CEN Chapter 6 Review: Emergency Nursing Exam Prep, Key Concepts, Practice Questions &
Rationales
A patient is being discharged following treatment for excessive vomiting and diarrhea from a
possible foodborne illness. You know the patient understands the discharge instructions when
the patient states:
I will drink clear liquids, such as sports drinks, for the next 24 hours. - ✔✔Once vomiting has
been controlled, oral hydration should begin with the use of fluids that contain glucose, sodium,
and potassium, such as sport or electrolyte replacement drinks. Institution of a regular diet
following vomiting and diarrhea may induce the vomiting and diarrhea again. Patients should be
instructed to gradually increase their diet as tolerated. Milk or milk productes are not
recommended following vomiting and diarrhea. Clear liquids are defined as liquids that a
person can see through, such as water, fruit juice without pulp, broth, clear sodas, jell-o, and
popsicles. Milk and orange juice are not defined as clear liquids.
Emergency nursing core curriculum 6th edition pp. 159-186
Category: Environment and Toxicology Emergencies, and Communicable
Diseases/Environment/Food Poisoning
Which type of skull fracture would place the patient at the highest risk for developing an
intracranial infection?
Basilar skull fracture - ✔✔Basilar skull fractures include the fracture of any of the five bones at
the base of the skull. T hese fractures can cause a laceration of the dura mater, resulting in an
open passage of cerebrospinal fluid, which places the patient at risk for intracranail infections
such as meningitis, encephalitis, and or brain abscess. A linear skull fracture is a nondisplaced
fracture of the cranium and does not increase the risk of intracranial infections. A depressed
skull is a fracture extending below the surface of the skull and lacerating the dura mater, which
may cause intracranial infections; however, the incidence of infection is statistically higher in
basilar skull fractures. Temporal b one fractures increase the risk of epidural hematoma.
,Trauma Nursing Core Course: Provider manual 7th ed. pp. 105-122
Category: Neurological Emergencies/Trauma
A patient is being discharged after being treated for the presence of a cough for 3 months and
increasing shortness of breath with excretion. The patient has been diagnosed with COPD. The
emergency nurse knows that the only proven medical therapy shown to reduce the progression
and mortality of COPD is:
Smoking cessation. - ✔✔Studies have shown that the reduction of risk factors slows the
progression of COPD. Eliminating cigarette smoking is the single most valuable therapy in the
reduction of COPD. Bronchodilators are used to control symptoms but have no effect on airway
iflammation, which is the main cause of worsening disease. Airway inflammation is a
characteristic of COPD. Anti-inflammatory medications may decrease the frequency of
exacerbations but have not been shown to improve lung function or decrease mortality.
Pulmonary rehab can improve a patient's quality of life by increasing exercise tolerance, but it
does not improve lung function.
Category: Respiratory Emergencies/COPD
A male presents to the emergency department with complaints of pain and swelling in his right
groin area. The patient states the pain intensity has increased, and the swelling has become
larger over the past several days. The emergency nurse should anticipate which diagnostic test
to best identify the source of the patient's complaint.
Abdominal ultrasound - ✔✔An abdominal radiograph would be helpful in diagnosing a bowel
obstruction but would not provide enough information to validate a diagnosis of inguinal
hernia. A CT scan of the abdomen would be helpful to identify the source of the patient's
discomfort in the absence of any physical signs. This patient has an obvious bulge in the inguinal
area, so a CT would yield little additional information. An MRI might show the hernia, but the
preferred method to diagnose a hernia is an ultrasound. The patient's symptoms are most likely
,a result of an inguinal hernia. The patient's physical exam usually is diagnostic, but an
ultrasound can be performed to determine if strangulation or an intestinal obstruction is
present.
Category: Gastrointestinal, Genitourinary, Gynecology, and Obstetrical
Emergencies/Gastrointestinal/Hernia
A patient arrives complaining of a sudden onset of chest pain. The patient is anxious and
tachypnic. The initial priority intervention for the emergency nurse to perform for this patient
would be to
administer supplemental oxygen - ✔✔Although an appropriate intervention, it is not a priority.
Ensuring adequate oxygen exchange through administration of supplemental oxygen is the
priority intervention for this patient. An echocardiogram is an ultrasound diagnostic tool to
determine the function and structure of the heart. Although obtaining IV access is an
appropriate intervention, it is not the priority.
