MOD 5 Buttaro CH 22-34 201-2015 Flashcards
A patient diagnosed with asthma has been prescribed three bronchodilator treatments but
continues to experience wheezing and shortness of breath. The health care provider caring for
the patient notes an oxygen saturation of 90% on room air. What action is indicated?
a. Administer oxygen and continue to monitor the patient.
b. Contact the respiratory therapist to administer another treatment.
c. Notify the patient’s physician immediately.
d. Reassure the patient that the treatments will take effect soon.
c. Notify the patient’s physician immediately.
Patients with bronchospasm who have oxygen saturations less than 92% on room air and who
fail to improve with nebulizer treatment given three times, need physician consultation.
While
oxygen administration and further nebulizer treatments may be indicated, it is incorrect to
continue to monitor the patient without notifying the physician.
Which symptom in a patient diagnosed with asthma indicates severe bronchospasm?
a. Breathlessness with minimal activity or eating
b. Pausing to breathe while attempting to talk
c. Repetitive, spasmodic coughing at night
d. Wheezing after exposure to a trigger
b. Pausing to breathe while attempting to talk
Inability to speak a full sentence without pausing to breathe indicates severe bronchospasm.
Breathlessness, repetitive and spasmodic coughing, and wheezing are all common signs of bronchospasm and do not necessarily indicate severe bronchospasm.
Which clinical findings are worrisome in a patient experiencing acute bronchospasm,
requiring immediate treatment? (Select all that apply.)
a. A silent chest after previously wheezing
b. Decreasing blood pressure
c. Presence of an urticarial rash
d. Pulsus paradoxus of 10 mm Hg
e. Wheezing on both inspiration and expiration
a. A silent chest after previously wheezing
b. Decreasing blood pressure
c. Presence of an urticarial rash
A silent chest indicates severe spasm and is an ominous sign. Decreasing blood pressure
urticarial rash are present with anaphylaxis, which is a respiratory emergency requiring
oxygen, diphenhydramine or epinephrine.
A pulsus paradoxus greater than 25 mm Hg is worrisome. Wheezing on inspiration and expiration is a common finding and not necessarily an emergency.
A child with no previous history of asthma is brought to the emergency department with
wheezing, stridor, and shortness of breath. When the child is started on oxygen and given a
nebulized bronchodilator treatment, the treatment team notes a wheal and flare rash on the
child’s trunk. What medication will be given immediately?
a. Inhaled racemic epinephrine
b. Intramuscular epinephrine
c. Intravenous diphenhydramine
d. Intravenous ranitidine
b. Intramuscular epinephrine
The patient has signs of anaphylaxis and should be given IM or SC epinephrine immediately as first-line therapy, with this repeated every 5 to 20 minutes as needed to prevent cardiovascular shock.
Inhaled epinephrine is used for acute upper airway bronchospasm.
Diphenhydramine and ranitidine are given as second-line treatment after epinephrine is
administered or for mild, non-life-threatening allergic reactions.
A man self-administers aqueous epinephrine after experiencing a bee sting and developing
angioedema and wheezing. What should the man do next?
a. Obtain transport to an emergency department immediately.
b. Repeat the epinephrine dose if needed and notify a physician of the episode.
c. Resume normal activity if symptom free after 30 to 60 minutes.
d. Take oral diphenhydramine and report any symptoms to a provider.
a. Obtain transport to an emergency department immediately.
The man has a history of anaphylaxis and experienced symptoms after contact with a trigger.
The aqueous epinephrine should be used immediately but does not prevent the need for follow
up in an emergency department for close observation, since continued reaction to the allergen
can occur for 6 to 8 hours. The epinephrine dose may be given if needed before emergency
personnel arrive, but a second dose is not enough to prevent ongoing reaction to the allergen.
A child experiences a snake bite while camping and is seen in the emergency department. The
child’s parents are not able to identify the type of snake. An inspection of the site reveals two
puncture wounds on the child’s arm with no swelling or erythema at the site. The child has
normal vital signs. Which treatment is indicated?
a. Administering antivenom and observing the child for 24 to 48 hours
b. Cleaning the wound, giving tetanus prophylaxis, and observing for 12 hours
c. Performing a type and cross match of the child’s blood
d. Referral to a surgeon for incision and suction of the wound
b. Cleaning the wound, giving tetanus prophylaxis, and observing for 12 hours
The child does not have immediate symptoms of envenomation, since there is no swelling or erythema. Because symptoms may be delayed, and the type of snake is unknown, the child should be observed in an ED or hospital for 12 hours after providing wound care and tetanus prophylaxis.
