CEN Certification Exam Prep Test

The patient's assessment findings, including hoarseness, pain with speaking, nasal congestion, and erythematous posterior oropharynx, are indicative of acute laryngitis. Acute laryngitis is an inflammation of the larynx caused by viral or bacterial infection, often associated with upper respiratory tract infections (URI). The presence of purulent nasal discharge and a low-grade fever (temp 101 F) further supports the diagnosis of acute laryngitis. Chronic laryngitis, laryngeal carcinoma, and vocal cord polyps would typically present with different symptoms or findings.

Homans' Sign is a sign/symptom characterized by calf pain that occurs when the foot is forcibly dorsiflexed and is associated with venous thrombosis. This sign is used to assess for deep vein thrombosis (DVT) in the lower extremities. The presence of calf pain during dorsiflexion suggests the presence of a blood clot in the veins of the leg. It is important to note that Homans' Sign is not a definitive diagnostic tool for DVT, but it can be used as an indication to further investigate the possibility of a blood clot.

Lorazepam (Ativan) is the correct answer because it is a benzodiazepine that acts as a sedative and anxiolytic. It can help to manage the adrenergic manifestations of cocaine use, such as hypertension, tachycardia, and hyperthermia, by reducing anxiety and calming the individual. This can help to lower blood pressure and heart rate, and reduce the risk of complications associated with cocaine use. Nitroprusside (Nipride) is a vasodilator used to treat hypertensive emergencies, but it may not be the best choice for managing the other symptoms. Chlorpromazine (Thorazine) is an antipsychotic medication that may help with some symptoms, but it is not specifically indicated for adrenergic manifestations of cocaine use. Beta-adrenergic antagonists can lower blood pressure and heart rate, but they may not address the other symptoms as effectively as lorazepam.

Petechiae refers to minute, pinpoint hemorrhages into the skin, mucosal or serosal surfaces. It is characterized by small red or purple spots on the skin caused by bleeding underneath. Purpura refers to larger areas of bleeding under the skin, while ecchymoses refers to larger bruises. Fibrinolytic is not related to the definition given. Therefore, the correct answer is Petechiae.

Naloxone (Narcan) should be given to a patient suspected of taking a heroin overdose. Naloxone is an opioid receptor antagonist that can quickly reverse the effects of opioid overdose, including respiratory depression. It works by binding to the opioid receptors in the brain, displacing the opioids and reversing their effects. Atropine is not used for opioid overdose but for certain types of poisoning or to treat bradycardia. Methylphenidate is a stimulant used for ADHD, and physostigmine is an acetylcholinesterase inhibitor used for certain types of poisoning.

The green color of triage represents delayed care, which means that the patient's condition is not life-threatening and can afford to wait for up to three hours before receiving medical attention. This category is assigned to patients who have non-urgent injuries or illnesses that do not require immediate treatment. It allows medical professionals to prioritize more critical cases and allocate resources efficiently.

The correct answer is to stabilize the neck, establish a large-bore IV line, and perform a rapid secondary survey. This is the most appropriate nursing action for a patient who has been in a motor vehicle crash and is presenting with neck and leg pain, vomiting, lacerations of the parietal scalp, low blood pressure, increased heart rate, and rapid respiration. Stabilizing the neck is crucial to prevent further injury to the spine. Establishing a large-bore IV line allows for the administration of fluids and medications. Performing a rapid secondary survey helps to assess for any other injuries or complications that may need immediate attention.

Dehydration is a condition characterized by a lack of sufficient water in the body. Symptoms of dehydration include dry mucous membranes, postural hypotension, and thirst. However, a decreased hematocrit is not associated with dehydration. Hematocrit refers to the percentage of red blood cells in the blood, and it is not directly affected by dehydration.

During the transport of an adult patient with suspected cardiac tamponade, the earliest clinical sign is tachycardia. Tachycardia refers to an abnormally rapid heart rate, which can be a compensatory mechanism to maintain cardiac output in the presence of decreased filling of the heart due to the accumulation of fluid or blood in the pericardial sac. This increased heart rate helps to maintain an adequate blood supply to the body. Hypotension, anxiety, and jugular venous distention may occur later as the condition progresses.