Category: Respiratory Emergencies/Pulmonary Embolus
When caring for an elderly patient with dementia, the emergency nurse is aware that a patient
with dementia will directly exhibit which of the following first?
Impaired Communication - ✔✔The dementia patient will first require additional time to
promote communication. Patients with dementia frequently cannot recall their past medical
history, medications, and recent visits to providers. Thus, the medical history may be
incomplete, and this increases the risk for medical error in this population. The fast-paced and
overwhelming ER environment increases confusion and distraction, impairs communication, and
increases the risk of disruptive behaviors. This is the rationale that supports separate, quieter
environments for the geriatric population. In the busy, rapidly changing, noisy atmosphere of
the ED, patients with dementia are easily distracted, and communication becomes difficult.
Category: Neurological Emergencies/Alzheimer's disease/dementia
, A 5-year-old patient presents to a general emergency department. The patient requires a dose
of oral medication for the illness. The nurse understands that this patient is at increased risk for
medications errors because of which of the following?
Weight-based dosing - ✔✔A patient's inability to swallow is of concern, and precautions or a
change in the route of administration should be considered. However, the primary cause for
medication errors in children is the failure to administer medications per weight-based dosing.
For medications to be administered in the appropriate dose, the child's weight must be
obtained and the medication dose properly calculated. Children pose a risk for emergency care
because most emergency departments are built around adult needs. Children are at increased
risk of medication errors because of weight-based dosing, medicine dilution, and the inability to
communicate their needs or responses.
Category: Professional Issues/Patient/Patient Safety
A patient with a 2-year history of uncontrolled hypertension presents to the ED with a
complaint of a severe headache. A computed tomography scan of teh head reveals the presence
of a large subarachnoid hemorrhage. Which of the following is a LATE sign of increased
intracranial pressure?
Bradycardia - ✔✔Apnea, not tachypnea, would be a late sign of increased intracranial
pressure. Late signs of incranial pressure include the presence of Cushing's triad: bradycardia,
widening pulse pressure, and apnea. In addition, late signs of intracranial pressure includes
headaches, nausea/vomiting, changes in mental status, and behavioral change In addition, late
signs of intracranial pressure may also include unresponsiveness, dilated nonreactive pupils, and
posturing.
Category: Neurological Emergencies/Stroke
Rationales
A patient is being discharged following treatment for excessive vomiting and diarrhea from a
possible foodborne illness. You know the patient understands the discharge instructions when
the patient states:
I will drink clear liquids, such as sports drinks, for the next 24 hours. - ✔✔Once vomiting has
been controlled, oral hydration should begin with the use of fluids that contain glucose, sodium,
and potassium, such as sport or electrolyte replacement drinks. Institution of a regular diet
following vomiting and diarrhea may induce the vomiting and diarrhea again. Patients should be
instructed to gradually increase their diet as tolerated. Milk or milk productes are not
recommended following vomiting and diarrhea. Clear liquids are defined as liquids that a
person can see through, such as water, fruit juice without pulp, broth, clear sodas, jell-o, and
popsicles. Milk and orange juice are not defined as clear liquids.
Emergency nursing core curriculum 6th edition pp. 159-186
Category: Environment and Toxicology Emergencies, and Communicable
Diseases/Environment/Food Poisoning
Which type of skull fracture would place the patient at the highest risk for developing an
intracranial infection?
Basilar skull fracture - ✔✔Basilar skull fractures include the fracture of any of the five bones at
the base of the skull. T hese fractures can cause a laceration of the dura mater, resulting in an
open passage of cerebrospinal fluid, which places the patient at risk for intracranail infections
such as meningitis, encephalitis, and or brain abscess. A linear skull fracture is a nondisplaced
fracture of the cranium and does not increase the risk of intracranial infections. A depressed
skull is a fracture extending below the surface of the skull and lacerating the dura mater, which
may cause intracranial infections; however, the incidence of infection is statistically higher in
basilar skull fractures. Temporal b one fractures increase the risk of epidural hematoma.
,Trauma Nursing Core Course: Provider manual 7th ed. pp. 105-122
Category: Neurological Emergencies/Trauma
A patient is being discharged after being treated for the presence of a cough for 3 months and
increasing shortness of breath with excretion. The patient has been diagnosed with COPD. The
emergency nurse knows that the only proven medical therapy shown to reduce the progression
and mortality of COPD is:
Smoking cessation. - ✔✔Studies have shown that the reduction of risk factors slows the
progression of COPD. Eliminating cigarette smoking is the single most valuable therapy in the
reduction of COPD. Bronchodilators are used to control symptoms but have no effect on airway
iflammation, which is the main cause of worsening disease. Airway inflammation is a
characteristic of COPD. Anti-inflammatory medications may decrease the frequency of
exacerbations but have not been shown to improve lung function or decrease mortality.
