CEN EXAM 2024/2025 WITH 100% ACCURATE SOLUTIONS, Exams of Nursing

Download CEN EXAM 2024/2025 WITH 100% ACCURATE SOLUTIONS and more Exams Nursing in PDF only on Docsity! CEN EXAM 2024/2025 WITH 100% ACCURATE SOLUTIONS Preload refers to: a. The volume of blood entering the left side of the heart b. The volume of blood entering the right side of the heart c. The pressure in the venous system that the heart must overcome to pump the blood d. The pressure in the arterial system that the heart must overcome to pump the blood - Precise Answer ✔✔b. The volume of blood entering the right side of the heart Preload is the volume of blood that enters the right side of the heart. This volume stretches the fibers in the heart prior to contraction. Preload is commonly measured as atrial pressure. The patient is brought to the ED with an anterior ST-elevation myocardial infarction (STEMI). You are assessing him for possible administration of fibrinolytics. An absolute contraindication for this treatment is: a. The patient's pain is not relieved by medications. b. Symptoms began 36 hours before arrival. c. The patient has received aspirin in the last 2 hours. d. The patient had a previous MI 6 years ago. - Precise Answer ✔✔b. Symptoms began 36 hours before arrival. Fibrinolytic therapy is generally NOT recommended for patients whose symptoms began more than 12 hours before arrival. Fibrinolytics should not be given if the onset of symptoms was more than 24 hours before arrival UNLESS a posterior MI is diagnosed. In this case, the MI was anterior. The team is performing CPR on a patient. The rhythm that will respond to an electrical shock is: a. Asystole b. PEA c. Ventricular fibrillation d. SVT - Precise Answer ✔✔c. Ventricular fibrillation Ventricular fibrillation and pulseless ventricular tachycardia are the two rhythms that are considered to be "shockable" cardiac arrest rhythms. Although asystole and PEA are cardiac arrest rhythms, they will not respond to electrical shock. When suctioning during a cardiac arrest, suctioning should be limited to which of the following? You are providing positive pressure ventilation through an ET tube to a patient in respiratory distress. Indications that you are ventilating too fast include all of the following EXCEPT: a. Increasing waveform capnography readings b. Stomach insufflation c. Tension pneumothorax d. Aspiration - Precise Answer ✔✔a. Increasing waveform capnography readings Latrogenic effects of hyperventilation through an ET tube include aspiration, stomach insufflation, and tension pneumothorax. Increasing waveform capnography readings are an indication of efficient CPR. According to American Heart Association ACLS guidelines, when available, the best way to confirm and maintain tracheal tube position is by: a. Clinical examination only. b. Quantitative waveform capnography. c. Clinical examination and Pulse oximetry. d. Clinical examination and quantitative waveform capnography. - Precise Answer ✔✔d. Clinical examination and quantitative waveform capnography. The AHA recommends continuous waveform capnography and clinical examination to confirm and maintain ET tube position. Signs of respiratory failure include all of the following EXCEPT: a. Bradypnea b. Diminished air movement c. Decreased level of consciousness d. Nasal flaring and retractions - Precise Answer ✔✔d. Nasal flaring and retractions Nasal flaring and retractions are signs of respiratory distress, not respiratory failure. In respiratory failure, you will see decreased respiratory effort with late bradypnea, diminished air movement, peripheral and central cyanosis, and decreased level of consciousness. Emergency Medical Service has brought a 24-year-old man to the ED with gunshot wounds to his abdomen and left groin area. His blood pressure is 84/52 and heart rate is 120 per minute. His skin is diaphoretic, cool, and pale. The treatment the nurse should prepare for is: a. Chest compressions b. Endotracheal intubation c. Administration of verapamil d. Rapid administration of a crystalloid solution - Precise Answer ✔✔d. Rapid administration of a crystalloid solution The gunshot wounds and symptoms would indicate that the young man has lost a significant amount of blood that has resulted in hypovolemia. The treatment of hypovolemia is a rapid infusion of a crystalloid intravenous solution. You are on the ED team caring for a 10-year-old child with a normal systolic blood pressure, increased heart rate, slightly delayed capillary refill and cool, pale skin. What severity of shock is the child likely in? a. Decompensated shock b. Hypotensive shock c. Compensated shock d. None of the above - Precise Answer ✔✔c. Compensated shock Severity of shock is often characterized by its effect on the systolic blood pressure. When the compensatory mechanisms work and maintain the systolic blood pressure, the shock is defined as "compensated". When the mechanisms can no longer support the blood pressure, shock is classified as "hypotensive" (formally called "decompensated"). You are caring for a patient in cardiogenic shock. You know that a probable cause of this condition is: The Epworth Scale is a measure of sleepiness and is not part of the standard evaluation of a child's neurological exam. The AVPU and Glasgow Coma scales can be used to evaluate