Antivenom is not indicated unless envenomation occurs. Type and cross match is done if envenomation is severe. Incision and suction of the sound is not recommended.
A patient is seen in the emergency department after experiencing a spider bite. The spider is in
a jar and is less than one inch in size, yellow-brown, and has a violin-shaped marking on its
back. Depending on the patient’s symptoms, which treatments and diagnostic evaluations may
be ordered? (Select all that apply.)
a. Airway management
b. An acute abdominal series
c. Antivenom therapy
d. CBC, BUN, electrolytes, and creatinine
e. Coagulation studies
f. Tetanus prophylaxis
d. CBC, BUN, electrolytes, and creatinine
e. Coagulation studies
f. Tetanus prophylaxis
The spider is a brown recluse. If the patient exhibits systemic symptoms, laboratory workup, including CBC, BUN, creatinine, electrolytes, and coagulation studies should be performed. Tetanus prophylaxis is given. Airway management, an acute abdominal series, and antivenom therapy are used for black widow spider bites.
Which cardiac arrhythmia in an unstable patient requires unsynchronized shocks, or defibrillation? a. Atrial fibrillation b. Atrial flutter c. Monomorphic ventricular tachycardia d. Polymorphic ventricular tachycardia
d. Polymorphic ventricular tachycardia
Polymorphic ventricular tachycardia should be treated as ventricular fibrillation with
unsynchronized shocks. The other arrhythmias are treated with synchronized cardioversion.
What is true when considering activated charcoal for gastrointestinal decontamination to treat
a toxic substance ingestion?
a. It acts by enhancing gastric motility to reduce absorption.
b. It is administered only through a nasogastric tube.
c. It may be used when petroleum distillates are ingested.
d. Its use is controversial, though in specific situations can be used.
d. Its use is controversial, though in specific situations can be used.
The use of activate charcoal is controversial, though in specific situations can be used for
gastrointestinal decontamination. It absorbs ingested substances and reduces absorption and may cause bowel obstruction;
it does not increase bowel motility.
It may be given orally or by nasogastric tube.
Because it is associated with vomiting, it should not be used when caustic substances, alcohols, and petroleum distillates are ingested.
A lawn maintenance worker is brought to the emergency department after an accident in
which a large amount of pesticide was sprayed all over his clothing. He can relate the details
of the accident to the emergency department personnel. What is the priority treatment on
admission?
a. Administer intravenous diphenhydramine and possibly epinephrine.
b. Contact the Poison Control center to ask about appropriate antidotes.
c. Place on a cardiorespiratory monitor and establish intravenous access.
d. Remove the patient’s clothing and irrigate the skin for 15 to 30 minutes.
d. Remove the patient’s clothing and irrigate the skin for 15 to 30 minutes.
Most skin exposure to chemicals must be treated immediately with copious irrigation with water, so this is the initial priority in a stable patient. Since he can converse with staff, he is likely to be stable. If signs of anaphylaxis occur, diphenhydramine and epinephrine are indicated. The Poison Control center should be contacted, but this is not the priority. After irrigation to minimize exposure, other interventions, such as cardiorespiratory monitoring and
IV access, may be necessary.
A child is brought to the emergency department (ED) when a grandparent suspects ingestion
of a tricyclic antidepressant medication found in the bathroom. What symptoms will the ED
professionals expect to observe if this is the case? (Select all that apply.)
a. Excessive salivation
b. Flushed skin
c. Hallucinations
d. Hypothermia
e. Mydriasis
f. Urinary frequency
b. Flushed skin
c. Hallucinations
e. Mydriasis
Tricyclic antidepressants will cause anticholinergic effects, including flushing of the skin, hallucinations or psychosis, and mydriasis. These medications also cause dry mucous membranes, hyperthermia, and urinary retention.
An adolescent male has received an electrical injury from a high-voltage wire that was found lying on the ground. The adolescent is stabilized by the emergency medical service (EMS) personnel who responded to the call. Upon arrival at the emergency department, which diagnostic test is the priority?
a. 12-lead electrocardiogram
b. Cervical spine radiography
c. Complete blood count and electrolytes
d. Creatine kinase and myoglobin level
a. 12-lead electrocardiogram
An early essential assessment in all patients with electrical injury is a 12-lead ECG to assess arrhythmias and conduction disturbances. The other labs are part of the initial workup, but not a priority over the ECG. A C-spine radiograph is done if cervical injury is suspected.
