Emergency Medicine Case Studies for Various Medical Conditions, Exams of Nursing

Download Emergency Medicine Case Studies for Various Medical Conditions and more Exams Nursing in PDF only on Docsity! 2023-2024 PROPHECY EMERGENCY DEPARTMENT RN A EXAM What is the proper procedure for testing visual acuity? Correct Ans- The proper procedure for testing visual acuity is based on the usage of the Snellen test which has letters or symbols. The letters are arranged in rows and columns in the chart and they have different sizes. A 22-year-old man with sickle cell disease is brought into the ED by Campus Police from his local university. He is complaining of increasing pain to his bilateral lower extremities, consistent with his past sickle cell pain crisis. Which intervention would you expect the provider to order? Correct Ans- IV Fluids Normal Saline TPA would be contraindicated for which of the following patients? Correct Ans- 80 year old diagnosed with stroke 2 weeks ago A 24 year old female, who has recently received methotrexate for a tubal pregnancy, presents to the ED with severe abdominal pain. What would be the PRIORITY nursing intervention? Correct Ans- Prepare to go to the OR A 3 year old boy with a history of hydrocephalus with a cerebral shunt arrives to the ED with a fever of 102.0°F, an enlarged abdomen, tachycardia and hypotension. The patient is mildly lethargic, however is cooperative with the ED staff. Immediate treatment for this child should include: Correct Ans- Antibiotics and IV Fluids When caring for a patient who has received a massive blood transfusion, monitoring which of the following lab results is a top priority? Correct Ans- Ionized Calcium Level What medication would you anticipate administering to a six month old having an active tonic-clonic seizure? Correct Ans- Ativan Patient presents to the ED with a snake bite that occurred 30 minutes ago. The snake was identified as a poisonous rattlesnake. What medication would you expect the physician to order for this patient? Correct Ans- CroFab Crotalidae Polyvalent Immune Fab (Ovine) A 26 year old male with a history of asthma presents to the ED with dyspnea, audible expiratory wheezes, substernal retractions, accessory muscle use, with BP- 145/72, HR -26, RR-32, O2 Sat 88% on room air. What is the FIRST treatment of choice for this patient? Correct Ans- Give albuterol and atrovent nebulizer with oxygen A 40-year-old man presents to the ED with shortness of breath and a headache, after being sprayed by pesticides while working on a farm. What is the FIRST nursing intervention? Correct Ans- Decontaminate the patient according to hospital procedure Four patients are being transported to the ED after a severe collision between a train and two motor vehicles. Which of the following patients should be triaged for FIRST treatment? Correct Ans- 28-year-old with respiratory distress and open chest wound A 53 year old female with a history of sarcoidosis presents to the ED after being rescued by firefighters from her burning apartment. She is currently alert and oriented, BP-115/78, HR-110, RR- 24, T-100.4 F, oxygen saturation 97% on room air. She is currently only complaining of a headache and her carboxyhemoglobin is 13%. What is the MOST appropriate nursing intervention? Correct Ans- Place on high-flow non-rebreather A 28 year old, obsterical patient presents at 38 weeks gestation status post motor vehicle collision. Upon arrival via EMS, you note she is on a backboard and c- collar is in place. What is the immediate nursing intervention for this patient? Correct Ans- Place patient in left tilt position A 36 year old male presents to the ED with an amputated hand. What should you do FIRST? Correct Ans- Apply direct pressure to extremity Of the following patients, which one needs referral to the closest burn center? Correct Ans- Partial-thickness and full-thickness burns involving the genitalia or perineum What are three signs of cardiac tamponade? Correct Ans Sharp pain in the chest. ... A 54 yr old male with a history of non-insulin dependent diabetes, presents to the ED with new onset of confusion, weakness, lethargy and nausea with frequent large volume urine output. Vital signs are BP-102/54, HR-115, RR-12, T- 97.4 and oxygen saturation is 97% on room air. Blood glucose is 725 mg/dl. pH is 7.40. What diagnosis would you expect to see for this patient? Correct Ans- Hyperosmolar hyperglycemic state Your patient arrives hypotensive and tachycardic after a motorcycle collision. His pelvis is unstable upon palpation and a portable pelvic film reveals an open book pelvic fracture. What immediate intervention should you expect? Correct Ans- Pelvic sheeting or placement of a commercial pelvic binder A nurse is at end of their shift and has been dealing with a difficult and unruly patient. The nurse threatens to place the patient in restraints without justification. This is an example of: Correct Ans- Assault Your patient is an 84-year-old man who presents to the ED with increasing forgetfulness, restlessness, and anxiety, which has become progressively worse over the past 2 months. The patient feels well and is independent with his ADLs but will forget where he placed things. The head CT, labs and ECG are all normal. The diagnosis is likely dementia. Which of the following is correct about dementia? Correct Ans- There is progressive deterioration in cognition and/or behavior without altered consciousness Which of the following fractures