CARDIOVASCULAR EMERGENCIES
To check orthostatic vital signs, BP and HR should be measured after the patient is
a) 1 min supine, 1 min sitting, and 1 min standing
b) 3 mins supine, 3 mins sitting and 3 mins standing
c) 3 mins prone and 3 mins standing
d) none of the above
b) 3 mins supine, 3 mins sitting and 3 mins standing
A 4-year-old is brought to urgent care with the mother describing vomiting and diarrhea for several days. The child is lethargic and pale. Which nursing assessment finding would indicate severe dehydration?
A. Sunken anterior fontanel
B. Capillary refill of 2 seconds
C. Difficulty palpating the radial pulse
D. Blood pressure of 104/70 mm Hg
C. Difficulty palpating the radial pulse
A young man is hit on the head with a blunt object in a mugging. He was briefly unconscious and was BIBEMS c/o severe headache and a dilated pupil on the side of injury. During examination, he becomes more comatose. He is stabilized and taken for CT head and neck. What is the most likely finding?
a) epidural hematoma
b) subdural hematoma
c) intraventricular hemorrhage
d) cervical spine injury
a) epidural hematoma
A 45 y/o man is admitted to the ED after a bout of bloody vomiting. He is noted to be mildly hypotensive with slight scleral icterus, palmar erythema, and hepatomegaly. No h/o aspirin or NSAID use but he does admit to long-term alcohol abuse. The most likely source of the bleeding is:
a) gastric ulcer
b) esophageal varices
c) gastric cancer
d) angiodysplasia
b) esophageal varices
A 12 y/o is brought to the ED with h/o dog bite (household pet) the previous day. Her family treated it with 70% alcohol and bandage. Today, the laceration continues to hurt and appears somewhat swollen and red with a dark exudate. Which of the following interventions is inappropriate?
a) irrigation followed by suturing
b) debridement of nonviable tissue
c) amoxicillin/clavulanate (Augment) PO x 5 days
d) irrigation with povidone-iodine (Betadine)
a) irrigation followed by suturing
A young woman with h/o lupus and recent aminoglycoside treatment of an infection develops nausea, extreme fatigue, and poor UOP. Serum creatinine is 4.5 mg/dL. EKG shows peaked T waves, prolonged PRI, and slightly widened QRS. What is the appropriate emergency therapy?
a) IV calcium
b) IV glucose and insulin
c) both A and B
d) neither A or B
c) both A and B
A patient is intubated and on mechanical ventilation. The ventilator alarm rings, and the airway pressure is found to be elevated. Possible causes include the following EXCEPT
a) endotracheal tube obstruction with sputum
b) pneumothorax
c) bronchospasm
d) cuff leak
d) cuff leak
A 17 y/o football player was knocked unconscious for about a minute after a vigorous tackle. On recovering consciousness, he was somewhat confused and complained of mild nausea and headache. Both resolved in a few minutes. He was examined by the team doctor, who did not find any neurologic deficits. He wants to return to the game, how should the player be managed?
a) send him back to the game after a brief rest
b) bench him for the game but allow him to practice the following week
c) hospitalize him for observation and CT scanning
d) no athletics with continued observation for neurologic signs and gradual return to school and the team
d) no athletics with continued observation for neurologic signs and gradual return to school and the team
After an auto accident x-ray of the patient's leg shows a transverse fracture of the mid-femur with several bone fragments surrounding the fracture site. The skin of the leg is intact. This type of fracture is called:
a) compression fracture
b) comminuted fracture
c) avulsion fracture
d) open fracture
b) comminuted fracture
Pyelonephritis is a serious infection that can lead to what complications during pregnancy?
a) cystitis
b) fever
c) bleeding
d) preterm labor and preeclampsia
d) preterm labor and preeclampsia
What is not associated with rhabdomyolysis?
a) use of statin drugs
b) elevated creatinine kinase
c) use of beta blockers
d) hyperkalemia
c) use of beta blockers
107. Disaster preparation and prevention measures include
a. disaster-related supply inventory.
b. plan for housing, food, and water for staff.
c. establish communication protocol for notifying public health and law enforcement.
d. all of the above.
D. All of the above
A farmer's arm is severed by a threshing machine at the mid-humerus. Which of the following would best preserve the amputated arm for possible reimplantation?
a) no action; such arm injuries cannot be reimplanted
b) irrigate the arm with normal saline and pack directly in ice water
c) pack the arm directly in warm saline
d) moisten with saline, wrap in a plastic bag, and preserve on crushed ice and water
d) moisten with saline, wrap in a plastic bag, and preserve on crushed ice and water
An ED nurse is speaking at the education session for the ED. Which of the statements regarding drugs of misuse would be correct?
