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CEN EXAM 1 QUESTIONS AND ANSWERS
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CEN EXAM 1 QUESTIONS AND ANSWERS
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CEN EXAM 1 QUESTIONS AND ANSWERSWhich dysrhythmia would be identified on an ECG/EKG six-second strip by a heart rate
of 76 and a PR interval of 0.24?
a.sinus tachycardia
b.first-degree atrioventricular block
c.sinus bradycardia
d.junctional escape rhythm - Answers -B: First-degree atrioventricular block is
diagnosed partially by an EKG showing a PR interval of greater than 0.20 seconds.
Which blood test may indicate infection or inflammation and would need to be used as
part of the clinical picture with diagnosing and treating abdominal pain?
a.white blood cell (WBC) count of 5.0
b.hematocrit (HCT) of 45
c.WBC count of 28.0
d.blood sugar (BS) of 74 - Answers -C: An elevated WBC count would be indicative of
infection or inflammation. The WBC count of 5.0 is normal. The HCT and BS levels
listed would also be considered within normal limits.
A 30-year-old man comes to the emergency department with the acute onset of left
flank pain radiating to the groin. Microscopic hematuria is present on urinalysis. What is
the most likely diagnosis?
a.ureteral calcium oxalate calculus
b.ureteral cystine calculus
c.testicular torsion
d.cystitis - Answers -A: Ureteral calculi are a quite common cause of acute emergency
evaluation, usually causing flank pain with radiation to the back and/or groin. About 75%
of these are calcium oxalate or phosphate; less common are struvite, uric acid, or
cystine calculi. While KUB or ultrasound may show the stone, helical CT is now the
preferred diagnostic method. Additional workup includes CBC, chemistry panel,
urinalysis, and straining of urine to catch a passed stone for chemical analysis. Nursing
attention should be directed to intravenous hydration with input and output recording
and narcotic or narcotic plus NSAID (e.g., ketorolac) administration for pain. Some
patients may be discharged with analgesics and instructions for hydration and calculus
capture. Testicular torsion is most common in adolescents and usually presents with
testicular and groin pain with abdominal radiation; increasing pain by lifting the scrotum
to the level of the pubic symphysis causes exacerbation of the pain (Prehn sign).
Cystitis may be infectious or drug-induced, but cystitis usually causes dysuria and
pyuria and shows positive urine cultures.
Which of the following is NOT appropriate for screening for domestic violence by the
emergency department nurse?
a.asking if the person has been hit, kicked, or otherwise hurt by someone in the past
year; if so, by whom
b.asking, "Do you feel safe in your present relationship?"
, c.avoid asking about intimate person violence if the patient is in the emergency
department for a medical ailment, not trauma
d.asking if there is a partner from a previous relationship that makes the individual feel
unsafe - Answers -C: Domestic violence, nearly always perpetrated against women, is a
major problem confronted by the emergency nurse. Screening for possible cases should
include answers A, B and D. Interestingly, victims of intimate partner violence often
present with a medical ailment, not trauma. These include back, abdominal, or pelvic
pain, headaches, urinary infections, sexually transmitted disease, or symptoms
consistent with posttraumatic stress disorder (PTSD). Sometimes evidence of old
trauma such as healing fractures or cosmetically concealed bruises may point toward
the presence of domestic violence. Many victims will deny it but sometimes
compassionate questioning in a private setting will elicit a positive response. The nurse
may then offer advice, refer to a social agency or shelter, or ask for a consultation by
the hospital social worker.
A patient presents with a history of nausea, vomiting, and diarrhea for several days after
a Caribbean cruise. In the emergency department, she is weak, moderately
hypotensive, and dehydrated. An ECG shows bradycardia, mild ST depression, and a U
wave with some ventricular ectopic beats. What is the most likely electrolyte
abnormality?
a.hypomagnesemia
b.hyperkalemia
c.Hypokalemia
d.hypocalcemia - Answers -C: Hypokalemia (potassium lower than 3.5 mEq/L) may
result from gastrointestinal or renal loss, or from transfer from extracellular fluid to
intracellular fluid. Drugs such as aldosterone, insulin, and beta2-agonists promote the
latter. Gastrointestinal loss is the most likely cause in this patient and hypokalemia may
be a feature of traveler's gastroenteritis. Renal loss occurs with diuretics or kidney
disease and low potassium may be a feature of diabetic ketoacidosis or excess
steroids. The ECG findings described are typical of low potassium but do not
necessarily correlate with the degree. Potassium administration should be through a
large bore or central venous catheter (it is locally irritating) by an infusion pump at 40
mEq/L not to exceed 10 to 20 mEq per hour. For severe hypokalemia, a 5 to 10 mEq
bolus may be given but serial potassium and cardiac monitoring is required to avoid
hyperkalemia, ventricular dysrhythmias, and death. Low serum magnesium levels may
accompany hypokalemia and should be checked.
The Emergency Medical Treatment and Active Labor Act (EMTALA) includes the
following provisions EXCEPT:
a.participating hospitals have emergency departments and receive funding from Health
and Human Services (HHS)
b.any patient who comes to the emergency department requesting examination or
treatment must receive an appropriate medical screening exam to determine if an
emergency situation exists
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