Emergency and Disaster Nursing
During the primary assessment of a victim of a motor vehicle collision, the nurse determines that the
patient 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.
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.
DIF: Cognitive Level: Apply (application)
During the primary survey of a patient with severe leg trauma, the nurse observes that the patient's left
pedal and posterior tibial pulses are absent and the entire leg is swollen. Which action will the nurse
take next?
a. Send blood to the lab for a complete blood count.
b. Assess further for a cause of the decreased circulation.
c. Finish the airway, breathing, circulation, disability survey.
d. Start normal saline fluid infusion with a large-bore IV line.
ANS: D
The assessment data indicate that the patient may have arterial trauma and hemorrhage. When a
possibly life-threatening injury is found during the primary survey, the nurse should immediately start
interventions before proceeding with the survey. Although a complete blood count is indicated,
administration of IV fluids should be started first. Completion of the primary survey and further
assessment should be completed after the IV fluids are initiated.
DIF: Cognitive Level: Analyze (analysis)
After the return of spontaneous circulation following the resuscitation of a patient who had a cardiac
arrest, therapeutic hypothermia is ordered. Which action will the nurse include in the plan of care?
a. Initiate cooling per protocol.
b. Avoid the use of sedative drugs.
c. Check mental status every 15 minutes.
d. Rewarm if temperature is below 91° F (32.8° C).
ANS: A
When therapeutic hypothermia is used postresuscitation, external cooling devices or cold normal saline
infusions are used to rapidly lower body temperature to 89.6° F to 93.2° F (32° C to 34° C). Because
hypothermia will decrease brain activity, assessing mental status every 15 minutes is not done at this
stage. Sedative drugs are given during therapeutic hypothermia.
, DIF: Cognitive Level: Apply (application)
A patient who is unconscious after a fall from a ladder is transported to the emergency department by
emergency medical personnel. During the primary survey of the patient, the nurse should
a. obtain a complete set of vital signs.
b. obtain a Glasgow Coma Scale score.
c. attach an electrocardiogram monitor.
d. ask about chronic medical conditions.
ANS: B
The Glasgow Coma Scale is included when assessing for disability during the primary survey. The other
information is part of the secondary survey.
DIF: Cognitive Level: Apply (application)
A 19-yr-old patient is brought to the emergency department (ED) with multiple lacerations and tissue
avulsion of the left hand. When asked about tetanus immunization, the patient denies having any
previous vaccinations. The nurse will anticipate giving
a. tetanus immunoglobulin (TIG) only.
b. TIG and tetanus-diphtheria toxoid (Td).
c. tetanus-diphtheria toxoid and pertussis vaccine (Tdap) only.
d. TIG and tetanus-diphtheria toxoid and pertussis vaccine (Tdap).
ANS: D
For an adult with no previous tetanus immunizations, TIG and Tdap are recommended. The other
immunizations are not sufficient for this patient.
DIF: Cognitive Level: Apply (application)
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).
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 the diagnosis of
intraabdominal bleeding.
DIF: Cognitive Level: Apply (application)
A patient with hypotension and an elevated temperature after working outside on a hot day is treated in
the emergency department (ED). The nurse determines that discharge teaching has been effective when
During the primary assessment of a victim of a motor vehicle collision, the nurse determines that the
patient 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.
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.
DIF: Cognitive Level: Apply (application)
During the primary survey of a patient with severe leg trauma, the nurse observes that the patient's left
pedal and posterior tibial pulses are absent and the entire leg is swollen. Which action will the nurse
take next?
a. Send blood to the lab for a complete blood count.
b. Assess further for a cause of the decreased circulation.
c. Finish the airway, breathing, circulation, disability survey.
d. Start normal saline fluid infusion with a large-bore IV line.
ANS: D
The assessment data indicate that the patient may have arterial trauma and hemorrhage. When a
possibly life-threatening injury is found during the primary survey, the nurse should immediately start
interventions before proceeding with the survey. Although a complete blood count is indicated,
administration of IV fluids should be started first. Completion of the primary survey and further
assessment should be completed after the IV fluids are initiated.
DIF: Cognitive Level: Analyze (analysis)
After the return of spontaneous circulation following the resuscitation of a patient who had a cardiac
arrest, therapeutic hypothermia is ordered. Which action will the nurse include in the plan of care?
a. Initiate cooling per protocol.
b. Avoid the use of sedative drugs.
c. Check mental status every 15 minutes.
d. Rewarm if temperature is below 91° F (32.8° C).
ANS: A
When therapeutic hypothermia is used postresuscitation, external cooling devices or cold normal saline
infusions are used to rapidly lower body temperature to 89.6° F to 93.2° F (32° C to 34° C). Because
hypothermia will decrease brain activity, assessing mental status every 15 minutes is not done at this
stage. Sedative drugs are given during therapeutic hypothermia.
, DIF: Cognitive Level: Apply (application)
A patient who is unconscious after a fall from a ladder is transported to the emergency department by
emergency medical personnel. During the primary survey of the patient, the nurse should
a. obtain a complete set of vital signs.
b. obtain a Glasgow Coma Scale score.
c. attach an electrocardiogram monitor.
d. ask about chronic medical conditions.
ANS: B
The Glasgow Coma Scale is included when assessing for disability during the primary survey. The other
information is part of the secondary survey.
DIF: Cognitive Level: Apply (application)
A 19-yr-old patient is brought to the emergency department (ED) with multiple lacerations and tissue
avulsion of the left hand. When asked about tetanus immunization, the patient denies having any
previous vaccinations. The nurse will anticipate giving
a. tetanus immunoglobulin (TIG) only.
b. TIG and tetanus-diphtheria toxoid (Td).
c. tetanus-diphtheria toxoid and pertussis vaccine (Tdap) only.
d. TIG and tetanus-diphtheria toxoid and pertussis vaccine (Tdap).
ANS: D
For an adult with no previous tetanus immunizations, TIG and Tdap are recommended. The other
immunizations are not sufficient for this patient.
DIF: Cognitive Level: Apply (application)
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).
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 the diagnosis of
intraabdominal bleeding.
DIF: Cognitive Level: Apply (application)
A patient with hypotension and an elevated temperature after working outside on a hot day is treated in
the emergency department (ED). The nurse determines that discharge teaching has been effective when