is highly associated with child abuse? Correct Ans- Spiral leg fracture of the tibia in an 8 month old You enter a patient's room and notice the chest tube has become dislodged from the patient's chest and is hanging off the bed. The primary intervention is to: Correct Ans- Cover the chest tube site with 4x4 dressing and taping only 3 sides of the dressing An 18 year old female presents to ED unresponsive via private car. Her friends state that she has overdosed on hydrocodone. BP- 80/40, HR- 58, RR- 8, O2 sat 86% on room air. You expect an order for which of the following medications? Correct Ans- Naltrexone (Narcan) A patient with a tension pnuemothorax should have a needle decompression catheter placed Correct Ans- IN the 2nd intercostal space, midclavicular line An intubated patient becomes extremely agitated and the ventilator begins to alarm. What should you do FIRST? Correct Ans- Check the ventilator tubing for disconnection Which of the following is a responsibility of the nurse collecting forensic evidence during the care of a sexual assault patient? Correct Ans- Maintaining the evidence chain of custody A 26 year old male presents to the ED with an alcohol level of 225 mg/dl. The patient also consumed an unmeasured amount of benzodiazepines, is positive for THC and opiates. An eye witness states that the patient also consumed bleach while intoxicated. What is the next most important step to take in order to ensure proper treatment for this patient? Correct Ans- Call the Poison Control Center for toxic ingestion recommendations A 38 week pregnant patient presents to the ED in active labor. The patient states she has not had any prenatal care. The fetal heart rate is assessed to be 85 beats per minute. What is the PRIORITY nursing intervention? Correct Ans- Have the patient lay on her left side and place patient on high flow oxygen A patient arrives to the ED intubated and decompressed on the left side status post gunshot wound to the chest. During the primary survey, the endotracheal tube placement is confirmed but breath sounds ae noted to be absent on the right. A right-sided chest tube is place with immediate return of 500 ml or blood. Which of the following would you perform FIRST? Correct Ans- Transfuse 2 unite of uncrossmatched red blood cells A 22-year old woman pre3sent to the ED appearing disheveled and tearful with obvious bruising to her face and neck. The patient reports that she was assaulted and raped by an acquaintance several hours ago. What is the PRIORITY nursing intervention? Correct Ans- Evaluate the patient's physical injuries A 35 year old construction worker arrived in the ED after falling from a ladder while working on a house. He is lying on his back in a co-worker's truck with blood pooling around his head. He has snoring respiration and a GCS of 7. What initial interventions would you perform? Correct Ans- C-spine stabilization, assistive ventilations and preparation for intubation An elderly couple present to the ED via EMS. The husband sustained a broken hip after a fall at home. The wife states to the nurse :I don't think I can take care of him anymore." What is the most appropriate nurse intervention? Correct Ans- Arrange a social services consult Your patient is intubated and sedated with extensive second and third degree burns after being pulled from a house fire. You note the patient's core temp to be 94 F. Which of the following interventions should you implement immediately? Correct Ans- Application for forced-air warming system and warmed fluids An 8 year old boy presents to the ED with fever for the last 6 hours. Which of the following assessment findings would cause the MOST concerns? Correct Ans- Petechial rash on the trunk An 83-year old woman presents to the ED triage with shortness of breath, generalized fatigue and weakness. Her daughter says her symptoms are similar to what she experienced several months ago from a urinary tract infections. There are no beds immediately available in the ED. Her vital signs BP- 127/70, HR-65, RR- 16, T-99 F, O2 sat 100% RA. Which of the following diagnostic tests is MOST important to obtain during triage? Correct Ans- ECG A 25-year old female presents to the ED via ambulance for evaluation of erratic behavior. She was found acting bizarrely and speaking loudly in a public park. The patient is irritable, displays pressured speech, and flight of ideas. She is hyperactive and pacing around the room. The patient's presentation is most consistent with: Correct Ans- Mania Your patient fell 15 feet of a roof landing chest first onto a barrel. He is complaining of shortness of breath and shoulder pain. When assessing his lung sounds anteriorly, you auscultate bowel wounds in the chest. Based on this assessment, which of the following injuries would you suspect? Correct Ans- Ruptured diaphragm You have a bariatric patient that was involved in an MVC. The patient was in the driver's side, restrained by seatbelt, and airbag deployed. The patient is responsive upon arrival and complains of pain to the left arm. The patient has seatbelt marks across the chest. What is your priority assessment for this patient? Correct Ans- Assess the patient for signs of possible airway and respiratory compromise A 38-year old man with a history of schizophrenia arrives at this emergency department reporting that he is being monitored and plotted against by his neighbors through his television. He appears mildly agitated and suspicious. He