CEN Practice Test Exam Questions with 100% Correct Answers-with Rationale, Exams of Laboratory Practices and Management

Download CEN Practice Test Exam Questions with 100% Correct Answers-with Rationale and more Exams Laboratory Practices and Management in PDF only on Docsity!

CEN Practice Test Exam Questions with 100% Correct

Answers-with Rationale

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 - Correct 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. - Correct answer b. Symptoms began 36 hours before arrival. Fibrinolysis therapy is generally NOT recommended for patients whose symptoms began more than 12 hours before arrival. Fibrinolysis 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. Systole b. PEA c. Ventricular fibrillation d. SVT - Correct answer c. Ventricular fibrillation Ventricular fibrillation and pulseless ventricular tachycardia are the two rhythms that are considered to be "shock able" cardiac arrest rhythms. Although systole 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? a. Less than 5 seconds b. Less than 10 seconds c. Less than 20 seconds

d. Less than 30 seconds - Correct answer b. Less than 10 seconds According to the 2010 BLS and ACLS guidelines, suctioning for longer than 10 seconds may result in pulling too much oxygen out of the airways resulting in hypoxemia. Possible causes of cardiac arrest include all of the following EXCEPT: a. Hypervolemia b. Hypoxia c. Hypokalemia d. Tension Pneumothorax - Correct answer a. Hypervolemia Common causes of cardiac arrest are known as the H's and T's and include: hypovolemia (NOT hypervolemia), hypoxia, hydrogen ion excess (acidosis), hypo or hyperkalemia, hypothermia, tension pneumothorax, tamponed, toxins, and thrombosis (pulmonary or coronary). Correction of these causes can often reverse a cardiac arrest. You are providing ventilations using a Bag-mask device. Suddenly, you do not see the patient's chest rise with the ventilation. You reposition the patient to ensure an open airway. When you attempt to ventilate, you do not see his chest rise. The most likely cause of this is: a. The bag-mask device is faulty b. Airway obstruction c. The patient has suffered an MI d. Cardiac tamponed - Correct answer b. Airway obstruction The most likely cause of the failure of the chest to rise during ventilations is an airway obstruction. Although a faulty bag-mask device is a possibility, it is unlikely that it would fail in the middle of providing ventilations. According to American Heart Association ACLS guidelines, cricoid pressure during intubation: a. Should be done in all cases. b. Is no longer recommended. c. Should only be done on children. d. None of the above. - Correct answer b. Is no longer recommended. According to the most current AHA guidelines, cricoid pressure may delay or prevent placement of an advanced airway so is no longer recommended. 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 scenography readings b. Stomach insufflation c. Tension pneumothorax d. Aspiration - Correct answer a. increasing waveform scenography readings

Iatrogenic effects of hyperventilation through an ET tube include aspiration, stomach insufflation, and tension pneumothorax. Increasing waveform scenography 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 scenography. c. Clinical examination and Pulse oximetry. d. Clinical examination and quantitative waveform scenography. - Correct answer d. Clinical examination and quantitative waveform scenography. The AHA recommends continuous waveform scenography 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 - Correct 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 - Correct 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 - Correct 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: a. Dehydration b. Spinal cord injury c. Congestive heart failure d. Infection - Correct answer c. Congestive heart failure Congestive heart failure is a common cause of cardiogenic shock. Acute myocardial infarction and other heart conditions can also cause cardiogenic shock. Dehydration can be a cause of hypovolemic shock. Spinal cord injury can cause neurogenic shock. Infection can cause septic shock. You are caring for a 10-year-old child with normal blood pressure, increased heart rate, and cool pale skin. The child is reported to have had vomiting and diarrhea the past two days. As you perform your primary assessment, you note that respirations are clear and not labored. What is the probable first intervention for this child? a. Give 20 ml/kg bolus of saline or lactated Ringer's b. Start an Epinephrine infusion at 0.1mg/kg c. Give Epinephrine bolus of 0.01 mg/kg d. Give Amiodarone 5 mg/kg IV over 60 minutes - Correct answer a. Give 20 ml/kg bolus of saline or lactated Ringer's By all indications, the child is in hypovolemic shock and the first interventions should be a fluid bolus at 20 ml/kg of saline or lactated Ringer's solution. You assume care for the patient in the ED. During the time she has been in the ED, she has consistently complained of photophobia, a stiff neck, increasing confusion, and nausea. Her history shows a motor vehicle accident several days ago. She states the pain is the worst headache she has ever had. You suspect she might have a: a. Subarachnoid hemorrhage b. Migraine headache c. Whiplash injury d. Sinus headache - Correct answer a. subarachnoid hemorrhage Given the history of the recent MVA and these classic symptoms, the prudent nurse should have a high degree of suspicion of a subarachnoid hemorrhage. Assessment will show

