Medical Tests Medical Tests Certifications CEN Questions & Answers

• Question 41:

  You are caring for a patient with a gunshot wound. As a result of the patient's Coumadin therapy, the prothrombin time is twice the normal amount. Which blood product do you expect the physician to order?

  A. Fresh frozen plasma

  B. Random donor platelets

  C. Red blood cells

  D. Crystalloids

  Correct Answer: A

  The patient with a prothrombin time greater than 1.5 times normal who is bleeding should receive fresh frozen plasma. A patient with thrombocytopenia would receive platelets. Anemic patients receive red blood cells, and crystalloids help establish and maintain fluid and electrolyte balance.

• Question 42:

  You are caring for a patient who has been receiving a blood transfusion for the last 30 minutes. On assessment, you find the patient to be dyspneic and show bilateral crackles and a heart rate of 110. Which of the following complications do you suspect the patient is experiencing?

  A. Immune response

  B. Hypovolemia

  C. Fluid overload

  D. Polycythemia vera

  Correct Answer: C

  The patient exhibiting these signs and symptoms is most likely going into fluid overload. Crackles in the lungs would not be associated with the other options. The physician should be notified to get a diuretic for the patient.

• Question 43:

  You determine that the patient you are caring for is having a transfusion reaction. You stop the blood immediately. Which action would you take next?

  A. Notify a physician.

  B. Determine the patient's white blood cell count.

  C. Administer normal saline at KVO.

  D. Administer normal saline bolus.

  Correct Answer: C

  The nurse should start normal saline at KVO for this patient to keep the IV open. Then the nurse should notify the physician of the reaction. The physician may order a white blood cell count or normal saline bolus, but the nurse should not initiate either without an order.

• Question 44:

  Which IV fluids would you need to hang with a transfusion?

  A. Lactated ringers

  B. Dextrose 5% and normal saline 0.9%

  C. Dextrose 5% and normal saline 0.45%

  D. Normal saline 0.9%

  Correct Answer: D

  The nurse should hang normal saline 0.9% with a transfusion. All other options are contraindicated due to clotting and hemolysis. Normal saline is the only option that can be hung with a transfusion.

• Question 45:

  You are about to administer blood to a patient. You have verified that it is the correct blood for the patient with another nurse. What do you need to assess before you start the blood?

  A. Vital signs

  B. Skin color

  C. Hemoglobin level

  D. Creatinine level

  Correct Answer: A

  The nurse needs to assess vital signs prior to beginning a transfusion. Most transfusion reactions happen in the first 15 minutes of a reaction. It is important for the nurse to have set of baseline vital signs to determine if the patient is having a reaction.

• Question 46:

  You are caring for a patient who was brought into the emergency department unresponsive, hypotensive and tachypneic. Upon further assessment, you realize that the patient's temperature is 106 degrees Fahrenheit. You suspect heat stroke. What would your priority nursing intervention be?

  A. Obtain a history from the patient.

  B. Take oral temperature to monitor effectiveness of treatment.

  C. Call the family for consent to treat.

  D. Take off the patient's clothing, wrap him or her in wet towels and place a fan on the patient.

  Correct Answer: D

  The nurse's priority would be to undress and wrap the patient in wet towels and place a fan on him or her. Interventions must be taken quickly to lower the body temperature because heat stroke is life threatening. Core body temperatures should be monitored for effective treatment.

• Question 47:

  You are caring for a patient in shock. Which parameter would you want to monitor to determine if treatment is effective?

  A. Cardiac output

  B. Respiratory rate

  C. Peripheral pulse rate

  D. Central venous pressure

  Correct Answer: A

  The nurse needs to monitor the cardiac output to determine if treatment is effective. The cardiac output monitors the left ventricular function of the heart. The peripheral pulses and respiratory rate may remain within normal, so they are not the best indicators of treatment effectiveness.

• Question 48:

  Which finding would make you suspect that your patient might be in cardiogenic shock?

  A. Decreased or muffled heart sounds

  B. A cardiac index greater than 2.2 L/min

  C. Bounding pulses

  D. Increased cardiac output

  Correct Answer: A

  In cardiogenic shock the patient heart sounds will become decreased or muffled. This is caused by the myocardium's decreased ability to pump due to weakening by blood or fluid. This would cause a decreased cardiac index, decreased cardiac output and weak, thready pulses.

• Question 49:

  Your patient has been stung by a bee. What signs and symptoms would you see if the patient had an allergic reaction to the sting?

  A. Normal respiratory rate

  B. Prolonged expiratory phase

  C. Wheezing on inspiration

  D. Decreased respiratory rate

  Correct Answer: B

  The nurse would want to monitor the patient for a prolonged expiratory phase. The allergic reaction would lead to air trapping and alveoli distention that occurs as a result of an anaphylactic response. Respiratory rate will be within normal limits, and wheezing occurs on expiration due to constricted bronchi.

• Question 50:

  Your patient has come into the emergency department with a self-inflicted wrist laceration that has severe bleeding. You have begun to apply pressure to the wound. What would your immediate priority be?

  A. See to the patient's need for psychiatric evaluation.

  B. Lower the patient's body temperature to decrease circulation.

  C. Place the extremity below the level of the heart.

  D. Monitor the patient for signs of shock.

  Correct Answer: D

  The nurse would need to monitor this patient for hypovalemic shock. Symptoms of shock would include tachycardia, cool, clammy skin and a change in level of consciousness. Hypovolemia leads to vasoconstriction and shunting of blood to central circulation. The patient will need to have a psychiatric evaluation, but it is not priority.