Nursing Management Emergency Care Situations

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Question 1
Free
Multiple Choice

The nurse is conducting a primary assessment of a trauma victim and determines that the client is breathing and has an unobstructed airway. Which of the following actions should the nurse take next?

Choose correct answer/s
A

Observe the client's respiratory effort.

B

Check the client's level of consciousness.

C

Palpate extremities for capillary refill time.

D

Examine the client for any external bleeding.

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Question 2
Free
Multiple Choice

The nurse is conducting a primary survey of a client with multiple traumatic injuries and observes that the client's right pedal pulses are absent and the leg is swollen. Which of the following actions will the nurse take next?

Choose correct answer/s
A

Assess further for a cause of the decreased circulation.

B

Send blood to the lab for a complete blood count (CBC).

C

Finish the airway, breathing, circulation, disability survey.

D

Initiate isotonic fluid infusion through two large-bore IV lines.

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Question 3
Free
Multiple Choice

The nurse is assessing a client with hypothermia. Which of the following assessments should the nurse expect to find?

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A

Hypertension

B

Reddened, swollen extremities

C

Hyperventilation

D

Bradycardia

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Question 4
Free
Multiple Choice

Aclient who is unconscious after a fall from a ladder is transported to the emergency department by family members. During the primary survey of the client, which of the following actions should the nurse implement?

Choose correct answer/s
A

Assess the client's vital signs.

B

Attach a cardiac electrocardiogram (ECG) monitor.

C

Obtain a Glasgow Coma Scale score.

D

Ask about chronic medical conditions.

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Question 5
Free
Multiple Choice

The nurse is assessing a client who is brought to the emergency department (ED) with multiple lacerations and tissue avulsion of the right hand. When asked about tetanus immunization, the client denies having any previous vaccinations. Which of the following should the nurse anticipate administering to the client?

Choose correct answer/s
A

Tetanus-diphtheria toxoid (TD) only

B

Tetanus immunoglobulin (TIG) only

C

Tetanus immunoglobulin (TIG) and tetanus-diphtheria (TD) toxoid

D

TIG and tetanus-diphtheria toxoid and pertussis vaccine (Tdap)

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Question 6
Multiple Choice

The nurse is caring for a client who has experienced blunt abdominal trauma during a car accident and has increasing abdominal pain. Which of the following diagnostic tests should the nurse prepare the client for?

Choose correct answer/s
A
Ultrasonography
B
Peritoneal lavage
C
X-ray
D
Magnetic resonance imaging (MRI)
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Question 7
Multiple Choice

The nurse is caring for a client with hypotension and temperature elevation after doing yard work on a hot day and is being treated in the emergency department. After the nurse has completed discharge teaching, which of the following client statements indicates that the teaching has been effective?

Choose correct answer/s
A
"I will take salt tablets when I work outdoors in the summer."
B
"I should take acetaminophen if I start to feel too warm."
C
"I should have sports drinks when exercising outside in hot weather."
D
"I will get into a cool environment if I notice that I am feeling confused."
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Question 8
Multiple Choice

The nurse is preparing to rewarm a client with hypothermia. Which of the following actions should the nurse implement?

Choose correct answer/s
A
Attach a cardiac monitor.
B
Insert a urinary catheter.
C
Assist with endotracheal intubation.
D
Prepare sympathomimetic drugs for emergency administration.
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Question 9
Multiple Choice

The nurse is observing a client who experienced a near drowning accident in a local lake, but now is awake and breathing spontaneously. Which of the following actions will be most important for the nurse to take during the observation period?

Choose correct answer/s
A
Listen to heart sounds.
B
Palpate peripheral pulses.
C
Auscultate breath sounds.
D
Check pupil reaction to light.
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Question 10
Multiple Choice

The nurse is caring for a client that has sustained a black widow spider bite. Which of the following times should the nurse be aware of that the symptoms usually peak?

Choose correct answer/s
A
30 minutes
B
2-3 hours
C
5-6 hours
D
9-10 hours
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Question 11
Multiple Choice

The nurse is rewarming a client who arrived in the emergency department (ED) with a temperature of 29°C (84.2°F) and no audible pulse. Which of the following temperatures should the nurse rewarm the client to, prior to a pronouncement of death?

Choose correct answer/s
A
30C (86F)
B
32°C (89.6°F)
C
34C (93.2F)
D
36C (96.8F)
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Question 12
Multiple Choice

The nurse is assessing a client admitted to the emergency department (ED) with a broken arm and facial bruises and notes multiple additional bruises in various stages of healing. Which of the following responses by the nurse is most appropriate?

Choose correct answer/s
A
"Is someone at home hurting you?"
B
"You should not return to your home."
C
"Would you like to see a social worker?"
D
"I have to report this abuse to the police."
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Question 13
Multiple Choice

A client arrives in the emergency department (ED) a few hours after taking "20-30" acetaminophen (Tylenol) tablets. Which of the following actions will the nurse plan to take?

Choose correct answer/s
A
Give N-acetylcysteine.
B
Discuss the use of chelation therapy.
C
Have the client drink large amounts of water.
D
Administer oxygen using a non-rebreather mask.
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Question 14
Multiple Choice

A triage nurse is assessing a client who complains of 6/10 abdominal pain and states, "I had a temperature of 40.3°C (104.5°F) at home." Which of the following actions should the nurse implement first?

Choose correct answer/s
A
Assess the client's current vital signs.
B
Obtain a clean-catch urine for urinalysis.
C
Tell the client that it may be several hours before being seen by the doctor.
D
Ask the health care provider to order an analgesic medication for the client.
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Question 15
Multiple Choice

The triage nurse is assessing four victims of an automobile accident. Which of the following clients has the highest priority for treatment?

Choose correct answer/s
A
A client with absent pedal pulses
B
A client with an open femur fracture
C
A client with a sucking chest wound
D
A client with bleeding of facial lacerations
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Question 16
Multiple Choice

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

Choose correct answer/s
A
Remove the client's rings.
B
Place ice packs on both hands.
C
Apply calamine lotion to any itching areas.
D
Give diphenhydramine 100 mg PO.
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Question 17
Multiple Choice

Gastric lavage and administration of activated charcoal are prescribed for an unconscious client who has been admitted to the emergency department (ED) after ingesting 30 diazepam tablets. Which of the following actions will the nurse plan to take first?

Choose correct answer/s
A
Administer activated charcoal.
B
Insert a large-bore orogastric tube.
C
Prepare a 60-mL syringe with saline.
D
Assist with intubation of the client.
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Question 18
Multiple Choice

After spending the previous weekend camping out with some friends, a client arrives at the emergency department and is diagnosed with flaccid ascending paralysis. Based upon this information, the nurse concludes that the client has been bitten by whichofthefollowing?

Choose correct answer/s
A
Spider
B
Wasp
C
Tick
D
Snake
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Question 19
Multiple Choice

An unresponsive older-adult client is admitted to the emergency department (ED) during a summer heat wave. The client's core temperature is 41.2°C (106.1°F), blood pressure (BP) 86/52, and pulse 102. Which of the following actions should the nurse implement initially?

Choose correct answer/s
A
Administer an Aspirin rectal suppository.
B
Start O2 at 6 L/minute with a nasal cannula.
C
Apply wet sheets and a fan to the client.
D
Infuse lactated Ringer's solution at 1 000 mL/hour.
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Question 20
Multiple Choice

The nurse is admitting a client to the emergency department after a submersion injury. Which of the following assessments is priority?

Choose correct answer/s
A
Apical pulse
B
Lung sounds
C
Body temperature
D
Level of consciousness
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