CPEN TEST 4 Practice questions with answers 2023, Exams of Nursing

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CPEN TEST 4 Practice questions with

answers 2023

Peds Assessment Triangle ✔Apperance, WOB, and circulation No touch 3 S's ✔Sick: nothing abmornal Sicker: acute disruption Sickest: 2 or more disruptions Urgent vs. Emergent ✔U: need care within 24 hrs E: threats to life, limb, or eyesight 4 components of Peds Triage ✔PAT, initial assessment, triage hx, acuity Gastric Lavage ✔Needs to be done within 1 hr Helpful if med slow gastric motility Iron Ingestion Tricyclic Activated Charcoal ✔Within 1hr 1gm/kg Will not absorb alcohols, hydrocarbons, caustics, or heavy metals Whole bowel Irrigation ✔Golytely For iron, lead, sustained release Acetaminophen Ingestion ✔Liver damage St.1: 12-24 hr- vague, N/V, anorexia, pallor St.2: 1-4 days, latent St.3: 72-96 hr hepatic necrosis St.4: 7-8 days worse or better

4 hr level, Acetodote Disc Batteries ✔Remove immediately, fatal tissue injury Methanol ✔Windshield washer fld, gas additives GI, CNS, and ocular: acidosis and CNS depression Formic Acid damages optic nerve Give Antidote: formepizole or ethanol inhibitors Isopropyl Alcohol ✔Rubbing alcohol, hand sanitizer Absorbed by the GI tract, excreted by kidney, metabolized by liver Ethanol ✔alcoholic beverages, perfumes, mouthwash hypoglycemia Is the antidote for ethylene glycol and methanol CNS depression Ethylene glycol ✔Antifreeze and deicer GI, CNS, renal effects, acidosis Can develop sx after 12 hrs Renal failure causes by calcium oxalate crystals in urine(occlude kidneys) Give bicarb, antidote: formepizole, ethanol, pyridoxine Tricyclic ✔Any amt toxic to a child CNS and cardiac problems(wide QRS), hypotension, anticholinergic symptoms Bicarb for cardiac toxicity, lidocaine to prevent vent. dysrhythmias, benzos for sx Ca Channel Blockers ✔small amt lethal Decontaminate GI Monitor, Ca Chloride supplement, glucagon to increase HR, insulin Digitalis ✔Dysrhythmia, N/V, halos, increased K, brady, dec BP Antidote: Dig Fab binds to to dig

Lomotil ✔Mixture opioid and atropine-toxic Delayed absorption Lasts 24 hr 1 pill can be toxic Hydrofluoric acid ✔Call PC rust removers, glass etch causes local and systemic toxicity Irrigate, watch Ca levels, hard to control pain Opioids ✔Clonidine: slows HR, hypotension Treat with Narcan Methemoglobinemia ✔Blue baby, can be congenital or caused by the nitrates in well water treated with Methylene blue Caustic Substances ✔Ph of <2 or >12 greater injury Similar to a burn Ocular lesions:irrigate, pH before and after Organophosphates ✔Insecticides MTWtHF syndrome: mydriasis, muscle twitching, muscle cramps, inc HR, weakness, HTN SLUDGE: muscarinic- salivation, urination, defecation, gastric cramping, emesis Bronchial secretions- give atropine Anticholinergic/Antihistimines ✔Benadryl: hot,dry, flushed, agitated, sx, tachy, CNS depression Sympathomimetic/Decongestants/cocaine/amphetamines ✔Flushed, diaphoretic, agitated, enlarged pupils, inc BP, inc HR, sx, inc Temp,A ,B,C,D Dextromethorpan