Pulmonary rehab can improve a patient's quality of life by increasing exercise tolerance, but it
does not improve lung function.
Category: Respiratory Emergencies/COPD
A male presents to the emergency department with complaints of pain and swelling in his right
groin area. The patient states the pain intensity has increased, and the swelling has become
larger over the past several days. The emergency nurse should anticipate which diagnostic test
to best identify the source of the patient's complaint.
Abdominal ultrasound - ✔✔An abdominal radiograph would be helpful in diagnosing a bowel
obstruction but would not provide enough information to validate a diagnosis of inguinal
hernia. A CT scan of the abdomen would be helpful to identify the source of the patient's
discomfort in the absence of any physical signs. This patient has an obvious bulge in the inguinal
area, so a CT would yield little additional information. An MRI might show the hernia, but the
preferred method to diagnose a hernia is an ultrasound. The patient's symptoms are most likely
,a result of an inguinal hernia. The patient's physical exam usually is diagnostic, but an
ultrasound can be performed to determine if strangulation or an intestinal obstruction is
present.
Category: Gastrointestinal, Genitourinary, Gynecology, and Obstetrical
Emergencies/Gastrointestinal/Hernia
A patient arrives complaining of a sudden onset of chest pain. The patient is anxious and
tachypnic. The initial priority intervention for the emergency nurse to perform for this patient
would be to
administer supplemental oxygen - ✔✔Although an appropriate intervention, it is not a priority.
Ensuring adequate oxygen exchange through administration of supplemental oxygen is the
priority intervention for this patient. An echocardiogram is an ultrasound diagnostic tool to
determine the function and structure of the heart. Although obtaining IV access is an
appropriate intervention, it is not the priority.
Category: Respiratory Emergencies/Pulmonary Embolus
When caring for an elderly patient with dementia, the emergency nurse is aware that a patient
with dementia will directly exhibit which of the following first?
Impaired Communication - ✔✔The dementia patient will first require additional time to
promote communication. Patients with dementia frequently cannot recall their past medical
history, medications, and recent visits to providers. Thus, the medical history may be
incomplete, and this increases the risk for medical error in this population. The fast-paced and
overwhelming ER environment increases confusion and distraction, impairs communication, and
increases the risk of disruptive behaviors. This is the rationale that supports separate, quieter
environments for the geriatric population. In the busy, rapidly changing, noisy atmosphere of
the ED, patients with dementia are easily distracted, and communication becomes difficult.
Category: Neurological Emergencies/Alzheimer's disease/dementia
, A 5-year-old patient presents to a general emergency department. The patient requires a dose
of oral medication for the illness. The nurse understands that this patient is at increased risk for
medications errors because of which of the following?
Weight-based dosing - ✔✔A patient's inability to swallow is of concern, and precautions or a
change in the route of administration should be considered. However, the primary cause for
medication errors in children is the failure to administer medications per weight-based dosing.
For medications to be administered in the appropriate dose, the child's weight must be
obtained and the medication dose properly calculated. Children pose a risk for emergency care
because most emergency departments are built around adult needs. Children are at increased
risk of medication errors because of weight-based dosing, medicine dilution, and the inability to
communicate their needs or responses.
Category: Professional Issues/Patient/Patient Safety
A patient with a 2-year history of uncontrolled hypertension presents to the ED with a
complaint of a severe headache. A computed tomography scan of teh head reveals the presence
of a large subarachnoid hemorrhage. Which of the following is a LATE sign of increased
intracranial pressure?
Bradycardia - ✔✔Apnea, not tachypnea, would be a late sign of increased intracranial
pressure. Late signs of incranial pressure include the presence of Cushing's triad: bradycardia,
widening pulse pressure, and apnea. In addition, late signs of intracranial pressure includes
headaches, nausea/vomiting, changes in mental status, and behavioral change In addition, late
signs of intracranial pressure may also include unresponsiveness, dilated nonreactive pupils, and
posturing.
Category: Neurological Emergencies/Stroke
