Relias ED RN A A 22-year old female who is 8 weeks pregnant presents with a sudden onset of left lower abdominal pain and vaginal bleeding. The patient's family member stated that she had a syncopal episode shortly after that. What is the MOST likely diagnosis for her? Ruptured appendix Placenta previa Abruptio placenta Ruptured ectopic pregnancy ANSWER Ruptured ectopic pregnancy A 35-year-old patient complains of night sweats, low-grade fever, weight loss, and a productive cough with pink-tinged sputum for 3-4 weeks. They have been staying at a local shelter since they lost their job 6 months ago. What diagnosis is most likely? Tuberculosis Influenza COVID 19 Liver cancer ANSWER TB A confused patient is trying to grasp at their IV with their right hand. Which is the LEAST restrictive measure to maintain patient safety? 2-point restraint on right arm and left leg Safety "mitt" for both hands 2-point restraints on upper limbs Safety "mitt" for right hand only ANSWER Safety "mitt" for right hand only A new nurse observes their preceptor giving the incorrect dosage of a medication to a patient. Implementing the ethical principle veracity, what action would the new nurse take? Keep the information confidential to avoid repercussions from the preceptor. Inform the charge nurse about what happened and document it. Since the patient was not harmed, do not report the incident.
Tell only the patient about the incident and have them decide what to do. ANSWER Inform the charge nurse about what happened and document it. A patient arrives with acute onset of central chest pain. The patient is tachycardic and tachypneic and appears very anxious and restless. What would be the MOST important initial intervention for this patient? Obtain electrocardiogram Administer nitroglycerin Administer oxygen Obtain venous blood gas ANSWER IDK, but its not administer nitroglycerin or obtain electrocardiogram!! A patient arrives with suspected appendicitis. What action, if observed, would require additional training for the unlicensed assistive personnel (UAP)? The UAP offers the patient a ginger ale. The UAP allows the patient to move to a position of comfort. The UAP helps the patient with a bedpan. The UAP reminds the patient to stay in bed. ANSWER The UAP offers the patient a ginger ale. A patient has sustained multiple traumatic injuries after a fall from a height. What is considered an important component of the primary survey assessment? Complete set of vital signs Neurological assessment Head to toe assessment Patients allergy history ANSWER Neurological Assessment A patient is being treated in a hyperbaric oxygen chamber for carbon monoxide poisoning. What measurement is the BEST indicator of treatment success? Pulse oximetry Vital signs Pulse pressure O Arterial blood gas ANSWER ABG
A patient is being treated with an anticoagulant for pulmonary embolism (PE). What patient assessment finding indicates that a heparin infusion would be stopped IMMEDIATELY? © Decreased level of consciousness Decreased urine output Increase in blood pressure of 140/85 Increase in temperature to 100.1 F ANSWER Decreased level of consciousness A patient is brought in after being struck by lightning during a heavy thunderstorm. What would be the PRIORITY intervention for this patient upon arrival? Measuring urine output Monitoring cardiac rhythm Cleaning of the burn wounds Obtaining chest x-ray ANSWER Monitoring cardiac rhythm A patient is brought in for a potential overdose of heroin. What is the PRIORITY nursing intervention? Administering normal saline fluids Maintaining airway and breathing Starting an IV line Administering naloxone ANSWER Maintaining airway and breathing. A patient is brought in with a history of a head-on motor vehicle accident. The patient was not wearing a seat belt and was traveling at 120 mph with the deployment of an airbag. They complain of severe lower abdominal and hip pain. A secondary trauma survey reveals an unstable hip on lateral compression. What would be a PRIORITY intervention in managing this patient? Application of pelvic blinder Initiation of massive transfusion protocol Administration of IV fluids Insertion of second IV line ANSWER Application of a pelvic binder
A patient is brought in with possible foreign body obstruction and respiratory distress. The provider suctions the patient and unsuccessfully tries to insert an endotracheal tube (ETT). What type of procedure would you anticipate NEXT? Placement of laryngeal mask Tracheostomy Bronchoscopy Chest tube insertion ANSWER Trach A patient is complaining of a burning sensation in both eyes with pain, redness, swelling, and purulent discharge. The visual assessment using the Snellen chart reveals no changes in vision. You anticipate that the patient has signs and symptoms of: Iritis Conjuntivitis Retinal detachment Glaucoma ANSWER Conjuntivitis A patient is frustrated at the length of time they have been waiting to be triaged. They start to yell obscenities and threaten you with violence. Why would this incident be reported to your supervisor? The patient is responsible for their actions even though they are ill You have the right to personal safety at work As no physical injury actually occurred, no further action is necessary This type of behavior is expected and accepted in the ED ANSWER You have a right to personal safety at work A patient presents after an intentional overdose of propranolol approximately 2 hours ago. The patient has severe hypotension and bradycardia. IV fluids and vasopressors are initiated. What nursing assessment findings indicate the treatment has been effective? Decreasing pulse pressure Decreasing central venous pressure Increasing serum glucose Increasing serum cortisol ANSWER Increasing serum glucose A patient presents after falling from a height and fracturing their right tibia and fibula. What symptom would be reported to the provider IMMEDIATELY? Bounding pulse
