Ch. 67 /68 Emergency & Disaster Nursing
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Which client should the nurse prioritize as needing emergent treatment, assuming no other injuries are present except the ones outlined?
A. A client with a blunt chest trauma with some difficulty breathing
B. A client with a sore neck who was immobilized in the field on a backboard with a cervical collar
C. A client with a possible fractured tibia with adequate pedal pulses
D. A client with an acute onset of confusion
A. A client with a blunt chest trauma with some difficulty breathing
A client has sustained multiple injuries from a gunshot wound while hunting in cold winter weather. The client has waited several hours for rescue and is transported in a helicopter to the emergency department. The nurse recognizes what additional factors are associated with increased mortality for this client?
A. Time of injury, hyperhidrosis, and thermal changes
B. Comorbidities, location of injury, and gravitational forces
C. Hypothermia, acidosis, and coagulopathy
D. Venous insufficiency, barometric changes, and fatigue
C. Hypothermia, acidosis, and coagulopathy
The nurse is admitting a client who is suspected of having heat stroke. What assessment finding would be most consistent with this diagnosis?
A. Widening pulse pressure
B. Hot, dry skin
C. Core body temperature of 99.0°F/37.2°C
D. Cheyne-Stokes respirations
B. Hot, dry skin
A client is brought to the ED by ambulance after swallowing highly acidic toilet bowl cleaner 2 hours earlier. The client is alert and oriented. What is the care team's most appropriate treatment?
A. Administering syrup of ipecac
B. Performing a gastric lavage
C. Giving milk to drink
D. Referring to psychiatry
C. Giving milk to drink
The paramedics bring a client who has suffered a sexual assault to the ED. What is important for the sexual assault nurse examiner to do when assessing a sexual assault victim?
A. Respect the client's privacy during assessment.
B. Shave all pubic hair for laboratory analysis.
C. Place items for evidence in plastic bags.
D. Bathe the client before the examination.
A. Respect the client's privacy during assessment.
A client with a history of major depression is brought to the ED by the client's parents. Which of the following nursing actions is most appropriate?
A. Noting that symptoms of physical illness are not relevant to the current diagnosis
B. Asking if the client has ever thought about taking their own life
C. Conducting interviews in a brief and direct manner
D. Arranging for the client to spend time alone to consider their feelings
B. Asking if the client has ever thought about taking their own life
The nurse is caring for a client with alcohol withdrawal syndrome. What would be an appropriate nursing action to minimize the potential for hallucinations?
A. Engage the client in a process of health education.
B. Administer opioid analgesics as prescribed.
C. Place the client in a private, well-lit room.
D. Provide television or a radio as therapeutic distraction
C. Place the client in a private, well-lit room.
An obtunded client is admitted to the ED after ingesting bleach. The nurse should prepare to assist with what intervention?
A. Prompt administration of an antidote
B. Gastric lavage
C. Administration of activated charcoal
D. Helping the client drink large amounts of water
D. Helping the client drink large amounts of water
A client with multiple injuries is brought to the emergency department by ambulance. The client has had his airway stabilized and is breathing on their own. The nurse does not see any active bleeding, but should suspect internal hemorrhage based on what finding?
A. Absence of bruising at contusion sites
B. Rapid pulse and decreased capillary refill
C. Increased BP with narrowed pulse pressure
D. Sudden diaphoresis
B. Rapid pulse and decreased capillary refill
A client is brought to the emergency room (ER) in an unconscious state and emergency surgery is needed. No family members are present, and the client does not have identification. What action by the nurse is the priority regarding consent for treatment?
A. Ask the social worker to come and sign the consent.
B. Contact the police to obtain the client's identity.
C. Obtain an emergency court order to treat the client.
D. Clearly document level of consciousness (LOC) and health status on the client's chart.
D. Clearly document level of consciousness (LOC) and health status on the client's chart.
A client is brought by friends to the ED after being involved in a motor vehicle accident. The client sustained blunt trauma to the abdomen. What nursing action would be most appropriate for this client?
