Question 1

The nurse is assessing her patient for pressure ulcers. On the patient's right heel, she notices one inch by ½ inch red shallow crater with a small amount of white drainage, surrounded by bright pink skin. She documents this finding as a:

Accepted Answer

The nurse would document the pressure ulcer on the heel as a stage 2 partial thickness pressure ulcer. It involves two layers of the skin- the epidermis and the dermis with a shallow crater that breaks through the first layer of skin.

Question 2

A 47 year old female is assigned as one of your patients on the cardiac care unit. On your rounds you notice that her Mean Arterial Blood Pressure is decreasing. What is the Mean Arterial Blood Pressure?

Accepted Answer

The Mean Arterial Blood Pressure (MAP) is a measure of the average between the systolic and diastolic pressure. It is a means of seeing if the patients' organs are being perfuse appropriately, a MAP of at least 60 mmHg is required for organ perfusion.

Question 3

A 67 year male enters the emergency room with a blood pressure of 210/105. The nursing assistant asks you, "how is blood pressure in the body calculated"?

Accepted Answer

Blood pressure in the body is calculated by peripheral resistance and cardiac output. The formula for blood pressure is cardiac output multiplied by peripheral resistance where the cardiac output is the stroke volume multiplied by the heart rate.

Question 4

You are attending to an 87 year old female, when a physician assistant states that your patients cardiac output is decreasing. Why is cardiac output important?

Accepted Answer

Cardiac output is important for helping determine blood pressure. Blood pressure is calculated as the cardiac output (i.e. stroke volume multiplied by heart rate) multiplied by the peripheral resistance in the body.

Question 5

You are working in a busy emergency room when an 84 year old male comes rushing in with crushing pain over his sternum. What is the first treatment for angina?

Accepted Answer

In a patient with angina the first treatment that should be given is nitroglycerin spray or sublingual tablets up to three times. Nitroglycerin is a powerful vasodilator and relieving chest pain is of utmost importance before administering other treatments.

Question 6

A patient in the emergency room is being worked up for acute coronary syndrome. You are performing an EKG on the patient and notice wide QRS complexes in the pre-cordial leads. What is the significance of this finding?

Accepted Answer

A wide QRS complex on the EKG rhythm is indicative of a bundle branch block. It is important to check old EKG's to see if the bundle branch is new or old. A new bundle branch block can indicate a developing myocardial infarction.

Question 7

A 50 year old female is in the emergency department with a diagnosis of Thyroid Crisis. What are the main signs and symptoms of thyroid crisis?

Accepted Answer

The main symptoms of a Thyroid Crisis are tachycardia and elevated temperature. As a nurse any patient who begins to exhibit these signs and symptoms should immediately be evaluated by the physician for possible thyroid crisis. Thyroid crisis is caused by untreated hyperthyroidism.

Question 8

A student nurse rotating in the emergency department overhears the emergency room physician explaining to the client about heart block and mentions the electrical impulse of the heart. Where does the electrical impulse in the heart begin?

Accepted Answer

The electrical impulse in the heart begins at the Sinoatrial node, which is the pacemaker of the heart and coordinates normal sinus rhythm. It is located near the entrance of the superior vena cava in the right atrium.

Question 9

An 18 year old female Type I diabetic patient is in the emergency room after suffering an episode of Diabetic Ketoacidosis. Which of the following is true regarding regular insulin administered subcutaneously?

Accepted Answer

Regular insulin administered subcutaneously peaks in 2-4 hours. This is important to know when a patient is put on a insulin regimen or in a Hyperglycaemic attack that rapid acting insulin should be used instead of regular insulin initially.

Question 10

A 45 year old male patient presented to the emergency room with crushing chest pain. Although his EKG did not show ST-elevation, he did have a Troponin I level of 4.0. The emergency room physician has ordered Eptifibatide Bolus. What serum levels are important to monitor when on Eptifibatide?

Accepted Answer

In patients who have been administered Eptifibatide, a GP IIb-IIIa inhibitor, serum levels of INR, PTT, Platelets, Hemoglobin, Hematocrit and Creatinine should all be monitored post bolus. Eptifibatide is indicated for use in non ST-elevation (NSTEMI) and can cause severe bleeding along with renal impairment so it is vital to monitor for this.

Question 11

A set of emergency surgeries were performed and you are the post operative nurse. Which of the following patients should be most closely monitored in the ICU?

