LACHARITY 21 - Emergencies and Disasters

Question 1

A client presents to triage with fever, myalgia, severe headache, abdominal
pain, vomiting, diarrhea, and unexplained bruising that started after
returning from Africa. The triage nurse suspects, but is unsure, that the client
may have Ebola. What should the nurse do first?
1. Delay any additional assessment or questioning and don full personal
protective equipment.
2. Isolate the client in a private room and initiate standard, contact, and
droplet precautions.
3. Direct all clients and staff out of the triage area and call the infection control
department.
4. Continue assessment and questioning to determine the likelihood of
exposure to Ebola

Answer 1

Ans: 2 First, the nurse would isolate the client and initiate standard, contact,
and droplet precautions. The person can be taken out of isolation at any time
if the health care provider (HCP) determines that the client does not have
Ebola, but in the meantime, isolation precautions protect others. After the
client is in isolation, the nurse’s next actions are based on the acuity of the
client. If the client needs immediate assistance, the nurse would alert the HCP
and charge nurse. Selected team members would don personal protective
equipment, and care would be initiated. The infection control department
should be notified as soon as possible so that system-wide measures can be
activated as needed. Focus: Prioritization; Test Taking Tip: Safety is one of
the concepts that is used to identify priorities. In this case, recognize that the
safety priority is for other people and the environment.

Question 2

An emergency department clinical nurse specialist is training staff in how to
don and doff personal protective equipment (PPE) when caring for clients
with infections, such as Ebola. Which staff member has demonstrated the
most grievous error during the practice session?
1. Triage nurse forgets to perform hand hygiene before donning PPE.
2. Unlicensed assistive personnel performs self-inspection; then begins to doff
PPE.
3. Health care provider forgets to wipe shoes with disinfectant after doffing
shoe covers.
4. Emergency medical technician doffs both pairs of gloves first.

Answer 2

Ans: 4 All team members have made errors, but removing both pairs of
gloves puts the emergency medical technician at the greatest risk because the
outer surfaces of the remaining PPE are considered contaminated. According
to the latest recommendations from the Centers for Disease Control and
Prevention, the flow of donning is as follows: hand hygiene, inner gloves,
shoe covers, gown, N95 respirator, hood, outer gloves, face shield, inspection
(by self and trained observer), range of motion, and hand hygiene. The flow
of doffing is inspection (by self and trained observer), hand hygiene, remove
shoe covers, remove outer gloves, inspect inner gloves, remove face shield,
hand hygiene, remove hood, hand hygiene, remove gown, hand hygiene,
remove inner gloves, hand hygiene, apply new gloves, remove n95 respirator,
hand hygiene, disinfect shoes, hand hygiene, remove gloves, hand hygiene,
and inspection (by self and trained observer). Focus: Supervision.

Question 3

The charge nurse in an emergency department (ED) and must assign two staff
members to cover the triage area. Which team is the most appropriate for this
assignment?
1. An advanced practice nurse and an experienced RN
2. An experienced LPN/LVN and an inexperienced RN
3. An experienced RN and an inexperienced RN
4. An experienced RN and an experienced unlicensed assistive personnel
(UAP)

Answer 3

Ans: 1 Triage requires at least one experienced RN. Advanced practice nurses
can perform medical screening exams, and this expedites treatment and
decreases overall time spent in the ED. Pairing an experienced RN with an
inexperienced RN provides opportunities for mentoring. This would be the
second-best choice. Pairing an experienced RN with an experienced UAP is
an option if licensed staff is unavailable because the UAP can measure vital
signs and assist in transporting. An LPN/LVN is not qualified to perform the
initial client assessment or decision making, and the expertise of the
LPN/LVN could be used elsewhere in a busy ED. Focus: Assignment.

Question 4

The nurse is working in the triage area of an emergency department, and the
following four clients approach the triage desk at the same time. List the
order in which the nurse will assess these clients.
1. An ambulatory, dazed 25-year-old man with a bandaged head wound
2. An irritable newborn with a fever, petechiae, and nuchal rigidity
3. A 35-year-old jogger with a twisted ankle who has a pedal pulse and no
deformity
4. A 50-year-old woman with moderate abdominal pain and occasional vomiting
_____, _____, _____, _____

Answer 4

Ans: 2, 1, 4, 3 An irritable newborn with fever and petechiae should be
further assessed for other signs of meningitis. The client with the head
wound needs additional assessment because of the risk for increased
intracranial pressure. The client with moderate abdominal pain is in
discomfort, but her condition is not unstable at this point. For the ankle
injury, medical evaluation could be delayed for 24 to 48 hours if necessary,
but the client should receive the appropriate first aid. Focus: Prioritization;
409Test Taking Tip: Use knowledge of growth and development and remember
that newborns have immature immune systems that are readily
overwhelmed by infection. Any temperature elevation in a neonate is
considered a life-threatening emergency.