a child's neuro status. Pupillary size and response should also be checked. According to the American Heart Association stroke recommendations, the critical goal time from arrival to the Emergency Department to CT brain scan is: a. 10 minutes b. 25 minutes c. 45 minutes d. 60 minutes - Precise Answer ✔✔b. 25 minutes The goal for CT brain scan is 25 minutes after arrival to the Emergency Department. The assessment should occur within 10 minutes of arrival, diagnosis of ischemic stroke should be made within 45 minutes, and the administration of fibrinolytics should occur with 60 minutes. The National Institute of Neurological Disorders and Stokes (NINDS) has set the goal for immediate general assessment by a stroke team or emergency physician as: a. Within 1 minute of arrival. b. Within 10 minutes of arrival. c. Within 30 minutes of arrival. d. Within 60 minutes of arrival. - Precise Answer ✔✔b. Within 10 minutes of arrival. The goal for general assessment by an ED or stroke team physician is within 10 minutes of arrival to the ED. Within the same 10 minutes, an urgent CT without contrast should also be ordered. A 16-year-old boy is brought to the ED by his parents. They state that he awoke from sleep with nausea, vomiting, and pain in his scrotum. The nurse notes that the boy's scrotum is swollen and he has a low-grade fever. His urinalysis is normal. The physician suspects a testicular torsion. The definitive treatment for this boy is: a. Antibiotics b. Bed rest for several days c. Anti-emetic and pain medication d. Surgery - Precise Answer ✔✔d. Surgery The nurse should recognize that these signs and symptoms in a teenage boy may be indicative of testicular torsion. Although all of the treatments may be used, surgery is the definitive treatment for this condition. A 24-year-old woman is seen in the emergency department complaining of urinary frequency, pain with urination and urgency. Vital signs are stable and within normal limits. When you obtain a urine specimen, you note that it is cloudy and foul smelling. You should prepare the patient for: a. Admission for acute renal failure b. Discharge with antibiotic therapy c. Admission for lithotripsy d. Discharge without medications - Precise Answer ✔✔b. Discharge with antibiotic therapy The symptoms of dysuria, urgency and frequency are classic indicators of a urinary tract infection. Urinary tract infections are very common in women and can almost always be treated on an outpatient basis with a course of antibiotics. A woman is admitted to the ED with complaints of lower abdominal pain, smelly vaginal discharge, pain with intercourse, and burning with urination. Her vital signs are stable, and she has no other symptoms. Treatment for this patient will likely include: a. Hysterectomy b. Inpatient treatment c. Antibiotics d. No treatment is needed - Precise Answer ✔✔c. Antibiotics Given the patient symptoms, the nurse should suspect that the patient has pelvic inflammatory disease (PID). With early antibiotic treatment, The nurse should recognize that these signs and symptoms indicate possible anaphylaxis following the fire ant bites. Antibiotics are not indicated for the initial treatment of anaphylaxis. They may be necessary at a future time if the ant bites become infected. Adrenaline, oxygen, and antihistamines will help reduce some of the symptoms the patient is experiencing. The nurse should also be prepared for emergency intubation if the respiratory problems increase and result in respiratory distress. An eight-year-old child is brought to the emergency department by his parents after receiving multiple fire ant bites at his home. His lips are swollen, and he is complaining of itching. During your assessment, you note that he is wheezing. The most appropriate immediate treatment for this child is: a. Antibiotic b. IV antihistamine c. IV steroid d. IM epinephrine - Precise Answer ✔✔d. IM epinephrine The mechanism of injury and symptoms would indicate an anaphylactic reaction to the fire ant bites. Since the child has respiratory symptoms, immediate treatment must be instituted with attention to airway maintenance. Epinephrine will act rapidly and should be given as soon as possible and every 10 to 15 minutes as needed. Steroids and antihistamines may be given, but act much more slowly than epinephrine. The Emergency Department nurse knows that the best way to prevent transmission of nosocomial infections is: a. Using sterile supplies b. Isolating patients c. Wearing appropriate personal protective equipment d. Hand hygiene - Precise Answer ✔✔d. Hand hygiene According to the CDC and infection control personnel, hand hygiene is the single most important precaution to take to prevent hospital-acquired infections. The other interventions may be necessary for specific circumstances. However, hand hygiene is the most important intervention to prevent nosocomial infections. Patient placement in the emergency department should be based on: a. Route of transmission of the suspected infectious agent b. Risk factors in other patients in the ED c. Availability of single-patient rooms d. All the above e. Both a and b only - Precise Answer ✔✔d. All the above Isolation precautions should be based on all of these factors. In addition, ED personnel must consider risk factors for transmission