SAEM M4 EXAM 2024/2025 WITH 100% ACCURATE SOLUTIONS, Exams of Nursing

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SAEM M4 EXAM 2024/2025 WITH 100%

ACCURATE SOLUTIONS

True or False: gastric distension due to excessive volume or rate of ventilation impairing ventilatory function is a reason to intubate a neonate - Precise Answer ✔✔False management for nursemaid elbow injury - Precise Answer ✔✔apply pressure to the radial head while flexing and supinating elbow A 17 year old boy injured his right shoulder playing football. He tried to arm-tackle a player when his right arm was pulled away from his body and back (abducted and extended). He felt a sudden pain in his shoulder. He presents to the emergency department holding his arm in slight abduction and external rotation by his good arm. He has severe pain with adduction or internal rotation. What is the most common fracture associated with this injury? - Precise Answer ✔✔compression fracture of the posteriolateral aspect of the humeral head (Hill-Sachs deformity) What are most common heart rhythms seen in pediatric arrest? - Precise Answer ✔✔bradycardia or asystole risk factors for neonatal resuscitation - Precise Answer ✔✔prematurity IUGR multiple gestation

thick meconium In the post-arrest setting, which of the following is the drug of choice in treating hypotension in a child: - Precise Answer ✔✔epi Low body temperatures in newborns can lead to severe physiologic consequences, which include all EXCEPT: Answers:

1. metabolic acidosis
2. increased oxygen consumption
3. hypoglycemia
4. apnea
5. hyperglycemia - Precise Answer ✔✔3. hypoglycemia In a newborn, bradycardia is most commonly an indicator of: - Precise Answer ✔✔hypoxemia All the following are signs of hypoxemia in a newborn, EXCEPT: Answers: 1.cyanosis 2.lethargy 3.tachycardia

4.unresponsiveness 5.bradycardia - Precise Answer ✔✔3. tachycardia A newborn presents to the emergency department a few days after hospital discharge. The infant has been noted to be drooling, choking, and coughing, and the mother reports seeing bubbles at the baby's mouth. Which is the most likely explanation? Answers: 1.osteogenesis imperfecta 2.inborn error of metabolism 3.congenital diaphragmatic hernia 4.foreign body 5.tracheoesophageal fistula - Precise Answer ✔✔5. tracheoesophageal fistula Which of the following pairs of maneuvers are consistent with current recommendations for emergency care for a choking 5-month-old infant? Answers: 1.back blow then blind finger sweep 2.back blow then chest thrust 3.chest thrust then Heimlich maneuver 4.Heimlich maneuver then blind finger sweep

5.Heimlich maneuver then chest thrust - Precise Answer ✔✔2.back blow then chest thrust All of these steps are involved in pediatric rapid sequence intubation (RSI) EXCEPT: Answers: 1.If administering succinylcholine, pretreatment with atropine is always indicated in children under age 10. 2.Lidocaine pretreatment is usually provided to children with head trauma. 3.When deciding which size endotracheal tube to use, one may approximate by using the size of the small finger or nares as a reference. 4.Due to the fragility of the pediatric C-spine, a cervical collar should always be placed prior to intubation for children under age ten. 5.Uncuffed endotracheal tubes are the preferred devices used in children under 6-8 years of age. - Precise Answer ✔✔4.Due to the fragility of the pediatric C-spine, a cervical collar should always be placed prior to intubation for children under age ten. A 23 year old woman is dropped off by her boyfriend after an unknown overdose. You notice that she is has very large pupils and is sweating profusely. Her respiratory rate, blood pressure and heart rate are elevated. Which of the following is the most likely agent to have caused her symptoms? Answers:

1.Jimson weed 2.Cocaine 3.Heroin 4.Insulin - Precise Answer ✔✔2. cocaine A mother brings in her 4 year old child who was happily eating "blackberries" from weeds in the garden and is now acting strangely. She has identified them as Belladonna from a quick internet search. Which physical examination finding might you also expect to find in this child? Answers: 1.Diaphoresis 2.Flushed skin 3.Miosis 4.Urinary incontinence - Precise Answer ✔✔2. flushed skin For which of the following cases is activated charcoal therapy most appropriate? Answers: 1.Acetaminophen overdose 2.Drain cleaner ingestion 3.Iron supplement overdose 4.Lithium overdose - Precise Answer ✔✔1. Acetaminophen overdose

