CEN Emergency Nursing: Recognition, Priorities, and Reassessment Study Guide

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An adult collapses in the waiting area and makes occasional snorting breaths. You cannot identify a pulse within ten seconds. Activate the response system, begin compressions, and have another team member bring the defibrillator immediately.

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A pulseless patient has ventricular fibrillation on attached pads. While one nurse continues compressions, another prepares the defibrillator. Deliver the indicated shock as soon as ready and restart compressions without waiting for a prolonged rhythm inspection.

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Prepare synchronised cardioversion for a regular narrow-complex tachycardia causing hypotension and confusion. If the rhythm instead becomes sustained polymorphic ventricular tachycardia, prepare immediate unsynchronised defibrillation rather than waiting for synchronisation markers.

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The monitor shows a very rapid wide-complex rhythm with varying beat intervals and changing QRS appearances. Before a proposed adenosine administration, identify the irregular pattern and escalate for rhythm-specific management instead of treating it as regular supraventricular tachycardia.

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A patient with ongoing burning chest discomfort, sweating, and jaw pain has an initially normal ECG and an early troponin below the reference limit. Continue monitored evaluation, repeat the ECG, and complete the appropriate serial troponin pathway.

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A patient with heart failure reports new inability to lie flat, sudden weight gain, and rapidly worsening breathlessness. When speech becomes difficult because of respiratory distress, escalate immediately rather than treating this as a routine medication-review visit.

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A patient with sudden pleuritic pain and a swollen calf collapses. If no definite pulse is present despite organised complexes, begin CPR and communicate the preceding symptoms as clues to possible pulmonary embolism.

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An adult initially wheezes loudly but later becomes drowsy, speaks only a few words, and has barely audible breath sounds. Treat this as deterioration and summon advanced support while continuing indicated acute asthma treatment and monitoring.

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After chest trauma, a patient develops severe respiratory distress, hypotension, and markedly reduced breath sounds on one side. Alert the trauma team and prepare emergency decompression rather than delaying for transport to radiology.

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A patient repeatedly returns after using only a short-acting reliever. During discharge preparation, clarify the prescribed corticosteroid-containing regimen, observe inhaler use, and ask what has prevented consistent access or use before arranging follow-up.

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Before discharge, ask a patient to explain what they would do if nighttime symptoms increased and which findings would trigger emergency care. Compare the response with the written plan and correct any mismatch involving their actual inhalers.

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Soon after intubation for severe asthma, a patient's blood pressure collapses and expiratory flow has not returned to the zero baseline before the next inspiration. Alert the airway team to possible dynamic hyperinflation and support immediate ventilation reassessment.

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An unresponsive adult has a definite central pulse but no effective breaths. Support the airway and provide one breath every six seconds with visible chest rise. Reassess circulation and begin compressions if the pulse is lost.

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A responsive diner cannot speak and has an ineffective cough. Begin five back blows followed by five abdominal thrusts and repeat as needed. If the diner becomes unresponsive, lower them safely and begin CPR.

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A patient awakens with weakness at 06:30 after a partner observed normal function at 22:00. Document 22:00 as the reported last-known-well and 06:30 as discovery time, then communicate both clearly during stroke escalation and handoff.

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A patient's right arm weakness and slurred speech resolve while travelling to the emergency department. Maintain urgent evaluation and obtain the symptom timeline and witness account even though the patient now answers questions and moves both arms normally.

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A patient suddenly develops double vision and cannot walk steadily, although facial movement and arm strength appear symmetric. Establish the timeline and escalate for urgent neurological assessment rather than dismissing the presentation because common FAST findings are absent.

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A witness reports that convulsions began four minutes before arrival and they continue during assessment. Start stabilisation immediately and prepare benzodiazepine treatment as total duration reaches five minutes. Check glucose without postponing seizure termination.

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A patient begins convulsing beside a trolley. Clear hard equipment, protect the head, call for help, and time the event. Redirect a bystander who tries to hold the patient's arms down or place a spoon between the teeth.

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A previously conversational patient becomes difficult to keep awake after a head injury and develops new arm weakness. Escalate immediately and communicate the change from the earlier examination.

