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Knowledge Assessment and Preparation for the Certified Emergency Nurses Examination
CEN REVIEW QUESTIONS
KNOWLEDGE ASSESSMENT AND PREPARATION FOR THE CERTIFIED EMERGENCY NURSES EXAMINATION Author: Carrie A. McCoy, PhD, MSPH, RN, CEN, Highland Heights, Ky Section Editors: Kathleen Carlson, RN, MSN, CEN, and Carrie A. McCoy, PhD, MSPH, RN, CEN With the current emphasis on credentialing in nursing, many nurses have committed to taking the CEN examination. The following questions have been developed to assist in emergency nursing knowledge assessment and in preparation for the CEN examination. Questions, rationale for the correct answers, and references are provided here for your self-evaluation. ENA has developed educational materials that can be used as further resources for CEN preparation: Emergency Nursing Core Curriculum and CEN Review Manual. For further information on educational review materials, please contact the ENA Association Services Team at (800) 243-8362. REFERENCES 1. Nunnelee JD. Snakebit! How do you know when it’s poisonous? RN 2007;70(9):25-30. 2. Madigan K. Now, intraosseous infusions for adults. Am Nurs Today 2008;3:11-2. 3. Brown-Guttovz H. Action stat: testicular torsion. Nursing 2007;37(10):72. 4. Gilboy N, Tanabe P, Travers D. The emergency severity index version 4: changes to ESI level 1 and pediatric fever criteria. J Emerg Nurs 2005;31:357-62. 5. Pool D. Prevailing over acute pancreatitis. Am Nurs Today 2008; 3:10-2. 6. Atassi K. Water intoxication. Nursing 2008;38(2):72.
QUESTIONS
1. An 8-year-old child is brought to the emergency department after being bitten by a snake when he reached into a pile of rocks. The child states it was a copperhead. Which of the following is true regarding signs or symptoms of a copperhead snake envenomation? A. Numbness at the bite site B. Complaints of diplopia C. Increased platelet count D. Elevated international normalized ratio
2. An adult patient without peripheral access has an intraosseous infusion devise inserted into the anterior proximal tibia. Which of the following is true when caring for a patient with an intraosseous infusion device? A. Placement should be checked by aspirating for blood. B. An intravenous pump must be used to deliver fluid. C. Mild calf edema is normal and will not affect the infusion. D. An intraosseous device can be used for up to 72 hours.
3. A 25-year-old man presents to the emergency department with a 2-hour history of sudden onset of severe right testicular pain. According to the Emergency Severity Index (ESI) version 4, This patient initially should be triaged as level: A. 2 B. 3 C. 4
Carrie A. McCoy, Greater Cincinnati Chapter, is Professor of Nursing, Northern Kentucky University, Highland Heights, Ky, and part-time Staff Nurse, University Hospital, Cincinnati, Ohio. For correspondence, write: Carrie A. McCoy, PhD, MSPH, RN, CEN, 3466 Easton Ln, Burlington, KY 41005; E-mail: [email protected]. J Emerg Nurs 2008;34:348-9. 0099-1767/$34.00 Copyright © 2008 by the Emergency Nurses Association.
D. 5 4. Which of the following signs or symptoms is associated with acute pancreatitis in an adult patient presenting to the emergency department? A. Nausea and vomiting B. Hypertension C. Hyperglycemia D. Epigastric pain radiating to the back
doi: 10.1016/j.jen.2008.04.005
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5. A psychiatric patient with psychogenic polydipsia is brought to the emergency department with lethargy and confusion. Which of the following findings would be consistent with dilutional hyponatremia? A. Urine osmolality 70 mOsm B. Serum sodium 138 mEq/L C. Plasma osmolality 300 mOsm D. Serum creatinine 0.8 mg/dL
2. Correct answer: C Intraosseous needles are placed into the bone marrow and not into a vein (A). Bone marrow may be aspirated with a 5- to 10-mL syringe to check for placement. Although the rate of infusion can be increased with the use of a pump or pressure bag (B), fluid should flow by gravity. Intraosseous devises are designed for short-term use in an emergency until venous access can be obtained. They should be used for less than 24 hours (D). Calf edema should not develop after the intraosseous device is inserted. If calf edema occurs, it is a sign of infiltration, and the device should be removed. Failure to remove the intraosseous device after edema develops places the patient at risk for compartment syndrome. Madigan,2 12. 3. Correct answer: A Sudden onset of severe unilateral testicular pain is a sign of testicular torsion. This patient should be triaged as level 2 because he is at high risk for testicular infarction if torsion is present. Testicular torsion generally is seen in teens and men younger than 30 years. BrownGuttovz,3 72; Gilboy, Tanabe, and Travers,4 358.
