Chapter 69 - Emergency, Terrorism, Disaster Nursing (Submersion Injuries)

Question 1

A 22-year-old patient who experienced a near drowning accident in a local pool, but now is awake and
breathing spontaneously, is admitted for observation. Which assessment will be most important for the
nurse to take during the observation period?
a. Auscultate heart sounds.
b. Palpate peripheral pulses.
c. Auscultate breath sounds.
d. Check pupil reaction to light.

Answer 1

ANS: C
Because pulmonary edema is a common complication after near
drowning, the nurse should assess the breath sounds frequently.
The other information also will be obtained by the nurse, but it is
not as pertinent to the patient’s admission diagnosis

Question 2

The emergency department (ED) triage nurse is assessing four victims involved in a motor
vehicle collision. Which patient has the highest priority for treatment?
a. A patient with no pedal pulses.
b. A patient with an open femur fracture.
c. A patient with bleeding facial lacerations.
d. A patient with paradoxic chest movements

Answer 2

ANS: D
Most immediate deaths from trauma occur because of problems with
ventilation, so the patient with paradoxic chest movements should be treated
first. Face and head fractures can obstruct the airway, but the patient with
facial injuries only has lacerations. The other two patients also need rapid
intervention but do not have airway or breathing problems

Question 3

During the primary assessment of a victim of a motor vehicle collision, the nurse determines that the
patient is breathing and has an unobstructed airway. Which action should the nurse take next?
a. Palpate extremities for bilateral pulses.
b. Observe the patient’s respiratory effort.
c. Check the patient’s level of consciousness.
d. Examine the patient for any external bleeding.

Answer 3

ANS: B
Even with a patent airway, patients can have other problems that
compromise ventilation, so the next action is to assess the patient’s
breathing. The other actions are also part of the initial survey but assessment
of breathing should be done immediately after assessing for airway patency

Question 4

The following four patients arrive in the emergency department (ED) after a motor vehicle
collision. In which order should the nurse assess them? (Put a comma and a space between
each answer choice [A, B, C, D, E].)
a. A 74-year-old with palpitations and chest pain
b. A 43-year-old complaining of 7/10 abdominal pain
c. A 21-year-old with multiple fractures of the face and jaw
d. A 37-year-old with a misaligned left leg with intact pulses

Answer 4

ANS:
C, A, B, D
The highest priority is to assess the 21-year-old patient for airway obstruction, which is the most lifethreatening
injury. The 74-year-old patient may have chest pain from cardiac ischemia and should be
assessed and have diagnostic testing for this pain. The 43-year-old patient may have abdominal trauma or
bleeding and should be seen next to assess circulatory status. The 37-year-old appears to have a possible
fracture of the left leg and should be seen soon, but this patient has the least life-threatening injury.

Question 5

A patient who has experienced blunt abdominal trauma during a motor vehicle collision is complaining of
increasing abdominal pain. The nurse will plan to teach the patient about the purpose of
a. peritoneal lavage.
b. abdominal ultrasonography.
c. nasogastric (NG) tube placement.
d. magnetic resonance imaging (MRI).

Answer 5

ANS: B
For patients who are at risk for intraabdominal bleeding, focused abdominal
ultrasonography is the preferred method to assess for intraperitoneal
bleeding. An MRI would not be used. Peritoneal lavage is an alternative, but
it is more invasive. An NG tube would not be helpful in diagnosis of
intraabdominal bleeding

Question 6

What condition occurs with saltwater near-drowning but not with freshwater near-drowning?

a. Destruction of surfactant
b. Noncardiogenic pulmonary edema
c. Water leaks from alveoli to capillary bed and circulation
d. Fluid is drawn into the alveoli from the pulmonary capillaries

Answer 6

d. With saltwater near-drowning fluid is drawn from
the vascular space into the alveoli, impairing alveolar ventilation and resulting in hypoxia. Surfactant destruction and noncardiogenic pulmonary edema occur with both saltwater near-drowning and freshwater near-drowning. Water leaks from the alveoli to the circulation with freshwater near-drowning

Question 7

Priority Decision: What is the priority of management of the near-drowning patient?

a. Correction of hypoxia
b. Correction of acidosis
c. Maintenance of fluid balance
d. Prevention of cerebral edema

Answer 7

a. Airway and oxygenation are the first priorities. A life- threatening consequence of near-drowning of any type is hypoxia from fluid-filled and poorly ventilated alveoli. Correction of metabolic acidosis occurs with effective ventilation and oxygenation. Lactated Ringer’s solution or normal saline solution is started to manage fluid balance and mannitol or furosemide may be used to treat free water and cerebral edema