Question 5

When a primary survey of a trauma client is conducted, what is one of the
priority actions that would be performed first?
1. Obtain a complete set of vital sign measurements.
2. Palpate and auscultate the abdomen.
3. Perform a brief neurologic assessment.
4. Check the pulse oximetry reading.

Answer 5

Ans: 3 A brief neurologic assessment to determine level of consciousness and
pupil reaction is part of the primary survey. Measuring vital signs, assessing
the abdomen, and checking pulse oximetry readings are considered part of
the secondary survey. Focus: Prioritization.

Question 6

A 56-year-old client comes to the triage area with left-sided chest pain,
diaphoresis, and dizziness. What is the priority action?
1. Initiate continuous electrocardiographic monitoring.
2. Notify the emergency department health care provider.
3. Administer oxygen via nasal cannula.
4. Draw blood and establish IV access.

Answer 6

Ans: 3 The priority goal is to increase myocardial oxygenation. The other
actions are also appropriate and should be performed immediately after
administering oxygen. Focus: Prioritization; Test Taking Tip: Remember to
use the ABCs (airway, breathing, and circulation) in determining priorities.
This is especially important when the client is in critical distress.

Question 7

The client’s blood alcohol level is 0.45%. Based on this information, what is
the priority nursing concept that underlies emergency medical and nursing
interventions for this client?
1. Cognition
2. Addiction
3. Gas exchange
4. Functional ability

Answer 7

Ans: 3 At a blood alcohol level of 0.45%, the client would demonstrate
respiratory depression, stupor, and coma. At 0.05%, client would display
euphoria and decreased inhibitions; at 0.20%, reduced motor skills and
slurred speech occur; and at 0.30%, altered perception and double vision
occur. Focus: Prioritization.

Question 8

A client comes to the emergency department and reports nausea, vomiting,
colicky abdominal pain, fever, and tachycardia. The health care provider
informs the nurse that the client probably has a strangulated intestinal
obstruction with perforation. What diagnostic testing and interventions does
the nurse anticipate for this emergency condition? Select all that apply.
1. Preparation for surgery
2. Barium enema examination
3. Nasogastric (NG) tube insertion
4. Abdominal radiography
5. IV fluid administration
6. IV administration of broad-spectrum antibiotics

Answer 8

Ans: 1, 3, 4, 5, 6 Strangulated intestinal obstruction is a surgical emergency.
The NG tube is for decompression of the intestine. Abdominal radiography is
the most useful diagnostic aid. IV fluids are needed to maintain fluid and
electrolyte balance. IV broad-spectrum antibiotics are usually ordered. A
barium enema examination is not ordered if perforation is suspected. Focus:
Prioritization

Question 9

It is the summer season, and clients with signs and symptoms of heat-related
illness come to the emergency department. Which client needs attention first?
1. Older adult reports dizziness and syncope after standing in the sun for
several hours to view a parade
2. Marathon runner reports severe leg cramps and nausea and shows
tachycardia, diaphoresis, pallor, and weakness
3. Healthy homemaker reports that air conditioner has been broken for days;
400she has tachypnea, hypotension, fatigue, and profuse diaphoresis
4. Homeless person displays altered mental status, poor muscle coordination,
and hot, dry, ashen skin; duration of heat exposure is unknown

Answer 9

Ans: 4 The homeless person has symptoms of heat stroke, a medical
emergency that increases the risk for brain damage. The older adult client is
at risk for heat syncope and should be educated to rest in a cool area and
avoid future similar situations. The runner is having heat cramps, which can
be managed with rest and fluids. The housewife is experiencing heat
exhaustion, and management includes administration of fluids (IV or oral)
and cooling measures. Focus: Prioritization.

Question 10

The nurse responds to a call for help from the emergency department waiting room. An older adult client is lying on the floor. List the order in which the nurse must carry out the following actions.
1. Perform the chin lift or jaw thrust maneuver.
2. Establish unresponsiveness.
3. Initiate cardiopulmonary resuscitation (CPR).
4. Call for help and activate the code team.
5. Instruct unlicensed assistive personnel to get the crash cart.
_____, _____, _____, _____, _____

Answer 10

Ans: 2, 4, 1, 3, 5 Establish unresponsiveness first. (The client may have fallen and sustained a minor injury.) If the client is unresponsive, get help and activate the code team. Performing the chin lift or jaw thrust maneuver opens the airway. The nurse is then responsible for starting CPR. A pocket mask or bag-valve mask is used to deliver rescue breaths. CPR should not be
interrupted until the client recovers or it is determined that all heroic efforts have been exhausted. A crash cart should be at the site when the code team arrives; however, basic CPR can be effectively performed until the code team arrives. Focus: Prioritization.

