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Prophecy Emergency Department RN A
Questions and Answers Latest Update.
A 53-year-old female with a history of
Addison’s disease due to an
autoimmune disorder presents with
fatigue, generalized weakness, nausea,
vomiting, and abdominal pain. Which of
the following is consistent with an
adrenal crisis?
Hypotension Your patient has presented to the emergency department with pneumonia. You also note an allergy to penicillin. Which of the following medications would you question if ordered by the physician? Ceftriaxone A 55 - year-old man presents with left-sided chest pain that began 30 minutes ago during sexual intercourse. The pain radiates to his left shoulder. Upon initial history intake you learn that he has taken a phosphodiesterase inhibitor (Viagra) for erectile dysfunction. His ECG is concerning for STEMI. Which of the following medication orders should you question if ordered by the provider? Nitroglycerin A 26 - year-old woman presents with severe eye pain, photophobia, and the sensation of sand in her right eye. She is a contact lens wearer and states that she frequently leaves them in overnight. Which of the following is indicated for this patient? Slit lamp exam using fluorescein staining A 28 - year old male patient presents with severe dysuria and white, foul smelling drainage from his penis. The symptoms have lasted about one month and have become progressively worse over the last few days. On exam, the patient is noted to have a petechial rash to his bilateral upper extremities. The patient’s signs and symptoms are consistent with which of the following? Disseminated gonorrhea
Which of the following would be the FIRST fluid of choice for a patient in hypovolemic shock secondary to hemorrhaging? PRBCs RhoGAM would be administered to a pregnant patient for which of the following reasons To prevent an RH- negative mother from forming antibodies to RH- positive fetal blood A pediatric patient was brought in by EMS for seizure activity. The patient is post ictal on arrival. During assessment, the patient begins to have convulsions with body stiffening, jerking motions of legs and arms, loss of consciousness and loss of bladder control. What is your PRIORITY nursing intervention?
A 24 year old female, who has recently received methotrexate for a tubal pregnancy, presents to the ED with severe abdominal pain. What would be the PRIORITY nursing intervention? Prepare to go to the OR A 3 year old boy with a history of hydrocephalus with a cerebral shunt arrives to the ED with a fever of 102.0°F, an enlarged abdomen, tachycardia and hypotension. The patient is mildly lethargic, however is cooperative with the ED staff. Immediate treatment for this child should include: Antibiotics and IV Fluids When caring for a patient who has received a massive blood transfusion, monitoring which of the following lab results is a top priority? Ionized Calcium Level What medication would you anticipate administering to a six month old having an active tonic- clonic seizure? Ativan Patient presents to the ED with a snake bite that occurred 30 minutes ago. The snake was identified as a poisonous rattlesnake. What medication would you expect the physician to order for this patient? CroFab Crotalidae Polyvalent Immune Fab (Ovine) A 26 year old male with a history of asthma presents to the ED with dyspnea, audible expiratory wheezes, substernal retractions, accessory muscle use, with BP-145/72, HR - 26, RR-32, O2 Sat 88% on room air. What is the FIRST treatment of choice for this patient? Give albuterol and atrovent nebulizer with oxygen A 40 - year-old man presents to the ED with shortness of breath and a headache, after being sprayed by pesticides while working on a farm. What is the FIRST nursing intervention? Decontaminate the patient according to hospital procedure Four patients are being transported to the ED after a severe collision between a train and two motor vehicles. Which of the following patients should be triaged for FIRST treatment? 28 - year-old with respiratory distress and open chest wound A 53 year old female with a history of sarcoidosis presents to the ED after being rescued by firefighters from her burning apartment. She is currently alert and oriented, BP-115/78, HR-110, RR- 24, T-100.4 F, oxygen saturation 97% on room air. She is currently only complaining of a
headache and her carboxyhemoglobin is 13%. What is the MOST appropriate nursing intervention? Place on high-flow non-rebreather A 28 year old, obsterical patient presents at 38 weeks gestation status post motor vehicle collision. Upon arrival via EMS, you note she is on a backboard and c-collar is in place. What is the immediate nursing intervention for this patient? Place patient in left tilt position A 36 year old male presents to the ED with an amputated hand. What should you do FIRST? Apply direct pressure to extremity Of the following patients, which one needs referral to the closest burn center? Partial-thickness and full-thickness burns involving the genitalia or perineum What are three signs of cardiac tamponade? WRONG 1) Bradycardia, hypertension, muffled heart sounds An 11-year-old female is brought to the emergency department with complaints of excessive sleeping, headache, sore throat and swollen neck glands. The patient has no complaints of pain. On exam, you note a pink rash on her torso. Her mother states that her appetite has decreased over the last week. What is the most likely diagnosis Mononucleosis An 88 year old male transferred to the ED from a nursing home with a chief complaint of being unable to void for the past 12 hours. He has a history of prostate cancer. Which of the following nursing interventions should be performed FIRST? Insert urinary catheter Which of the following would be a primary complication of a bowel obstruction? Dehydration A 32 - year-old woman recently diagnosed with multiple sclerosis presents to the ED with several days of upper respiratory infection and now progressively weakened lower extremities, and vertigo. What is the FIRST line of treatment for this patient? Methylprednisolone 1 g IV daily Which of the following elevated lab values supports the diagnosis of congestive heart failure (CHF)?