ANSWERS
4. Correct answer: D Patients with acute pancreatitis frequently present to the emergency with acute onset of severe abdominal or epigastric pain that radiates to the back. Nausea and vomiting, hypertension, and hyperglycemia may be present but are not specific to pancreatitis. The most common causes of pancreatitis are gallstones and alcohol abuse. Pool,5 10-1.
1. Correct answer: D Copperhead snakes are pit vipers, and their venom has a hemotoxin that injures blood vessels, causes tissue necrosis, and affects blood clotting. Copperhead snakes are the least venous of the pit vipers, and their bites may not cause severe systemic symptoms requiring antivenom in adults. However, children are more vulnerable to the effects of envenomation because of their smaller size. Copperheads are common in the eastern part of the United States. Most pit viper envenomations, except for the Mojave rattlesnake (which injects a neurotoxin), cause severe pain at the site of the bite (A). Severe envenomation causes a prolonged international normalized ratio and decreased platelet count (D). Nunnelee,1 26.
5. Correct answer: A When dilutional hyponatremia occurs because of excess water intake, the patient’s urine will be very dilute and the urine osmolality will be low (less than 75 mOsm/kg). The patient also will have low serum sodium levels (less than 135 mEq/L) and plasma osmolality levels (less than 285 mOsm/kg) because of dilution. Atassi,6 72.
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KNOWLEDGE ASSESSMENT AND PREPARATION FOR THE CERTIFIED EMERGENCY NURSES EXAMINATION Author: Carrie A. McCoy, PhD, MSPH, RN, CEN, Highland Heights, Ky Section Editors: Kathleen Carlson, RN, MSN, CEN, and Carrie A. McCoy, PhD, MSPH, RN, CEN With the current emphasis on credentialing in nursing, many nurses have committed to taking the CEN examination. The following questions have been developed to assist in emergency nursing knowledge assessment and in preparation for the CEN examination. Questions, rationale for the correct answers, and references are provided here for your self-evaluation. ENA has developed educational materials that can be used as further resources for CEN preparation: Emergency Nursing Core Curriculum and CEN Review Manual. For further information on educational review materials, please contact the ENA Association Services Team at (800) 243-8362. REFERENCES 1. Nunnelee JD. Snakebit! How do you know when it’s poisonous? RN 2007;70(9):25-30. 2. Madigan K. Now, intraosseous infusions for adults. Am Nurs Today 2008;3:11-2. 3. Brown-Guttovz H. Action stat: testicular torsion. Nursing 2007;37(10):72. 4. Gilboy N, Tanabe P, Travers D. The emergency severity index version 4: changes to ESI level 1 and pediatric fever criteria. J Emerg Nurs 2005;31:357-62. 5. Pool D. Prevailing over acute pancreatitis. Am Nurs Today 2008; 3:10-2. 6. Atassi K. Water intoxication. Nursing 2008;38(2):72.
QUESTIONS
1. An 8-year-old child is brought to the emergency department after being bitten by a snake when he reached into a pile of rocks. The child states it was a copperhead. Which of the following is true regarding signs or symptoms of a copperhead snake envenomation? A. Numbness at the bite site B. Complaints of diplopia C. Increased platelet count D. Elevated international normalized ratio
2. An adult patient without peripheral access has an intraosseous infusion devise inserted into the anterior proximal tibia. Which of the following is true when caring for a patient with an intraosseous infusion device? A. Placement should be checked by aspirating for blood. B. An intravenous pump must be used to deliver fluid. C. Mild calf edema is normal and will not affect the infusion. D. An intraosseous device can be used for up to 72 hours.
