks and a third at 6 to 12 months.
All of the following are indications to utilize intravenous regional anesthesia or bier block EXCEPT: A bier block is not used for evaluating or treating an open fracture.
A patient arrives in the emergency department with severe pain from an anterior shoulder dislocation. After completing the primary assessment, the highest priority for this patient is to assess: The highest priority assessment would be distal circulation. Circulatory compromise can lead to avascular necrosis and loss of the limb without rapid intervention.
A pt presents with pain and a foul odor coming from their cast. The fingers are edematous and cold. Initial VS are: T 100°F (37.8°C); HR 135 beats/minute; RR 24 breaths/minute; and BP 100/62 mmHg. Cast removal shows tissue death and a foul-smelling wound. This wound needs aggressive surgical exploration to determine extent of infection along with antibiotic therapy.
Patients who have experienced a high pressure injection injury will generally: Patients with high pressure injection injuries generally require debridement and extensive irrigation under anesthesia since serious problems result from the injected material spreading along the fascial planes
An elderly patient complains of wrist pain after landing on an outstretched hand. The anterior/posterior and lateral wrist radiographs reveal a distal radius/ulna fracture with dorsal angulation, indicating that the patient has which type of fracture? A Colles' fracture is a specific type of radial fracture resulting in a backward, outward position of the hand in relation to the forearm with a dinner fork appearance.
Clenched fist injuries during an altercation are at an increased risk for: Clenched fist injuries (e.g. human bites over the metacarpophalangeal joint) typically occur during an altercation and are at an increased risk of infection because of joint penetration.
The triage process begins with which of the following? Obtaining patient chief complaint and history are not the initial steps in the triage process; rather this step is part of the triage interview.
Which of the diagnostic peritoneal lavage findings below would be considered positive for pancreatic injury? Amylase is specific for pancreatic injury.
Which of the following laboratory values would require immediate attention and intervention? A serum osmolality of 360mOsm/kg is considered high, with a normal range of 285-295mOsm/kg.
A patient arrives in the emergency department complaining of left anterior chest pain for the last 2 hours, associated with nausea and diaphoresis. After evaluation admission is advised. The patient refuses: The first step the nurse should take is to determine competency of the patient. A competent person has the right to refuse care.
Emergency nurses must deliver care that complies with the following ethical principles: The ANA Nursing: Scopes and Standards of Practice defines the four ethical principles of nursing care as autonomy, beneficence, nonmaleficence and justice.
A middle aged pt with a h/o DMII & occ. anxiety presents complaining of a feeling of apprehension & a 'racing heart.' Assess. reveals cool & sweaty skin, inc. HR, & slight inc. RR. What is the most important for the triage nurse to consider about this pt? Anxiety or apprehension may be caused by a medical condition
Which of the following statements is true about advance directives? The durable power of attorney for healthcare allows the patient to appoint a decision maker (known as a surrogate or proxy) in the case of future incapacity. This surrogate must be appointed while the patient still has decisional capacity.
An anxious patient is considered at risk for self-violence after expressing suicidal ideations. The most appropriate short term goal is that the patient will: Clarifying hazards for the patient and facilitating the expression of negative feelings are basic interventions.
Under normal physiologic circumstances, the respiratory drive is triggered by a(n): Under normal physiologic circumstances, the respiratory drive is triggered by a high partial pressure of arterial carbon dioxide (PaCO2).
When teaching patients with asthma, which of the following are correct discharge instructions? If the patient's peak flow is 50-79% of their personal best they can use their rescue inhaler. If they drop below 50% of their personal best they should seek help immediately which may include calling 911.
The following patients required chest tube placement as a result of their injuries. Initial chest tube output in each case is 1500 mL. In which patient would an emergency resuscitative thoracotomy be a priority? An emergency resuscitative thoracotomy is NOT beneficial for patients with no documented vital signs or signs of life (e.g., no pupillary reflexes, spontaneous movement, or organized electrocardiogram activity).
