Chapter 71- Emergency Nursing

Chapter 71- Emergency Nursing Brunner: Medical-Surgical Nursing, 11th Edition Test Bank Chapter 71: Emergency Nursing Multiple Choice 1. Which patient would 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 that 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 confusion Ans: A Chapter: 71 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Patient Needs: A-1 Feedback: The patient with blunt chest trauma possibly has a compromised airway. An emergent situation is potentially life-threatening. 2. The nurse notes that the family members of a patient who was injured in an accident are blaming each other for the event. The nurse appropriately lets the family members express their remorse, while explaining that there was probably little they could do to prevent the injury. The family is in which stage of crisis? A) Anxiety and denial B) Remorse and guilt C) Anger D) Grief Ans: B Chapter: 71 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing Process Objective: 1 Patient Needs: C-2 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. 3. The physician notes that an unconscious patient brought to the emergency room needs emergency surgery. No family members are present, and the patient does not have identification. Which of the following actions by the nurse is most important regarding obtaining consent to examine and treat the patient? A) Ask the social worker to come and sign the consent. B) Contact the police to obtain the patient's identity. C) Obtain a court order to treat the patient. D) Document in the patient's chart the level of consciousness and health status of patient. Ans: D Chapter: 71 Cognitive Level: Application Difficulty: Moderate Integrated Process: Documentation/Communication Objective: 2 Patient Needs: A-2 Feedback: When a patient is unconscious and in critical condition, the level of consciousness and health status of the patient should be documented so that treatment can be quickly administered when consent cannot be obtained by usual routes. 4. The patient is experiencing respiratory insufficiency and is unable to maintain spontaneous respirations. The nurse expects that the physician will perform or insert which of the following airway management techniques or devices? A) Oropharyngeal airway B) Jaw thrust maneuver C) Endotracheal intubation D) Cricothyroidotomy Ans: C Chapter: 71 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Patient Needs: A-1 Feedback: Endotracheal tubes are used in cases when the patient cannot be ventilated with an oropharyngeal airway. The latter is used in patients who are breathing spontaneously. 5. The most appropriate nursing diagnosis for a patient who has difficulty maintaining a patent airway due to hemorrhage in the oral cavity would be: A) Ineffective airway clearance B) Impaired swallowing C) Risk for trauma D) Ineffective individual coping Ans: A Chapter: 71 Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Patient Needs: D-4 Feedback: Ineffective airway clearance describes difficulty with maintaining a patent airway.