Question 11

Emergency medical services has transported a client with severe chest pain.
As the client is being transferred to the emergency stretcher, the nurse notes
unresponsiveness, cessation of breathing, and no palpable pulse. Which task
is appropriate to delegate to the unlicensed assistive personnel (UAP)?
1. Performing chest compressions
2. Initiating bag-valve mask ventilation
3. Assisting with oral intubation
4. Placing the defibrillator pads

Answer 11

Ans: 1 UAPs are trained in basic cardiac life support and can perform chest
compressions. The use of the bag-valve mask requires practice, and usually a
respiratory therapist will perform this function. The nurse or the respiratory
410therapist should provide assistance as needed during intubation. The
defibrillator pads are clearly marked; however, placement should be done by
the RN or health care provider because of the potential for skin damage and
electrical arcing. Focus: Delegation.

Question 12

Tetanus immunizations are routinely administered during childhood and in
the emergency department (ED) for clients who sustain wounds. Although
the incidence of tetanus has decreased, there is still a danger. Which client
represents the group that is most vulnerable for risk?
1. Child who helps with the farm work sustained scratches while feeding the
animals
2. Newborn infant delivered in the emergency department; mother had no
prenatal care
3. Older adult who lives alone sustained a minor cut while cleaning the
basement
4. Young adult who works in an auto repair shop sustained a deep cut on a
metal edge

Answer 12

Ans: 3 Older adults are the most likely to be nonvaccinated or
undervaccinated. Tetanus usually occurs when a minor wound gets
contaminated by wood, metal, or other organic material. In addition, most
people would not seek medical treatment for minor wounds. Farm work
offers many opportunities for injuries, but most children are usually
immunized before entering elementary school (the nurse should always ask).
Persons with deep cuts from industrial accidents are more likely to present to
the ED for treatment. Neonatal tetanus is more likely to occur in
underdeveloped countries related to poor hygienic conditions during birth.
Focus: Prioritization.

Question 13

A healthy but anxious 24-year-old college student reports tingling
sensations, palpitations, and sore chest muscles. Deep, rapid breathing and
carpal spasms are noted. What priority action should the nurse take?
1. Notify the health care provider immediately.
2. Administer supplemental oxygen.
3. Have the student breathe into a paper bag.
4. Obtain an order for an anxiolytic medication.

Answer 13

Ans: 3 The client is hyperventilating secondary to anxiety, and breathing
into a paper bag will allow rebreathing of carbon dioxide. Also, encouraging
slow breathing will help. Other treatments such as oxygen administration
and medication may be needed if other causes are identified. Focus:
Prioritization.

Question 14

An experienced traveling nurse has been assigned to work in the emergency
401department (ED); however, this is the nurse’s first week on the job. Which
area of the ED is the most appropriate assignment for this nurse?
1. Trauma team
2. Triage
3. Ambulatory or fast-track clinic
4. Pediatric medicine team

Answer 14

Ans: 3 The fast-track clinic deals with clients in relatively stable condition.
The triage, trauma, and pediatric medicine areas should be staffed with
experienced nurses who know the hospital routines and policies and can
rapidly locate equipment. Focus: Assignment.

Question 15

The nurse and group of friends are at the lake. Suddenly, someone says,
“Look across the lake! It looks like someone might be drowning out there!”
What is the nurse’s first action?
1. Determine who is the strongest swimmer in the group.
2. Direct someone to locate a cell phone and call 911.
3. Find a boat, raft, or some type of flotation device.
4. Use a pair of binoculars and look across the lake.

Answer 15

Ans: 4 First, the nurse would gather as much data as possible. In this case,
the number of potential victims; distance from shore; hazards or barriers that
may affect rescue (e.g., water temperature, roughness of waves, wind, or
lightning); and resources available to victim(s) or rescuers (e.g., boat, pier,
closer rescuers). These data can be reported to the 911 dispatcher and used to
decide whether a rescue attempt is reasonably safe for the nurse and the
bystanders. Focus: Prioritization; Test Taking Tip: The step in the nursing
process is assessment. In this case, assess the multiple factors that affect the
safety of potential victims and rescuers. This data is then used to weigh
harms and benefits.

Question 16

In the care of a client who has experienced sexual assault, which task is most
appropriate for an LPN/LVN to perform?
1. Assessing immediate emotional state and physical injuries
2. Collecting hair samples, saliva specimens, and scrapings beneath
fingernails
3. Providing emotional support and supportive communication
4. Ensuring that the chain of custody of evidence is maintained

Answer 16

Ans: 3 An LPN/LVN is able to listen and provide emotional support for
clients. The other tasks are the responsibility of an RN, or preferably, a sexual
assault nurse examiner who has received training in assessing, collecting, and
safeguarding evidence, and caring for assault victims. Focus: Assignment.