but breath sounds ae noted to be absent on the right. A right-sided chest tube is place with immediate return of 500 ml or blood. Which of the following would you perform FIRST? Transfuse 2 unite of uncrossmatched red blood cells A 22-year old woman pre3sent to the ED appearing disheveled and tearful with obvious bruising to her face and neck. The patient reports that she was assaulted and raped by an acquaintance several hours ago. What is the PRIORITY nursing intervention? Evaluate the patient’s physical injuries A 35 year old construction worker arrived in the ED after falling from a ladder while working on a house. He is lying on his back in a co-worker’s truck with blood pooling around his head. He has snoring respiration and a GCS of 7. What initial interventions would you perform? C-spine stabilization, assistive ventilations and preparation for intubation An elderly couple present to the ED via EMS. The husband sustained a broken hip after a fall at home. The wife states to the nurse :I don’t think I can take care of him anymore.” What is the most appropriate nurse intervention? Arrange a social services consult Your patient is intubated and sedated with extensive second and third degree burns after being pulled from a house fire. You note the patient’s core temp to be 94 F. Which of the following interventions should you implement immediately? Application for forced-air warming system and warmed fluids An 8 year old boy presents to the ED with fever for the last 6 hours. Which of the following assessment findings would cause the MOST concerns? Petechial rash on the trunk An 83-year old woman presents to the ED triage with shortness of breath, generalized fatigue and weakness. Her daughter says her symptoms are similar to what she experienced several months ago from a urinary tract infections. There are no beds immediately available in the ED. Her vital signs BP- 127/70, HR-65, RR-16, T-99 F, O2 sat 100% RA. Which of the following diagnostic tests is MOST important to obtain during triage? ECG A 25-year old female presents to the ED via ambulance for evaluation of erratic behavior. She was found acting bizarrely and speaking loudly in a public park. The patient is irritable, displays pressured speech, and flight of ideas. She is hyperactive and pacing around the room. The patient’s presentation is most consistent with: Mania
Your patient fell 15 feet of a roof landing chest first onto a barrel. He is complaining of shortness of breath and shoulder pain. When assessing his lung sounds anteriorly, you auscultate bowel wounds in the chest. Based on this assessment, which of the following injuries would you suspect? Ruptured diaphragm You have a bariatric patient that was involved in an MVC. The patient was in the driver’s side, restrained by seatbelt, and airbag deployed. The patient is responsive upon arrival and complains of pain to the left arm. The patient has seatbelt marks across the chest. What is your priority assessment for this patient? Assess the patient for signs of possible airway and respiratory compromise A 38-year old man with a history of schizophrenia arrives at this emergency department reporting that he is being monitored and plotted against by his neighbors through his television. He appears mildly agitated and suspicious. He reports he has blocked the people working against him by putting aluminum foil over TV and over the doors and windows. He left his apartment because he suddenly feared they would retaliate. This patient is demonstrating which of the following psychotic symptom? Persecutory delusions You are caring for a patient who has decided to discontinue treatment. You recognize that the patient is competent to make this decision. What action should you take NEXT? Comply with the patient wishes and ensure proper documentation of refusal The physician orders a heparin infusion of 900 units/hr. Heparin is prepared 25,000 units in 500 ml of D5W. The pump should be set to deliver mL/hr. 18 You are caring for a patient in second-degree AV block type 2 with a heart rate of 30, BP – 86/62 and with an altered mental status. IV access attempts have been unsuccessful, and the patient becomes unresponsive. What is the PRIORITY nursing intervention? Begin transcutaneous pacemaker During CPR in progress, the physician calls for a pulse check. The monitor shows a change from the previously recorded rhythm. Which of the following would indicate the need for a shock? V-fib A patient with severe pre-eclampsia is sent to the ED by her OB/GYN. The OB/GYN called ahead and instructs the charge nurse to start the patient on a magnesium drip. You notice signs of
50 year old Female (JVD and muffled heart sounds) Cardiac tamponade 68 lbs x 2.2 = 30.9kg (20 ml / kg) 618 ml/ hr
