Chapter 11: Care of Patients with Common Environmental Emergencies Nursing School Test Banks

Chapter 11: Care of Patients with Common Environmental Emergencies

Test Bank

MULTIPLE CHOICE

1. While the nurse is visiting the community pool, an adult swimmer is pulled out of the pool, unconscious and cyanotic. What is the priority action of the nurse?

a.

Begin chest compressions.

b.

Move from the pool area.

c.

Give two rescue breaths.

d.

Check for a carotid pulse.

ANS: C

The highest priority is to maintain ventilatory support until the victim can breathe on his or her own. The other options are important, but maintaining the airway and breathing are always priority.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationMedical Emergencies) MSC: Integrated Process: Nursing Process (Implementation)

2. The nurse working at a first aid booth during a summer marathon sees several runners. Which runner should be seen first? A runner who:

a.

Has fallen several times

b.

Is fatigued

c.

Thinks he has the flu

d.

Has tachypnea

ANS: A

Hot, dry skin, tachycardia, tachypnea, and hypotension are signs of heat stroke. A marathon runner who has fallen several times may have a thermal injury to the brain, causing loss of coordination. Mental status changes from thermal injury to the brain include confusion, bizarre behavior, seizures, and even coma. The nurse should prioritize the client with potential thermal brain injury over the other clients.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationMedical Emergencies) MSC: Integrated Process: Nursing Process (Planning)

3. The nurse is working at a first aid booth for a spring training game on a hot day. A spectator comes in, reporting that he is not feeling well. Vital signs are temperature 104.1 F (40.1 C), pulse 132 beats/min, respirations 26 breaths/min, and blood pressure 106/66 mm Hg. He trips over his feet as the nurse leads him to a cot. What is the priority action of the nurse?

a.

Encourage drinking of cool water or sports drinks.

b.

Sponge the victim with cool water and remove his shirt.

c.

Administer Tylenol (acetaminophen), 650 mg orally.

d.

Encourage rest, and reassess in 15 minutes.

ANS: B

The spectator shows signs of heat stroke, which is a medical emergency. The spectator should be transported to the emergency department as quickly as possible. The nurse should take actions to lower his body temperature in the meantime by removing his shirt and sponging his body with cool water. Lowering body temperature by drinking cool fluids or taking acetaminophen is not as effective in an emergency situation. The client needs to be cooled quickly and is a priority for treatment.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationMedical Emergencies) MSC: Integrated Process: Nursing Process (Implementation)

4. The emergency department nurse assesses a client in extreme pain with an apparent snakebite of the leg. Vital signs are stable. What is the priority action of the nurse?

a.

Call the regional poison control center.

b.

Administer IV pain medication.

c.

Place a tourniquet around the leg.

d.

Apply an immobilization splint.

ANS: D

Treatment involves immobilization to minimize the spread of venom. A tourniquet should not be used because it impairs arterial blood flow. Pain medication should be administered and collaboration with the regional poison control center begun after the leg is immobilized.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationMedical Emergencies) MSC: Integrated Process: Nursing Process (Implementation)

5. The nurse is teaching a wilderness survival class. Which statement by a participant indicates that additional teaching is needed?

a.

If I get too cold, I can have some brandy to help me get warmed up.

b.

My climbing partner should let me know right away if my nose turns white.

c.

If my partner cant think straight, we should descend to a lower altitude.

d.

It is okay to feel a little short of breath when I am climbing, but not at rest.

ANS: A

Alcohol will increase the risk of cold-related injuries and should be avoided. The other options all show good understanding of the education.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Health Promotion and Maintenance (Principles of Teaching/Learning)

MSC: Integrated Process: Teaching/Learning

6. A community nurse assesses a client, who has an allergy to bees, after a bee sting. The clients lips are swollen, and wheezes are audible. What is the priority action of the nurse?

a.

Elevate the site and notify the clients next of kin.

b.

Remove the stinger with tweezers and encourage rest.

c.

Administer diphenhydramine (Benadryl) and apply ice.

d.

Administer an EpiPen from the first aid kit and call 911.