Warm extremity Paresthesia of the foot Capillary refill pf toes <2 sec ANSWER Paresthesia of the foot A patient presents after sustaining a roll-over motor vehicle accident. They are complaining of pain around the mid-upper back. On your initial triage assessment, you find that patient has preserved motor function below L5 but is suffering from a loss of sensory function. The assessment findings are consistent with: Posterior cord syndrome Central cord syndrome Anterior cord syndrome Autonomic syndrome ANSWER Posterior cord syndrome A patient presents to the lobby stating she thinks she is in active labor. Your facility doesn't have a labor and delivery unit. What is the NEXT action you would take? Tell the patient she needs to go to the nearest hospital with a labor and delivery unit. Have an ED provider perform a medical screening exam to determine if she is in active labor. Call the nearest hospital with a labor and delivery unit to see if they will accept the patient. Get a wheelchair for the patient and inform her that there will be a 3 hour wait time. ANSWER Have an ED provider preform a MSE A patient presents with a 1-day history of pain in the right upper abdomen with nausea and vomiting. The provider suspects that the patient has cholecystitis. What lab value supports the diagnosis? Elevated amylase A Elevated creatinine Elevated bilirubin Decreased hemoglobin ANSWER Elevated Bilirubin A patient presents with a 5-day history of runny nose, headache, and productive cough. The patient is unable to speak full sentences, reports having a history of moderate to severe COPD, and has a Sp02 reading of 89%. What intervention do you anticipate implementing FIRST for this patient? •
Provide oxygen Obtain venous blood gas (VBG) Obtain vital signs Obtain ECG ANSWER Provide Oxygen A patient presents with a facial burn with significant facial swelling and acute respiratory distress. Based on a 1-4 triage acuity scale with 1 being most critical, what is the appropriate category based on the patient presentation? 1 2 3 4 ANSWER 1 A patient presents with a history of acute urinary retention. An indwelling catheter is placed and the patient is sent for an ultrasound scan. The imaging confirms benign prostatic hyperplasia as the cause of urinary retention. What medication do you anticipate the provider to order? Tamsulosin (Flomax®) Vasopressin Phenylephrine (Omidria®) Methoxamine (Vasoxy|®) ANSWER Flomax A patient presents with a two-day history of fever, cough, mild shortness of breath (SOB), sore throat, myalgia, and new onset of loss of taste and smell. What is the patient MOST likely suffering from? Giardia Microsporidia COVID 19 Tuberculosis ANSWER COVID 19 A patient presents with acute onset of chest pain and goes into cardiac arrest immediately upon arrival. What is a possible reversible cause of cardiac arrest? Hypervolemia Alkalosis
Hyperthermia Tension Pneumothorax ANSWER Tension Pneumothorax A patient presents with an episode of hypertensive crisis, a blood pressure of 220/118, and the provider has put in the order for nitroprusside. What demonstrates that the treatment has been effective? Systolic blood pressure reaches 160 mm Hg Systolic blood pressure reaches 210 mm Hg Patients states that he no longer has chest pain Oxygen saturation increased from 94% to 99% ANSWER SBP reaches 160 A patient presents with possible organophosphate toxicity. What would you expect to find upon assessment? Diaphoresis Tachycardia Constipation Hot and dry skin ANSWER Diaphoresis A patient presents with sudden onset of aphasia and left-sided weakness for the last 25 minutes. What action would be taken NEXT? Triage them to the screening area Complete a thorough triage evaluation, initiate the appropriate stroke resources Register the patient prior to triage, and collect smoking and drug use history Activate your department's code stroke protocol ANSWER Activate your deptartment's code stroke protocol A patient who is 8 weeks pregnant presents to triage with vaginal bleeding and lower abdominal pain. RhoGAM will be given for which situation? Father is negative Father is positive Mother is positive Mother is Rh negative ANSWER Mother is Rh negative
A patient who is 24 weeks pregnant presents with fever and right upper quadrant pain. The patient states that the pain is radiating to the right shoulder blade, and started an hour after having a pizza for lunch. She is tachycardic, tachypneic, and diaphoretic on the initial triage assessment. What is the MOST likely diagnosis for this patient? Pericarditis Cholecystitis Diverticulitis Pancreatitis ANSWER Cholecystitis A patient who is 27 weeks pregnant presents with painless bright red vaginal bleeding. What condition correlates with the presenting symptoms? Abruptio placenta Placenta Previa Ectopic pregnancy Premature rupture of membranes (PROM) ANSWER Placenta Previa A patient who is 32 weeks pregnant presents with a three-day history of headache and significant swelling of the lower extremities and face. The patient's vital signs are BP: 160/90, HR: 105/min, RR:19/min, Spo2: 94% on RA, Temp: 97.3 F. What medication do you anticipate the provider to order FIRST? Furosemide (Lasix) Magnesium Sulfate Labetalol (Trandate) Acetaminophen (Tylenol) ANSWER Magnesium Sulfate A patient who is suspected of having hyperkalemia is MOST likely to have what ECG changes? • Tall, peaked T waves T wave inversion Prolonged QT interval ST-segment elevation ANSWER Tall, peaked T wave A patient with a history of advanced-stage leukemia presents with a history of increasing shortness of breath in the last 4 days. The patient is anemic and has multiple bruises on their extremities. What is the MOST likely cause of bruising?
