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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 75-year-old man has a history of several episodes of transient right-sided arm and
hand weakness lasting an hour or two but with full recovery. He is diabetic and
hypertensive and is taking medication for both conditions. This time the episode does
not resolve and he is taken to the emergency department some 2 hours after the onset
of symptoms. He is awake and able to answer questions and give a medical history. His
chest is clear and no bruits are heard over the carotids. There is drift of the right arm on
examination and his speech is slightly garbled. His blood pressure is 160/95 mm Hg
and his pulse is irregular at 80 beats per minute. A CT of the brain reveals a small left-
sided occlusion in a branch of the middle cerebral arterial circulation without
hemorrhage. What should be the next step in his management?
a.start nitroprusside to reduce his blood pressure to normal
b.begin fibrinolytic therapy with altep - Answers-B: This patient had several transient
ischemic attacks prior to his clear-cut signs of a stroke, shown to be nonhemorrhagic in
nature. Such strokes may be caused by local thrombosis, especially in arteriosclerotic
vessels, or by emboli arising in the carotid artery (usually at the bifurcation of the
internal and external vessels) or the heart, most often in atrial fibrillation patients with
clots in the atrial appendage. Because this patient arrived in the emergency department
within 3 hours from the onset of symptoms, the current recommendation is to begin
fibrinolytic therapy with recombinant tissue plasminogen activator (r-TPA). Some recent
studies indicate benefit from this therapy may be achieved up to 4.5 hours after the
onset of symptoms. Blood pressure management in stroke patients is tricky. Most would
agree with slow reduction if the value is greater than 220 systolic or 120 diastolic or the
stroke is hemorrhagic in nature. For patients treated with a fibrinolytic agent,
significantly elevated blood pressure should be lowered to prevent reperfusion
problems. If noninvasive carotid scanning shows marked stenosis, neurosurgical
consultation for endarterectomy or angioplasty with stent placement is reasonable.
Subsequent warfarin treatment may be appropriate if atrial fibrillation is present.
A chronically anemic patient is receiving a packed red blood cell (PRBC) transfusion. He
suddenly develops fever and chills, tachypnea and dyspnea, and tightness in the chest.
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