CEN Exam 5
1. A pt presents to the ED experiencing an anterior ST segment elevation MI. The pts vital signs
are normal. The hospital is not equipped with a cardaic catheterization lab. The pt can be
transferred to a cardaic catheterization lab within 60 mins. Which of the following would you
anticipate for this pt?:
A. A bolus of tissue plasminogen activator, followed by an infusion for fibrinolytic therapy
B. Immediate transfer to the hospital with a cardiac catheterization lab for percutaneous
coronary intervention
C. A single bolus of tenecteplase (Tnkase) for fibrinolytic therapy
D. A bolus of reteplase (Retavase), followed by a second bolus of reteplase 30 mins later for
fibrinolytic therapy - ANS-B. Immediate transfer to the hospital with a cardiac catheterization lab
for percutaneous coronary intervention
In adult pts presenting with a STEMI of a hospital that does not have PCI capability, it is
recommended that the pt be transferred immediately without fibrinolytics to a PCI center,
instead of immediate fibrinolysis at the intial hospital with transfer onlu for ischemia driven PCI
10. In preparing to discharge a pt who has been given a prescription for nitroglycerin tablets
0.4mg SL PRN, the ED nurse acknowledges that the pt teaching has been effective when the pt
states:
A. " I am to take the tablets at least every 2-3 mins when I experience chest pain"
B. " I will call my doctor every time I need to take a tablet for my chest pain"
C. " I should keep the tablets on my window sill in the kitchen so I can find them easily"
D. " If my chest pain has not gone away after I have taken 2 tablets, I will come to the hospital" -
ANS-D. " If my chest pain has not gone away after I have taken 2 tablets, I will come to the
hospital"
Nitro should result in vasodilation of the coronary arteries, leading to improved blood flow and a
decrease in the pts chest discomfort. Pts are instructed to seek medical care if their chest pain
has not subsided after taking 2-3 NTG 5 mins apart
100. When caring for a variety of pts, the ED nurse is knowledgeable that the pt with the least
risk for developing compartment syndrome would be a pt with which of the following injuries?:
A. A pt with a venomous snake bite to the forearm
B. A crush injury to the shaft of the femur
C. A pt with circumferential full thickness burn to the calf
D. A nondisplaced fracture to the medial malleolus - ANS-D. A nondisplaced fracture to the
medial malleolus
Most malleolus fractures are associated with inversion or eversion injuries related to ankle
sprains. This fracture is nondisplaced and the pt most likely will only need a splint/cast applied
,101. The ED nurse is discharging a pt who developed back pain 1 week ago after bending over
pick up a young child. The ED nurse determines that the pt teaching has been effective when
the pt states which of the following?:
A. " Nonsteroidal anti-inflammatory drugs and acetaminophen are not effective in relieving my
back pain"
B. " I need to limit my activity and rest as much as possible"
C. " It is important that I stop smoking so that I will heal faster"
D. " I should only use ice and heat during the first 24 hours of my back pain" - ANS-C. " It is
important that I stop smoking so that I will heal faster"
Smoking is associated with delayed healing for low back pain. Encouraging smoking cessation
is very important for most health conditions and can assist with healing for low back pain
102. A pt presents to the ED by EMS in complete cervical spine immobilization. The pt is
intoxicated, and EMS reports the pt had been drinking and jumped off the second floor of a
parking garage and landed on their heels. The pt is found to have bilateral calcaneal fractures.
