Deck 69: Nursing Management: Emergency, Terrorism, and Disater Nursing

Question 1

During the secondary survey of a trauma patient in the ED, why is it important that the nurse obtain details of the incident?

A) The mechanism of injury can indicate specific injuries.
B) Important facts may be forgotten when needed later for legal actions.
C) Alcohol use associated with many accidents can affect treatment of injuries.
D) Many types of accidents or trauma must be reported to government agencies.

Answer 1

A. Specific injuries are associated with specific types of. accidents and events surrounding an incident and details of. the incident and the trajectory of penetrating injuries are. important in identifying and treating injury. Alcohol use. is assessed with blood testing and although information. may be used for regulatory agencies, the primary use of the. information is for treatment of the patient.

Question 2

The patient is admitted with severe acidosis from trying to commit suicide by ingesting aspirin.What should be used to treat this patient?

A) Milk
B) Cathartics
C) Hemodialysis
D) Whole bowel irrigation

Answer 2

C. Hemodialysis is reserved for patients who develop severe. acidosis from ingestion of toxic substances. Milk or water. may be used for immediate dilution of acids such as toilet. bowl cleaners. Cathartics are given with activated charcoal.. Whole bowel irrigation is controversial and can cause. electrolyte imbalance.

Question 3

What nursing intervention is performed during the "E" step of the secondary survey?

A) Obtain full set of vital signs.
B) Remove the patient's clothing and assess.
C) Elicit history and head-to-toe assessment.
D) Assess mental status and capillary refill for signs of shock.

Answer 3

B. A nasally placed tube is contraindicated if the patient. has facial fractures or a possible basilar skull fracture. because the tube could enter the brain. It would not be. contraindicated in the other conditions.

Question 4

For which of the following ingested poisons may gastric lavage be considered (select all that apply)?

A) Bleach
B) Aspirin
C) Drain cleaner
D) Iron supplements
E) Amitriptyline (Elavil)

Question 5

When is the placement of a nasogastric tube contraindicated during emergency care?

A) Inhalation injury
B) Head or facial trauma
C) Intraabdominal bleed
D) Cervical spine fracture

Question 6

Priority Decision: A patient is admitted to the ED with nausea, vomiting, and right upper quadrant pain.The patient's family brought an empty container of acetaminophen that was found near him.A large oral gastric tube is inserted.What does the nurse prepare to administer first?

A) Cathartics
B) Ipecac syrup
C) Gastric lavage
D) Activated charcoal

Question 7

In assessing the emergency patient's health history, what information is obtained with the use of the mnemonic AMPLE?

A) Anatomy of injuries, mucous membranes, peripheral edema, leukocytosis, eczema location
B) Approximate weight, motor function, palpable swelling, labored breathing, edema severity
C) Allergies, medications, past health history, last meal, and events/environment leading to the illness or injury
D) Abdominal sounds, memory loss, people exposed to, last medication, earliest availability of past medical records

Question 8

Which biologic agent of terrorism is a bacterial neurotoxin that causes paralysis and respiratory failure, with death occurring within 24 hours of exposure?

A) Sarin
B) Botulism
C) Smallpox
D) Tularemia

Question 9

A 65-year-old trauma patient has open wounds and the nurse questions the patient about her tetanus immunization status.When should tetanus immunoglobulin be administered to the patient?

A) Had three doses of tetanus toxoid as a child
B) Has had a dose of tetanus toxoid in the past 10 years
C) Is unsure of the history of tetanus toxoid vaccinations
D) Has not had a dose of tetanus toxoid in the past 3 years

Question 10

Which agent of terrorism does not have an established treatment for those exposed to it?

A) Plague
B) Anthrax
C) Tularemia
D) Hemorrhagic fever

Question 11

In which situation would therapeutic hypothermia be instituted in the ED?

A) 48-year-old male found unconscious by neighbors; on ED arrival, he is moaning and moving all extremities
B) 62-year-old man defibrillated by emergency medical technicians (EMTs); on ED arrival, he is not responsive although his heart rhythm and blood pressure (BP) are stable
C) 30-year-old female who suffered heat exhaustion following a marathon; on ED arrival, she is hypotensive and extremely diaphoretic with a temperature of 102.6°F (39.2°C)
D) 38-year-old female found face down in her bathtub; she has a history of seizures; on ED arrival, she is responsive to pain only and she was intubated by paramedics with evidence of pulmonary edema; her pulse oximetry is 91%

Question 12

Which biologic agents of terrorism can be protected against with a vaccine (select all that apply)?

