1.

Which therapy should not be implemented for the patient

with hemorrhagic complications from oral anticoagulants?
A. Volume replacement
B. Whole blood
C. Fresh frozen plasma
D. Protomine sulfate

2. A 4-year-old boy is admitted because of a sudden

high fever. His mother noted that he has been generally
weak and dyspenic and has had generalized pain and
recurrent infections. He is found to have an elevated
white blood cell (WBC) count and anemic, as well as
being thrombocytopenic and tachycardic. A diagnosis of
acute lymphocytic leukemia is made.

A common complication in the acute phase of leukemia

is:
A. Thrombocytosis
B. Polycythemia vera
C. Gram-negative septicemia
D. Seizures

3. The most appropriate basis for discontinuing life-

support in a comoatose patient without any hope of
meaningful recovery is:
A. An agreement reached by the health team and family
B. Two flat electroencephalograms
C. State law regarding discontinuing life-support
D. Physician's order of "no code"

4. Under what circumstances, if any, may a nurse use

force against a patient?
 A. Under no circumstances
B. To bring an emotionally distraught patient back to his
senses
C. To asses an unconscious patient's level of reaction to
physical stimuli.
D. In self-defense, but only if the nurse has reasonable
grounds to believe that she is being, or is about to be attacked.

5. If a nurse is floated to a unit where she has no

experience and, as a result, commits an act of
negligence, who is legally liable?
A. The hospital
B. The nurse
C. The nurse and the hospital
D. The supervisor who floated the nurse

6. A 22-year-old woman who has a recent history of an

upper respiratory tract infection is seen in the
emergency department (ED). She complains of
hoarsness that has lasted 3 days, along with pain on
speaking, nasal congestion, and dysphagia. Assessment
findings reveal a purulent nasal disharge, erythematous
posterior oropharynx, and a temperature of 101o F
(38o C)

These assesment findings indicate what condition?

A. Acute laryngitis
B. Chronic laryngitis
C. Laryngeal carcinoma
D. Vocal cord polyps

7. An 18-year-old man, who was sleeping awoke

suddenly with complaints of "something moving" in his
ear, comes to the ED. On physical examination a large,
live cockroach is noted in his external auditory canal.
The nurse would anticipate the initial treatment to be:
A. Removing the insect with forceps
B. Spraying lidocaine (Xylocaine) 10% in the auditory canal
C. Irrigating the ear with warm water
D. Instilling warm mineral oil in the ear

8. A 65-year-old man with a known history os chronic

obstructive pulmonary disease (COPD) and laryngeal
carcinoma is seen in the ED. Is currently undergoing
radiation therapy and presents symptoms of acute
respiratory distress. Assessment reveals inspiratory
stridor, dyspnea, increasing apprehension, and facial
flushing.

Immediate action should include:

A. Arterial blood gas evacuation (ABGs) and 100% oxygen
via mask
B. Tracheotomy
C. Intubation
D. Chest X-ray

9. A 40-year-old man is brought to the ED after being

mugged. Blood is coming from his left ear, and the
physician diagnoses a ruptured tympanic membrane.

The initial treatment for this patient should include:

A. Remove clots and pack canal
B. Administer antibacterial otic drops
C. Administer ampicillin (Amcill) 500mg P.O t.i.d.
D. Administer tetanus toxoid

10. A 26-year-old man was involved in an automobile

accident. Approximately 20 minutes elapsed between
the time of the accident and the arrival of the
paramedics. He sustained severe abdominal injuries as
well as multiple fractures. When he arrives in the
emergency department (ED), his vital signs are as
follows:
Blood Pressure: 80/50 mm Hg
Heart Rate: 120 beats/minute
Respiratory Rate: 30 breaths/minute

Which of the following nursing actions is inappropriate

during the initial stabilization of this patient?
A. Administering oxygen therapy
B. Applying medical antishock trousers (MAST)
C. Placing the patient in the Trendelenburg (head-down)
position
D. Infusing lactated Ringer's solution via large-bore IV line

