Out & About
A patient arrives at the ED after suffering chemical burns while at work. What is the first priority of care for this patient?
A. Administering pain medication
B. Applying burn ointment
C. Immediate decontamination
D. Covering the burns with sterile dressings
Correct Answer: C. Immediate decontamination
Rationale: Immediate decontamination is essential to remove the chemical from the skin and prevent further tissue damage. This involves flushing the affected area with copious amounts of water and removing contaminated clothing. This step is crucial to minimize injury and protect both the patient and healthcare personnel from further harm.
After a fall down a flight of stairs, a patient in her 38th week of pregnancy is brought to your ED. Unless contraindicated, this patient should be placed in which position during assessment?
A. Supine position
B. Left lateral recumbent position
C. Trendelenburg position
D. Right lateral recumbent position
Correct Answer: B. Left lateral recumbent position
Rationale: Placing a pregnant patient in the left lateral recumbent position helps to relieve pressure on the inferior vena cava, improving venous return and cardiac output. This
position helps to prevent supine hypotensive syndrome, which can cause reduced blood flow to both the mother and the fetus. It is a standard practice for assessing and managing pregnant patients to ensure both maternal and fetal well-being.
Which organ is most frequently injured in blunt abdominal trauma?
A. Liver
B. Spleen
C. Kidney
D. Small intestine
Correct Answer: B. Spleen
Rationale: The spleen is the organ most frequently injured in blunt abdominal trauma due to its location in the left upper quadrant of the abdomen and its relatively fragile structure. Blunt force can easily cause splenic rupture, leading to internal bleeding and requiring prompt medical attention to prevent hemorrhagic shock and other complications.
What is the treatment of choice for patients with a pneumothorax?
A. Observation with supplemental oxygen therapy
B. Needle aspiration
C. Chest tube insertion (thoracostomy)
D. Video-assisted thoracoscopic surgery (VATS)
Correct Answer: C. Chest tube insertion (thoracostomy)
Rationale: The treatment of choice for patients with a pneumothorax is chest tube insertion (thoracostomy). This procedure involves inserting a flexible tube into the pleural space to remove air, allowing the lung to re-expand1. It is particularly used for larger or symptomatic pneumothoraxes to ensure effective and rapid re-expansion of the lung. Observation with supplemental oxygen therapy, needle aspiration, and VATS are other options, but chest tube insertion is the most common and effective treatment for significant pneumothoraxes.
patient presents with sudden onset of unilateral facial droop, slurred speech, and arm weakness. What is the most appropriate immediate action?
A. Administering aspirin
B. Performing a neurological assessment
C. Preparing for a head CT scan
D. Starting an IV line
Correct Answer C. Preparing for a head CT scan. The symptoms are indicative of a possible stroke. Rationale: A head CT scan is essential to differentiate between ischemic and hemorrhagic stroke, which guides subsequent treatment. Immediate imaging is critical in the acute phase of stroke management.
Which blood test is the most indicative of myocardial damage?
A. Complete Blood Count (CBC)
B. Cardiac Enzymes (Troponin)
C. Liver Function Tests (LFTs)
D. Basic Metabolic Panel (BMP)
Correct Answer: B. Cardiac Enzymes (Troponin)
Rationale: Cardiac enzymes, specifically troponin, are the most indicative of myocardial damage. Troponin levels rise significantly in the blood within hours of a heart attack, making it a highly sensitive and specific marker for myocardial injury2. Elevated troponin levels are used to diagnose and assess the severity of myocardial infarction (heart attack)
Why are alkali burns more serious than acid burns?
A. Alkali burns cause superficial damage
B. Acid burns are more painful
C. Alkalis penetrate deeper into tissues and cause more extensive damage
D. Alkalis neutralize on contact with skin
Correct Answer: C. Alkalis penetrate deeper into tissues and cause more extensive damage
Rationale: Alkalis tend to penetrate deeper into the tissues than acids, leading to more extensive and severe damage. Alkalis saponify fats in the skin, causing liquefactive necrosis, which allows them to continue penetrating and damaging deeper layers. In contrast, acids typically cause coagulation necrosis, which can create a barrier that limits further penetration and damage. This makes alkali burns potentially more serious and harder to treat.