of the agent in the infected patient. Room-sharing should only be considered if the patients have the same infection. Terminal clean should be instituted for any room that has been occupied by a potentially infectious patient. You are caring for a patient who has just been diagnosed with hepatitis A. The discharge instructions for this patient will likely include all of the following EXCEPT: a. Medication for nausea b. Advising eating several small meals rather than 3 large meals c. Scheduled medicines for pain d. Resting frequently - Precise Answer ✔✔c. Scheduled medicines for pain Patients with hepatitis A rarely have pain so having scheduled pain medication would not be necessary. However, these patients do have nausea and fatigue necessitating medication and small meals for nausea and frequent rests for the fatigue. A 12-year-old patient is brought to the emergency department by his parents after accidentally swallowing a disk battery while changing the battery in his watch. A chest x-ray reveals that the battery is in the patient's esophagus. He is able to swallow and breathe without difficulty. The most appropriate intervention for this patient is to: a. Prepare the patient and his family for emergent endoscopy to remove the battery. d. Prone with the head facing to the side - Precise Answer ✔✔a. Sitting with head leaning forward The patient should be sitting up with his head leaning forward. This position helps to prevent blood from being swallowed by the patient. Swallowing blood can cause vomiting. Pinching the nose below the bridge of the nose may help stop bleeding A patient presents to the ED with complaint of ear and jaw pain. Upon assessment, you note that his tympanic membranes are non-bulging, pearly gray. You look in his mouth and see this: The primary diagnosis for this patient will be: a. Acute otitis media b. Acute otitis externa c. Dental caries d. None of the above - Precise Answer ✔✔c. Dental caries The normal eardrum is pearly gray in color so this would rule out any of the ear infections. This patient has an extensive dental caries that should be referred to a dentist. The ED provider may prescribe antibiotics and/or pain medications for this patient to clear any infection that may be causing the ear pain. A young woman is brought to the ED by her roommates. The nurse notes that a knitting needle is sticking out of her right eye. All of the following are appropriate initial interventions EXCEPT: a. Consult an ophthalmologist b. Apply gauze around the knitting needle to stabilize it c. Remove the knitting needle and patch the eyed. d. Patch the other eye. - Precise Answer ✔✔c. Remove the knitting needle and patch the eyed. A penetrating object should never be removed by the nurse since doing so can cause more injury to the eye. Instead, attempt to stabilize the object, patch the other eye to prevent eye movement, and call for an ophthalmology consult. A baseball coach calls the emergency department after a 15-year-old boy had a tooth knocked out during a baseball game. The baseball coach found the intact tooth on the ground and has rinsed off the dirt. What should the coach be advised to do? a. The tooth and boy should go to the dentist in the morning. b. You cannot give any advice over the telephone. c. If the child is alert and oriented, put the tooth under his tongue and bring him to the ED. d. Wrap the tooth in a clean shirt and bring the boy and tooth to the ED. - Precise Answer ✔✔c. If the child is alert and oriented, put the tooth under his tongue and bring him to the ED. Many times, an avulsed tooth can be reimplanted if the tooth is out of the socket for less than 60 minutes. After that time, the periodontal ligaments begin to die. An avulsed tooth is best transported in the patient's own mouth if he is not at risk for swallowing the tooth and if there are no other injuries. Generally, the rule of thumb is that children under the age of six should not transport the tooth in their mouth. The child pictured on the right is seen in the ED for a left forearm fracture. The orthopedic surgeon reduces the fracture in the ED and applies the cast. The discharge instructions have not been understood because: a. The sling is too long b. The child's hand is lower than the elbow. c. The child is cradling her fractured limb in her other hand. d. The child's clothes will not be easily removable. - Precise Answer ✔✔b. The child's hand is lower than the elbow The child and parent should understand that the hand must be elevated above the level of the heart (on a pillow, for example) when the child is sitting. When the child is up, the sling should be adjusted to keep the hand elevated as much as possible. Hanging the hand down will cause blood to collect in the hand causing swelling. The swelling under the cast may cause decreased venous return. The parents should be taught to check capillary refill, movement, and sensation of the hand as long as the cast is in place. Third Degree (full thickness) - whitish, charred or translucent, no pin prick sensation The medication indicated for a suspected opioid overdose is: a. Atropine b. Epinephrine c. Lidocaine d. Naloxone - Precise Answer ✔✔d. Naloxone Naloxone (Narcan) is the medication that is indicated for the treatment of an opioid overdose. If the patient's