ANS: D

The students swollen lips indicate that anaphylaxis may be developing, and this is a medical emergency. 911 should be called immediately, and the client transported to the emergency department as quickly as possible. If an EpiPen is available, it should be administered at the first sign of an anaphylactic reaction. The other answers do not provide adequate interventions to treat airway obstruction due to anaphylaxis.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationMedical Emergencies) MSC: Integrated Process: Nursing Process (Implementation)

7. While on a camping trip, the nurse provides care for a camper who was bitten by a black widow spider. What is the priority action of the nurse?

a.

Apply ice to the site of the bite.

b.

Apply a loose tourniquet to the limb.

c.

Give acetaminophen (Tylenol) for pain.

d.

Cover the camper with a warm blanket.

ANS: A

Ice inhibits the action of neurotoxin and should be the first intervention provided to a client bitten by a black widow spider. A tourniquet should not be used because it impairs arterial blood flow. Tylenol and covering the camper do not treat the neurotoxic effect of the black widow spiders bite.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationMedical Emergencies) MSC: Integrated Process: Nursing Process (Implementation)

8. A client presents to the emergency department after prolonged exposure to the cold. The client is shivering, has slurred speech, and is slow to respond to questions. Which treatment will the nurse prepare for this client?

a.

Dry clothing and warm blankets

b.

Administration of warmed IV fluids

c.

Peritoneal lavage with warmed normal saline

d.

Continuous arteriovenous rewarming

ANS: A

Mild hypothermia is manifested by shivering, slurred speech, poor muscular coordination, and impaired cognitive abilities. Mild hypothermia may be treated with dry clothing and warm blankets. Rewarming should occur slowly by removing wet clothing and providing dry warm blankets first. Other treatments are secondary and should be used to treat moderate to severe hypothermia.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationIllness Management) MSC: Integrated Process: Nursing Process (Planning)

9. The emergency department nurse assesses a middle-aged mountain climber who reports headache, nausea, vomiting, and feeling winded. What is the nurses priority intervention?

a.

Administer acetazolamide (Diamox).

b.

Administer prochlorperazine (Compazine).

c.

Perform a neurologic assessment.

d.

Assess for bowel sounds.

ANS: A

The client is exhibiting signs of mountain sickness. Acetazolamide (Diamox, Apo-Acetazolamide) is used to prevent and treat acute mountain sickness. The other interventions will not treat mountain sickness.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Pharmacological and Parenteral TherapiesExpected Actions/Outcomes) MSC: Integrated Process: Nursing Process (Planning)

10. A nurse is at the scene of a lightning strike during a thunderstorm. Which is the priority action of the nurse?

a.

Make sure that victims are not electrically charged.

b.

Assess victims for second- and third-degree burns.

c.

Start emergency resuscitation on anyone not breathing.

d.

Move victims and first aid responders to a sheltered area.

ANS: D

Victims of a lightning strike are not electrically charged afterward. Cardiopulmonary resuscitation (CPR) should be started once victims and first aid responders are in a sheltered area, because the thunderstorm presents a continued threat of lightning strikes.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationMedical Emergencies) MSC: Integrated Process: Nursing Process (Implementation)

11. On a hot, humid day, several clients present to the emergency department with symptoms of heat exposure. Which client will be treated first? A client who:

a.

Has normal mental status and flu-like symptoms

b.

Is diaphoretic with nausea and vomiting

c.

Is hypotensive and tachycardic

d.

Is anxious and confused

ANS: D

Normal mental status, flu-like symptoms, diaphoresis, nausea and vomiting, hypotension, and tachycardia all are symptoms of heat exhaustion. The differentiating symptom between heat exhaustion and exertional heat stroke is the presence of mental status changes, which indicate thermal injury to the brain and represent an emergency situation.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationMedical Emergencies) MSC: Integrated Process: Nursing Process (Planning)

12. The nurse is teaching a community health class about water safety. Which statement by a participant indicates that additional teaching is needed?

a.

I can go swimming all by myself because I am a certified lifeguard.

b.

I cannot leave my toddler alone in the bathtub for even a minute.

c.

I will appoint one adult to supervise the pool at all times during a party.

d.

I will make sure that there is a phone near my pool in case of an emergency.

