Knowledge Assessment and Preparation for the Certified Emergency Nurses Examination

Abstract

With the current emphasis on credentialing in nursing, many nurses have committed to taking the CEN examination. The following questions have been developed to assist in the emergency nursing knowledge assessment and in preparation for the CEN examination. Questions, rationale for the correct answers, and references are provided here for your self-evaluation. ENA has developed educational materials that can be used as further resources for CEN preparation: Emergency Nursing Core Curriculum and CEN Review Manual. For further information on educational review materials, please contact the ENA Association Services Team at (800) 243-8362. With the current emphasis on credentialing in nursing, many nurses have committed to taking the CEN examination. The following questions have been developed to assist in the emergency nursing knowledge assessment and in preparation for the CEN examination. Questions, rationale for the correct answers, and references are provided here for your self-evaluation. ENA has developed educational materials that can be used as further resources for CEN preparation: Emergency Nursing Core Curriculum and CEN Review Manual. For further information on educational review materials, please contact the ENA Association Services Team at (800) 243-8362. Kathleen Carlson, Member, Tidewater Chapter, is Staff Nurse, Emergency Department, Sentara Virginia Beach General Hospital, Virginia Beach, VA. 1.A carpal spasm develops in a patient as the blood pressure cuff is inflated on the patient's upper arm. This finding is associated with which of the following electrolyte disturbances?A.HypercalcemiaB.HypomagnesemiaC.HyperkalemiaD.Hypophosphatemia2.Which of the following laboratory values should be monitored when caring for a patient who ingested a large amount of ibuprofen?A.Liver function testB.TroponinC.GlucoseD.Blood urea nitrogen3.Milrinone (Primacor) is indicated for the care of which of the following conditions?A.DiabetesB.Torsades de pointesC.Heart failureD.Hypertension4.After placement of an orogastric tube in a pediatric patient who has been vomiting, the child becomes suddenly lethargic and unresponsive, with a heart rate of 40 beats per minute. Cardiopulmonary resuscitation has begun. Which of the following medications should be prepared for intravenous administration?A.Epinephrine, 0.1 mg/kgB.Atropine, 0.02 mg/kgC.Magnesium sulfate, 50 mg/kgD.Amiodarone, 5 mg/kg5.Which of the following laboratory findings would you expect to find for a patient diagnosed with HELLP syndrome?A.Elevated platelet countB.Decreased serum glutamic-oxaloacetic transaminase (SGOT)C.Elevated total bilirubinD.Decreased lactate dehydrogenase (LDH) Carpal spasm, induced by inflating the blood pressure cuff (Trousseau's sign), is a finding in hypomagnesemia and hypocalcemia (A) (not hypercalcemia). Prior to onset of treatment for hypocalcemia, the patient should be screened for hypomagnesemia, because patients with low magnesium levels respond poorly to calcium replacement therapy. Patients with hyperkalemia (C) would exhibit paresthesia and severe muscle weakness. Patients with hypophosphatemia (D) can exhibit muscle weakness and rhabdomyolysis. It should be noted that sudden symptomatic hypocalcemia can develop secondary to increased calcium phosphorus binding as a complication of intravenous phosphorus administration. Kuiper,1Kuiper B Fluids and electrolytes.in: Howard P Steinmann R Sheehy's Emergency Nursing: Principles and Practice. 6th ed. Elsevier Mosby, St Louis, Mo2010: 490-498Google Scholar 497. Ibuprofen, a nonsteroidal anti-inflammatory drug (NSAID), is nephrotoxic; therefore, this patient's renal function should be monitored with serial blood urea nitrogen and creatinine measurements. Besides renal failure, large ingestions of NSAIDs can result in drowsiness, coma acidosis, apnea, and bradycardia. It is recommended that patients who have ingested a large amount of an NSAID be treated with activated charcoal (if presenting 1 to 2 hours after ingestion) and that appropriate measures be taken for the symptoms of gastric irritation. Acetaminophen ingestion is hepatotoxic, and the liver function of these patients should be monitored by serial liver function tests (A). Patients can have an elevated troponin level (B) following a cocaine overdose and an elevated glucose level (C) following an iron overdose. Sturt,2Sturt P Toxicologic emergencies.in: Howard P Steinmann R Sheehy's Emergency Nursing: Principles and Practice. 6th ed. Elsevier Mosby, St Louis, Mo2010: 564-577Google Scholar 569. Milrinone (Primacor) is indicated for the short-term management of advanced heart failure that has not responded to other medications and for management of cardiogenic shock. Metformin (Glucophage) is a drug administered for diabetes (A). Magnesium would be indicated to treat a patient with torsades de pointes (B). Metoprolol (Lopressor) is a β-blocker that is one of many drugs indicated for use in hypertension (D) and also is an antianginal agent indicated for administration to all patients with suspected myocardial infarction and unstable angina in the absence of contraindication. Metoprolol decreases oxygen consumption and increases myocardial salvage in the infracted area and can reduce the occurrence of ventricular ectopy and fibrillation. Skidmore-Roth,3Skidmore-Roth L Mosby's 2009 Nursing Drug Reference. 22nd ed. Elsevier Mosby, St Louis, Mo2009: 705Google Scholar 705; American Heart Association,4American Heart Association Handbook of Emergency Cardiovascular Care for Healthcare Providers. American Heart Association, Dallas, Tex2006: 44-63Google Scholar 58. Atropine, 0.02 mg/kg, is indicated for the treatment of symptomatic vagally induced bradycardia (caused by orogastric tube placement). Epinephrine (A), 0.01 mg/kg, could be administered for symptomatic bradycardia, but the dose mentioned, 0.01 mg/kg, is considered high dose and is not appropriate for administration. Magnesium sulfate, 25-50 mg/kg (C), would be administered to a patient with a torsades de pointes or polymorphic ventricular tachycardia. Amiodarone (D), 5 mg/kg, is indicated for the treatment of life-threatening ventricular arrhythmias, not vagally induced bradycardia. American Heart Association,5American Heart Association Pediatric Advanced Life Support: Provider Manual. American Heart Association, Dallas, Tex2006: 115-151Google Scholar 124. HELLP syndrome, a severe form of pre-eclampsia, is characterized by hemolysis, elevated liver enzymes, and a low platelet count. Therefore, the total bilirubin count would be greater than 1.2 mg/dL (hemolysis); the platelet count (A) would be decreased (less than 100,000); and the liver enzymes, SGOT (B), and LDH (D) would be elevated (SGOT >72 units/L and LDH >600 units/L). Jordan,6Jordan KS Obstetric and gynecologic emergencies.in: In Hoyt S Selfridge-Thomas J Emergency Nursing Core Curriculum. 6th ed. Elsevier Saunders, Philadelphia, Pa2007: 536-570Google Scholar 548.