Question 1

A patient is admitted to the emergency department after a near-drowning accident in a local lake. The patient received rescue breathing at the site and now has spontaneous respirations. The nurse will observe the patient for several hours to monitor for symptoms of

Accepted Answer

Pulmonary edema is a common complication after a near-drowning incident. Hypernatremia would not occur in a freshwater submersion. Hypothermia and head injury may be associated with near-drowning but would be apparent at the time of admission and would not develop after several hours.

Question 2

An unresponsive 78-year-old patient is admitted to the emergency department in a coma during a summer heat wave. The patient's core temperature is 106.2° F (41.2° C), blood pressure (BP) 86/52, and pulse 102. The nurse will plan to

Accepted Answer

The priority intervention is to cool the patient. Antipyretics are not effective in decreasing temperature in heat stroke, and 100% oxygen should be given, which requires a high flow rate through a non-rebreathing mask. An older patient would be at risk for developing complications such as pulmonary edema if given fluids at 1000 ml/hr.

Question 3

An unconscious patient is admitted to the emergency department 45 minutes after ingesting approximately 30 diazepam (Valium) tablets. The health care provider prescribes gastric lavage. The first action the nurse will plan when implementing the order is to

Accepted Answer

An unconscious patient cannot protect the airway and is at risk for aspiration during gastric lavage, so intubation is done before starting the lavage. Positioning the patient on his or her side will decrease the risk for aspiration, but the patient will need to be supine for intubation. An orogastric tube is used for gastric lavage. The saline will be injected after the intubation.

Question 4

During the primary assessment of a patient with multiple trauma, the nurse observes that the patient's right pedal pulses are absent and the leg is swollen. The nurse's first action should be to

Accepted Answer

The assessment data indicate that the patient may have arterial trauma and hemorrhage. When a possibly life-threatening injury is found during the primary survey, the nurse should immediately start interventions before proceeding with the survey. Although a CBC is indicated, administration of IV fluids should be started first. Completion of the primary survey and further assessment should be completed after the IV fluids are initiated.

Question 5

A patient has experienced blunt abdominal trauma from a motor vehicle accident. The nurse should explain to the patient the purpose of

Accepted Answer

If intra-abdominal bleeding is suspected, focused abdominal ultrasonography is obtained to look for intraperitoneal bleeding. MRI would not be used. Peritoneal lavage is an alternative, but it is more invasive. An NG tube would not be helpful in diagnosis of intra-abdominal bleeding.

Question 6

A patient is brought to the hospital in cardiac arrest by emergency personnel who are performing resuscitation. The spouse arrives as the patient is taken into a treatment room and asks to stay with the patient. The nurse should

Accepted Answer

Family members and patients report benefits from family presence during resuscitation efforts, so the nurse should try to accommodate the spouse. Having the spouse wait outside the room is not as supportive to the spouse or patient. It would be inappropriate to imply that the spouse's presence would have adverse consequences for the patient. Family members do not report problems with grieving caused by being present during resuscitation efforts.

Question 7

A triage nurse in a busy emergency department assesses a patient who complains of 6/10 abdominal pain and states, "I had a temperature of 104.6º F (40.3º C) at home." The nurse's first action should be to

Accepted Answer

The patient's pain and statement about an elevated temperature indicate that the nurse should obtain vital signs before deciding how rapidly the patient should be seen by the health care provider. A urinalysis may be needed, but vital signs will provide the nurse with more useful data for triage. The health care provider will not order a medication before assessing the patient.

Question 8

All of the following actions are needed for a patient admitted with multiple bee stings to the hands. Which one will the nurse accomplish first?

Accepted Answer

The patient's rings should be removed first because it might not be possible to remove them if swelling develops. The other orders should also be implemented as rapidly as possible after the nurse has removed the jewelry.

Question 9

When preparing to rewarm a patient with hypothermia, the nurse will plan to

Accepted Answer

Rewarming can produce dysrhythmias, so the patient should be monitored and treated if necessary. Urinary catheterization and endotracheal intubation are not needed for rewarming. Cardiac inotropes tend to stimulate the heart and increase the risk for fatal dysrhythmias such as ventricular fibrillation.

