20220928102743_6334219f5cde6_ena_emergency_nursing_orientation_3.docx (2)
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Chamberlain College of Nursing *
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Course
602
Subject
Nursing
Date
Nov 24, 2024
Type
docx
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87
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ENA Emergency
Nursing
Orientation
3.0
All Questions Review 2023-2024
Which
type
of
shock
causes
a
temporary
loss
of
motor,
sensory,
and reflex
functions below
the
level
of
a
lesion?
-
ANSWER
Spinal
shock
According
to
the
rule
of
nines,
burns
of
the anterior
trunk
and
both anterior
arms account
for
which percentage
of
body
surface
area?
- ANSWER
27
percent
Which
effect
does
parasympathetic
stimulation
have
on the
heart? A.
It increases
peripheral
vascular
resistance.
B.
It
enhances
atrioventricular
node
function.
C.
It
shortens
His-Purkinje
and
ventricular
muscle refractoriness. D.
It
slows
sinoatrial
node
discharge.
- ANSWER D.
Parasympathetic stimulation slows sinoatrial node discharge. Sympathetic
stimulation enhances atrioventricular node function, shortens His-Purkinje
and ventricular muscle refractoriness,
and
increases peripheral
vascular
resistance.
Hypertension
is
a
finding
in
which
type
of
poisoning?
A.
Opioid
B.
Antidepressa
nt C. Anticholinergic
D.
Organophosphate
-
ANSWER
C
For
a
patient
with
chronic
immune
thrombocytopenia,
which
intervention is
the
initial treatment?
A.
Infuse
intravenous
immunoglobulin.
B.
Administer
prednisone (Deltasone). C.
Prepare
the
patient for
a
splenectomy.
D.
Administer
cyclophosphamide
(Cytoxan).
-
ANSWER
B.
Administer prednisone (Deltasone).
For
which
disorder
is
phenazopyridine
(Pyridium)
most
commonly administered?
- ANSWER
D. Urethritis
Rhabdomyolysis
is
a
complication of
which
type
of
toxicity?
A.
Central
nervous
system
stimulant
B.
Opiate
C.
Tricyclic
antidepressant
D.
Calcium
channel
blocker
-
ANSWER
A.
Central
nervous
system
stimulant
Which intervention is used to treat a patient with ventricular fibrillation who has an implantable
cardiac
defibrillator?
-
ANSWER
Apply
hands-free adhesive
patches
in
the anterior-posterior position
and
defibrillate.
For
which
disorder
is
phenazopyridine
(Pyridium)
most
commonly administered?
- ANSWER
D. Urethritis
Which
term
defines pain
caused
by
the stretching
of
a
hollow
organ and
is described
as cramping
or
a
sensation
of
gas? -
ANSWER
Visceral
pain
When
a
patient
is
in
the
compensatory
stage
of
shock,
the
body
preferentially
maintains blood
flow
to
which organs?
-
ANSWER
heart
and
brain
Which laboratory test result should the nurse expect in a patient with alcoholic ketoacidosis?
-
ANSWER
Below
normal
to
slightly
elevated serum
glucose
level
Which
finding
is
characteristic
of
preeclampsia?
-
ANSWER
Proteinuria
Sciatic
nerve
damage
is
associated
with
dislocation
of
which
joint?
A.
Patellar
B.
Kne
e C. Hip
D.
Ankle -
ANSWER
C.
Hip
Which
intervention
is
indicated
for
a
patient
with
circumferential
full-
thickness
burns
of the
chest,
inadequate
chest
expansion,
and restlessness?
-
ANSWER
Escharotomy
Calcium
channel
blockers
are
indicated
to
treat
which dysrhythmia? A.
Atrial
fibrillation
B.
Accelerated
junctional
tachycardia
C.
Second-degree
atrioventricular
block,
type
II
D.
Polymorphic
ventricular
tachycardia
-
ANSWER
A.
Treatment
of
atrial
fibrillation
aims
to
control
the
rapid
ventricular
rate
with medications,
such as calcium channel blockers or beta-blockers. Calcium channel blockers
are not used to treat the other dysrhythmias listed. Accelerated junctional tachycardia is a transient rhythm that only requires treatment of the underlying disorder. Patients with second-degree atrioventricular block, type II, require careful monitoring and may need transcutaneous
pacing. Treatment
for
polymorphic
ventricular
tachycardia
is
magnesium sulfate
and
defibrillation if
the
patient's
condition
is
unstable.
Activated
charcoal
can
absorb
which
substance?
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A.
Cyanide
B.
Kerosen
e C.
Lead
D.
Potassium
-
ANSWER
B
Which
herb
can
decrease
the
clotting
time?
A.
Evening
primrose
B.
Cinnamo
n C.
Garlic
D.
Skull
cap
-
ANSWER
B.
Cinnamon
Which
medication
causes
urine
retention?
-
ANSWER
D.
Diphenhydramine (Benadryl)
The
ingestion
of
the
foxglove
plant
can
cause
which
finding?
A.
Hypertension
B.
Bradycard
ia C. Agitation
D.
Lacrimation
-
ANSWER
B.
Bradycardia
Which
medication
causes
urine
retention?
-
ANSWER
D.
Diphenhydramine (Benadryl)
For
a
patient
with
a
gunshot
wound,
which
intervention
is
appropriate?
A.
Perform
a
neurovascular
assessment
of
each
limb.
B.
Estimate
the
amount
of
injury
based
on
the
wounds
appearance.
C.
Remove
projectiles
with
Kelly
clamps
and
place
them
in
a
sterile container. D.
Label the
entrance
and exits
wounds.
-
ANSWER
A. Perform
a
neurovascular assessment
of
each
limb.
Which
disorder
is
associated
with
fatty,
foul-smelling
stool?
-
ANSWER Pancreatitis
Emergency
needle
thoracentesis
is
a
treatment
for
which
type
of
shock
- ANSWER obstructive
shock
In
a
patient
with
diabetic
ketoacidosis,
the
nurse
should
expect
to
find
which effect
of ketoacidosis? -
ANSWER
Tachycardia
In
a
pregnant
patient,
which
assessment
finding
may
signal
the
onset
of preeclampsia?
-
ANSWER
A
systolic
blood
pressure
greater
than
140
mm Hg
Which
dysrhythmia
has
an
irregularly
irregular
ventricular
response
-
ANSWER
Atrial fibrillation
Which
of
the
following
statements
regarding
autonomic
dysreflexia
is
correct?
- ANSWER
It
may
occur
at
any
time
after spinal
shock
has subsided.
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A
scald
burn
is
most
likely
to
result
from
which
mechanism?
-
ANSWER Exposure
to water
at 140°F
(60°C)
Which
intervention
is
used
to
treat
a
patient
with
ventricular
fibrillation who
has
an implantable
cardiac
defibrillator?
A.
Apply
hands-free
adhesive
patches
in
the
anterior-posterior
position
and defibrillate. B.
Wait for
the
device
to
fire.
C.
Apply
hands-free
adhesive
patches
in
the
standard
position
and
cardiovert.
D.
Apply
one
hands-free
adhesive
patch
over
the
device
and
the
other
on
the opposite side of
the
sternum
and
defibrillate. -
ANSWER
A.
When
a
patient
with
an
implantable
cardiac
defibrillator
requires
external defibrillation
because the implanted device has malfunctioned or failed, ideally place hands-free adhesive patches in the anterior-posterior position. Do not wait for the device to fire because
a
malfunction
has
occurred
if
ventricular fibrillation
is
present.
Cardioversion
is not appropriate because no QRS complexes are present for synchronization. Do not place
the
adhesive patches
directly
over
the implantable
cardiac
defibrillator.
Organophosphate
toxicity
produces
which
sign
or
symptom?
A.
Constipation
B.
Salivatio
n C. Mydriasis
D.
Hot,
dry
skin
-
ANSWER B
A
patient
with
severe
neutropenia
has
a
temperature
of
100.4°F
(38°C). Which intervention
is
indicated
for
this
patient?
A.
Obtain
blood
cultures.
B.
Maintain
respiratory
isolation.
C.
Administer
packed
red
blood
cells.
D.
Administer
antibody-purified
factor IX.
-
ANSWER
A.
Obtain
blood
cultures.
The
administration
of
azithromycin
(Zithromax)
is
indicated
for
which sexually transmitted
infection?
-
ANSWER
C.
Chlamydia
infection
Which
gastric
decontamination
technique
is
most
effective
for
treating
a patient
who
has swallowed
cocaine-filled
balloons?
A.
Whole
bowel
irrigation
B.
Activated
charcoal administration C.
Gastric lavage
D.
Syrup
of
ipecac
administration
-
ANSWER
A.
Whole
bowel
irrigation
Which of the following is the first step performed when removing a helmet from a suspected spinal injured
patient? -
ANSWER
Apply
in-line
stabilization by
placing
hands on
each side
of
the
helmet
with
fingers on
the patient's
mandible.
The
administration
of
azithromycin
(Zithromax)
is
indicated
for
which sexually transmitted
infection?
-
ANSWER
C.
Chlamydia
infection
Which
fracture
results
in
multiple
splintered
bone
fragments?
A.
Depressed
fracture
B.
Impacted
fracture
C.
Compression
fracture
D.
Comminuted
fracture -
ANSWER
D.
Comminuted
fracture
Which
sign
is
an
indicator
of
cholecystitis
-
ANSWER
Murphy's
sign
Which
disorder
is
a
cause
of
cardiogenic
shock?
-
ANSWER
Dysrhythmias
A
patient
with
hyperosmolar
hyperglycemic
state
is
likely
to
have
which laboratory
test result? -
ANSWER
Normal
blood pH
Which
of
these
is
a
common
cause
of
postpartum
hemorrhage?
- ANSWER
Uterine atony
Which
medication
should
be
administered
during
the
resuscitation
of
a patient
with ventricular
fibrillation?
-
ANSWER
Epinephrine
(Adrenalin)
Which
sexually
transmitted
infection
is
caused
by
bacteria
and
develops as
a
small bump
in
the
genitals? -
ANSWER
A.
Chancroid
Which
hydrocarbon
is
least
likely
to
result
in
aspiration?
A.
Lighter
fluid
B.
Kerosen
e C. Gasoline
D.
Motor
oil
-
ANSWER
D
Which
adjunct
is
most
effective
in
managing
adults
with
sickle
cell
disease?
A.
Hydroxyurea
(Droxin)
B.
Heparin
C.
Prednisone
(Deltasone)
D.
Rho(D)
immunoglobulin
(RhoGAM)
-
ANSWER
A.
Hydroxyurea
(Droxin)
Which
sexually
transmitted
infection
is
caused
by
bacteria
and
develops as
a
small bump
in
the
genitals? -
ANSWER
A.
Chancroid
Which
finding
is
a
sign of
serotonin
syndrome?
A.
Bradycardia
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B.
Diaphoresi
s C. Hypothermia
D.
Lethargy
-
ANSWER
B.
Diaphoresis
Which
sign
or
symptom
is
a
characteristic
of
carbon
monoxide
poisoning?
- ANSWER Headache
Which
receptor
is
located
in
the lungs? A.
Alpha
B. Beta1 C. Beta2
D.
Dopaminergic
-
ANSWER
C.
Beta2
receptors
are
located
in
the
lungs
and
peripheral
vessels.
Alpha receptors
exist
in
vascular
smooth
muscle.
Beta1
receptors
are
in
the
myocardium. Dopaminergic receptors
are found
in
renal,
mesenteric,
cerebral,
and coronary arteries.
A
fracture
of
which
bone
does
not
always
require
anatomic
alignment
for healing?
A.
Wrist
B.
Hip C. Elbow
D.
Clavicle
-
ANSWER
D.
Clavicle
Which
organ
is
responsible
for
absorbing
nutrients
and
other
products
of digestion
- ANSWER
Small
intestine
In
a
pediatric
patient,
which
finding
is
an
early
sign
of
shock?
-
ANSWER Delayed capillary
refill
Which
finding
is
most
closely
associated
with
syndrome
of
inappropriate antidiuretic hormone?
-
ANSWER
Seizures
Your patient with preeclampsia is receiving magnesium sulfate while waiting to be transferred
out
of
the
emergency
department.
While
the patient
is
in
your
care,
you should monitor her closely for which finding? -
ANSWER Absence of deep tendon reflexes
Which
disorder
is
likely
to
produce
a
delta
wave
on
the
cardiac
monitor?
-
ANSWER Wolff-Parkinson-White
syndrome
Which of the following is the first step performed when initiating spinal protection? - ANSWER
Leader
is
positioned
at
the
head
of
the
patient
with
hands
on
each
side
of
the patient's head.
Which
dysrhythmia
has
premature
P
waves
with
a
different
configuration
than
other
P waves in
the
cardiac
cycle?
A.
Atrial
flutter
B.
Premature
atrial
complex
C.
First-degree
atrioventricular
block
D.
Second-degree
atrioventricular
block,
type
II
-
ANSWER
B.
Premature
atrial
complexes
are
ectopic
beats
that
are
initiated
by
an
irritable atrial
focus. P waves are present, but because the ectopic focus originates the impulse outside the sinoatrial node, the premature P waves have a different configuration. Atrial flutter causes no P waves, but it causes flutter waves in a sawtoothed pattern. First- degree atrioventricular block has a P wave for every QRS complex, but the PR interval is
consistently
prolonged.
Second-
degree
atrioventricular
block,
type
II,
has
one
or
more P waves for every QRS
complex. In first-degree atrioventricular block and second- degree atrioventricular
block,
type
II,
the
P
wave
configuration
is
consistent
from
P wave to P
wave
Nutmeg
toxicity
is
likely
to
cause
which
finding?
A.
Hallucinations
B.
Salivation
C.
Rhabdomyolysis
D.
Seizures
-
ANSWER
A
In
a
patient
with
immune
thrombocytopenic
purpura,
which
finding
should you
expect?
A.
Tachypnea
B.
Severe pain C. Petechiae
D.
Narrowing
pulse
pressure
-
ANSWER
C.
Petechiae
Which
is
the
main
electrolyte
disturbance
in
rhabdomyolysis?