A 24-year-old woman complains of lower quadrant pain radiating to her shoulder. Her last menstrual period (LMP) was 8 weeks ago. As a nurse, you suspect the patient may have which medical problem?
A. Appendicitis
B. Ectopic pregnancy
C. Ovarian Cyst Rupture
D. Urinary tract infection
Correct Answer: B. Ectopic pregnancy
Rationale: Given the patient's symptoms of lower quadrant pain radiating to her shoulder and her LMP being 8 weeks ago, an ectopic pregnancy is a likely concern. An ectopic pregnancy occurs when a fertilized egg implants outside the uterus, often in a fallopian tube. This can cause severe pain and shoulder pain due to referred pain from diaphragmatic irritation. Immediate medical evaluation is crucial to confirm the diagnosis and provide appropriate care.
What is the most appropriate nursing diagnosis for a patient with acute pancreatitis?
A. Impaired Physical Mobility (Due to the pain and discomfort, patients might limit their movements)
B. Acute Pain (Pain management is critical due to severe abdominal pain)
C. Risk for Infection (Due to inflammation and potential pancreatic necrosis)
D. Deficit Fluid Volume (Adequate hydration [targeted bolus followed by maintenance fluids] is needed to offset the rapid fluid and mineral loss caused by the pancreatitis)
Correct Answer: D. Deficit Fluid Volume
Rationale: Acute pancreatitis often leads to significant fluid shifts and losses due to inflammation and third-spacing, resulting in a deficit fluid volume. This condition necessitates aggressive fluid resuscitation to restore and maintain intravascular volume and prevent hypovolemia. Adequate hydration, typically involving a targeted bolus followed by maintenance fluids, is essential to counteract the rapid loss of fluids and electrolytes, ensuring stable hemodynamic status and aiding in the recovery process. Monitoring and managing fluid balance are critical aspects of care for patients with acute pancreatitis.
What can happen to a chronic COPD patient when given high levels of oxygen?
A. Hypertension
B. Hypokalemia
C. Decreased respiratory drive
D. Hyperglycemia
Answer: What is decreased respiratory drive? (Chronic COPD patients rely on low oxygen levels to drive their breathing and giving them high levels of oxygen can suppress this drive.)
Rationale: Chronic COPD patients rely on low oxygen levels to drive their breathing, known as the hypoxic drive. When given high levels of oxygen, their respiratory drive can be suppressed, leading to decreased respiratory drive. This can result in hypoventilation, increased carbon dioxide levels (hypercapnia), and potentially respiratory acidosis. Oxygen therapy in COPD patients must be carefully managed to avoid these risks.
n a patient with increased ICP, which position should be avoided to prevent further elevation of intracranial pressure?
A. Supine position with head flat
B. Head elevated at 30 degrees
C. Lateral decubitus position
D. Semi-Fowler's position
Correct Answer: A. Supine position with head flat. Rationale: Keeping the head flat can increase ICP by impeding venous outflow from the brain. Elevating the head at 30 degrees helps facilitate venous drainage and reduces ICP.
The resuscitation team is performing CPR on a patient. Which rhythm will respond to defibrillation?
A. Asystole
B. Pulseless electrical activity (PEA)
C. Ventricular fibrillation (VF)
D. Sinus bradycardia
Correct Answer: C. Ventricular fibrillation (VF)
Rationale: Ventricular fibrillation (VF) is a chaotic and irregular heart rhythm that leads to the heart being unable to pump blood effectively. It is one of the most common rhythms that respond to defibrillation. Defibrillation delivers an electric shock to the heart, which can help restore a normal heart rhythm and improve the chances of survival in a cardiac arrest situation. Other rhythms like asystole and pulseless electrical activity do not typically respond to defibrillation and require different approaches for treatment.
At what core body temperature is it acceptable to consider pronouncing death in a hypothermic patient, given aggressive warming measures have failed?