A patient complains of numbness and tingling to the hand following puncture of the radial artery for an arterial blood gas sample. The nurse suspects this patient has sustained: Compromised circulation is a complication from lack of collateral circulation to the extremity after the radial artery has been damaged or hematoma has formed, which can subsequently block circulation. An Allen's test should be performed prior to radial a
Following a MVC in which there was airbag deployment and significant damage to the front and driver side of the car, a patient is drowsy, very pale, and appears to be very anxious and dyspneic. After 100% oxygen via nonrebreather mask is administered, a p Chest tube placement would be the appropriate treatment for a pneumothorax or hemothorax, however at this time there is no evidence that either one of these are present. Arterial blood gases and a chest radiograph would lend to further evaluation of the p
What is the earliest, most reliable sign of hypoperfusion in an infant? AMS
Which form of shock occurs due to the loss of vasomotor tone and sympathetic nervous system disruption? Within the category of distributive shock is neurogenic shock. This results from high thoracic or cervical cord injury and causes disruption of the sympathetic nervous system.
All of the following are causes of distributive shock EXCEPT: Pericardial tamponade results from obstruction of blood flow due to compression of the pericardial sac. Either blood or fluid can accumulate in the sac and compress the heart.
A non-English speaking female presents to the emergency department complaining of vaginal discharge. Her 12-year old child is acting as an interpreter for her. What is the primary reason the emergency department nurse should utilize a medical interpreter The child may not understand all the terms associated with getting a complete history on a woman who is experiencing vaginal discharge. This lack of understanding may affect the interpretation that is done, which may mean erroneous information is obtained
An acute coronary syndrome (ACS) patient reports taking ginkgo biloba for memory, garlic for cholesterol and ginger for arthritis. Which of the following medications should be administered with caution and careful monitoring? All three of these herbal products have anticoagulation effects which may potentiate heparin and increase the risk of bleeding.
Which of the following should be considered when obtaining a history from an elderly patient? Obtaining a history from an elderly patient may be difficult secondary to many factors. One common factor is impaired hearing of the patient. A quiet surrounding is optimal.
Which of the following assessment findings is associated with the presence of Ludwig's angina? Swelling and cellulitis extend into the submandibular, submental, and sublingual spaces resulting in elevation and protrusion of the tongue toward the palate.
Which of the following dental fractures would most likely be associated with pain when exposed to heat or cold? An Ellis II fracture is a tooth fracture that involves the enamel in addition to the dentin layer and causes the most pain and sensitivity to exposure to heat or cold.
An elderly female presents for treatment. Her daughter states her awareness has been diminished and that her mother seems a little confused. Her vital signs are: BP 90/60 mmHg, HR 100 beats/minute, RR 28 breaths/minute, T 98.9°F (37°C). The only presentin Infections in the geriatric population may manifest with a fall or generalized weakness rather than with a fever or elevation of white blood cell count (WBC). A urinary tract infection may present with very subtle changes such as confusion or a poor appet
Which of the following is the drug of choice to inhibit the catecholamine effects associated with thyroid storm? In thyroid storm there are excess catecholamines. Propanol (Inderal), a beta blocker, will lessen adrenergic effects. It also blocks conversion of T4 to T3. The goal is to keep the heart rate less than 100 beats/minute.
Parents accompany a young child to the emergency department. Initial assessment reveals that the child has a headache, stiff neck, photophobia, and purpura on arms and legs. Immediate interventions would include: The child's symptoms are highly suggestive of Neisseria meningitides, (Meningococcemia) which is most commonly spread through respiratory droplet.
The nursing management of a patient with compartment syndrome may include: Measurements are part of the initial assessment in a patient with an acute case of compartment syndrome.
Underreporting of workplace violence may result from all of the following EXCEPT: Research indicates that employees may feel that violence is an acceptable part of the job.
When a thoracentesis is performed for therapeutic purposes, the most common complication is? When a large quantity of fluid is removed with thoracentesis re-expansion pulmonary edema occurs. Removing no more than 1000-1500 mL at one time will decrease this risk.
A patient presents to the emergency department following smoke inhalation and exposure to combustion of synthetic materials during a house fire. The nurse would suspect cyanide inhalation poisoning if the: Cyanide is released during the combustion of synthetic materials, such as plastics or polyurethane. Although the oxygen is delivered to the cell, it cannot be utilized.