-
ANSWER C. Hyperkalemia
Which
drug
can
cause
a
sense
of
omnipotence,
excitement, hyperalertness, hyperactivity,
or
hypersexuality?
A.
Clonidine
(Catapres)
B.
Methaqualone (Quaalude) C. Amphetamine
(Adderall)
D.
Amitriptyline
(Elavil)
-
ANSWER C.
Amphetamine
(Adderall)
Among
patients
with
contact
burns,
which body
region
is
the
most
common injury
site? - ANSWER
Palm
of
the
hand
Volkmann's
contracture
may
be
a
complication
of
which
fracture?
A.
Shoulder
fracture
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B.
Elbow
fracture
C.
Scapular
fracture
D.
Clavicular
fracture
-
ANSWER
B.
Elbow
fracture
Which
is
the
main
electrolyte
disturbance
in
rhabdomyolysis?
-
ANSWER C. Hyperkalemia
What
is
the
cardinal
sign
of
lower
gastrointestinal
bleeding?
-
ANSWER hematochezia
Which
type
of
shock
is
typically
associated
with
acute
spinal
cord disruption
from trauma
or
spinal
anesthesia?
-
ANSWER
Neurogenic shock
Which
medications
can
precipitate
a
hyperosmolar
hyperglycemic
state?
- ANSWER Diuretics
For
a
patient
with
an
obstetric
emergency,
what
are
the
priorities
during the
initial assessment? -
ANSWER
Airway,
breathing,
and
circulation
A
preexcitation
syndrome,
such
as
Wolff-Parkinson-White
syndrome,
results from
which conduction pattern? - ANSWER Atrial impulses bypass the typical
electrical pathway and
activate
the
ventricular
myocardium
directly.
For
a
patient
with
partial
airway
obstruction
who
cannot
tolerate
the
supine position
for spinal stabilization, which intervention is appropriate? - ANSWER Protect the cervical spine in
the
position
the patient
uses
to protect
the airway.
Which
method
delivers
nonsynchronous
energy
to
the myocardium? A.
Transcutaneous
pacing
B. Cardioversion C. Defibrillation
D.
Transvenous
pacing
-
ANSWER
C.
Defibrillation
is
the
nonsynchronous
delivery
of
energy
to
the
heart
during any
phase
of
the cardiac cycle. The intent of this energy delivery is to simultaneously depolarize all of the heart cells, interrupting the abnormal electrical rhythm and allowing the sinoatrial node to resume its normal pacemaker activity. In synchronized cardioversion, energy delivery
is
timed
to
correspond
with
the QRS
complex
to
avoid
shock
delivery
during
the relative refractory period, which can induce ventricular fibrillation. Transcutaneous and transvenous pacemakers electrically stimulate a heartbeat when the heart's intrinsic electrical
system cannot
generate
a rate that
is
adequate
to support
cardiac output.
Which
type
of
toxicity
causes
hyperglycemia?
A.
Methanol
B.
Ethanol
C.
Isopropanol
D.
Ethylene
glycol
-
ANSWER
C
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Which
disorder
is
an
inherited
disease?
A.
Syndrome
of
inappropriate
antidiuretic
hormone
B.
Acute
idiopathic
thrombocytopenic purpura C.
Acute
leukemia
D.
Sickle
cell
disease
-
ANSWER
D.
Sickle
cell
disease
Which
disorder
causes
unbearable
pain
due
to
increased
pressure
and dilation
of
the kidney?
-
ANSWER
B. Prostatitis
For
which
drugs
can
you
obtain
blood
levels to
determine
toxicity?
A.
Morphine
and
hydrocodone
(Vicodin)
B.
Marijuana
and
cocaine
C.
Acetaminophen
(Tylenol)
and
digoxin
(Lanoxin)
D.
Diazepam (Valium) and midazolam (Versed) - ANSWER C. Acetaminophen (Tylenol) and
digoxin
(Lanoxin)
Which
hourly
amount
of
intravenous
fluid
should
the
nurse
administer
to
a 75-kg
patient with
a
significant
electrical
burn?
-
ANSWER
1,500 mL/hour
Which
intervention
is
indicated
for
a
patient
with
an
amputation?
A.
Maintain
the
limb
in
the
correct
anatomic
position.
B.
Clean
the
amputated
part
with
povidone-iodine
(Betadine)
solution. C.
Soak
the stump
in distilled
water.
D.
Place
the
amputated
part
directly
in
ice.
-
ANSWER
A.
Maintain
the limb
in
the correct
anatomic
position.
Which
disorder
causes
unbearable
pain
due
to
increased
pressure
and dilation
of
the kidney?
-
ANSWER
B. Prostatitis
A
woman,
age
27,
presents
to
your
emergency
department
with
chills,
fever,
abdominal pain, nausea, vomiting, and tachycardia. The abdominal pain becomes localized in her right lower quadrant. What is your priority intervention? - ANSWER Initiate intravenous access.
Which
statement
accurately
characterizes
shock
in
a
pregnant
patient?
- ANSWER
The risk
of
fetal
distress exists
despite
maternal
stability.
The
inadequate
or
impaired
secretion
of
antidiuretic
hormone
(ADH [vasopressin]) causes
which
endocrine emergency?
-
ANSWER
Diabetes insipidus
A patient reports that she had a positive pregnancy test 1 week ago and now has left lower
quadrant
pain,
which
was
severe
and
then
seemed
to
get better.
On
assessment, you note that she has a weak radial pulse, tachycardia, and pallor. Which intervention should
you
anticipate
as
the priority? -
ANSWER
Establish vascular
access.
A patient has stable, monomorphic ventricular tachycardia. To perform synchronized cardioversion
with
a
biphasic
defibrillator
and
convert
this dysrhythmia,
which
energy setting
should
be
used first?
-
ANSWER
100
joules
A paraplegic patient comes to the ED with a severe headache and blurred vision. Findings
include
a
flushed
face,
severe
hypertension,
and bradycardia.
What
is
the most
likely cause
of
these signs
and symptoms?
-
ANSWER
Constipation
Which
medication
should
be
administered
during
the
resuscitation
of
a patient
with ventricular
fibrillation?
A.
Ibutilide
(Corvert)
B.
Procainamide (Pronestyl) C. Epinephrine
(Adrenalin)
D.
Sotalol
(Betapace)
-
ANSWER
C.
During the resuscitation of a patient with ventricular fibrillation, administer intravenous epinephrine (Adrenalin) or vasopressin (Pitressin) to enhance the effectiveness of the cardiopulmonary
resuscitation.
Procainamide (Pronestyl)
or
sotalol
(Betapace)
may
be prescribed for a patient with stable ventricular tachycardia. Ibutilide is used to convert new-onset
atrial fibrillation.
A
man,
age
75,
presents
with
blurred
vision,
flushing,
fever,
tachycardia, and
urine retention.
These
manifestations
suggest which toxidrome?
A.
Anticholinergic
B.
Opioid
C.
Sympathomimetic
D.
Cholinergic -
ANSWER
A
Which
statement
accurately
characterizes
immune
thrombocytopenic purpura?
A.
It
is
caused
by
immune
autoreactive
antibodies.
B.
It
occurs
primarily
in adolescents. C.
It
is
more common
in
women.
D.
It
follows
a
bacterial
infection.
-
ANSWER
A.
It
is
caused
by
immune autoreactive antibodies.
Which
patient
should
have
priority
for
room
placement
and
evaluation?
- ANSWER
A.
A man,
age
30,
with
signs
and
symptoms
of testicular
torsion
Glucagon
(GlucaGen)
is
the
antidote
for
which
type
of
poisoning?
A.
Opiate
B.
Beta-blocker
C.
Acetaminophen
(Tylenol)
D.
Digitalis
glycoside
-
ANSWER
B.
Beta-blocker
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Which
type
of
burn
causes
extensive
tissue
damage
from
liquefaction necrosis?
- ANSWER
Chemical
burn
from
an alkali
Which
injury
is
defined
as
a
complete
joint
disruption?
A.
Subluxation
B.
Third-degree strain C. Dislocation
D.
Third-degree
sprain
-
ANSWER
C.
Dislocation
Which
patient
should
have
priority
for
room
placement
and
evaluation?
- ANSWER
A.
A man,
age
30,
with
signs
and
symptoms
of testicular
torsion
Which
laboratory
test
result
indicates pancreatitis?
-
ANSWER
Elevated lipase level
If
a
patient's
pH
is
less
than
7.1,
what
is
the
most
appropriate
initial treatment?
- ANSWER
Ensure adequate
oxygenation
and
ventilation.
In
a
patient
with
diabetic
ketoacidosis,
the
nurse
should
expect
which laboratory finding?
-
ANSWER Decreased
serum
bicarbonate
level
A
woman,
34
weeks
pregnant,
presents
with
acute
respiratory
distress, hypotension, and tachycardia. She complains of a headache and right upper quadrant abdominal pain.
You
should suspect
which
disorder?
- ANSWER
HELLP
syndrome
Which
disorder
can
initiate
atrial
flutter?
-
ANSWER
Pulmonary
embolism
Which
of
the
following
signs
would
be
anticipated
in
a
patient
with
neurogenic
shock?
- ANSWER
Warm,
dry
skin
Which
event
corresponds
with
ventricular contraction? A.
Chordae
tendineae
relaxation
B.
Diastole
C.
Closing
of
the
aortic
valve
D.
Opening
of
the
pulmonary
valve
-
ANSWER
D.
The
systolic
phase
of
the
cardiac
cycle
corresponds
with
ventricular contraction
and
the opening of the pulmonary semilunar and aortic semilunar valves. During ventricular contraction, the atrioventricular valves close, and the chordae tendineae contract to prevent
blood
regurgitation.
Activated
charcoal
may
be
used
beyond
the
60-minute
administration window
to
treat the
ingestion
of which
substance?
A.
An
anticholinergic
medication
B.
An
organic
solvent
C.
A
mineral
acid
D.
Iron
-
ANSWER
A
During
the
primary
survey,
which
finding
requires
immediate
intervention
first?
- ANSWER
Difficulty
swallowing
Which
disorder
may
result
from
radiation
therapy for
a
malignant
pelvic disease?
- ANSWER
B. Prostatitis
An
overdose
of
which
drug
can
cause
hyperreflexia,
opisthotonus,
and increased muscle tone?
A.
Carisoprodol
(Soma)
B.
Baclofen (Lioresal) C. Hydroxyzine (Vistaril)
D.
Buspirone
(BuSpar)
-
ANSWER
A.
Carisoprodol
(Soma)
A
patient
with
an
absolute
neutrophil
count
of
600
cell/mm3
is
at
which
level of
risk
for infection?
A.
None
B.
Mild
C.
Moderate
D.
High
-
ANSWER
C.
Moderate
When
fitting
a
patient
for
a cane,
the
elbow should
be
flexed
to
what
degree?
A. 15 degrees
B. 30 degrees
C. 45 degrees
D.
90
degrees
-
ANSWER
B.
30
degrees
our
patient
is
37
weeks
pregnant
and
reports
some
vaginal
bleeding.
She denies
pain and
trauma.
On assessment,
you
detect
a
fetal
heart
rate
of 140
beats per minute.
Which
disorder
should
you
suspect?
-
ANSWER
Placenta previa
Which of the following statements regarding spinal cord injury without radiographic abnormality
is
accurate?
-
ANSWER
It
is
an
injury
primarily
found
in
younger
children.
Which
disorder
is
potentially
reversible
if
the
cause
is
immediately
treated?
- ANSWER Pulseless
electrical
activity
Which
disorder
may
result
from
radiation
therapy for
a
malignant
pelvic disease?
- ANSWER
B. Prostatitis
When
a
stressor
adversely
affects
a
patient
with
type
1
diabetes
mellitus,
which
action occurs
first?
-
ANSWER
Gluconeogenesis
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Treatment
for
an
acute
exacerbation
of
diverticulitis
includes
which measure?
- ANSWER
Rehydration
with
a
crystalloid
solution
Which
parameter
is
a
resuscitation
endpoint
for
shock?
-
ANSWER
Central
venous pressure of
10
cm
H2O
Which
bacteria
is
the
primary
organism
that
causes
urinary
tract
infections?
-
ANSWER A.
Escherichia
coli
In
most
people,
which
area
of
the
heart
receives
its
blood
supply
from
the right
coronary artery?
A.
Posterior
surface
of
the
left
ventricle
B.
Anterior
surface
of
the
ventricular septum C.
Sinoatrial
node
D.
Left
atrium
-
ANSWER C.
In
about
60
percent
of
the
population,
the
right
coronary
artery
supplies
the
sinoatrial
node.
The
left
anterior
descending
artery
supplies
the
anterior
surface
of
the
ventricular septum.
The
circumflex
artery
supplies
the
posterior
surface
of
the
left
ventricle
and
the left
atrium.
Increased
bowel
sounds
are
a
finding
in
which
type
of
poisoning?
A.
Barbiturate
B.
Anticholinergic
C.
Tricyclic
antidepressant
D.
Organophosphate
-
ANSWER
D
When
caring
for
a
patient
with
superior
vena
cava
syndrome,
you
should be
alert
for which
finding?
A.
Hemarthrosis
B.
Abdominal pain C.
Laryngeal swelling
D. Petechiae -
ANSWER
C.
Laryngeal
swelling
Which
bacteria
is
the
primary
organism
that
causes
urinary
tract
infections?
-
ANSWER A.
Escherichia
coli
Urinary
alkalinization
increases
the
renal
elimination
of
which
substance?
A.
Nifedipine
(Procardia)
B.
Digoxin
(Lanoxin)
C.
Phenobarbital
(Luminal)
D.
Paroxetine
(Paxil)
-
ANSWER
C.
Phenobarbital
(Luminal)
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A
partial-thickness
burn
has
which
characteristic?
-
ANSWER
Damage
of
the dermal layer
After ensuring the airway, breathing, circulation and disability, what is the priority intervention
for
a
patient
with
a
deformed
wrist
and
several
abrasions
caused
by
falling from a
significant height?
A.
Examine
for
other
injuries.
B.
