Emergency Medicine Practice Questions and Answers, Exams of Nursing

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CEN practice questions and answer

Pulse pressure is the difference between systolic blood pressure and diastolic blood pressure, and is widened in which of the following disorders? (A) Early hypovolemic shock (B) Increased ICP (C) Cardiac tamponade (D) Neurogenic shock \Correct Answer(B) Increased ICP [pulse pressure is narrow in early shock, cardiac tamponade, and aortic valve stenosis] Parents bring in their 4-week-old infant with non-bilious projectile vomiting and persistent hunger. Which of the following conditions is suspected? \Correct Answer(A) Pyloric stenosis [PS is characterized by non-bilious projectile vomiting and persistent hunger; volvulus has bilious vomiting] Systemic vascular resistance (SVR) is decreased in which type of shock? \Correct Answer(D) Distributive [Afterload (pressure) is low in distributive shock (neurogenic, septic, anaphylactic) due to vasodilation, and high in all other forms of shock due to vasoconstriction] Which is the following is the hallmark symptom of Prinzmetal's angina? \Correct AnswerPain at rest due to coronary vasospasm; may be seen with stimulant use ST segment elevation in ECG leads II, III and aVF indicates injury to which area of the heart? \Correct AnswerInferior wall [V1-V4 look at the anterior wall; I, aVL, V5, V6 look at the lateral wall of the left ventricle] A 40F who is 36-weeks pregnant presents to the ED with painless bright red vaginal bleeding. The nurse knows a pelvic exam is contraindicated since the most likely cause of the bleeding is \Correct AnswerPlacenta previa [think P's - painless privates, placenta previa; abrupt placenta - always painful] A 14-year-old c/o lightheadedness & palpitations. Which cardiac disorder is characterized by a short PR interval and a Delta wave? \Correct AnswerWolff- Parkinson-White (WPW) syndrome [WPW is characterized by a short PR interval, and a slurred QRS on the upstroke, yielding a widened QRS complex; this morphology is referred to as a "Delta wave"] A 22F c/o thick, white, "cottage-cheese" like vaginal discharge, pruritus, vulvar burning and dyspareunia. The nurse suspects a diagnosis of: \Correct AnswerCandidiasis [characterized by pruritus & thick, white, "cottage-cheese" like vaginal discharge] Which atrioventricular block is characterized by a consistent but prolonged PR interval, and a consistent R to R interval? \Correct AnswerFirst degree AV block [Second degree type I has progressive elongation of PR interval; second degree type 2 has a consistent

PR interval, but inconsistent R to R interval; third degree heart block has a consistent R to R interval, but the P waves get lost] Fever, bloating, and pain at the right costal margin upon palpation is associated with which disorder? \Correct AnswerCholecystitis [pain at the right costal margins = "Murphy's sign"] JVD, increased CVP, hepatomegaly, and peripheral edema is seen in which disorder?
Correct AnswerRight heart failure [S&S = JVD, increased right atrial pressure (CVP), peripheral edema, ascites, hepatomegaly, and splenomegaly; left heart failure S&S = pulmonary edema] The following are signs of pericardial tamponade? \Correct AnswerS&S: Beck's triad (hypotension, JVD, muffled heart sounds); the pressure on the heart also causes pulses paradoxus [decreased BP and pulse strength upon inspiration], and electrical alternans [low EKG amplitude] Which of the following is an early sign/symptom of left ventricular heart failure? \Correct AnswerParoxysmal nocturnal dyspnea & dyspnea [crackles, JVD, ascites, hepatomegaly, peripheral edema = right heart failure] Morphine is contraindicated in a right ventricular MI (RV MI) because of what drug action? \Correct AnswerMorphine reduces preload [preload reducing agents like morphine Lasix [venodilator], and NTG are contraindicated in RV MI b/c they decrease preload] Which of the following signs/symptoms is not characteristic of Wernicke's encephalopathy? Confabulation, chronic memory loss, ataxia, nystagmus. \Correct AnswerChronic memory loss [Wernick's encephalopathy is characterized by confusion, confabulation, gait ataxia and nystagmus; chronic/permanent memory loss is a symptom of Korsakoff's syndrome] A patient c/o an excruciating unilateral headache with nasal congestion and excessive lacrimation on the affect side. The nurse suspects: \Correct AnswerCluster headache [excessive tearing/lacrimation, along with unilateral nasal congestion, are signs of a cluster HA; temporal (Giant cell) arteritis has a palpable cord-like temporal artery Which highly communicable infection is characterized by swollen salivary and parotid glands? \Correct AnswerMumps [Measles = Koplik spots; pertussis = "whooping cough"; diphtheria = gray pseudomembranous coating in throat] A 68F with a history of AFIB c/o sudden onset of painless, unilateral vision loss and denies any trauma. Which ocular emergency does the nurse suspect? \Correct AnswerCentral retinal artery occlusion (CRAO) [acute angle glaucoma = "tunnel vision" and halos around lights; hyphema = blood in anterior chamber of eye]