A 45 year-old is brought in 8 hours after a large overdose of his lithium. What is the best treatment method for this overdose? Answers: 1.Activated charcoal 2.Gastric lavage 3.Hemodialysis 4.Whole bowel irrigation - Precise Answer ✔✔3.Hemodialysis A 42 year-old woman presents with an overdose of her Xanax (alprazolam) that her family indicates she has been taking for years to help with her anxiety. The bottle indicates that the prescription was filled yesterday with 90 pills and is now empty. The patient is minimally responsive to painful stimuli and does not react when you suction secretions out of her posterior pharynx. What is your next management step? Answers: 1.Administration of flumazenil 2.Administration of narcan 3.Close observation 4.Intubation for airway support - Precise Answer ✔✔4.Intubation for airway support

A 72 year-old presents with an intentional overdose of a bottle of aspirin about 3 hours prior to presentation in the ED. Which of the following arterial blood gas results would you expect to come from this patient? Answers: 1.pH 7.14 pCO2 68 pO2 102 HCO3 23 2.pH 7.33 pCO2 48 pO2 58 HCO3 29 3.pH 7.45 pCO2 21 pO2 124 HCO3 14 4.pH 7.47 pCO2 31 pO2 96 HCO3 25 - Precise Answer ✔✔3.pH 7. pCO2 21 pO2 124 HCO3 14 A teenager presents one hour after ingesting a "handful" of acetaminophen tablets. Which of the following statements is TRUE? Answers: 1.An acetaminophen level drawn at hour four dictates need for antidotal therapy. 2.Serial liver function tests are indicated in all acetaminophen ingestions. 3.Renal sequelae are expected. 4.The intravenous formulation of N-acetylcysteine is safer than oral N- acetylcysteine. - Precise Answer ✔✔1.An acetaminophen level drawn at hour four dictates need for antidotal therapy.

A 2 year old child presents with an overdose of her mother's iron containing multivitamins. What antidote should you consider for iron toxicity? Answers: 1.Deferoxamine 2.Glucagon 3.Methylene blue 4.Pyridoxine - Precise Answer ✔✔1.Deferoxamine Severe lead toxicity can commonly result in which of the following clinical symptoms Answers: 1.Constipation 2.Dermatitis 3.Memory loss 4.Stocking glove peripheral neuropathy - Precise Answer ✔✔3.Memory loss A 27 year old woman is brought into the emergency department by her roommate 30 minutes after ingesting a bottle of aspirin in a suicide attempt. Which of the following acid-base disorders is most likely to be present in this patient?

Answers: 1.Respiratory acidosis due to somnolence causing decreased respiratory drive 2.Respiratory alkalosis due to stimulation of the respiratory center and increased CO2 production 3.Primary respiratory acidosis with compensatory metabolic alkalosis 4.Primary metabolic acidosis with compensatory respiratory alkalosis - Precise Answer ✔✔2.Respiratory alkalosis due to stimulation of the respiratory center and increased CO2 production The most common cause of intrinsic lower gastrointestinal (GI) bleeding in an adult is: Answers: 1.Cancer 2.Diverticulosis 3.Inflammatory bowel disease 4.Polyps - Precise Answer ✔✔2.Diverticulosis Which of the following bacteria does NOT produce bloody diarrhea? Answers: 1.Campylobacter enteritis 2.Clostridium perfringens 3.Escherichia coli 0157

4.Yersinia enterocolitica - Precise Answer ✔✔2.Clostridium perfringens With respect to laboratory findings in diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar nonketotic coma (HHNC), all of the following guidelines are generally true EXCEPT: Answers: 1.Patients with HHNC typically have blood glucose > 700 mg/dL, whereas patients with DKA have blood glucose > 350 mg/dL. 2.Serum ketones are present in patients with DKA but not usually in patients with HHNC. 3.Serum bicarbonate is typically severely low (<10mEq) in patients with either DKA or HHNC. 4.Serum osmolality in patients with HHNC is typically > 350 mOsm/L. 5.BUN is elevated more in patients with HHNC (>50 mg/dL) than in patients with DKA (25-50 mg/dL). - Precise Answer ✔✔3.Serum bicarbonate is typically severely low (<10mEq) in patients with either DKA or HHNC. Regarding the treatment of hyperosmolar hypertonic nonketotic coma (HHNC) and its associated symptoms, which of the following is correct: Answers: 1.Half of the fluid deficit should be corrected over the first hour and the remainder over the following 8 hours.

