SurgicalNeurologyCases Question Title * 1. What diagnoses are you actively considering at this point? Syncope Seizure Stroke Orthostatic Hypotension Arrhythmia Question Title * 2. How confident at this point are you about a diagnosis of syncope? Definite Likely Unlikely Impossible Question Title * 3. The emergency room is always very busy and time is limited. Which of the following would be the highest priority for the nurse interacting with the sister? Obtain an extensive history from the sister. Explain to the sister all of the events and test results Not speak with the sister unless there is written consent from the patient to do so Tell the sister that when the intern comes down he/she would be the best person to speak with Question Title * 4. If you seek additional history at this point, what is the most important question to ask? Question Title * 5. Does this additional information change your diagnosis? Yes No Maybe Question Title * 6. Based on this new information, what action do you take? Document the additional history on your ER nursing sheet Inform the ER doctor Inform the medicine intern Question Title * 7. What do you do at this time? Wait for the intern to come down Call the resident Escalate to the ER attending Question Title * 8. Is there anything the nursing staff might do to prevent this from happening in the future? Question Title * 9. What is the most likely diagnosis now? Syncope Seizure Stroke Orthostatic Hypotension Arrhythmia Question Title * 10. What piece of information was most important in making this diagnosis at this point? Question Title * 11. What should be done about neurological checks? Institute neurological checks q4hours Institute neurological checks q8 hours Institute neurological checks q2 hours Institute neurological checks q1hours Because the patient is on telemetry, frequent neurological checks are not necessary Question Title * 12. What other actions should the nurse take? Call the intern to suggest another diagnosis Move the patient to another location on the telemetry floor Transfer the patient to an intensive care unit Question Title * 13. What should the nurse do at this time? Tell the intern that he is incorrect. Escalate to the resident Follow the orders issued and monitor the patient as suggested. Question Title * 14. Which change would practically have most likely prevented the negative outcome of a hip fracture in the patient? The intern could have arrived to the ER a more timely manner. The nurse could have called the intern again from the ER to inform him of the additional history. The ER nurse could have escalated to the attending ER doctor or resident and made them aware of the additional pertinent history The ER nurse could have suggested that the patient be given a room closer to the nurse’s station The nurse should have suggested a neurology consult be done in the ER The nurse could have started keppra (levetiracetam) without physician orders. Question Title * 15. What was the most likely cause of death? Allergic reaction to pain medication Narcotic overdose Seizure Pulmonary Embolus Done