Ignat Ch 09: Care of Patients with Common Environmental Emergencies Flashcards
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.
b. Start an intravenous line and infuse 0.9% saline solution.
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.
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.
d. Administer an EpiPen from the first aid kit and call 911.
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.
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.
b. Administer warmed intravenous fluids to the client.
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.
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.
a. Administer dexamethasone (Decadron).
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.
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
a. Electrocardiogram (ECG)
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.
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.
a. I can go swimming all by myself because I am a certified lifeguard.
People should never swim alone, regardless of lifeguard status. The other statements indicate good understanding of the teaching.
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.
a. Administer intravenous morphine.
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.
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
c. Cardiopulmonary status
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.
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)
b. The poison control center
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.
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.
a. Deliver rescue breaths.
In this emergency situation, the nurse should immediately initiate airway clearance and ventilator support measures, including delivering rescue breaths.
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.
d. Monitor the clients temperature every 4 hours.
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.
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).
c. Ask about allergies to pineapple or papaya.
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.
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.
b. It will relieve your muscle rigidity and spasms.
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.
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.
c. My partner and I will plan to sleep at a higher elevation to acclimate more quickly.
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.
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.
a. Wear synthetic clothing instead of cotton to keep your skin dry.
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.
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.