Question 10

A 67-year-old patient who has fallen from a ladder is transported to the emergency department by ambulance. The patient is unconscious on arrival and accompanied by family members. During the primary survey of the patient, the nurse should

Accepted Answer

The Glasgow Coma Scale is included when assessing for disability during the primary survey. The other information is part of the secondary survey.

Question 11

During the primary assessment of a trauma victim, the nurse determines that the patient has a patent airway. The next assessment by the nurse should be to

Accepted Answer

Even with a patent airway, patients can have other problems that compromise ventilation, so the next action is to assess the patient's breathing. The other actions are also part of the initial survey but are not accomplished as rapidly as the assessment of breathing.

Question 12

A 24-year-old is brought to the emergency department with multiple lacerations and tissue avulsion of the right hand after catching the hand in a produce conveyor belt. When asked about tetanus immunization, the patient says, "I've never had any vaccinations." The nurse will anticipate administration of tetanus

Accepted Answer

For a patient with unknown immunization status, the tetanus immune globulin is administered along with the Tdap (since the patient has not had pertussis vaccine previously). The other immunizations are not sufficient for this patient.

Question 13

When planning the response to the potential use of smallpox as a biologic weapon, the emergency department manager will focus on obtaining sufficient quantities of

Accepted Answer

Smallpox infection can be prevented or ameliorated by the administration of vaccine given rapidly after exposure. The other interventions would be helpful for other biologic weapons, but not for smallpox.

Question 14

A patient has been brought to the emergency department with a gunshot wound to the abdomen. In obtaining a history of the incident to determine possible injuries, the nurse asks

Accepted Answer

The entry point and direction of the bullet will help to predict the type of injuries the patient has. The other information is not as useful in determining which diagnostic studies and care are needed immediately.

Question 15

A patient arrives in the emergency department after exposure to radioactive dust. Which action should the nurse take first?

Accepted Answer

The initial action should be to protect staff members and decrease the patient's exposure to the radioactive agent by decontamination. The other actions can be accomplished after the decontamination is completed.

Question 16

Four victims of an automobile crash are brought by ambulance to the emergency department (emergency department). The triage nurse determines that the victim who has the highest priority for treatment is the one with

Accepted Answer

Most immediate deaths from trauma occur because of problems with ventilation, so the patient with a sucking chest wound should be treated first. Face and head fractures can obstruct the airway, but the patient with facial injuries has lacerations only. The other two patients also need rapid intervention but do not have airway or breathing problems.

Question 17

A 77-year-old patient is brought into the emergency department unconscious and with a core temperature of 89° F (31.6° C). During rewarming measures, the nurse determines that the goals of treatment are being met when the patient

Accepted Answer

The improvement in the patient's body temperature is the best indication that the goals of rewarming are being met. Shivering, improvement in level of consciousness (LOC), and normalization of pH all might confirm that the patient's condition is improving, but they are not as clear as the elevation in temperature.

Question 18

During the summer, a patient with heat cramps is treated in the emergency department. The nurse determines that discharge teaching regarding the prevention of another episode of heat cramps has been effective when the patient states,

Accepted Answer

Electrolyte solutions such as sports drinks help replace fluid and electrolytes lost when exercising in hot weather. Salt tablets are not recommended because of the risks of gastric irritation and hypernatremia. It is not necessary to double one's water intake simply when the weather is warm. A patient who is confused is likely to have more severe hyperthermia and will be unable to remember to take appropriate action.

Question 19

A patient is admitted to the emergency department with multiple bruises of the face and arms and an obvious deformity of the right upper arm. A friend accompanying the patient tells the nurse that the patient's spouse was responsible for the injuries. The nurse's role in this patient's care is

Accepted Answer

The nurse's role includes informing victims of domestic violence about options and safe housing. The nurse should speak directly to the patient about the option of reporting the abuse to the police (after further assessment of the patient). A competent adult patient is responsible for reporting abuse to the police. The nurse is responsible for assessing for domestic violence and making appropriate referrals in addition to providing care for the physical injuries.

Question 20

When caring for a patient with head and neck trauma after a motorcycle accident, the emergency department nurse's first action should be to

Accepted Answer

When there is a risk of spinal cord injury, the nurse's initial action is immobilization of the cervical spine during positioning of the head and neck for airway management. Suctioning, supplemental oxygen administration, and venous access are also necessary after the cervical spine is protected by immobilization.

Quiz 69: Nursing Management: Emergency and Disaster Nursing