Question 1

A provider prescribes Crotalidae Polyvalent Immune Fab (CroFab)for a client who is admitted after being bitten by a pit viper snake.Which assessment should the nurse complete prior to administering this medication?

Accepted Answer

CroFab is an antivenom for pit viper snakebites.Clients should be assessed for hypersensitivity to bromelain (a pineapple derivative),papaya,and sheep protein prior to administration.During and after administration,the nurse should assess for urticaria,fever,and joint pain,which are signs of serum sickness.

Question 2

A nurse teaches a community health class about water safety.Which statement by a participant indicates that additional teaching is needed?

Accepted Answer

People should never swim alone,regardless of lifeguard status.The other statements indicate good understanding of the teaching.

Question 3

A client presents to the emergency department after prolonged exposure to the cold.The client is difficult to arouse and speech is incoherent.Which action should the nurse take first?

Accepted Answer

Moderate hypothermia manifests with muscle weakness,increased loss of coordination,acute confusion,apathy,incoherence,stupor,and impaired clotting.Moderate hypothermia should be treated by core rewarming methods,which include administration of warm IV fluids,heated oxygen,and heated peritoneal,pleural,gastric,or bladder lavage,and by positioning the client in a supine position to prevent orthostatic changes.The client's trunk should be warmed prior to the extremities to prevent peripheral vasodilation.Extracorporeal warming with cardiopulmonary bypass or hemodialysis is a treatment for severe hypothermia.

Question 4

After teaching a client how to prevent altitude-related illnesses,a nurse assesses the client's understanding.Which statement indicates the client needs additional teaching?

Accepted Answer

Teaching to prevent altitude-related illness should include descending when symptoms start,staying hydrated,and taking acetazolamide (Diamox),which is commonly used to prevent and treat acute mountain sickness.The client should be taught to sleep at a lower elevation.

Question 5

A nurse is teaching a wilderness survival class.Which statements should the nurse include about the prevention of hypothermia and frostbite? (Select all that apply.)

Accepted Answer

To prevent hypothermia and frostbite,the nurse should teach clients to wear synthetic clothing (which moves moisture away from the body and dries quickly),layer clothing,and wear a hat,facemask,sunscreen,and sunglasses.The client should also be taught to drink plenty of fluids,but to avoid alcohol when participating in winter activities.Clients should know their physical limits and come in out of the cold when these limits have been reached.

Question 6

An emergency department nurse plans care for a client who is admitted with heat stroke.Which interventions should the nurse include in this client's plan of care? (Select all that apply.)

Accepted Answer

Heat stroke is a medical emergency.Oxygen therapy and intravenous fluids should be provided,and baseline laboratory tests should be performed as quickly as possible.The client should be cooled until core body temperature is reduced to 102° F.Antipyretics should not be administered.

Question 7

A nurse assesses a client recently bitten by a coral snake.Which assessment should the nurse complete first?

Accepted Answer

Manifestations of coral snake envenomation are the result of its neurotoxic properties.The physiologic effect is to block neurotransmission,which produces ascending paralysis,reduced perception of pain,and,ultimately,respiratory paralysis.The nurse should monitor for respiratory rate and depth.Severe swelling and clotting problems do not occur with coral snakes but do occur with pit viper snakes.Electrocardiogram rhythm is not affected by neurotoxins.

Question 8

A nurse is providing health education at a community center.Which instructions should the nurse include in teaching about prevention of lightning injuries during a storm? (Select all that apply.)

Accepted Answer

When thunder is heard,shelter should be sought in a safe area such as a building or an enclosed vehicle.Electrical equipment such as TVs and stereos should be turned off.Stay away from plumbing,water,and metal objects.Do not stand under an isolated tall tree or a structure such as a flagpole.Body piercings will not increase a person's chances of being struck by lightning.

Question 9

An emergency department nurse moves to a new city where heat-related illnesses are common.Which clients does the nurse anticipate being at higher risk for heat-related illnesses? (Select all that apply.)

Accepted Answer

Some of the most vulnerable,at-risk populations for heat-related illness include older adults; blacks (more than whites); people who work outside,such as construction and agricultural workers (more men than women); homeless people; illicit drug users (especially cocaine users); outdoor athletes (recreational and professional); and members of the military who are stationed in countries with hot climates (e.g.,Iraq,Afghanistan).

Question 10

An emergency department nurse assesses a client admitted after a lightning strike.Which assessment should the nurse complete first?

