KNOWLEDGE ASSESSMENT AND PREPARATION

FOR THE CERTIFIED EMERGENCY

NURSES EXAMINATION

Author: Kathleen Carlson, RN, MSN, CEN, FAEN, Virginia Beach, VASection Editors: Kathleen Carlson, RN, MSN, CEN, FAEN, and Carrie A. McCoy, PhD, MSPH, RN, CEN

With the current emphasis on credentialing in nursing,many nurses have committed to taking the CEN examina-tion. The following questions have been developed to assistin the emergency nursing knowledge assessment and in pre-paration for the CEN examination. Questions, rationale forthe correct answers, and references are provided here foryour self-evaluation. ENA has developed educational materi-als that can be used as further resources for CEN prepara-tion: Emergency Nursing Core Curriculum and CENReview Manual. For further information on educationalreview materials, please contact the ENA Association ServicesTeam at (800) 243-8362.

QUESTIONS

1. Which of the following conditions would cause a urine specificgravity (USG) of 1.005?

A. Diabetes mellitus

B. Congestive heart failure

C. Glomerulonephritis

D. Syndrome of inappropriate secretion of antidiuretic hormone

2. Which of the following medications can be administered to apatient diagnosed with an unstable narrow tachycardia with arapid ventricular response through an accessory pathway?

A. Amiodarone (Cordarone)

B. Digoxin (Lanoxin)

C. Diltiazem (Cardizem)

D. Verapamil (Calan or Isoptin)

3. Hypotension, constricted pupils, urinary incontinence, emesis,and diaphoresis are toxic symptoms caused by which of thefollowing substances?

A. Petroleum distillate

B. Pesticide

C. Gamma-hydroxybutyrate

D. Jimsonweed

4. A common side effect of levetiracetam (Keppra) would be

A. Euphoria

B. Cardiac arrhythmia

C. Somnolence

D. Hypertension

5. Which of the following drugs would be given first in the com-bination of drugs to treat a patient for hyperkalemia?

A. Sodium polystyrene sulfonate (Kayexalate)

B. Sodium bicarbonate

C. Calcitonin (Calcimar)

D. Insulin

Kathleen Carlson, Member, Tidewater Chapter, is Staff Nurse, EmergencyDepartment, Sentara Virginia Beach General Hospital, Virginia Beach, VA.

For correspondence, write: Kathleen Carlson, RN, MSN, CEN, FAEN;E-mail: kkcarls@aol.com.

J Emerg Nurs 2010;36:38-9.

Available online 3 December 2009.

0099-1767/$36.00

Copyright © 2010 Emergency Nurses Association. Published by Elsevier Inc.All rights reserved.

doi: 10.1016/j.jen.2009.10.017

REFERENCES1. Flasar C. What is urine specific gravity? Nursing. 2008;38(7):14.

2. Hemingway T. Wolff-Parkinson-White syndrome: treatment & medica-tion. http://emedicine.medscape.com/article/761066-treatment. AccessedAugust 30, 2009.

3. Chernecky CC, Garrett K, George-Gay B, Hodges RK. Conduction de-fects and accessory pathways. In: Saunders Nursing Survival Guide: ECGs& the Heart. 2nd ed. St Louis, MO: Elsevier Saunders; 2006:341-7.

4. Phillips M. Toxicologic emergencies. In: Hoyt S, Selfridge-Thomas J,eds. Emergency Nursing Core Curriculum. 6th ed. Philadelphia, PA: Else-vier Saunders; 2007:604-58.

5. Skidmore-Roth L, ed. Mosby’s 2009 Nursing Drug Reference. 22nd ed. StLouis, MO: Elsevier Mosby; 2009:619-620, 835-837.

6. Hall A, Salazar M, Larison D. The sequencing of medication administrati-on in the management of hyperkalemia. J Emerg Nurs. 2009;35(4):339-42.

C E N R E V I E W Q U E S T I O N S

38 JOURNAL OF EMERGENCY NURSING VOLUME 36 • ISSUE 1 January 2010

ANSWERS

1. Correct answer: CUSG measures the concentration of particles in urine and comparesthe density of water with the density of the urine. It is an indicatorof the patient’s hydration status as well as kidney function. Normalresults range from 1.010 to 1.020. A USG of 1.005 is caused byconditions such as glomerulonephritis, excessive fluid intake, poly-dipsia, diabetes insipidus, or other conditions causing dilute urine.Diabetes mellitus, congestive heart failure, and syndrome of inap-propriate secretion of antidiuretic hormone would have an increasedUSG level above 1.020. Flasar,1 14.

