NUR 445 EXAM 4 QUESTIONS AND ANSWERS | NUR 445 EXAM
4 STUDY GUIDE & PRACTICE TEST 2026/2027
A nurse is assisting with triaging clients following an explosion. Which of the following clients should the
nurse identify as the highest priority? - ANS ✔✔A conscious adult client who has second-degree burns
on both lower legs; respiratory rate is > 30/min
A charge nurse is discussing the phases of community response to disaster with nursing staff. Which of
the following statements indicates an understanding of the heroic phase of disaster response? - ANS
✔✔"Personnel are willing to work in dangerous conditions to provide assistance."
A nurse is assessing an adolescent who experienced blunt trauma to the abdomen. Which of the
following findings is the nurse's priority? - ANS ✔✔Blood pressure 92/50 mm Hg
A nurse is caring for a client who experienced an open, right femur fracture following a motor-vehicle
crash. - ANS ✔✔The nurse should identify that the client is most likely experiencing compartment
syndrome. Compartment syndrome occurs following a fracture due to increased edema of the extremity
or restriction by a cast or splint. It is identified by the five Ps: pain, pallor, pulselessness, paresthesia, and
paralysis. Compartment syndrome is a medical emergency. The nurse's priorities are to loosen the
dressing to the splint and assess the client's peripheral pulses. A pulse volume recorder may be
necessary to detect the peripheral pulses. The nurse should frequently monitor the client's
neurovascular function to detect any changes that may indicate further progression of compartment
syndrome. The nurse should also monitor and treat the client's pain using prescribed opioids.
A nurse is reviewing treatment protocols for clients exposed to bioterrorism agents. For which of the
following agents should the nurse plan to administer a vaccine following exposure? - ANS ✔✔Smallpox
Which of the following are potential signs or symptoms of internal bleeding caused by a brown recluse
spider bite? - ANS ✔✔Internal bleeding caused by a brown recluse spider bite can manifest as
abdominal pain, black or tarry stools, bloody or dark urine, and chest pain with shortness of breath. Skin
rash and itching, headache and dizziness, joint pain and swelling, numbness and tingling, and fever and
chills are not typically associated with internal bleeding from a spider bite.
A nurse is preparing a response protocol for botulism as a bioterrorism agent. The nurse should prepare
the protocol based on which of the following information? (Select all that apply.) - ANS ✔✔Botulism can
produce paralysis within 12 to 72 hr following exposure is correct. Botulism is a neurotoxin that can
cause flaccid paralysis within hours of exposure. Notify the Centers for Disease Control and Prevention
(CDC) when more than three cases are confirmed is incorrect. Due to the threat of a botulism outbreak,
the CDC should be notified if even a single case is suspected. Botulism is acquired through direct contact
with an infected person is incorrect. Botulism is primarily acquired through ingestion of a contaminated
food source. Vomiting and diarrhea are expected findings following exposure is correct. Vomiting and
diarrhea are expected findings following ingestion of botulism. Botulism is a toxin found in castor beans
is incorrect. Ricin, rather than botulism, is a toxin found in castor beans.
, A nurse is caring for a client who has burns to his face, ears, and eyelids. The nurse should identify which
of the following is the priority finding to report to the provider? - ANS ✔✔Difficulty swallowing
A nurse in an emergency department is caring for a client who has a sucking chest wound resulting from
a gunshot. The client has a blood pressure of 100/60 mm Hg, a weak pulse rate of 118/min, and a
respiratory rate of 40/min. Which of the following actions should the nurse take? - ANS ✔✔Administer
oxygen via nasal cannula.
A community health nurse is teaching a group of community members about natural disasters. Which of
the following information about natural disasters should the nurse include in the teaching? - ANS
✔✔They are geological or meteorological occurrences.
A nurse is among the first responders to a mass-casualty incident and does not know what type of
personal protective equipment (PPE) is needed. Which of the following actions should the nurse take? -
ANS ✔✔Choose the highest level of protection equipment available.
A public health nurse is teaching a group of nurses about smallpox. Which of the following statements by
one of the nurses indicates understanding of the teaching? - ANS ✔✔"Unlike chickenpox, the vesicles of
smallpox are more abundant on the face."
A nurse is admitting a client who sustained severe burn injuries. The nurse refers to the rule of nines to
determine the total body surface area of the burn injury. What percentage of body surface area should
the nurse estimate the client has burned? - ANS ✔✔54%
Which of the following are potential indications for spinal immobilization in clients? - ANS ✔✔Spinal
immobilization is indicated in clients with suspected spinal cord injury and loss of consciousness as these
conditions may be associated with spinal injury. Simple fractures of extremities, acute myocardial
infarction, asthma exacerbation, severe allergic reactions, and acute appendicitis do not require spinal
immobilization unless there is suspicion of associated spinal injury.
A nurse is performing triage for a group of clients following a mass casualty incident (MCI). Which of the
following clients should the nurse plan to care for first? - ANS ✔✔A client experiencing a tension
pneumothorax
When should a client with rib fractures use the incentive spirometer? - ANS ✔✔Every 1 hour while
awake
A burn patient with 20% total body surface area (TBSA) burn is receiving fluid resuscitation. The Parkland
formula is being used to calculate the fluid replacement. The formula recommends administering 4 mL of
lactated Ringer's solution per kilogram of body weight for the first 24 hours, with half of the total volume
given in the first 8 hours. The patient weighs 70 kg. How much lactated Ringer's solution should the
patient receive in the first 8 hours? - ANS ✔✔1400 mL
CORRECT
Correct! According to the Parkland formula, the patient should receive half of the total volume in the
first 8 hours. Therefore, the patient should receive 1400 mL of lactated Ringer's solution in the first 8
hours (70 kg x 20 mL/kg = 1400 mL).