A) Plague
B) Anthrax
C) Botulism
D) Smallpox
E) Tularemia.
F) Hemorrhagic fever

Question 13

Following a death in the ED of a 36-year-old man from a massive head injury, what would be appropriate for the nurse to do?

A) Ask the family members to consider donating their loved one's organs.
B) Notify an organ procurement agency that a death has occurred that could result in organ donation.
C) Explain to the family what a generous act it would be to donate the patient's organs to another patient who needs them.
D) Ask the family to check the patient's driver's license to determine whether he had designated approval of donation of his organs in case of death.

Question 14

When a patient is admitted with hemorrhagic fever, what nursing treatment should be provided?

A) Parenteral analgesics
B) Supportive treatment
C) Warfarin administration
D) Care of the rodent or mosquito bite

Question 15

What heat-related emergency would the healthy athlete with inadequate fluid intake be most likely to experience after exercise?

A) Heatstroke
B) Heat attack
C) Heat cramps
D) Heat exhaustion

Question 16

As a member of a volunteer disaster medical assistance team (DMAT), what would the nurse be expected to do?

A) Triage casualties of a tornado that hit the local community.
B) Assist with implementing the hospital's emergency response plan.
C) Train citizens of communities how to respond to mass casualty incidents.
D) Deploy to local or other communities with disasters to provide medical assistance.

Question 17

What describes heat exhaustion (select all that apply)?

A) Volume and electrolyte depletion
B) High risk of mortality and morbidity
C) Treated with rapid cooling methods
D) Rectal temperature of 99.6°F to 104°F (37.5°C to 40°C)
E) Causes mild confusion, headache, and dilation of pupils

Question 18

Case study:
Heatstroke
Patient Profile
M.M., age 72, was taking a short break from nailing new shingles on his roof during the summer when he lost consciousness, fell off of the roof, and collapsed in his yard. Accompanied by his wife, he was brought by ambulance to
the ED.
Subjective Data
• Wife states that M.M. has been working all week on the roof, even though he has not felt well for the last day or two
Objective Data
• Vital signs: Temp 106.6°F (41.4°C), HR 124 bpm and weak and thready, RR 36 and shallow, BP 82/40
• Skin hot, dry, and pale
What factors in M.M.'s history place him at risk for heatstroke?

Question 19

What should the nurse do during rewarming of a patient's toes that have suffered deep frostbite?

A) Apply sterile dressings to blisters.
B) Place the feet in a cool water bath.
C) Ensure that analgesics are administered.
D) Massage the digits to increase circulation.

Question 20

Case study:
Heatstroke
Patient Profile
M.M., age 72, was taking a short break from nailing new shingles on his roof during the summer when he lost consciousness, fell off of the roof, and collapsed in his yard. Accompanied by his wife, he was brought by ambulance to
the ED.
Subjective Data
• Wife states that M.M. has been working all week on the roof, even though he has not felt well for the last day or two
Objective Data
• Vital signs: Temp 106.6°F (41.4°C), HR 124 bpm and weak and thready, RR 36 and shallow, BP 82/40
• Skin hot, dry, and pale
What laboratory tests would the nurse anticipate to be ordered and what alterations in these tests would be indications of heatstroke?

Question 21

Priority Decision: A patient is brought to the ED following a skiing accident after which he was not found for several hours.He is rigid and has slowed respiratory and heart rates.What should the nurse do during the primary assessment of the patient?

A) Initiate active core rewarming interventions.
B) Monitor the core temperature via the axillary route.
C) Manage and maintain ABCs (airway, breathing, circulation).
D) Expose the patient to check for areas of frostbite and other injuries.

Question 22

Case study:
Heatstroke
Patient Profile
M.M., age 72, was taking a short break from nailing new shingles on his roof during the summer when he lost consciousness, fell off of the roof, and collapsed in his yard. Accompanied by his wife, he was brought by ambulance to
the ED.
Subjective Data
• Wife states that M.M. has been working all week on the roof, even though he has not felt well for the last day or two
Objective Data
• Vital signs: Temp 106.6°F (41.4°C), HR 124 bpm and weak and thready, RR 36 and shallow, BP 82/40
• Skin hot, dry, and pale
How would cooling for M.M.be carried out?

Question 23

A homeless man is brought to the ED in severe hypothermia with a temperature of 85°F (29.4°C).What should the nurse expect to find on initial assessment?