A. 95 degrees Fahrenheit (35 degrees Celsius)
B. 93 degrees Fahrenheit (33.9 degrees Celsius)
C. 90 degrees Fahrenheit (32.2 degrees Celsius)
D. 87 degrees Fahrenheit (30.6 degrees Celsius)
Correct Answer: D. 87 degrees Fahrenheit (30.6 degrees Celsius)
Rationale: In cases of severe hypothermia, resuscitative efforts are continued until the patient's core body temperature is at least 87 degrees Fahrenheit (30.6 degrees Celsius). If the patient remains unresponsive to aggressive warming measures and other life-saving interventions by this point, it may be acceptable to consider pronouncing death. This protocol ensures that every possible effort is made to revive the patient before making such a critical decision.
How long is a woman at risk for postpartum preeclampsia after delivery?
A. 24 hours
B. 1 week
C. 3 weeks
D. 6 weeks
Correct Answer: D. 6 weeks
Rationale: A woman is at risk for postpartum preeclampsia for up to six weeks after delivery. While most cases develop within the first 48 hours postpartum, the risk can extend throughout this period. Monitoring for symptoms such as high blood pressure, severe headache, visual disturbances, and edema is crucial during these six weeks to ensure timely detection and management of postpartum preeclampsia.
Your patient has been vomiting every 30-45 minutes for the past 8 hours. In addition to hypovolemia, the patient is at risk of developing which two problems?
A. Hypertension and Hyperglycemia
B. Hypokalemia and Metabolic Alkalosis
C. Hypoglycemia and Hyperthermia
D. Anemia and Polycythemia
Answer: What is hypokalemia and metabolic alkalosis? (From loss of hydrochloric acid)
Rationale: Frequent vomiting leads to the loss of hydrochloric acid from the stomach. This can result in metabolic alkalosis, where the blood becomes too alkaline due to the loss of stomach acid. Additionally, vomiting causes significant losses of potassium, leading to hypokalemia. Both conditions require careful monitoring and management to restore electrolyte balance and maintain the patient's overall health.
What is the most serious injury associated with a fracture of the 1st or 2nd rib?
A. Pneumothorax
B. Flail chest
C. Aortic rupture
D. Pulmonary contusion
Correct Answer: C. Aortic rupture
Rationale: Fractures of the 1st or 2nd ribs are rare but can be associated with serious injuries such as aortic rupture. The proximity of these ribs to the great vessels, including the aorta, means that a fracture can cause life-threatening bleeding and require immediate medical intervention. Recognizing the potential for aortic rupture is crucial for timely diagnosis and management to prevent catastrophic outcomes.
.A patient with a confirmed diagnosis of ischemic stroke is a candidate for thrombolytic therapy. According to Our Policy, what is the maximum critical time window for administering Tenecteplase (tnk)?
A. Within 1 hour of symptom onset
B. Within 4.5 hours of symptom onset
C. Within 6 hours of symptom onset
D. Within 24 hours of symptom onset
Correct Answer: B. Within 4.5 hours of symptom onset.
Rationale: The administration of tnk is most effective when given within 4.5 hours of symptom onset for ischemic stroke. Early administration can significantly improve outcomes. Reference: PolicyStat ID16544729
You are doing an EKG on a patient with a potassium level of 7.8 mEq/L. Which of the following findings are you most likely to see on their EKG?
A. Peaked T waves and widened QRS complex
B. Prolonged PR interval and inverted T waves
C. Shortened QT interval and normal P waves
D. Normal EKG with no abnormalities
Correct Answer: A. Peaked T waves and widened QRS complex
Rationale: A potassium level of 7.8 mEq/L indicates severe hyperkalemia, which is associated with characteristic EKG changes. These changes include peaked T waves and a widened QRS complex. These findings are due to the effects of high potassium levels on cardiac conduction and repolarization. Recognizing these EKG changes is crucial for the timely management of hyperkalemia to prevent serious cardiac complications.
A patient arrives at the ED after collapsing while running a 5K race. The core temperature is 105 degrees Fahrenheit, and the urine appears tea-colored. What is the reason for the tea-colored urine, and what is the patient at risk for?