Question 17

The nurse is caring for a client with frostbite to the feet. Place the following
interventions in the correct order.
1. Apply a loose, sterile, bulky dressing.
2. Give pain medication.
3. Remove the client from the cold environment.
4. Immerse the feet in warm water of 105° to 115°F (40.6° to 46.1°C).
5. Monitor for compartment syndrome.
_____, _____, _____, _____, _____

Answer 17

Ans: 3, 2, 4, 1, 5 The client should be removed from the cold environment
first. The rewarming process will be painful, so pain medication should be
given before immersing the feet in warm water. A loose, sterile, bulky
bandage should be applied to the area after warming to protect the feet. The
client should be monitored for compartment syndrome every hour after
initial treatment. Focus: Prioritization.

Question 18

The LPN/LVN is performing care for a client who sustained an amputation
of the first and second digits in a chainsaw accident. What instructions would
the RN give to the LPN/LVN?
1. Clean the amputated digits and the hand with a povidone-iodine and
normal saline solution; then wrap with gauze.
2. Clean the amputated digits, wrap them in gauze, and place cleansed digits
directly into an ice slurry.
3. Clean the amputated digits with saline, wrap in moist gauze, seal in a
plastic bag, and place in ice slurry.
4. Clean the digits with sterile normal saline and submerge the digits in sterile
normal saline in a sterile cup.

Answer 18

Ans: 3 The correct intervention is to gently cleanse the digits with normal
saline, wrap them in sterile gauze moistened with saline, and place them in a
plastic bag or container. The container is then placed in an ice slurry. Focus:
Supervision, Knowledge.

Question 19

The nurse is giving discharge instructions to a woman who has been treated
for contusions and bruises sustained during an episode of domestic violence.
What is the priority intervention for this client?
1. Encourage client to go to a safe house.
2. Make a referral to a counselor.
3. Advise the client about contacting the police.
4. Make an appointment to follow up on the injuries.

Answer 19

Ans: 1 Safety is a priority for this client, and she should not return to a place
where violence could recur. The other options are important for the long-
term management of this case. Focus: Prioritization.

Question 20

A newly graduated nurse overhears a senior emergency department nurse
making sarcastic remarks toward a medical student and refusing to help the
student find the equipment for a nonemergent client procedure. What should
the new nurse do first?
1. Step in and offer to assist the medical student because the other nurse is
unwilling.
2. Confront the senior nurse and indicate that an apology is the right thing to
do.
3. Observe the situation and then report behaviors of both parties to the
charge nurse.
4. Watch and observe the dynamics; the scenario is probably typical of unit
norms.

Answer 20

Ans: 1 First, the new nurse steps in and takes action to protect and address
the needs of the vulnerable persons: the medical student who is being bullied
and the client who needs the procedure. The next step would be to take the
senior nurse aside and discuss the behaviors and how those behaviors impact
team moral and overall client care. It is difficult to approach someone who is
more senior, but the new nurse can use “I” statements, which are less
accusatory. For example, “I overheard the interaction with the medical
student. I stepped into help him, because I felt uncomfortable. I was
wondering how you felt.” Observing the dynamics of the scenario is
appropriate, and those observations can be shared with the charge nurse or
unit manager so that steps can be taken to create a climate of
interprofessional collaboration. Focus: Prioritization.

Question 21

The nurse notifies the emergency department (ED) health care provider
(HCP) about a client who reports abdominal pain, nausea and vomiting, and
fever. The abdomen is distended, rigid, and boardlike, and there is rebound
tenderness. Later the nurse sees that the client is to be discharged with a
follow-up appointment in the morning. The nurse reexamines the client and
the symptoms seem worse. What should the nurse do first?
1. Contact the nursing supervisor and express concerns.
2. Express findings and concerns to the HCP.
3. Discharge the client but stress the importance of follow-up.
4. Follow the discharge orders and write an incident report.

Answer 21

Ans: 2 First, the nurse tries to express concerns to the HCP. The ED can be
very hectic, and the ED staff should work as a team and watch out for each
other as well as the clients. If the HCP refuses to consider concerns, then the
nurse may have to contact the nursing supervisor or write an incident report.
This client has the signs of peritonitis. If the client dies or has a poor outcome,
the nurse is liable for failing to intervene. Focus: Prioritization.

