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TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

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Chapter72:EmergencyNursing  1.

Whichpatientshouldthenurseprioritizeasneedingemergenttreatment,assumingnootherinjuriesare presentexcepttheonesoutlinedbelow?

A)

Apatientwithabluntchesttraumawithsomedifficultybreathing

B)

Apatientwithasoreneckwhowasimmobilizedinthefieldonabackboardwithacervicalcollar

C)

Apatientwithapossiblefracturedtibiawithadequatepedalpulses

D)

Apatientwithanacuteonsetofconfusion

Ans:

A Feedback: Thepatientwithbluntchesttraumapossiblyhasacompromisedairway.Establishmentandmaintenance ofapatentairwayandadequateventilationisprioritizedoverotherhealthproblems,includingskeletal injuriesandchangesincognition.

2.

Thenurseobservesthatthefamilymembersofapatientwhowasinjuredinanaccidentareblaming eachotherforthecircumstancesleadinguptotheaccident.Thenurseappropriatelyletsthefamily membersexpresstheirfeelingsofresponsibility,whileexplainingthattherewasprobablylittlethey coulddotopreventtheinjury.Inwhatstageofcrisisisthisfamily?

A)

Anxietyanddenial

B)

Remorseandguilt

C)

Anger

D)

Grief

Ans:

B Feedback: Remorseandguiltarenaturalprocessesofthestagesofacrisisandshouldbefacilitatedforthefamily memberstoprocessthecrisis.Thefamilyssenseofblameandresponsibilityaremoresuggestiveofguilt thananger,grief,oranxiety.

3.

ApatientisbroughttotheEDbyambulancewithagunshotwoundtotheabdomen.Thenurseknows thatthemostcommonholloworganinjuredinthistypeofinjuryiswhat?

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

A)

Liver

B)

Smallbowel

C)

Stomach

D)

Largebowel

Ans:

B

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Feedback: Penetratingabdominalwoundshaveahighincidenceofinjurytoholloworgans,especiallythesmall bowel.Theliverisalsoinjuredfrequently,butitisasolidorgan. 4.

ApatienthasbeenbroughttotheEDwithmultipletraumaafteramotorvehicleaccident.After immediatethreatstolifehavebeenaddressed,thenurseandtraumateamshouldtakewhataction?

A)

Performarapidphysicalassessment.

B)

Initiatehealtheducation.

C)

Performdiagnosticimaging.

D)

Establishthecircumstancesoftheaccident.

Ans:

A Feedback: Onceimmediatethreatstolifehavebeencorrected,arapidphysicalexaminationisdonetoidentify injuriesandprioritiesoftreatment.Healtheducationisinitiatedlaterinthecareprocessanddiagnostic imagingwouldtakeplaceafterarapidphysicalassessment.Itisnotthecareteamsresponsibilityto determinethecircumstancesoftheaccident.

5.

Thenursingeducatorisreviewingthesignsandsymptomsofheatstrokewithagroupofnurseswho providecareinadesertregion.Theeducatorshoulddescribewhatsignorsymptom?

A)

Hypertensionwithawidepulsepressure

B)

Anhidrosis

C)

Copiousdiuresis

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

D)

Cheyne-Stokesrespirations

Ans:

B

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Feedback: Heatstrokeismanifestedbyanhidrosisconfusion,bizarrebehavior,coma,elevatedbodytemperature, hotdryskin,tachypnea,hypotension,andtachycardia.Thishealthproblemisnotassociatedwith anhidrosisorCheyne-Stokesrespirations. 6.

ApatientisbroughttotheEDbyambulanceafterswallowinghighlyacidictoiletbowlcleaner2hours earlier.Thepatientisalertandoriented.Whatisthecareteamsmostappropriatetreatment?

A)

Administeringsyrupofipecac

B)

Performingagastriclavage

C)

Givingmilktodrink

D)

Referringtopsychiatry

Ans:

C Feedback: Apatientwhohasswallowedanacidicsubstance,suchastoiletbowlcleaner,maybegivenmilkor watertodrinkfordilution.Gastriclavagemustbeperformedwithin1hourofingestion.Apsychiatric consultmaybeconsideredoncethepatientisphysicallystableanditisdeemedappropriatebythe physician.Syrupofipecacisnolongerusedinclinicalsettings.

7.

