CEN online exams With Correct Answers 2024

CEN online exams With Correct Answers 2024 Blunt chest trauma Correct Answer: Rib fx most common Eptifibatide (Integrilin) Correct Answer: glycoprotein IIbIIIa inhibitor used to inhibit platelet aggregation; for a non stemi Infant sized paddles used for infants Correct Answer: Less than 10 kg Pain control in tx cholecystitis Correct Answer: Narcotic analgesics Ecchymosis around umbilicus (positive Cullen's sign) Correct Answer: Retroperitoneal bleeding Hollow organ most susceptible to blunt trauma Correct Answer: Small bowel Diverticulitis tx Correct Answer: Give antibiotics IBS tx Correct Answer: Anticholinergics Renal failure electrolyte abnormality that can be lethal Correct Answer: Hyperkalemia (cardiac arrest from kidney unable to excrete potassium) Hyphema drug tx Correct Answer: Beta blockers and antifibrinolytic agents (dec rate of rebleed) Ludwig angina one sign Correct Answer: Tongue elevation and protrusion toward palate, swelling and cellulitis EOM movement abnormality consistent with orbital fx Correct Answer: Inability to look downward Most pain and sensitivity to exposure to heat and cold with tooth fx Correct Answer: Ellis II- involves enamel and dentin layers Removal of impacted cerumen Correct Answer: 1:1 of hydrogen peroxide and warm water (alcohol and warm water is used to remove organic materials like vegetables) Solu-cortef for adrenal crisis; monitor pts for Correct Answer: dysrhythmias (incl. hyperkalemia) Sickle cell crisis child Correct Answer: First given supplemental O2 PPD results Correct Answer: >=10 mm induration; redness is not a factor. >= 5 positive for HIV pt for person in close contact with a newly diagnosed TB Normal ICP Correct Answer: 1-15 Atlanto-occipital dislocations Correct Answer: Skeletal traction is contraindicated Area of orientation most likely lost first Correct Answer: Situation Clenched fist injuries most at risk for Correct Answer: Joint infection (bc of joint penetration) Waddell's triad Correct Answer: Injuries to head, chest/abd, lower extremities Pts who have experienced a high pressure injection injury Correct Answer: Require general anesthesia for management (for debridement and extensive irrigation) Normal serum osmolality Correct Answer: 285-295 mOsm/kg Normal anion gap range Correct Answer: 12+ or -4 Normal mag levels Correct Answer: 1.5-2.5 Normal phosphorus level Correct Answer: 2.5-4.5 Most common complication thoracentesis Correct Answer: Reexpanding pulmonary edema (reduce this if remove no more than ml at one time) Emergency resuscitative thoracotomy not beneficial for Correct Answer: Pts with no documented VS or signs of life (best results from pts with single penetrating injury or witnessed cardiac arrest) Numbness and tingling of hand post puncture of radial artery for arterial BG sample Correct Answer: Due to nerve damage or hematoma formation causing compression neuropathy Nurse would suspect cyanide inhalation poisoning following smoke inhalation if Correct Answer: PaO2 is normal Cyanide fatal levels Correct Answer: 2-3 Angioedema med side effect Correct Answer: ACE inhibitor (lip, larynx and tongue swelling) Albuterol can cause Correct Answer: HYPOkalemia Hemorrhagic hypovolemia preferred therapy Correct Answer: Transfusion of PRBCs Most effective to prevent rabies after a bite from rabid animal Correct Answer: Cleanse wound with betadine solution (virucidal agent). Infiltrate Rabies IG into wound proximal to bite to counteract virus traveling to CNS. Administer rabies vaccine, human diploid cell vaccine (HDVC) on days 0, 3, 7, 14, 28 S/s assoc with arterial gas embolism Correct Answer: Focal or general seizure (bubbles from barotrauma of ascent, s/s occur immediately, unconsciousness, altered LOC, diverse neuro s/s) Vision loss assoc with Correct Answer: Decompression sickness secondary to nitrogen bubbles; can occur over min or up to 12 hrs; when ascent is too rapid Extremity heaviness or weakness and severe joint pain Correct Answer: Assoc with decompression sickness secondary to nitrogen bubbles when ascent is too rapid Toxic pts with high salicylate levels Correct Answer: Hemodialysis preferred tx; activated charcoal not as helpful in later stages bc drug has already been absorbed Serum sickness from bee stings can occur Correct Answer: As late as 2 weeks after Med that can precipitate heat stroke Correct Answer: Propanolol (inderal), meds that limit