ENA Emergency Nursing Orientation 3.0 Exam 2023 with complete solutions

Which type of shock causes a temporary loss of motor, sensory, and reflex functions below the level of a lesion? - Answer- Spinal shock According to the rule of nines, burns of the anterior trunk and both anterior arms account for which percentage of body surface area? - Answer- 27 percent Which effect does parasympathetic stimulation have on the heart? A. It increases peripheral vascular resistance. B. It enhances atrioventricular node function. C. It shortens His-Purkinje and ventricular muscle refractoriness. D. It slows sinoatrial node discharge. - Answer- D. Parasympathetic stimulation slows sinoatrial node discharge. Sympathetic stimulation enhances atrioventricular node function, shortens His-Purkinje and ventricular muscle refractoriness, and increases peripheral vascular resistance. Hypertension is a finding in which type of poisoning? A. Opioid B. Antidepressant C. Anticholinergic D. Organophosphate - Answer- C For a patient with chronic immune thrombocytopenia, which intervention is the initial treatment? A. Infuse intravenous immunoglobulin. B. Administer prednisone (Deltasone). C. Prepare the patient for a splenectomy. D. Administer cyclophosphamide (Cytoxan). - Answer- B. Administer prednisone (Deltasone). For which disorder is phenazopyridine (Pyridium) most commonly administered? - Answer- D. Urethritis Rhabdomyolysis is a complication of which type of toxicity? A. Central nervous system stimulant B. Opiate C. Tricyclic antidepressant D. Calcium channel blocker - Answer- A. Central nervous system stimulant Which intervention is used to treat a patient with ventricular fibrillation who has an implantable cardiac defibrillator? - Answer- Apply hands-free adhesive patches in the anterior-posterior position and defibrillate. For which disorder is phenazopyridine (Pyridium) most commonly administered? - Answer- D. Urethritis Which term defines pain caused by the stretching of a hollow organ and is described as cramping or a sensation of gas? - Answer- Visceral pain When a patient is in the compensatory stage of shock, the body preferentially maintains blood flow to which organs? - Answer- heart and brain Which laboratory test result should the nurse expect in a patient with alcoholic ketoacidosis? - Answer- Below normal to slightly elevated serum glucose level Which finding is characteristic of preeclampsia? - Answer- Proteinuria Sciatic nerve damage is associated with dislocation of which joint? A. Patellar B. Knee C. Hip D. Ankle - Answer- C. Hip Which intervention is indicated for a patient with circumferential full-thickness burns of the chest, inadequate chest expansion, and restlessness? - Answer- Escharotomy Calcium channel blockers are indicated to treat which dysrhythmia? A. Atrial fibrillation B. Accelerated junctional tachycardia C. Second-degree atrioventricular block, type II D. Polymorphic ventricular tachycardia - Answer- A. Treatment of atrial fibrillation aims to control the rapid ventricular rate with medications, such as calcium channel blockers or beta-blockers. Calcium channel blockers are not used to treat the other dysrhythmias listed. Accelerated junctional tachycardia is a transient rhythm that only requires treatment of the underlying disorder. Patients with second-degree atrioventricular block, type II, require careful monitoring and may need transcutaneous pacing. Treatment for polymorphic ventricular tachycardia is magnesium sulfate and defibrillation if the patient's condition is unstable. Activated charcoal can absorb which substance? A. Cyanide B. Kerosene C. Lead D. Potassium - Answer- B Which herb can decrease the clotting time? A. Evening primrose B. Cinnamon C. Garlic D. Skull cap - Answer- B. Cinnamon Which medication causes urine retention? - Answer- D. Diphenhydramine (Benadryl) The ingestion of the foxglove plant can cause which finding? A. Hypertension B. Bradycardia C. Agitation D. Lacrimation - Answer- B. Bradycardia Which medication causes urine retention? - Answer- D. Diphenhydramine (Benadryl) For a patient with a gunshot wound, which intervention is appropriate? A. Perform a neurovascular assessment of each limb. B. Estimate the amount of injury based on the wounds appearance. C. Remove projectiles with Kelly clamps and place them in a sterile container. D. Label the entrance and exits wounds. - Answer- A. Perform a neurovascular assessment