A. Ambulate the client to expel flatus.
B. Place the client in a high Fowler position.
C. Immobilize the client on a backboard.
D. Place the client in a left lateral position.
C. Immobilize the client on a backboard.
A client with a fractured femur presenting to the ED exhibits cool, moist skin, increased heart rate, and falling BP. The care team should consider the possibility of what complication of the client's injuries?
A. Myocardial infarction
B. Hypoglycemia
C. Hemorrhage
D. Peritonitis
C. Hemorrhage
A client who has been diagnosed with cholecystitis is being discharged home from the ED to be scheduled for later surgery. The client received morphine during the present ED admission and is visibly drowsy. When providing health education to the client, what would be the most appropriate nursing action?
A. Give written instructions to client.
B. Give verbal instructions to one of the client's family members.
C. Telephone the client the next day with verbal instructions.
D. Give verbal and written instructions to the client and a family member.
D. Give verbal and written instructions to the client and a family member.
A client who attempted suicide is being treated in the ED. The client is accompanied by the client's mother, father, and brother. When planning the nursing care of this family, the nurse should perform which of the following actions?
A. Refer the family to a psychiatrist in order to provide them with support.
B. Explore the causes of the client's suicide attempt with the family.
C. Encourage the family to participate in the bedside care of the client.
D. Ensure that the family receives appropriate crisis intervention services.
D. Ensure that the family receives appropriate crisis intervention services.
A client with multiple trauma is brought to the emergency department (ED) by ambulance after a fall while rock climbing. What is a responsibility of the ED nurse in this client's care?
A. Intubating the client
B. Notifying family members
C. Ensuring Intravenous (IV) access
D. Testing laboratory specimens
C. Ensuring Intravenous (IV) access
A client has been brought to the ED after suffering genitourinary trauma in an assault. Initial assessment reveals that the client's bladder is distended. What is the nurse's most appropriate action?
A. Withhold fluids from the client.
B. Perform intermittent urinary catheterization.
C. Insert a narrow-gauge indwelling urinary catheter.
D. Await orders following the urologist's assessment.
D. Await orders following the urologist's assessment.
A homeless person is admitted the ED during a blizzard, and is unable to feel the feet and lower legs. Core temperature is noted at 33.2°C (91.8°F). The client is intoxicated with alcohol at the time of admission and is visibly malnourished. What is the triage nurse's priority in the care of this client?
A. Addressing the client's hypothermia
B. Addressing the client's frostbite in his lower extremities
C. Addressing the client's alcohol intoxication
D. Addressing the client's malnutrition
A. Addressing the client's hypothermia
A client admitted to the ED with severe diarrhea and vomiting is subsequently
diagnosed with food poisoning. The nurse caring for this client assesses for signs and symptoms of fluid and electrolyte imbalances. For what signs and symptoms would this nurse assess? Select all that apply.
A. Dysrhythmias
B. Hypothermia
C. Hypotension
D. Hyperglycemia
E. Delirium
A. Dysrhythmias
C. Hypotension
E. Delirium
A client is admitted to the ED with an apparent overdose of IV heroin. After stabilizing the client's cardiopulmonary status, the nurse should prepare to perform what intervention?
A. Administer a bolus of lactated Ringer.
B. Administer naloxone hydrochloride (Narcan).
C. Insert an indwelling urinary catheter.
D. Perform a focused neurologic assessment.
B. Administer naloxone hydrochloride (Narcan).
A client is being treated for bites suffered during an assault. After the bites have been examined and documented by a forensic examiner, the nurse should perform what action?
A. Apply a dressing saturated with chlorhexidine.
B. Wash the bites with soap and water.
C. Arrange for the client to receive a hepatitis B vaccination.
D. Assess the client's immunization history.
B. Wash the bites with soap and water.
The ED nurse is planning the care of a client who has been admitted following a sexual assault. The nurse knows that all of the nursing interventions are aimed at what goal?