ApatientisadmittedtotheEDwithsuspectedalcoholintoxication.TheEDnurseisawareoftheneed toassessforconditionsthatcanmimicacutealcoholintoxication.Inlightofthisneed,thenurseshould performwhataction?

A)

Checkthepatientsbloodglucoselevel.

B)

Assessforadocumentedhistoryofmajordepression.

C)

Determinewhetherthepatienthasingestedacorrosivesubstance.

D)

Arrangeforassessmentofserumpotassiumlevels.

Ans:

A

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

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Feedback: Hypoglycemiacanmimicalcoholintoxicationandshouldbeassessedinapatientsuspectedofalcohol intoxication.Potassiumimbalances,depression,andpoisoningestionarenotnotedtomimicthe characteristicsignsandsymptomsofalcoholintoxication. 8.

TheparamedicsbringapatientwhohassufferedasexualassaulttotheED.Whatisimportantforthe sexualassaultnurseexaminertodowhenassessingasexualassaultvictim?

A)

Respectthepatientsprivacyduringassessment.

B)

Shaveallpubichairforlaboratoryanalysis.

C)

Placeitemsforevidenceinplasticbags.

D)

Bathethepatientbeforetheexamination.

Ans:

A Feedback: Thepatientsprivacyandsensitivitymustberespected,becausethepatientwillbeexperiencingastress responsetotheassault.Pubichairiscombedortrimmedforsampling.Paperbagsareusedforevidence collectionbecauseplasticbagsretainmoisture,whichpromotesmoldandmildewthatcandestroy evidence.Bathingthepatientbeforetheexaminationwoulddestroyorremovekeyevidence.

9.

ApatientwithahistoryofmajordepressionisbroughttotheEDbyherparents.Whichofthefollowing nursingactionsismostappropriate?

A)

Notingthatsymptomsofphysicalillnessarenotrelevanttothecurrentdiagnosis

B)

Askingthepatientifshehaseverthoughtabouttakingherownlife

C)

Conductinginterviewsinabriefanddirectmanner

D)

Arrangingforthepatienttospendtimealonetoconsiderherfeelings

Ans:

B Feedback: Establishingifthepatienthassuicidalthoughtsorintentshelpsidentifythelevelofdepressionand intervention.Physicalsymptomsarerelevantandshouldbeexplored.Allowthepatienttoexpress feelings,andconducttheinterviewatacomfortablepaceforthepatient.Neverleavethepatientalone, becausesuicideisusuallycommittedinsolitude.

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

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10. Atriagenurseistalkingtoapatientwhenthepatientbeginschokingonhislunch.Thepatientis coughingforcefully.Whatshouldthenursedo? A)

Standhimupandperformtheabdominalthrustmaneuverfrombehind.

B)

Layhimdown,straddlehim,andperformtheabdominalthrustmaneuver.

C)

Leavehimtogetassistance.

D)

Staywithhimandencouragehim,butnotinterveneatthistime.

Ans:

D Feedback: Ifthepatientiscoughing,heshouldbeabletodislodgetheobjectorcauseacompleteobstruction.If completeobstructionoccurs,thenurseshouldperformtheabdominalthrustmaneuverwiththepatient standing.Ifthepatientisunconscious,thenurseshouldlaythepatientdown.Anurseshouldneverleave achokingpatientalone.

11. Youareafloornursecaringforapatientwithalcoholwithdrawalsyndrome.Whatwouldbean appropriatenursingactiontominimizethepotentialforhallucinations? A)

Engagethepatientinaprocessofhealtheducation.

B)

Administeropioidanalgesicsasordered.

C)

Placethepatientinaprivate,well-litroom.

D)

Providetelevisionoraradioastherapeuticdistraction

Ans:

C Feedback: Thepatientshouldbeplacedinaquietsingleroomwithlightsonandinacalmnonstressful environment.TVandradiostimulationshouldbeavoided.Analgesicsarenotnormallynecessary,and wouldpotentiallycontributetohallucinations.Healtheducationwouldbeinappropriatewhilethepatient isexperiencingacutewithdrawal.