Question 22

A confused client admits to frequently drinking alcohol. The emergency
department health care provider (HCP) makes a preliminary diagnosis of
Wernicke encephalopathy. Which medication does the nurse anticipate that
the HCP will prescribe initially?
1. Glucagon IV
2. Naltrexone IM
3. Thiamine IV
4. Naloxone IV

Answer 22

Ans: 3 Wernicke encephalopathy is caused by a thiamine deficiency and
manifests as confusion, nystagmus, and abnormal ocular movements. It can
be reversed with thiamine. IV glucagon is given if change of mental status is
caused by severe hypoglycemia. Naltrexone is used to decrease the craving
for alcohol. Naloxone is used to reverse opioid overdose. Focus:
Prioritization.

Question 23

When an unexpected death occurs in the emergency department, which task
is most appropriate to delegate to the unlicensed assistive personnel (UAP)?
1. Escorting the family to a place of privacy
4032. Accompanying organ donor specialist to talk to family
3. Assisting with postmortem care
4. Helping the family to collect belongings

Answer 23

Ans: 3 Postmortem care requires some turning, cleaning, lifting, and so on,
and the UAP is able to assist with these duties. The RN should take
responsibility for the other tasks to help the family begin the grieving
process. In cases of questionable death, belongings may be retained for
evidence, so the chain of custody would have to be maintained. Focus:
Delegation.

Question 24

After emergency endotracheal intubation, the health care team and the nurse
must verify tube placement before securing the tube. What is the most
accurate bedside assessment that can be performed immediately after the
tube is placed?
1. Visualize the movement of the thoracic cage.
2. Auscultate the chest during assisted ventilation.
3. Confirm that the breath sounds are equal and bilateral.
4. Check exhaled carbon dioxide levels with capnography.

Answer 24

Ans: 4 Checking exhaled carbon dioxide levels is the most accurate way of
immediately verifying placement. Observing chest movements and
auscultating and confirming equal bilateral breath sounds are considered less
accurate. (Note to student: Possibly, you may see the health care team
auscultating the chest; this is a long-time practice that is quick to perform and
doesn’t harm the client if used in conjunction with other verification
412methods.) Radiographic study will verify and document correct placement.
Focus: Prioritization.

Question 25

A man with a known history of alcohol abuse has been in police custody for
48 hours. Initially, anxiety, sweating, and tremors were noted. Now
disorientation, hallucination, and hyperreactivity are observed. The medical
diagnosis is delirium tremens. What is the priority nursing concept to
consider in planning interventions for this emergency condition?
1. Safety
2. Psychosis
3. Thermoregulation
4. Addiction

Answer 25

Ans: 1 The client demonstrates neurologic hyperreactivity and is on the
verge of a seizure. Client safety is the priority. The client needs medications
such as chlordiazepoxide to decrease neurologic irritability and phenytoin for
seizures. Thiamine is given to correct underlying nutritional deficiency, and
haloperidol may be prescribed for the psychotic symptoms. Focus:
Prioritization.

Question 26

The nurse is assigned to telephone triage. A client who was just stung by a
common honeybee calls for advice. Which question would the nurse ask
first?
1. “Is this the first time you have been stung by a bee or wasp?”
2. “Do you have access to and know how to use an epinephrine autoinjector?”
3. “What type of first aid measures have you tried?”
4. “Are you having any facial swelling, wheezing, or shortness of breath?”

Answer 26

Ans: 4 First, the nurse would try determine if the client is having a severe
allergic reaction to the bee sting. Facial swelling, wheezing, or shortness of
breath can rapidly progress to a life-threatening airway obstruction. If these
signs and symptoms are occurring, the nurse would instruct the client to call
911 and to use the epinephrine autoinjector if it is available. If the client is not
having a life-threatening reaction, the nurse could ask other questions to
determine appropriate interventions. Focus: Prioritization.

Question 27

A victim of heat stroke arrives in the emergency department. His skin is hot
and dry; his body temperature is 105°F (40.6°C). He is confused and
demonstrates bizarre behavior. His blood pressure is 85/60 mm Hg, pulse 130
beats/min, and respirations are 40 breaths/min. Which task should be
assigned to an experienced LPN/LVN?
1. Insert a rectal probe to measure core body temperature.
2. Administer aspirin or another antipyretic.
3. Insert an indwelling urinary drainage catheter.
4. Assess respiratory effort, hemodynamics, and mental status.

Answer 27

Ans: 3 Inserting an indwelling urinary catheter is within the scope of
practice of an experienced LPN/LVN. Experienced unlicensed assistive
personnel should be directed to insert the rectal probe to monitor the core
temperature. Initial assessment of new clients and critically ill clients should
be performed by the RN. Aspirin and other antipyretics are not given because
they won’t work to decrease the body temperature and may be harmful. The
care of this client would also include arterial blood gases; possible
endotracheal intubation; IV fluids; blood for electrolytes, cardiac and liver
enzymes, and complete blood count; muscle relaxants (benzodiazepines) if
the client begins to shiver; monitoring urine output and specific gravity to
determine fluid needs; cooling interventions; and discontinuing cooling
interventions when core body temperature is reduced to 102°F (38.9°C).
Focus: Assignment.