ANS: A

People should never swim alone, regardless of lifeguard status. The other statements indicate good understanding of the teaching.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Safe and Effective Care Environment (Safety and Infection ControlAccident/Injury Prevention) MSC: Integrated Process: Teaching/Learning

13. The nurse is assessing a client recently bitten by a coral snake. Which assessment is the priority?

a.

Peripheral edema and swelling

b.

Evaluation of clotting times

c.

Respiratory rate and depth

d.

Electrocardiogram rhythm

ANS: C

Manifestations of coral snake envenomation are the result of its neurotoxic properties. The physiologic effect is to block neurotransmission, which produces ascending paralysis, reduced perception of pain, and, ultimately, respiratory paralysis. The nurse should monitor for respiratory rate and depth. Severe swelling and clotting problems do not occur with coral snakes but do occur with pit viper snakes. Electrocardiogram rhythm is not affected by neurotoxins.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationPathophysiology)

MSC: Integrated Process: Nursing Process (Assessment)

14. The nurse is teaching a client with severe allergies how to prevent bug bites. Which statement by the client indicates that additional teaching is needed?

a.

I will avoid wearing perfume when I go outside.

b.

I will put the picnic food out when we are ready to eat.

c.

I will keep my car windows up at all times.

d.

I will wear sandals whenever I go outside.

ANS: D

Shoes rather than sandals should be worn outside to prevent insect bites. The other statements indicate good understanding of the teaching.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Health Promotion and Maintenance (Self-Care)

MSC: Integrated Process: Teaching/Learning

15. The nurse is planning care for a client admitted with a snakebite to the right leg. With whom should the nurse collaborate?

a.

The facilitys neurologist

b.

The regional poison control center

c.

The physical therapy department

d.

A herpetologist (snake specialist)

ANS: B

Contact the regional poison control center immediately for specific advice on antivenom administration and client management.

DIF: Cognitive Level: Knowledge/Remembering REF: p. 141

TOP: Client Needs Category: Safe and Effective Care Environment (Management of CareCollaboration with Interdisciplinary Team)

MSC: Integrated Process: Nursing Process (Implementation)

16. The nurse is caring for a client who had a near-drowning incident in a lake. Which action will the nurse take to monitor for possible complications?

a.

Assess the clients temperature every 4 hours.

b.

Check the clients blood glucose level before meals.

c.

Assess the clients bowel sounds three times daily.

d.

Check the clients skin for petechiae daily.

ANS: A

Chemicals, algae, microbes, sand, and mud found in lake water put the client at risk for developing a lung infection. The clients temperature should be assessed every 4 hours. A near-drowning victim will not be at risk for glucose or bowel complications. Assessing for petechiae is not necessary.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialPotential for Alterations in Body Systems) MSC: Integrated Process: Nursing Process (Assessment)

17. The nurse is working in the emergency department on a hot, humid day, when a hiker is brought in after collapsing. The hiker is confused and tachycardic with a temperature of 105.6 F (40.9 C). Which IV solution and medication will the nurse have ready for the client?

a.

Normal saline and methylprednisolone (Solu-Medrol)

b.

Lactated Ringers solution and morphine sulfate

c.

Normal saline and lorazepam (Ativan)

d.

Dextrose 5% and diphenhydramine (Benadryl)

ANS: C

The client has heat stroke and is at risk for developing seizures, so the nurse should be prepared to administer lorazepam (Ativan) as needed. The optimal solution for clients with heat stroke is IV normal saline. Ringers lactate solution cannot be used because the liver is unable to metabolize lactate during hyperthermia. Methylprednisolone and diphenhydramine would not be used to treat heat stroke.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Pharmacological and Parenteral TherapiesExpected Actions/Outcomes) MSC: Integrated Process: Nursing Process (Planning)

18. The nurse is assessing a client admitted with a brown recluse spider bite. What priority assessment should the nurse perform?

a.

Ask the client about pruritus at the bite site.

b.

Inspect for a bluish purple vesicle.

c.

Assess for redness and swelling.

d.

Obtain the clients temperature.