12. AnobtundedpatientisadmittedtotheEDafteringestingbleach.Thenurseshouldpreparetoassistwith whatintervention? A)

Promptadministrationofanantidote

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

B)

Gastriclavage

C)

Administrationofactivatedcharcoal

D)

Helpingthepatientdrinklargeamountsofwater

Ans:

D

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Feedback: Thepatientwhohasingestedacorrosivepoison,suchasbleach,isgivenwaterormilktodrinkfor dilution.Gastriclavageisnotusedtotreatingestionofcorrosivesandactivatedcharcoalisineffective. Thereisnoantidoteforacorrosivesubstancesuchasbleach. 13. A6-year-oldisadmittedtotheEDafterbeingrescuedfromapondafterfallingthroughtheicewhileice skating.Whatactionshouldthenurseperformwhilerewarmingthepatient? A)

Assessingthepatientsoraltemperaturefrequently

B)

EnsuringcontinuousECGmonitoring

C)

Massagingthepatientsskinsurfacestopromotecirculation

D)

Administeringbronchodilatorsbynebulizer

Ans:

B Feedback: AhypothermicpatientrequirescontinuousECGmonitoringandassessmentofcoretemperatureswith anesophagealprobe,bladder,orrectalthermometer.Massageisnotperformedandbronchodilators wouldnormallybeinsufficienttomeetthepatientsrespiratoryneeds.

14. AmalepatientwithmultipleinjuriesisbroughttotheEDbyambulance.Hehashadhisairway stabilizedandisbreathingonhisown.TheEDnursedoesnotseeanyactivebleeding,butshould suspectinternalhemorrhagebasedonwhatfinding? A)

Absenceofbruisingatcontusionsites

B)

Rapidpulseanddecreasedcapillaryrefill

C)

IncreasedBPwithnarrowedpulsepressure

D)

Suddendiaphoresis

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

Ans:

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B Feedback: ThenursewouldanticipatethatthepulsewouldincreaseandBPwoulddecrease.Urineoutputwould alsodecrease.Anabsenceofbruisingandthepresenceofdiaphoresiswouldnotsuggestinternal hemorrhage.

15. A13-year-oldisbeingadmittedtotheEDafterfallingfromaroofandsustainingbluntabdominal injuries.Toassessforinternalinjuryinthepatientsperitoneum,thenurseshouldanticipatewhat diagnostictest? A)

Radiograph

B)

Computedtomography(CT)scan

C)

Completebloodcount(CBC)

D)

Bariumswallow

Ans:

B Feedback: CTscanoftheabdomen,diagnosticperitoneallavage,andabdominalultrasoundareappropriate diagnostictoolstoassessintra-abdominalinjuries.X-raysdonotyieldsufficientdataandaCBCwould notrevealthepresenceofintraperitonealinjury.

16. ApatientisbroughttotheERinanunconsciousstate.Thephysiciannotesthatthepatientisinneedof emergencysurgery.Nofamilymembersarepresent,andthepatientdoesnothaveidentification.What actionbythenurseismostimportantregardingconsentfortreatment? A)

Askthesocialworkertocomeandsigntheconsent.

B)

Contactthepolicetoobtainthepatientsidentity.

C)

Obtainacourtordertotreatthepatient.

D)

ClearlydocumentLOCandhealthstatusonthepatientschart.

Ans:

D Feedback: Whenpatientsareunconsciousandincriticalcondition,theconditionandsituationshouldbe

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documentedtoadministertreatmentquicklyandtimelywhennoconsentcanbeobtainedbyusual routes.Asocialworkerisnotaskedtosigntheconsent.Findingthepatientsidentityisnotapriority. Obtainingacourtorderwouldtaketoolong. 17. Apatientisexperiencingrespiratoryinsufficiencyandcannotmaintainspontaneousrespirations.The nursesuspectsthatthephysicianwillperformwhichofthefollowingactions? A)

Insertanoropharyngealairway.

B)

Performthejawthrustmaneuver.

C)

Performendotrachealintubation.

D)

Performacricothyroidotomy.

Ans:

C Feedback: Endotrachealtubesareusedincaseswhenthepatientcannotbeventilatedwithanoropharyngeal airway,whichisusedinpatientswhoarebreathingspontaneously.Thejawthrustmaneuverdoesnot establishanairwayandcricothyroidotomywouldbeperformedasalastresort.

18. ApatientisbroughtbyfriendstotheEDafterbeinginvolvedinamotorvehicleaccident.Thepatient sustainedblunttraumatotheabdomen.Whatnursingactionwouldbemostappropriateforthispatient? A)

Ambulatethepatienttoexpelflatus.

B)

PlacethepatientinahighFowlersposition.

C)

Immobilizethepatientonabackboard.

D)

Placethepatientinaleftlateralposition.

