Nursing Case Studies for Emergency Situations, Exams of Nursing

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A 22-year old female who is 8 weeks pregnant presents with a sudden onset of left lower abdominal pain and vaginal bleeding. The patient's family member stated that she had a syncopal episode shortly after that. What is the MOST likely diagnosis for her? – ANS Answer is NOT Abruption placenta A confused patient is trying to grasp at their IV with their right hand. Which is the LEAST restrictive measure to maintain patient safety? – ANS Safety "mitt" for right hand only A new nurse observes their preceptor giving the incorrect dosage of a medication to a patient. Implementing the ethical principle veracity, what action would the new nurse take? – ANS Inform the charge nurse about what happened and document it. A patient arrives with acute onset of central chest pain. The patient is tachycardia and tachypnea and appears very anxious and restless. What would be the MOST important initial intervention for this patient? – ANS Administer oxygen Answer is NOT Obtain electrocardiogram A patient arrives with suspected appendicitis. What action, if observed, would require additional training for the unlicensed assistive personnel (UAP)? – ANS The UAP offers the patient a ginger ale. A patient has sustained multiple traumatic injuries after a fall from a height. What is considered an important component of the primary survey assessment? – ANS Neurological assessment A patient is being treated in a hyperbaric oxygen chamber for carbon monoxide poisoning. What measurement is the BEST indicator of treatment success? – ANS Arterial blood gas A patient is being treated with an anticoagulant for pulmonary embolism (PE). What patient assessment finding indicates that a heparin infusion would be stopped IMMEDIATELY? – ANS Decreased level of consciousness A patient is brought in after being struck by lightning during a heavy thunderstorm. What would be the PRIORITY intervention for this patient upon arrival? – ANS Monitoring cardiac rhythm A patient is brought in for a potential overdose of heroin. What is the PRIORITY nursing intervention? – ANS Maintaining airway and breathing A patient is brought in with a history of a head-on motor vehicle accident. The patient was not wearing a seat belt and was traveling at 120 mph with the deployment of an

airbag. They complain of severe lower abdominal and hip pain. A secondary trauma survey reveals an unstable hip on lateral compression. What would be a PRIORITY intervention in managing this patient? – ANS Application of pelvic blinder A patient is brought in with possible foreign body obstruction and respiratory distress. The provider suctions the patient and unsuccessfully tries to insert an endotracheal tube (ETT). What type of procedure would you anticipate NEXT? - ANSTracheostomy A patient is frustrated at the length of time they have been waiting to be triaged. They start to yell obscenities and threaten you with physical violence. Why would this incident be reported to your supervisor? - ANSYou have the right to personal safety in the work environment. A patient presents after an intentional overdose of propranolol approximately 2 hours ago. The patient has severe hypotension and bradycardia. IV fluids and vasopressors are initiated. What nursing assessment findings indicate the treatment has been effective? - ANSAnswer is NOT Increasing serum cortisol A patient presents after an intentional overdose of propranolol approximately 2 hours ago. The patient has severe hypotension and bradycardia. IV fluids and vasopressors are initiated. What nursing assessment findings indicate the treatment has been effective? - ANSIncreasing serum cortisol Increasing serum glucose Decreasing pulse pressure Decreasing central venous pressure A patient presents after falling from a height and fracturing their right tibia and fibula. What symptom would be reported to the provider IMMEDIATELY? - ANSParesthesia of the foot A patient presents after sustaining a roll-over motor vehicle accident. They are complaining of pain around the mid-upper back. On your initial triage assessment, you find that patient has preserved motor function below L5 but is suffering from a loss of sensory function. The assessment findings are consistent with: - ANSAnswer is NOT Anterior cord syndrome Answer is NOT central cord syndrome A patient presents with a 1-day history of pain in the right upper abdomen with nausea and vomiting. The provider suspects that the patient has cholecystitis. What lab value supports the diagnosis? - ANSElevated bilirubin A patient presents with a 5-day history of runny nose, headache, and productive cough. The patient is unable to speak full sentences, reports having a history of moderate to severe COPD, and has a SpO2 reading of 89%. What intervention do you anticipate implementing FIRST for this patient? - ANSProvide oxygen

A patient presents with a facial burn with significant facial swelling and acute respiratory distress. Based on a 1-4 triage acuity scale with 1 being most critical, what is the appropriate category based on the patient presentation? - ANS A patient presents with a partial thickness burn to the anterior portion of the chest. Based on the rule of nine estimations, what is the patient's estimated total body surface area burned? - ANS18% A patient presents with a two-day history of fever, cough, mild shortness of breath (SOB), sore throat, myalgia, and new onset of loss of taste and smell. What is the patient MOST likely suffering from? - ANSCOVID 19 A patient presents with acute onset of chest pain and goes into cardiac arrest immediately upon arrival. What is a possible reversible cause of cardiac arrest? - ANSTension Pneumothorax A patient presents with an episode of hypertensive crisis, a blood pressure of 220/118, and the provider has put in the order for nitroprusside. What demonstrates that the treatment has been effective? - ANSSystolic blood pressure reaches 160 mm Hg A patient presents with possible organophosphate toxicity. What would you expect to find upon assessment? - ANSDiaphoresis A patient who is 24 weeks pregnant presents with fever and right upper quadrant pain. The patient states that the pain is radiating to the right shoulder blade, and started an hour after having a pizza for lunch. She is tachycardic, tachypneic, and diaphoretic on the initial triage assessment. What is the MOST likely diagnosis for this patient? - ANSCholecystitis A patient who is 27 weeks pregnant presents with painless bright red vaginal bleeding. What condition correlates with the presenting symptoms? - ANSPlacenta Previa A patient who is 32 weeks pregnant presents with a three-day history of headache and significant swelling of the lower extremities and face. The patient's vital signs are BP: 160/90, HR: 105/min, RR: 19/min, Spo2: 94% on RA, Temp: 97.3 F. What medication do you anticipate the provider to order FIRST? - ANSLabetalol (Trandate®) A patient who is 8 weeks pregnant presents to triage with vaginal bleeding and lower abdominal pain. RhoGAM will be given for which situation? - ANSMother is Rh negative A patient with a history of advanced-stage leukemia presents with a history of increasing shortness of breath in the last 4 days. The patient is anemic and has multiple bruises on their extremities. What is the MOST likely cause of bruising? - ANSThrombocytopenia