ANS: D

Fever and chills indicate systemic toxicity, which can lead to hemolytic reactions, renal failure, pulmonary edema, cardiovascular collapse, and death. Assessing for a fever should be the nurses priority. All other symptoms are normal for a brown recluse bite. These should be assessed, but they do not provide information about complications from the bite and therefore are not the priority.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationPathophysiology)

MSC: Integrated Process: Nursing Process (Assessment)

19. The nurse is providing emergency care to a client with frostbite. Which intervention is performed first?

a.

Wrap the affected area in a warm, dry blanket to rewarm.

b.

Rewarm the affected area in a 104 F water bath.

c.

Elevate the affected area above the heart to decrease tissue edema.

d.

Use a splint to immobilize the affected area.

ANS: B

Rewarming of the client with frostbite must occur first. Rapid rewarming in a water bath at a temperature of 104 F is preferable. If a warm bath is not available, warm wet towels can be used, but not warm dry blankets. After rewarming the affected area, elevate and apply an immobilization splint.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationMedical Emergencies) MSC: Integrated Process: Nursing Process (Intervention)

20. The nurse is caring for a drowning victim after resuscitation. What focused assessment will the nurse perform to identify complications from drowning?

a.

Palpation of abdominal cavity

b.

Inspection of skin color

c.

Auscultation of lungs

d.

Palpation of pulse strength

ANS: C

Auscultation of the lungs will assist the nurse to identify complications from drowning, including pulmonary infection and acute respiratory distress syndrome (ARDS). All other assessments are important, but the nurse must focus on the respiratory system as most likely to demonstrate complications.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction in Risk PotentialPotential for Alterations in Body Systems) MSC: Integrated Process: Nursing Process (Assessment)

MULTIPLE RESPONSE

1. The nurse is assessing a group of clients. Which clients are at greater risk for hypothermia or frostbite? (Select all that apply.)

a.

A young man who has just consumed six martinis

b.

A young man with a body mass index (BMI) of 42

c.

An older man who smokes a pack of cigarettes a day

d.

A young woman who is anorexic

e.

An older woman with hypertension

f.

A young woman who is diabetic

ANS: A, C, D, F

Clients with poor nutrition, fatigue, and multiple chronic illnesses are at greater risk for hypothermia. Clients who smoke, consume alcohol, or have impaired peripheral circulation have a higher incidence of frostbite.

DIF: Cognitive Level: Comprehension/Understanding REF: p. 148

TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationPathophysiology)

MSC: Integrated Process: Nursing Process (Assessment)

2. The nurse is providing health education at a community center. Which instructions should the nurse include in teaching about prevention of lightning injuries during a storm? (Select all that apply.)

a.

Seek shelter inside a building or vehicle.

b.

Seek shelter under a tall tree.

c.

Do not take a bath or shower.

d.

Turn off the television.

e.

Remove body piercings.

f.

Put down golf clubs or gardening tools.

ANS: A, C, D, F

When you hear thunder, seek shelter in a safe area such as a building or an enclosed vehicle. Electrical equipment such as TVs and stereos should be turned off. Stay away from plumbing and water, and metal objects. Do not stand under an isolated tall tree or a structure such as a flagpole. Body piercings will not increase a persons chances of being struck by lightning.

DIF: Cognitive Level: Knowledge/Remembering REF: Chart 11-6, p. 147

TOP: Client Needs Category: Health Promotion and Maintenance (Self-Care)

MSC: Integrated Process: Teaching/Learning

3. An emergency department nurse moves to a new city, where heat-related illnesses are common. Which clients should the nurse anticipate as at higher risk for heat-related illness? (Select all that apply.)

a.

Homeless individuals

b.

Illicit drug users

c.

Whites

d.

Hockey players

e.

Older adults

ANS: A, B, E

Some of the most vulnerable, at-risk populations for heat-related illness include older adults; blacks (more than whites); people who work outside, such as construction and agricultural workers (more men than women); homeless people; illicit drug users (especially cocaine users); outdoor athletes (recreational and professional); and members of the military who are stationed in countries with hot climates (e.g., Iraq, Afghanistan).

DIF: Cognitive Level: Knowledge/Remembering REF: pp. 136-137

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialPotential for Alterations in Body Systems) MSC: Integrated Process: Nursing Process (Assessment)

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