✔intox, hallucinations, euphoria treat with narcan Magnets ✔may pass if single multiples can entrap tissues Hydrocarbons ✔Fuel, oil, waxes, polish No GI decontam- can cause V and aspiration Lipid pna Obs for 6 hrs Inhaled hydrocarbons ✔Huffing/sniffing: myocardial irritability(butane, propane, air fresheners) Refrigerants: may freeze mouth and airway Toulene sniffing: glue and nail polish Iron ingestion ✔60mg/kg toxic St. 1: 30m-2hr N/V/D c abd discomfort St. 2: 2-12 hr latent, toxic St. 3: Cardivas. collapse, hepatic injury, dec LOC St. 4: Damage to GI if survived Antidote: Deferoxamine- bonds with free iron, rose colored urine. Urine clear with all iron excreted Lead ✔High levels cause leth and seizures Methadone ✔Opioid used as a detox, 1/2 life as long as 40 hr CNS depression, resp depression, constricted pupils Narcan will reverse symptoms Hypoglycemics ✔1 tab fatal Can cause delayed hypogly Sandostatin: suppresses insulin release Glasgow: Eye opening ✔4: spontaneously

3: to speech 2: to pain 1: no response Glasgow: Best verbal response ✔5: oriented/coos 4: irritable and cries/ confused 3: inappropriate words/ cries to pain 2: Incomprehensible/ moans or grunts 1: no response Glasgow: Best Motor Response ✔6:Obeys command/ spontaneous 5:localizes pain 4:withdraw from pain 3: flexion 2: extension 1: no response Seizure ✔Med: Ativan(lorazepam) drug of choice Valium(diazepam) IV or rectal Versed(midazolam) IM or IN Types of seizures ✔Febrile Simple <15 min, no focal onset, 1st 24 hr Complex >15 min, focal onset, more than 1 in 24hr Types of seizures partial ✔Simple Partial: no impairment in LOC, 10-20sec, w/o postictal Complex Partial: impairment in LOC, more than 30 sec., postictal Generalized Seizures ✔Absence(petit mal): staring, slight loss of muscle tone Tonic/Clonic- + LOC, postictal Myoclonic: brief sudden massive muscle contractions, whole or part body, possible LOC Atonic: sudden loss of muscle tone, fall to the ground, dec LOC Tonic: 10 sec, tonic contractions, dec LOC, fall, postictal Shunt Dysfunction

✔Tachy, inc RR then slowed, inc HR for younger children, inc BP: Cushing triad Fever!!!- infection Know baseline Sundowning, dec LOC Inc HOB, head midline Traumatic Brain Injury ✔Elevate HOB 30 degrees, head midline, immobilize C spine Watch for Cushing's triad(brady, HTN, alt in resp) CO2 30- Unilateral dilation: herniation Basilar skull fracture ✔Significant force, Hemotympanum, raccoon eyes, battle sign , otorrhea/rhinorrhea Sedate, intubate, osmotic(mannitol) Do not give ketamine, inc ICP Normal ICP is 10 Epidural Hematoma ✔arterial bleed, middle meningeal artery, quick deteriorate rapidly, surgery Bleeds quickly, + LOC, alert but not normal Blown and pin pt pupils- herniation Subdural Hematoma ✔Venous bleed, slower onset of symptoms Shaken Baby TBI interventions ✔Fracture: great deal of force Babinski: normal for 2yo and younger Brudzinski: meningeal sign, knee/hip flex when neck is flexed Kernig: meningeal sign, leg flexs at hip and pt cannot extend Doll's eye: eyes move in the opposite direction Cold Calories: eyes move toward the ear stimulated with cold water Spinal Cord Trauma ✔Steroids are beneficial Spinal Cord Trauma Peds ✔Lap belt: worn around the abdomen rather than pelvis, frontal impact causes mid- lumbar (2nd-4th fx) aka Chance Fx. Internal bleeding Autonomic Dysreflexia

✔Life Threatening- after acute phase of SCI Over rxn of sympathetic nervous system- full bladder, full rectum, decubitus HA, inc BP, sweating, flushing Elevate HOB, relieve cause, gang blockers Compartment Syndrome ✔dec vascular perfusion after cast placement position at level of heart, no ice Cut cast Slipped Capital Femoral Epiphysis ✔Slippage of the proximal femoral epiphysis on the femoral neck Adolescent males who are inactive and over weight Muscular dystrophy ✔inherited muscle weakness and atrophy Duchenne most common type Juvenile Rheumatoid Arthritis ✔unk triggers overgrowth of articular cartilage causing joint destruction Osgood Schlatter disease ✔inflammation of the tibia tubercle Overuse by active adolescents