Question 1

When rewarming a patient who arrived in the emergency department (ED)with a temperature of 87° F (30.6° C),which finding indicates that the nurse should discontinue active rewarming?

Accepted Answer

A)  The patient begins to shiver.
B)  The BP decreases to 86/42 mm Hg.
C)  The patient develops atrial fibrillation.
D)  The core temperature is 94° F (34.4° 
C)  . D

Question 2

The following interventions are part of the emergency department (ED)protocol for a patient who has been admitted with multiple bee stings to the hands. Which action should the nurse take first?

Accepted Answer

A)  Remove the patient's rings.
B)  Apply ice packs to both hands.
C)  Apply calamine lotion to itching areas.
D)  Give diphenhydramine (Benadryl)  50 mg PO. A

Question 3

The emergency department (ED)triage nurse is assessing four victims involved in a motor vehicle collision. Which patient has the highest priority for treatment?

Accepted Answer

A)  A patient with no pedal pulses
B)  A patient with an open femur fracture
C)  A patient with bleeding facial lacerations
D)  A patient with paradoxical chest movement D

Question 4

A patient arrives in the emergency department (ED)after topical exposure to powdered lime at work. Which action should the nurse take first?

Accepted Answer

A)  Obtain the patient's vital signs.
B)  Obtain a baseline complete blood count.
C)  Decontaminate the patient by showering with water.
D)  Brush off any visible powder on the skin and clothing.

Question 5

A patient arrives in the emergency department (ED)several hours after taking "25 to 30" acetaminophen (Tylenol)tablets. Which action will the nurse plan to take?

Accepted Answer

A)  Give N-acetylcysteine.
B)  Discuss the use of chelation therapy.
C)  Start oxygen using a non-rebreather mask.
D)  Have the patient drink large amounts of water.

Question 6

During the primary survey of a patient with severe leg trauma,the nurse observes that the patient's left pedal and posterior tibial pulses are absent and the entire leg is swollen. Which action will the nurse take next?

Accepted Answer

A)  Send blood to the lab for a complete blood count.
B)  Assess further for a cause of the decreased circulation.
C)  Finish the airway, breathing, circulation, disability survey.
D)  Start normal saline fluid infusion with a large-bore IV line.

Question 7

After the return of spontaneous circulation following the resuscitation of a patient who had a cardiac arrest,therapeutic hypothermia is ordered. Which action will the nurse include in the plan of care?

Accepted Answer

A)  Initiate cooling per protocol.
B)  Avoid the use of sedative drugs.
C)  Check mental status every 15 minutes.
D)  Rewarm if temperature is below 91° F (32.8° 
C)  .

Question 8

Following an earthquake,patients are triaged by emergency medical personnel and transported to the emergency department (ED). Which patient will the nurse need to assess first?

Accepted Answer

A)  A patient with a red tag
B)  A patient with a blue tag
C)  A patient with a black tag
D)  A patient with a yellow tag

Question 9

A patient who has experienced blunt abdominal trauma during a motor vehicle collision is complaining of increasing abdominal pain. The nurse will plan to teach the patient about the purpose of

Accepted Answer

A)  peritoneal lavage.
B)  abdominal ultrasonography.
C)  nasogastric (NG)  tube placement.
D)  magnetic resonance imaging (MRI) .

Question 10

The emergency department (ED)nurse is starting therapeutic hypothermia in a patient who has been resuscitated after a cardiac arrest. Which actions in the hypothermia protocol can be delegated to an experienced licensed practical/vocational nurse (LPN/LVN)?

Accepted Answer

A)  Continuously monitor heart rhythm.
B)  Assess neurologic status every 2 hours.
C)  Give acetaminophen (Tylenol)  650 mg.
D)  Place cooling blankets above and below patient.
E)  Attach rectal temperature probe to cooling blanket control panel.

Question 11

When assessing an older patient admitted to the emergency department (ED)with a broken arm and facial bruises,the nurse observes several additional bruises in various stages of healing. Which statement or question by the nurse should be first?

Accepted Answer

A)  "You should not go home."
B)  "Do you feel safe at home?"
C)  "Would you like to see a social worker?"
D)  "I need to report my concerns to the police."

Question 12

An unresponsive patient is admitted to the emergency department (ED)after falling through the ice while ice skating. Which assessment will the nurse obtain first?

Accepted Answer

A)  Pulse
B)  Heart rhythm
C)  Breath sounds
D)  Body temperature

Question 13

A 19-yr-old patient is brought to the emergency department (ED)with multiple lacerations and tissue avulsion of the left hand. When asked about tetanus immunization,the patient denies having any previous vaccinations. The nurse will anticipate giving

Accepted Answer

A)  tetanus immunoglobulin (TIG)  only.
B)  TIG and tetanus-diphtheria toxoid (Td) .
C)  tetanus-diphtheria toxoid and pertussis vaccine (Tdap)  only.
D)  TIG and tetanus-diphtheria toxoid and pertussis vaccine (Tdap) .