A. Encouraging the client to gain a sense of control over his or her life
B. Collecting sufficient evidence to secure a criminal conviction
C. Helping the client understand that this will not happen again
D. Encouraging the client to verbalize what happened during the assault
A. Encouraging the client to gain a sense of control over his or her life
The ED nurse admitting a client with a history of depression is screening the client for suicide risk. What assessment question should the nurse ask when screening the client?
A. "How would you describe your mood over the past few days?"
B. "Have you ever thought about taking your own life?"
C. "How do you think that your life is most likely to end?"
D. "How would you rate the severity of your depression right now on a 10-point scale?"
B. "Have you ever thought about taking your own life?"
A client is brought to the ED by two police officers. The client was found unconscious on the sidewalk, the client's face and hands covered in blood. At present, the client is verbally abusive and is fighting the staff in the ED, but appears medically stable. The decision is made to place the client in restraints. What action should the nurse perform when the client is restrained?
A. Frequently assess the client's skin integrity.
B. Inform the client about the likelihood of being charged with assault.
C. Avoid interacting with the client until the restraints are removed.
D. Take the opportunity to perform a full physical assessment.
A. Frequently assess the client's skin integrity.
An emergency department (ED) nurse is triaging clients according to a triage severity rating. When assigning clients to a triage level, the nurse will consider the clients' acuity as well as what other variable?
A. The likelihood of a repeat visit to the ED in the next seven days
B. The resources that the client is likely to currently require
C. The client's or insurer's ability to cover the cost of care
D. Whether other hospitals are on diversionary status and ability to manage the client
B. The resources that the client is likely to currently require
A client in the critical care unit is prescribed crystalloid intravenous fluids. The nurse anticipates administering which fluid? Select all that apply.
A. Normal saline
B. Lactated Ringer
C. Dextrose 5% in water
D. Albumin
E. Hetastarch (TM)
A. Normal saline
B. Lactated Ringer
C. Dextrose 5% in water
CH. 68 1. The emergency department (ED) received news of a train derailment locally and the number of clients injured is reported between 50 and 100. The hospital has determined that it can accommodate 50 clients and still remain self-sufficient. What criteria is the hospital using to project the number of clients it can support?
A. The understanding that the institution can rely on outside services after 3 days
B. Based on the emergency operations plan that incorporates assistance from the Red Cross
C. Decided by the institution's ability to sustain core services for at least 96 hours
D. Based on the hospital's incident command system that updates the hospital on the severity of injuries
C. Decided by the institution's ability to sustain core services for at least 96 hours
CH. 68 2. A workplace explosion has left a 40-year-old client with full thickness burns over 75% of the body. Despite these injuries, the client is conscious. How would this person be triaged?
A. Green
B. Yellow
C. Red
D. Black
D. Black
CH. 68 (3). A client has been witness to a disaster involving a large number of injuries. The client appears upset, but states feeling capable of dealing with the emotions involved. What is the nurse's most appropriate intervention?
A. Educate the client about the potential harm in denying their emotions.
B. Refer the client to social work or spiritual care.
C. Encourage the client to take a leave of absence from their job to facilitate emotional healing.
D. Encourage the client to return to normal social roles when appropriate.
D. Encourage the client to return to normal social roles when appropriate.
CH. 68 (4). A nurse is caring for clients exposed to a terrorist attack involving chemicals. The nurse has been advised that personal protective equipment must be worn in order to give the highest level of respiratory protection with a lesser level of skin and eye protection. What level protection is this considered?
A. Level A
B. Level B
C. Level C
D. Level D
B. Level B
CH. 68 (5), A client who has been exposed to anthrax is being treated in the local hospital. The nurse should prioritise what health assessments?
A. Integumentary assessment
B. Assessment for signs of haemorrhage
C. Neurological assessment
D. Assessment of respiratory status
D. Assessment of respiratory status
CH. 68 (6). When assessing clients who are victims of a chemical agent attack, the nurse is aware that assessment findings vary based on the type of chemical agent. The chemical sulfur mustard is an example of what type of chemical warfare agent?
