CEN Practice Revision Guide with Complete Rationale

Emergency Medical Service has brought a 24-year-old man to the ED with gunshot wounds to his abdomen and left groin area. His blood pressure is 84/52 and heart rate is 120 per minute. His skin is diaphoretic, cool, and pale. The treatment the nurse should prepare for is: a. Chest compressions b. Endotracheal intubation c. Administration of verapamil d. Rapid administration of a crystalloid solution ️️ d. Rapid administration of a crystalloid solution The gunshot wounds and symptoms would indicate that the young man has lost a significant amount of blood that has resulted in hypovolemia. The treatment of hypovolemia is a rapid infusion of a crystalloid intravenous solution. You are on the ED team caring for a 10-year-old child with a normal systolic blood pressure, increased heart rate, slightly delayed capillary refill and cool, pale skin. What severity of shock is the child likely in? a. Decompensated shock b. Hypotensive shock c. Compensated shock d. None of the above ️️ c. Compensated shock Severity of shock is often characterized by its effect on the systolic blood pressure. When the compensatory mechanisms work and maintain the systolic blood pressure, the shock is defined as "compensated". When the mechanisms can no longer support the blood pressure, shock is classified as "hypotensive" (formally called "decompensated"). You are caring for a patient in cardiogenic shock. You know that a probable cause of this condition is: a. Dehydration b. Spinal cord injury c. Congestive heart failure d. Infection ️️ c. Congestive heart failure Congestive heart failure is a common cause of cardiogenic shock. Acute myocardial infarction and other heart conditions can also cause cardiogenic shock. Dehydration can be a cause of hypovolemic shock. Spinal cord injury can cause neurogenic shock. Infection can cause septic shock. You are caring for a 10-year-old child with normal blood pressure, increased heart rate, and cool pale skin. The child is reported to have had vomitting and diarrhea the past two days. As you perform your primary assessment, you note that respirations are clear and not labored. What is the probable first intervention for this child? a. Give 20 ml/kg bolus of saline or lactated Ringer's b. Start an Epinephrine infusion at 0.1mg/kg c. Give Epinephrine bolus of 0.01 mg/kg d. Give Amiodarone 5 mg/kg IV over 60 minutes ️️ a. Give 20 ml/kg bolus of saline or lactated Ringer's By all indications, the child is in hypovolemic shock and the first interventions should be a fluid bolus at 20 ml/kg of saline or lactated Ringer's solution. You assume care for the patient in the ED. During the time she has been in the ED, she has consistently complained of photophobia, a stiff neck, increasing confusion, and nausea. Her history shows a motor vehicle accident several days ago. She states the pain is the worst headache she has ever had. You suspect she might have a: a. Subarachnoid hemorrhage b. Migraine headache c. Whiplash injury d. Sinus headache ️️ a. Subarachnoid hemorrhage Given the history of the recent MVA and these classic symptoms, the prudent nurse should have a high degree of suspicion of a subarachnoid hemorrhage. Assessment will show neurologic deficits and decreased eye movements. The nurse should prepare the patient for a CT scan of the brain. To quickly evaluate a child's neurological status, all of the following standard evaluations can be used EXCEPT: a. The Epworth Scale. b. The AVPU scale. c. The Glasgow Coma Scale. d. Pupillary responses to light. ️️ a. The Epworth Scale. The Epworth Scale is a measure of sleepiness and is not part of the standard evaluation of a child's neurological exam. The AVPU and Glasgow Coma scales can be used to evaluate a child's neuro status. Pupillary size and response should also be checked.