Cheyne-Stokes Respiration is characterized by cycles of gradually increasing tidal volume followed by gradually decreasing tidal volume, usually separated by brief periods of apnea. This pattern of breathing is often seen in patients with heart failure or brain damage. Biot's Respiration, Apneusis, and Kussmaul's breathing are all different patterns of abnormal breathing, but they do not match the specific description given in the question.

A Glasgow Coma Score (GCS) of 7 indicates a severe neurological impairment. A GCS of 7 means that the patient is unable to open their eyes, has no verbal response, and has abnormal motor responses. This suggests a significant decrease in brain function and requires immediate intervention. The other options, such as urine output, oxygen saturation, and diaphoresis, may also require monitoring or intervention, but a GCS of 7 indicates a critical condition that needs immediate attention.

Beck's triad is a set of three classic signs associated with cardiac tamponade, which is a condition characterized by the accumulation of fluid in the pericardial cavity. The three characteristic signs of Beck's triad are rising jugular venous pressure, suppressed heart sounds, and a fall in systolic blood pressure. Pain and tingling in the fingers after exposure to cold is not a characteristic of Beck's triad and is unrelated to cardiac tamponade.

The signs and symptoms of cocaine intoxication typically include increased heart rate (tachycardia), high blood pressure (hypertension), and elevated body temperature (fever). These physiological effects are commonly observed in individuals who have ingested cocaine and can be indicative of cocaine intoxication.

Mannitol is the most appropriate medication in this scenario because it is a osmotic diuretic that can help reduce intracranial pressure. The fixed and dilated pupils indicate a severe increase in intracranial pressure, which can be caused by shunt dysfunction in a hydrocephalic infant. Mannitol works by drawing fluid out of the brain tissue and into the bloodstream, thereby reducing the pressure. Dexamethasone is a steroid that may be used to reduce brain inflammation but is not the first-line treatment for acute increase in intracranial pressure. Diamox is a carbonic anhydrase inhibitor that can reduce cerebrospinal fluid production but may not be as effective as mannitol in this case. Phenobarbital is an antiepileptic medication and would not directly address the elevated intracranial pressure.

In this acute situation, the priority is to stabilize the child's hemodynamic status, and the best immediate action is to administer IV fluids such as Lactated Ringer's to address hypotension and tachycardia due to blood loss. While clearing clots and managing the bleeding site are important, these actions will not immediately address the critical issue of circulatory volume depletion. Intravenous fluid resuscitation can stabilize the child's condition while further assessments and interventions (such as drawing blood for hemoglobin and hematocrit (H&H) levels, type and cross-match, or more definitive bleeding control measures) are prepared.

The primary reason for initiating a magnesium sulfate infusion prior to transporting a patient who has preeclampsia is to reduce seizure potential. Preeclampsia is a condition characterized by high blood pressure and can lead to seizures, known as eclampsia. Magnesium sulfate is a medication commonly used to prevent seizures in patients with preeclampsia. It works by relaxing the muscles and reducing the excitability of the nervous system, thereby reducing the risk of seizures.

The emergency nurse would not expect the patient's feet to bleed after re-warming them. Frostbite occurs when the skin and underlying tissues freeze due to extreme cold temperatures. When the tissue is re-warmed, blood flow is restored to the area. However, the blood vessels may be damaged, leading to poor circulation and potential tissue death. While purplish-blue discoloration, blistering, and pain are common symptoms of frostbite, bleeding is not typically expected.

Adding 50 mEq of sodium bicarbonate to every liter of normal saline solution is the best method to ensure adequate alkalization of urine in a crush syndrome patient with a urine pH of 6.0. Sodium bicarbonate is an alkalizing agent that can help raise the pH of urine, which is important in managing crush syndrome. Crush syndrome can lead to muscle breakdown and release of myoglobin, which can cause kidney damage. Alkalization of urine helps prevent the formation of myoglobin casts in the renal tubules, reducing the risk of kidney injury. Administering NSS at a rate of 200 cc/hr, giving a mannitol IV bolus, or checking arterial blood gases for metabolic alkalosis are not the most effective methods for alkalizing the urine in this case.