Cover
an
open
fracture
with
a
moist
sterile dressing. C.
Splint the
obviously
deformed wrist.
D.
Administer
ibuprofen
(Motrin)
for
pain.
-
ANSWER
A.
Examine
for
other injuries.
When
assessing
a
patient
with
gastroenteritis,
the
nurse
should
expect
which finding?
- ANSWER
Abdominal
cramping
You are caring for a patient in the emergency department who is extremely anxious. She
is
short
of
breath
and
slightly
nauseated.
She
has
large
red hives all
over
her body and reports that her skin is burning and itchy. She is flushed, hypotensive, and tachycardic.
What
type
of
shock
should
you suspect?
-
ANSWER
Anaphylactic
shock
Which
intervention
is
indicated
to
treat
a
patient
with
diabetic
ketoacidosis?
-
ANSWER Administration of 5% dextrose in normal saline (D5NS) solution for a glucose level of 250
to
300
mg/dL
A
patient
presents
to
triage
and
says
she
may
be
pregnant
because
she missed
her
last menstrual period. She reports pelvic pain, left shoulder pain, and dizziness. She denies trauma and has tachycardia. Which disorder should the nurse suspect? - ANSWER Ectopic
pregnancy
Which
drug
may
be
used
to
convert
new-onset
atrial
fibrillation?
-
ANSWER Amiodarone (Cordarone)
Which
of
the
following
vertebral
column
injuries
is
most
likely
to
result
in a
bone fragment
impinging
on
the
spinal
cord?
-
ANSWER
Teardrop fracture
An
unstable
patient
with
polymorphic
ventricular
tachycardia
requires
which
electrical treatment
with
a
biphasic
defibrillator?
A.
Cardioversion
at
200
joules B.
Cardioversion
at
100
joules C.
Defibrillation
at
100
joules
D.
Defibrillation
at
200
joules
-
ANSWER
D.
Polymorphic
ventricular
tachycardia
in
an
unstable
patient
requires defibrillation,
using 200 joules. For a biphasic defibrillator, use the manufacturer's recommended energy level (120 to 200 joules) for the initial
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defibrillation. If the manufacturer's recommendation
is
unknown,
use the maximum
energy available.
Monomorphic
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ventricular
tachycardia
with
a
pulse
calls
for
cardioversion
with
100
joules. Defibrillation at 100 joules and cardioversion at 200 joules are not appropriate interventions for polymorphic ventricular
tachycardia
Radiography
can
help
detect
which
substance(s)?
A.
Organophosphates
B.
Iron
C.
Phenazopyridine (Pyridium) D. Hydrocarbons
-
ANSWER
B
A
patient
with
hemophilia
who
fell
off
a
skateboard
is
at
risk
for
which problem?
A.
Acute
chest
syndrome
B.
Spinal
cord compression C. Hemarthrosis
D.
Superior
vena
cava
syndrome
-
ANSWER
C.
Hemarthrosis
Which
sexually
transmitted
infection
causes
pink-gray
soft
lesions
with
no discharge?
- ANSWER
D. Human
papillomavirus
An
overdose
of
which
nonsteroidal
anti-inflammatory
drug
can
cause seizures?
A.
Ketorolac
(Toradol)
B.
Celecoxib (Celebrex) C. Indomethacin (Indocin)
D.
Piroxicam
(Feldene)
-
ANSWER
D.
Piroxicam
(Feldene)
According to the American Burn Association's classification of injury severity, where should
care
occur
for
an
adult
younger
than age
40
with
deep,
partial-
thickness
burns over
27
percent
of
the
total
body
surface
area?
-
ANSWER Specialized
burn
facility
Which
sexually
transmitted
infection
causes
pink-gray
soft
lesions
with
no discharge?
- ANSWER
D. Human
papillomavirus
What
is
the
initial
step
in
splint
application?
A.
Cleanse
the
area
to
be
splinted.
B.
Assess
the
neurovascular status. C.
Apply
the appropriate
padding.
D.
Apply
the
appropriate
splint
material.
-
ANSWER
B.
Assess
the neurovascular
status.
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Which
disorder
may
cause
hypovolemic
shock?
-
ANSWER
Burns
Which
effect
is
associated
with
Cushing's
syndrome?
-
ANSWER
Delayed wound healing
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You are discharging a woman who was diagnosed with a threatened abortion. Which patient
instruction
is
appropriate?
-
ANSWER
"Return
to
the emergency
department
or call your
primary
caregiver
if
the
bleeding increases."
An
unstable
patient
with
polymorphic
ventricular
tachycardia
requires
which electrical treatment
with
a
biphasic
defibrillator?
-
ANSWER
Defibrillation
at 200 joules
In
which
of
the
following
injuries
would
you
find
paralysis
below
the
injury
and
crude touch,
pressure,
and proprioception
intact? -
ANSWER
Anterior cord
syndrome
Which
medication
is
used
to
treat
gastroesophageal
reflux
disease
by increasing
the lower
esophageal
sphincter
pressure?
-
ANSWER Metoclopramide (Reglan)
Which
finding
is
a
sign
of
circulatory
compromise
caused
by a
significant
burn
injury?
- ANSWER
Ileus
In
which
dysrhythmia
does
a
compensatory
pause commonly
occur? A.
Second-degree
atrioventricular block, type II
B.
Bundle
branch
block
C.
Premature
ventricular
complex
D.
Wolff-Parkinson-White
syndrome -
ANSWER
C.
Premature ventricular complexes are initiated by an irritable (ectopic) focus
in the ventricles
and
cause
a
compensatory
pause
on
the
cardiac
monitor. (The
preceding
R- to-R interval equals the sum of two R-to-R intervals of the underlying rhythm.) A compensatory
pause is not associated
with the other
dysrhythmias
listed
Which
drug
is
used
to
treat
the
effects
of
organophosphate
poisoning?
A.
Phenytoin
(Dilantin)
B.
Succinylcholine (Anectine) C.
Atropine
D.
Sodium
bicarbonate
-
ANSWER
C
Which
blood
product
contains
the
largest
amount
of
factor
VIII?
A.
Fresh
frozen
plasma
B.
Cryoprecipita
te C.
Platelets
D.
Packed
red
blood
cells
-
ANSWER
B.
Cryoprecipitate
Which
disorder
is
an
intrarenal
cause
of
acute
kidney
injury?
-
ANSWER
C.
Rhabdomyolysis
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A
patient
presents
with
a
gastrointestinal
upset
that
has
not
subsided despite
having taken
Pepto-Bismol
and
Alka
Seltzer several
times
in
the past
48
hours.
He now
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complains
of
ringing
in
his
ears.
You
should
suspect
that
this
patient
has mild
toxicity from which
substance?
A.
Salicylate
B.
Acetaminophen (Tylenol) C.
Ibuprofen (Motrin)
D.
Naproxen
(Aleve)
-
ANSWER
A.
Salicylate
Which
intervention
demonstrates
appropriate
splint
application?
A.
Avoid
the
gradual
traction
of
the
extremity
because
it
is
contraindicated.
B.
Correct
angulation
if
neurovascular
compromise
is
not present. C.
Make
sure
the
splint
covers the
injured
area
and
the
joint
above
it.
D.
Perform
initial
immobilization
as
soon
as
possible.
-
ANSWER
D. Perform
initial immobilization
as
soon
as
possible.
Which
disorder
is
an
intrarenal
cause
of
acute
kidney
injury?
-
ANSWER
C.
Rhabdomyolysis
Which
effect
occurs
in
a
patient
with
hypovolemic
shock?
-
ANSWER Decreased venous return
to
the
heart
Alcoholic
ketoacidosis
causes
which
effect?
-
ANSWER
Glycogen
stores
are used.
When
assessing
a
patient
with
vaginal
bleeding
and
suspected
abruptio placentae,
the emergency
nurse
is
likely
to
note
which
finding?
-
ANSWER Severe abdominal
pain
In
the
PAAS
mnemonic
for
performing
automated
external
defibrillation,
what does
the
P stand
for?
-
ANSWER
Power
Pulse
Which
of
the
following
is
a
secondary
injury
to
the
spinal
cord?
-
ANSWER Edema
Which
disorder
can
initiate
atrial flutter? A.
Elevated
intracranial pressure
B.
Pulmonary embolism C. Hypokalemia
D.
Mitral
valve
prolapse
-
ANSWER
B
Atrial
flutter
is
usually
initiated
by
a
premature
atrial
complex
and
is
the
most
common
in
patients
with
coronary
artery
disease,
rheumatic
heart
disease,
pulmonary embolism,
or chronic obstructive pulmonary disease. Elevated intracranial pressure can initiate bradycardia. Hypokalemia is a cause of dysrhythmias,
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such as a junctional escape rhythm and ventricular dysrhythmias. Mitral valve prolapse can lead to paroxysmal supraventricular tachycardia.
For
a
patient
who
has
swallowed
a
foreign
body,
such
as
a
cocaine-filled balloon,
which gastric
decontamination
technique
is
the
most
effective?
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A.
Whole
bowel
irrigation
B.
Activated
charcoal administration C.
Gastric lavage
D.
Syrup
of
ipecac
administration
-
ANSWER
A
Which
finding
is
common
among
patients
with
acute
anemia?
A.
Widening
pulse
pressure
B.
Hemarthros
is C. Petechiae
D.
Tachypnea -
ANSWER D.
Tachypnea
In
a
patient
with
acute
kidney
injury,
which
electrolyte
imbalance
is expected?
- ANSWER
A.
Hypocalcemia
Which
drug
can
cause
pinpoint
pupils,
amnesia,
and
hypotension?
A.
Methylphenidate
(Ritalin)
B.
Dextromethorphan (Robitussin) C.
Amphetamine (Adderall)
D.
Cocaine
-
ANSWER
B.
Dextromethorphan
(Robitussin)
Which
patient
is
in
danger
of
airway
obstruction
and
likely
to
require
early intubation?
- ANSWER
A
camper
whose
clothing
ignited
while
barbequing
In
a
patient
with
acute
kidney
injury,
which
electrolyte
imbalance
is expected?
- ANSWER
A.
Hypocalcemia
Which
dysrhythmia
results
from
the
continuous
stimulation
of
two conduction
pathways in
the
atrioventricular node?
-
ANSWER
Atrial fibrillation
Which
dislocation
may
cause
neurovascular
compromise
of
the
brachial artery?
A.
Elbow
dislocation
B.
Acromioclavicular dislocation C.
Shoulder dislocation
D.
Wrist
dislocation
-
ANSWER
A.
Elbow
dislocation
Which
of
the
following
mechanisms
would
be
involved
when
a
patient's
head is
forcibly moved
to
the
side
during
an assault?
-
ANSWER Overrotation and distraction
When managing a patient with shock, which intervention is appropriate? -
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ANSWER Obtain
a
manual
blood
pressure
before
using
a
noninvasive blood
pressure
monitor.
Which
term
refers
to
how
many
pregnancies
the
patient
has
had?
-
ANSWER Gravidity
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Which
intervention
is
indicated
for
a
patient
with
alcoholic
ketoacidosis?
-
ANSWER Thiamine
administration
Which
of
the following
devices
provides
the
most
rigid
immobilization
for a
C1,
C2 fracture?
-
ANSWER
Halo
fixation
device
During
combustion,
which
material
can
cause
cyanide
poisoning?
-
ANSWER Leather
Which
event
corresponds
with diastole? A.
Closing
of
the
mitral valve
B.
Opening
of
the pulmonary valve C.
Filling
of
the ventricles
D.
Relaxation
of
the
atria
-
ANSWER
C.
During
diastole,
the
ventricles
fill,
the
aortic
and
pulmonary
semilunar
valves close,
and the mitral and tricuspid valves open. This corresponds to electrical stimulation and mechanical contraction
of the
atria
Which
disorder
results
from
acute
lead
poisoning?
A.
Noncardiogenic
pulmonary
edema
B.
Agitation
C.
Renal
failure
D.
Encephalopathy
-
ANSWER D
An
oncologic
patient
complains
of
back
pain
that
worsens
when
he moves,
coughs, sneezes,
or
lies
supine.
This patient
should
have
a workup
for which
disorder?
A.
Superior
vena
cava
syndrome
B.
Spinal
cord compression C.
Sickle cell
crisis
D.
Hemophilia
-
ANSWER
B.
Spinal
cord
compression
In
which
dysrhythmia
does
an
impulse
originate
in
the
atrioventricular junction
before the
next
expected
sinus impulse?
-
ANSWER
Premature junctional
complex
Which
disorder
is
a
prerenal
cause
of
acute kidney
injury?
-
ANSWER
B.
Sepsis
Which
disorder
is
a
prerenal
cause
of
acute kidney
injury?
-
ANSWER
B.
Sepsis
In
a
patient
with
a
knee
injury,
which
finding
is
of
greatest
concern?
A.
The
knee
has
a
large amount
of
swelling.
B.
Effective
pain
management
requires
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opioids. C.
The
patient
cannot
extend the
great
toe.
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D.
The
patient
has
impaired
mobility.
-
ANSWER
The
test
explains
that
C
is correct,
but marks it wrong. A and D are also wrong. Unknown if B works as an answer. It would have
to
be
INEFFECTIVE
PAIN MANAGEMENT
to be correct.
What
is
the
most
sensitive
sign
of
early
shock
in
a
pediatric
patient?
- ANSWER Delayed
capillary
refill
Which
imbalance
should
the
nurse
expect
in
a
patient
with
acute
adrenal insufficiency? - ANSWER
Hypoglycemia
HELLP
syndrome
is
characterized
by
which
triad
of
signs and
symptoms?
- ANSWER Tachypnea,
hypertension,
and
epigastric
pain
Constipation
is
a
side
effect
of
which
drug?
A.
Hydrocodone
B.
Aspirin (Bayer) C. Cocaine
D.
Paroxetine
(Paxil)
-
ANSWER
A.
Hydrocodone
For
a
patient
with
a
minor
thermal
burn,
the
nurse
should
be
prepared to perform
which intervention? - ANSWER Apply bacitracin (Bacitracin) to the wound before applying a dressing.
