NUR 2239 Exam 1 study guide Questions With Complete
Solutions
A 19 year old is brought to the emergency department 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) Correct Answers D
A 20 year old patient arrives in the emergency department
several hours after taking "25 to 30" acetaminophen tablets.
Which action will the nurse plan to take?
A. Give N-acetylcysteine (Mucomyst)
B. Discuss the use of chelation therapy
C. Start oxygen using a non-rebreather mask
D. Have the patient drink large amounts of water Correct
Answers A
A 22 year old patient who experience a near drowning accident
in a local pool, but now is awake and breathing spontaneously,
is admitted for observation. Which assessment will be most
important for the nurse to take during the observation period?
A. Auscultate heart sounds
B. Palpate peripheral pulses
C. Auscultate breath sounds
D. Check pupil reaction to light Correct Answers C
,A 28 year old patient who has deep human bite wounds on the
left hand is being treated in the urgent care center. Which action
will the nurse plan to take?
A. Prepare to administer rabies immune globulin (BayRab)
B. Assist the health care provider with suturing of the bite
wounds
C. Teach the patient the reason for the use of prophylactic
antibiotics
D. Keep the wounds dry until the health care provider can assess
them Correct Answers C
A 54 year old patient arrives in the ED after exposure to
powdered lime at work. Which action should the nurse take
first?
A. Obtain the patient's vital signs
B. Obtain a baseline complete blood count
C. Decontaminate the patient by showering with water
D. Brush off any visible powder on the skin and clothing
Correct Answers D
A client who is hospitalized with burns after losing the family
home in a fire becomes angry and screams at a nurse when
dinner is served late. How should the nurse respond?
A. "Do you need something for pain right now?"
B. "Please stop yelling. I brought dinner as soon as I could."
C. "I suggest that you get control of yourself."
D. "You seem upset. I have time to talk if you'd like." Correct
Answers D.
,A family in the emergency department is overwhelmed at the
loss of several family members due to a shooting incident in the
community. Which intervention should the nurse complete first?
a. Provide a calm location for the family to cope and discuss
needs.
b. Call the hospital chaplain to stay with the family and pray for
the deceased.
c. Do not allow visiting of the victims until the bodies are
prepared.
d. Provide privacy for law enforcement to interview the family.
Correct Answers A
A hospital prepares for a mass casualty event. Which functions
are correctly paired with the personnel role? (SATA)
A. Paramedic - decides the number, acuity, and resources needs
of clients
B. hospital incident commander - assumes overall leadership for
implementing the emergency plan
C. Public information officer - provides advanced life support
during transportation to the hospital
D. Triage officer - rapidly evaluates each client to determine
priorities for treatment
E. Medical command physician - serves as a liaison between the
health care facility and the media Correct Answers B, D
A hospital prepares to receive large numbers of casualties from a
community disaster. Which clients should the nurse identify as
appropriate for discharge or transfer to another facility? (SATA)
A. Older adult in the medical decision unit for evaluation of
chest pain
, B. Client who had open reduction and internal fixation of a
femur fracture 3 days ago
C. Client admitted last night with community-acquired
pneumonia
D. Infant who has a fever of unknown origin
E. Client on the medical unit for wound care Correct Answers
B, E
A hospital responds to a local mass casualty event. Which action
should the nurse supervisor take to prevent staff post-traumatic
stress disorder during a mass casualty event?
a. Provide water and healthy snacks for energy throughout the
event.
b. Schedule 16-hour shifts to allow for greater rest between
shifts.
c. Encourage counseling upon deactivation of the emergency
response plan.
d. Assign staff to different roles and units within the medical
facility. Correct Answers A.
A nurse administers topical gentamicin sulfate to a client's burn
injury. Which lab value should the nurse monitor while the
client is prescribed this therapy?
A. Creatinine
B. Red blood cells
C. Sodium
D. Magnesium Correct Answers A
A nurse assess a client who has a burn injury. Which statement
indicates the client has a positive perspective of his or her
appearance?