A. Nerve agent
B. Blood agent
C. Pulmonary agent
D. Vesicant
D. Vesicant
CH. 68 (7). A major earthquake has occurred within the vicinity of the local hospital. The nursing supervisor working the night shift at the hospital receives information that the hospital disaster plan will be activated. The supervisor will need to work with what organization responsible for coordinating interagency relief assistance?
A. Office of Emergency Management
B. Incident Command System
C. Centers for Disease Control and Prevention (CDC)
D. American Red Cross
A. Office of Emergency Management
CH. 68 (8). While developing an emergency operations plan (EOP), the committee is discussing the components of the EOP. During the post-incident response of an emergency operations plan, what activity should take place?
A. Deciding when the facility will go from disaster response to daily activities
B. Conducting practice drills for the community and facility
C. Conducting a critique and debriefing for all involved in the incident
D. Replacing the resources in the facility
C. Conducting a critique and debriefing for all involved in the incident
CH. 68 (9). The announcement is made that the facility may return to normal functioning after a local disaster. In the emergency operations plan, what is this referred to as?
A. Demobilization response
B. Post-incident response
C. Crisis diffusion
D. Reversion
A. Demobilization response
CH. 68 (10). A group of disaster survivors is working with the critical incident stress management (CISM) team. Members of this team should be guided by what goal?
A. Determining whether the incident was managed effectively
B. Educating survivors on potential coping strategies for future disasters
C. Providing individuals with education about recognizing stress reactions
D. Determining if individuals responded appropriately during the incident
C. Providing individuals with education about recognizing stress reactions
CH. 68 (11). Level C personal protective equipment has been deemed necessary in the response to an unknown substance. The nurse is aware that what piece of equipment or clothing will be included?
A. A self-contained breathing apparatus
B. A vapor-tight, chemical-resistant suit
C. A uniform only
D. An air-purified respirator
D. An air-purified respirator
CH. 68 (12). A client with smoke inhalation arrives at the emergency department (ED) after involvement in a house fire and is lethargic with tachypnea and tachycardia. The nurse anticipates what specific intervention(s) for this client? Select all that apply.
A. Intubation and ventilator support.
B. Treatment in a hyperbaric chamber.
C. Hydroxocobalamin medication administration
D. Receive nitrate pearls through the ventilator.
E. Pralidoxime medication administration.
A. Intubation and ventilator support.
B. Treatment in a hyperbaric chamber.
C. Hydroxocobalamin medication administration
A nurse takes a shift report and will be caring for a client who has been exposed to anthrax by inhalation. What precautions does the nurse know must be put in place when providing care for this client?
A. Standard precautions
B. Airborne precautions
C. Droplet precautions
D. Contact precautions
A. Standard precautions
A military nurse is treating a soldier after an unexploded ordnance (UXO) was purposely detonated for disposal. The blast radius was larger than anticipated and debris injured the soldier. The nurse anticipates what phase of blast injury occurred to this soldier?
A. Primary
B. Quaternary
C. Secondary
D. Tertiary
C. Secondary
A client is being treated in the ED following a terrorist attack. The client is experiencing visual disturbances, nausea, vomiting, and behavioral changes. The nurse suspects this client has been exposed to what chemical agent?
A. Nerve agent
B. Pulmonary agent
C. Vesicant
D. Blood agent
A. Nerve agent
A client is admitted to the ED who has been exposed to a nerve agent. The nurse should anticipate the STAT administration of what drug?
A. Amyl nitrate
B. Dimercaprol
C. Erythromycin
D. Atropine
D. Atropine
A client was exposed to a dose of more than 5,000 rads of radiation during a terrorist attack. The client's skin will eventually show what manifestation?
A. Erythema
B. Ecchymosis
C. Desquamation
D. Necrosis
D. Necrosis
There has been a radiation-based terrorist attack and a client is experiencing
vomiting, diarrhea, and shock after the attack. How will the client's likelihood of survival be characterized?