Which
disorder
is
likely
to
produce
a
delta
wave
on
the
cardiac monitor? A.
Ventricular
fibrillation
B.
Atrial
flutter
C. Wolff-Parkinson-White syndrome D.
Bundle
branch block
-
ANSWER
C.
Wolff-Parkinson-White syndrome produces a delta wave (an abnormal "slurring" and slow rise of the initial upstroke of the QRS complex), which represents the early, abnormal depolarization of the ventricles. Atrial flutter
is characterized by flutter waves, which have a sawtoothed pattern. In ventricular fibrillation, the ventricles quiver (fibrillate) rather than contract, producing no effective cardiac output. A block in one bundle
branch
causes the
ventricle
on
that
side
to
depolarize
later
than
the
ventricle
on the
intact side.
This
results
in
a
wide,
bizarre
QRS
complex.
Which
signs
and
symptoms
are
likely
to
occur
in
a
patient
with
a sedative-hypnotic toxidrome?
A.
Blurred
vision
and
urine
retention
B.
Decreased
respirations
and nystagmus C. Hypothermia and decreased respirations D. Bronchospasm
and
delirium
-
ANSWER
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B
Which
finding
commonly
occurs
in
patients
with
chronic
anemia?
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A.
Complaints
of
feeling
cold
B.
Thirst
C.
Shortness
of
breath
D.
Cool,
clammy
skin
-
ANSWER
C.
Shortness
of
breath
Which
disorder
is
a
postrenal
cause
of
acute
kidney
injury?
-
ANSWER
D. Prostatic hypertrophy
In
a
patient
who
overdosed
on
cocaine,
which
finding
is
expected?
A.
Nystagmus
B.
Hypotensio
n C. Hypothermia
D.
Tachycardia
-
ANSWER
D.
Tachycardia
Which
disorder
is
a
postrenal
cause
of
acute
kidney
injury?
-
ANSWER
D. Prostatic hypertrophy
A
transverse
fracture
results
from
which
mechanism?
A.
Twisting
force
B.
Sharp, direct blow C. Compression
force
D.
Forceful
contraction
of
a
muscle
mass
-
ANSWER
B.
Sharp,
direct
blow
Which
laboratory
result
is
most
associated
with
increased
mortality
in
the patient
with shock?
-
ANSWER
Elevated
serum
lactate
level
Which
intervention
is
indicated
for
treating
central
diabetes
insipidus?
- ANSWER Antidiuretic
hormone
(ADH)
replacement
A molar pregnancy is characterized by which pathophysiology? - ANSWER
The chorionic
villi
around
the
aborting
embryo
degenerate
to
form clusters
of
fluid-filled vesicles.
In
which
dysrhythmia
does
a
compensatory
pause
commonly
occur?
- ANSWER Premature
ventricular
complex
Which
of
the
following
is
the
most
common
mechanism
for
spinal
trauma?
- ANSWER Motor
vehicle
crash
Which
area
of
the
heart
receives
its
blood
supply
from
the
left circumflex
artery? A.
Intraventricular
septum
B. Bundle of His
C.
Sinoatrial node
D.
Atrioventricular
node
-
ANSWER
B.
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The left circumflex artery supplies the bundle of His. The left anterior descending artery supplies
the
intraventricular
septum,
and
the
right coronary
artery
supplies
the
sinoatrial and
atrioventricular
nodes
in
most individuals.
Which
decontamination
method
is
most
effective
for
treating
heavy
metal poisoning?
A.
Whole
bowel
irrigation
B.
Activated
charcoal administration C.
Chelation therapy
D.
Urine
alkalinization
-
ANSWER
C
Pregnancy-induced
hypertension
places
the
patient
at
risk
for
which condition?
A.
Vaso-occlusive
crisis
B.
Hepatomegaly
C.
Disseminated
intravascular
coagulation
D.
Chronic
immune
thrombocytopenia
-
ANSWER
C.
Disseminated intravascular coagulation
Which
disorder
is
a
complication
of
sexually
transmitted
infections?
- ANSWER
B. Endocarditis
Cyproheptadine
(Periactin)
may
be
used to
treat
an
overdose
of
which
drug?
A.
Bupropion
(Wellbutrin)
B.
Oxycodone (OxyContin) C.
Doxepin
(Sinequan)
D.
Amitriptyline
(Elavil)
-
ANSWER
A.
Bupropion
(Wellbutrin)
For
what
amount
of
time
would
the
patient
be
expected
to
demonstrate increased capillary
permeability
from
large
burns?
-
ANSWER
2
to
3 weeks
Which
disorder
is
a
complication
of
sexually
transmitted
infections?
- ANSWER
B. Endocarditis
A
traction
splint
is
appropriate
for
a
fracture of
which
site?
A.
Hip
B.
Knee
C.
Upper
third
of
the
tibia
D.
Fibula
-
ANSWER
C.
Upper
third
of
the tibia
Which statement accurately characterizes fluid resuscitation in a patient with
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hemorrhagic shock?
-
ANSWER
Aggressive
fluid
resuscitation
can
cause blood
clots to dislodge.
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To appropriately treat a conscious patient with hypoglycemia, the nurse should select which
item
to
provide
roughly
10
to
15
grams
of
fast-acting carbohydrate?
-
ANSWER
5 or
6
Life
Savers&#-62;&#-82;
candies
For
a
patient
with
an
unruptured
ectopic
pregnancy
in
the
ampulla,
what
is the
surgical procedure
of choice?
-
ANSWER
Salpingostomy
Patients
with
which
type
of
premature
complexes
require
close
monitoring?
- ANSWER Multifocal premature
ventricular
complexes
In spinal stabilization of the adult, which action demonstrates correct stabilization technique?
-
ANSWER
Keep
the
patient's
nose
and
umbilicus aligned
at
all
times.
A patient has stable, monomorphic ventricular tachycardia. To perform synchronized cardioversion
with
a
biphasic
defibrillator
and
convert
this dysrhythmia,
which
energy setting
should
be
used
first?
A.
50
joules
B.
100
joules
C.
120
joules
D.
200
joules
-
ANSWER
B.
If a biphasic defibrillator is used to manage a patient with stable, monomorphic ventricular
tachycardia,
the
recommended
energy
level
is
100
joules.
The recommended
energy
level
for
supraventricular
tachycardia
and atrial
flutter
is
50
to
100 joules.
The
level for
atrial fibrillation
is
120 to
200 joules.
A
repeat
dose
of
activated
charcoal
is
indicated
for
the
ingestion
of
which substance?
A.
Ethylene
glycol
B.
Lead C. Fluoride
D.
Digoxin
(Lanoxin)
-
ANSWER
D
In
a
hematologic
emergency,
which
finding
requires
priority
intervention?
A.
Hematemesis
B.
Tachycardia
C.
Frank
bleeding
from
the
mouth
D.
Unusual
bruising
-
ANSWER
C.
Frank
bleeding
from
the
mouth
The
nurse
should
teach
a
patient
with
which disorder
not
to
wear
tight clothing
or synthetic
underwear?
-
ANSWER
A.
Urethritis
Which
drug
should
you
anticipate
administering
to
a
patient
with
clonazepam (Klonopin) toxicity?
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A.
Naloxone
(Narcan)
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B.
Flumazenil (Romazicon) C.
Sodium
bicarbonate
D. N-acetylcysteine (Mucomyst) -
ANSWER
B.
Flumazenil
(Romazicon)
When caring for a patient with an electrical burn, the nurse should consider which factor?
-
ANSWER
Alternating
current is
more
likely to cause
ventricular
fibrillation.
Which
age-related
consideration
applies
to
a
geriatric
patient
with
a
fracture?
A.
The
bones
are
softer.
B.
Healing
takes
longer.
C.
The
blood
loss
is
more
significant.
D.
Future
bone
growth
is
affected.
-
ANSWER
B.
Healing
takes
longer.
The
nurse
should
teach
a
patient
with
which disorder
not
to
wear
tight clothing
or synthetic
underwear?
-
ANSWER
A.
Urethritis
Which
method
delivers
nonsynchronous
energy
to
the
myocardium?
- ANSWER Defibrillation
Which
of
the following
statements
regarding
spinal
stabilization
is
accurate? -
ANSWER A patient whose cervical spine is stabilized is secured on a backboard, with a rigid collar,
straps
at
the
shoulders
and
hips
and
above the
knees,
head
blocks
and
tape.
During
times
of
decreased
tissue
perfusion,
the
body
shunts
blood
away from
which organ?
-
ANSWER
Kidneys
For a
patient
with
preeclampsia,
what
is
the priority
treatment?
-
ANSWER Administer oxygen.
In
which
endocrine
emergency
is
tongue
edema
a
presenting
sign?
- ANSWER Myxedema coma
Which
of
the
following
patients
would
most
likely
have
a
spinal
injury?
- ANSWER
An intoxicated
patient with a
severe
head
injury.
A
patient
admitted
with
an
amphetamine
overdose
may
require
which
key intervention?
A.
Systemic
alkalinization
B.
Abdominal
radiography
C.
Administration
of
a
proton
pump
inhibitor
D.
Application
of a
cooling
blanket
-
ANSWER
D.
Application of
a
cooling blanket
In
which
dysrhythmia
does
the
P
wave disappear
or
occur
just
before or
after the
QRS complex?
-
ANSWER
Junctional
escape
rhythm
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Which
layer
of
the
heart
is
made of
smooth
tissue
and
is
the innermost portion
of
the atria
and
ventricles?
A. Myocardium B. Endocardium
C.
Visceral
pericardium
D.
Epicardium
-
ANSWER
B.
The endocardium is the innermost portion of the atria and ventricles and is made of smooth
tissue.
The
myocardium
is
the
muscular
middle
layer.
The visceral
pericardium (epicardium) is
the
outer
layer
of the
heart.
Sarin
is
an
example
of
which
type
of
substance?
A.
Organophosphate
B.
Anticholinergic
C.
Central
nervous
system depressant D.
Heavy
metal
- ANSWER
A
Which
type
of
cancer
is
a
common
cause
of
spinal
cord compression?
A.
Esophageal
B.
Colon C. Cervical
D.
Breast
-
ANSWER
D.
Breast
Which
laboratory
test
is
the
primary
diagnostic
indicator
of
rhabdomyolysis? -
ANSWER D.
Serum
creatine
phosphokinase
level
Which
burn
injury
is
commonly
associated
with
significant
thermal
damage
of the
upper airway?
-
ANSWER
Flash
burn
Which
laboratory
test
is
the
primary
diagnostic
indicator
of
rhabdomyolysis? -
ANSWER C.
Hyperkalemia
Which
type
of
nerve
injury
causes
an
inability
to
extend
the
thumb in
a hitchhiker's
sign?
A.
Ulnar
nerve
B.
Radial nerve C. Median
nerve
D.
Peroneal
nerve
-
ANSWER
B.
Radial
nerve
Which
structure
is
a
collection
of
specialized neural
tissues
that
respond to
small changes
in
vascular
tone
or
pressure?
-
ANSWER
Baroreceptors
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Which
finding
is
associated
with
thyroid
storm? -
ANSWER
Tremors
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Preload influences myocardial fiber length and stretch. The amount of stretch partly determines the strength of contraction (contractility). Afterload is the pressure in the
Which
disorder
places
a
pregnant
woman at
a
higher
risk
of
an amniotic
fluid embolism?
-
ANSWER
Abruptio
placentae
In
a
patient
with
acute
kidney
injury,
which
medication
is
used
to
improve
cardiac conductivity?
-
ANSWER
D.
Calcium
chloride
Which
factor
influences
cardiac contractility? A.
Preload
B.
Afterload
C.
Systemic
vascular
resistance
D.
Postsystolic
volume
-
ANSWER
A.
arterial
system
that
the heart
must
overcome
to eject
its
ventricular
blood volume.
Afterload
is
commonly
called
systemic
vascular
resistance.
Preload
is associated
with the
volume of
blood
stretching the
ventricles
at
the end
of diastole—not
systole.
For
a
patient
with
poisoning,
why
is
activated
charcoal
used?
A.
To
decrease
the
gastrointestinal
transit
time
B.
To
propel
the
gastric
contents
past
the pylorus C.
To induce
emesis
D.
To
prevent
absorption
-
ANSWER
D
Which
disorder
results
from
reduced
bone
marrow
production?
A.
Hemophilia
B.
Sickle
cell anemia C.
Acute anemia
D.
Aplastic
anemia -
ANSWER
D.
Aplastic
anemia
Which
factor
increases
the
risk
for
scald
burns?
-
ANSWER
Diabetes
In
a
patient
with
acute
kidney
injury,
which
medication
is
used
to
improve
cardiac conductivity?
-
ANSWER
D.
Calcium
chloride
Which
bone
fracture
can
damage
the
peroneal
nerve,
sciatic
nerve,
and popliteal artery?
A.
Hip
B.
Pelvis
C. Femur
D.
Distal
fibula
-
ANSWER
C.
Femur
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Which type of block causes one P wave to precede each QRS complex
until a QRS complex
is
dropped
in
a
regular
pattern?
-
ANSWER
Second-
degree
atrioventricular block,
type
II
Which
complication
of
shock
has
the
highest
mortality
rate?
-
ANSWER Multiple
organ dysfunction syndrome
Which
of
the
following
injuries
is considered
to
be
the
most
unstable?
- ANSWER Atlantoaxial
joint dislocation
You
should
plan
to
monitor
liver
function
for
a
patient
with
which
type
of toxicity?
A.
Ketorolac
(Toradol)
B.
Aspirin
(Bayer)
C.
Indomethacin
(Indocin)
D.
Acetaminophen
with
hydrocodone
(Vicodin)
-
ANSWER
D. Acetaminophen
with hydrocodone (Vicodin)
Which
intervention
is
the
first
step
in
resuscitating a
neonate? -
ANSWER Warming
Which
finding
should
the
nurse
expect
in
a
patient
with
hyperosmolar hyperglycemic state? -
ANSWER
Severe
dehydration
Which
body
component
is
more
resistant
to
electrical
current
and
is
less easily damaged
by
electrical
injury?
