CEN® Q & A 2nd Edition

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Sample Questions

Cardiovascular Questions

1. A patient is seen in the ED for chest pain that started two hours prior to arrival. She has T wave inversion and ST segment elevation in V1, V2, V3 and V4. She is given 10 units of reteplase (Retavase) intravenously. Which of the following would indicate reperfusion for this patient?
a. change in pain level from 3 to 8 on a scale of 1–10
b. presence of Q wave measuring greater than 0.04 seconds
c. short run of accelerated idioventricular rhythm noted
d. sudden hypertensive episode with quick resolution

Answer: C

Rationale: Monitoring for reperfusion status is important in patients who are administered thrombolytics. Symptoms of reperfusion include: resolution of chest pain, normalization of ST elevation and dysrhythmias. The most common reperfusion dysrhythmia is accelerated idioventricular. The nurse would expect a reduction in chest pain, not an increase. A pathologic Q wave would indicate necrosis in that part of the heart wall. A hypertensive episode would not be expected as an indicator of reperfusion.


2. The following four patients in the ER triage area are complaining of chest pain that is sharp and knifelike in nature. They each state that “it feels like something is tearing.” Onset of the chest pain for each patient was sudden and unbearable. Which of these patients would the nurse take first?
a 54-year-old male with a past history of stent placement
b. a 36-year-old male with a past history of chronic bronchitis
c. a 16-year-old male with a history of hemophilia
d. a 24-year-old male with a history of Marfan syndrome

Answer: D

Rationale: Marfan syndrome is a connective tissue disorder and the usual cause of death for these patients is a dissecting thoracic aneurysm. The other patients listed do not have an increase risk for a dissecting thoracic aneurysm.



Respiratory Questions

3. A patient involved in a multiple-car crash, in which his car was airborne, presents with chest pain, shortness of breath and tenderness to the left upper quadrant. Suddenly he becomes more dyspneic and is noted to have distended neck veins and tracheal deviation to the left.
      Blood pressure: 88/64
      Respiratory rate: 36 breaths per minute
      Pulse oximetry: 86% on room air
      Pulse: 130 beats per minute
A quick needle thoracostomy is performed. Which of the following would be a true statement regarding the performance of this procedure:
a. The needle should be placed at the fifth intercostals space, mid-axillary line.
b. A quick escape of air should be recognized after the needle is removed from the catheter.
c. The needle should be placed inferior to the rib in order to avoid vessel and nerve injury.
d. The needle should be placed in the left side of the upper chest to relieve the tension pneumothorax.

Answer: B

Rationale: When the needle is removed from the catheter, a slight woosh of air should occur, indicating relief of the buildup of pressure within the chest from the tension pneumothorax. The correct placement for a needle thoracostomy is the second intercostals space mid-clavicular line. For this patient, the needle would be placed in the right side of the chest since he has tracheal deviation to the left, indicating the buildup of pressure from the initial pneumothorax on the right. The needle needs to be placed superior to the rib since the nerves and vessels run on the inferior surface of the rib.



Genitourinary, Gynecology and Obstetrical Questions

1. Which of the following women presents as a high risk for developing a placenta previa?
a. the first pregnancy for a 14-year-old girl
b. the third pregnancy in seven years for a 29-year-old woman who has two healthy children
c. a 20-year-old woman who had two therapeutic abortions, one at age 14 and one at age 17
d. a 44-year-old woman who had one live birth and one abortion in her second decade of life, and is now pregnant for the third time

Answer: D

Rationale: Risk factors for a placenta previa include advanced age or a woman with multiple pregnancies, especially in rapid succession. Teenage first-time pregnancies, pregnancies that are not in rapid succession and previous therapeutic abortions are not considered risk factors for placenta previa.



Neurological Questions

1. A lumbar puncture reveals that a patient has viral meningitis. Which of the following interventions should the emergency nurse anticipate?
a. immediate initiation of strict isolation procedures
b. initiation of prophylactic anticonvulsant medication
c. serial neurological assessments to rule out the onset of increased intracranial pressure or the onset of encephalitis
d. prompt initiation of intravenous antibiotics for the patient and initiation of antibiotics for anyone who had been in close personal contact with the patient

Answer: C

Rationale: Viral meningitis is usually mild and requires nothing more than supportive therapy. Some patients with viral meningitis may even be discharged home. Because this infection affects the meninges surrounding the brain, serial neurological assessments should be performed to rule out negative sequelae such as increased intracranial pressure or encephalitis. Strict isolation procedures are not indicated for viral meningitis, as it is only mildly contagious. Patients should be instructed to wash their hands after defecating and to cover their mouth and nose when they cough or sneeze, but they do not require isolation. Prophylactic anticonvulsant medication is not indicated in cases of viral meningitis. Antibiotics will not be effective for viral meningitis.



Medical Emergency Questions

1. A nurse receives a needle stick after administering an IM injection of ceftriaxone (Rocephin) to a patient with a known history of hepatitis B. Which of the following would provide quick, passive immunity for this nurse?
a. immune globulin
b. hepatitis vaccine
c. ribarivin (Rebetol)
d. zidovudine (Retrovir)

Answer: A

Rationale: Immune globulin provides passive immunity to patients for post exposure prophylaxis. The vaccine is an active immunity that will create antibodies. Interferon and zidovudine are medications used to treat hepatitis B and HIV (human immunodeficiency virus).

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