A. Cocaine causes pupillary dilation and injected conjunctiva
B. Marijuana causes pupillary constriction and clear conjunctiva
C. Benzodiazepines cause pupillary constriction and slow pupillary response.
D. Fentanyl causes dilated pupils and a rapid pupillary response.
A. Cocaine causes pupillary dilation and injected conjunctiva
A pediatric client is seen with high fever, conjunctivitis, mouth lesions, and a rash. He is diagnosed with Kawasaki's syndrome. What is the most serious potential complication of this disease?
a) hepatitis
b) renal failure
c) intestinal blockage
d) coronary artery disease
d) coronary artery disease
1. A 3-year-old patient presents to the emergency department with a temperature of 39.4 C (103.0 F). The child is flushed appearing, drooling, and displaying obvious difficulty in breathing. Inspiratory stridor is noted on auscultation of the chest. The parent describe no symptoms before bedtime and noticed fever and drooling upon the child's awakening this morning. The nurse would suspect which of the following:
A. Pertussis
B. Laryngotracheobronchitis
C. Epiglottitis
D. Bronchiolitis
C. Epiglottitis
A 40-year-old man is rescued from a house fire and brought to the ED by paramedics. He is quite lethargic, breathing is rapid and shallow, and heart rate is regular but increased and blood pressure is moderately low. A carboxyhemoglobin (COHb) level is 40%. An endotracheal tube is placed. Which of the following would be the best treatment?
a. hyperbaric oxygen at 3 atm for 46 minutes; repeat in 6 hours if full CNS activity not restored
b. hyperbaric oxygen at 6 atm for 1 hour; repeat in 4 hours if full CNS activity not restored
c. 100% oxygen until the COHb falls below 10%
d. 60% oxygen until the COHb falls below 10%
a. hyperbaric oxygen at 3 atm for 46 minutes; repeat in 6 hours if full CNS activity not restored
5. A Patient presents to the emergency department after dropping frozen hamburger meat on their left foot. The patient complains of severe pain to the left fifth toe and purple bruising is noted to the toe. The following radiograph is obtained. Which evaluation would be correct along with treatment option?
A. Fractured left distal metacarpal with a posterior splint recommended
B. Fractured left distal metatarsal with stirrup splint recommended
C. Fractured left distal tarsal with short leg walking cast recommended
D. Fractured left fifth phalanx with buddy taping recommended
An adult male comes into the ED appearing anxious and exhibiting unusual involuntary posturing. His eyes are gazing upward, and his neck is hyperextended and deviated to the left side. He recently started talking metoclopramide for gastroesophageal reflux disease (GERD), but he denies any other drug use. The ED physician has written orders for the nurse to give the patient diphenhydramine 50 mg IV. Within 15 minutes of treatment, the symptoms fully resolve. The nurse asks the physician what caused these symptoms, and she says it was a
a. partial seizure
b. dystonic reaction
c. catatonic reaction
d. transient ischemic attack.
D. Fractured left fifth phalanx with buddy taping recommended
b. dystonic reaction
An adult male comes into the ED appearing anxious and exhibiting unusual involuntary posturing. His eyes are gazing upward, and his neck is hyperextended and deviated to the left side. He recently started talking metoclopramide for gastroesophageal reflux disease (GERD), but he denies any other drug use. The ED physician has written orders for the nurse to give the patient diphenhydramine 50 mg IV. Within 15 minutes of treatment, the symptoms fully resolve. The nurse asks the physician what caused these symptoms, and she says it was a
a. partial seizure
b. dystonic reaction
c. catatonic reaction
d. transient ischemic attack.
b. dystonic reaction
At what age are boys at the most risk for testicular torsion?
a) the first year of life
b) the ages of 5-7 years
c) the risk for testicular torsion is minimal at any age
d) the ages of 7-9 years
a) the first year of life
A patient presents to the ER with a PE. The patient is hemodynamically stable, and the patient is not a candidate for thrombolytics due to history. The patient is started on anticoagulation therapy. Which of the following is NOT true regarding anticoagulation therapy?
a) anticoagulation therapy can lyse existing clots
b) the goal of AC therapy is to achieve an INR of 2-2.5
c) ACs are more likely than other medications to cause harm
d) anticoagulants prevent clot propagation
a) anticoagulation therapy can lyse existing clots
A patient is being transported via EMS from an industrial site after being sprayed with hydrofluoric acid on the left lower extremity. The patient's skin was irrigated for more than 30 minutes earlier and during transport. The emergency nurse would anticipate which of the following treatments upon arrival in the ED
A. Cover the wound with a petroleum gel
B. Apply a sterile dressing
C. Apply 2.5% calcium gluconate gel to the affected side
D. Neutralize the chemical with a mild alkali solution.
C. Apply 2.5% calcium gluconate gel to the affected side
A 12 y/o presents with a Grade 3 hyphema after being hit with a baseball at a game. Which of the following are true?
A. patch and shield will not be necessary
B. Motrin should be given for pain
C. Aminocaproic acid should be given to prevent secondary hemorrhage
D. system or topical antibiotics are a cornerstone of treatment for hyphema
C. Aminocaproic acid should be given to prevent secondary hemorrhage
A patient presents to the ER with a PE. The patient is hemodynamically stable, and the patient is not a candidate for thrombolytics due to history. The patient is started on anticoagulation therapy. Which of the following is NOT true regarding anticoagulation therapy?
a) anticoagulation therapy can lyse existing clots
b) the goal of AC therapy is to achieve an INR of 2-2.5
c) ACs are more likely than other medications to cause harm
d) anticoagulants prevent clot propagartion
a) anticoagulation therapy can lyse existing clots
A 6 y/o is brought to the ED with CPR in progress. The AED has activated 3 times during transport. the child was found unresponsive by the parents at home with bystander CPR initiated. An intraosseous line is placed and the cardiac monitor VF. No drugs have been administered before arrival. the estimated weight is 30 kg. Which of the following medication would be top priority.
A. Calcium chloride 1 mg IO
B. Epinephrine 0.3 mg IO
C. Amiodarone 150 mg IO
D. Atropine 0.6 mg IO
Epinephrine 0.3 mg IO