Question 28

The nurse is assessing a client who has sustained a cat bite to the left hand.
The cat’s immunizations are up to date. The date of the client’s last tetanus
shot is unknown. What is the priority concern?
1. Treating infection specific to cat bites
4042. Suturing the puncture wounds
3. Administering tetanus vaccine
4. Maintaining mobility of finger joints

Answer 28

Ans: 1 Cats’ mouths contain a virulent organism, Pasteurella multocida, which
can lead to septic arthritis or bacteremia. Appropriate first aid includes
rigorous washing of the wound site with soap and water to combat infection.
Puncture wounds, especially those caused by bites, are usually not sutured.
There is also a risk for tendon damage and loss of joint mobility caused by
deep puncture wounds, but an orthopedic surgeon would be consulted after
initial emergency care is started. A tetanus shot can be given before
discharge. Focus: Prioritization.

Question 29

The following clients come to the emergency department triage desk
reporting acute abdominal pain. Which client has the most severe condition?
1. A 35-year-old man reporting severe intermittent cramps with three
episodes of watery diarrhea 2 hours after eating
2. An 11-year-old boy with a low-grade fever, right lower quadrant
tenderness, nausea, and anorexia for the past 2 days
3. A 23-year-old woman reporting dizziness and severe left lower quadrant
pain who states she is possibly pregnant
4. A 50-year-old woman who reports gnawing midepigastric pain that is
worse between meals and during the night

Answer 29

. Ans: 3 The woman with lower left quadrant pain is at risk for ectopic
pregnancy. This is a life-threatening condition. The 11-year-old boy needs
evaluation to rule out appendicitis. The 35-year-old man has food poisoning,
which is usually self-limiting. The woman with midepigastric pain may have
an ulcer, but follow-up diagnostic testing and teaching of lifestyle
modification can be scheduled with the primary care provider. Focus:
Prioritization.

Question 30

The nurse manager decides to form a committee to address the issue of
violence against emergency department (ED) personnel. Which combination
of employees would be best suited to fulfill this assignment?
1. ED physicians and charge nurses
2. Experienced RNs and experienced paramedics
3. RNs, LPNs/LVNs, and unlicensed assistive personnel
4. At least one person from all ED groups

Answer 30

Ans: 4 At least one representative from each group should be included
because all employees are potential targets for violence in the ED. Focus:
Assignment

Question 31

. The nurse is caring for a client with multiple injuries sustained during a
head-on car collision. Which assessment finding takes priority?
1. A deviated trachea
2. Unequal pupils
3. Ecchymosis in the flank area
4. Irregular apical pulse

Answer 31

Ans: 1 A deviated trachea is a symptom of tension pneumothorax, which
will result in respiratory arrest if not corrected. All of the other symptoms are
potentially serious but are of lower priority. Focus: Prioritization.

Question 32

A client involved in a one-car rollover comes in with multiple injuries. List
in order of priority the interventions that must be initiated for this client.
1. Secure two large-bore IV lines and infuse normal saline.
2. Use the chin lift or jaw thrust maneuver to open the airway.
3. Assess for spontaneous respirations.
4. Give supplemental oxygen via mask.
5. Obtain a full set of vital sign measurements.
6. Remove or cut away the client’s clothing.
_____, _____, _____, _____, _____, _____

Answer 32

Ans: 3, 2, 4, 1, 5, 6 For a trauma client with multiple injuries, many
interventions (e.g., assessing for spontaneous respirations, performing
techniques to open the airway such as chin lift or jaw thrust, and applying
oxygen) may occur simultaneously as team members assist in the
resuscitation A quick assessment of respiratory status precedes intervention.
Opening the airway must precede the administration of oxygen because, if
the airway is closed, the oxygen cannot enter the air passages. Starting IV
lines for fluid resuscitation is part of supporting circulation. (Emergency
medical service personnel will usually establish at least one IV line in the
field.) Unlicensed assistive personnel can be directed to obtain and report
vital signs and remove or cut away clothing. Focus: Prioritization.

Question 33

A young woman is brought to the emergency department (ED) by
emergency medical services (EMS). EMS reports they were called because the
woman has been depressed and threatening to commit suicide. On arrival to
the ED, the woman is confused; her speech is slurred, and there is vomit on
her clothes. EMS found several empty prescription bottles at the house. What
405are the priority interventions for this client?
1. Identify toxic substances by history and analysis of blood, urine, and
gastric contents.
2. Initiate supportive care, such as checking airway and giving oxygen and IV
fluids.
3. Reduce absorption by giving activated charcoal or performing gastric
lavage.
4. Promote poison removal using drugs to facilitate excretion or by starting
hemodialysis.