Accepted Answer

Clients who survive an immediate lightning strike can have serious myocardial injury,which can be manifested by ECG and myocardial perfusion abnormalities.The nurse should prioritize the ECG.Other assessments should be completed but are not the priority.

Question 11

A nurse plans care for a client admitted with a snakebite to the right leg.With whom should the nurse collaborate?

Accepted Answer

For the client with a snakebite,the nurse should contact the regional poison control center immediately for specific advice on antivenom administration and client management.

Question 12

While at a public park,a nurse encounters a person immediately after a bee sting.The person's lips are swollen,and wheezes are audible.Which action should the nurse take first?

Accepted Answer

The client's swollen lips indicate that anaphylaxis may be developing,and this is a medical emergency.911 should be called immediately,and the client transported to the emergency department as quickly as possible.If an EpiPen is available,it should be administered at the first sign of an anaphylactic reaction.The other answers do not provide adequate interventions to treat airway obstruction due to anaphylaxis.

Question 13

A nurse assesses a client admitted with a brown recluse spider bite.Which priority assessment should the nurse perform to identify complications of this bite?

Accepted Answer

Fever and chills indicate systemic toxicity,which can lead to hemolytic reactions,kidney failure,pulmonary edema,cardiovascular collapse,and death.Assessing for a fever should be the nurse's priority.All other symptoms are normal for a brown recluse bite and should be assessed,but they do not provide information about complications from the bite,and therefore are not the priority.

Question 14

An emergency department nurse cares for a middle-aged mountain climber who is confused and exhibits bizarre behaviors.After administering oxygen,which priority intervention should the nurse implement?

Accepted Answer

The client is exhibiting signs of mountain sickness and high altitude cerebral edema (HACE).Dexamethasone (Decadron)reduces cerebral edema by acting as an anti-inflammatory in the central nervous system.The other interventions will not treat mountain sickness or HACE.

Question 15

On a hot humid day,an emergency department nurse is caring for a client who is confused and has these vital signs: temperature 104.1° F (40.1° C),pulse 132 beats/min,respirations 26 breaths/min,blood pressure 106/66 mm Hg.Which action should the nurse take?

Accepted Answer

The client demonstrates signs of heat stroke.This is a medical emergency and priority care includes oxygen therapy,IV infusion with 0.9% saline solution,insertion of a urinary catheter,and aggressive interventions to cool the client,including external cooling and internal cooling methods.Oral hydration would not be appropriate for a client who has symptoms of heat stroke because oral fluids would not provide necessary rapid rehydration,and the confused client would be at risk for aspiration.Acetaminophen would not decrease this client's temperature or improve the client's symptoms.The client needs immediate medical treatment; therefore,rest and re-assessing in 15 minutes is inappropriate.

Question 16

A nurse teaches a client who has severe allergies to prevent bug bites.Which statements should the nurse include in this client's teaching? (Select all that apply.)

Accepted Answer

To prevent arthropod bites and stings,clients should wear protective clothing,cover garbage cans,use screens in windows and doors,inspect clothing and shoes before putting them on,consult an exterminator,remove nests,avoid swatting at insects,and carry a prescription epinephrine auto-injector at all times if they are known to be allergic to bee or wasp stings.

Question 17

A provider prescribes a rewarming bath for a client who presents with partial-thickness frostbite.Which action should the nurse take prior to starting this treatment?

Accepted Answer

Rapid rewarming in a water bath is recommended for all instances of partial-thickness and full-thickness frostbite.Clients experience severe pain during the rewarming process and nurses should administer intravenous analgesics.

Question 18

A provider prescribes diazepam (Valium)to a client who was bitten by a black widow spider.The client asks,"What is this medication for?" How should the nurse respond?

Accepted Answer

Black widow spider venom produces a syndrome known as latrodectism,which manifests as severe abdominal pain,muscle rigidity and spasm,hypertension,and nausea and vomiting.Diazepam is a muscle relaxant that can relieve pain related to muscle rigidity and spasms.It does not prevent respiratory difficulty or failure.

Question 19

While on a camping trip,a nurse cares for an adult client who had a drowning incident in a lake and is experiencing agonal breathing with a palpable pulse.Which action should the nurse take first?

Accepted Answer

In this emergency situation,the nurse should immediately initiate airway clearance and ventilator support measures,including delivering rescue breaths.

Quiz 9: Care of Patients with Common Environmental Emergencies

A provider prescribes Crotalidae Polyvalent Immune Fab (CroFab) for a client who is admitted after being bitten by a pit viper snake.Which assessment should the nurse complete prior to administering this medication?