Deck 66: Caring for the Patient in the Emergency Department

Question 1

The prehospital nurse is screening several people injured in a store robbery. Of those injured, the nurse should encourage which one to seek additional care at the nearest emergency department?

A) Male in his mid-20s who had several light boxes of products fall on him while the robbers ran through the store
B) Teenage female who took cover under a shelving unit and sustained a scratch on her arm
C) Middle-age female who crouched down in a corner of the room and strained her knee
D) Elderly male who was briefly unconscious

Answer 1

Elderly male who was briefly unconscious

Question 2

The nurse is collecting evidence of sexual assault from a female patient. What should the nurse do with damp clothing?

A) Place the clothing in a plastic bag and document the time it was collected.
B) Drape the clothing over a chair in the room and give it to law enforcement officers when they arrive.
C) Allow the clothing to dry, place it in a paper bag, and label it appropriately.
D) Secure the clothing on a wire hanger and label it appropriately.

Answer 2

Allow the clothing to dry, place it in a paper bag, and label it appropriately.

Question 3

A paramedic was asked by family members to take a patient complaining of chest pain to the local hospital. However, the patient is being taken to a hospital that is farther away and harder for the family to reach. The decision to take the patient to a different hospital is the result of which factor?

A) The patient does not have sufficient insurance.
B) The paramedic did not understand the request.
C) The emergency department at the local hospital would not accept the patient.
D) The patient was taken to the care center that provides the optimal care for the problem.

Answer 3

The patient was taken to the care center that provides the optimal care for the problem.

Question 4

Which patient statement would the nurse evaluate as reflecting the current trend in use of the emergency department?.Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) "I had to wait for 3 hours to be seen for my head cold."
B) "My dad had to stay in the ED overnight until a bed was available in the intensive care unit."
C) "I wanted to go to an ED across town, but they aren't accepting any ambulance patients right now."
D) "The lady in the office told me I should go somewhere else for care, but I am just too sick."
E) "The waiting room is packed with people who are sneezing and coughing."

Question 5

A patient without health insurance comes to the emergency department limping and dripping blood from a head wound. Which intervention should be performed first with this patient?

A) Tell the patient that there are no orthopedic doctors available and that the hospital in the next town will be better able to help him.
B) Determine the patient's triage level, examine, and treat as needed.
C) Have the patient sign in and provide method of payment for services.
D) Tell the patient that he will have to go to the emergency room at a hospital that treats people who do not have health insurance.

Question 6

The nurse has worked for 8 years on an adult medical-surgical unit and is transferring to become an emergency department nurse. Which type of training will this nurse most likely need to become proficient in providing emergency nursing care?

A) Pediatric and obstetric nursing care
B) Managing the care of four or five patients simultaneously
C) Basic cardiac life support
D) Neurologic emergencies with the elderly

Question 7

A nurse working in the emergency department (ED) decides which cubicles to place patients in to be seen by the health care provider. The nurse talks with one patient about the fall he sustained from his motorcycle and whether he is able to move all four extremities independently. What part of the role of the emergency department nurse is this nurse fulfilling?

A) Triage
B) Referral to hospital-identified policies and procedures
C) Following physician orders for admitting a patient
D) Following evidence-based practice

Question 8

A patient from another country is brought to the emergency department (ED) after sustaining a serious leg wound. The ED nurse asks how the wound would be treated in the patient's country of origin. The nurse is practicing which part of the ABCDE Diversity Practice Model?

A) "A" or assumptions
B) "B" or beliefs
C) "C" or communication
D) "D" or diversity

Question 9

The nurse is discharging a patient from the emergency department. The patient will need to walk with crutches for a sprained ankle. What should the nurse do to ensure that the patient will safely use the crutches at home?

A) Instruct a family member on the use of the crutches and suggest that he or she access the Internet for any questions.
B) Demonstrate the use of the crutches while the patient observes from the wheelchair.
C) Demonstrate the use of the crutches and ask for a return demonstration before discharge.
D) Provide a written handout on the use of crutches.

Question 10

A patient arrives by ambulance to the emergency department. A paramedic is administering a breathing bag to help with the patient's respirations. Which triage level will the nurse assign?

A) Nonurgent
B) Resuscitative
C) Emergent
D) Urgent

Question 11

The nurse is reviewing the current status of patients who have been waiting in the emergency department for several hours. At the time of first arrival, each of the patients was identified as nonurgent. Which nonurgent patient should be seen and treated first?