In this scenario, the question is asking about when it may be acceptable to forego gastric emptying in patients who have ingested something. The correct answer is "Large doses many hours earlier but are asymptomatic." This means that if a patient has ingested a large dose of a substance many hours ago but is not showing any symptoms, it may not be necessary to perform gastric emptying. This is because the substance has likely already been absorbed or metabolized by the body, and there is no immediate danger to the patient.

The patient's frostbite injury is considered third degree because the description of the patient's feet being white and solid to the touch suggests severe tissue damage. Third degree frostbite is characterized by complete tissue destruction and can result in the loss of affected body parts.

Charcot's Triad is a set of three clinical signs/symptoms that are associated with cholangitis. These include right upper quadrant pain, fever (chills), and jaundice. This triad is often indicative of an infection in the biliary system, specifically the common bile duct. It is named after Jean-Martin Charcot, a French neurologist who first described these signs in relation to cholangitis. Bouchard's Nodes, Chandelier's Sign, and Chvostek's Sign are unrelated to the signs/symptoms described in the question.

The PQRST mnemonic is commonly used to assess and describe pain. The options provided describe different aspects of pain assessment. The first option, P, refers to prodromal (early signs) or palliative (relieving factors) symptoms. The second option, Q, refers to the quality of pain, such as stabbing or aching. The third option, R, refers to the region and radiation of pain. The fourth option, S, is the correct answer, as severity is typically assessed on a scale of 0 to 10, not 0 to 20.

Lorazepam (Ativan) is the correct answer because it is a benzodiazepine that acts as a sedative and anxiolytic. It can help to calm the individual and reduce agitation and anxiety associated with cocaine use. This can indirectly help to lower blood pressure, heart rate, and body temperature, which are the adrenergic manifestations of cocaine use. Nitroprusside (Nipride) is a vasodilator used to treat hypertensive emergencies, but it does not directly address the other adrenergic symptoms. Chlorpromazine (Thorazine) is an antipsychotic medication that may help with agitation, but it is not specifically indicated for the adrenergic symptoms of cocaine use. Beta-adrenergic antagonists may help with hypertension and tachycardia, but they do not address hyperthermia or provide sedation.

The patient in this scenario is presenting with signs of hypovolemic shock, such as low blood pressure and a slow heart rate. Despite receiving 2 L of crystalloids, the vital signs remain unchanged, indicating that the patient may require additional interventions to improve their hemodynamic status. Dopamine (Intropin) is a vasopressor medication commonly used in the management of hypotension. By initiating a dopamine infusion, it can help increase the patient's blood pressure and improve perfusion to vital organs. Infusing colloids, administering packed red blood cells, or continuing crystalloid bolus may not address the underlying issue of hypovolemia and may not be as effective in improving the patient's hemodynamics.

The correct answer is complete voice rest. In this case, the woman is experiencing symptoms of upper respiratory infection (URI) including hoarseness, pain with speaking, nasal congestion, and dysphagia. These symptoms indicate inflammation and irritation of the throat and vocal cords. Complete voice rest involves avoiding any vocal activities, allowing the vocal cords to rest and heal. This is the most appropriate recommendation to alleviate the symptoms and promote recovery. Whispering and gargling with alcohol or aspirin and salt water may further irritate the vocal cords and prolong the healing process.

Left axis deviation is not a characteristic of Mitral Stenosis. Mitral Stenosis is a condition where the mitral valve in the heart becomes narrowed, causing obstruction of blood flow from the left atrium to the left ventricle. Common characteristics of Mitral Stenosis include atrial fibrillation, absence of visible P waves on an ECG, and an irregularly irregular rhythm. However, left axis deviation refers to a deviation in the electrical axis of the heart, which is not typically associated with Mitral Stenosis.