neurologic deficits and decreased eye movements. The nurse should prepare the patient for a CT scan of the brain. To quickly evaluate a child's neurological status, all of the following standard evaluations can be used EXCEPT: a. The Epworth Scale. b. The AVPU scale. c. The Glasgow Coma Scale. d. Pupillary responses to light. - Correct answer a. The Epworth Scale. 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 neuron 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 - Correct 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 fibrinolysis 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. - Correct 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 - Correct 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 - Correct 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 - Correct answer c. Antibiotics Given the patient symptoms, the nurse should suspect that the patient has pelvic inflammatory disease (PID). With early antibiotic treatment, this infection can be treated on an outpatient basis. Without treatment, the infection can continue and cause scar tissue that may lead to infertility and ectopic pregnancies. When evaluating a patient for Acute Renal Failure, it is helpful to use the RIFLE criteria for classification. This acronym refers to: a. Risk, Injury, Functional decrease, Loss, and End-Stage kidney disease b. Risk, Iatrogenic factors, Failure, Labile diabetes, and End-Stage kidney disease c. Risk, Iatrogenic factors, Failure, Loss, and End-Stage kidney disease d. Risk, Injury, Failure, Loss, and End-Stage kidney disease - Correct answer d. Risk, Injury, Failure, Loss, and End-Stage kidney disease ARF can be classified by using Risk, Injury, Failure, Loss and End-stage kidney disease. Risk is defined as an increased serum creatinine level at 1.5 times normal or decrease of glomerular filtration rate (GFR) by 25% or decrease in urine output less than 0.5 cc/kg/hr. for more than 6 hours. AFR is defined as Injury when the serum creatinine level is increased more than 2 times, GFR is decreased by 50% or urine output is less than 0.5 cc/kg/hr. for 12

hours. AFR is defined as Failure when the serum creatinine level is increased more than 3 times, GFR is decreased by 75% or urine output is less than 0.3 cc/kg/hr. for 24 hours or anuria for 12 hours. AFR is classified as Loss if there is persistent ARF or if there is a complete loss of kidney function for more than 4 weeks. End-stage kidney disease is defined as a loss of kidney function for more than 3 months. The nurse has assisted in an emergent delivery of an infant in the Emergency Department. The infant was born 2 weeks before the due date and is small for gestational age. The nurse documents a thin upper lip, small eye openings, and a smooth phylum above the upper lip. This child may be diagnosed with: a. Vitamin B12 deficiency b. Folic acid deficiency c. Fetal alcohol syndrome d. Diabetes - Correct answer c. Fetal alcohol syndrome The symptoms described in the scenario are classic signs of fetal alcohol syndrome caused by maternal consumption of alcohol during pregnancy. The other vitamin deficiencies can result in defects and delays in growth and development, but the particular facial deformities in this scenario are unique to FAS. A young man is brought to the Emergency Department after receiving multiple fire ant bites while working in his yard. Although initially alert and oriented, he begins to develop wheezing and an itchy throat. He complains of nausea and severe anxiety. The ED nurse should prepare to administer all of the following for initial treatment EXCEPT: a. Adrenaline b. Antibiotic c. Oxygen d. Antihistamines - Correct answer b. Antibiotic 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 - Correct 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 - Correct 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 - Correct 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 ACCEPT: a. Medication for nausea B. Advising eating several small meals rather than 3 large meals c. Scheduled medicines for pain d. Resting frequently - Correct 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. b. Allow the patient clear liquids until repeat x-rays show that the battery has moved into the stomach. c. Discharge the patient to home with instructions to check his stools until the battery passes. d. Prepare to administer polyethylene glycol. - Correct answer a. Prepare the patient and his family for emergent endoscopy to remove the battery. Emergent endoscopy is indicated for any obstruction: when a patient is unable to manage secretions, when a patient swallows a sharp-pointed object, or when a patient swallows a disk battery. Any of these ingestions may constitute an emergency and the patient and family should be prepared for possible emergent endoscopy. A nurse is caring for a patient with pancreatitis. Which of the following symptoms would indicate a possible life-threatening complication? a. Abnormal bowel sounds b. Abdominal pain c. Nausea and vomiting d. Increased respiratory rate - Correct answer d. Increased respiratory rate Respiratory distress as evidenced by increased respiratory rate is a potentially life- threatening complication of pancreatitis. The other symptoms are all common findings in the patient with pancreatitis. If the symptoms have not changed significantly, they should be noted but are not life-threatening. An alcoholic patient well known to the emergency department staff presents to the department with complaints of generalized weakness, low-grade fever off and on for the last month, new onset ankle edema, anorexia, right upper quadrant abdominal pain and vomiting. He denies any bloody or coffee ground emesis. This patient should be evaluated for esophageal varies. a. True b. False - Correct answer a. True Given the history of alcoholism and the presenting symptoms, this patient should be considered at very high risk for esophageal varies. As the disease progresses, one would expect to see bleeding from the varies. Ruptured esophageal varies should be considered a medical/surgical emergency. A patient has been admitted to the Emergency Department with persistent epistaxis. Vital signs are stable. The correct position for this patient is: a. Sitting with head leaning forward b. Supine with the head facing to the side c. Left lateral recumbent

