1. The nurse prepares to administer acetylcysteine (Mucomyst) to the client with an overdose of acetaminophen (Tylenol).

What is
the appropriate action when administering this antidote?
a. Administer the medication subcutaneously in the deltoid muscle.
b. Administer the medication by intramuscular (IM) injection in the gluteal muscle.
c. Mix the medication in a flavored ice drink and allowing the client to drink the medication.
d. Administer the medication by an intravenous (IV) line, mixed in 50 mL of normal saline and
piggybacked through the main IV line.

Rationale:
Acetylcysteine is the antidote for acetaminophen. Because acetylcysteine has a pervasive flavor of rotten eggs, it must
be disguised in a flavored ice drink and is preferably drunk through a straw to minimize contact with the mouth. It is a
solution that also is used as a mucolytic agent, administered via nebulization. It is not administered by the IV, IM, or
subcutaneous route.

2. Which of the following patients are NOT considered ESI level 2 patients?
a. Suicidal ideation.
b. Rash with no shortness of breath or stridor.
c. Dialysis patient after fistula placement that same day and having arm swelling.
d. Chest pain radiating to the left arm and into the back.

3. What is a major issue as it relates to "frequent flyers" to the Emergency Department?

a. The tendency to anger the staff for consuming their time.
b. The possibility that a future visit may turn out to be an emergency need.
c. The increased amount of cost to the system.
d. The need to provide specialty consultation such as behavioral health.

4. What is the correct response to a mother presenting to your triage window with a small child in her arms that appears:
dusky with discolored nail beds, listless, and retractions?
a. Grab the child from mom and run immediately to a room.
b. Call the ER physician to request orders.
c. Shake the child to attempt to arouse the child.
d. Immediately push the "code" button on the wall and administer high flow oxygen via a large volume device while in the
triage room.

5. What ESI level would a patient who is deemed a "P" on the AVPU scale?
a. ESI 1
b. ESI 2
c. ESI 3
d. ESI 4
e. ESI 5

48y/o woman comes into the ER very upset about the abusive behavior she received from police when she went to report
being beaten by her husband. And she's also upset because she doesn't think the officer took her situation seriously
because he didn't take any notes. She is very fixated on the police mishandling of her report. She presents with anxiety,
depression, and scattered bruising on her limbs in various stages of healing. She declines to undress and don a hospital
gown for examination stating she only wants her wrist examed due to the bruising and severe pain with movement.