INSTRUCTIONS Current best practices in emergency evaluation and management of syncope

TEST INSTRUCTIONS

* Read the article. The test for this CE activity is to be taken online at http://www.nursingcenter.com/CE/NP. Tests can no longer be mailed or faxed.

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Current best practices in emergency evaluation and management of syncope

Learning Outcomes: By completing this activity and taking the posttest, participants will achieve a minimum score of 70%.

Learning Objectives: After reading the article and completing the posttest, the participant will be able to: 1. Identify common presentations and etiologies of syncope. 2. Describe risk stratification tools used in clinical decision-making for patients with syncope. 3. Summarize appropriate testing and treatment options for patients with syncope in the outpatient setting.

Posttest:

Case-Based Assessment: Placing yourself in the role of the NP, use the scenarios below to apply knowledge and skills learned in the attached article.

Questions #1 - #10 will be based on the following Case Scenario: You are a family NP taking care of a variety of patients at a local urgent care center.

1. DS is a 59-year-old male whose only medical history is Parkinson disease. He experienced a transient loss of consciousness this morning when standing up but has recovered fully. The most likely syncopal cause is

a. cardiac syncope.

b. orthostatic hypotension.

c. neurally mediated syncope.

2. TW is a 36-year-old police detective who vomited and "passed out" at a homicide scene. She has had infrequent similar episodes. The most likely diagnosis is

a. vasovagal syncope.

b. carotid sinus pressure.

c. drug-related postural hypotension.

3. JM is a 66-year-old man whose wife reports that he had a syncopal episode an hour ago. He does not recall the events prior to the episode. What risk factors make this concerning for cardiac syncope?

a. mild dementia and recent Lyme disease infection

b. his obesity and family history of colon cancer

c. history of atrial fibrillation diagnosed 5 months ago

4. TC is a 41-year-old woman who reports a sudden-onset migraine headache during which she "passed out" for about 3 minutes. She had trouble formulating sentences after this event. Your clinical impression is that she experienced

a. a vasovagal syncope event.

b. syncope related to a neurologic etiology.

c. a period of retrograde amnesia.

5. According to current evidence-based practice guidelines, which assessment component is not warranted in every syncope evaluation?

a. ECG

b. orthostatic BPs

c. troponin lab test

6. Which risk stratification tool includes a scoring category of primary central nervous events and has a negative predictive value of 100%?

a. Boston Syncope Rule

b. San Francisco Syncope Rule

c. Canadian Syncope Risk Score

7. JK is a 54-year-old man with coronary artery disease who reports having palpitations and a syncopal episode last night. He is on a statin medication. ECG shows increased QT interval. What would be his risk stratification and treatment plan?

a. intermediate risk, cleared of any serious medical conditions, then treated in the outpatient setting

b. intermediate risk, with concern for symptom being related to statin medication, sent to hospital for evaluation

c. high risk, with concern for multiple cardiac factors, sent to the hospital for further evaluation

8. Your urgent care clinic is looking to reduce unnecessary testing in patients as a quality improvement goal. What is the best suggestion for reducing outpatient testing in patients presenting with syncope?

a. obtaining ambulatory ECGs in all patients within one day of syncopal episodes

b. using clinical judgment and risk stratification tools to guide treatment decisions

c. referring all cases with negative Boston Syncope Pathway tests to cardiology or neurology

9. You are evaluating a 54-year-old woman who reports that she had a brief syncopal episode this afternoon. Which one of the following risk stratification tools does not require lab work?

a. OESIL score

b. FAINT score

c. San Francisco Syncope Rule

10. You are in contact with the primary care provider for AW, a 20-year-old woman whom you saw in your urgent care clinic last week with low-risk factors and recurrent syncope. Expected outpatient treatment may include

a. sequential compression devices and ACE inhibitors.

b. compression vest and calcium channel blockers.

c. beta-blockers and compression stockings.