A) Shivering and lethargy
B) Fixed and dilated pupils
C) Respirations of 6 to 8 per minute
D) BP obtainable only by Doppler

Question 24

Case study:
Heatstroke
Patient Profile
M.M., age 72, was taking a short break from nailing new shingles on his roof during the summer when he lost consciousness, fell off of the roof, and collapsed in his yard. Accompanied by his wife, he was brought by ambulance to
the ED.
Subjective Data
• Wife states that M.M. has been working all week on the roof, even though he has not felt well for the last day or two
Objective Data
• Vital signs: Temp 106.6°F (41.4°C), HR 124 bpm and weak and thready, RR 36 and shallow, BP 82/40
• Skin hot, dry, and pale
What supportive treatment is indicated for M.M.?

Question 25

What condition occurs with saltwater near-drowning but not with freshwater near-drowning?

A) Destruction of surfactant
B) Noncardiogenic pulmonary edema
C) Water leaks from alveoli to capillary bed and circulation
D) Fluid is drawn into the alveoli from the pulmonary capillaries

Question 26

Case study:
Heatstroke
Patient Profile
M.M., age 72, was taking a short break from nailing new shingles on his roof during the summer when he lost consciousness, fell off of the roof, and collapsed in his yard. Accompanied by his wife, he was brought by ambulance to
the ED.
Subjective Data
• Wife states that M.M. has been working all week on the roof, even though he has not felt well for the last day or two
Objective Data
• Vital signs: Temp 106.6°F (41.4°C), HR 124 bpm and weak and thready, RR 36 and shallow, BP 82/40
• Skin hot, dry, and pale
What should M.M.'s wife be told about M.M.'s condition?

Question 27

Priority Decision: Triage the following patient situations that may be present in an emergency department (ED) as 1, 2, 3, 4, or 5 on the Emergency Severity Index.
________ a. A 6-year-old child with a temperature of 103.2°F (39.6°C)
________ b. A 22-year-old woman with asthma in acute respiratory distress
________ c. An infant who has been vomiting for 2 days
________ d. A 50-year-old man with low back pain and spasms
________ e. A 32-year-old woman who is unconscious following an automobile accident.
________ f. A 40-year-old woman with rhinitis and a cough.
________ g. A 58-year-old man with midsternal chest pain.
________ h. A 16-year-old teenager with an angulated forearm following a sports injury

Question 28

Priority Decision: What is the priority of management of the near-drowning patient?

A) Correction of hypoxia
B) Correction of acidosis
C) Maintenance of fluid balance
D) Prevention of cerebral edema

Question 29

Case study:
Heatstroke
Patient Profile
M.M., age 72, was taking a short break from nailing new shingles on his roof during the summer when he lost consciousness, fell off of the roof, and collapsed in his yard. Accompanied by his wife, he was brought by ambulance to
the ED.
Subjective Data
• Wife states that M.M. has been working all week on the roof, even though he has not felt well for the last day or two
Objective Data
• Vital signs: Temp 106.6°F (41.4°C), HR 124 bpm and weak and thready, RR 36 and shallow, BP 82/40
• Skin hot, dry, and pale
Priority Decision: Based on the assessment data presented, what are the priority nursing diagnoses? Are there any collaborative problems?

Question 30

When a nurse is performing a primary survey in the ED, what is she assessing?

A) Whether the resources of the ED are adequate to treat the patient
B) The acuity of the patient's condition to determine priority of care
C) Whether the patient is responsive enough to provide needed information
D) The status of airway, breathing, circulation, disability, and exposure/environmental control

Question 31

The ascending paralysis caused by exposure to the wood tick or dog tick may cause respiratory arrest unless what happens?

A) The tick is removed.
B) Antibiotics are administered.
C) An antidote for the neurotoxin is administered.
D) Hemodialysis is instituted to remove the neurotoxin.

Question 32

Priority Decision: During the primary survey the nurse identified asymmetric chest wall movement in the patient.What intervention should the nurse do first?

A) Check a central pulse.
B) Stabilize the cervical spine.
C) Apply direct pressure to the wound.
D) Administer bag-mask ventilation with 100% oxygen.

Question 33

A 68-year-old patient was bitten by the neighbor's dog 8 hours ago.What treatment should the nurse plan to provide for the patient?

A) Report the bite to the police.
B) Give rabies prophylaxis now.
C) Administer IV antibiotics prophylactically.
D) Dress the wound to prevent exposure to neurotoxins.