Medical-Surgical Nursing: Concepts for Interprofessional
Collaborative Care (11th Ed.),
Unit II: Emergency Care & Disaster Preparedness.
Medical-Surgical Nursing
11th Edition
• Author(s)Donna D. Ignatavicius; Cherie R. Rebar; Nicole M.
Heimgartner
Reference: Ch. 10: Concepts of Emergency and Trauma Nursing
— Primary Survey and Initial Management
Question Stem: A 42-year-old man arrives by ambulance after a
motor vehicle collision. He is awake, complaining of shortness
of breath, and has obvious chest wall deformity on the left.
During the primary survey, which intervention should the nurse
perform first?
A. Obtain a 12-lead ECG.
B. Apply high-flow oxygen and assess airway/ventilation.
C. Start two large-bore IVs for fluid resuscitation.
D. Perform a focused neurological exam.
,Correct Answer: B
Rationales:
• Correct (B): The primary survey (ABCDE) prioritizes Airway
and Breathing — applying high-flow oxygen and assessing
airway/ventilation takes precedence for a patient with
chest trauma and dyspnea. This stabilizes oxygenation and
identifies life-threatening respiratory compromise.
• A: ECG is important for chest trauma with potential cardiac
injury but is secondary to securing airway/oxygenation.
• C: IV access is necessary but follows immediate airway and
breathing interventions in the primary survey.
• D: Neurologic assessment is part of Disability (D) and
comes after airway, breathing, and circulation are
addressed.
Teaching Point: In trauma, follow ABCs: airway/ventilation
before diagnostics or fluids.
Citation: Ignatavicius, Rebar, & Heimgartner, 11th Ed., Ch.
10: Primary Survey and Initial Management
2
Reference: Ch. 10: Concepts of Emergency and Trauma Nursing
— Chest Trauma Management
Question Stem: A patient with blunt chest trauma has
decreased breath sounds on the left, hypotension, and tracheal
deviation to the right. Which immediate nursing action is most
,appropriate?
A. Prepare for emergent left-sided needle decompression.
B. Apply a nonrebreather mask and observe.
C. Administer IV morphine for chest pain control.
D. Place the patient in Trendelenburg position.
Correct Answer: A
Rationales:
• Correct (A): Signs of tension pneumothorax (hypotension,
tracheal shift, unilateral decreased breath sounds) require
immediate needle decompression before definitive chest
tube placement. Prompt decompression relieves
mediastinal shift and restores circulation.
• B: Oxygen is helpful but inadequate for tension
pneumothorax — procedural decompression is required
emergently.
• C: Analgesia is important but cannot delay life-saving
decompression in tension pneumothorax.
• D: Trendelenburg may worsen respiratory compromise and
is not indicated for tension pneumothorax.
Teaching Point: Tension pneumothorax is treated
immediately with needle decompression.
Citation: Ignatavicius, Rebar, & Heimgartner, 11th Ed., Ch.
10: Chest Trauma
3
, Reference: Ch. 10: Concepts of Emergency and Trauma Nursing
— Hemorrhagic Shock & Circulatory Support
Question Stem: An adult trauma patient in the ED has an SBP of
78 mm Hg, cool extremities, and a distended abdomen after
blunt abdominal trauma. Which action should the nurse
prioritize?
A. Administer a rapid crystalloid bolus and prepare for
emergent laparotomy.
B. Apply abdominal binder and monitor urine output.
C. Obtain abdominal CT with contrast to locate the bleed.
D. Give IV broad-spectrum antibiotics and observe.
Correct Answer: A
Rationales:
• Correct (A): Hypotension with signs of hemorrhagic shock
and distended abdomen suggests intra-abdominal
bleeding. Rapid volume resuscitation and surgical
consultation/preparation for emergent laparotomy are
priorities to control hemorrhage and restore perfusion.
• B: An abdominal binder does not control intra-abdominal
hemorrhage and could mask distention; monitoring urine
output is important but not the priority.
• C: CT requires hemodynamic stability; unstable patients
should proceed to the OR rather than imaging.
• D: Antibiotics do not address active hemorrhage and are
not first-line in this presentation.