2. Correct answer: AThis patient has Wolff-Parkinson-White syndrome, a conditionwhere the ventricles are stimulated by an early impulse travelingdown an accessory pathway, the bundle of Kent. This pathway hasa greater conduction velocity as it bypasses the delay at the atrioven-tricular node. This pre-excitation results in asynchronous activationof the ventricles. A delta wave or slurred upstroke of the QRS com-plex results from these impulses traveling to the ventricles by differ-ent conduction pathways and then depolarizing the myocardium.According to American Heart Association guidelines, 150 mg ofamiodarone given intravenously over a period 10 minutes shouldbe considered after expert consultation. Atrioventricular nodal block-ing agents such as adenosine (Adenocard), digoxin (Lanoxin), diltia-zem (Cardizem), and verapamil (Calan or Isoptin) are class III drugs(can be harmful) and should be avoided because they may speed upconduction through the accessory pathway, further increasing theheart rate. Hemingway2; Chernecky et al,3 341-3.

3. Correct answer: BThese are symptoms of organophosphate poisoning, which includespesticides. These patients will exhibit a cholinergic reaction or sti-mulation of the parasympathetic system. The pneumonic “MUD-DLES” is helpful to remember the symptoms (M, miosis orpinpoint pupils; U, urination increased; D, defecation; D, diaphor-esis; L, lacrimation; E, excitation; S, salivation). Petroleum distillate

poisoning (A) presents with euphoria, hallucinations, ataxia, petro-leum odor, hyperthermia, tachypnea, and abnormal breath sounds(crackles, rhonchi, wheezes). Gamma-hydroxybutyrate poisoning(C) presents with lethargy to deep coma, respiratory depression,hypertension, bradycardia, and generalized or tonic clonic seizures.Jimsonweed poisoning (D) will cause anticholinergic symptoms,which block parasympathetic stimulation. Symptoms causing antic-holinergic toxicity can be remembered by the saying “Blind as a bat(mydriasis or dilated pupils), red as a beet (flushed, hot skin), dry asa bone (failure of the body to make fluids), mad as a hatter (hallu-cinations), and hotter than Hades (hyperthermia).” Phillips,4 648.

4. Correct answer: CCommon side effects of levetiracetam (Keppra), used to control seizureactivity, are somnolence and asthenia, a general loss or lack of bodilystrength, and weakness. Depression, not euphoria (A), may also occur.Cardiac arrhythmias (B) and hypotension (D) are side effects of phe-nytoin (Dilantin), not levetiracetam (Keppra). Skidmore-Roth,5 619.

5. Correct answer: DOf the medications listed, insulin would be the first drug to be ad-ministered. Insulin (usual dose, 10 units) can reduce the potassiumlevel significantly, up to 1 mEq in an hour. However, 50 g of dex-trose should be administered just before the insulin to preventhypoglycemia in a patient with a normal or decreased glucose level.Sodium polystyrene sulfonate (Kayexalate) (A) with sorbitol solu-tion (usual dose, 15-45 g, 1-4 times daily) takes 1 to 2 hours beforethe effects take place and would be administered after the rapid-act-ing medications have been administered. Sodium polystyrene sulfo-nate absorbs the potassium in the large intestine and eliminates it inthe feces. Sodium bicarbonate (B) would be administered later inthe order of drug administration and is only effective if metabolicacidosis is present. Calcitonin (Calcimar) (C) is administered tolower the calcium level in hypercalcemia and has no effect onpotassium level. Calcium chloride or calcium gluconate would beadministered initially to stabilize the myocardium but only whenthe patient has a wide QRS, when S and T merge together (sinewave pattern), or in a patient in cardiac arrest caused by hyperka-lemia. Hall et al,6 339-40.

Carlson/CEN REVIEW QUESTIONS

January 2010 VOLUME 36 • ISSUE 1 WWW.JENONLINE.ORG 39