A. Dehydration; risk of hypovolemic shock
B. Urinary tract infection; risk of sepsis
C. Exertional rhabdomyolysis; risk of acute kidney injury
D. Hematuria; risk of bladder injury
Correct Answer: C. Exertional rhabdomyolysis; risk of acute kidney injury
Rationale: The tea-colored urine is indicative of myoglobinuria, which occurs in exertional rhabdomyolysis. This condition arises from muscle breakdown due to extreme physical exertion, releasing myoglobin into the bloodstream. Myoglobin is toxic to the kidneys and can lead to acute kidney injury, necessitating prompt treatment to prevent severe
complications. Immediate interventions include aggressive hydration to flush out myoglobin and continuous monitoring of renal function.
A patient who is 32 weeks pregnant arrives at the ED complaining of painless bright red vaginal bleeding of sudden onset. As the attending nurse, what condition do you suspect?
A. Placental abruption
B. Preterm labor
C. Placenta previa
D. Uterine rupture
Correct Answer: C. Placenta previa
Rationale: Painless bright red vaginal bleeding in the third trimester is a hallmark sign of placenta previa. This condition occurs when the placenta is implanted low in the uterus and covers the cervical opening. Immediate assessment and management are necessary to ensure the safety of both the mother and the fetus, including possible delivery planning if the condition poses significant risks.
Which sign is a common finding during the assessment of a patient with cholecystitis?
A. Positive Murphy's sign
B. Cullen's sign
C. Grey Turner's sign
D. Rovsing's sign
Correct Answer: A. Positive Murphy's sign
Rationale: A positive Murphy's sign is a common finding during the assessment of a patient with cholecystitis. This sign is characterized by the cessation of inspiration due to pain when the right upper quadrant of the abdomen is palpated deeply. It indicates inflammation of the gallbladder, which is typical in cholecystitis. Recognizing this sign helps in the prompt diagnosis and management of the condition.
EXTRA: To assess for a positive Murphy's sign, follow these steps:
1. Position the Patient: Have the patient lie down on their back (supine position) on the examination table.
2. Locate the Right Upper Quadrant: Place your left hand on the patient's lower right rib cage, just below the costal margin (the lower edge of the rib cage).
3. Palpate During Inspiration: Ask the patient to take a deep breath. As they inhale, gently press your right thumb into the abdomen just below the right costal margin1.
4. Observe the Patient's Reaction: If the patient experiences pain and abruptly stops their inspiration, this indicates a positive Murphy's sign.
Which condition is indicated by a "shark fin" pattern on a capnography waveform?
A. Hyperventilation
B. Bronchospasm
C. Cardiac arrest
D. Hypoventilation
Correct Answer: B. Bronchospasm
Rationale: A "shark fin" pattern on a capnography waveform typically represents bronchospasm. This occurs when the airways are constricted, causing uneven and prolonged exhalation. The characteristic shape is due to the obstruction in the airways, making it difficult for the patient to exhale fully and efficiently. Recognizing this pattern is essential for timely intervention and management of conditions like asthma or chronic obstructive pulmonary disease (COPD).
True or False: According to our policy, consent is needed prior to administration of Tenecteplase (tnk)?
False
Correct Answer: FALSE
Rationale: TNK does not require consent. Our policy (Tenecteplase) states the following "does not require consent. However, the purpose of treatment and risks and benefits of treatment must be explained and assent obtained if possible. If the patient cannot give assent and does not have family available to give assent, treatment may still proceed" Reference: PolicyStat ID16544729
Your patient arrives by EMS with complaints of shortness of breath (SOB) and frothy pink sputum. Lung sounds reveal crackles and wheezing bilaterally. Vital signs are: BP 90/50 mmHg, pulse 120 bpm, RR 34 bpm, and the patient is afebrile. The patient has a history of diabetes mellitus (DMM), hypertension (HTN), and heart failure. What do you immediately suspect?
A. Asthma
B. Pulmonary embolism
C. Acute bronchitis
D. Acute pulmonary edema
Correct Answer: D. Acute pulmonary edema
Rationale: Given the patient's symptoms of shortness of breath, frothy pink sputum, crackles and wheezing on lung auscultation, along with a history of heart failure, the most likely diagnosis is acute pulmonary edema. This condition involves the accumulation of fluid in the lungs, making it difficult to breathe and often presenting with crackles and pink, frothy sputum1. The low blood pressure and high heart rate indicate the patient is in a critical state and requires immediate medical intervention
A patient arrives in the ED after a scuba diving trip. He complains of shortness of breath (SOB), coughing up pink frothy sputum, chest pain (CP), and vertigo. What is the best position to place the patient in to reduce the chance of a cerebral embolus, which may occur due to failure to exhale properly when surfacing?