Answer 33

Ans: 2 Maintaining airway, oxygenation, and circulation are the priorities.
The other steps are also important in managing clients who have ingested
toxic substances. Focus: Prioritization.

Question 34

A group of people arrive at the emergency department by private car. They
all have extreme periorbital swelling, coughing, and tightness in the throat.
There is a strong odor emanating from their clothes. They report exposure to
a “gas bomb” that was set off in their house. What is the priority action?
1. Measure vital signs and listen to lung sounds.
2. Direct clients to the decontamination area.
3. Alert security about possible terrorism activity.
4. Direct clients to cold or clean zones for immediate treatment.

Answer 34

Ans: 2 Decontamination in a specified area is the priority. Performing
assessments delays decontamination and does not protect the total
environment. Personnel should don personal protective equipment before
assisting with decontamination or assessing the clients. The clients must
undergo decontamination before entering cold or clean areas. The nurse
should notify the charge nurse or nurse manager about communicating with
security regarding potential terrorist activities. Focus: Prioritization.

Question 35

In the work setting, what is the nurse’s primary responsibility in preparing
for management of disasters, including natural disasters and bioterrorism
incidents?
1. Knowing the agency’s emergency response plan
2. Being aware of the signs and symptoms of potential agents of bioterrorism
3. Knowing how and what to report to the Centers for Disease Control and
Prevention
4. Making ethical decisions about exposing self to potentially lethal
substances

Answer 35

Ans: 1 In preparing for disasters, the RN should be aware of the emergency
response plan. The plan gives guidance that includes the roles of team
members, responsibilities, and mechanisms of reporting. Signs and
symptoms of exposure to many agents will mimic common complaints, such
as flulike symptoms. Discussions with colleagues and supervisors may help
the individual nurse to sort through ethical dilemmas related to potential
danger to self. Focus: Prioritization.

Question 36

Emergency and ambulatory care nurses are among the first health care
workers to encounter victims of a bioterrorist attack. List in order of priority
the actions that should be taken by emergency department staff in the event
of a biochemical incident.
1. Report to public health department or Centers for Disease Control and
Prevention per protocol.
2. Decontaminate the affected individuals in a separate area.
3. Protect the environment for the safety of personnel and nonaffected clients.
4. Don personal protective equipment.
5. Perform triage according to protocol.
_____, _____, _____, _____, _____

Answer 36

Ans: 3, 4, 2, 5, 1 The first priority is to protect personnel, unaffected clients,
bystanders, and the facility. Personal protective gear should be donned by
staff before victims are assessed or treated. Decontamination of victims in a
separate area is followed by triage and treatment. The incident should be
reported according to protocol as information about the number of people
involved, history, and signs and symptoms becomes available. Focus:
Prioritization.

Question 37

According to The Joint Commission, hospitals are required to form
emergency management committees to periodically exercise the disaster
operations plan. Hospital administration has selected various health care
providers (HCPs) to join the committee. Members from which other key
406departments should be included? Select all that apply.
1. Security and communications
2. Nursing and unlicensed assistive personnel
3. Laboratory and diagnostic services
4. Medical and information technology
5. Maintenance and engineering
6. Physical therapy and occupational therapy

Answer 37

Ans: 1, 2, 3, 4, 5 When the disaster plan is activated, the expectation is that a
large number of clients will arrive who need triage and various levels of care.
414Security and communications are essential to the flow of people and
information in and out of the facility. HCPs, nurses, and unlicensed assistive
personnel are assigned to care for clients. Laboratory and diagnostic services
are required for ongoing client care. Accurate records and client tracking is
essential during a disaster. Maintenance and engineering are responsible for
the ongoing integrity of the facility’s structure. In fact, all hospital personnel
are needed in the immediate period after a disaster, but members of
departments such as quality improvement, physical therapy, volunteer
services, and occupational therapy are less likely to be performing their usual
functions. Focus: Assignment.

Question 38

A newly hired emergency department (ED) clinical nurse specialist (CNS) is
reviewing the hospital’s disaster plan and finds that it has not been reviewed
or revised for 3 years. Which finding will be most important for the CNS to
address related to the status of the disaster plan?
1. Stockpiles of antibiotics and resuscitation equipment may be depleted.
2. Current staff is unlikely to have training and practice in using the plan.
3. Resources within and outside of the hospital are likely to have changed.
4. Surrounding communities are at increased risk for technologic disasters.