What is true about electrical injuries? (Select all that apply.)
a. Alternating current causes tetanic skeletal muscle contractions.
b. Direct current is more dangerous than alternating current.
c. Electrical injury causes more tissue necrosis in nerves than other tissues.
d. Lightning is less lethal because the duration of electrical strike is short.
e. Low-voltage contact has no potential to be lethal.
a. Alternating current causes tetanic skeletal muscle contractions.
c. Electrical injury causes more tissue necrosis in nerves than other tissues.
d. Lightning is less lethal because the duration of electrical strike is short.
Alternating current tends to be more lethal than direct current because it causes tetanic muscle contractions. Electrical injury affects nerves more than other tissues because nerve tissue has the least resistance to direct flow and is most easily damaged. Lightning, although it has a voltage of 10 million to 2 billion volts, has a short duration of contact. Alternating current is more dangerous than direct current. Low-voltage contact has the potential to be lethal.
When performing diagnostic tests to determine which environmental allergens cause symptoms in an atopic patient, which aspects of scratch testing are preferable to other methods? (Select all that apply.)
a. It has a lower potential for anaphylaxis.
b. It is more sensitive.
c. It is safer.
d. It produces more rapid results.
e. It requires a stepwise approach.
a. It has a lower potential for anaphylaxis
c. It is safer.
d. It produces more rapid results.
Scratch testing involves scratching the surface of the skin. This method has a lower potential for anaphylaxis, is safer, and has more rapid results. It is not as sensitive as the intradermal method, which requires a stepwise approach.
Which food allergies in children may be outgrown in the first decade of life? (Select all that apply.)
a. Egg allergy
b. Fish allergy
c. Milk allergy
d. Nut allergy
e. Shell fish allergy
a. Egg allergy
c. Milk allergy
Both egg and milk allergy may be outgrown within the first decade of life. Fish, nut, and shell fish allergies are more common in adults and have a higher incidence of lifetime allergy.
A patient is brought to the emergency department after being hit in the head with a baseball. The patient is awake and talking but is confused and disoriented and does not obey simple commands. The patient can point to the area of pain and opens eyes only when commanded to do so. Bystanders report a period of unconsciousness lasting almost 5 minutes. Which severity of traumatic brain injury is likely?
a. Normal
b. Mild
c. Moderate
d. Severe
c. Moderate
This patient’s Glasgow Coma score (GCS) is 11, based on eye opening to verbal command (3), ability to localize pain (4), and conversing while confused (4). The patient was unconscious less than 10 minutes, which usually indicates less severe injury. A patient with a GCS between 9 and 12 with or without loss of consciousness is considered to have a moderate head injury.
A patient is in the emergency department after sustaining a blow to the head in a motor
vehicle accident. The patient’s Glasgow Coma score (GCS) is 14 and the patient is drowsy.
The patient has a small amount of blood in one external auditory canal. Which is a priority in diagnosing the extent of injury in this patient?
a. Close monitoring of pulse, respiration, and oxygenation
b. Continued assessment of neurological status
c. Magnetic resonance imaging of the head
d. Non-enhanced computed tomography of the head
d. Non-enhanced computed tomography of the head
Although this patient’s GCS is nonconcerning, the type of injury and the sign of blood in the external auditory canal put this patient at high risk for skull fracture, so a head CT is indicated immediately. Close monitoring of vital signs and neurological status should be continuously performed, the CT is a priority to help determine the treatment needed. MRI is not especially useful but may be performed after CT if more detail of structures is needed.
A patient who sustained a head injury has a Glasgow Coma score (GCS) of 14. The patient’s spouse reported that the patient lost consciousness for approximately 7 minutes after falling down the stairs. A head computed tomography (CT) scan does not reveal brain lesions. Which treatment is indicated?
a. Admission to the hospital with a neurosurgical evaluation
b. Continued observation in the emergency department until stability is ensured
c. Discharge to home with close observation by the patient’s spouse for 24 hours
d. Dismissal to home with a referral for follow-up with a neurologist
a. Admission to the hospital with a neurosurgical evaluation
This patient had loss of consciousness longer than 5 minutes and has a GCS of 14; both are indications for admission to the hospital with a neurosurgery consult, even though the CT is currently normal.
A young adult patient is being treated for hypertension and is noted to have a resting blood pressure of 135/88 mm Hg just after finishing a meal. After standing, the patient has a blood pressure of 115/70 mm Hg. What is the likely cause of this change in blood pressure?
a. A hyperglycemic episode
b. Antihypertensive medications
c. Neurogenic orthostatic hypotension
d. Postprandial hypotension
b. Antihypertensive medications
Medications to treat hypertension may cause orthostatic hypotension. Hypoglycemia may cause hypotension. Neurogenic orthostatic hypotension is less likely since there is no direct connection to the neurological system. Postprandial hypotension occurs in elderly patients.