diaphoresis, anticholinergics, antihistamines, phenothiazines and cause heat production (sympathomimetics, thyroid meds) or dec thirst (haloperidol) 15-18 lead ECG needed for pt with inferior wall MI to R/O Correct Answer: R ventricular infarction (bc of occlusion of the R coronary artery) Mechanism of action of adenosine Correct Answer: Interrupts re-entry pathway through AV node Lab finding assoc with pancreatitis Correct Answer: HYPERglycemia and HYPOcalcemia (bc FFA formed by lipase release into soft tissue spaces bind Ca and cause dec) Primary complication with mechanical bowel obstructions Correct Answer: Intestinal infarction Primary complication with diverticulitis Correct Answer: Bowel perforation (when weakened area ruptures) Normal FHRs throughout pregnancy are Correct Answer: 120-160 bpm Calcium acetate (PhosLo) purpose Correct Answer: to lower phosphorus level Clonidine (catapres) purpose Correct Answer: anti-hypertensive med Buetanide (bumex) purpose Correct Answer: loop diuretic (can cause hypotension) Major adverse effect of Epoetin (Epogen) Correct Answer: Hypertension Potential signs of DIC Correct Answer: Bleeding, lightheaded, RASH>>>>need to check coag factors (PT and PTT FIRST before type and screen) Increased risk for preterm labor Correct Answer: Younger mothers, infections of uterus, cervix or urinary tract Abruptio placenta findings Correct Answer: Abdomen tender with uterine RIGIDITY felt on palpation Biggest complication of hyphema Correct Answer: Secondary bleeding (3-5 days post injury), occurs in 30% cases. Need bed rest, limited activity, HOB elevated 30 deg, eye shield, avoid aspirin and NSAIDs Maxillary fx s/s Correct Answer: Malocclusion and paresthesia/anesthesia of upper lid Zygomatic fx s/s Correct Answer: Flattening of cheek on affected side, subq emphysema of face (bc bone extends into paranasal sinus) Mandibular fx s/s Correct Answer: Lower lip paresthesia/anesthesia bc of injury to inferior alveolar nerve. Patients with thyroid storm need to be monitored closely for Correct Answer: CHF (can occur in extreme instances with high HR) HHNC Correct Answer: Serum osmolarity > 350 bc of dehydration Glucose > 800 Sodium can vary INC BUN levels (higher than DKA) Normal pH DKA Correct Answer: Serum osmolarity < 350 Glucose usu < 800 Sodium usu low BUN not as high pH < 7.35 Kussmaul, fruity odor Thyroid storm s/s Correct Answer: INC glucose, liver enzymes, WBC, T4 Inc temp, AMS, tachycardia, HF, D/N/V, abd pain, jaundice DKA most often results from Correct Answer: Infection and stress (low pH, lack of insulin causes dec cell glucose uptake and release of FFA> converted to ketone which release H ions, inc creatinine and BUN too) LP in anticoagulated pt Correct Answer: May result in spinal epidural hematoma LP positioning can result in Correct Answer: Airway occlusion (excess neck flexion) To reverse warfarin (coumadin) toxicity Correct Answer: FFP (plasma, clotting factors, fibrinogen) give Vitamin K (aquamephyton) too before blood products Lumbar puncture opening pressure in bacterial meningitis (vs viral) Correct Answer: Higher Bacterial CSF appearance Correct Answer: Cloudy bc WBC usu greater than 1000 Symptoms observed most commonly in early stages of myasthenia gravis Correct Answer: Ptosis with difficulty keeping affected eye closed Most common cause of AMS in pt with VP shunt is Correct Answer: Inc intracranial pressure Layer of skin that provides insulation against heat loss Correct Answer: Subcutaneous layer (below dermis, stores fat) Lab studies for pt c/o inflamed great toe Correct Answer: Sedimentation rate (ESR) and uric acid Duration time of bupivacaine (Marcaine) for suturing Correct Answer: 8-16 hrs Duration time xylocaine (lidocaine) Correct Answer: 30-60 min Splints used for midshaft femur fractures Correct Answer: Hare traction, thomas ring, sager traction Ephedra aka Ma Huang Correct Answer: Banned drug; illegal and dangerous in many states (s/e: HTN, tachycardia, dangerous dysrhythmias). Used in the past for resp disorders Dong quai Correct Answer: Used by herbalists to tx gyno disorders; has few s/e but should not be used in pregnant pts Valerian Correct Answer: Used for anxiety and promotion of sleep Higher priority in elderly: SOB or altered LOC Correct Answer: SOB (typical for MI in elderly) 5 rights with delegating Correct Answer: Task, person, direction/communication, supervision/evaluation and circumstance Most