Answer 38

Ans: 2 The ED CNS would be most concerned that the staff has not had any
training or practice opportunities for at least the past 3 years because training
staff members is the direct responsibility of the CNS. The Joint Commission
recommends biannual training practice and rehearsal; training exercises also
provide data that can be used to revise and update the plan. The CNS should
also alert hospital administration about the need to inventory stockpiles, to
conduct an internal and external resource analysis, and to contact public
health officials about increased risk in surrounding communities. Focus:
Supervision.

Question 39

The nurse is talking to a group of people about an industrial explosion in
which many people were killed or injured. Which individual has the greatest
risk for psychiatric difficulties, such as post-traumatic stress disorder, related
to the incident?
1. Individual who repeatedly watched television coverage of the event
2. Person who recently learned that her son was killed in the incident
3. Individual who witnessed the death of a co-worker during the explosion
4. Person who was injured and trapped for several hours before rescue

Answer 39

Ans: 4 Any of these people may need or benefit from psychiatric counseling.
Obviously, there will be variations in previous coping skills and support
systems; however, a person who experienced a threat to his or her own life is
at the greatest risk for psychiatric problems after a disaster incident. Focus:
Prioritization.

Question 40

Identify the five most critical elements in performing disaster triage for
multiple victims.
1. Obtain past medical and surgical histories.
2. Check airway, breathing, and circulation.
3. Assess the level of consciousness.
4. Visually inspect for gross deformities, bleeding, and obvious injuries.
5. Note the color, presence of moisture, and temperature of the skin.
6. Check vital signs, including pulse and respirations.
_____, _____, _____, _____, _____

Answer 40

Ans: 2, 3, 4, 5, 6 Quickly assessing respiratory effort, level of consciousness,
obvious injuries, appearance of skin (indicative of peripheral perfusion), and
vital signs are appropriate for disaster triage. Other information, such as
medical and surgical history, medication history, support systems, and last
tetanus booster, would be collected when the staff has more time and
resources. Focus: Prioritization.

Question 41

The nurse is working in a small rural community hospital. There is a fire in a local church, and six injured clients have arrived at the hospital. Many others are expected to arrive soon, and other hospitals are 5 hours away. Using disaster triage principles, place the following six clients in the order in whichthey should receive medical attention, with 1 being the first to receive attention and 6 being the last to receive attention.
1. A 52-year-old man in full cardiac arrest who has been receiving
cardiopulmonary resuscitation (CPR) continuously for the past 60 minutes
2. A firefighter who is showing combative behavior and has respiratory
stridor
3. A 60-year-old woman with full-thickness burns to the hands and forearms
4. A teenager with a crushed leg that is very swollen; he is anxious and has tachycardia
5. A 3-year-old child with respiratory distress and burns over more than 70% f the anterior body
6. A 12-year-old child with wheezing and very labored respirations
unrelieved by an asthma inhaler
_____, _____, _____, _____, _____, _____

Answer 41

Ans: 6, 2, 4, 3, 5, 1 Treat the 12-year-old child with asthma first by initiating an albuterol treatment. This action is quick to initiate, and the child or parent can be instructed to hold the apparatus while the nurse attends to other clients. The firefighter is in greater respiratory distress than the 12-year-old child; however, managing a strong combative client is difficult and time consuming (e.g., the 12-year-old could die if too much time is spent trying to control the firefighter). Attend to the teenager with a crush injury next.
Anxiety and tachycardia may be caused by pain or stress; however, the swelling suggests hemorrhage. Next attend to the woman with burns on the forearms by providing dressings and pain management. The child with burns over more than 70% of the anterior body should be given comfort measures; however, the prognosis is very poor. The prognosis for the client in cardiac
arrest is also very poor because CPR efforts have been prolonged. Focus: Prioritization.

Question 42

The nurse is caring for a client who is on the cardiac monitor because of
these symptoms: syncope, dizziness, and intermittent episodes of
palpitations. Below is a display of what the nurse sees on the cardiac monitor.
What should the nurse do first? (ECG RHYTHM: PREMATURE VENTRICULAR CONTRACTIONS - PVCs)
1. Call the Rapid Response Team.
2. Obtain the automated external defibrillator.
3. Assess the client and take vital signs.
4. Check the adherence of the gel pads on the chest.

Answer 42

Ans: 3 The nurse recognizes that the monitor is showing sinus rhythm with
occasional premature ventricular contractions (PVCs). The client is likely to
be alert and in no distress. Sometimes people do report the subjective
sensation of “skipped beats.” The nurse would ask the client about subjective
symptoms and assess for any signs of decreased cardiac output or problems
related to decreased perfusion. The nurse would continue to observe the
client. Increase in frequency or duration of PVCs can precede ventricular
tachycardia or dysthymias. Focus: Prioritization.