-
ANSWER
Fat
Patients
with
which
type
of
premature
complexes
require
close monitoring? A.
Premature
atrial
complexes
B.
Premature
junctional
complexes
C.
Unifocal
premature
ventricular
complexes
D.
Multifocal
premature
ventricular
complexes
-
ANSWER
D.
Patients
who
develop
multifocal
premature
ventricular
complexes
(PVCs) should
be
closely monitored because multifocal PVCs indicate a more serious condition. Premature
atrial
complexes,
premature
junctional
complexes, and
unifocal
premature
ventricular
complexes
can
occur
in
healthy
individuals
and
are
usually
benign.
Which
patients
have
an
increased
risk
of
life-threatening
complications from
toxic exposure?
A.
Male
patients
and
pediatric
patients
B.
Female patients and geriatric patients C.
Pediatric
patients
and geriatric
patients
D.
Homeless
patients
and
pregnant
patients
-
ANSWER
C
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Which
disorder
poses
the
greatest
risk
for
the
patient
to
develop
deep venous thrombosis and
pulmonary
emboli?
A.
Factor
V
Leiden
thrombophilia
B.
Hemophilia
A
C.
Von
Willebrand's
disease
D.
Chronic immune thrombocytopenia
-
ANSWER
A.
Factor
V
Leiden thrombophilia
In
a
patient
with
acute
kidney
injury,
which
cardiac
dysrhythmia
is
expected?
-
ANSWER D.
Prolonged
PR
interval
For
a
patient
with
tricyclic
antidepressant
toxicity,
you
should
expect
to
treat ventricular dysrhythmias with
which
cardiac
medication?
A.
Digoxin
(Lanoxin)
B.
Procainamide (Pronestyl) C.
Quinidine (Quinidex)
D.
Amiodarone
(Cordarone) -
ANSWER
D.
Amiodarone
(Cordarone)
In
a
patient
with
acute
kidney
injury,
which
cardiac
dysrhythmia
is
expected?
-
ANSWER D.
Prolonged
PR
interval
Why
do
geriatric
patients
respond
differently
to
shock
than
younger patients?
- ANSWER
Geriatric
patients have
decreased
physiologic reserves.
Which
pathophysiologic
change
occurs
in
a
patient
with
myxedema
coma?
- ANSWER Decreased
cardiac
output
Which
sign
is
characteristic
of
eclampsia?
-
ANSWER
Seizures
A
transcutaneous
pacemaker
is
most
likely
an
intervention
for
which dysrhythmia?
- ANSWER
Second-degree
atrioventricular block, type II
Which
of
the
following
mechanisms
would
be
involved
when
a
patient jumps
from
a height
and
lands
on
their
feet?
-
ANSWER
Axial
loading
Which
fracture
is
likely
to cause
arm
shortening
and
rapid
swelling?
A.
Clavicular
fracture
B.
Humeral fracture C. Scapular
fracture
D.
Elbow
fracture
-
ANSWER
D.
Elbow
fracture
Using the Parkland formula (4 mL/kg/% total body surface area), the nurse should administer
which
amount
of
fluid
over
24
hours
to a
50-kg
patient with burns
over
35% of
the
total
body surface
area?
-
ANSWER
7,000
mL
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Which
dysrhythmia
has
an
irregularly
irregular
ventricular response? A.
First-degree
atrioventricular
block
B.
Paroxysmal
supraventricular tachycardia C.
Sinus
bradycardia
D.
Atrial
fibrillation
-
ANSWER
D.
In
atrial
fibrillation,
multiple
ectopic
atrial
pacemakers
fire
chaotically
in
rapid
succession.
This
causes
a
ventricular
rhythm
that
is
always
irregularly irregular. Paroxysmal supraventricular tachycardia, sinus bradycardia, and first-degree atrioventricular block
produce
a
regular
pattern
of
QRS complexes.
Windshield
wiper
fluid
contains
which
type
of
alcohol?
A.
Ethylene
glycol
B.
Ethanol
C.
Isopropanol
D.
Methanol
-
ANSWER
D
Which
organ
is
most
commonly
affected
by
leukostasis,
a
complication
of leukemia?
A.
Liver
B.
Hear
t C. Brain
D.
Spleen
-
ANSWER
C.
Brain
Which
diagnostic
test
has
the
highest
sensitivity
for
detecting
renal
calculi?
-
ANSWER B.
Helical
computed
tomography
When
treating
a
patient
with
severe
salicylate
toxicity,
you
should
expect
to use
which drug?
A.
N-acetylcysteine
(Mucomyst)
B.
Sodium bicarbonate C. Naloxone
(Narcan)
D. Cyproheptadine
(Periactin) -
ANSWER
B.
Sodium
bicarbonate
Which
diagnostic
test
has
the
highest
sensitivity
for
detecting
renal
calculi?
-
ANSWER B.
Helical
computed
tomography
Which
finding
is
expected
in
a
patient
with
shock
caused
by
an
isolated spinal
cord injury?
-
ANSWER
Hypotension
Which
physiologic
effect
results
from
hypoglycemia?
-
ANSWER
Release
of epinephrine
Which
area
is
the
most
common
site
for
implantation
of
an
ectopic
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pregnancy?
- ANSWER
Ampulla
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Calcium
channel
blockers
are
indicated
to
treat
which
dysrhythmia?
- ANSWER
Atrial fibrillation
Which
of
the
following
spinal
column
injuries
is
most
frequently
caused
by penetrating trauma?
-
ANSWER
Brown-Séquard
syndrome
Which
nerve
injury
is
associated
with
a
knee
dislocation?
A.
Median
nerve
B.
Sciatic nerve C. Tibial
nerve
D.
Peroneal
nerve
-
ANSWER
D.
Peroneal
nerve
For
a
patient
with
renal
calculi,
discharge
instructions
should
include which
dietary restriction? -
ANSWER
C. Coffee
Circulating
blood
passes
through
which
valve
as
it
leaves the
heart? A.
Tricuspid
valve
B.
Pulmonary
semilunar valve C.
Mitral
valve
D.
Aortic
semilunar valve
-
ANSWER
D.
Blood
flows
from
the
right
atrium
through
the
tricuspid
valve
to
the
right ventricle.
From
there, blood flows through the pulmonic valve into the pulmonary artery to be oxygenated
in
the
lungs.
From
the
lungs,
blood
flows
through
the pulmonary
vein
to
the left atrium and through the mitral valve into the left ventricle. From the left ventricle, blood
flows
through
the
aortic
valve
to
the aorta
Which
population
accounts
for
almost
two-thirds
of
toxic
exposures?
A.
Geriatric
men
B.
Pediatric patients C. Pregnant
women
D.
College
students
-
ANSWER
B
Which
statement
accurately
characterizes
hemophilia?
A.
It
causes
frank
exsanguination.
B.
It
occurs
mainly
in
females.
C.
It
is
passed
on
by
males
to their
children.
D.
Its
chief
complaint
is
severe
joint
pain.
-
ANSWER
D.
Its
chief
complaint
is
severe joint
pain.
Which
finding
suggests
an
open
fracture?
A.
Edema
B.
Puncture
wound
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C.
Obvious
deformity
D.
Contusion
-
ANSWER
B.
Puncture
wound
A
patient
with
chronic
toxicity
from
naproxen
(Aleve)
is
likely
to
develop which problems?
A.
Pulmonary
edema
and
hypoglycemia
B.
Rhabdomyolysis
and
hypertension
C.
Respiratory
depression
and
bradycardia
D.
Increased
bleeding
time
and
thrombocytopenia
-
ANSWER
D.
Increased
bleeding time
and
thrombocytopenia
For
a
patient
with
renal
calculi,
discharge
instructions
should
include which
dietary restriction? -
ANSWER
C. Coffee
Which
manifestation
should
you
expect
in
a
patient
with
shock?
-
ANSWER Increased blood
glucose
level
For
a
patient
with
HELLP
syndrome,
which
laboratory
test
results should
you expect
to see?
-
ANSWER
Decreased
platelet
level
For
a
patient
with
suspected
acute
coronary
syndrome,
which
agent
is
not part
of
the recommended
management? -
ANSWER
Nitroprusside
(Nitropress)
Which
intervention
is
indicated
for
the
initial
management
of
tricyclic antidepressant toxicity?
A.
Dopamine
(Intropin)
infusion
B.
Gastric
lavage
C.
Administration
of
activated
charcoal
with
sorbitol
D.
Hemodialysis -
ANSWER
C.
Administration
of
activated
charcoal
with sorbitol
In
the
PAAS
mnemonic
for
performing
automated
external
defibrillation,
what does
the
P stand
for?
A.
Primary
B.
Percutaneo
us C.
Power
D.
Pulse
-
ANSWER C.
The
PAAS
mnemonic
stands
for:
Power:
Turn
on
the
power
for
the
unit.
Attach:
Attach
the
pads
that
obtain
the
cardiac
rhythm
and
deliver
the hands-free
shock. Analyze: Allow a short time for the automated external defibrillator to analyze the patient's rhythm.
During
this
time, do not move the
patient.
Shock:
If
appropriate
for
the
patient's
rhythm,
deliver
the
shock
with
a semiautomated external defibrillator or allow a fully automated external defibrillator to deliver it automatically.
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Which
statement
accurately
characterizes
immune
thrombocytopenic purpura?
A.
It
is
caused
by
immune
autoreactive
antibodies.
B.
It
occurs
primarily
in adolescents. C.
It
is
more common
in
women.
D.
It
follows
a
bacterial
infection.
-
ANSWER
A.
It
is
caused
by
immune autoreactive antibodies.
Elevation
of
the
scrotum
is
likely
to
cause
decreased
pain
in
which
disorder?
- ANSWER C.
Epididymitis
After
being
exposed
to
an
organophosphate
insecticide,
a
landscaping worker
presents to
the
emergency
department.
Decontamination
should begin
with which
step?
A.
Brush
the
insecticide
off
the
patient.
B.
Remove
the
patient's
clothing.
C.
Place
the
patient
is
a
well-ventilated, isolated
area. D.
Apply a
neutralizing agent. - ANSWER
C
Elevation
of
the
scrotum
is
likely
to
cause
decreased
pain
in
which
disorder?
- ANSWER C.
Epididymitis
Which
factor
places
the
patient
at
risk
for
distributive
shock?
-
ANSWER Presence
of
an invasive
device, such
as a
urinary
catheter
or
feeding
tube
Apgar
scoring
is
used to
assess
a
neonate's
condition
based
on
which parameters?
- ANSWER
Color,
heart
rate,
reflex
irritability,
muscle
tone,
and respiratory
effort
Which statement does not accurately characterize nitroglycerin (Nitrostat) administration? -
ANSWER
Monitor the
patient's vital
signs
every 2
hours while
giving intravenous
nitroglycerin.
When
assessing
for
arterial
injury,
which
factor
should
you
consider?
A.
Arterial
injuries
may
not
require
repair.
B.
Arterial injuries are associated with low-impact trauma. C.
A
distal
pulse
is
not
detectable
if
an arterial
injury
exists.
D.
Arterial
injuries
can
result
from
compression
due
to
prolonged
skeletal traction.
- ANSWER
A.
Arterial
injuries may
not
require
repair.
With
which
toxicity
should
you
expect
to
find
tall,
peaked
T
waves
on
an electrocardiogram
tracing?
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A.
Central
nervous
system
stimulant
B.
Beta-blocker
C.
Calcium
channel
blocker
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D.
Digitalis
-
ANSWER
D.
Digitalis
Urinary
alkalinization
increases
the
renal
elimination
of
which
substance?
A.
Atropine
B.
Digoxin
(Lanoxin)
C.
Phenobarbital (Luminal) D.
Cyanide
- ANSWER
C
Among
patients
with
sickle
cell
disease,
which
disorder
is
the
leading
cause
of
mortality and
morbidity?
A.
Pneumonia
B.
Acute
chest
syndrome
C.
Acute
myocardial
infarction
D.
Cor
pulmonale
-
ANSWER
B.
Acute
chest
syndrome
Which
substance
is
the
most
common
component
of
renal
calculi?
- ANSWER
A. Calcium
oxalate
Which
disorder
is
potentially
reversible
if
the
cause
is
immediately
treated? A.
Pulseless
electrical
activity
B.
Bundle
branch block C.
Long
QT syndrome
D.
Third-degree
atrioventricular
block
-
ANSWER
A.
In
pulseless
electrical
activity,
some
cardiac
activity
is
present
but
no
pulse
is palpable.
Pulseless electrical activity is usually a preterminal rhythm, but survival is possible if a reversible cause is identified and immediately treated. The common causes of bundle branch block include acute myocardial infarction, hypertension, cardiomyopathy, congestive
heart
failure,
and
degenerative diseases
of
the
electrical
conduction
system, which are not immediately treatable. The treatment of long QT syndrome depends on symptom severity
and the underlying cause. Treatment does not immediately reverse this dysrhythmia. Third-degree atrioventricular block can be permanent or transient, depending
on
its
cause.
Which
substance
is
the
most
common
component
of
renal
calculi?
- ANSWER
A. Calcium
oxalate
Amputation
by
which
mechanism
has
the
best
chance
for
a
good outcome
after replantation?
A.
Dog
bite
B.
Snow blower C. Tree
grinder
D.
Meat
slicer
-
ANSWER
D.
Meat
slicer
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During
anaerobic metabolism,
which
substance
accumulates in
cells?
- ANSWER Lactate
In a pregnant woman in the third trimester, the fetal heart rate is 90 beats per minute. Which
intervention
is
the
priority
at
this
time?
-
ANSWER Administer
high-flow
oxygen.
Which
electrocardiogram
leads
reflect
the
inferior
wall?
-
ANSWER
Leads II,
III,
and aVF
A
transcutaneous
pacemaker
is
most
likely
an
intervention
for
which dysrhythmia? A.
Second-degree
atrioventricular
block,
type I
B.
Second-degree
atrioventricular
block, type
II C.
Wolff-Parkinson-White syndrome
D.
Wandering
atrial
pacemaker
-
ANSWER
B.