A) Male child holding left arm in sling, fingers and wrist intact to sensation, motion, and pulse
B) Female with swollen ankle, leg elevated, ice pack currently applied, pulse present
C) Elderly male whose swollen hand now is slightly blue-tinged with a faint pulse
D) Adolescent male with bruised right eye, ice pack applied, no further bleeding from nose

Question 12

The nurse provides care in a hospital in an inner-city with a large immigrant population. How can the nurse provide the most culturally competent care?

A) Approach the care of every patient in the same manner.
B) Plan to attend educational programs to understand ethnic differences in health values.
C) Discuss with the supervisor the types of patients for whom the nurse feels prepared to provide care.
D) Realize that the best care is standardized care.

Question 13

Which characteristics of the emergency department (ED) would the nurse cite as causing long waits and overcrowded conditions?.Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) "We are open 24 hours a day and 7 days a week."
B) "So many of our patients don't have any insurance."
C) "We cannot turn people away even if they don't have an emergent condition."
D) "Patients don't want to wait at the doctor's office and they think they can be seen here faster."
E) "We have such a large population of older people in our community."

Question 14

The emergency department (ED) nurses are planning a community education program during Summer Safety Week at the hospital. Including which topic in this program would support the Emergency Nurses Association (ENA) initiatives?

A) Clean House: Eliminate Winter Pathogens Just in Time for Spring!
B) Bicycles and Helmets: Friends for Life!
C) Recycle Your Clothing: Help a Friend in Need!
D) Get Out and Walk!

Question 15

The nurse works in an emergency department (ED) that implements the spot check triage system. Which activity will the nurse triaging patients perform?

A) Starting intravenous access lines
B) Applying cardiac monitoring leads on patients
C) Determining patients' urgency for care
D) Drawing serum laboratory samples

Question 16

A patient, assigned the category of nonurgent in the emergency department, begins to have shortness of breath and is dizzy. What should be done to assist this patient?

A) Immediately reassess the patient and assign the category of urgent.
B) Immediately reassess the patient and assign the category of resuscitation.
C) Remind the individual to be patient and wait to be seen.
D) Immediately reassess the patient and assign the category of emergent.

Question 17

The nurse assessing a patient who walked into the emergency department decides the patient is in no acute distress. Which patient condition would support the nurse's decision?

A) Limping and walking with the assistance of a possible family member or friend
B) Gasping for breath and holding a bloody tissue to the nose
C) Ambulating, breathing without difficulty, possible right arm/shoulder pain because holding arm bent and close to body
D) Calling for help while limping with the use of a cane

Question 18

A nurse who is considering transfer to the emergency department (ED) asks, "How is ED nursing different from what I have been doing?" How would the experienced ED nurse answer this question?.Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) "It is episodic."
B) "We focus on primary care."
C) "Most of what we do is acute care or critical care."
D) "ED nurses provide care to patients of all ages."
E) "Most of the time we are providing care to patients without a medical diagnosis."

Question 19

Which statements by an emergency department nurse reflect poor compliance with the "A" portion of the diversity practice model?.Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) "If patients are going to live in the U.S., they should at least attempt to learn English."
B) "Her clothes are dirty, so I bet she doesn't have any insurance."
C) "This patient is weird. He has all kinds of marks on his skin and says they will make him feel better."
D) "You know how it is with these young mothers; they never follow instructions on how to prevent their kids from getting ear infections."
E) "Oh no, another old man with influenza. You take care of him. They all stink."

Question 20

A patient comes to the emergency department and signs a general consent for treatment. While waiting to be seen, the patient experiences cardiac arrest and is subsequently resuscitated, stabilized, and admitted to the intensive care unit. The emergency nurse acted on which type of consent?

A) Implied
B) Blanket
C) Expected
D) Informed

Question 21

The nurse is planning to conduct research on the top 10 most common reasons for visiting the emergency department. Which chief complaints would the nurse include in this work?.Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) "I have had stomach pain for the last 2 hours."
B) "I have been vomiting since I ate a chicken salad sandwich for lunch."
C) "I hit a curb and the airbag in my car deployed."
D) "I cut my hand when a glass broke as I was washing dishes."
E) "I have a terrible headache."

Question 22

A nurse who has worked in the hospital for 10 years has committed to a new job in the emergency department. The nurse should expect to attend which courses to help prepare for this position?.Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) Basic Life Support (BLS) instructor course
B) Advanced Cardiac Life Support (ACLS)
C) Pediatric Advanced Life Support (PALS)
D) Trauma Nursing Core Course (TNCC)
E) Emergency Nursing Pediatric Course (ENPC)

Question 23

Workmen preparing to paint have set up equipment near the emergency department entrance and have taken down all the signage. What is the primary reason the nurse manager is concerned when this is mentioned in the shift report?