4 STUDY GUIDE & PRACTICE TEST 2026/2027
A nurse is assisting with triaging clients following an explosion. Which of the following clients should the
nurse identify as the highest priority? - ANS ✔✔A conscious adult client who has second-degree burns
on both lower legs; respiratory rate is > 30/min
A charge nurse is discussing the phases of community response to disaster with nursing staff. Which of
the following statements indicates an understanding of the heroic phase of disaster response? - ANS
✔✔"Personnel are willing to work in dangerous conditions to provide assistance."
A nurse is assessing an adolescent who experienced blunt trauma to the abdomen. Which of the
following findings is the nurse's priority? - ANS ✔✔Blood pressure 92/50 mm Hg
A nurse is caring for a client who experienced an open, right femur fracture following a motor-vehicle
crash. - ANS ✔✔The nurse should identify that the client is most likely experiencing compartment
syndrome. Compartment syndrome occurs following a fracture due to increased edema of the extremity
or restriction by a cast or splint. It is identified by the five Ps: pain, pallor, pulselessness, paresthesia, and
paralysis. Compartment syndrome is a medical emergency. The nurse's priorities are to loosen the
dressing to the splint and assess the client's peripheral pulses. A pulse volume recorder may be
necessary to detect the peripheral pulses. The nurse should frequently monitor the client's
neurovascular function to detect any changes that may indicate further progression of compartment
syndrome. The nurse should also monitor and treat the client's pain using prescribed opioids.
A nurse is reviewing treatment protocols for clients exposed to bioterrorism agents. For which of the
following agents should the nurse plan to administer a vaccine following exposure? - ANS ✔✔Smallpox
Which of the following are potential signs or symptoms of internal bleeding caused by a brown recluse
spider bite? - ANS ✔✔Internal bleeding caused by a brown recluse spider bite can manifest as
abdominal pain, black or tarry stools, bloody or dark urine, and chest pain with shortness of breath. Skin
rash and itching, headache and dizziness, joint pain and swelling, numbness and tingling, and fever and
chills are not typically associated with internal bleeding from a spider bite.
A nurse is preparing a response protocol for botulism as a bioterrorism agent. The nurse should prepare
the protocol based on which of the following information? (Select all that apply.) - ANS ✔✔Botulism can
produce paralysis within 12 to 72 hr following exposure is correct. Botulism is a neurotoxin that can
cause flaccid paralysis within hours of exposure. Notify the Centers for Disease Control and Prevention
(CDC) when more than three cases are confirmed is incorrect. Due to the threat of a botulism outbreak,
the CDC should be notified if even a single case is suspected. Botulism is acquired through direct contact
with an infected person is incorrect. Botulism is primarily acquired through ingestion of a contaminated
food source. Vomiting and diarrhea are expected findings following exposure is correct. Vomiting and
diarrhea are expected findings following ingestion of botulism. Botulism is a toxin found in castor beans
is incorrect. Ricin, rather than botulism, is a toxin found in castor beans.
, A nurse is caring for a client who has burns to his face, ears, and eyelids. The nurse should identify which
of the following is the priority finding to report to the provider? - ANS ✔✔Difficulty swallowing
A nurse in an emergency department is caring for a client who has a sucking chest wound resulting from
a gunshot. The client has a blood pressure of 100/60 mm Hg, a weak pulse rate of 118/min, and a
respiratory rate of 40/min. Which of the following actions should the nurse take? - ANS ✔✔Administer
oxygen via nasal cannula.
A community health nurse is teaching a group of community members about natural disasters. Which of
the following information about natural disasters should the nurse include in the teaching? - ANS
✔✔They are geological or meteorological occurrences.
A nurse is among the first responders to a mass-casualty incident and does not know what type of
personal protective equipment (PPE) is needed. Which of the following actions should the nurse take? -
ANS ✔✔Choose the highest level of protection equipment available.
A public health nurse is teaching a group of nurses about smallpox. Which of the following statements by
one of the nurses indicates understanding of the teaching? - ANS ✔✔"Unlike chickenpox, the vesicles of
smallpox are more abundant on the face."
A nurse is admitting a client who sustained severe burn injuries. The nurse refers to the rule of nines to
determine the total body surface area of the burn injury. What percentage of body surface area should
the nurse estimate the client has burned? - ANS ✔✔54%
Which of the following are potential indications for spinal immobilization in clients? - ANS ✔✔Spinal
immobilization is indicated in clients with suspected spinal cord injury and loss of consciousness as these
conditions may be associated with spinal injury. Simple fractures of extremities, acute myocardial
infarction, asthma exacerbation, severe allergic reactions, and acute appendicitis do not require spinal
immobilization unless there is suspicion of associated spinal injury.
A nurse is performing triage for a group of clients following a mass casualty incident (MCI). Which of the
following clients should the nurse plan to care for first? - ANS ✔✔A client experiencing a tension
pneumothorax
When should a client with rib fractures use the incentive spirometer? - ANS ✔✔Every 1 hour while
awake
A burn patient with 20% total body surface area (TBSA) burn is receiving fluid resuscitation. The Parkland
formula is being used to calculate the fluid replacement. The formula recommends administering 4 mL of
lactated Ringer's solution per kilogram of body weight for the first 24 hours, with half of the total volume
given in the first 8 hours. The patient weighs 70 kg. How much lactated Ringer's solution should the
patient receive in the first 8 hours? - ANS ✔✔1400 mL
CORRECT
Correct! According to the Parkland formula, the patient should receive half of the total volume in the
first 8 hours. Therefore, the patient should receive 1400 mL of lactated Ringer's solution in the first 8
hours (70 kg x 20 mL/kg = 1400 mL).
