Emergency Nursing (CEN)
Emergency Nursing Review CEN
Vasopressor administration is CONTRAINDICATED in the initial resuscitation of the patient in which type of shock?
Answer: A. Hypovolemic
Hypovolemic shock is treated with fluids (crystalloids and blood products). As long as VOLUME is the problem, replacing volume is the answer. The patient with HEMORRHAGIC losses should receive balanced (1:1:1) resuscitation with red cells, plasma, and platelets as soon as possible. In the dehydrated patient (e.g., DKA, massive GI losses, environmental dehydration), there is no limit to the volume of crystalloids that can be administered if necessary. Give fluids to effect. The only time vasopressors are indicated in the volume deficient patient is when a patient cannot sustain his or her own vascular tone. This is the case in anaphylactic, septic, and neurogenic shock. Many cardiogenic shock patients require both vasopressor support (e.g., norepinephrine) and inotropic support (e.g., dobutamine) to improve cardiac contractility.
A patient with a completed ischemic stroke is to be admitted to the hospital as soon as a bed is available. The emergency nurse knows the most effective way to reduce the incidence of aspiration pneumonia in the stroke patient is to
A. place patients in a left, lateral recumbent position.
B. elevate the head of the bed to at least 30°.
C. keep patients NPO until they can tolerate a regular diet.
D. begin early, prophylactic antibiotic therapy.
Answer: B. elevate the head of the bed to at least 30°.
Even in the NPO patient, aspiration can occur when saliva is not swallowed effectively or when contents from the GI tract enter the lungs via vomiting or occult regurgitation. Stroke patients, and anyone with an altered level of consciousness, are at highest risk. Positioning patients with the head of the bed elevated ≥30° is the single most important intervention for preventing aspiration and subsequent pneumonia. Side positioning promotes pulmonary function and skin integrity but does not reduce aspiration risk unless accompanied by head-of-bed elevation. Patients who can swallow safely need not wait until they can tolerate a regular diet to receive oral nutrition. Those with altered mental status must remain strictly NPO until they have passed a swallow evaluation test, a key component of stroke patient assessment.
A 55-year-old woman complains of a series of severe, unilateral right forehead headaches that are associated with visual disturbances and tongue numbness. These findings suggest
A. tension headaches.
B. trigeminal neuralgia.
C. cluster headaches.
D. temporal arteritis.
Answer: D. temporal arteritis.
Temporal arteritis is an inflammation of the branches of the carotid artery. This condition occurs most often in women over the age of 50 years. Headache is the primary complaint and is described as severe and stabbing in one or both temporal regions. Headache is often accompanied by decreased visual acuity, as well as pain in the jaw associated with mouth opening. Untreated temporal arteritis can lead to blindness. Tension (a.k.a. common) headaches are described as a sensation of band tightness around the head. Cluster headaches–more common in men–are a series of brief and severe headaches that occur episodically and focus on one eye. Trigeminal neuralgia is an exquisitely painful sensation along the facial nerve, unassociated with visual changes.
A patient who is 37-weeks pregnant arrives in active labor. The umbilical cord is protruding and the fetal head is starting to crown. In which position should the mother be placed?
A. Prone, in a knee-chest position
B. Side-lying, tilted 15° to the left
C. Supine, in the lithotomy position
D. Squatting, supported bilaterally
Answer: A. Prone, in a knee-chest position
Cord prolapse often happens concurrently with amniotic sac rupture, especially if the sac ruptures before the fetal head is fully engaged in the pelvis (e.g., a preterm precipitous delivery). Once the sac is ruptured and the cord has prolapsed, movement of the fetal head into the pelvis entraps and compresses the cord, like a cork in a bottle. As a result, fetal oxygenation is diminished or completely cut-off. Immediate vaginal or Cesarean delivery must be performed at the first sign of fetal distress. Risks to the fetus are increased in cases of fetal malpresentation, such as a breech positioning. Placing the mother prone, in a knees-to-chest position ("derrière in the air") temporarily alleviates pressure on the cord. Manual pressure relief–a hand in the vagina to lift the fetal head off the cord–is usually required as well.
After spraying pesticides all day, a farmhand walks into the ED complaining of diaphoresis, productive cough, nausea, vomiting, and diarrhea. The priority intervention is
A. intravenous cannulation.
B. oxygen supplementation.
C. skin decontamination.
D. antidote administration.
Answer: C. skin decontamination.
The patient's presentation and recent history suggest organo-phosphate or carbamate poisoning. These substances are found in industrial insecticides used on farms, as well as in home pesticides (bug spray). Toxicity causes a cholinergic crisis resulting in stimulation and hypersecretion of body fluids. Findings in the patient with a cholinergic toxicity are SLUDGE: Salivation, Lacrimation, Urination, Defecation, GI upset, and Emesis. Death occurs related to respiratory failure caused by respiratory muscle paralysis and increased secretions. In the walking and talking patient, the priority intervention is to decontaminate the patient to avoid cross-contamination of medical caregivers and equipment. Antidote administration–intravenous atropine and pralidoxime (2-PAM; Protopam®)–will likely be required.
Emergency Nursing Review CEN
Emergency Nursing Review CEN®
Pocket Study Guide Volume 3
Cheryl L. Randolph MSN RN FNP-BC CEN CPEN CCRN TCRN FAEN
Laura M. Criddle PhD RN CEN CPEN CFRN CCRN-K TCRN FAEN