3. A 25-year-old man presents to the emergency department with a 2-hour history of sudden onset of severe right testicular pain. According to the Emergency Severity Index (ESI) version 4, This patient initially should be triaged as level: A. 2 B. 3 C. 4
Carrie A. McCoy, Greater Cincinnati Chapter, is Professor of Nursing, Northern Kentucky University, Highland Heights, Ky, and part-time Staff Nurse, University Hospital, Cincinnati, Ohio. For correspondence, write: Carrie A. McCoy, PhD, MSPH, RN, CEN, 3466 Easton Ln, Burlington, KY 41005; E-mail: [email protected]. J Emerg Nurs 2008;34:348-9. 0099-1767/$34.00 Copyright © 2008 by the Emergency Nurses Association.
D. 5 4. Which of the following signs or symptoms is associated with acute pancreatitis in an adult patient presenting to the emergency department? A. Nausea and vomiting B. Hypertension C. Hyperglycemia D. Epigastric pain radiating to the back
doi: 10.1016/j.jen.2008.04.005
348
JOURNAL OF EMERGENCY NURSING
34:4 August 2008
CEN REVIEW QUESTIONS/McCoy
5. A psychiatric patient with psychogenic polydipsia is brought to the emergency department with lethargy and confusion. Which of the following findings would be consistent with dilutional hyponatremia? A. Urine osmolality 70 mOsm B. Serum sodium 138 mEq/L C. Plasma osmolality 300 mOsm D. Serum creatinine 0.8 mg/dL
2. Correct answer: C Intraosseous needles are placed into the bone marrow and not into a vein (A). Bone marrow may be aspirated with a 5- to 10-mL syringe to check for placement. Although the rate of infusion can be increased with the use of a pump or pressure bag (B), fluid should flow by gravity. Intraosseous devises are designed for short-term use in an emergency until venous access can be obtained. They should be used for less than 24 hours (D). Calf edema should not develop after the intraosseous device is inserted. If calf edema occurs, it is a sign of infiltration, and the device should be removed. Failure to remove the intraosseous device after edema develops places the patient at risk for compartment syndrome. Madigan,2 12. 3. Correct answer: A Sudden onset of severe unilateral testicular pain is a sign of testicular torsion. This patient should be triaged as level 2 because he is at high risk for testicular infarction if torsion is present. Testicular torsion generally is seen in teens and men younger than 30 years. BrownGuttovz,3 72; Gilboy, Tanabe, and Travers,4 358.
ANSWERS
4. Correct answer: D Patients with acute pancreatitis frequently present to the emergency with acute onset of severe abdominal or epigastric pain that radiates to the back. Nausea and vomiting, hypertension, and hyperglycemia may be present but are not specific to pancreatitis. The most common causes of pancreatitis are gallstones and alcohol abuse. Pool,5 10-1.
1. Correct answer: D Copperhead snakes are pit vipers, and their venom has a hemotoxin that injures blood vessels, causes tissue necrosis, and affects blood clotting. Copperhead snakes are the least venous of the pit vipers, and their bites may not cause severe systemic symptoms requiring antivenom in adults. However, children are more vulnerable to the effects of envenomation because of their smaller size. Copperheads are common in the eastern part of the United States. Most pit viper envenomations, except for the Mojave rattlesnake (which injects a neurotoxin), cause severe pain at the site of the bite (A). Severe envenomation causes a prolonged international normalized ratio and decreased platelet count (D). Nunnelee,1 26.
5. Correct answer: A When dilutional hyponatremia occurs because of excess water intake, the patient’s urine will be very dilute and the urine osmolality will be low (less than 75 mOsm/kg). The patient also will have low serum sodium levels (less than 135 mEq/L) and plasma osmolality levels (less than 285 mOsm/kg) because of dilution. Atassi,6 72.
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