A. Probable
B. Possible
C. Improbable
D. Extended
C. Improbable
A 44-year-old client has been exposed to severe amount of radiation after a leak in a reactor plant. When planning this client's care, the nurse should implement what action?
A. The client should be scrubbed with alcohol and iodine.
B. The client should be carefully protected from infection.
C. The client's immunization status should be promptly assessed.
D. The client's body hair should be removed to prevent secondary contamination.
B. The client should be carefully protected from infection.
The nurse is coordinating the care of victims who arrive at the ED after a radiation leak at a nearby nuclear plant. What would be the first intervention initiated when victims arrive at the hospital?
A. Administer prophylactic antibiotics.
B. Survey the victims using a radiation survey meter.
C. Irrigate victims' open wounds.
D. Perform soap and water decontamination.
B. Survey the victims using a radiation survey meter.
An industrial site has experienced a radiation leak and workers who have been potentially affected are en route to the hospital. To minimize the risks of contaminating the hospital, managers should perform what action?
A. Place all potential victims on reverse isolation.
B. Establish a triage outside the hospital.
C. Have hospital staff put on personal protective equipment.
D. Place hospital staff on abbreviated shifts of no more than 4 hours.
B. Establish a triage outside the hospital.
After radiation exposure, a client has been assessed and determined to be a possible survivor. Following the resolution of the client's initial symptoms, the care team should anticipate what event?
A. A return to full health
B. Internal bleeding
C. A latent phase
D. Massive tissue necrosis
C. A latent phase
A hospital's emergency operations plan has been enacted following an industrial accident. While one nurse performs the initial triage, what should other emergency medical services personnel do?
A. Perform life-saving measures.
B. Classify clients according to acuity.
C. Provide health promotion education.
D. Modify the emergency operations plan.
A. Perform life-saving measures.
A nurse is triaging clients after a chemical leak at a nearby fertilizer factory. What is the guiding principle of this activity?
A. Assigning a high priority to the most critical injuries
B. Doing the greatest good for the greatest number of people
C. Allocating resources to the youngest and most critical
D. Allocating resources on a first-come, first-served basis
B. Doing the greatest good for the greatest number of people
A nurse has been called for duty during a response to a natural disaster. In this context of care, the nurse should expect to do which of the following?
A. Practice outside of the nurse's normal area of clinical expertise.
B. Perform interventions that are not based on assessment data.
C. Prioritize psychosocial needs over physiologic needs.
D. Prioritize the interests of older adults over younger clients.
A. Practice outside of the nurse's normal area of clinical expertise.
A nurse is participating in the planning of a hospital's emergency operations plan. The nurse is aware of the potential for ethical dilemmas during a disaster or other emergency. Ethical dilemmas in these contexts are best addressed by which of the following actions?
A. Having an ethical framework in place prior to an emergency
B. Allowing staff to provide care anonymously during an emergency
C. Assuring staff that they are not legally accountable for care provided during an emergency
D. Teaching staff that principles of ethics do not apply in an emergency situation
A. Having an ethical framework in place prior to an emergency
A nurse is undergoing debriefing with the critical incident stress management (CISM) team after participating in the response to a disaster. During this process, the nurse will do which of the following?
A. Evaluate the care that he or she provided during the disaster.
B. Discuss the nurse's own emotional responses to the disaster.
C. Explore the ethics of the care provided during the disaster.
D. Provide suggestions for improving the emergency operations plan.
B. Discuss the nurse's own emotional responses to the disaster.
A client survived a workplace accident that claimed the lives of many of the client's colleagues several months ago. The client has recently sought care for the treatment of depression. How should the nurse best understand the client's current mental health problem?
A. The client is experiencing a common response following a disaster.
B. The client fails to appreciate the fact that the client survived the disaster.
C. The client most likely feels guilty about actions the client took during the disaster.
D. The client's depression most likely predated the disaster.
A. The client is experiencing a common response following a disaster.
The nurse has been notified that the ED is expecting terrorist attack victims and that level D personal protective equipment (PPE) is appropriate. What does level D PPE include?
