Chapter 9: Care of Patients with Common Environmental Emergencies Nursing School Test Banks

Chapter 9: Care of Patients with Common Environmental Emergencies
Ignatavicius: Medical-Surgical Nursing, 8th Edition

MULTIPLE CHOICE

1. On a hot humid day, an emergency department nurse is caring for a client who is confused and has these vital signs: temperature 104.1 F (40.1 C), pulse 132 beats/min, respirations 26 breaths/min, blood pressure 106/66 mm Hg. Which action should the nurse take?
a. Encourage the client to drink cool water or sports drinks.
b. Start an intravenous line and infuse 0.9% saline solution.
c. Administer acetaminophen (Tylenol) 650 mg orally.
d. Encourage rest and re-assess in 15 minutes.
ANS: B
The client demonstrates signs of heat stroke. This is a medical emergency and priority care includes oxygen therapy, IV infusion with 0.9% saline solution, insertion of a urinary catheter, and aggressive interventions to cool the client, including external cooling and internal cooling methods. Oral hydration would not be appropriate for a client who has symptoms of heat stroke because oral fluids would not provide necessary rapid rehydration, and the confused client would be at risk for aspiration. Acetaminophen would not decrease this clients temperature or improve the clients symptoms. The client needs immediate medical treatment; therefore, rest and re-assessing in 15 minutes is inappropriate.

DIF: Applying/Application REF: 121
KEY: Heat-related illness| environmental emergencies
MSC: Integrated Process: Nursing Process: Implementation
NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation

2. While at a public park, a nurse encounters a person immediately after a bee sting. The persons lips are swollen, and wheezes are audible. Which action should the nurse take first?
a. Elevate the site and notify the persons 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 clients 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: Applying/Application REF: 129
KEY: Bee and insect sting| anaphylaxis| environmental emergencies
MSC: Integrated Process: Nursing Process: Implementation
NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation

3. A client presents to the emergency department after prolonged exposure to the cold. The client is difficult to arouse and speech is incoherent. Which action should the nurse take first?
a. Reposition the client into a prone position.
b. Administer warmed intravenous fluids to the client.
c. Wrap the clients extremities in warm blankets.
d. Initiate extracorporeal rewarming via hemodialysis.
ANS: B
Moderate hypothermia manifests with muscle weakness, increased loss of coordination, acute confusion, apathy, incoherence, stupor, and impaired clotting. Moderate hypothermia should be treated by core rewarming methods, which include administration of warm IV fluids, heated oxygen, and heated peritoneal, pleural, gastric, or bladder lavage, and by positioning the client in a supine position to prevent orthostatic changes. The clients trunk should be warmed prior to the extremities to prevent peripheral vasodilation. Extracorporeal warming with cardiopulmonary bypass or hemodialysis is a treatment for severe hypothermia.

DIF: Applying/Application REF: 131
KEY: Cold-related illness| environmental emergencies
MSC: Integrated Process: Nursing Process: Implementation
NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation

4. An emergency department nurse cares for a middle-aged mountain climber who is confused and exhibits bizarre behaviors. After administering oxygen, which priority intervention should the nurse implement?
a. Administer dexamethasone (Decadron).
b. Complete a minimental state examination.
c. Prepare the client for computed tomography of the brain.
d. Request a psychiatric consult.
ANS: A
The client is exhibiting signs of mountain sickness and high altitude cerebral edema (HACE). Dexamethasone (Decadron) reduces cerebral edema by acting as an anti-inflammatory in the central nervous system. The other interventions will not treat mountain sickness or HACE.

DIF: Applying/Application REF: 134
KEY: Altitude-related illness| environmental emergencies
MSC: Integrated Process: Nursing Process: Planning
NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

5. An emergency department nurse assesses a client admitted after a lightning strike. Which assessment should the nurse complete first?
a. Electrocardiogram (ECG)
b. Wound inspection
c. Creatinine kinase
d. Computed tomography of head
ANS: A
Clients who survive an immediate lightning strike can have serious myocardial injury, which can be manifested by ECG and myocardial perfusion abnormalities. The nurse should prioritize the ECG. Other assessments should be completed but are not the priority.