A) Inappropriate signage can result in loss of federal funding.
B) Patients and families may get lost if signs are not present.
C) Fumes from paint can impair the breathing ability of patients with lung disorders.
D) The presence of painting equipment is a fall hazard for patients and nurses.

Question 24

The nurse manager makes a quick visit with patients in the emergency department (ED) waiting area. The manager is concerned about one patient who was originally assigned nonurgent status, even though there is no specific change from the triage assessment. What action should the manager take?

A) Check on the patient in another 15 minutes.
B) Tell the admittance clerk to keep an eye on the patient.
C) Change the triage tag to urgent and admit the patient to the ED.
D) Blame the concern on the number of patients still waiting to be seen.

Question 25

The nurse is concerned that the chain of custody for evidence collected in the emergency department may have been breached. Which situation would support the nurse's concern?.Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) The evidence was placed at the foot of the patient's bed while the nurse who collected it went to get an evidence bag.
B) The nurse who collected the evidence sealed it in a bag and placed a label on the bag.
C) The nurse who collected the evidence left it at the busy nurses' station for law enforcement authorities to pick up.
D) The nurse handed the sealed and labeled evidence bag to a law enforcement officer.
E) The wet clothing was hung in the utility room to dry before bagging.

Question 26

Nursing administrators are trying to decide if they want a "traffic director," "spot check," or "comprehensive" form of triage in the emergency department. What information should be considered when making this decision?.Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) All forms will require employment of a registered nurse.
B) All forms will include evaluation of the patient.
C) Both spot check and comprehensive triage nurses order lab or radiographs according to established protocol.
D) A comprehensive triage plan results in patients receiving pain medications earlier.
E) Both the spot check and comprehensive triage nurses assign urgency categories.

Question 27

The nurse has removed clothing with gunshot residue from a murder victim. What information should the nurse include when labeling the bag containing this clothing?.Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) Patient's name
B) Attending physician
C) Date
D) Time
E) The name of the person who collected the evidence

Question 28

A patient has returned to the emergency department (ED) numerous times over the past 3 months. The patient has newly diagnosed diabetes and cannot afford testing supplies. Which ED nurse referral is indicated?

A) Nurse educator
B) Emergency nurse practitioner (ENP)
C) Emergency clinical nurse specialist (ECNS)
D) Case manager

Question 29

A patient is admitted to the emergency department with multiple wounds inflicted by an unknown assailant. What action should the nurse take?

A) Clean and dress the wounds as soon as initial assessment is completed.
B) Dispose of bloody clothing in a biohazard bag.
C) Change gloves often during patient care.
D) Keep evidence in the patient's room until it is released to authorities.

Question 30

A patient being cared for in the emergency department (ED) will require endoscopy to remove a foreign object from the esophagus. Whose responsibility is it to obtain informed consent for this procedure?

A) The admittance clerk
B) The nurse who admitted the patient to the ED
C) The nurse who will assist in the procedure room
D) The health care provider performing the procedure.

Question 31

A 17-year-old unmarried female presents to the emergency department and says, "I am pregnant and I have a urinary tract infection." There is no parent present. How should the nurse proceed regarding consent?

A) Assume consent because the patient came to the ED seeking help.
B) Assume consent is legal because the patient is pregnant.
C) Ask the patient to call her parents to give telephone consent.
D) Refer to the hospital policy and procedure manual about conditions of consent.

Question 32

The emergency department (ED) nurse is using the CIAMPEDS mnemonic to triage an 8-year-old patient. Which questions would the nurse ask?.Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) "C": What is the chief complaint?
B) "I": Has the child been exposed to anything requiring isolation?
C) "P": What do you think is the problem?
D) "E": Has the patient ever had these symptoms before today?
E) "D": Has the patient's diet or appetite changed?

Question 33

A patient is being transferred from the emergency department to another hospital. The nurse would expect which conditions to be documented before this transfer occurs?.Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) The current facility does not have the capacity to provide the needed care.
B) The medical benefits of the transfer outweigh the risks of transfer.
C) A medical screening exam has been conducted.
D) No physician with admitting privileges at the current hospital will assume the care of the patient.
E) The appropriate level of care must be provided during the transfer.

Question 34

A hospital nurse administrator is working to help the emergency department meet the Institute of Medicine (IOM) recommendations for emergency care. Which initiatives should be included in this work?.Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) Funding for a new pediatric coordinator position in the ED
B) Revision of the ED physical layout to improve patient flow
C) Decreasing the number of standards that affect the operation of the ED
D) Advocating for payment for all ED care provided
E) Development of a clinical decision unit

Question 35

The patient signed a consent for treatment when admitted to the emergency department. This consent would allow which procedures?.Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) Vital signs
B) Drawing lab work
C) Endoscopy
D) X-rays without contrast
E) Medication administration