The ED nurse anticipates the pt may have experienced which of the following injuries?:
A. Spinous process fracture of the thoracic vertebrae 6 (T6)
B. Spiral fracture of the femur
C. Bilateral bipartite patella
D. Burst fracture of lumbar vertebrae 1 (L1) - ANS-D. Burst fracture of lumbar vertebrae 1 (L1)
Calcaneal fractures, especially in injuries that involve the pt landing on their feet, is a type of
axial loading injury where other injuries may be considered. Injuries associated with calcaneal
fractures include burst fractures, tibeal plateau fractures and internal organ injuries
103. A pt is being discharged from the ED with a lower leg cast. The pt is concerned about how
they will be able to walk up and down the steps with crutches at home. The ED nurse will
instruct the pt that the proper technique to go up and down the stairs is:
A. up with the "bad" leg and down with the "good" leg
B. Up with the "bad" leg and down with the "bad" leg
C. Up with the "good" leg and down with the "bad" leg
D. Up with the "good" leg and down with the " good" leg - ANS-C. Up with the "good" leg and
down with the "bad" leg
104.The ED nurse is caring for a pt with a pelvic fracture. At the beginning of the assessment,
the nurse notes the presence of distal pulses with good motor and sensory function of the lower
extremities. However, during ongoing assessments, the nurse is no longer able to palpate distal
pulses, and the pt has an altered mental status. Which of the following could be responsible for
this change in the pt status?:
A. Fat emboli
B. Hemorrhage
C. Compartment syndrome
D. Neurogenic shock - ANS-B. Hemorrhage
S/S of progressive or decompensated shock include an altered level of consciousness, the
presence of weak or thready pulse and cool, clammy skin as the blood shunts to vital organs
,105. The ED nurse is aware that the pts with gout will experience periodic exacerbation of
painful joint inflammation, resulting in acute painful episodes to be treated with the following
medications:
A. Allopurinol
B. Antibiotics
C. NSAIDS
D. Biphosphonates - ANS-C. NSAIDS
Although indomethacin (indocin) is often preferred, almost any NSAID is effective in treating
acute gout. Colchicine can be dramatically effective if initiated shortly after the onset of acute
symptoms
106. A pt arrives by EMS to the ED. EMS reports that the pt jumped from a third story balcony
when the support structure gave way. The pt landed on both feet and has been found to have a
compression fracture of the lumbar spine with significant pain. GCS scale is 15, with no reported
loss of consciousness. In addition to the compression fracture of the lumbar spine, this pt should
also be evaluated for the presence of a:
A. Hidden foreign body impalement
B. Femur fracture
C. Subdural hematoma
D. Calcaneus fracture - ANS-D. Calcaneus fracture
these fractures can occur in jumps or falls when the pt jumps directly onto their feet
107. A young pt presents to triage with complaints of left ankle pain. The pt reports that while
playing basketball, they lost their balance and landed hard on their left foot; a "popping" sound
in the ankle followed. The ankle is swollen and painful, and the pt is unable to bear weight on
the left foot. The pt is exhibiting signs and symptoms of what type of ankle injury?:
A. Avulsion fracture
B. Sprain
C. Dislocation
D. Strain - ANS-B. Sprain
Sprain is the result of injury to the ankle ligaments that have been stretched or torn by excessive
force
108. A pt with a laceration to the middle phalanx of the palmar side of the index finger from a
kitchen knife presents to triage. Bleeding has been controlled. After examining the pt for
possible tendon injury, the ED nurse anticipates preparing the pt for wound closure by first:
A. Cleansing the wound
B. Administering antibiotics
C. Providing anesthesia with lidocaine and epinephrine into the affected finger
D. Administering an opioid analgesia - ANS-A. Cleansing the wound
Remove visable contamination and dried blood
109. A Pt presents to the ED with a shortened, deformed and outwardly rotated right leg. The pt
requires application of a traction splint. The splint has been appropriately applied when:
, A. The affected limb begins to swell
B. The pt reports an increase in pain
C. The dorsalis pedis pulse is faint
D. The pt reports a decrease in pain - ANS-D. The pt reports a decrease in pain
Stabilization of the limb will decrease pain
11. Which of the following findings would the ED nurse to anticipate in a pt experiencing signs
and symptoms of cardiac tamponade following successful aspiration of fluid from the pericardial
sac?:
A. Presence of electrical alternans
B. Increase in the pts heart rate
C. Decrease in the pts BP
D. Increase in the pts BP - ANS-D. Increase in the pts BP
Following removal of fluid from the pericardial sac, the pts central venous pressure should
decrease, allowing for increased preload and an increase in the pts blood pressure