Beck's triad is a classic clinical finding associated with cardiac tamponade. It consists of three components: hypotension, muffled heart tones, and severe jugular venous distention. Tachycardia, which refers to an abnormally fast heart rate, is not a component of Beck's triad.

The symptoms of hypertension, increased temperature, and dilated pupils are consistent with amphetamine abuse. Amphetamines are stimulant drugs that can cause an increase in blood pressure, elevated body temperature, and dilation of the pupils. These symptoms are often seen in individuals who have taken amphetamines, indicating that the patient may have abused amphetamines.

Pain with finger extension would be an early sign of compartment syndrome. Compartment syndrome occurs when there is increased pressure within a closed space, such as the forearm, leading to impaired blood flow and tissue damage. Pain with finger extension suggests that the muscles and tissues within the forearm are being compressed and unable to expand properly, causing pain. This is an early sign of compartment syndrome and should be promptly addressed to prevent further complications.

Hypokalaemia refers to low levels of potassium in the blood. One of the changes that can occur with hypokalaemia is small or absent T waves on an electrocardiogram (ECG). This is because potassium plays a crucial role in the repolarization phase of the cardiac action potential, and low levels can affect the T wave. Another change associated with hypokalaemia is slight depression of the ST segment. First or second degree AV block can also be seen with hypokalaemia. However, wide QRS complexes are not typically associated with hypokalaemia. Wide QRS complexes are more commonly seen in conditions such as bundle branch block or ventricular tachycardia.

The correct answer is administration of anticonvulsants. Hydrocephalic infants are at risk for seizures due to increased intracranial pressure. The shunt dysfunction can further exacerbate this risk. Therefore, it is important for the nurse to anticipate the need for anticonvulsant medication to prevent seizures during transportation to the tertiary care center. The other options, such as ventilatory assistance, manual pumping of the shunt, and elevation of the head of bed, may be necessary interventions for other conditions but are not specifically indicated for a hydrocephalic infant with shunt dysfunction.

During the assessment of a patient in diabetic ketoacidosis, the emergency nurse would expect to find rapid, deep respirations, orthostatic hypotension, and a fruity odor on the breath. However, cool, clammy skin would not be expected in a patient with diabetic ketoacidosis. This is because diabetic ketoacidosis is a condition characterized by high levels of ketones in the blood, which can lead to dehydration and electrolyte imbalances. These imbalances can cause dry skin rather than cool, clammy skin.

Right Axis Deviation (RAD) is a deviation of the electrical axis of the heart to the right. It can be caused by various conditions, such as chronic lung disease, anterolateral myocardial infarction, and pulmonary embolus. Left ventricular hypertrophy, however, is not a cause of RAD. Left ventricular hypertrophy refers to the thickening of the left ventricle of the heart, which can be caused by conditions such as hypertension or aortic stenosis. While left ventricular hypertrophy can cause changes in the electrical activity of the heart, it typically does not result in RAD.

During the transport of an adult patient with suspected cardiac tamponade, tachycardia is the earliest clinical sign. Cardiac tamponade is a condition where fluid accumulates in the pericardial sac, putting pressure on the heart. This can lead to decreased cardiac output and subsequent compensatory mechanisms, such as an increase in heart rate (tachycardia), to maintain adequate blood flow. Hypotension, anxiety, and jugular venous distention may occur later as the condition progresses. Therefore, tachycardia is the earliest sign that can be observed during transport.

To promote patient comfort in this case, applying an icebag to the throat would be beneficial. This can help reduce inflammation and provide a numbing effect, alleviating pain and discomfort. It can also help soothe the sore throat and reduce swelling.

Cooling and sedation are the first priorities in treating cocaine overdose because cocaine overdose can lead to hyperthermia and agitation. Cooling the patient helps to lower their body temperature and reduce the risk of complications associated with hyperthermia. Sedation helps to calm the patient and prevent further agitation, which can increase their heart rate and blood pressure. Additionally, sedation can also help to manage any potential seizures that may occur as a result of cocaine overdose.