Anemia Thrombocytopenia Lymphadenopathy Septicemia ANSWER Thrombocytopenia A patient with a history of chronic alcohol use is brought in with possible esophageal varices. What medication is used to stop upper gastrointestinal (GI) bleeding in patients with this condition? Octreotide (Sandostatin®) Acetaminophen (Tylenol®) Warfarin (Jantoven®) Ibuprofen (Motrin®) ANSWER Octreotide (Sandostatin) A patient with a traumatic brain injury (TBI) is MOST likely to suffer from what condition? Diabetes mellitus Cerebral palsy Diabetes Insipidus Myxedema coma ANSWER Diabetes Insipidus A patient with dementia has a family member with MPOA, who is unable to be reached. The provider needs a consent signed and allows the patient to sign. What is the MOST appropriate action you would take? • Report the provider to their supervisor. Do nothing as the form has already been signed. Call the ethics committee. Report the provider to the Medical Board. ANSWER Report the provider to their supervisor A patient's family has decided to withdraw life-sustaining treatment. When communicating with the family of the patient, what reassurance would you provide? Life support is essential in the patient's quality of life. Efforts will be made to make the patient comfortable. That the patient lived a full and complete life.
Substantial amounts of pain medication will be provided. ANSWER Efforts with be made to make the patient comfortable. Acute deficiency of cortisol and aldosterone can lead to what severe life-threatening condition? Cushing syndrome Diabetes Insipidus. Adrenal Crisis Myxedema coma ANSWER Adrenal Crisis An adult patient who is 70 kg has a full-thickness burn over 30% of their body surface area. What is the anticipated fluid replacement for a patient in the first 8 hours is based on the Parkland formula? 4200 mL 4800 mL 6300 mL 8400 mL ANSWER 4200 mL An elderly patient is brought in with new onset of confusion and gradual onset of headache in the last 48hours. The patient states that they had a fall 3 days ago. Based on the history and presenting complaints, what diagnostic test do you anticipate the provider to order? MRI of the brain Complete Blood Count Finger stick blood sugar CT scan of the brain ANSWER CT scan of the brain During cardiogenic shock what temporary intervention might be ordered to improve perfusion until definitive treatment is provided? Coronary artery bypass notropic iffusion Percutaneous intervention Continuous renal replacement therapy ANSWER Inotropic infusion The deficiency of anti-diuretic hormone (ADH) can lead to what endocrine disorders? Diabetes Insipidus
Diabetes Mellitus Adrenal Insufficiency Syndrome of inappropriate secretion of ADH (SIADH) ANSWER Diabetes Insipidus The life-threatening and rare complication of hypothyroidism is known as: Pheochromocytoma Adrenal crisis Thyroid storm Myxedema coma ANSWER Myxedema Under what circumstances can the hospital transfer an unstable patient to another facility and maintain compliance with the Emergency Medical Treatment and Active Labor Act (EMTALA)? The patient has no health insurance coverage. The receiving facility is conducting research on specific disease condition. The necessary treatment is not available at the current hospital. The family members are requesting to transfer the patient near to them. ANSWER The necessary treatment is not available at the current hospital. What are you MOST likely to see during your initial assessment of a patient with chronic obstructive pulmonary disease (COPD)? Pursed lip breathing Absent breath sounds on one side Fever Blood tinged sputum ANSWER Pursed lip breathing What do you anticipate is the BEST indicator of adequate hydration in an adult patient with 30% body surface area burn during initial fluid resuscitation? Blood pressure of 110/60 mm Hg Urine output of 0.5 mL/kg/hr Central venous pressure of 25 mm Hg Urine output of 0.2 mL/kg/hr ANSWER Urine output 0.5mL/kg/hr What is a common assessment finding in a patient with a tension pneumothorax?