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A patient with suspected cervical cord injury is hypotensive and bradycardic. Communicate possible neurogenic shock, maintain urgent trauma assessment, and continue searching for bleeding or other causes of hypotension.

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A patient with melaena becomes pale, clammy, and confused. Escalate for haemorrhage resuscitation even though only a small stool specimen is available and there has been no bright-red vomiting.

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A patient with gallstones develops persistent epigastric pain radiating to the back and repeated vomiting. Support diagnostic evaluation and reassess perfusion and breathing while fluids and analgesia are administered.

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A patient with known cirrhosis vomits blood and feels faint. Include possible variceal bleeding in the urgent handoff, assess for shock, and support the emergency bleeding pathway rather than assuming an uncomplicated irritation from vomiting.

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A patient with previous brief post-meal attacks now has sustained upper right abdominal pain, fever, and jaundice. Escalate evaluation for complicated biliary disease and reassess for infection-associated deterioration.

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A patient who had bowel surgery years earlier develops cramping pain, progressive distension, repeated vomiting, and no flatus. Communicate the surgical history and obstructive pattern before an oral constipation remedy is considered.

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A patient under evaluation for obstruction develops more severe pain, fever, and tachycardia. Promptly communicate the change and escalate for possible compromised bowel rather than waiting for a scheduled reassessment or assuming pain is expected.

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An adolescent reports abrupt severe testicular pain with vomiting and no trauma. Escalate immediately for possible torsion rather than arranging routine follow-up for presumed infection.

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At 32 weeks, a previously normotensive patient has blood pressures of 166/104 and 164/102 mmHg 15 minutes apart, normal platelets and creatinine, and no proteinuria. The systolic pressure alone meets the severe threshold, supporting preeclampsia with severe features. Activate urgent obstetric management, initiate prescribed antihypertensive treatment, and prepare magnesium sulfate for seizure prevention. Monitor breathing, reflexes, and urine output during magnesium therapy.

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A patient with unusual spotting develops severe lower abdominal pain, shoulder-tip pain, and near-syncope. Treat the presentation as possible internal haemorrhage and support urgent resuscitation and obstetric assessment, even if pregnancy has not yet been confirmed.

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A patient arrests with the uterus above the umbilicus. Assign manual uterine displacement, continue CPR and defibrillator assessment, and activate immediate delivery preparation. If circulation is not restored, the team proceeds toward delivery at the arrest location with completion targeted by five minutes.

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A cooperative patient reports current suicidal thoughts, or denies current thoughts but describes a recent attempt. Maintain appropriate safety precautions and communicate both current responses and recent behaviour to the assessing clinician.

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A patient reports thoughts of overdose and says a large supply of medication is already set aside at home. Communicate the preparation and access explicitly, maintain appropriate safety precautions, and include means restriction in the clinician-led safety assessment.

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A patient says voices are telling them to attack a relative. Assess the command content and likelihood of acting, arrange immediate safety measures, and investigate recent sleep, medication, substance, and illness changes.

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A pacing patient becomes louder as three staff members give instructions. Reduce unnecessary personnel nearby, designate one speaker, and offer two suitable assessment locations while maintaining a safe exit and support.

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A patient reports swallowing an uncertain number of tablets to die and becomes increasingly drowsy. Prioritise airway and respiratory reassessment, identify available packaging, obtain toxicology guidance, and maintain direct safety observation.

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Established diabetes, glucose 176 mg/dL, beta-hydroxybutyrate 4.6 mmol/L, and pH 7.22 satisfy DKA criteria. Later glucose 168 mg/dL with ketones 2.4 mmol/L and pH 7.24 still represents unresolved ketoacidosis.

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A patient meets DKA criteria, but potassium is 3.1 mmol/L before insulin begins. Notify the treating clinician, initiate prescribed potassium replacement and monitoring, and withhold insulin until the potassium requirement for safe initiation has been met.

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A patient with renal failure has potassium 7.1 mmol/L and widening QRS complexes. Prepare prescribed calcium, insulin-glucose treatment, serial glucose and potassium checks, and urgent renal assessment for potassium removal.

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An older adult has profound dehydration, glucose 780 mg/dL, effective osmolality 326 mOsm/kg, beta-hydroxybutyrate 1.2 mmol/L, pH 7.36, and bicarbonate 22 mmol/L. All four HHS components are present.