The use of a transcutaneous pacemaker is an intervention for second-degree
atrioventricular block, type II. The affected patient's condition is unstable because this type of block can progress to third-degree atrioventricular block. Second-degree atrioventricular block, type I, usually does not require intervention. If a decreased heart rate
causes
signs
and
symptoms,
the physician
may
order
atropine.
Treatment
for
Wolff- Parkinson-White syndrome can include synchronized cardioversion but not transcutaneous pacemaker use. A patient with a wandering atrial pacemaker usually is asymptomatic.
If
he
or
she
is
symptomatic,
expect
to
treat
the
underlying condition
Exposure
to
which
caustic
substance
may
call
for
the
application
of
calcium gluconate (Calgonate)?
A.
Hydrochloric
acid
B.
Hydrofluoric acid C. Phosphoric
acid
D.
Sulfuric
acid
-
ANSWER
B
What
is the
most
common
reason
for
a
patient
with
sickle cell
crisis
to
seek care
in
the emergency
department?
A.
Pneumonia
B.
Pulmonary emboli C.
Pain
D.
Meningitis
-
ANSWER
C.
Pain
For
a
patient
with
nonoliguric
acute
kidney
injury,
which
treatment
is indicated?
- ANSWER
A.
Volume
replacement
For
a
patient
with
nonoliguric
acute
kidney
injury,
which
treatment
is indicated?
- ANSWER
A.
Volume
replacement
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In
a
patient
with
toxicity
due
to
the
beta-blocker
sotalol
(Betapace), which electrocardiogram
findings
should
you
expect to
see?
A.
Bradycardia
and
atrioventricular
block
B.
Third-degree
atrioventricular
block
and
tall,
peaked T
waves C.
Prolonged
QT
intervals
and tall,
peaked
T waves
D.
Bradycardia
and
prolonged
QT
intervals
-
ANSWER
D.
Bradycardia
and prolonged QT
intervals
A
patient
has
the
highest
risk
of
infection
after
being
impaled
with
which object?
A.
Knife
B.
Nail
gun
C.
Wooden
fence
post
D.
Sewing
needle
-
ANSWER
C.
Wooden
fence
post
Which
type
of
shock
results
from
the
release
of
endotoxins?
-
ANSWER Distributive
Which
condition
can
cause
a
spontaneous
abortion?
-
ANSWER
Infection
A
man,
age
65,
presents
with
chest
pain
and
changes
on
his
12-lead electrocardiogram tracing. Which change suggests an acute myocardial infarction? - ANSWER ST- segment
elevation greater
than
1
mm in
two
or more
contiguous
leads
During
which
phase
of
the
cardiac
cycle
do
myocardial
cells
receive
their blood
supply? A.
Opening
of
the
aortic
valve
B.
Ventricular
diastole
C.
Blood
flow
through
the
pulmonary
vein
D.
Activation
of
the
bundle
of
His
-
ANSWER
B.
Myocardial
cells
receive
their
blood
supply
only
during
ventricular
diastole, when
the
ventricle is relaxed. This does not occur when the aortic valve opens, blood flows through
the
pulmonary
vein,
or
the
bundle
of
His
is
activated.
The
left ventricle
contracts to push blood out when the aortic valve is open. Blood flows from the lungs through the pulmonary vein to the left atrium. The activation of the bundle of His sends the impulse to the
ventricular
muscle, resulting
in
ventricular
contraction
For
a
patient
with
iron
toxicity,
which
laboratory
test
result
should
you
expect to
see?
A.
Elevated
blood
urea
nitrogen
level
B.
Decreased blood glucose level C.
Decreased
red
blood cell
count
D.
Elevated
white
blood
cell
count
-
ANSWER
D
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Which
factor
may cause
a
decreased
platelet
count?
A.
Ibuprofen
(Motrin)
use
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B.
Sepsis
C.
Increased
bone
marrow
production
D.
Decreased
splenic
sequestration
-
ANSWER
B.
Sepsis
The
toxic
ingestion
of
which
drug
can
prolong
the
partial
thromboplastin time?
A.
Ibuprofen
(Advil)
B.
Aspirin
(Bayer)
C.
Acetaminophen
(Tylenol)
D.
Celecoxib
(Celebrex)
-
ANSWER
C.
Acetaminophen
(Tylenol)
Which
statement
correctly
defines
oliguria?
-
ANSWER
C.
Urine
output
is
less than
400 mL
in
24
hours.
Which
statement
correctly
defines
oliguria?
-
ANSWER
C.
Urine
output
is
less than
400 mL
in
24
hours.
When
shock
causes
cells
to
switch
from
aerobic
to
anaerobic
metabolism, which
event occurs? - ANSWER Digestive organelles leak destructive enzymes into cells, which begin
to
be
autodigested
The
physician
performs
a
manual
vaginal
examination,
using
sterile technique.
Which finding indicates that fluid found during the examination is amniotic fluid? - ANSWER The
pH
of the
fluid
is
neutral.
A man, age 42, presents to the emergency department with sharp, severe chest pain that increases with inspiration. In addition, he has a fever. The nurse immediately obtains
a
12-lead
electrocardiogram
tracing,
which demonstrates
ST-segment
elevation in all leads except aVR and V1. Based on the history and electrocardiographic findings, what
is
the
most likely diagnosis?
-
ANSWER Pericarditis
Radial
nerve
damage
is
associated
with
which
fracture?
A.
Humeral
fracture
B.
Scapular fracture C. Shoulder
fracture
D.
Navicular
fracture
-
ANSWER
A.
Humeral
fracture
Early-stream
hematuria
suggests
an
abnormality
in
which
genitourinary structure?
- ANSWER
D. Urethra
A
rhythm
strip
shows
five
dark vertical
lines
between
R
waves.
Using
the sequence method,
what is
the
calculated
heart rate?
A. 60 beats per minute B. 75 beats per minute C.
100 beats
per
minute
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D.
150
beats
per
minute -
ANSWER
A.
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To calculate heart rate using the sequence method, select an R wave that falls on a dark vertical line. Number the next six consecutive dark vertical lines as follows: 300, 150, 100, 75, 60, and 50. Note where the next R wave falls in relation to the six dark vertical lines already marked. This is the heart
rate. In the strip with five dark vertical lines between R waves, the calculated heart rate is 60 beats per minute. For greater accuracy,
learn
to count
the
lines
between
the
dark
vertical
lines
to
determine
the
actual rate.
In
a
patient
with
syndrome
of
inappropriate
antidiuretic
hormone,
which finding
should you
expect?
A.
Fever
B.
Hyperactivi
ty C. Petechiae
D.
Confusion
-
ANSWER
D.
Confusion
Magnesium
hydroxide
effectively
reduces
the
blood
level
of
which
poison?
A.
Ethylene
glycol
B.
Mercury C. Turpentine
D.
Iron
-
ANSWER
D
Early-stream
hematuria
suggests
an
abnormality
in
which
genitourinary structure?
- ANSWER
D. Urethra
The
appropriate
care
of
a
patient
with
an
open
fracture
includes
which intervention?
A.
Cover
the
wound
with
a
dry sterile
dressing.
B.
Do
not
irrigate
deep
lacerations.
C.
Irrigate
a
puncture
wound
with
copious
amounts
of
normal
saline
solution.
D.
Position
the
extremity
at
or
below
the
level
of
the
heart.
-
ANSWER
A. Cover
the wound
with
a
dry
sterile
dressing.
Which
intervention
might
you
perform
initially
to
manage
a
patient
with obstructive shock?
-
ANSWER Emergency
needle
thoracentesis
What is the initial intervention for a patient in labor who presents with shoulder dystocia?
-
ANSWER
Position
the
mother
with
her
legs
hyperflexed over
the
abdomen.
Which
medication
is
a
first-line
agent
for
managing
cardiac
arrest?
- ANSWER Epinephrine
(Adrenalin)
For
a
patient
who
is
suspected
of
having
an
aortic
dissection,
which intervention
is appropriate?
-
ANSWER
Administer
a
beta-blocker
to
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control
the
heart
rate.
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Which
sign
is
characteristic
of
preeclampsia?
-
ANSWER
Proteinuria
Which
finding
should
you
expect
in
a
70-kg
patient
with an
estimated blood
loss
of 1,700
mL?
-
ANSWER
Anxiety and
confusion
The
immobilization
of
which
fracture
depends
on
the
patient's
comfort
and functional demands?
C.
Elbow
fracture
D.
Clavicle
fracture
-
ANSWER
D.
Clavicle
fracture
Which
condition
may
cause
urine
retention?
-
ANSWER
A.
Spinal
cord
injury
Which
condition
may
cause
urine
retention?
-
ANSWER
A.
Spinal
cord
injury
Acetone
is
a
toxic
metabolite
of
which
alcohol?
A.
Methanol
B.
Ethanol
C.
Isopropanol
D.
Ethylene
glycol
-
ANSWER
C
Which
rhythm
is
a
common
cause
of
sudden
cardiac arrest? A.
Ventricular
tachycardia
B.
Supraventricular tachycardia C.
Sinus tachycardia
D.
Junctional
tachycardia
-
ANSWER
A.
A common cause of sudden cardiac arrest in adults is ventricular tachycardia that, if untreated,
deteriorates
into
ventricular
fibrillation.
Supraventricular tachycardia,
sinus tachycardia,
and
junctional
tachycardia are
not
causes
of sudden
cardiac
arrest.
Damage
to which
area
of
the
heart
is
most
likely
to result
in
severe heart
failure? A.
Inferior
wall
B.
Posterior wall C.
Lateral
wall
D.
Anterior
wall
-
ANSWER
D.
Heart failure is likely to result from an anterior wall infarction, which produces
left ventricular
failure,
pulmonary
congestion,
and
a
reduction
in
contractility. Although
heart failure can also result from damage to other areas of the heart, anterior wall infarctions are
most commonly
associated
with severe failure
Poisoning
with
which
heavy
metal
causes
a
garlic
breath
odor?
A. Shoulder fracture
B. Humerus
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A. Arsenic B. Mercury C.
Lead
D.
Zinc -
ANSWER
A
Which
substance
can
cause
the
appearance
of
red
or
dark
urine?
- ANSWER
A. Phenytoin
(Dilantin)
A
patient
reports
a
sudden,
sharp
pain
from
the
heel
to
the
back
of
the
leg after
running. Which
injury
should
you
suspect?
A.
Quadriceps
tear
B.
Achilles
tendon rupture C.
Heel fracture
D.
Patellar
dislocation
-
ANSWER
B.
Achilles
tendon
rupture
Which
substance
can
cause
the
appearance
of
red
or
dark
urine?
- ANSWER
A. Phenytoin
(Dilantin)
Which
sign
suggests
a
missed
abortion?
-
ANSWER
Uterus
that
fails
to
grow
Which
patient
is having
a
hypertensive emergency?
-
ANSWER
A
patient
with a
blood pressure of
190/150
mm Hg, headache, and
blurred
vision
Which
manifestation
is
an
early
sign
of
hypovolemic
shock
in
adults?
- ANSWER Tachypnea
Which
sign
or
symptom
is
not
expected
in
a
patient
with
acute
heart
failure?
-
ANSWER Bilateral
wheezing
An anxious patient presents to the emergency department with severe pelvic pain and left
shoulder
pain.
She
states
that
she
is
12
weeks
pregnant. Based
on
this
information, which intervention is the priority for this patient? -
ANSWER Establish intravenous access
with
a
large-bore
catheter.
When
caring
for
a
multiple
trauma
patient
with
a
narrowed
pulse
pressure and
anxiety, you should consider which intervention the priority? - ANSWER Initiate large-caliber intravenous
lines
Which
complication
of
a
fracture
results
in
petechiae
over
the
upper
half
of the
body?
A.
Fat
embolism
syndrome
B.
Volkmanns contracture C. Avascular
necrosis
D.
Compartment
syndrome
-
ANSWER
A.
Fat
embolism
syndrome
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Which
sexually
transmitted
infection
produces
epididymitis
in
men
and pelvic inflammatory
disease in
women?
-
ANSWER
C.
Chlamydia infection
Which
sexually
transmitted
infection
produces
epididymitis
in
men
and pelvic inflammatory
disease in
women?
-
ANSWER
C.
Chlamydia infection
Which
toxic
alcohol
may
cause
urine
to
fluoresce
under
a
Wood's
lamp?
A.
Ethanol
B.
Ethylene glycol C. Methanol
D.
Isopropanol
-
ANSWER
B
Which
disorder
results
from
the
inflammation,
rupture,
or
erosion
of atheromatous plaque
in
the
coronary
arteries?
A.
Pericarditis
B.
Acute
coronary syndrome C.
Heart failure
D.
Hypertensive
crisis
-
ANSWER
B.
Acute
coronary
syndrome
results
from
the
inflammation,
rupture,
or
erosion of
atheromatous
plaque
in
the
coronary
arteries.
Pericarditis,
heart
failure, and hypertensive
crisis
result from
other
causes.
The
treatment
of
rhabdomyolysis
calls
for
administration
of
which medication?
- ANSWER
B. Sodium
bicarbonate
For
a
cardiac
arrest
in
the
emergency
department,
what
is
the
priority treatment
for ventricular
fibrillation?
A.
Rescue
breathing
B.
Cardiac compressions C. Epinephrine (Adrenalin)
D.
Vasopressin
(Pitressin
-
ANSWER
B.
The recommendation for management of an arrest due to ventricular fibrillation or pulseless ventricular tachycardia is immediate defibrillation. High quality chest compressions are begun immediately while the defibrillator
is attached and charged. Neither of these interventions are delayed for ventilations or medications. Epinephrine (Adrenalin)
is
the
first
medication administered.
Vasopressin
is
no
longer
recommended as a first-line drug in cardiac arrest. It has been shown that vasopressin offer no advantage
over epinephrine.
The
treatment
of
rhabdomyolysis
calls
for
administration
of
which medication?
- ANSWER
B. Sodium
bicarbonate
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Which
cardiac
biomarker
may
result
in
a
more
timely
and
definitive diagnosis
of myocardial
injury?
-
ANSWER
Troponin
A
complete
disruption
of
a
muscle
or
tendon
belongs
to
which
classification?