An elderly patient who experiences orthostatic hypotension secondary to antihypertensive medications is noted to have a drop in systolic blood pressure of 25 mm Hg. Which intervention is important for this patient?
a. Administration of intravenous fluids
b. Close monitoring cardiorespiratory status
c. Initiation of a fall risk protocol
d. Withholding antihypertensive medications
c. Initiation of a fall risk protocol
A reduction of systolic blood pressure >20 mm Hg is a risk factor for falls in the elderly, so a fall risk protocol should be initiated. Unless the patient is dehydrated, IV fluids are not recommended. Close monitoring of CR status will not prevent falls. Withholding antihypertensive medications often worsens orthostatic hypotension.
During chemistry class, a nursing student has accidentally splashed a chemical into his or her left eye. What intervention has priority while awaiting the arrival of the emergency medical service (EMS) personnel?
a. Flushing the eye with water
b. Removing the student to a quiet, dark area
c. Encouraging the student to relax and remain calm
d. Securing a sample of the chemical to be given to EMS
a. Flushing the eye with water
In general, skin and eye decontamination are done immediately on hospital arrival (should be started prehospital, if possible, and completed on hospital arrival). While encouraging the student to remain calm and placing them in a quiet environment as well as preparing to provide a sample of the chemical may all be helpful, none of those interventions have priority over beginning the decontamination of the eye.
A patient who ingested a bottle of acetaminophen tablets is brought to the emergency department. Which treatment is indicated?
a. Flumazenil
b. N-acetylcysteine
c. Naloxone
d. Supportive care only
b. N-acetylcysteine
N-acetylcysteine is used as an antidote for acetaminophen overdose.
Flumazenil is used to treat benzodiazepine overdose. Naloxone is given for opioid overdose.
What is the priority in emergency management of a biological terrorism attack?
a. Basic life support
b. Communication with authorities
c. Containing the exposures
d. Informing the public of the risk
c. Containing the exposures
In a bioterrorism attack, the initial priority is to contain the exposures and prevent expansion of the event to others. Basic life support is the second priority and close communication with authorities is the third priority. Informing the public is a later priority after the situation has been stabilized.
- When beginning a health maintenance exam, the health care provider learns that an adult patient has been sexually assaulted the previous day. What is the initial responsibility of the provider?
a. Notify the police and encourage the patient to press criminal charges.
b. Perform a thorough gynecological exam and obtain cultures.
c. Question the patient about the events surrounding the assault.
d. Refer the patient to the emergency department (ED) for a forensic examination.
d. Refer the patient to the emergency department (ED) for a forensic examination.
If a patient has been sexually assaulted within the past 5 days, and especially if within the previous 72 hours, the provider should defer a physical examination and refer the patient to the ED for a forensic examination. It is not necessary to notify the police unless the victim is a child, elderly, or disabled. The provider should not perform the exam—a forensic exam ensures that standard protocol is followed, and appropriate evidence is obtained. Retelling the story of the assault may be traumatizing to the patient, so this should be left to providers performing the forensic exam.
A patient who was sexually assaulted one month prior tells her provider that she is concerned about contracting human immunodeficiency virus (HIV). When is it appropriate to perform testing?
a. Immediately and then every 6 months for the first year
b. Immediately with definitive results
c. In 2 weeks and then 3 to 6 months after the assault
d. Three to six months after the assaul
c. In 2 weeks and then 3 to 6 months after the assault
Because of the length of time for seroconversion to occur, patients concerned about HIV exposure should be tested 6 weeks after and then 3 to 6 months after the assault. Immediate results will not provide accurate information. The initial testing should be 6 weeks after potential exposure.
During a health maintenance examination, 17-year-old female reports having been raped repeatedly at a college party during the previous semester and tells the practitioner that she did not seek help at the time. Which action is a priority for the primary care provider?
a. Recommending counseling at a local mental health center
b. Referring the patient to the emergency department for sexually transmitted
infection (STI) testing
c. Reporting the alleged assault to law enforcement
d. Suggesting that the patient report the incident to the school
c. Reporting the alleged assault to law enforcement
Any sexual assault perpetrated on a victim younger than 18 years must be reported to the local child or adult protective agency as well as to law enforcement, regardless of whether the patient reports that sexual assault occurred. Counseling, STI testing, and reporting the incident to the school are important, but are not the priority.