D. Prone with the head facing to the side - Correct 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 external c. Dental caries d. None of the above - Correct 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. - Correct 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. - Correct 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 replanted 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. - Correct 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. A seventeen-year-old is brought to the emergency department complaining of leg pain after a motor vehicle crash. X-rays show a fracture of the femur with several bone fragments at the fracture site. You note that the skin above the fracture site is intact but bruised. This type of fracture is called: a. Open b. Avulsion C. compression d. Comminuted - Correct answer d. Comminuted A comminuted fracture is one in which there are more than two portions of the fractured bone. In a comminuted fracture, you may see bone fragments at the site of the fracture. An open fracture is one in which the skin is broken. Since the skin is intact, this fracture is a closed, comminuted fracture of the femur. A nurse is caring for a farmer who was bitten by a rattlesnake while working in his field. He killed the snake and brought it to the ED for positive identification. The triage nurse notes two puncture marks on his right hand. The proper interventions for this patient may include all of the following ACCEPT: a. Tetanus vaccination b. Antivenin administration c. Positioning the patient's hand above the heart D. Cleansing of the bite - Correct answer c. positioning the patient's hand above the heart The optimal position of the affected extremity is below the level of the heart to slow venom movement into central circulation. Tetanus vaccination and antivenin administration should be given as medically indicated. Cleaning the puncture wounds should be done gently.

A 36-year-old African American man presented to the emergency department with burns to his hands that were suffered when his car radiator boiled over onto his hands. He has run cool water over his hands but he is still experiencing what he describes as "horrible" pain. He does not have burns on any other area of his body. How should this burn be classified according to the American Burn Association's guidelines? a. First degree b. Second degree c. Third degree d. Fourth degree - Correct answer b. Second degree Minor shallow or deep partial thickness burns on less than 15% of an adult's body less than 40 years of age can be treated on an outpatient basis. Because the burns are on his hands, the patient may be admitted as an observation patient since there is a functional risk to his hands. The American Burn Association's guidelines are as follows: First Degree (partial thickness) - superficial, red, sometimes painful Second Degree (partial thickness) - red, blistered, swollen, very painful 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 - Correct answer d. Naloxone Naloxone (Narran) 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 - Correct 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 - Correct 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. - Correct 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. - Correct 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 untrusted, trapped, and spied on. The other options should all be considered by the nurse. As an emergency department nurse, you must report suspected child abuse or neglect. a. True b. False - Correct answer a. True All 50 states have mandatory reporting requirements for healthcare professionals. These laws also protect you for good faith reporting of suspected abuse.

You are the nurse in the Emergency Department caring for a patient with a known history of alcoholism. He is loud, verbally abusive and argumentative to the staff, and uncooperative with requests from the staff. His blood pressure is 158/84. Heart rate is 104, respiratory rate 22, and a blood alcohol level of 0.30%. The first action by the staff should be to: a. Administer clonazepam b. Move the patient to a quiet, secluded room c. Take vital signs every 15 minutes d. Order a magnesium level - Correct answer b. Move the patient to a quiet, secluded room The first action is to move the patient to a quiet room where the activity in the Emergency Department will not escalate the patient's abusive behavior. Locking the room is a form of restraint so rounds should be made every 15 minutes or more frequently as defined by hospital policy. Clonazepam is an appropriate medication to calm the patient and help prevent seizures. A magnesium level is appropriate since the risk of seizures increases if the magnesium level is low. The ENA Code of Ethics expects the emergency nurse to do all of the following EXCEPT: a. Maintain accountability for individual practice b. Act to protect the patient from incompetent or illegal practice c. Work to improve access to health care for all d. Complete all required tasks for every patient - Correct answer d. complete all required tasks for every patient An integral part of being an effective ED nurse is knowing what tasks can or should be delegated to other roles. The ED nurse should not expect to perform all tasks for every patient but should know what tasks can be delegated. Emergency nurses are encouraged to use evidence based practices (EBP) in the practice of emergency nursing. Which of the following practices is not recommended by the Emergency Nurse's Association? a. Use of two or more patient identifiers when providing care. b. Not taking verbal or telephone orders. c. Comply with hand hygiene guidelines d. Assure central lines are inserted under sterile conditions. - Correct 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. - Correct 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 - Correct answer a. Do oral care The only task that the nurse should delegate to the unlicensed technician is the provision of oral care.