A.
Second-degree
sprain
B.
Third-degree sprain C.
Second-
degree
strain
D.
Third-degree
strain
-
ANSWER
D.
Third-degree
strain
A
patient
with
an
isolated
blunt
cardiac
injury
is
most
at
risk
for which type
of
shock
- ANSWER
Cardiogenic
At
which
point
in
pregnancy
does
preeclampsia
usually
occur?
-
ANSWER
22 weeks' gestation
A
woman,
age
52,
is
found
unresponsive,
apneic,
and
pulseless
at
her desk
an
hour after returning from lunch. What is the most likely cause of her cardiac arrest? - ANSWER
Coronary
heart disease
You
are
teaching
a
patient
with
an
ankle
fracture
how
to
use
crutches
after discharge. Which patient statement indicates an accurate understanding of your discharge instructions?
A.
I'll
place
the
crutches
about
6
inches
to each
side.
B.
I'll
lean
on
my
underarms
when
I'm moving. C.
I'll keep
my
elbows
at
a
45-
degree
angle.
D.
While
leaning
on
the
crutches,
I'll
bring
my
injured
leg
forward
first.
- ANSWER
A.
I'll place the
crutches
about
6
inches
to
each
side.
Which
disorder
contributes
to
a
continued
rise
of
nitrogenous
wastes
in
a patient
with acute
kidney
injury?
-
ANSWER
B. Fever
Which
disorder
contributes
to
a
continued
rise
of
nitrogenous
wastes
in
a patient
with acute
kidney
injury?
-
ANSWER
B. Fever
Which
patient
with
a
myocardial
infarction
is
most
likely
to
present
with crushing
chest pain that lasts
longer
than
30
minutes?
A.
A
man,
age
48
B.
A
man,
age
50,
with
diabetes mellitus C. A woman, age 62, with hypertension D.
A
man,
age 86
- ANSWER
A.
Of
these
patients,
the
man,
age
48,
is
most
likely
to
present
with
crushing chest
pain
that
lasts
longer
than
30
minutes.
Up
to
20
percent
of
patients
with
an
acute myocardial infarction do not experience chest pain. Patients with diabetes
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mellitus are more prone to
neuropathy
and
may
not
experience
pain. Women
have
more atypical
symptoms,
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such
as
profound
fatigue
and
shortness
of
breath.
Among
patients
older than
age
85, the
classic
symptom
of
acute
myocardial
infarction
is shortness
of
breath.
A man, age 64, presents to the emergency department with severe dyspnea and weakness.
A
physical
examination
reveals
bilateral
crackles,
S3,
heart
sound
and dependent
edema.
Which
disorder
is
the most
likely cause of
his findings?
A. Pericarditis B.
Heart failure
C.
Aortic
aneurysm
D.
Hypertensive
crisis
-
ANSWER
B.
The signs and symptoms of heart failure include severe dyspnea, weakness, bilateral crackles,
S3,
heart
sound
dependent
edema,
orthopnea,
fatigue, abdominal
discomfort, and jugular vein distention. Pericarditis, aortic aneurysm, and hypertensive crisis produce
different
constellations
of findings
Which
disorder
involves
the
retrograde
passage
of
infected
urine?
- ANSWER
C. Epididymitis
Which
disorder
involves
the
retrograde
passage
of
infected
urine?
- ANSWER
C. Epididymitis
Damage
to which
area
of
the
heart
is
most
likely
to result
in
severe
heart failure?
- ANSWER
Anterior
wall
A
patient
with
compartment
syndrome
undergoes
arteriography
to
identify which
cause of
this
disorder?
A.
Nerve
compression
B.
Muscle ischemia C. Thrombus
D.
High
compartment
pressure
-
ANSWER
C.
Thrombus
You
should
expect
to
administer
ibuprofen
(Motrin)
to
a
patient
with
which disorder?
- ANSWER
Acute
coronary
syndrome
Which
closed
fracture
site
is
associated
with
the
smallest
amount
of
blood loss?
A.
Humerus
B.
Ankle
C. Elbow
D.
Tibia
and
fibula
-
ANSWER
C.
Elbow
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Which
disorder
is
more
prevalent
in
patients
with
diabetes
mellitus?
- ANSWER
C. Pyelonephritis
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Which
disorder
is
more
prevalent
in
patients
with
diabetes
mellitus?
- ANSWER
C. Pyelonephritis
Which
disorder
is
likely
to
produce
pathologic
Q
waves
on
an electrocardiogram tracing?
A.
Pericarditis
B.
Myocardial necrosis C.
Recent ischemic
event
D.
Unstable
angina
-
ANSWER
B
Pathologic Q waves that measure more than 0.04 second in width and 25 percent or more of the overall QRS height occur within 24 hours of a myocardial infarction and indicate
myocardial
necrosis.
Electrocardiographic changes
associated
with
pericarditis include ST-segment elevation of 1 to 3 mm in all electrocardiogram leads, except aVR and V1. T-wave inversion occurs 6 to 24 hours after an ischemic event and can persist for months to years. Unstable angina can produce ST-segment depression, T-wave inversion,
or
a
normal
electrocardiogram tracing.
After
an
acute
myocardial
infarction,
which
cardiac
biomarker
is
released first?
- ANSWER
Myoglobin
When
determining
the
appropriate
splint
for
a
patient
with
an
angulated
wrist fracture, which
factor
should
you
consider?
A.
Commercially
manufactured
immobilization
devices
are
acceptable.
B.
Air
splints
provide
the
greatest
comfort.
C.
Distal
pulse
assessment
is
difficult
after
traction
splint
application.
D.
Traction
splints
are
indicated
for
angulated
fractures.
-
ANSWER
A. Commercially manufactured immobilization
devices are
acceptable.
Which
laboratory
test
is
the
primary
diagnostic
indicator
of
rhabdomyolysis? -
ANSWER D.
Serum
creatine
phosphokinase
level
The
treatment
of
rhabdomyolysis
calls
for
administration
of
which medication?
- ANSWER
Sodium
bicarbonate
In
acute
coronary
syndrome,
which
finding
is
caused
by
phrenic
nerve stimulation? A.
Nausea
B. Vomiting C. Hiccups
D.
Diaphoresis
-
ANSWER
C.
Hiccups
are
caused
by
phrenic
nerve
stimulation.
Phrenic
nerve
stimulation does
not produce
nausea, vomiting,
or
diaphoresis.
After
an
acute
myocardial
infarction,
which
cardiac
biomarker
returns
to
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baseline
last?
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A.
Myoglobin
B. Troponin
I C.
Troponin
T
D.
Creatine
kinase-MB
(CK-MB)
-
ANSWER
C.
Troponin T is the last biomarker to return to baseline at 14 to 21 days after the myocardial infarction. Myoglobin returns to baseline within 18 to 24 hours. Creatine kinase-MB
returns
to
baseline
between
48
and
72
hours. Troponin
I
returns
to
baseline between
5
and
7
days.
A
blockage
of
the
left
anterior
descending
coronary
artery
causes
the infarction
of
which part
of the
left
ventricle?
-
ANSWER
Anterior
wall
Which
intervention
is
immediately
indicated
for
a
finger
injury
from
a
high-
pressure
paint gun?
A.
Provide
a
referral
for
follow-up
with
an
orthopedist.
B.
Prepare
for
surgery.
C.
Apply
a
metal
finger
splint
in
the
position
of
function.
D.
Prepare
for
nail
trephination.
-
ANSWER
B.
Prepare
for
surgery.
Hyperkalemia-induced
cardiac
arrest
requires
which
treatment
in addition
to cardiopulmonary
resuscitation? -
ANSWER
Calcium
chloride
You
should
expect
to
administer
ibuprofen
(Motrin)
to
a
patient
with which
disorder? A.
Acute
heart
failure
B.
Pericarditis
C.
Hypertensive
crisis
D.
Acute
coronary
syndrome
-
ANSWER
B.
Because pericarditis is primarily an inflammatory complication, patients usually respond to nonsteroidal anti-inflammatory drugs, such as ibuprofen (Motrin). Furosemide (Lasix) is used to reduce preload in a patient with acute
heart failure. Vasodilators, such as nitroglycerin (Nitrostat) or nitroprusside (Nitropress), are used to treat hypertensive crisis.
Aspirin
(Bayer),
not ibuprofen,
is
given
to
a
patient
with
acute
coronary
syndrome.
In addition to cardiopulmonary resuscitation, sodium bicarbonate is the treatment for cardiac
arrest
caused
by
which
disorder?
-
ANSWER
Tricyclic antidepressant
overdose
Which
statement
accurately
describes
the
pathogenesis
of
atherosclerosis?
A. Atherosclerosis includes lipid accumulation in the medial lining of the
arteries. B.
Atherosclerosis
causes
calcification
and
sclerosis
of
the intimal
layer
of
arteries. C.
Atherosclerosis causes
the thickening
of
the walls
of
the aorta.
D. Atherosclerosis affects the small arteries and arterioles. - ANSWER The pathogenesis of atherosclerosis includes lipid accumulation in the intimal
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lining of the arteries,
calcification
and
sclerosis
of
the
medial
layer
of arteries,
and
the
thickening
of
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the
walls
of
the
arteries.
Usually,
atherosclerosis
affects
the
aorta
and
the coronary, cerebral,
femoral, and
other
large
or
medium-size
arteries.
Drugs
from
which
category
reduce
preload
and
afterload?
-
ANSWER Vasodilators
Which
drug
is
administered
to
treat
acutely
decompensated heart
failure? A.
Vasopressin
(Pitressin)
B.
Epinephrine (Adrenalin) C. Nesiritide
(Natrecor)
D.
Amiodarone
(Cordarone)
-
ANSWER
C.
Nesiritide
(Natrecor)
is
administered
to
treat
acutely
decompensated
heart failure.
Esmolol (Brevibloc) is a vasodilator used to treat hypertensive crisis. Epinephrine (Adrenalin)
is
the
first-line
drug
for
cardiac
arrest.
Amiodarone (Cordarone)
is
used
to treat
ventricular
dysrhythmias.
Vasopressin
is
used to
treat
diabetes
insipidus;
it
is
no longer
recommended
as
a
first-line drug in
cardiac
arrest.
Which
statement
accurately
describes
the
pathogenesis
of
atherosclerosis?
- ANSWER Atherosclerosis
affects
the
small
arteries
and
arterioles.
Which
disorder
is
most
likely to
cause substernal chest
pain
at
rest
that occurs
at
the same
time
each
day?
A.
Preinfarction angina B.
Unstable angina
C.
Pericarditis
D.
Prinzmetal
angina
-
ANSWER
D.
Prinzmetal
(variant)
angina
occurs
when
the
patient
is
at
rest
and
usually
at the
same
time each day. Patients with pericarditis have continuous anterior chest pain that worsens
with
deep
inspiration.
Patients
with
preinfarction
(unstable) angina
complain
of frequent episodes of chest pain on exertion, which is at least partially relieved with nitrates.
When
performing
right-sided
electrocardiography,
which
lead
should
you place
at
the fifth intercostal
space
in the
right
midaxillary
line?
-
ANSWER RV6
A
patient
presents
with
a
headache,
blurred
vision,
and
a
blood
pressure
of 280/150
mm Hg.
Which
drug is the
most
effective
in
rapidly
managing this patient's
disorder?
A.
Epinephrine (Adrenalin) B. Nesiritide (Natrecor)
C.
Alteplase
(Activase)
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D.
Nitroprusside
(Nitropress)
-
ANSWER
D.
This
patient
is
experiencing
a
hypertensive
emergency,
which
requires
blood pressure
reduction within 1 to 2 hours to prevent new or worsening end-organ damage. Nitroprusside
(Nitropress)
is
a
potent
arterial
and
venous
dilator
with
an
immediate onset
of
action.
Nesiritide
(Natrecor)
is
used
to
treat acutely
decompensated
heart
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failure.
Alteplase
(Activase)
is
a
fibrinolytic
drug
used
to
reperfuse
a hypoperfused myocardium
and
epinephrine
(Adrenalin)
is
used
in
cardiac
arrest.
In
addition
to
cardiopulmonary
resuscitation,
sodium
bicarbonate
is
the treatment
for cardiac arrest caused
by
which
disorder?
A.
Pulmonary embolus B. Hypokalemia
C. Tricyclic antidepressant overdose D.
Beta-blocker
toxicity
-
ANSWER
C.
Sodium
bicarbonate
is
used
to
treat
cardiac
arrest
caused
by
a
tricyclic antidepressant
overdose. It is also indicated in cardiac arrest caused by hyperkalemia but not hypokalemia.
Ventilatory
support
and
the
consideration
of
fibrinolytic drugs
are
indicated for pulmonary embolus. Glucagon is used to treat cardiac arrest caused by beta-blocker toxicity.
Which
drug
reduces
preload
and
afterload?
-
ANSWER
Nitroglycerin
(Nitrostat)
Which
rhythm
is
a
common
cause
of
sudden
cardiac
arrest?
-
ANSWER Ventricular tachycardia
After
a
patient
with
a
myocardial
infarction
receives
a
fibrinolytic
agent, which
finding
is a
marker
of reperfusion?
A.
Accelerated idioventricular rhythm B.
Chest
pain
only on exertion
C.
ST-segment
depression
D.
Precipitous
drop
in
blood
pressure.
-
ANSWER
A.
Markers of reperfusion include reperfusion dysrhythmias, such as accelerated idioventricular rhythms; the resolution of chest pain; and the normalization of ST changes.
A
precipitous
drop
in
blood
pressure
is
a complication
of
fibrinolytic
therapy
Which
drug
is
administered
to
treat
acutely
decompensated
heart
failure?
- ANSWER Nesiritide
(Natrecor)
Which
drug
reduces
preload
and afterload? A.
Nitroglycerin
(Nitrostat)
B.
Dobutamine (Dobutrex) C. Dopamine
(Intropin)
D.
Phenylephrine
(Neo-Synephrine)
-
ANSWER
A.
Because
nitroglycerin
(Nitrostat)
is
a
vasodilator,
it
reduces
preload
and afterload.