DIF: Applying/Application REF: 130
KEY: Lightning injuries| environmental emergencies
MSC: Integrated Process: Nursing Process: Assessment
NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation

6. A nurse teaches 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: Analyzing/Analysis REF: 135
KEY: Drowning| environmental emergencies
MSC: Integrated Process: Teaching/Learning
NOT: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control

7. A provider prescribes a rewarming bath for a client who presents with partial-thickness frostbite. Which action should the nurse take prior to starting this treatment?
a. Administer intravenous morphine.
b. Wrap the limb with a compression dressing.
c. Massage the frostbitten areas.
d. Assess the limb for compartment syndrome.
ANS: A
Rapid rewarming in a water bath is recommended for all instances of partial-thickness and full-thickness frostbite. Clients experience severe pain during the rewarming process and nurses should administer intravenous analgesics.

DIF: Applying/Application REF: 133
KEY: Cold-related illness| environmental emergencies
MSC: Integrated Process: Nursing Process: Implementation
NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation

8. A nurse assesses a client recently bitten by a coral snake. Which assessment should the nurse complete first?
a. Unilateral peripheral swelling
b. Clotting times
c. Cardiopulmonary status
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: Applying/Application REF: 124
KEY: Snakebite| environmental emergencies
MSC: Integrated Process: Nursing Process: Assessment
NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation

9. A nurse plans care for a client admitted with a snakebite to the right leg. With whom should the nurse collaborate?
a. The facilitys neurologist
b. The poison control center
c. The physical therapy department
d. A herpetologist (snake specialist)
ANS: B
For the client with a snakebite, the nurse should contact the regional poison control center immediately for specific advice on antivenom administration and client management.

DIF: Remembering/Knowledge REF: 124
KEY: Snakebite| poison control| environmental emergencies
MSC: Integrated Process: Nursing Process: Planning
NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care

10. While on a camping trip, a nurse cares for an adult client who had a drowning incident in a lake and is experiencing agonal breathing with a palpable pulse. Which action should the nurse take first?
a. Deliver rescue breaths.
b. Wrap the client in dry blankets.
c. Assess for signs of bleeding.
d. Check for a carotid pulse.
ANS: A
In this emergency situation, the nurse should immediately initiate airway clearance and ventilator support measures, including delivering rescue breaths.

DIF: Applying/Application REF: 135
KEY: Drowning| environmental emergencies
MSC: Integrated Process: Nursing Process: Implementation
NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation

11. A nurse assesses a client admitted with a brown recluse spider bite. Which priority assessment should the nurse perform to identify complications of this bite?
a. Ask the client about pruritus at the bite site.
b. Inspect the bite site for a bluish purple vesicle.
c. Assess the extremity for redness and swelling.
d. Monitor the clients temperature every 4 hours.
ANS: D
Fever and chills indicate systemic toxicity, which can lead to hemolytic reactions, kidney 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 and should be assessed, but they do not provide information about complications from the bite, and therefore are not the priority.

DIF: Applying/Application REF: 126
KEY: Spider bite| environmental emergencies
MSC: Integrated Process: Nursing Process: Assessment
NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation

12. A provider prescribes Crotalidae Polyvalent Immune Fab (CroFab) for a client who is admitted after being bitten by a pit viper snake. Which assessment should the nurse complete prior to administering this medication?
a. Assess temperature and for signs of fever.
b. Check the clients creatinine kinase level.
c. Ask about allergies to pineapple or papaya.
d. Inspect the skin for signs of urticaria (hives).
ANS: C
CroFab is an antivenom for pit viper snakebites. Clients should be assessed for hypersensitivity to bromelain (a pineapple derivative), papaya, and sheep protein prior to administration. During and after administration, the nurse should assess for urticaria, fever, and joint pain, which are signs of serum sickness.

DIF: Understanding/Comprehension REF: 125
KEY: Antivenom| snakebite| environmental emergencies
MSC: Integrated Process: Nursing Process: Assessment
NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

13. A provider prescribes diazepam (Valium) to a client who was bitten by a black widow spider. The client asks, What is this medication for? How should the nurse respond?
a. This medication is an antivenom for this type of bite.
b. It will relieve your muscle rigidity and spasms.
c. It prevents respiratory difficulty from excessive secretions.
d. This medication will prevent respiratory failure.
ANS: B
Black widow spider venom produces a syndrome known as latrodectism, which manifests as severe abdominal pain, muscle rigidity and spasm, hypertension, and nausea and vomiting. Diazepam is a muscle relaxant that can relieve pain related to muscle rigidity and spasms. It does not prevent respiratory difficulty or failure.