Accepted Answer

Patients with post abscess Appendenctomy and post aortic valve replacement have the highest occurrence of infection and sepsis post operatively. These patients need to be monitored closely for developing signs and symptoms of infection/sepsis such as fever, tachycardia and hypotension.

Question 12

A patient has returned after a lengthy abdominal surgery. The nurse enters the room to assess the patient and observes the patient forcefully coughing without using anything to protect her abdomen. The nurse would teach the patient to use an abdominal pillow over her abdomen when coughing to avoid the post operative complication of:

Accepted Answer

After an abdominal surgery, the nurse would teach the patient to use an abdominal pillow over the incision while coughing to avoid the post operative complication of dehiscence. Wound dehiscence occurs when the wound edges separate and can lead to evisceration.

Question 13

The nurse is called in to see a 47 year old patient who underwent abdominal surgery to remove abdominal tumors. He anxiously tells her that he feels oozing around his incision. When the nurse assesses the site, she notes part of the bowels protruding through a dehiscence in the wound. The first thing the nurse would need to do:

Accepted Answer

The first thing the nurse would do when discovering an evisceration of the bowel through the wound dehiscence would be to use sterile technique to cover the wound with warm sterile saline soaks. Keep the patient in bed and stay with him. If another nurse is near, request that they call the doctor for you so you can monitor the patient closely.

Question 14

An intensive care nurse is asked to assess a nurse on a medical telemetry unit whom the medical nurse is questioning whether the patient might be experiencing septic shock. What symptoms would the nurse observe if the patient was in the late stages of septic shock?

Accepted Answer

The symptoms observed in a patient experiencing the late signs and symptoms of shock would be decreased pulse and respiratory rales. Early signs of shock include increased pulse, decreased or normal blood pressure, fever, chills, warm, dry skin and reduced urine output.

Question 15

A patient is showing the signs and symptoms of septicemia. What test would confirm the suspected diagnosis?

Accepted Answer

To confirm a suspected diagnosis of septicemia obtaining samples of a urine specimen, blood cultures and wound specimen are indicated. Septicemia is a systemic infection of the blood stream. Changes in level of consciousness and changes in vital signs would show signs and symptoms of septicemia.

Question 16

The nurse is doing a complete neurological examination to evaluate the patient's status 24 hours after a stroke has occurred. Testing of which cranial nerve would assess the patient's ability to chew?

Accepted Answer

To asses the ability of the patient to chew after a stroke, testing of the Trigeminal nerve is appropriate. The Trigeminal nerve is responsible for chewing and facial sensations.

Question 17

During intracranial pressure monitoring, what kind of normal activities would show an increase of temporary intracranial pressure elevations?

Accepted Answer

During intracranial pressure monitoring, normal coughing or straining during a bowel movement can cause temporary pressure elevations. Brain mass shifts and gasping as a compensatory effort would be unwanted activities. Dysrhythmias will not show during intracranial pressure monitoring.

Question 18

You are working in the emergency room when a 45 year old male comes in with signs and symptoms of acute renal failure. What is the most accurate measure of renal function?

Accepted Answer

The most accurate measure of renal function is the Glomerular Filtration Rate (GFR). The GFR is the flow rate of filtration through the kidneys and provides the most accurate state of kidney function and physiology.

Question 19

A 35 year old woman comes to your office. She states that recently she has been having a lot of problems. Some of her symptoms include periodic episodes of feeling like she is very afraid. You decide that there is likely a psychiatric component to her symptoms and decide to treat her medically with a combination of the most appropriate medications. A panic attack does NOT involve the sudden appearance of which of the following symptoms:

Accepted Answer

Otalgia is NOT one of the symptoms of panic attacks. Chest pain and discomfort is the most common symptom during panic attacks and sudden appearance of sweating and palpitation of heart is observed during a panic attack.

Question 20

Which of the following form part of the treatment for panic attacks in adults and elderly people?

Accepted Answer

Administration of Benzodiazepines forms part of the treatment for panic attacks in adults and elderly people. Anti-psychotic medication, beta blockers and use of Clonidine are not related with treatment for panic attacks. Beta blockers are used for treatment of cardiac diseases and Clonidine is used for high blood pressure, alcohol withdrawal and as an aid to stop smoking.

Quiz 1: Adult