110. A college student presents to triage complaining of a constant buzzing sound in their ear.
On examination, an insect is seen in the ear canal. The physician has instilled viscous lidocaine
in the ear of the pt. The ED nurse identifies that the treatment has been effective when the pt
states which of the following?:
A. " My ear feels numb"
B. " I no longer hear the buzzing sound in my ear, I dont think the insect is moving"
C. " My ear no longer hurts"
D. " My hearing has improved in that ear now" - ANS-B. " I no longer hear the buzzing sound in
my ear, I dont think the insect is moving"
Live insects in the ear canal should be immobilized before removal is attempted. The
administration of lidocaine will imobillize the insect and stop the buzzing sound
111. A pt presents to the ED complaining of decreased vision, an intense headache, and the
appearance of halos around lights with photophobia. The ED nurse identifies these symptoms
as being consistent with the development of which of the following?:
A. Central retinal artery occlusion
B. Glaucoma
C. Corneal abrasion
D. Iritis - ANS-B. Glaucoma
112. The ED nurse is preparing to dress a stage 2 pressure injury on the shoulder of a pt. Which
solution would be most appropriate to cleanse the wound bed with?:
A. Lactated ringers solution
B. Povidone iodine (Betadine)
C. Hydrogen peroxide
D. Tap water - ANS-D. Tap water
Potable water or normal saline is appropriate for cleansing a wound
113. Which pt would be least likely to require a tetanus booster shot?:
1. A pt presents to the ED experiencing an anterior ST segment elevation MI. The pts vital signs
are normal. The hospital is not equipped with a cardaic catheterization lab. The pt can be
transferred to a cardaic catheterization lab within 60 mins. Which of the following would you
anticipate for this pt?:
A. A bolus of tissue plasminogen activator, followed by an infusion for fibrinolytic therapy
B. Immediate transfer to the hospital with a cardiac catheterization lab for percutaneous
coronary intervention
C. A single bolus of tenecteplase (Tnkase) for fibrinolytic therapy
D. A bolus of reteplase (Retavase), followed by a second bolus of reteplase 30 mins later for
fibrinolytic therapy - ANS-B. Immediate transfer to the hospital with a cardiac catheterization lab
for percutaneous coronary intervention
In adult pts presenting with a STEMI of a hospital that does not have PCI capability, it is
recommended that the pt be transferred immediately without fibrinolytics to a PCI center,
instead of immediate fibrinolysis at the intial hospital with transfer onlu for ischemia driven PCI
10. In preparing to discharge a pt who has been given a prescription for nitroglycerin tablets
0.4mg SL PRN, the ED nurse acknowledges that the pt teaching has been effective when the pt
states:
A. " I am to take the tablets at least every 2-3 mins when I experience chest pain"
B. " I will call my doctor every time I need to take a tablet for my chest pain"
C. " I should keep the tablets on my window sill in the kitchen so I can find them easily"
D. " If my chest pain has not gone away after I have taken 2 tablets, I will come to the hospital" -
ANS-D. " If my chest pain has not gone away after I have taken 2 tablets, I will come to the
hospital"
Nitro should result in vasodilation of the coronary arteries, leading to improved blood flow and a
decrease in the pts chest discomfort. Pts are instructed to seek medical care if their chest pain
has not subsided after taking 2-3 NTG 5 mins apart
100. When caring for a variety of pts, the ED nurse is knowledgeable that the pt with the least
risk for developing compartment syndrome would be a pt with which of the following injuries?:
A. A pt with a venomous snake bite to the forearm
B. A crush injury to the shaft of the femur
C. A pt with circumferential full thickness burn to the calf
D. A nondisplaced fracture to the medial malleolus - ANS-D. A nondisplaced fracture to the
medial malleolus
Most malleolus fractures are associated with inversion or eversion injuries related to ankle
sprains. This fracture is nondisplaced and the pt most likely will only need a splint/cast applied
,101. The ED nurse is discharging a pt who developed back pain 1 week ago after bending over
pick up a young child. The ED nurse determines that the pt teaching has been effective when
the pt states which of the following?:
A. " Nonsteroidal anti-inflammatory drugs and acetaminophen are not effective in relieving my
back pain"
B. " I need to limit my activity and rest as much as possible"
C. " It is important that I stop smoking so that I will heal faster"
D. " I should only use ice and heat during the first 24 hours of my back pain" - ANS-C. " It is
important that I stop smoking so that I will heal faster"
Smoking is associated with delayed healing for low back pain. Encouraging smoking cessation
is very important for most health conditions and can assist with healing for low back pain
102. A pt presents to the ED by EMS in complete cervical spine immobilization. The pt is
intoxicated, and EMS reports the pt had been drinking and jumped off the second floor of a
parking garage and landed on their heels. The pt is found to have bilateral calcaneal fractures.