DIF: Applying/Application REF: 127
KEY: Benzodiazepine| spider bite| environmental emergencies
MSC: Integrated Process: Teaching/Learning
NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

14. After teaching a client how to prevent altitude-related illnesses, a nurse assesses the clients understanding. Which statement indicates the client needs additional teaching?
a. If my climbing partner cant think straight, we should descend to a lower altitude.
b. I will ask my provider about medications to help prevent acute mountain sickness.
c. My partner and I will plan to sleep at a higher elevation to acclimate more quickly.
d. I will drink plenty of fluids to stay hydrated while on the mountain.
ANS: C
Teaching to prevent altitude-related illness should include descending when symptoms start, staying hydrated, and taking acetazolamide (Diamox), which is commonly used to prevent and treat acute mountain sickness. The client should be taught to sleep at a lower elevation.

DIF: Applying/Application REF: 134
KEY: Altitude-related illness| environmental emergencies
MSC: Integrated Process: Teaching/Learning
NOT: Client Needs Category: Health Promotion and Maintenance

MULTIPLE RESPONSE

1. A nurse is teaching a wilderness survival class. Which statements should the nurse include about the prevention of hypothermia and frostbite? (Select all that apply.)
a. Wear synthetic clothing instead of cotton to keep your skin dry.
b. Drink plenty of fluids. Brandy can be used to keep your body warm.
c. Remove your hat when exercising to prevent the loss of heat.
d. Wear sunglasses to protect skin and eyes from harmful rays.
e. Know your physical limits. Come in out of the cold when limits are reached.
ANS: A, D, E
To prevent hypothermia and frostbite, the nurse should teach clients to wear synthetic clothing (which moves moisture away from the body and dries quickly), layer clothing, and wear a hat, facemask, sunscreen, and sunglasses. The client should also be taught to drink plenty of fluids, but to avoid alcohol when participating in winter activities. Clients should know their physical limits and come in out of the cold when these limits have been reached.

DIF: Applying/Application REF: 131
KEY: Cold-related illness| environmental emergencies
MSC: Integrated Process: Teaching/Learning
NOT: Client Needs Category: Health Promotion and Maintenance

2. A nurse teaches a client who has severe allergies to prevent bug bites. Which statements should the nurse include in this clients teaching? (Select all that apply.)
a. Consult an exterminator to control bugs in and around your home.
b. Do not swat at insects or wasps.
c. Wear sandals whenever you go outside.
d. Keep your prescribed epinephrine auto-injector in a bedside drawer.
e. Use screens in your windows and doors to prevent flying insects from entering.
ANS: A, B, E
To prevent arthropod bites and stings, clients should wear protective clothing, cover garbage cans, use screens in windows and doors, inspect clothing and shoes before putting them on, consult an exterminator, remove nests, avoid swatting at insects, and carry a prescription epinephrine auto-injector at all times if they are known to be allergic to bee or wasp stings.

DIF: Applying/Application REF: 126
KEY: Bee and insect sting| environmental emergencies
MSC: Integrated Process: Teaching/Learning
NOT: Client Needs Category: Health Promotion and Maintenance

3. A 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. Hide under a tall tree.
c. Do not take a bath or shower.
d. Turn off the television.
e. Remove all body piercings.
f. Put down golf clubs or gardening tools.
ANS: A, C, D, F
When thunder is heard, shelter should be sought 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, 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: Remembering/Knowledge REF: 130
KEY: Lightning injuries| environmental emergencies
MSC: Integrated Process: Teaching/Learning
NOT: Client Needs Category: Health Promotion and Maintenance

4. An emergency department nurse moves to a new city where heat-related illnesses are common. Which clients does the nurse anticipate being at higher risk for heat-related illnesses? (Select all that apply.)
a. Homeless individuals
b. Illicit drug users
c. White people
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: Remembering/Knowledge REF: 120
KEY: Heat-related illness| environmental emergencies
MSC: Integrated Process: Nursing Process: Assessment
NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential

5. An emergency department nurse plans care for a client who is admitted with heat stroke. Which interventions should the nurse include in this clients plan of care? (Select all that apply.)
a. Administer oxygen via mask or nasal cannula.
b. Administer ibuprofen, an antipyretic medication.
c. Apply cooling techniques until core body temperature is less than 101 F.
d. Infuse 0.9% sodium chloride via a large-bore intravenous cannula.
e. Obtain baseline serum electrolytes and cardiac enzymes.
ANS: A, D, E
Heat stroke is a medical emergency. Oxygen therapy and intravenous fluids should be provided, and baseline laboratory tests should be performed as quickly as possible. The client should be cooled until core body temperature is reduced to 102 F. Antipyretics should not be administered.

DIF: Understanding/Comprehension REF: 123
KEY: Heat-related illness| environmental emergencies
MSC: Integrated Process: Nursing Process: Planning
NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation

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