CEN Exam with Complete Rationale

A cancer patient is seen in the emergency department with high fevers and malaise for 2 days. She received chemotherapy about 10 days ago. Her physical exam is not revealing but her temperature is 103°F. A CBC shows a hemoglobin of 10 g/dL, WBC 4000 with 10% polys, 5% bands, 70% lymphs, 10% monos, and 5% other white or unidentified cells. Platelets are 60,000/mm3. Which of the following is NOT immediately appropriate? cultures from different sites rolytes, liver and renal function tests if she has been receiving granulocyte colony-stimulating factor (G-CSF) blood cell transfusion ️️ Answer: D This patient has fever and neutropenia after chemotherapy. Neutropenia is defined as an absolute neutrophil count (ANC) under 1000/mm3, and a severe neutropenia less than 500/mm3 is particularly dangerous. These patients must be worked up quickly and antibiotic and possibly additional therapy started as soon as possible since the situation may be life-threatening. While myelosuppressive drugs differ in the length of time between administration and the nadir of the ANC, 10 to 14 days is typical. Multiple cultures from different possible sites of origin for sepsis must be done along with chest x-ray and other imaging as indicated by examination. Broad-spectrum antibiotics, such as ceftazidime or imipenem/cilastatin, should be started after cultures are obtained. She should be asked if she has been receiving G-CSF (Neupogen, Neulasta). WBC transfusions are rarely used today since they have a very short shelf life, do not last long in the circulation, and may cause allergic reactions. Which statement best describes acute respiratory distress syndrome (ARDS)? a.ARDS is caused by trauma only. b.ARDS is sudden, progressive, and severe. c.ARDS is caused by an illness only. d.ARDS never results in lung scarring. ️️ Answer: B ARDS is sudden, progressive, and severe, and can even lead to death. A forty-year-old female presents to the emergency department (ED) complaining of chest pain. After triaging the client, obtaining vital signs including a blood pressure of 90/46, and establishing an adequate airway, what is the next most important intervention for this client? a. registering the patient into the system b. ordering serum blood laboratory tests c. placing the client on a cardiac monitor, administering oxygen, and obtaining an electrocardiogram (EKG) d. giving a sublingual nitroglycerin tablet for the immediate relief of pain ️️ C: A family member can register the patient into the system, blood tests must be done but can be done after the EKG, and, although nitroglycerin is an appropriate intervention for pain, the low blood pressure may need evaluation before choosing to give nitroglycerin. The appropriate intervention is to place the client on a cardiac monitor, give oxygen to decrease cardiac workload, and obtain an EKG to immediately evaluate the heart. The ED is a controlled setting where a physician should be readily available to look at the client, evaluate the cardiac monitor, and interpret the EKG to determine further interventions. The purpose of the primary assessment in any emergency is to a. perform a quick look-see to determine the illness or injury b. assess for life-threatening problems that require an immediate intervention c. make the client comfortable and remove wet clothing for the assessment d. gain a medical and surgical history, including allergies and medication ️️ B: The primary assessment is done in a systematic way. Identifying a need and performing an intervention are essential before going on to the next step. Assess the airway and then intervene, assess the breathing and then intervene, and so on until you have performed a complete head-to-toe assessment to identify the immediate illness or injury and provided an immediate emergency intervention. Answer a is incorrect because it neglects the intervention aspect of the assessment. Answers c and d are incorrect because they are not aspects of the primary assessment.