Teaching Point: In suspected intra-abdominal hemorrhage
Collaborative Care (11th Ed.),
Unit II: Emergency Care & Disaster Preparedness.
Medical-Surgical Nursing
11th Edition
• Author(s)Donna D. Ignatavicius; Cherie R. Rebar; Nicole M.
Heimgartner
Reference: Ch. 10: Concepts of Emergency and Trauma Nursing
— Primary Survey and Initial Management
Question Stem: A 42-year-old man arrives by ambulance after a
motor vehicle collision. He is awake, complaining of shortness
of breath, and has obvious chest wall deformity on the left.
During the primary survey, which intervention should the nurse
perform first?
A. Obtain a 12-lead ECG.
B. Apply high-flow oxygen and assess airway/ventilation.
C. Start two large-bore IVs for fluid resuscitation.
D. Perform a focused neurological exam.
,Correct Answer: B
Rationales:
• Correct (B): The primary survey (ABCDE) prioritizes Airway
and Breathing — applying high-flow oxygen and assessing
airway/ventilation takes precedence for a patient with
chest trauma and dyspnea. This stabilizes oxygenation and
identifies life-threatening respiratory compromise.
• A: ECG is important for chest trauma with potential cardiac
injury but is secondary to securing airway/oxygenation.
• C: IV access is necessary but follows immediate airway and
breathing interventions in the primary survey.
• D: Neurologic assessment is part of Disability (D) and
comes after airway, breathing, and circulation are
addressed.
Teaching Point: In trauma, follow ABCs: airway/ventilation
before diagnostics or fluids.
Citation: Ignatavicius, Rebar, & Heimgartner, 11th Ed., Ch.
10: Primary Survey and Initial Management
2
Reference: Ch. 10: Concepts of Emergency and Trauma Nursing
— Chest Trauma Management
Question Stem: A patient with blunt chest trauma has
decreased breath sounds on the left, hypotension, and tracheal
deviation to the right. Which immediate nursing action is most
,appropriate?
A. Prepare for emergent left-sided needle decompression.
B. Apply a nonrebreather mask and observe.
C. Administer IV morphine for chest pain control.
D. Place the patient in Trendelenburg position.
Correct Answer: A
Rationales:
• Correct (A): Signs of tension pneumothorax (hypotension,
tracheal shift, unilateral decreased breath sounds) require
immediate needle decompression before definitive chest
tube placement. Prompt decompression relieves
mediastinal shift and restores circulation.
• B: Oxygen is helpful but inadequate for tension
pneumothorax — procedural decompression is required
emergently.
• C: Analgesia is important but cannot delay life-saving
decompression in tension pneumothorax.
• D: Trendelenburg may worsen respiratory compromise and
is not indicated for tension pneumothorax.
Teaching Point: Tension pneumothorax is treated
immediately with needle decompression.
Citation: Ignatavicius, Rebar, & Heimgartner, 11th Ed., Ch.
10: Chest Trauma
3
, Reference: Ch. 10: Concepts of Emergency and Trauma Nursing
— Hemorrhagic Shock & Circulatory Support
Question Stem: An adult trauma patient in the ED has an SBP of
78 mm Hg, cool extremities, and a distended abdomen after
blunt abdominal trauma. Which action should the nurse
prioritize?
A. Administer a rapid crystalloid bolus and prepare for
emergent laparotomy.
B. Apply abdominal binder and monitor urine output.
C. Obtain abdominal CT with contrast to locate the bleed.
D. Give IV broad-spectrum antibiotics and observe.
Correct Answer: A
Rationales:
• Correct (A): Hypotension with signs of hemorrhagic shock
and distended abdomen suggests intra-abdominal
bleeding. Rapid volume resuscitation and surgical
consultation/preparation for emergent laparotomy are
priorities to control hemorrhage and restore perfusion.
• B: An abdominal binder does not control intra-abdominal
hemorrhage and could mask distention; monitoring urine
output is important but not the priority.
• C: CT requires hemodynamic stability; unstable patients
should proceed to the OR rather than imaging.
• D: Antibiotics do not address active hemorrhage and are
not first-line in this presentation.
Teaching Point: In suspected intra-abdominal hemorrhage