Question 14

The urgent care center protocol for tick bites includes the following actions. Which action will the nurse take first when caring for a patient with a tick bite?

Accepted Answer

A)  Use tweezers to remove any remaining ticks.
B)  Check the vital signs, including temperature.
C)  Give doxycycline (Vibramycin)  100 mg orally.
D)  Obtain information about recent outdoor activities.

Question 15

A 22-yr-old patient who experienced a drowning accident in a local pool,but now is awake and breathing spontaneously,is admitted for observation. Which assessment will be most important for the nurse to take during the observation period?

Accepted Answer

A)  Auscultate heart sounds.
B)  Palpate peripheral pulses.
C)  Auscultate breath sounds.
D)  Check mental orientation.

Question 16

During the primary assessment of a victim of a motor vehicle collision,the nurse determines that the patient has an unobstructed airway. Which action should the nurse take next?

Accepted Answer

A)  Palpate extremities for bilateral pulses.
B)  Observe the patient's respiratory effort.
C)  Check the patient's level of consciousness.
D)  Examine the patient for any external bleeding.

Question 17

The following four patients arrive in the emergency department (ED)after a motor vehicle collision. In which order should the nurse assess them? (Put a comma and a space between each answer choice [A,B,C,D,E].)
A)A 74-yr-old patient with palpitations and chest pain
B)A 43-yr-old patient complaining of 7/10 abdominal pain
C)A 21-yr-old patient with multiple fractures of the face and jaw
D)A 37-yr-old patient with a misaligned lower left leg with intact pulses

Accepted Answer

The answer of The following four patients arrive in the...

Question 18

A patient who has deep human bite wounds on the left hand is being treated in the urgent care center. Which action will the nurse plan to take?

Accepted Answer

A)  Prepare to administer rabies immune globulin (BayRab) .
B)  Assist the health care provider with suturing of the bite wounds.
C)  Teach the patient the reason for the use of prophylactic antibiotics.
D)  Keep the wounds dry until the health care provider can assess them.

Question 19

Family members are in the patient's room when the patient has a cardiac arrest and the staff start resuscitation measures. Which action should the nurse take next?

Accepted Answer

A)  Keep the family in the room and assign a staff member to explain the care given and answer questions.
B)  Ask the family to wait outside the patient's room with a designated staff member to provide emotional support.
C)  Ask the family members whether they would prefer to remain in the patient's room or wait outside the room.
D)  Tell the family members that patients are comforted by having family members present during resuscitation efforts.

Question 20

A patient who is unconscious after a fall from a ladder is transported to the emergency department by emergency medical personnel. During the primary survey of the patient,the nurse should

Accepted Answer

A)  obtain a complete set of vital signs.
B)  obtain a Glasgow Coma Scale score.
C)  attach an electrocardiogram monitor.
D)  ask about chronic medical conditions.

Exam 68: Emergency and Disaster Nursing

When rewarming a patient who arrived in the emergency department (ED) with a temperature of 87° F (30.6° C) ,which finding indicates that the nurse should discontinue active rewarming?

The following interventions are part of the emergency department (ED) protocol for a patient who has been admitted with multiple bee stings to the hands. Which action should the nurse take first?

The emergency department (ED) triage nurse is assessing four victims involved in a motor vehicle collision. Which patient has the highest priority for treatment?

A patient arrives in the emergency department (ED) after topical exposure to powdered lime at work. Which action should the nurse take first?

A patient arrives in the emergency department (ED) several hours after taking "25 to 30" acetaminophen (Tylenol) tablets. Which action will the nurse plan to take?

During the primary survey of a patient with severe leg trauma,the nurse observes that the patient's left pedal and posterior tibial pulses are absent and the entire leg is swollen. Which action will the nurse take next?

After the return of spontaneous circulation following the resuscitation of a patient who had a cardiac arrest,therapeutic hypothermia is ordered. Which action will the nurse include in the plan of care?

Following an earthquake,patients are triaged by emergency medical personnel and transported to the emergency department (ED) . Which patient will the nurse need to assess first?

A patient who has experienced blunt abdominal trauma during a motor vehicle collision is complaining of increasing abdominal pain. The nurse will plan to teach the patient about the purpose of

The emergency department (ED) nurse is starting therapeutic hypothermia in a patient who has been resuscitated after a cardiac arrest. Which actions in the hypothermia protocol can be delegated to an experienced licensed practical/vocational nurse (LPN/LVN) ?

When assessing an older patient admitted to the emergency department (ED) with a broken arm and facial bruises,the nurse observes several additional bruises in various stages of healing. Which statement or question by the nurse should be first?

An unresponsive patient is admitted to the emergency department (ED) after falling through the ice while ice skating. Which assessment will the nurse obtain first?

A 19-yr-old patient is brought to the emergency department (ED) with multiple lacerations and tissue avulsion of the left hand. When asked about tetanus immunization,the patient denies having any previous vaccinations. The nurse will anticipate giving