of each limb. Which disorder is associated with fatty, foul-smelling stool? - Answer- Pancreatitis Emergency needle thoracentesis is a treatment for which type of shock - Answer- obstructive shock In a patient with diabetic ketoacidosis, the nurse should expect to find which effect of ketoacidosis? - Answer- Tachycardia In a pregnant patient, which assessment finding may signal the onset of preeclampsia? - Answer- A systolic blood pressure greater than 140 mm Hg Which dysrhythmia has an irregularly irregular ventricular response - Answer- Atrial fibrillation Which of the following statements regarding autonomic dysreflexia is correct? - Answer- It may occur at any time after spinal shock has subsided. A scald burn is most likely to result from which mechanism? - Answer- Exposure to water at 140°F (60°C) Which intervention is used to treat a patient with ventricular fibrillation who has an implantable cardiac defibrillator? A. Apply hands-free adhesive patches in the anterior-posterior position and defibrillate. B. Wait for the device to fire. C. Apply hands-free adhesive patches in the standard position and cardiovert. D. Apply one hands-free adhesive patch over the device and the other on the opposite side of the sternum and defibrillate. - Answer- A. When a patient with an implantable cardiac defibrillator requires external defibrillation because the implanted device has malfunctioned or failed, ideally place hands-free adhesive patches in the anterior-posterior position. Do not wait for the device to fire because a malfunction has occurred if ventricular fibrillation is present. Cardioversion is not appropriate because no QRS complexes are present for synchronization. Do not place the adhesive patches directly over the implantable cardiac defibrillator. Organophosphate toxicity produces which sign or symptom? A. Constipation B. Salivation C. Mydriasis D. Hot, dry skin - Answer- B A patient with severe neutropenia has a temperature of 100.4°F (38°C). Which intervention is indicated for this patient? A. Obtain blood cultures. B. Maintain respiratory isolation. C. Administer packed red blood cells. D. Administer antibody-purified factor IX. - Answer- A. Obtain blood cultures. The administration of azithromycin (Zithromax) is indicated for which sexually transmitted infection? - Answer- C. Chlamydia infection Which gastric decontamination technique is most effective for treating a patient who has swallowed cocaine-filled balloons? A. Whole bowel irrigation B. Activated charcoal administration C. Gastric lavage D. Syrup of ipecac administration - Answer- A. Whole bowel irrigation Which of the following is the first step performed when removing a helmet from a suspected spinal injured patient? - Answer- Apply in-line stabilization by placing hands on each side of the helmet with fingers on the patient's mandible. The administration of azithromycin (Zithromax) is indicated for which sexually transmitted infection? - Answer- C. Chlamydia infection Which fracture results in multiple splintered bone fragments? A. Depressed fracture B. Impacted fracture C. Compression fracture D. Comminuted fracture - Answer- D. Comminuted fracture Which sign is an indicator of cholecystitis - Answer- Murphy's sign Which disorder is a cause of cardiogenic shock? - Answer- Dysrhythmias A patient with hyperosmolar hyperglycemic state is likely to have which laboratory test result? - Answer- Normal blood pH Which of these is a common cause of postpartum hemorrhage? - Answer- Uterine atony Which medication should be administered during the resuscitation of a patient with ventricular fibrillation? - Answer- Epinephrine (Adrenalin) Which sexually transmitted infection is caused by bacteria and develops as a small bump in the genitals? - Answer- A. Chancroid Which hydrocarbon is least likely to result in aspiration? A. Lighter fluid B. Kerosene C. Gasoline D. Motor oil - Answer- D Which adjunct is most effective in managing adults with sickle cell disease? A. Hydroxyurea (Droxin) B. Heparin C. Prednisone (Deltasone) D. Rho(D) immunoglobulin (RhoGAM) - Answer- A. Hydroxyurea (Droxin) Which sexually transmitted infection is caused by bacteria and develops as a small bump in the genitals? - Answer- A. Chancroid Which finding is a sign of serotonin syndrome? A. Bradycardia B. Diaphoresis C. Hypothermia D. Lethargy - Answer- B. Diaphoresis Which sign or symptom is a characteristic of carbon monoxide