2.Since patients are not acidotic, close monitoring of glucose is not necessary. 3.Hyperosmolarity should be corrected within the first few hours in the emergency department. 4.Phenytoin (Dilantin) is often ineffective for seizures associated with HHNC. 5.In HHNC patients with severe dehydration, bleeding diathesis is a major clinical concern. - Precise Answer ✔✔4.Phenytoin (Dilantin) is often ineffective for seizures associated with HHNC. Regarding the development of cerebral edema in patients being treated for DKA, all of the following are true EXCEPT: Answers: 1.Cerebral edema typically occurs six to ten hours following onset of treatment. 2.Children have a higher incidence of cerebral edema. 3.Mannitol and steroids should be administered immediately to any patient suspected of developing cerebral edema. 4.Mortality of patients developing cerebral edema is 90%. 5.Patients with serum glucose below 250 mg/dL still being treated with insulin are most likely to develop clinically evident cerebral edema. - Precise Answer ✔✔3.Mannitol and steroids should be administered immediately to any patient suspected of developing cerebral edema. Metabolic abnormalities often seen with hypothyroidism include all of thefollowing EXCEPT:

Answers: 1.hyponatremia 2.hyperglycemia 3.hypercholesterolemia 4.respiratory acidosis from hypoventilation 5.anemia - Precise Answer ✔✔2.hyperglycemia Laboratory abnormalities typically seen with adrenal insufficiency include all of the following EXCEPT: Answers: 1.hypoglycemia 2.hyponatremia 3.hypokalemia 4.hypercalcemia 5.azotemia - Precise Answer ✔✔3.hypokalemia Regarding the treatment of suspected but not confirmed adrenal insufficiency, which of the following is most appropriate? Answers: 1.cosyntropin 0.25mg IV x 1 2.dexamthasone 4mg IV every 6 hours

3.hydrocortisone 100mg IV every 6 hours 4.cortisone 100mg IM every 6 hours 5.withholding of steroids until confirmation of the diagnosis of adrenal insufficiency - Precise Answer ✔✔2.dexamthasone 4mg IV every 6 hours Symptoms of secondary adrenal insufficiency include all of the following EXCEPT: Answers: 1.weakness 2.anorexia 3.hyperpigmentation 4.nausea and vomiting 5.weight loss - Precise Answer ✔✔3.hyperpigmentation Treatment with hyperbaric oxygen (HBO) is associated with contraindications. Which of the following is not a relative or absolute contraindication to HBO? Answers: 1.untreated pneumothorax 2.COPD with air trapping 3.otitis media 4.pregnancy - Precise Answer ✔✔4.pregnancy

Which of the following is not a common sign or symptom of thyrotoxicosis? Answers: 1.hypothermia 2.cogestive heart failure 3.tachycardia 4.hyperhidrosis 5.nervousness - Precise Answer ✔✔1.hypothermia Which of the following is true regarding the use of iodine in the treatment of thyroid storm? Answers: 1.Iodine should be the first drug administered in the treatment of thyroid storm. 2.Iodine should be administered only after treatment with propranolol. 3.Iodine should be administered at least one hour after propylthiouracil (PTU) has been given. 4.Dexamethasone must be given 30 minutes prior to iodine administration. 5.Iodine should be administered even in patients with known iodine allergy. - Precise Answer ✔✔3.Iodine should be administered at least one hour after propylthiouracil (PTU) has been given.

A 4 year old girl is brought to the ED two hours after being stung by a scorpion while on a camping trip in Arizona. She has periods of agitation and restlessness alternating with calmness. Her vital signs are: blood pressure 106/61, pulse 120, respiratory rate 24, temperature 37.0C, and oxygen saturations of 99% on room air. On physical examination you note drooling, a disconjugate gaze, and occasional jerking movements of the extremities.Which of the following is the most correct regarding the treatment of a scorpion sting in this child? Answers: 1.Treatment with antivemon is not indicated becase these symptoms will be self-limiting. 2.Complications of treatment with antivenom include delayed serum sickness 3.Analgesics have a minimal role in controlling symptoms 4.The patient should be intubated because respiratory failure is expected

• Precise Answer ✔✔2.Complications of treatment with antivenom include delayed serum sickness A 24 year old female gardener presents to the emergency department with foot pain 30 minutes after working barefoot in her garden. She saw a scorpion in the area. Which of the following signs or symptoms are most expected? Answers: 1.Puncture mark