The ED nurse anticipates the pt may have experienced which of the following injuries?:
A. Spinous process fracture of the thoracic vertebrae 6 (T6)
B. Spiral fracture of the femur
C. Bilateral bipartite patella
D. Burst fracture of lumbar vertebrae 1 (L1) - ANS-D. Burst fracture of lumbar vertebrae 1 (L1)
Calcaneal fractures, especially in injuries that involve the pt landing on their feet, is a type of
axial loading injury where other injuries may be considered. Injuries associated with calcaneal
fractures include burst fractures, tibeal plateau fractures and internal organ injuries
103. A pt is being discharged from the ED with a lower leg cast. The pt is concerned about how
they will be able to walk up and down the steps with crutches at home. The ED nurse will
instruct the pt that the proper technique to go up and down the stairs is:
A. up with the "bad" leg and down with the "good" leg
B. Up with the "bad" leg and down with the "bad" leg
C. Up with the "good" leg and down with the "bad" leg
D. Up with the "good" leg and down with the " good" leg - ANS-C. Up with the "good" leg and
down with the "bad" leg
104.The ED nurse is caring for a pt with a pelvic fracture. At the beginning of the assessment,
the nurse notes the presence of distal pulses with good motor and sensory function of the lower
extremities. However, during ongoing assessments, the nurse is no longer able to palpate distal
pulses, and the pt has an altered mental status. Which of the following could be responsible for
this change in the pt status?:
A. Fat emboli
B. Hemorrhage
C. Compartment syndrome
D. Neurogenic shock - ANS-B. Hemorrhage
S/S of progressive or decompensated shock include an altered level of consciousness, the
presence of weak or thready pulse and cool, clammy skin as the blood shunts to vital organs
,105. The ED nurse is aware that the pts with gout will experience periodic exacerbation of
painful joint inflammation, resulting in acute painful episodes to be treated with the following
medications:
A. Allopurinol
B. Antibiotics
C. NSAIDS
D. Biphosphonates - ANS-C. NSAIDS
Although indomethacin (indocin) is often preferred, almost any NSAID is effective in treating
acute gout. Colchicine can be dramatically effective if initiated shortly after the onset of acute
symptoms
106. A pt arrives by EMS to the ED. EMS reports that the pt jumped from a third story balcony
when the support structure gave way. The pt landed on both feet and has been found to have a
compression fracture of the lumbar spine with significant pain. GCS scale is 15, with no reported
loss of consciousness. In addition to the compression fracture of the lumbar spine, this pt should
also be evaluated for the presence of a:
A. Hidden foreign body impalement
B. Femur fracture
C. Subdural hematoma
D. Calcaneus fracture - ANS-D. Calcaneus fracture
these fractures can occur in jumps or falls when the pt jumps directly onto their feet
107. A young pt presents to triage with complaints of left ankle pain. The pt reports that while
playing basketball, they lost their balance and landed hard on their left foot; a "popping" sound
in the ankle followed. The ankle is swollen and painful, and the pt is unable to bear weight on
the left foot. The pt is exhibiting signs and symptoms of what type of ankle injury?:
A. Avulsion fracture
B. Sprain
C. Dislocation
D. Strain - ANS-B. Sprain
Sprain is the result of injury to the ankle ligaments that have been stretched or torn by excessive
force
108. A pt with a laceration to the middle phalanx of the palmar side of the index finger from a
kitchen knife presents to triage. Bleeding has been controlled. After examining the pt for
possible tendon injury, the ED nurse anticipates preparing the pt for wound closure by first:
A. Cleansing the wound
B. Administering antibiotics
C. Providing anesthesia with lidocaine and epinephrine into the affected finger
D. Administering an opioid analgesia - ANS-A. Cleansing the wound
Remove visable contamination and dried blood
109. A Pt presents to the ED with a shortened, deformed and outwardly rotated right leg. The pt
requires application of a traction splint. The splint has been appropriately applied when:
, A. The affected limb begins to swell
B. The pt reports an increase in pain
C. The dorsalis pedis pulse is faint
D. The pt reports a decrease in pain - ANS-D. The pt reports a decrease in pain
Stabilization of the limb will decrease pain
11. Which of the following findings would the ED nurse to anticipate in a pt experiencing signs
and symptoms of cardiac tamponade following successful aspiration of fluid from the pericardial
sac?:
A. Presence of electrical alternans
B. Increase in the pts heart rate
C. Decrease in the pts BP
D. Increase in the pts BP - ANS-D. Increase in the pts BP
Following removal of fluid from the pericardial sac, the pts central venous pressure should
decrease, allowing for increased preload and an increase in the pts blood pressure
110. A college student presents to triage complaining of a constant buzzing sound in their ear.
On examination, an insect is seen in the ear canal. The physician has instilled viscous lidocaine
in the ear of the pt. The ED nurse identifies that the treatment has been effective when the pt
states which of the following?:
A. " My ear feels numb"
B. " I no longer hear the buzzing sound in my ear, I dont think the insect is moving"
C. " My ear no longer hurts"
D. " My hearing has improved in that ear now" - ANS-B. " I no longer hear the buzzing sound in
my ear, I dont think the insect is moving"
Live insects in the ear canal should be immobilized before removal is attempted. The
administration of lidocaine will imobillize the insect and stop the buzzing sound
111. A pt presents to the ED complaining of decreased vision, an intense headache, and the
appearance of halos around lights with photophobia. The ED nurse identifies these symptoms
as being consistent with the development of which of the following?:
A. Central retinal artery occlusion
B. Glaucoma
C. Corneal abrasion
D. Iritis - ANS-B. Glaucoma
112. The ED nurse is preparing to dress a stage 2 pressure injury on the shoulder of a pt. Which
solution would be most appropriate to cleanse the wound bed with?:
A. Lactated ringers solution
B. Povidone iodine (Betadine)
C. Hydrogen peroxide
D. Tap water - ANS-D. Tap water
Potable water or normal saline is appropriate for cleansing a wound
113. Which pt would be least likely to require a tetanus booster shot?:
