CH 21 - Emergencies & Disasters

Question 1

The hospital administration issues a statement that surge capacity is likely to be exceeded because state wide measures have not been successful in “flattening the curve” of covid 19 cases. How is this information most likely to affect the nursing staff?

Answer 1

Nurses will be asked to work extra shifts or keep working beyond end of shift.

Question 2

An emergency department clinical nurse specialist is training staff in how to don & doff PPE when caring for pts with infections such as Ebola. Which staff member has demonstrated the most grievous error during the practice session?

Answer 2

An emergency medical tech doffs both pairs of gloves first.

Question 3

The charge nurse in an ED must assign two staff members to cover the triage area. Which team is best for this assignment? *

Answer 3

An advanced practice nurse and an experienced RN.

Question 4

The nurse is working in the triage area of an ED and the following four pts approach the triage desk at the same time. List the order in which the nurse will assess these pts.

Answer 4

Irritable newborn.

Bandaged head wound.

Moderate abdominal pain + vomit.

Jogger w/ twisted ankle.

Question 5

When a primary survey of a trauma pt is conducted, which action would be performed first? *

Answer 5

Perform a brief neurologic assessment.

Question 6

A 56 yr old pt comes to the triage area w/ left sided chest pain, diaphoresis, and dizziness. What is the priority action?

Answer 6

Administer oxygen via nasal cannula.

Question 7

The pts 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 pt?

Answer 7

Gas exchange

Question 8

According to the Emergency Nurses’ Association (ENA), what are the main issues when providing emergency care for pts with mental health problems or psychiatric disorders? SATA.

Answer 8

Seeking & ruling out.
Ensuring safety.
Improving length of stay.
Establishing ongoing care after triage.
Improving communication to describe.

Question 9

It is the summer season, and pts with s/s of heart related illness come to the emergency department. Which pt needs attention first? *

Answer 9

Homeless person who displays altered mental status, poor muscle coordination, and hot, dry, ashen skin, duration of heat exposure is unknown.

Question 10

The nurse responds to a call for help from the emergency department waiting room. An older adult patient is lying on the floor. List the order in which the nurse must carry out the following actions.

Answer 10

Establish unresponsiveness.
Call for help & activate the code team.
Perform the chin lift or jaw thrust maneuver.
CPR.
Instruct to get the crash cart.

Question 11

Emergency medical services has transported a patient with severe chest pain. As the patient 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 assistive personnel? *

Answer 11

Performing chest compressions.

Question 12

Although the incidence of tetanus has decreased through routine immunization, there is still a danger. Which patient represents the group that is most vulnerable for risk?

Answer 12

Older adult who lives alone and sustained a minor cut while cleaning the basement.

Question 13

A healthy but anxious 24 yr old college student reports tingling sensations, palpitations, and sore chest muscles. Deep, rapid breathing and carpal spasms are noted. Which action is the priority?

Answer 13

Have the student breathe into a paper bag.

Question 14

An experienced traveling nurse has been assigned to work in the emergency department, however, this is the nurse’s first week on the job. Which area of the ED would be the best assignment for this nurse?

Answer 14

Ambulatory or fast track clinic

Question 15

The nurse and her 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?

Answer 15

Use a pair of binoculars and look across the lake.

Question 16

In the care of a patient who has experienced sexual assault, which task is most appropriate for an LPN/LVN to perform? *

Answer 16

Providing emotional support and supportive communication.

Question 17

The LPN/LVN is performing care for a pt who sustained an amputation of the first and second digits in a chainsaw accident. What instructions would the RN give to the LPN/LVN? *

Answer 17

Clean the amputated digits with saline, wrap in moist gauze, seal in a plastic bag, and place in an ice slurry.

Question 18

According to the WHO, Violence Against Women: Guidelines for Health Sector Response, which group of pts should be screened for intimate partner violence (IPV)?

Answer 18

Any pt that presents with conditions suspected to have been caused by IPV.

Question 19

The nurse is giving discharge instructions to a woman who was treated for contusions and bruises sustained during an episode of domestic violence. Which intervention is the priority for this patient?

Answer 19

Discuss the option of going to a safe house.

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 pt procedure. What should the new nurse do first?

Answer 20

Step in and offer to assist the medical student because the other nurse is unwilling.

Question 21

The nurse notifies the ED HCP about a pt who has 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 pt is to be discharged with a follow up appt in the morning. The nurse reexamines the pt and the symptoms seem worse. What should the nurse do first?

Answer 21

Express findings and concerns to the HCP.

Question 22

When an unexpected death occurs in the ED which task is most appropriate to delegate to the AP?

Answer 22

Assisting with postmortem care.

Question 23

A confused pt admits to frequently drinking alcohol. The ED HCP makes a preliminary diagnosis of Wernicke encephalopathy. Which medication does the nurse anticipate the HCP will prescribe first?

Answer 23

Thiamine IV

Question 24

After emergency endotracheal intubation, tube placement must be verified before securing the tube. Which bedside assessment is the most accurate and can be performed immediately after the tube is placed?

Answer 24

Check exhaled carbon dioxide levels with capnography.

