Clinical Case Studies in Emergency Medicine, Exams of Nursing

Download Clinical Case Studies in Emergency Medicine and more Exams Nursing in PDF only on Docsity! Relias Emergency Department Test. Complete Test with Correct Answers. Already Graded A. A 22 year old female who is 8 weeks pregnant presents with a sudden onset of left lower abdominal and vaginal bleeding. The patient's family member stated that she had a syncopal episode shortly after that. What is the most likely diagnosis for her? - ANSRuptured ectopic pregnancy A 35 year old patient complains of night sweats, low-grade fever, weight loss, and a productive cough with pink-tinged sputum for 3-4 weeks. They have been staying at a local shelter since they lost their job 6 months ago. What diagnosis is most likely? - ANSTuberculosis A confused patient is trying to grasp at their IV with their right hand. Which is the LEAST restrictive measure to maintain patient safety? - ANSSafety "mitt" for right hand only A new nurse observes their preceptor giving the incorrect dosage of a medication to a patient. Implementing the ethical principle veracity, what action would the new nurse take? - ANSinform the charge nurse about what happened and document it. A patient arrives with acute onset of central chest pain. The patient is tachycardic and tachypneic and appears very anxious and restless. What would be the most important initial intervention for this patient? - ANSadminister oxygen A patient arrives with suspected appendicitis. What action, if observed, would require additional training for the unlicensed assistive personnel (UAP)? - ANSThe UAP offers the patient a ginger ale. A patient has sustained multiple traumatic injuries after a fall from a....height. What is considered an important component of the primary survey assessment? - ANSNeurological assessment A patient is being treated in a hyperbaric oxygen chamber for carbon monoxide poisoning. What measurement is the best indicator of treatment success? - ANSArterial blood gas A patient is being treated with an anticoagulant for pulmonary embolism (PE). What patient assessment finding indicates that a heparin infusion would be stopped IMMEDIATELY? - ANSdecreased level of consciousness A patient is brought in after being struck by lightning during a heavy thunderstorm. What would be the PRIORITY intervention for this patient upon arrival? - ANSMonitor cardiac rhythm A patient is brought in for a potential overdose of heroin. What is the PRIORITY nursing intervention? - ANSmaintaining airway and breathing A patient is brought in with a history of a head-on motor vehicle accident. The patient was not wearing a seat belt and was traveling at 120 mph with the deployment of an airbag. They complain of severe lower abdominal and hip pain. A secondary trauma survey reveals an unstable hip on lateral compression. What would be a PRIORITY intervention in managing this patient? - ANS*wrong* Insertion of second IV line other choices: initiation of massive transfusion protocol application of pelvic binder administration of IV fluids correct: application of a pelvic binder A patient is brought in with possible foreign body obstruction and respiratory distress. The provider suctions the patient and unsuccessfully tries to insert an endotracheal tube (ETT). What type of procedure would you anticipate NEXT? - ANS*wrong* Placement of laryngeal mask other choices: tracheostomy bronchoscopy chest tube insertion correct: tracheostomy A patient is complaining of a burning sensation in both eyes with pain, redness, swelling and purulent discharge. The visual assessment using the Snellen chart reveals no changes in vision. You anticipate that the patient has signs and symptoms of: - ANSConjunctivitis A patient is frustrated at the length of time they have been waiting to be triaged. They start to yell obscenities and threaten you with physical violence. Why would this incident be reported to your supervisor? - ANSYou have the right to personal safety in the work environment. A patient presents after an intentional overdose of propranolol approximately 2 hours ago. The patient has severe hypotension and bradycardia. IV fluids and vasopressors are initiated. What nursing assessment findings indicate the treatment has been effective? - ANSincreasing serum glucose A patient with dementia has a family member with a MPOA, who is unable to be reached. The provider needs a consent signed and allows the patient to sign. What is the most appropriate action you would take? - ANSReport the provider to their supervisor A patient's family has decided to withdraw life-sustaining treatment. When communicating with the family of the patient, what reassurance would you provide? - ANSEfforts will be made to make the patient comfortable. Acute deficiency of cortisol and aldosterone can lead to what severe life-threatening condition? - ANSadrenal crisis An adult patient who is 70 kg