2.Local erythema and swelling 3.Pain and paresthesias 4.Cranial nerve abnormalities - Precise Answer ✔✔3.Pain and paresthesias A 48 year old farmer is plowing his field when a thunderstorm rapidly overcomes him. Drivers on a nearby highway see him struck by lightening. You respond to the scene with EMS. What is the least likely finding on physical exam? Answers: 1.respiratory arrest 2.cardiac asystole 3.extensive skin burns 4.Glascow Coma Score of 3 - Precise Answer ✔✔3.extensive skin burns Which of the following anti-hypertensive medications is associated with a lupus-like syndrome? Answers:

1. hydralazine
2. labetalol
3. nicardipine
4. nitroglycerin
5. nitroprusside - Precise Answer ✔✔1. hydralazine

You need to treat an adult with no past medical history, who presents with a hypertensive emergency. You have access to all of the following agents. Which of the following is the preferred agent and initial dose? Answers:

1. clonidine PO 0.1 mg
2. esmolol IV 100-500 mic/kg load
3. hydralazine IM 0.1-0.2 mg/kg
4. labetolol PO 0.2-1.0 mg/kg bolus
5. metoprolol PO 10 mg - Precise Answer ✔✔2. esmolol IV 100- mic/kg load A 24 year old woman is playing racquetball and sustains a direct blow from the ball to the right eye. She presents to the emergency department complaining of eye pain and double vision. On exam, her right eye does not track properly with upward gaze. This finding suggests which of the following injuries? Select all that apply 1.Inferior orbital rim fracture 2.Superior orbital rim fracture 3.Inferior orbital wall fracture 4.Ethmoid fracture

5.Zygomatic arch fracture - Precise Answer ✔✔3.Inferior orbital wall fracture The most sensitive bedside test for nerve injury in a finger after trauma is: Select all that apply 1.light touch 2.O'Riain wrinkle test 3.pain 4.temperature sensation 5.two-point discrimination - Precise Answer ✔✔5.two-point discrimination In a patient with a suspected ruptured globe from penetrating trauma to the eye, all of the following should be performed EXCEPT: Answers: 1.administration of broad spectrum antibiotic therapy 2.ascertainment of intraocular pressure via tonometry 3.ascertainment of tetanus status 4.ophthalmology consultation 5.visual acuity assessment - Precise Answer ✔✔2.ascertainment of intraocular pressure via tonometry

Following a motor vehicle crash, a 25 year old man presents complaining of a painful right eye. Visual acuity is 20/200 in the right eye and 20/25 in the left eye. The right eye protrudes from the orbit and the patient has right eye pain with extraocular movement. What is the most likely cause of his symptoms? Answers: 1.chemosis 2.hyphema 3.orbital blow-out fracture 4.retrobulbar hematoma 5.ruptured globe - Precise Answer ✔✔4.retrobulbar hematoma Following a brawl at a local bar, a gentleman presents with an impressive right-sided periorbital ecchymosis. All of the following physical examination findings would suggest an orbital blowout fracture EXCEPT: Answers: 1.anesthesia of the right infraorbital region 2.diplopia with upward gaze 3.proptosis 4.right-sided epistaxis 5.right-sided infraorbital subcutaneous emphysema - Precise Answer ✔✔3.proptosis

Which of the following cervical spine fractures is considered stable? Answers: 1.Flexion teardrop fracture 2.Bilateral facet dislocation 3.Transverse process fracture 4.Jefferson fracture of C 5.Hangman's fracture of C2 - Precise Answer ✔✔3.Transverse process fracture A 23 year old man is stabbed in the anterior neck with a 3-inch knife during a street fight. At the scene, there is some bleeding, which is controlled with direct pressure. He presents to the emergency department breathing comfortably and in no distress. His pulse is 88, blood pressure 126/76, and oxygen saturation 99% on room air. There is a 1cm laceration 2cm above the right sternoclavicular junction, lateral to the trachea. There is mild oozing and no obvious underlying hematoma. There is no obvious subcutaneous air, and he has clear lung sounds. What is the most appropriate management for this patient? Answers: 1.Immediate operative exploration 2.Local wound exploration and discharge home if no significant injury identified