11. Which of the following statement regarding MAST

suits is false?
A. It is a single-unit suit with three compartments
B. Each compartment may be pressurized and deflated
individually or in combination
C. When inflated, it achieves pressures ranging from 0 to
160 mm Hg
D. Once optimal pressure is achieved, automatic release
valves prevent further pressure increases

12. A patient arrives in the emergency department (ED)

with an ice pick protruding from his left lower
abdominal quadrant. An appropriate nursing action is
to:
A. Immediately remove the object and apply firm pressure
to the wound
B. Leave the object in place until the patient is in the
operating room (OR)
C. Establish two large-bore intravenous (IV) line and then
remove the object
D. Obtain an abdominal X-ray and then remove the object

13. Which type of penetrating injury would a gunshot

wound at the sixth intercostal space be?
 A. Chest
B. Abdominal
C. Thoracoabdominal
D. Pelvic

14. Pancreatitis occurs as a complication of perforated

duodenal ulcer when:
A. Serum amylase is elevated to dangerous levels
B. A perforation erodes into the pancreas
C. The patient has a high alcohol intake
D. The pancreatic duct is obstructed

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Question 1
The correct answer is D. Protomine sulfate
Rationale: Protein sulfate neutralizes the effect of parenteral
anticoagulant heparin and is used to treat heparin overdose.
Therapy for hemorrhagic complications from oral
anticoagulants includes volume replacement, clotting factor
replacement, vitamin K administration, and infusions of fresh
frozen plasma and whole blood. Vitamin K acts as a
pharmacologic antagonist to oral anticoagulants and may be
given orally or parenterally.

Question 2
The correct answer is C. Gram-negative septicemia
Rationale: The major causes of death in acute leukemia are
infection and bleeding from anemia, and thrombocytopenia.
Infection is commonly caused by gram-negative sepsis.
Fequent cultures are necessary, and treatment with
appropriate antibiotics is required. The patient may require
placement in a protection environment. Seizures are rare.

Question 3
The correct answer is A. An agreement reached by the
health team and family
Rationale: An agreement reached by the health team and the family is the
most appropriate basis for discontinuing life-support in a comatose patient
without any hope of meaningful recovery. This decision has legal, ethical, and
psychological implications and can never truly be decided by legal or
procedural methods. Coming to an informed decision after careful
consideration of the facts prepares the family for death, reduces needless
suffering and cost, diminishes the ambiguity surrounding verbal "no code"
orders, and decreases the risk of legal action. Such a decision should then be
carefully documented in the patient's chart and made known to everyone
concerned.

Question 4
The correct answer is D. In self-defense, but only if the
nurse has reasonable grounds to believe that she is
being, or is about to be attacked.
Rationale: A nurse may legally use force against a patient in
self-defense, but only is the nurse has reasonable grounds to
believe that she is being, or is about to be attacked. Everyone,
including nurses, has the legal right to protect himself and well
as the right to work in a safe environment. When dealing with
combative patients and at risk for harm, nurses have the right
to defend themselves, as long as the defense is reasonable
and only to the extent necessary to defend themselves.
Moreover, the self-defense must not continue when the
apparent danger has passed and the patient is no longer
combative.

Question 5
The correct answer is C. The nurse and the hospital
Rationale: If a nurse is floated to a unit where she has no
experience and, as a result commits an act of negligence, the
nurse and the hospital are both legally liable. This situation is
unfortunately a "catch 22" for the nurse. She is responsible to
act as any reasonable nurse would in similar situations of
nursing care and prevent injury to the patient. However, she
may lose her job if she refuses to be floated to an unfamiliar
unit. The best advice to the nurse in such situation is to inform
the supervisor that she is unfamiliar with the unit being floated
to and request that the assignment be adjusted to
accommodate the floated nurse. For example, the nurse could
perform only those functions she feels comfortable with while
more expert nurses perform the more technically difficult skills.
The hospital also is liable as they are responsible for providing
competent care, especially to critically ill patients, or during an
emergency.