has a full-thickness burn over 30% of their body surface area. What is the anticipated fluid replacement for a patient in the first 8 hours is based on the Parkland formula? - ANS4200 ml An elderly patient is brought in with new onset of confusion and gradual onset of headache in the last 48 hours. The patient states that they had a fall 3 days ago. Based on the history and presenting complaints, what diagnostic test do you anticipate the provider to order? - ANSCT scan of the brain During cardiogenic shock, what temporary intervention might be ordered to improve perfusion until definitive treatment is provided? - ANSinotropic infusion The deficiency of anti-diuretic hormone (ADH) can lead to what endocrine disorders? - ANSDiabetes insipidus The life-threatening and rare complication of hypothyroidism is known as: - ANSmyxedema coma Under what circumstances can the hospital transfer an unstable patient to another facility and maintain compliance with the Emergency medical treatment and active labor act (EMTALA)? - ANSthe necessary treatment is not available at the current hospital. Upon triage of a patient, they state that they have suicidal ideation with intent. What would you do next? - ANSInstitute suicide precautions What are you most likely to see during your initial assessment of a patient with chronic obstructive pulmonary disease (COPD)? - ANSpursed lip breathing What do you anticipate is the best indicator of adequate hydration in an adult patient with 30% body surface area burn during initial fluid resuscitation? - ANSurine output of 0.5 ml/kg/hr What is a common assessment finding in a patient with a tension pneumothorax? - ANSdistended neck veins What is the appropriate intervention for patients with acute respiratory distress syndrome (ARDS)? - ANSmechanical ventilation What is the critical goal time from arrival to the ED to CT brain scan based on the American Heart Association stroke recommendations? - ANS25 minutes What is the current recommended dose of intravenous or intraosseous epinephrine in adult patients with cardiac arrest? - ANS1 mg every 3-5 minutes What laboratory value would you monitor closely if your patient is vomiting coffee- ground emesis - ANSHemoglobin What medication is used in reversing the effects of opioid overdose? - ANSNaloxone (Narcan) What staff member would you ask to accompany you when transporting an intubated patient to imaging for a CT? - ANSrespiratory therapist What symptom is commonly seen in patients with alcohol withdrawal? - ANSTachycardia What type of diet would a patient with diverticulitis follow? - ANSHigh fiber diet What type of medication is used in the emergency care setting to help manage the symptoms of alcohol withdrawal? - ANSBenzodiazepines Which of the following represent categories utilized to triage patients during a mass casualty incident (MCI)? - ANSGreen, yellow, red, black Which of the following wounds has the highest risk for developing osteomyelitis? - ANSPuncture wound from stepping on a rusty nail. You accidentally administered epinephrine 1:1000 intravenous push for a patient suffering from a severe anaphylactic reaction. You recognize this as a near-miss event and report this: - ANSinternally, per policy through the defined incident reporting system You are administering haloperidol (Haldol) to a patient with acute symptoms of Schizophrenia. What changes in the electrocardiogram (ECG) are possible as a result of this medication? - ANSProlonged QT interval You are assisting a novice nurse with a blood draw. You observe the nurse draw the blood, place the specimen tubes in a biohazard bag, and leave the room with the unlabeled specimen tubes. What do you do next? - ANSRe-educate the nurse, then redraw the labs, use patient identifiers and label at the bedside. You are caring for a patient who has a history of alcohol use and seizures. You suddenly notice the patient becoming diaphoretic, anxious, tachycardic and has clammy skin. What would you do NEXT? - ANSCheck their blood glucose You exit your patient's room and as you walk away, you hear a thud. Upon inspection, you find your patient on the floor. What would you do FIRST? - ANSAssess the patient for injury You see a fellow nurse placing an opioid medication in their pocket rather than administering it as ordered. What would you do NEXT? - ANSTell your immediate supervisor You want to implement the new evidence-based practice guidelines in managing patients to prevent falls on your unit. What provides the strongest evidence for interventions? - ANSsystematic reviews Your patient has just had a paracentesis during which 5 liters of fluid were removed. Which assessment is the priority? - ANSblood pressure Your patient's chest tube dressing has accidentally come off and you are preparing to place a new one. You have a slit drain spring, 4x4 gauzes, tape, scissors, and antiseptic swabs. What else do you need? - ANSPetroleum gauze