3.Local wound exploration and discharge home after 6-hour observation period 4.Angiography, esophogram, and admission for observation 5.CT scan of the neck and discharge home after 6 hours of - Precise Answer ✔✔4.Angiography, esophogram, and admission for observation Which is the most common associated neurological finding with a distal radius fracture? Answers: 1.Wrist drop 2.Decreased sensation over the thenar eminance 3.Weakness of finger adduction 4.Decreased sensation over the hypothenar eminance 5.Weakness with flexion at the finger MCP joints - Precise Answer ✔✔2.Decreased sensation over the thenar eminance A 22 year old running back is struck from behind by a 300-pound lineman. The blow occurs below the knee as his foot is firmly planted and two other linemen are holding his upper body. He presents to the emergency department with gross anterior dislocation of the tibia on the femur. His foot is cool and pale, and dorsalis pedis and posterior tibial pulses are not detected by Doppler ultrasound. What is the most appropriate management for this patient? Answers:

1.Immediate orthopedic consultation without attempts to manipulate the knee 2.Immediate arteriography to assess for popliteal artery disruption 3.Immediate reduction in emergency department under conscious sedation without X-rays 4.Open reduction in OR with exploration of popliteal artery - Precise Answer ✔✔3.Immediate reduction in emergency department under conscious sedation without X-rays In differentiating high voltage electrical injury from lightning injury, which of the following is your best discriminator? Answers: 1.Loss of consciousness 2.Cardiac arrest 3.Fractures or dislocations 4.Deep burns - Precise Answer ✔✔4.Deep burns Regarding the epidemiology of asthma in the United States, which of the following is true? Answers: 1.Etiology is thought to be genetic, not environmental 2.Incidence is comparable for Caucasians and African-Americans 3.More common in males than females in adult and pediatric populations

4.Prevalence increased in the 1980's, and then decreased in the 1990's - Precise Answer ✔✔4.Prevalence increased in the 1980's, and then decreased in the 1990's Which of the following patients is the most likely to develop S. pneumoniae pneumonia? Answers: 1.59 year old woman who is a cigarette smoker. 2.61 year old man with hypertension 3.64 year old man with type 2 diabetes 4.65 year old woman with no past medical history - Precise Answer ✔✔3.64 year old man with type 2 diabetes A 28 year old man is shot in the right chest. His vital signs are: T 97.9, HR 120, BP 70/50, RR 12, SPO2 84%. He has significant JVD, his trachea is deviated to the left, and he has decreased breath sounds on the right. The patient's diagnosis is: Answers: 1.Hypovolemic shock 2.Tension pneumothorax 3.Cardiac tamponade 4.Lung laceration 5.Spinal cord injury - Precise Answer ✔✔2.Tension pneumothorax

Regarding the diagnosis of pulmonary embolism (PE), which is correct. Answers: 1.Autospsy studies indicate that approximately 30% of patients who die in the hospital have undiagnosed PE 2.By 80 years of age, one out of four people will develop deep venous thrombosis 3.One-year mortality of PE is 25% even with early diagnosis and treatment 4.Pulseless electrical activity in Emergency Department cardiac arrest victims is associated with PE in 33% - Precise Answer ✔✔4.Pulseless electrical activity in Emergency Department cardiac arrest victims is associated with PE in 33% Regarding the role of malignancy in the diagnosis of pulmonary embolism (PE): Answers: 1.Hematologic malignancies such as leukemia and have the highest incidence of venous thromboembolism 2.25% of PE patients without identifiable risk factors are diagnosed with cancer within 2 years. 3.The risk of PE is decreased in patients on chemotherapy 4.Autopsy studies indicate that greater than 60% of patients who die of ovarian cancer have PE. - Precise Answer ✔✔2.25% of PE patients

without identifiable risk factors are diagnosed with cancer within 2 years. A 25 year old female presents with fever, productive cough, and shortness of breath. Physical exam reveals T101, RR 24 and SpO2 of 94%. Her left tympanic membrane is inflamed and there are TM bullae. The chest X-ray reveals a large right middle lobe pneumonia. The organism most commonly associated with this type of presentation is: Answers: 1.Legionella pneumoniae 2.Strep pneumoniae 3.H. influenzae 4.Mycoplasma pneumoniae 5.Moraxella catarrhalis - Precise Answer ✔✔4.Mycoplasma pneumoniae A pneumonia caused by which of the following organisms is classically associated with currant jelly sputum? Answers: 1.Strep. pneumoniae 2.viral 3.H. influenzae 4.Mycoplasma