Ans:

C Feedback: Whenadmittedforblunttrauma,patientsmustbeimmobilizeduntilspinalinjuryisruledout. Ambulation,side-lying,anduprightpositioningwouldbecontraindicateduntilspinalinjuryisruledout.

19. AbackcountryskierhasbeenairliftedtotheEDafterbecominglostanddevelopinghypothermiaand frostbite.Howshouldthenursebestmanagethepatientsfrostbite? A)

Immerseaffectedextremitiesinwaterslightlyabovenormalbodytemperature.

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

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B)

Immersethepatientsfrostbittenextremitiesinthewarmestwaterthepatientcantolerate.

C)

Gentlymassagethepatientsfrozenextremitiesinbetweenwaterbaths.

D)

Performpassiverange-of-motionexercisesoftheaffectedextremitiestopromotecirculation.

Ans:

A Feedback: Frozenextremitiesareusuallyplacedina37Cto40C(98.6Fto104F)circulatingbathfor30-to40minutespans.Toavoidfurthermechanicalinjury,thebodypartisnothandled.Massageis contraindicated.

20. ApatientwithafracturedfemurpresentingtotheEDexhibitscool,moistskin,increasedheartrate,and fallingBP.Thecareteamshouldconsiderthepossibilityofwhatcomplicationofthepatientsinjuries? A)

Myocardialinfarction

B)

Hypoglycemia

C)

Hemorrhage

D)

Peritonitis

Ans:

C Feedback: Thesignsandsymptomsthepatientisexperiencingsuggestavolumedeficitfromaninternalbleed. Thatthesymptomsfollowanacuteinjurysuggestshemorrhageratherthanmyocardialinfarctionor hypoglycemia.Peritonitiswouldbeanunlikelyresultofafemoralfracture.

21. ApatientwhohasbeendiagnosedwithcholecystitisisbeingdischargedhomefromtheEDtobe scheduledforsurgerylater.ThepatientreceivedmorphineduringthepresentEDadmissionandis visiblydrowsy.Whenprovidinghealtheducationtothepatient,whatwouldbethemostappropriate nursingaction? A)

Givewritteninstructionstopatient.

B)

Giveverbalinstructionstooneofthepatientsfamilymembers.

C)

Telephonethepatientthenextdaywithverbalinstructions.

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

D)

Giveverbalandwritteninstructionstopatientandafamilymember.

Ans:

D

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Feedback: Beforedischarge,verbalandwritteninstructionsforcontinuingcarearegiventothepatientandthe familyorsignificantothers.DischargeteachingiscompletedpriortothepatientleavingtheED,so phoningthepatientthenextdayinnotacceptable. 22. ApatientisadmittedtotheEDcomplainingofabdominalpain.Furtherassessmentoftheabdomen revealssignsofperitonealirritation.Whatassessmentfindingswouldcorroboratethisdiagnosis?Select allthatapply. A)

Ascites

B)

Reboundtenderness

C)

Changesinbowelsounds

D)

Muscularrigidity

E)

Copiousdiarrhea

Ans:

B,C,D Feedback: Signsofperitonealirritationincludeabdominaldistention,involuntaryguarding,tenderness,pain, muscularrigidity,orreboundtendernessalongwithchangesinbowelsounds.Diarrheaandascitesare notsignsofperitonealirritation.

23. ApatientwhoattemptedsuicidebeingtreatedintheEDisaccompaniedbyhismother,father,and brother.Whenplanningthenursingcareofthisfamily,thenurseshouldperformwhichofthefollowing action? A)

Referthefamilytopsychiatryinordertoprovidethemwithsupport.

B)

Explorethecausesofthepatientssuicideattemptwiththefamily.

C)

Encouragethefamilytoparticipateinthebedsidecareofthepatient.

D)

Ensurethatthefamilyreceivesappropriatecrisisinterventionservices.

Ans:

D

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

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Feedback: ItisessentialthatfamilycrisisinterventionservicesareavailableforfamiliesofEDpatients.Itwouldbe inappropriateandinsensitivetoexplorecausesofthepatientssuicideattemptwiththefamily.Family participationinbedsidecareisoftenimpracticalintheEDsetting.Psychiatryisnotthenormalsourceof psychosocialsupportandcrisisintervention. 24. ApatientisadmittedtotheEDafterbeinginvolvedinamotorvehicleaccident.Thepatienthasmultiple inj...