Question 6
The correct answer is A. Acute laryngitis
Rationale: A patient ith a recent history of an upper
respiratory tract infection, hoarsness, fever, and erythematous
oropharynx has acute laryngitis. Patients with vocal cord
polyps have hoarsness but no upper respiratory tract infection,
wheras those with laryngeal cancer may have hoarsness and
difficulty breathing only if the leasion is large. Layngeal cancer
usually occurs in older men with a long history of smoking and
alcohol abuse.

Question 7
The correct answer is B. Spraying lidocaine (Xylocaine)
10% in the auditory canal
Rationale: Recent studies reveal that insects may be removed
form the ear by spraying a topical neurostimulant, such as
lidocaine, into the external auditory canal. If this is unavailable,
the insect should be immobilized and drowned in mineral oil,
then removed with minute forceps. Irrigation with water may
cause the insect's body to swell or may push the insect closer
to the tympanic membrane.

Question 8
The correct answer is C. Intubation
Rationale: Immediate establishment of airway is required, and
intubation is appropriate. Patients undergoing radiation
therapy to the head and neck are subject to complications,
including edema of the upper airway, severe dryness of the
oral cavity, and burns of the skin. Tracteotomy should not be
performed in a patient with laryngeal cancer, because this may
lead to stomal carcinoma by direct extension.

Question 9
The correct answer is A. Remove clots and pack canal
Rationale: When a patient has a ruptured tympanic
membrane and basal skull fracture has been ruled out,
bleeding from the ear may e controlled by evacuating the clot
and packing the ear canal. The packing may be removed when
bleeding has stopped. Tympanic membrane rupture does not
require antibiotics; a healthy exposed middle ear mucosa is
especially vulnerable to ototoxicity from ear drops. The
tympanic membrane should heal in 1 to 2 weeks.

Question 10
The correct answer is C. Placing the patient in the
Trendelenburg (head-down) position
Rationale: The initial management of a patient in shock
involves provisions for airway and ventilation; maintenance of
blood volume, pressure, and circulation; and maintenance of
cellular oxygen consumption. Specific measures would include
oxygen therapy and administration of IV fluid, preferably
lactated Ringer's solution via large-bore IV line. A MAST suit
can also be used in patients with lower-extremity or abdominal
injuries who have signs and symptoms of hypovolemic shock.
This will autotransfuse approximately 1,000ml of blood, reduce
blood loss by application of direct pressure, and immobilize
injuries of the lower extremities. The patient in shock should be
flat with only the legs elevated. The Trendelenburg position,
one favored, has been abandoned because it allows the
diaphram to migrate upward, thus compromising ventilation.
Also, this position may cause a reflex inhibition of the
pressoreceptor activity, thereby decreasing sympathetic
stimulation and further compromising arterial blood presure.

Question 11
The correct answer is C. When inflated, it achieves
pressures ranging from 0 to 160 mm Hg
Rationale: MAST is a single-unit suit with three
compartments; an abdominal compartment and two individual
lower-etremity compartments. It may achieve pressures
ranging from 0 to 104 mm Hg. Each of the three compartments
may be pressurized and deflated individually or in combination.
Once a pressure of 104 mm Hg is achieved, automatic release,
or pop-off, valves prevent further pressure increases.
Question 12
The correct answer is B. Leave the object in place until the
patient is in the operating room (OR)
Rationale: Impaled objects should never be removed until the
patient is in the OR, where hemorrhage can be surgically
controlled once the object is removed.

Question 13
The correct answer is C. Thoracoabdominal
Rationale: The diaphram, which separates the chest from the
abdomen, rises to the level of the sixth intercostal space on
respiratory exhalation. Therefore, this injury is considered a
thoracoabdominal once, because the bullet may enter both the
abdomen and the chest.

Question 14
The correct answer is B. A perforation erodes into the
pancreas
Rationale: Perforation of a duodenal ulcer with ensuring
peritonitis erodes the wall of the pancreas, causing
pancreatitis.