poisoning? - Answer- Headache Which receptor is located in the lungs? A. Alpha B. Beta1 C. Beta2 D. Dopaminergic - Answer- C. Beta2 receptors are located in the lungs and peripheral vessels. Alpha receptors exist in vascular smooth muscle. Beta1 receptors are in the myocardium. Dopaminergic receptors are found in renal, mesenteric, cerebral, and coronary arteries. A fracture of which bone does not always require anatomic alignment for healing? A. Wrist B. Hip C. Elbow D. Clavicle - Answer- D. Clavicle Which organ is responsible for absorbing nutrients and other products of digestion - Answer- Small intestine In a pediatric patient, which finding is an early sign of shock? - Answer- Delayed capillary refill Which finding is most closely associated with syndrome of inappropriate antidiuretic hormone? - Answer- Seizures Your patient with preeclampsia is receiving magnesium sulfate while waiting to be transferred out of the emergency department. While the patient is in your care, you should monitor her closely for which finding? - Answer- Absence of deep tendon reflexes Which disorder is likely to produce a delta wave on the cardiac monitor? - Answer- Wolff-Parkinson-White syndrome Which of the following is the first step performed when initiating spinal protection? - Answer- Leader is positioned at the head of the patient with hands on each side of the patient's head. Which dysrhythmia has premature P waves with a different configuration than other P waves in the cardiac cycle? A. Atrial flutter B. Premature atrial complex C. First-degree atrioventricular block D. Second-degree atrioventricular block, type II - Answer- B. Premature atrial complexes are ectopic beats that are initiated by an irritable atrial focus. P waves are present, but because the ectopic focus originates the impulse outside the sinoatrial node, the premature P waves have a different configuration. Atrial flutter causes no P waves, but it causes flutter waves in a sawtoothed pattern. First-degree atrioventricular block has a P wave for every QRS complex, but the PR interval is consistently prolonged. Second-degree atrioventricular block, type II, has one or more P waves for every QRS complex. In first-degree atrioventricular block and second-degree atrioventricular block, type II, the P wave configuration is consistent from P wave to P wave Nutmeg toxicity is likely to cause which finding? A. Hallucinations B. Salivation C. Rhabdomyolysis D. Seizures - Answer- A In a patient with immune thrombocytopenic purpura, which finding should you expect? A. Tachypnea B. Severe pain C. Petechiae D. Narrowing pulse pressure - Answer- C. Petechiae Which is the main electrolyte disturbance in rhabdomyolysis? - Answer- C. Hyperkalemia Which drug can cause a sense of omnipotence, excitement, hyperalertness, hyperactivity, or hypersexuality? A. Clonidine (Catapres) B. Methaqualone (Quaalude) C. Amphetamine (Adderall) D. Amitriptyline (Elavil) - Answer- C. Amphetamine (Adderall) Among patients with contact burns, which body region is the most common injury site? - Answer- Palm of the hand Volkmann's contracture may be a complication of which fracture? A. Shoulder fracture B. Elbow fracture C. Scapular fracture D. Clavicular fracture - Answer- B. Elbow fracture Which is the main electrolyte disturbance in rhabdomyolysis? - Answer- C. Hyperkalemia What is the cardinal sign of lower gastrointestinal bleeding? - Answer- hematochezia Which type of shock is typically associated with acute spinal cord disruption from trauma or spinal anesthesia? - Answer- Neurogenic shock Which medications can precipitate a hyperosmolar hyperglycemic state? - Answer- Diuretics For a patient with an obstetric emergency, what are the priorities during the initial assessment? - Answer- Airway, breathing, and circulation A preexcitation syndrome, such as Wolff-Parkinson-White syndrome, results from which conduction pattern? - Answer- Atrial impulses bypass the typical electrical pathway and activate the ventricular myocardium directly. For a patient with partial airway obstruction who cannot tolerate the supine position for spinal stabilization, which intervention is appropriate? - Answer- Protect the cervical spine in the position the patient uses to protect the airway. Which method delivers nonsynchronous energy to the myocardium? A. Transcutaneous pacing B. Cardioversion C. Defibrillation D. Transvenous pacing - Answer- C. Defibrillation is the nonsynchronous