A. Supine position
B. Trendelenburg position
C. Left lateral decubitus position
D. Right lateral decubitus position
Correct Answer: C. Left lateral decubitus position
Rationale: Failing to exhale properly when surfacing can lead to air embolism, where air bubbles can enter the bloodstream and potentially travel to the brain, causing a cerebral embolus. Placing the patient in the left lateral decubitus position helps to trap the air emboli in the right ventricle, reducing the risk of these bubbles traveling to the cerebral circulation. This position is effective in minimizing the risk of serious complications such as a stroke due to an air embolus.
For a neonate, what should you suction first at the time of delivery, and using which tool?
A. Mouth, using a bulb syringe
B. Nose, using a bulb syringe
C. Mouth, using a suction catheter
D. Nose, using a suction catheter
Correct Answer: A. Mouth, using a bulb syringe
Rationale: At the time of delivery, the initial suctioning of a neonate focuses on the mouth first, using a bulb syringe. Suctioning the mouth before the nose helps to clear any secretions and prevents the neonate from inhaling fluid into the lungs, which could happen if the nose is suctioned first. This practice ensures a clear airway and reduces the risk of aspiration and respiratory complications.
A patient complains of abdominal pain and distention, fever, tachycardia, and diaphoresis. An abdominal x-ray shows free air under the diaphragm. What condition do you suspect?
A. Appendicitis
B. Bowel obstruction
C. Perforated bowel
D. Cholecystitis
Correct Answer: C. Perforated bowel
Rationale: The presence of free air under the diaphragm on an abdominal x-ray is a classic sign of a perforated bowel. This condition occurs when a hole develops in the wall of the intestine, allowing air to escape into the abdominal cavity. It is a medical emergency that requires immediate surgical intervention. The patient's symptoms of abdominal pain, distention, fever, tachycardia, and diaphoresis are consistent with this diagnosis.
You are providing ventilations using a bag-valve mask. Suddenly, you do not see the patient's chest rise with your ventilations. You reposition the airway and try to ventilate again. Still no chest rise. What is the most likely cause?
A. Equipment malfunction
B. Obstructed airway
C. Pneumothorax
D. Hypovolemia
Correct Answer: B. Obstructed airway
Rationale: When you are providing ventilations using a bag-valve mask and the patient's chest does not rise despite proper repositioning of the airway, the most likely cause is an obstructed airway. This could be due to a foreign body, mucus plug, or anatomical obstruction that is preventing air from reaching the lungs. Immediate assessment and intervention are necessary to clear the obstruction and ensure effective ventilation.
.Which of the following medications is commonly used to treat increased intracranial pressure in a patient?
A. Labetalol
B. Furosemide
C. Mannitol
D. Dexamethasone
Correct Answer: C. Mannitol.
Rationale: Mannitol is an osmotic diuretic used to reduce cerebral edema and lower ICP in patients with traumatic brain injury. It works by drawing fluid out of brain tissue, which decreases swelling and pressure inside the skull.
What are the steps involved in reading ST elevation on an EKG?
A. Identify the P wave, measure the PR interval, assess the T wave, check for reciprocal changes.
B. Identify the J point, measure the ST segment, assess the pattern, check for reciprocal changes, consider clinical context.
C. Identify the QRS complex, measure the QT interval, assess the U wave, check for P wave abnormalities.
D. Identify the baseline, measure the PR segment, assess the R wave, check for T wave abnormalities, consider patient's temperature.
Correct Answer: B. Identify the J point, measure the ST segment, assess the pattern, check for reciprocal changes, consider clinical context
Rationale: The correct steps to read ST elevation on an EKG are:
1. Identify the J point, where the QRS complex ends and the ST segment begins.
2. Measure the ST segment from the J point to the baseline.
3. Assess the pattern of the ST segment elevation.
4. Check for reciprocal changes in other leads.
5. Consider the clinical context to correlate EKG findings with the patient's symptoms and history.
This structured approach ensures accurate interpretation of EKG findings and effective patient management.