Solutions
A 19 year old is brought to the emergency department 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) Correct Answers D
A 20 year old patient arrives in the emergency department
several hours after taking "25 to 30" acetaminophen tablets.
Which action will the nurse plan to take?
A. Give N-acetylcysteine (Mucomyst)
B. Discuss the use of chelation therapy
C. Start oxygen using a non-rebreather mask
D. Have the patient drink large amounts of water Correct
Answers A
A 22 year old patient who experience a near drowning accident
in a local pool, but now is awake and breathing spontaneously,
is admitted for observation. Which assessment will be most
important for the nurse to take during the observation period?
A. Auscultate heart sounds
B. Palpate peripheral pulses
C. Auscultate breath sounds
D. Check pupil reaction to light Correct Answers C
,A 28 year old patient who has deep human bite wounds on the
left hand is being treated in the urgent care center. Which action
will the nurse plan to take?
A. Prepare to administer rabies immune globulin (BayRab)
B. Assist the health care provider with suturing of the bite
wounds
C. Teach the patient the reason for the use of prophylactic
antibiotics
D. Keep the wounds dry until the health care provider can assess
them Correct Answers C
A 54 year old patient arrives in the ED after exposure to
powdered lime at work. Which action should the nurse take
first?
A. Obtain the patient's vital signs
B. Obtain a baseline complete blood count
C. Decontaminate the patient by showering with water
D. Brush off any visible powder on the skin and clothing
Correct Answers D
A client who is hospitalized with burns after losing the family
home in a fire becomes angry and screams at a nurse when
dinner is served late. How should the nurse respond?
A. "Do you need something for pain right now?"
B. "Please stop yelling. I brought dinner as soon as I could."
C. "I suggest that you get control of yourself."
D. "You seem upset. I have time to talk if you'd like." Correct
Answers D.
,A family in the emergency department is overwhelmed at the
loss of several family members due to a shooting incident in the
community. Which intervention should the nurse complete first?
a. Provide a calm location for the family to cope and discuss
needs.
b. Call the hospital chaplain to stay with the family and pray for
the deceased.
c. Do not allow visiting of the victims until the bodies are
prepared.
d. Provide privacy for law enforcement to interview the family.
Correct Answers A
A hospital prepares for a mass casualty event. Which functions
are correctly paired with the personnel role? (SATA)
A. Paramedic - decides the number, acuity, and resources needs
of clients
B. hospital incident commander - assumes overall leadership for
implementing the emergency plan
C. Public information officer - provides advanced life support
during transportation to the hospital
D. Triage officer - rapidly evaluates each client to determine
priorities for treatment
E. Medical command physician - serves as a liaison between the
health care facility and the media Correct Answers B, D
A hospital prepares to receive large numbers of casualties from a
community disaster. Which clients should the nurse identify as
appropriate for discharge or transfer to another facility? (SATA)
A. Older adult in the medical decision unit for evaluation of
chest pain
, B. Client who had open reduction and internal fixation of a
femur fracture 3 days ago
C. Client admitted last night with community-acquired
pneumonia
D. Infant who has a fever of unknown origin
E. Client on the medical unit for wound care Correct Answers
B, E
A hospital responds to a local mass casualty event. Which action
should the nurse supervisor take to prevent staff post-traumatic
stress disorder during a mass casualty event?
a. Provide water and healthy snacks for energy throughout the
event.
b. Schedule 16-hour shifts to allow for greater rest between
shifts.
c. Encourage counseling upon deactivation of the emergency
response plan.
d. Assign staff to different roles and units within the medical
facility. Correct Answers A.
A nurse administers topical gentamicin sulfate to a client's burn
injury. Which lab value should the nurse monitor while the
client is prescribed this therapy?
A. Creatinine
B. Red blood cells
C. Sodium
D. Magnesium Correct Answers A
A nurse assess a client who has a burn injury. Which statement
indicates the client has a positive perspective of his or her
appearance?