Which of the following signs/symptoms should raise an index of suspicion that a patient is experiencing retinal detachment? \Correct AnswerPhotopsia and "floaters" in the visual field A hazardous vulnerability assessment is completed in which phase of disaster management? \Correct AnswerMitigation [disaster preparedness = stockpiling supplies, training and mutual aid agreements] A patient c/o sharp chest pain that worsens with inspiration and lying down. Which sound is commonly heard in pericarditis? \Correct AnswerPericardial friction rub, heard best when the patient leans forward [murmurs are audible in valve disorders] Pertussis is a highly communicable infection characterized by gagging, vomiting, and what hallmark sign? \Correct AnswerParoxysmal cough [inspiratory stridor = heard in upper airway obstruction, like croup; expiratory wheeze = heard early in lower airway obstruction, like asthma; drooling with respiratory distress = hallmark sign of epiglottitis] A patient with a history of alcoholism has steady, dull, epigastric pain radiating to the back and elevated amylase and lipase levels. A common complication of pancreatitis is: \Correct AnswerPleural effusion is a complication of pancreatitis, which may lead to ARDS [prepare for a thoracentesis] The following are common signs/symptoms of Digoxin toxicity, except: ventricular dysrhythmias; yellow/green halos in vision; mitosis; nausea and vomiting \Correct AnswerMiosis Which of the following is not a cause of priapism? Sickle cell crisis; testicular torsion; spinal cord injury; antidepressants such as Trazodone \Correct AnswerTesticular torsion [sickle cell, spinal cord injury, antidepressants, leukemia = all causes of priapism] Which lab value will be decreased in thyrotoxic crisis (thyroid storm)? \Correct AnswerTSH is decreased in hyperthyroidism, while T3 and T4 are elevated Which foreign body will more likely cause an infection? \Correct AnswerThorns, wooden splinters (vegetative materials) are most likely to cause infection, especially fungal infections Your patient has a history of Addision's disease. Which vital sign change would indicate adrenal crisis? \Correct AnswerHypotension is seen in adrenal crisis due to hypovolemic shock from a lack of aldosterone To assess the radial nerve, the nurse asks the patient to: \Correct AnswerGive the "thumbs up" sign [opposing the thumb to the fingers evaluates the medial nerve; abducting the fingers assesses the ulnar nerve]

Immerse the hand injured by a stingray in hot water until: \Correct AnswerImmerse the part in hot water until the pain subsides (which may take ~2 hrs) Parents bring in their 2-year-old child for a respiratory distress and a "barking" cough after a viral illness the last few days. Which of the following respiratory emergencies is the patient most likely experiencing? \Correct AnswerLaryngotracheobronchitis (LTB) or croup, which is characterized by low-grade fever and a "barking" cough after an URI; A- P chest film shows like the "steeple sign"; nebulizer epic is the mainstay of treatment A severe head trauma is diagnosed with syndrome of inappropriate antidiuretic syndrome (SIADH). The patient is most at risk for which of the following complications? \Correct AnswerSeizures -- SIADH is excessive secretion of antidiuretic hormone (ADH) seen in head trauma, meningitis, and oat cell carcinoma. The water retention leads to dilutional hyponatremia, which may cause seizures. A 16F c/o fever, nausea, and RLQ abdominal pain. Assessment reveals pain upon palpation at McBurney's point and rebound tenderness, so the nurse suspects: \Correct AnswerAppendicitis -- suspected with fever, nausea/vomiting, periumbilical to RLQ abdominal pain (McBurney's point) and rebound tenderness (Rovsing's sign) A victim of violence was unresponsive at the scene, awake on arrival to the ED, but had a second LOC in CT. Which of the following vessels is typically involved in an epidural bleed? \Correct AnswerMiddle meningeal artery -- typically injured with a temporal lobe hit, resulting in an epidural bleed. The classic sign of an EDH is unresponsiveness, a lucid period, then a second LOC. Which injury will least likely occur in a 6-year-old front-seat passenger secured only with a lap restraint? \Correct AnswerPelvic fracture -- common injuries w/ lap restraint injury = hollow organs, like duodenal rupture, pancreatic injury, and lumbar "chance" fracture Which hemodynamic changes are typically seen in neurogenic shock? \Correct AnswerBradycardia and hypotension -- neurogenic shock is seen in spinal cord injury from a blocked sympathetic nervous system, resulting in the maldistribution of blood flow. Hemodynamically, the vasodilation leads to hypotension and parasympathetic stimulation leads to bradycardia. A patient w/ gestational hypertension is receiving magnesium sulfate IV. The most important parameter to monitor is: \Correct AnswerRespiratory rate -- magnesium may cause a decrease in respiratory effort, so monitor the RR and O2 sat closely. If it decreases, stop the Mag & consider administering calcium gluconate. Lab results for a patient in DIC include: \Correct AnswerLab values seen in DIC include prolonged bleeding times, elevated PT/PTT, +D-dimer and increased fibrin split products.

A patient with a lower leg injury returns to the ED 24 hours later with severe throbbing pain, not relieved by analgesia. The initial care includes: \Correct AnswerKeeping the injured leg in neutral position -- the hallmark symptom of compartment syndrome = pain out of proportion to the injury, unrelieved by analgesia A patient with a crush injury to his lower leg has an increased K+, CK, myoglobin, and BUN. What is the hallmark sign of rhabdomyolysis? \Correct AnswerS/sx of rhabdo = myalgias, reddish-brown urine [lab values include increased K+, CK, myoglobin, BUN; treat with IVF, sodium bicarb, and dialysis to prevent acute kidney injury] A 20-year-old male strikes a wall with a closed fist fracturing his 5th metacarpal. This is referred to as a: \Correct AnswerBoxer's fracture -- treated with an ulnar gutter splint