A. A chemical-resistant coverall with splash hood, chemical-resistant gloves, and boots
B. A self-contained breathing apparatus (SCBA) and a fully encapsulating, vapor-tight, chemical-resistant suit with chemical-resistant gloves and boots
C. The SCBA and a chemical-resistant suit, but the suit is not vapor tight
D. The nurse's typical work uniform
D. The nurse's typical work uniform
The nurse is preparing to admit clients who have been the victim of a blast injury. The nurse should expect to treat a large number of clients who have experienced what type of injury?
A. Chemical burns
B. Spinal cord injury
C. Meningeal tears
D. Tympanic membrane rupture
D. Tympanic membrane rupture
A nurse who is a member of the local disaster response team is learning about blast injuries. The nurse should plan for what event that occurs in the tertiary phase of the blast injury?
A. Victims' preexisting medical conditions are exacerbated.
B. Victims are thrown by the pressure wave.
C. Victims experience burns from the blast.
D. Victims suffer injuries caused by debris or shrapnel from the blast.
B. Victims are thrown by the pressure wave.
A client suffering from blast lung has been admitted to the hospital and is exhibiting signs and symptoms of an air embolus. What is the nurse's most appropriate action?
A. Place the client in the Trendelenburg position.
B. Assess the client's airway and begin chest compressions.
C. Position the client in the prone, left lateral position.
D. Encourage the client to perform deep breathing and coughing exercises.
C. Position the client in the prone, left lateral position.
A client has been admitted to the medical unit with signs and symptoms that are suggestive of anthrax infection. The nurse should anticipate what intervention?
A. Administration of acyclovir
B. Hematopoietic stem cell transplantation (HSCT)
C. Administration of penicillin
D. Hemodialysis
C. Administration of penicillin
The ED staff has been notified of the imminent arrival of a client who has been exposed to chlorine. The nurse should anticipate the need to address what nursing diagnosis?
A. Impaired gas exchange
B. Decreased cardiac output
C. Chronic pain
D. Excess fluid volume
A. Impaired gas exchange
The nursing supervisor at the local hospital reports that your hospital will be receiving multiple trauma victims from a blast that occurred at a local manufacturing plant. The paramedics call in a victim of the blast with injuries including a head injury and hemorrhage. What phase of blast injury should the nurse expect to treat in this client?
A. Primary phase
B. Secondary phase
C. Tertiary phase
D. Quaternary phase
A. Primary phase
A nurse has had contact with a client who developed smallpox and became febrile after a terrorist attack. This nurse will require what treatment?
A. Watchful waiting
B. Treatment with colony-stimulating factors (CSFs)
C. Vaccination
D. Treatment with ceftriaxone
C. Vaccination
The emergency response team is dealing with a radiation leak at the hospital. What action should be performed to prevent the spread of the contaminants?
A. Floors must be scrubbed with undiluted bleach.
B. Waste must be promptly incinerated.
C. The ventilation system should be deactivated.
D. Air ducts and vents should be sealed.
D. Air ducts and vents should be sealed.
A client has been exposed to a nerve agent in a biochemical terrorist attack. This type of agent bonds with acetylcholinesterase, so that acetylcholine is not inactivated. What is the pathologic effect of this type of agent?
A. Hyperstimulation of the nerve endings
B. Temporary deactivation of the nerve endings
C. Binding of the nerve endings
D. Destruction of the nerve endings
A. Hyperstimulation of the nerve endings
A group of military nurses are reviewing the care of victims of biochemical terrorist attacks. The nurses should identify what agents as having the shortest latency?
A. Viral agents
B. Nerve agents
C. Pulmonary agents
D. Blood agents
B. Nerve agents
A nurse is giving an educational class to members of the local disaster team. What should the nurse instruct members of the disaster team to do in a chemical bioterrorist attack?
A. Cover their eyes.
B. Put on a personal protective equipment mask.
C. Stand up.
D. Crawl to an exit.
C. Stand up.