A patient with a history of chronic alcohol use is brought in with possible esophageal varices. What medication is used to stop upper gastrointestinal (GI) bleeding in patients with this condition? - ANSOctreotide (Sandostatin®) A patient with a traumatic brain injury (TBI) is MOST likely to suffer from what condition?

• ANSAnswer is NOT myxedema coma Answer is NOT Cerebral palsy A patient with dementia has a family member with MPOA, who is unable to be reached. The provider needs a consent signed and allows the patient to sign. What is the MOST appropriate action you would take? - ANSReport the provider to their supervisor A patient's family has decided to withdraw life-sustaining treatment. When communicating with the family of the patient, what reassurance would you provide? - ANSEfforts will be made to make the patient comfortable. An adult patient who is 70 kg has a full-thickness burn over 30% of their body surface area. What is the anticipated fluid replacement for a patient in the first 8 hours is based on the Parkland formula? - ANS4200 mL An elderly patient is brought in with new onset of confusion and gradual onset of headache in the last 48 hours. The patient states that they had a fall 3 days ago. Based on the history and presenting complaints, what diagnostic test do you anticipate the provider to order? - ANSCT scan of the brain During cardiogenic shock what temporary intervention might be ordered to improve perfusion until definitive treatment is provided? - ANSInotropic infusion The deficiency of anti-diuretic hormone (ADH) can lead to what endocrine disorders? - ANSAnswer is NOT Adrenal Insufficiency Answer is NOT Syndrome of inappropriate secretion of ADH (SIADH) The life-threatening and rare complication of hypothyroidism is known as: - ANSMyxedema coma Under what circumstances can the hospital transfer an unstable patient to another facility and maintain compliance with the Emergency Medical Treatment and Active Labor Act (EMTALA)? - ANSThe necessary treatment is not available at the current hospital. Upon triage of a patient, they state that they have suicidal ideation with intent. What would you do NEXT? - ANSInstitute suicide precautions. What are you MOST likely to see during your initial assessment of a patient with chronic obstructive pulmonary disease (COPD)? - ANSPursed lip breathing

What do you anticipate is the BEST indicator of adequate hydration in an adult patient with 30% body surface area burn during initial fluid resuscitation? - ANSUrine output of 0.5 mL/kg/hr What is a common assessment finding in a patient with a tension pneumothorax? - ANSDistended neck veins What is the appropriate intervention for patients with Acute Respiratory Distress Syndrome (ARDS)? - ANSMechanical ventilation What is the critical goal time from arrival to the ED to CT brain scan based on the American Heart Association stroke recommendations? - ANS25 minutes What is the current recommended dose of intravenous or intraosseous epinephrine in adult patients with cardiac arrest? - ANS1 mg every 3-5 minutes What laboratory value would you monitor closely if your patient is vomiting coffee- ground emesis? - ANSHemoglobin What medication is used in reversing the effects of opioid overdose? - ANSNaloxone (Narcan®) What symptom is commonly seen in patients with alcohol withdrawal? - ANSTachycardia What type of diet would a patient with diverticulitis follow? - ANSHigh fiber diet Answer is NOT high residual diet What type of medication is used in the emergency care setting to help manage the symptoms of alcohol withdrawal? - ANSBenzodiazepines Which of the following wounds has the highest risk for developing osteomyelitis? - ANSPuncture wound from stepping on a rusty nail You are administering haloperidol (Haldol®) to a patient with acute symptoms of Schizophrenia. What changes in the electrocardiogram (ECG) are possible as a result of this medication? - ANSProlonged QT interval You are assessing a patient who had an altercation involving a clenched fist injury. You notice that his right hand is swollen significantly with pain and bruising. What would you be MOST concerned about for the patient? - ANSRheumatoid arthritis Loss of function Osteomyelitis Active bleeding

You are assisting a novice nurse with a blood draw. You observe the nurse draw the blood, place the specimen tubes in a biohazard bag, and leave the room with the unlabeled specimen tubes. What would you do NEXT? - ANSRe-educate the nurse, then redraw the labs, use patient identifiers and label at the bedside. You are caring for a patient who has a history of alcohol use and seizures. You suddenly notice the patient becoming diaphoretic, anxious, tachycardic, and has clammy skin. What would you do NEXT? - ANSAnswer is NOT Turn them on their side Answer is NOT Administer propranolol You exit your patient's room and as you walk away you hear a thud. Upon inspection, you find your patient on the floor. What would you do FIRST? - ANSAssess the patient for injury. You see a fellow nurse placing an opioid medication in their pocket rather than administering it as ordered. What would you do NEXT? - ANSTell your immediate supervisor. You want to implement the new evidence-based practice guidelines in managing patients to prevent falls on your unit. What provides the STRONGEST evidence for interventions? - ANSSystematic reviews Your patient has just had a paracentesis during which 5 liters of fluid were removed. Which assessment is the PRIORITY? - ANSBlood pressure Your patient's chest tube dressing has accidentally come off and you are preparing to place a new one. You have a slit drain sponge, 4 x 4 gauzes, tape, scissors, and antiseptic swabs. What else do you need? - ANSPetrolatum gauze