delivery of energy to the heart during any phase of the cardiac cycle. The intent of this energy delivery is to simultaneously depolarize all of the heart cells, interrupting the abnormal electrical rhythm and allowing the sinoatrial node to resume its normal pacemaker activity. In synchronized cardioversion, energy delivery is timed to correspond with the QRS complex to avoid shock delivery during the relative refractory period, which can induce ventricular fibrillation. Transcutaneous and transvenous pacemakers electrically stimulate a heartbeat when the heart's intrinsic electrical system cannot generate a rate that is adequate to support cardiac output. Which type of toxicity causes hyperglycemia? A. Methanol B. Ethanol C. Isopropanol D. Ethylene glycol - Answer- C Which disorder is an inherited disease? A. Syndrome of inappropriate antidiuretic hormone B. Acute idiopathic thrombocytopenic purpura C. Acute leukemia D. Sickle cell disease - Answer- D. Sickle cell disease Which disorder causes unbearable pain due to increased pressure and dilation of the kidney? - Answer- B. Prostatitis For which drugs can you obtain blood levels to determine toxicity? A. Morphine and hydrocodone (Vicodin) B. Marijuana and cocaine C. Acetaminophen (Tylenol) and digoxin (Lanoxin) D. Diazepam (Valium) and midazolam (Versed) - Answer- C. Acetaminophen (Tylenol) and digoxin (Lanoxin) Which hourly amount of intravenous fluid should the nurse administer to a 75-kg patient with a significant electrical burn? - Answer- 1,500 mL/hour Which intervention is indicated for a patient with an amputation? A. Maintain the limb in the correct anatomic position. B. Clean the amputated part with povidone-iodine (Betadine) solution. C. Soak the stump in distilled water. D. Place the amputated part directly in ice. - Answer- A. Maintain the limb in the correct anatomic position. Which disorder causes unbearable pain due to increased pressure and dilation of the kidney? - Answer- B. Prostatitis A woman, age 27, presents to your emergency department with chills, fever, abdominal pain, nausea, vomiting, and tachycardia. The abdominal pain becomes localized in her right lower quadrant. What is your priority intervention? - Answer- Initiate intravenous access. Which statement accurately characterizes shock in a pregnant patient? - Answer- The risk of fetal distress exists despite maternal stability. The inadequate or impaired secretion of antidiuretic hormone (ADH [vasopressin]) causes which endocrine emergency? - Answer- Diabetes insipidus A patient reports that she had a positive pregnancy test 1 week ago and now has left lower quadrant pain, which was severe and then seemed to get better. On assessment, you note that she has a weak radial pulse, tachycardia, and pallor. Which intervention should you anticipate as the priority? - Answer- Establish vascular access. A patient has stable, monomorphic ventricular tachycardia. To perform synchronized cardioversion with a biphasic defibrillator and convert this dysrhythmia, which energy setting should be used first? - Answer- 100 joules A paraplegic patient comes to the ED with a severe headache and blurred vision. Findings include a flushed face, severe hypertension, and bradycardia. What is the most likely cause of these signs and symptoms? - Answer- Constipation Which medication should be administered during the resuscitation of a patient with ventricular fibrillation? A. Ibutilide (Corvert) B. Procainamide (Pronestyl) C. Epinephrine (Adrenalin) D. Sotalol (Betapace) - Answer- C. During the resuscitation of a patient with ventricular fibrillation, administer intravenous epinephrine (Adrenalin) or vasopressin (Pitressin) to enhance the effectiveness of the cardiopulmonary resuscitation. Procainamide (Pronestyl) or sotalol (Betapace) may be prescribed for a patient with stable ventricular tachycardia. Ibutilide is used to convert new-onset atrial fibrillation. A man, age 75, presents with blurred vision, flushing, fever, tachycardia, and urine retention. These manifestations suggest which toxidrome? A. Anticholinergic B. Opioid C. Sympathomimetic D. Cholinergic - Answer- A Which statement accurately characterizes immune thrombocytopenic purpura? A. It is caused by immune autoreactive antibodies. B. It occurs primarily in adolescents. C. It is more common in women. D. It follows a bacterial infection. - Answer- A. It is caused by immune autoreactive antibodies.