Exam A Flashcards
Caring for a client who was admitted due to hypovolemic shock from hemorrhage suffered during a plane crash. Initially administer which of the following fluids?
0.9% normal saline
Which of the following clients should the nurse consider as having the highest priority?
a 56 year old who is diaphoretic with substernal chest pain
The nurse is working in the ED. While performing an assessment, someone comes in and points a gun at the patient and yess, “I told you i was going to kill you if you harmed my daughter in any way!” What should the nurse do?
Get out of the line of fire and protect self
What is the most therapeutic response to a family’s request to view the body of their loved one who died in a plane crash?
“I’ll see what I can arrange so you can see and spend time with your loved one”
Which situation would most likely indicate a critical incident stress management staff meeting by the nurse manager of the ED?
Death of a 4 month old from a plane crash
The ICU nurse is monitoring a patient in shock who is receiving rapid IV infusions for fluid resuscitation. The patient is experiencing SOB, decreasing pulse pressure, absent bowel sounds and oliguria. The nurse suspects what?
Abdominal compartment syndrome
The nurse in the ED is receiving a client after a plane crash. The client is complaining of severe abdominal pain, has cool, diaphoretic skin, tachycardia, hypotension, and is extremely anxious. The nurse notes a large hematoma on the left flank. What is the priority?
Start an IV with a large bore angiocath
To assist the survivors in understanding heat exhaustion, which manifestations should the nurse include in the teaching?
-headache
-syncope
-diaphoresis
Patient has experienced an overdose of heparin. To manage adverse reactions from the antidote, which of the following actions should the nurse take?
Have equipment and personnel ready for possible resuscitation
Which of the following interventions is appropriate for the nurse to implement when caring for a client who has experienced frostbite?
soak the feet in warm water
A client needs sutures placed for lacerations on their arms and legs. Which piece of information is most important?
date of the client’s last tetanus toxoid vaccination
A patient is diagnosed with hypothermia. Which complication would you monitor for in rewarming?
ventricular fibrillation
A patient with a diagnosis of decompression sickness is being monitored by a nurse. Which of the following interventions would be appropriate to prevent complications?
insert a nasogastric tube and attach to low suction
The ED nurse has a client from a nonfatal drowning event. Which assessment data concerns you?
The onset of pink, frothy sputum
The nurse is teaching a class on Lyme disease. Which of the following should be included in the presentation?
Wear tight, light-colored clothing when hiking or hunting
Preparing to administer IV potassium chloride to a client with severe hypokalemia from a heat stroke. Which of the following nursing actions is appropriate?
Verifying adequate urine output