The QRS complex represents what mechanical event in the heart? Ventricular contraction is represented by the QRS complex.
The purpose of administering beta-blockers to patients experiencing an ST-segment elevation myocardial infarction (STEMI) is to: Current guidelines from the AHA and the American College of Cardiology recommend administration of beta-blockers on arrival (or within 24 hours) to reduce morbidity and mortality in patients with STEMI if there are no contraindications.
A primary adverse effect that is associated with a patient taking bethanechol (Urecholine) for gastroesophageal reflux disease (GERD) is: In the patient with GERD, Urecholine increases sphincter pressure and facilitates gastric emptying. Adverse effects of cholinergic drugs may include urinary urgency, diarrhea, abdominal cramping, hypotension, and increased salivation.
A patient is being discharged from the emergency department with a diagnosis of acute prostatitis. The discharge instructions should include: Increase daily fluid intake to assist in eliminating the bacteria.
Untreated Lyme disease may cause: Borrelia burgdorferi is transmitted by the deer tick causing Lyme disease. If left untreated, common symptoms are an expanding bull's-eye circle on the skin, flu-like symptoms, atrioventricular blocks, meningitis, hepatitis, and arthralgia.
Which of the following laboratory values would indicate viral versus bacterial meningitis? Leukocytes are less than 1000 cells/mL in viral meningitis and greater than 1000 cells/mL in bacterial meningitis; normal range is 0 to 5 white blood cells.
Which of the following is correct regarding the intravenous administration of phenytoin (Dilantin)? Side effects of phenytoin (Dilantin) administration include hypotension and bradycardia, especially with rapid IV use.
Which of the following is considered the most reliable indicator of neurological function? Level of consciousness is considered the most reliable indicator of neurological function.
S/p fall, a pt is noted to have loss of function in the BUE, but the lower extremity function remains intact. There was no loss of bowel or bladder control. These symptoms are associated with which of the following incomplete spinal cord injuries? Central cord syndrome is caused by hyperextension and is seen most often in elderly patients following a fall. This syndrome results in loss of function of upper extremities while the lower extremities remain functional. Bowel and bladder function is main
A splint has been placed on a fractured upper extremity. The patient continues to have 10/10 pain despite administration of intravenous narcotics. Which of the following conditions is the most likely cause of this patient's unrelieved pain? Unrelieved pain is a cardinal sign of compartment syndrome.
The local police escort a patient who was found in the parking lot of the local store without clothes on and running in circles around cars. The priority for this patient is which of the following? The main priority for this patient is maintaining safety. The patient is at high risk for injury due to the increased motor activity, increased energy, extreme hyperactivity, agitation, disorganized activity, and poor impulse control.
Increasing respiratory difficulties in the elderly patient are usually due to: The normal elderly patient loses both muscle mass and strength with age. Weakening of the diaphragmatic muscle results in increased difficulty in maintaining normal respirations.
Crackles in the lungs are caused by: Crackles are small popping sounds produced by the passage of air through fluid or secretions in the small airways or alveoli, most commonly during inspiration.
An early sign of hypovolemic shock in adults is: Inadequate circulating volume causes cellular hypoxia and anaerobic cellular metabolism. Tachypnea is an effort to decrease carbon dioxide and compensate for cellular acidosis.
Which of the following is an absolute CONTRAINDICATION to the administration of recombinant human activated protein C (Xigris) in patients with multiple organ failure? Recombinant human activated protein C (Xigris) is contraindicated in the presence of a bleeding risk.
Which of the following assessment findings is expected in a patient with altered mental status and suspected opioid ingestion? Pinpoint fixed pupils are an expected finding in the patient with suspected ingestion of opioids.
Which of the following treatments is indicated following hydrofluoric acid (HF) exposure to the skin? Unlike acid and alkali burns, HF penetrates the skin and affects calcium in bone and tissue. Its treatment requires a specific antidote, calcium gluconate
Created by: kiiirsten