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 hyperactivity are observed. The medical diagnosis is delirium tremens. Which nursing concept is the priority in planning interventions for this emergency condition? *

Answer 25

Safety

Question 26

The nurse is assigned to telephone triage. A pt who was just stung by a common honeybee calls for advice. Which question would the nurse ask first?

Answer 26

Are you having any facial swelling, wheezing, or shortness of breath?

Question 27

A victim of heat stroke arrives in the emergency department. His skin is hot and dry, his body temp is 105 F (40.6 C). He is confused and demonstrates bizarre behavior. His BP is 85/60, pulse is 130 beats/min, and RR 40. Which task should be assigned to an experienced LPN/LVN? *

Answer 27

Insert an indwelling urinary drainage catheter.

Question 28

The nurse is assessing a pt who has sustained a cat bite to the left hand. The cat’s immunizations are up to date. The date of the pt’s last tetanus shot is unknown. What is the priority concern? *

Answer 28

Treating an infection specific to cat bites.

Question 29

The following pts come to the emergency department triage desk reporting acute abdominal pain. Which pt has the most severe condition? *

Answer 29

A 23 yr old woman reporting dizziness and severe left lower quadrant pain who states she is possibly pregnant.

Question 30

Which combination of employees would be best to include in a committee to address the issue of violence against ED personnel?

Answer 30

At least one person from all ED groups.

Question 31

The nurse is caring for a patient with multiple injuries sustained during a head on car collision. Which assessment finding takes priority? *

Answer 31

A deviated trachea.

Question 32

A pt involved in a one car rollover comes in with multiple injuries. List in order of priority the interventions that must be initiated for this pt.

Answer 32

Assess for spontaneous respirations.

Use the chin lift/jaw thrust maneuver to open the airway.

Give supplemental oxygen via mask.

Secure two large bore IV lines and infuse normal saline.

Obtain a full set of vitals.

Remove or cut away the pts clothing.

Question 33

A young woman is brought to the emergency department by EMS because she 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. Which intervention is priority for this pt? *

Answer 33

Initiate supportive care, such as checking the airway and giving oxygen and IV fluids.

Question 34

The nurse is caring for a pt who is on the cardiac monitor because of these symptoms: syncope, dizziness, and intermittent episodes of palpitations. Below is a display of what is on the cardiac monitor. What should the nurse do first?

Answer 34

Assess the pt and take vital signs.

Question 35

A group of ppl arrive to 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. Which action is the priority?

Answer 35

Direct pts to the decontamination area.

Question 36

In the work setting what is the nurse’s primary responsibility in preparing for the management of disasters, including natural disasters and bioterrorism incidents?

Answer 36

Knowing the agency’s emergency response plan.

Question 37

List in order of priority the actions that should be taken by the ED staff in the event of a biochemical incident.

Answer 37

Protect.
Don PPE.
Decontaminate.
Perform triage.
Report to the public health dept.

Question 38

According to the Joint Commission, hospitals are required to form emergency management committees to periodically exerice the disaster operations plan. Hospital admin has selected various HCP to join the committee. Members from which other key departments should be included? SATA

Answer 38

Security & communications.
Nursing & assist personnel.
Lab & diagnositcs.
Medical records and info tech.
Maintenance & engineering.

Question 39

A newly hired ED clinical nurse specialist is reviewing the hospital’s disaster plan and find 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?

Answer 39

Current staff is unlikely to have training and practice in using this plan.

Question 40

The nurse is talking to a group of ppl about an industrial explosion in which many ppl were killed or injured. Which individual has the greatest risk for psychiatric difficulties, such as PTSD, related to the incident? *

Answer 40

Person who was injured and trapped for several hours before rescue.

Question 41

Identify the five most critical elements in performing disaster triage for multiple victims.

Answer 41

Check airway, breathing, circulation.

Assess LOC.

Visually inspect for gross deformities, bleeding, obvious injuries.

Note the color, presence of moisture, temp of skin.

Check VS, pulse, RR.

Question 42

Order of care for pts in ED.

1. Child has wheezing and very labored respirations.
2. 35 yr old firefighter confused, combative w/ respiratory stridor.
3. 16 yr old with crushed leg
4. 60 yr old woman full thickness burns to hands/forearms.
5. 3 yr old lethargic, slow shallow respirations, burns 70% of body. (too late for them)
6. 52 yr old man in full cardiac arrest. (too late for them)

Question 43

Pt presents to ED with nausea, vomit, colicky abdominal pain, fever, tachy. Fill in the sentences.

_______ and ______ are administered followed by _______ to decompress the stomach and intestine. _______ and _________ are performed ASAP to detect location of the obstruction and guide surgical decisions. The pt is prepared for ________.

Answer 43

1. IV normal saline
2. IV broad spectrum antibiotics
3. NG tube
4. Abdominal radiography
5. CT scan
6. emergency surgery

Question 44

Look at Chart

Question 45

An active shooter incident occurs in the triage area of a large busy emergency room. What is the priority action for the triage nurse to take? *

Answer 45

Locate a safe path and run to a safe place, take others if possible.