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A patient with suspected infection develops hypotension and confusion. Obtain lactate and cultures, support immediate antimicrobials and resuscitation, and reassess blood pressure, mentation, capillary refill, urine output, and fluid response.

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A patient develops hoarseness, wheeze, and hypotension after an exposure, with little visible rash. Recognise anaphylaxis and administer protocol-directed intramuscular epinephrine promptly while obtaining assistance and supporting oxygenation and circulation.

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After a tibial injury, a patient reports rapidly worsening pain despite treatment, and passive toe movement sharply increases discomfort. Escalate immediately for possible compartment syndrome and communicate the changing pain pattern and examination findings.

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A patient with an injured forearm has a strong radial pulse but increasing deep pain, a tense forearm, and painful passive finger extension. Report possible compartment syndrome urgently rather than documenting intact pulses as exclusion of a perfusion emergency.

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After a fall, a patient has a deformed forearm and a small puncture over the injury, with no exposed bone. Communicate a possible open fracture and protect the wound while arranging urgent evaluation rather than classifying it as closed.

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Before splinting, a patient can move the fingers and reports normal sensation. Afterward, increasing numbness and pain develop. Repeat the distal examination, assess the immobilisation, and promptly notify the treating clinician of the change.

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Start irrigation promptly for a cleaning-fluid splash without penetrating trauma. If an associated penetrating object is visible, protect it with a noncontact rigid shield and obtain immediate ophthalmology and trauma assistance.

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A patient reports sudden severe eye pain, blurred vision, coloured halos, and vomiting. Arrange immediate eye assessment rather than treating the vomiting as an isolated gastrointestinal illness.

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A patient continues bleeding into the throat despite sustained compression of the soft nose. Reassess airway and perfusion and prepare further haemostatic treatment rather than repeatedly releasing pressure to inspect.

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A febrile patient sits leaning forward, drools, and has noisy inspiration with difficulty swallowing. Keep the patient upright and activate emergency airway support rather than treating the presentation as an uncomplicated sore throat.

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Several family members develop headache and nausea after indoor generator use, and one patient's pulse oximeter reads 99%. Recognise the shared exposure pattern, support immediate treatment, and arrange blood CO-oximetry instead of excluding poisoning from saturation.

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A confused patient receives oxygen during a long transport after a heater malfunction. The later carboxyhaemoglobin result is lower than expected. Communicate the treatment and elapsed time so the value is interpreted alongside the exposure and neurological findings.

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After an enclosed-space combustion exposure, a patient briefly lost consciousness and remains confused despite oxygen. The current COHb is 18%. Both unconsciousness and ongoing neurological impairment support urgent hyperbaric consultation despite a value below 25–30%. In a pregnant patient with confirmed poisoning and milder symptoms, also seek urgent hyperbaric consultation because CDC recommends this treatment even for less severe maternal poisoning.

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A patient with fever, cough, conjunctivitis, and a new rash reports a relevant exposure. Apply source control and arrange airborne isolation immediately rather than leaving the patient in a shared waiting space until laboratory confirmation returns.

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An adult is removed from water unresponsive and without normal breathing or a definite pulse. Start the drowning resuscitation response with effective breaths and compressions, obtain oxygen and a defibrillator, and avoid delaying care for water-draining manoeuvres.

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During a mass-casualty response, assess an unmoving casualty before walking casualties, perform an indicated rapid lifesaving intervention within your role, and categorise using the activated incident protocol and available resources.

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A previously stable waiting patient develops faintness and clamminess near shift change. Reassess immediately, directly communicate the change and required action, and confirm who has assumed responsibility.

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A patient refusing treatment can repeat the proposed intervention but cannot explain how the stated risks apply personally. Escalate for capacity assessment and address communication or reversible impairment before treating the refusal as informed.

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A patient with limited English proficiency is discussing a sensitive history while a relative answers every question. Arrange qualified interpretation and address the patient directly, clarifying the patient's preferences for family involvement without treating the relative as the automatic interpreter.

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After explaining discharge instructions, ask the patient to describe which symptoms would bring them back and how they will take the new medication. Correct a misunderstanding and repeat teach-back before completing the discharge conversation.