Emergency Department Case Studies: Misdiagnosed Conditions and Treatments, Exams of Medicine

Download Emergency Department Case Studies: Misdiagnosed Conditions and Treatments and more Exams Medicine in PDF only on Docsity! 1 PROPHECY EMERGENCY DEPARTMENT RN exam solution 2024 What is the proper procedure for testing visual acuity? - ANS>> *BOTH WRONG* 1) Test the affected eye first, then the unaffected eye without corrective lenses 2) Test the unaffected eye first, then the affected eye with corrective lenses when available 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? - ANS>> *BOTH WRONG* 1) Oral hydrocodone 2) Intravenous acetaminophen TPA would be contraindicated for which of the following patients? - ANS>> WRONG 1) 67 year old with symptom onset 3 hours 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? - ANS>> *BOTH WRONG* 1) Administer pain medication and fluids as ordered 2) Prepare for a pelvic exam and assess for vaginal bleeding 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: - ANS>> *BOTH WRONG* 1) Removal of the shunt 2) Draining the shunt When caring for a patient who has received a massive blood transfusion, monitoring which of the following lab results is a top priority? - ANS>> *BOTH WRONG* 1) B-type natriuretic peptide 2 2) Hematocrit count What medication would you anticipate administering to a six month old having an active tonic-clonic seizure? - ANS>> *BOTH WRONG* 1) Phenobarbital 2)Phenytoin 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? - 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? - 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? - 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? - ANS>> 26-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? - 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? - 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? - ANS>> Apply direct pressure to extremity Of the following patients, which one needs referral to the closest burn center? - ANS>> Partial-thickness and full-thickness burns involving the genitalia or perineum 5 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: - 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? - ANS>> Naltrexone (Narcan) A patient with a tension pnuemothorax should have a needle decompression catheter placed - 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? - 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? - 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? - 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? - 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? - 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? - 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 6 would you perform? - 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? - 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? - 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? - 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? - 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: - 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? - 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? - 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 reports he has blocked the people working against him by putting aluminum foil over TV and over the doors and windows. He left his apartment because he suddenly feared they would retaliate. This 7 patient is demonstrating which of the following psychotic symptom? - ANS>> Persecutory delusions You are caring for a patient who has decided to discontinue treatment. You recognize that the patient is competent to make this decision. What action should you take NEXT? - ANS>> Comply with the patient wishes and ensure proper documentation of refusal The physician orders a heparin infusion of 900 units/hr. Heparin is prepared 25,000 units in 500 ml of D5W. The pump should be set to deliver ___ mL/hr. - ANS>> 18 You are caring for a patient in second-degree AV block type 2 with a heart rate of 30, BP - 86/62 and with an altered mental status. IV access attempts have been unsuccessful, and the patient becomes unresponsive. What is the PRIORITY nursing intervention? - ANS>> Begin transcutaneous pacemaker During CPR in progress, the physician calls for a pulse check. The monitor shows a change from the previously recorded rhythm. Which of the following would indicate the need for a shock? - ANS>> V-fib A patient with severe pre-eclampsia is sent to the ED by her OB/GYN. The OB/GYN called ahead and instructs the charge nurse to start the patient on a magnesium drip. You notice signs of magnesium toxicity including hypotension, bradypnea, loss of reflexes and decreased urinary output. Which of the following is the antidote used to treat magnesium toxicity? - ANS>> Calcium gluconate IV Which of the following statements from a patient exhibits a good understanding of discharge instructions after being diagnosed with trichomoniasis and given a prescription for metronidazole? - ANS>> I will avoid alcohol consumption while taking my medication Hypoparathyroidism tends to cause which of the following electrolyte imbalance? - ANS>> Hypocalcemia A 48-year old woman presents to the ED with nausea, vomiting, RUQ, and a fever (T- 101 F). The physician states that she has a positive Murphy's sign. Considering these symptoms and assessment findings, the patient is MOST likely experiencing: - ANS>> Cholecystitis What would you anticipate as part of the plan of care for a patient diagnosed with pancreatitis? - ANS>> Maintain NPO status Interpret the acid-base abnormality: ph 7.56, PaCO2- 24 mm Hg, HCO3 - 23 mEq/L,PO2 93 - ANS>> Respiratory alkalosis