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Dobutamine
(Dobutrex)
is
an
inotrope
used
to
improve
cardiac
contractility. Dopamine (Intropin) and phenylephrine (Neo-Synephrine) are vasopressors used to promote vasoconstriction
and
increase the
systemic
vascular resistance.
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A
patient
presents
with
a
headache,
blurred
vision,
and
a
blood
pressure
of 280/150
mm Hg. Which drug is the most effective in rapidly managing this patient's disorder? - ANSWER
Nitroprusside
(Nitropress)
Which
blood
pressure
reading
is
classified
as
a hypertensive
crisis? A.
Diastolic
pressure
of 110
mm
Hg
B. Systolic pressure of 139 mm
Hg C.
Diastolic
pressure
of
140
mm
Hg
D.
Systolic
pressure of
160
mm
Hg
-
ANSWER
C.
Patients with hypertensive crisis usually have a systolic blood pressure of more than 240
mm
Hg
or
a
diastolic
blood
pressure
of
more than 140
mm Hg.
The other
readings are
not
classified
as
hypertensive
crisis.
Which
medication
is
the
first
one
administered
to
a
patient
with
pulseless
electrical activity
(PEA)?
-
ANSWER
Epinephrine
(Adrenalin)
Which
medication
is
the
first
one
administered
to
a
patient
with
pulseless
electrical activity
(PEA)?
A.
Atropine
B.
Epinephrine (Adrenalin) C. Naloxone
(Narcan)
D.
Vasopressin
(Pitressin)
-
ANSWER
B.
The
first-line
drug
for
managing
cardiac
arrest
from
pulseless
electrical activity
(PEA)
is
epinephrine
(Adrenalin).
Atropine
is
used
to
treat
bradycardia.
Naloxone
is used
to
treat bradycardia and
respiratory depression
or
arrest
secondary to opiate
overdose.
Vasopressin
is
no
longer
recommended
as
a
first-line
drug
in
cardiac
arrest.
It has
been shown that
vasopressin
offer
no
advantage
over
epinephrine.
A
patient
with
electrocardiogram
changes
in
leads
V3
and
V4
that
reflect
an infarction
is experiencing
an
injury
to which area
of
the
heart?
-
ANSWER Anterior
The
right
coronary
artery
supplies
which
area
of the
heart? A.
Left
atrium
B.
Anterior
wall
of
the
left ventricle C.
Intraventricular septum
D.
Posterior
surface
of
the left
ventricle
-
ANSWER
D.
The
right
coronary artery
supplies
the
posterior
surface
of
left
ventricle,
right atrium,
right ventricle, bundle of His (which is also supplied by the left circumflex branch), and sinoatrial
node
in
50%
to
60%
of
the
population.
(The
left circumflex
branch
supplies
the sinoatrial node in 40%to 50% of the
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population.) The left anterior descending artery supplies the anterior wall of the left ventricle and the intraventricular septum. The left circumflex branch supplies
the
left
atrium.
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Atropine
is
most
likely
to
restore
adequate
perfusion
in
which
situation? -
ANSWER Cholinergic-induced
bradycardia
A
patient
with
electrocardiogram
changes
in
leads
V3
and
V4
that
reflect
an
infarction
is experiencing
an
injury
to
which area
of the
heart?
A.
Septal
B.
Inferior
C.
Lateral
D.
Anterior
-
ANSWER
D.
If
the
anterior
area
of
the
heart
is
affected,
leads
V2
through
V4
are abnormal.
Leads
V1
and
V2
are
abnormal
if
the
septal
area
of
the
heart
is
affected.
If
the
lateral area
of
the heart is affected, changes occur in leads I, aVL, V5, and V6. If the inferior area of the heart
is
affected,
leads
II, III,
and
aVF show
changes.
Which
disorder
results
from
the
inflammation,
rupture,
or
erosion
of atheromatous plaque
in
the
coronary
arteries?
-
ANSWER
Acute
coronary syndrome
Which
drug
can
precipitate
refractory
hypotension
in
a
patient
with
a myocardial infarction who
takes
a
phosphodiesterase
inhibitor?
A. Metoprolol (Lopressor) B. Amiodarone (Cordarone) C. Adenosine
(Adenocard)
D.
Nitroglycerin
(Nitrostat)
-
ANSWER
D.
Do
not
give
nitroglycerin
(Nitrostat)
to
a
patient
who
takes
a phosphodiesterase
inhibitor
(to treat erectile dysfunction). Both drugs are vasodilators, and concomitant use is contraindicated because it can precipitate refractory hypotension. Metoprolol (Lopressor),
amiodarone
(Cordarone),
and
adenosine
(Adenocard)
do
not
produce
this effect.
The
left
circumflex
branch
supplies
which
area
of
the
heart?
-
ANSWER Lateral
wall
of the
left ventricle
Which
drug
is
used
to
manage
a
patient
with
a
dissecting aneurysm? A.
Nesiritide
(Natrecor)
B.
Eptifibatide (Integrilin) C.
Esmolol
(Brevibloc)
D.
Amiodarone
(Cordarone)
-
ANSWER
C.
Dissecting
aneurysms
are
commonly
managed
with
a
beta-blocker,
such
as esmolol
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(Brevibloc),
to
control
the
heart
rate
and
reduce
the
blood
pressure.
The target
systolic blood pressure is 90 to 120 mm Hg. Eptifibatide (Integrilin), a glycoprotein IIb/IIIa inhibitor,
reduces
the
risk
of
thrombus
development
and is
not
given
to
a
patient
at
risk for imminent rupture and probable surgery. Nesiritide (Natrecor) is administered for acutely decompensated heart failure
but not a dissecting aneurysm. Amiodarone (Cordarone) is used
to manage disorders
such as ventricular dysrhythmias
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Which
leads
reflect
ischemic
changes
in
the
right
coronary
artery?
-
ANSWER
Leads
II, III,
and
aVF
Which
medication
is
infused
to
improve
cardiac contractility? A.
Nicardipine
(Cardene)
B.
Norepinephrine (Levophed) C. Dobutamine
(Dobutrex)
D.
Nitroprusside
(Nitropress)
-
ANSWER
C.
Dobutamine
(Dobutrex)
is
used
to
improve
cardiac
contractility. Norepinephrine
(Levophed)
is
administered
for
the
short-term
treatment
of
hypotension
or shock.
The calcium channel blocker nicardipine (Cardene) is used to manage
hypertensive emergencies.
Nitroprusside
(Nitropress)
is
also
used
for hypertensive
emergencies
Which
drug
is
used
to
manage
a
patient
with
a
dissecting
aneurysm?
- ANSWER Esmolol
(Brevibloc)
Which
class
of
drugs
decreases
ischemia
after
an
infarction
and
nonfatal acute myocardial
infarction?
A.
Glycoprotein
IIb/IIIa inhibitors B.
Beta-blockers
C. Angiotensin-converting enzyme (ACE) inhibitors D.
Low-molecular-weight
heparins -
ANSWER
B.
Beta-blockers
have
been
found
to
decrease
ischemia
after
an
infarction
and nonfatal
acute
myocardial
infarction.
Glycoprotein
IIb/IIIa
inhibitors,
such
as abciximab
(ReoPro), eptifibatide (Integrilin), and tirofiban (Aggrastat), reduce
the risk of thrombus development independent of aspirin and heparin therapies. Angiotensin-converting enzyme inhibitors, such as enalapril (Vasotec), captopril (Capoten), and lisinopril (Zestril), should be started within 24 hours of an acute myocardial infarction and have been associated with reduced mortality. Low-molecular-weight heparins, such as enoxaparin (Lovenox) and dalteparin (Fragmin) are used to prevent new clot formation and
the
reocclusion
of the
coronary
vessel.
Which
disorder
is
characterized
by
ST-segment
elevation
in
all electrocardiogram leads?
A.
Right
ventricular infarction B.
Pericarditis
C.
Hyperkalemia
D.
Unstable
angina
-
ANSWER
B.
Patients
with
pericarditis
demonstrate
ST-segment
elevation
in
all electrocardiogram
leads.
Right
ventricular
infarction,
which
is
present
in
up
to
40
percent
of
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patients
with inferior myocardial infarctions (ST-segment elevation in leads II, II, and aVF), is evidenced by ST-segment elevation in right-sided leads (RV3 through RV6) and elevation
in
inferior
leads.
Patients
with hyperkalemia
show
tall,
peaked
T
waves
on
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electrocardiogram
tracings.
Patients
with
unstable
angina
may
show
ST-
segment depression and
T-wave
inversion
Which
drug
is
indicated
for
the
treatment
of hyperkalemia? A.
Calcium
chloride
B. Magnesium sulfate C.
Sodium bicarbonate
D.
Amiodarone
(Cordarone)
-
ANSWER
A.
Calcium
chloride
is
recommended
for
hyperkalemia,
hypocalcemia,
and calcium
channel blocker toxicity. Magnesium is useful in treating torsades de pointes and suspected
hypomagnesemia.
Sodium
bicarbonate
is
reserved
for treating
cardiac
arrest in patients with a specific disorder, such as hyperkalemia, preexisting bicarbonate- responsive acidosis, or tricyclic antidepressant overdose. Amiodarone (Cordarone) is used
to
treat ventricular
dysrhythmias,
such
as
monomorphic
ventricular
tachycardia.
Question
12:
For
a
patient
with
acute
heart
failure,
which
intervention
is most appropriate?
A.
Administer
a
rapid-acting
diuretic,
as prescribed. B.
Place
the
patient
in
the
supine
position.
C.
Administer
an
analgesic,
as
prescribed.
D.
Rapidly
administer
fluids
to
replace
lost
volume.
-
ANSWER
A.
Interventions
for
acute
heart
failure
include
administering
a
rapid-acting diuretic,
such
as
furosemide (Lasix), to reduce preload. Interventions also typically include placing the patient
in
the
high-Fowler
position
rather
than
the
supine position.
Analgesics
usually are not needed to manage heart failure, and fluid administration is contraindicated because
fluid
overload
can
cause heart failure.
Which
leads
reflect
ischemic
changes
in
the
right coronary
artery? A.
Leads
II, III, and
aVF
B. Leads V1 to V4 C.
Leads
V5 to
V6
D.
Leads
I
and
aVL
-
ANSWER
A.
Leads
II,
III,
and
aVF
reflect
areas
of
the
heart
supplied
by
the
right
coronary artery.
Leads
V1
to
V4
reflect
the
left
anterior
descending
artery.
Leads
I,
aVL, V5,
and
V6 reflect
the
left circumflex artery.
For
a
patient
with
suspected
acute
coronary
syndrome,
which
agent
is
not part
of
the recommended
management?
A.
Oxygen
B.
Aspirin
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(Bayer) C. Morphine
D.
Nitroprusside
(Nitropress)
-
ANSWER
D.
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An easy way to remember the recommended therapies for a patient with suspected acute
coronary syndrome
is
to
use
the
mnemonic
MONA,
which stands
for
morphine, oxygen, nitroglycerin, and aspirin. Nitroprusside (Nitropress) is a potent vasodilator used
to
treat
severe
hypertension
but not
acute
coronary syndrome
Which
cardiac
biomarker
may
result
in
a
more
timely
and
definitive diagnosis
of myocardial
injury?
A.
Creatine
kinase-
MB B.
Myoglobin
C.
Troponin
D.
Creatine
kinase
-
ANSWER
C.
Troponin
I
and
troponin
T
are
detectable
early
after
an
acute
myocardial infarction
within
3 to 4 hours and aid in the definitive diagnosis of a myocardial infarction. Creatine kinase
and
creatine
kinase-MB
used
to
be
the
gold
standard
for
a definitive
diagnosis
of a acute myocardial infarction. However, their initial elevation occurs 4 to 8 hours after a myocardial infarction. Myoglobin is initially elevated 1 to 2 hours after a myocardial infarction,
but this biomarker
is
not
specific
for
a
myocardial
infarction
In
which
dysrhythmia
does
an
impulse
originate
in
the
atrioventricular junction
before the
next expected
sinus
impulse?
A.
Idioventricular
rhythm
B.
Second-degree
atrioventricular
block, type I C.
Sinus
bradycardia
D. Premature junctional complex - ANSWER A premature junctional complex occurs when an impulse originates in the atrioventricular junction before the next expected sinus impulse. A second-degree atrioventricular block, type I, occurs when successive atrial
impulses
take
progressively
longer
to
traverse the
atrioventricular
node
until
a
beat (QRS complex) is dropped. Sinus bradycardia is characterized by sinoatrial node discharge of less than 60 beats per minute in an adult. An idioventricular rhythm is marked
by
a
wide, bizarre QRS
complex
and
no
P
waves.
Which
drug
may
be
used
to
convert
new-onset
atrial fibrillation? A.
Atropine
B.
Amiodarone (Cordarone) C. Dopamine
(Intropin)
D. Adenosine (Adenocard) - ANSWER Chemical conversion for new-onset atrial fibrillation
can
be
accomplished
with
agents
including
amiodarone (Cordarone),
ibutilide (Corvert), and procainamide (Pronestyl). Atropine and dopamine may be used to treat sinus bradycardia. Adenosine (Adenocard) is
used to treat paroxysmal supraventricular tachycardia.
Which
type
of
block
results
in more
P
waves
that
QRS
complexes
with
a constant
PR interval?
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A.
First-degree
atrioventricular
block
B.
Second-degree atrioventricular block, type I C.
Second-degree
atrioventricular block,
type
II
D. Third-degree atrioventricular block - ANSWER In second-degree atrioventricular block,
type
II,
one
or
more
atrial
impulses
are
not
conducted through
the
atrioventricular node
to
the
ventricles.
With
this
dysrhythmia,
P waves
outnumber QRS
complexes.
However, the PR intervals remain constant. In second-degree atrioventricular block, type I, successive atrial impulses take progressively longer to conduct through the atrioventricular
node
until
one
ventricular depolarization
event
(QRS
complex)
does
not occur. With first-degree atrioventricular block, a P wave precedes each QRS complex, but the PR interval is prolonged. In third-degree atrioventricular block, the P wave and QRS
complex
are
completely independent
of
one another.
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