Petechial chest rash Distended neck veins Equal chest wall expansion Flattened neck veins ANSWER Distended Neck Veins What is the appropriate intervention for patients with Acute Respiratory Distress Syndrome (ARDS)? Increasing fluid volume Mechanical ventilation Bag mask valve (BMV) ventilation Administering sedatives ANSWER Mechanical ventilation What is the critical goal time from arrival to the ED to CT brain scan based on the American Heart Association stroke recommendations? 10 minutes 25 minutes 45 minutes 60 minutes ANSWER 25min What is the current recommended dose of intravenous or intraosseous epinephrine in adult patients with cardiac arrest? 10 mg every 10 minutes 1 mg every 3-5 minutes 1 mg every 7 minutes 0.1 mg every 2 minutes ANSWER 1 mg every 3-5 minutes What laboratory value would you monitor closely if your patient is vomiting coffee-ground emesis? White blood cells Serum potasgium Arterial Blood Gas Hemoglobin ANSWER Hemoglobin
What staff member would you ask to accompany you when transporting an intubated patient to imaging for a CT? Lift team Respiratory therapist Physician's assistant Nursing assistant ANSWER RT What symptom is commonly seen in patients with alcohol withdrawal? Tachycardia Hypotension Bradycardia Hypothermia ANSWER Tachycardia What type of diet would a patient with diverticulitis follow? High residual diet High fiber diet Low sugar diet High calorie diet ANSWER IDK, but its not High residual or Low sugar!! What type of medication is used in the emergency care setting to help manage the symptoms of alcohol withdrawal? Benzodiazepines Valproic acid Electrolytes Thiamine ANSWER Benzos Which of the following represent categories utilized to triage patients during a mass casualty incident (MCI)? Green, orange, black, purple Green, blue, red, black Red, black, pink, yellow Green, yellow, red, black ANSWER Green, yellow, red, black
Which of the following wounds has the highest risk for developing osteomyelitis? Closed fracture of tibia resulting from trauma Contusion and bruising to the head from a fall Puncture wound from stepping on a rusty nail Laceration of the face from breaking glass ANSWER Puncture wound from stepping on a nail You accidentally administered epinephrine 1:1000 intravenous push for a patient suffering from a severe anaphylactic reaction. You recognize this as a near-miss event and report this: Internally, per policy through the defined incident reporting system Externally, to the state board of nursing through the website Externally, to state board of pharmacy through the website Since it was a near miss reporting is not necessary ANSWER Internally, per policy through the defined incident reporting system. You are administering haloperidol (Haldol®) to a patient with acute symptoms of Schizophrenia. What changes in the electrocardiogram (ECG) are possible as a result of this medication? Depressed T wave O Prolonged QT interval Prolonged PR interval Elevated ST segment ANSWER Prolonged QT interval You are assisting a novice nurse with a blood draw. You observe the nurse draw the blood, place the specimen tubes in a biohazard bag, and leave the room with the unlabeled specimen tubes. What would you do NEXT? Don't confront the nurse, go redraw the labs and label at the bedside. Do nothing because they can label them anywhere. Report them to your supervisor. Re-educate the nurse, then redraw thexabs, use patient identifiers and label at the bedside. ANSWER Re-educate You are caring for a patient who has a history of alcohol use and seizures. You suddenly notice the patient becoming diaphoretic, anxious, tachycardic, and has clammy skin. What would you do NEXT? Check their blood glucose Turn them on their side Auscultate their lungs
Administer propranolol ANSWER Check their blood glucose You exit your patient's room and as you walk away you hear a thud. Upon inspection, you find your patient on the floor. What would you do FIRST? Assess the patient for injury. Call the familv. Get assistance. Notify the charge nurse. ANSWER Assess the pt for injury You see a fellow nurse placing an opioid medication in their pocket rather than administering it as ordered. What would you do NEXT? Don't say anything. Tell another coworker. Confront your coworker. Tell your immediate supervisor. ANSWER Tell your immediate supervisor You want to implement the new evidence-based practice guidelines in managing patients to prevent falling on your unit. What provides the STRONGEST evidence for interventions? Systematic reviews Retrospective study Single randomized control trial Observational study ANSWER Systematic reviews Your patient has just had a paracentesis during which 5 liters of fluid were removed. Which assessment is the PRIORITY? Palpate for tenderness Blood pressure Observation of puncture site Signs of infection ANSWER Blood pressure Your patient's chest tube dressing has accidentally come off and you are preparing to place a new one. You have a slit drain sponge, 4 x 4 gauzes, tape, scissors, and antiseptic swabs. What else do you need?
Kelly clamp Petrolatum gauze Tube connector Chest drainage system ANSWER Petrolatum gauze