important component in pediatric sexual abuse eval Correct Answer: Obtaining pt history (everything else supports history) Breaching pt confidentiality may be necessary if Correct Answer: The benefits outweigh the risks An appropriate medical screening exam according to the EMTALA Correct Answer: Statute does not clearly define what constitutes a medical screening exam (instead based on application of the same screening procedures to paying and indigent pts rather than adequacy of exam itself) Understanding of ethical principles exhibited by nurse who Correct Answer: Withdraws IV fluid administration in hospice pt Burn patterns on infant that suggest possible maltreatment Correct Answer: Small circular burns of uniform depth on buttocks and back (cigarette burns), burns to both feet Asthma exacerbation findings that are concerning Correct Answer: PaCO2 48 mmHg (inc and shows severe airflow obstruction and heightened resp failure risk) Peak flow reading for discharge with asthma pt Correct Answer: equal to or greater than 70% of personal best Quality indicators for pneumonia tx Correct Answer: AB admin within 4 hrs of arrival Best way to evaluate tidal volume with bag mask Correct Answer: Symmetrical chest rise and fall Respiratory rates and aging Correct Answer: Do not change as person ages (pt may have dec protective mechanisms for e.g. cough and dec resting oxygen tension) Percussion of asthmatic or COPD chest Correct Answer: Hyperresonance (hyperinflation) Simple pneumothorax Correct Answer: Accumulation of air in lung pleural space with loss of NEGATIVE intrapleural pressure What should O2 be maintained at for COPD pt Correct Answer: between 90-92% Peak flow in peds in Correct Answer: 300-400s Peak flow in adults Correct Answer: 350-600 Most definitive method of assuring that ET tube is in correct place Correct Answer: Visualizing it passing through the cords Adult respiratory distress syndrome (RDS) typical outcome Correct Answer: Lungs will always be damaged (from inflammatory process characterized by diffuse alveolar damage as primary insult to lungs or from secondary systemic illness). Have chronic phase with inflammation and lung scarring. Roller coaster ride with good and bad days. Recovery can take 6-12 months Geriatric trauma pt with rib fx Correct Answer: 2 or more rib fx bc of reduced ability to handle pulmonary secretions and loss of pulmonary reserve How to tell if septic shock pt is HYPOperfused? Correct Answer: Lactate level (greatest indicator than even ABGs). Indicative of end organ function too Uncompensated progressive shock Correct Answer: Hypotension, tachycardia, lack of peripheral pulses Irreversible shock Correct Answer: If pt has enough brain perfusion to respond to pain (higher GCS) Neurogenic shock tx Correct Answer: Give fluid boluses then vasopressors (as it can result from SNS disruption and loss of vasomotor tone) Adult pedestrian struck by car injuries Correct Answer: Lower extremity injuries most likely Black widow spider bite Correct Answer: Tachycardia, HTN, acute abdomen signs (N/V, body aches). 2 puncture wounds. Usually bites once Scorpion bite Correct Answer: One stinger on tail, anaphylaxis, numbness, paresthesias, agitation, tachycardia, edema, site discoloration Rattlesnack bite Correct Answer: 1-2 puncture wounds, site quickly becomes edematous and ecchymotic with bullae formation and bleeding Brown recluse bite Correct Answer: Vesicles and bullae present shortly after painless bite; inc tissue necrosis, eschar formation over days Third degree (deep) frostbite Correct Answer: Non pliable waxy skin with edema and deep purple blisters Fourth degree (complete) frostbite Correct Answer: Skin necrosis, minimal edema in frostbitten area and surrounding tissue edematous Organophosphates odor on breath Correct Answer: Garlic Carbon monoxide exposure odor on breath Correct Answer: Coal gas Cyanide exposure breath odor Correct Answer: Bitter almonds Methyl salicylates breath odor Correct Answer: oil of Wintergreen Acute salicylate poisoning; contraindicated procedure Correct Answer: Intubation for sustained hyperventilation (can cause dec in CO2 and lead to worsening alkalemia) Possible cocaine use, pt presents with MI symptoms Correct Answer: do NOT use Beta blockers (bc of unopposed alpha adrenergic effect). Can use morphine still Brevibloc use (esmolol) Correct Answer: For control of afib or flutter or sinus tach; short term use