condition is due to opioids, the nurse should be prepared for rapid reversal of the narcotic effects of the drug. A patient in the ED is diagnosed with West Nile virus. Which of the following is the mode of transmission for this disease? a. Bite of infected tick b. Bite of infected flea c. Bite of infected mosquito d. Bite of infected spider - Precise Answer ✔✔c. Bite of infected mosquito West Nile virus is caused by the bite of a mosquito. First discovered in the US in 1999, it is believed that the virus is actually carried by infected birds. The mosquito bites the bird and then bites a person. Mosquitoes carry the highest amount of virus in the early fall; typically, rates of the reported disease increases in late August and early September. As mosquitoes die off in the cold weather, the incidence of disease decreases. The pediatric Emergency Department nurse is required to report:a a. Sexual abuse b. Serious physical injury c. A suspicious death d. All of the above - Precise Answer ✔✔a. Sexual abuse Regardless of the patient's age or gender, the Emergency Department nurse is required to report any suspected abuse or injury that might have resulted from abuse or neglect. The reporter is protected by statute from retaliatory actions as a result of their report to protective services or local law enforcement. You are working in the pediatric emergency department. Parents bring their 6-year-old child in with what is diagnosed as a fracture of the left ulna. The mother states that the child fell off his bike. The child appears withdrawn and states "I fell" when you ask how his arm was broken. Which of the following would be an improper intervention with this family at this point? a. Interview the parents separately. b. Immediately call the appropriate child protective agency. c. Express genuine concern when interviewing the parents. d. Interview the child separately from the parents if possible. - Precise Answer ✔✔b. Immediately call the appropriate child protective agency. Although this may be a case of abuse, you should not call the official child protection agency until more information is gathered. Performing in-depth, non-judgmental interviews with the parents and child will help identify if there are family issues or if this injury was accidental. The nurse in the Emergency Department is discharging a patient who has been evaluated by the psychiatric team for suicidal ideations. Discharge instructions should include all of the following EXCEPT: a. Encourage the patient to sign a suicide prevention agreement. b. Give the patient the telephone number for the crisis hotline. c. Recommend that the family know where the patient is at all times. d. Educate the family members about what they can do to prevent suicide. - Precise Answer ✔✔c. Recommend that the family know where the patient is at all times. Recommending that the family know where the patient is at all times may be counterproductive since this action can cause the patient to feel b. Not taking verbal or telephone orders. c. Comply with hand hygiene guidelines d. Assure central lines are inserted under sterile conditions. - Precise Answer ✔✔b. Not taking verbal or telephone orders. Although verbal and telephone orders are not ideal, the practice of emergency nursing often requires taking verbal orders. In those cases, the nurse must employ the practice of reading back the order to ensure that it was received and recorded accurately. The nurse in a small rural hospital is caring for a pregnant woman who is at 34-weeks gestation in her first pregnancy. She is complaining of intermittent lower abdominal pain. The hospital does not have a labor and delivery unit, but the on-call physician has determined that her cervix is dilated to 3 cm. The fetal heart sounds are strong at a rate of 150 beats per minute. The woman is accompanied by her husband. The nearest hospital with a labor and delivery unit is 30 minutes away. The correct action in this situation is to: a. Admit the woman for observation. b. Keep the woman in the ED for monitoring. c. Transfer the woman via ambulance to the hospital with obstetrical care. d. Instruct the husband to transport the patient to the hospital with obstetrical care. - Precise Answer ✔✔d. Instruct the husband to transport the patient to the hospital with obstetrical care. According to EMTALA, a pregnant woman cannot be transferred if delivery is imminent. However, in this scenario, the patient is stable, the fetus does not seem to be in distress, and the woman is not in active labor. Therefore, the discharge of the patient is not restricted by the EMTALA statute. The husband should transport the patient to the nearest hospital with a labor and delivery unit for further monitoring. A nurse has inserted a nasogastric (NG) tube for the relief of nausea and vomiting. The technician working with the nurse does not have any special training or certification. The nurse asks the technician to "take care of the patient while I go to lunch". While the nurse is out of the department, the technician working with the patient can: a. Do oral care b. Irrigate the NG tube c. Administer meds through the NG d. All the above - Precise Answer ✔✔a. Do oral care The only task that the nurse should delegate to the unlicensed technician is the provision of oral care.