NR 341-NR341 Complex Adult Health
Exam 1 2025/2026 UPDATE | QUESTIONS
WITH 100% VERIFIED CORRECT
ANSWERS | CERTIFIED TEST BANK
SOLUTIONS GRADE A+.
______________________________________________________________________________
1. An emergency room nurse assesses a client who has been raped. With which health care
team member
should the nurse collaborate when planning this clients care?
a. Emergency medicine physician
b. Case manager
c. Forensic nurse examiner
d. Psychiatric crisis nurse
ANS: C
All other members of the health care team listed may be used in the management of this clients
care. However,
the forensic nurse examiner is educated to obtain client histories and collect evidence dealing
with the assault,
and can offer the counseling and follow-up needed when dealing with the victim of an assault.
DIF: Understanding/Comprehension REF: 118
KEY: Interdisciplinary team| emergency nursing
MSC: Integrated Process: Nursing Process: Planning
NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care
2. The emergency department team is performing cardiopulmonary resuscitation on a client
when the clients
spouse arrives at the emergency department. Which action should the nurse take first?
a. Request that the clients spouse sit in the waiting room.
b. Ask the spouse if he wishes to be present during the resuscitation.
c. Suggest that the spouse begin to pray for the client.
d. Refer the clients spouse to the hospitals crisis team.
ANS: B
If resuscitation efforts are still under way when the family arrives, one or two family members
may be given
the opportunity to be present during lifesaving procedures. The other options do not give the
spouse the
,opportunity to be present for the client or to begin to have closure.
DIF: Applying/Application REF: 126
KEY: Death| emergency nursing MSC: Integrated Process: Caring
NOT: Client Needs Category: Psychosocial Integrity
3. An emergency room nurse is triaging victims of a multi-casualty event. Which client should
receive care
first?
a. A 30-year-old distraught mother holding her crying child
b. A 65-year-old conscious male with a head laceration
c. A 26-year-old male who has pale, cool, clammy skin
d. A 48-year-old with a simple fracture of the lower leg
ANS: C
The client with pale, cool, clammy skin is in shock and needs immediate medical attention. The
mother does
not have injuries and so would be the lowest priority. The other two people need medical
attention soon, but
not at the expense of a person in shock.
DIF: Applying/Application REF: 129
KEY: Triage| emergency nursing
MSC: Integrated Process: Nursing Process: Implementation
NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care
4. While triaging clients in a crowded emergency department, a nurse assesses a client who
presents with
symptoms of tuberculosis. Which action should the nurse take first?
a. Apply oxygen via nasal cannula.
b. Administer intravenous 0.9% saline solution.
c. Transfer the client to a negative-pressure room.
d. Obtain a sputum culture and sensitivity.
ANS: C
A client with signs and symptoms of tuberculosis or other airborne pathogens should be placed
in a negativepressure room to prevent contamination of staff, clients, and family members in
the crowded emergency
department.
DIF: Applying/Application REF: 120
KEY: Infection control| Transmission-Based Precautions| emergency nursing| staff safety
MSC: Integrated Process: Nursing Process: Implementation
NOT: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control
5. A nurse is triaging clients in the emergency department (ED). Which client should the nurse
prioritize to
receive care first?
a. A 22-year-old with a painful and swollen right wrist
b. A 45-year-old reporting chest pain and diaphoresis
c. A 60-year-old reporting difficulty swallowing and nausea
d. An 81-year-old with a respiratory rate of 28 breaths/min and a temperature of 101 F
,ANS: B
A client experiencing chest pain and diaphoresis would be classified as emergent and would be
triaged
immediately to a treatment room in the ED. The other clients are more stable.
DIF: Applying/Application REF: 123
KEY: Triage| emergency nursing
MSC: Integrated Process: Nursing Process: Planning
NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care
6. A nurse is evaluating levels and functions of trauma centers. Which function is
appropriately paired with the
level of the trauma center?
a. Level I Located within remote areas and provides advanced life support within resource
capabilities
b. Level II Located within community hospitals and provides care to most injured clients
c. Level III Located in rural communities and provides only basic care to clients
d. Level IV Located in large teaching hospitals and provides a full continuum of trauma care for
all clients
ANS: B
Level I trauma centers are usually located in large teaching hospital systems and provide a full
continuum of
trauma care for all clients. Both Level II and Level III facilities are usually located in community
hospitals.
These trauma centers provide care for most clients and transport to Level I centers when client
needs exceed
resource capabilities. Level IV trauma centers are usually located in rural and remote areas.
These centers
provide basic care, stabilization, and advanced life support while transfer arrangements to
higher-level trauma
centers are made.
DIF: Remembering/Knowledge REF: 127
KEY: Trauma center| emergency nursing
MSC: Integrated Process: Nursing Process: Planning
NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care
7. Emergency medical technicians arrive at the emergency department with an unresponsive
client who has an
oxygen mask in place. Which action should the nurse take first?
a. Assess that the client is breathing adequately.
b. Insert a large-bore intravenous line.
c. Place the client on a cardiac monitor.
d. Assess for the best neurologic response.
ANS: A
The highest-priority intervention in the primary survey is to establish that the client is breathing
adequately.
Even though this client has an oxygen mask on, he or she may not be breathing, or may be
, breathing
inadequately with the device in place.
Test Bank - Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care 9e 51
DIF: Applying/Application REF: 128
KEY: Primary survey| emergency nursing
MSC: Integrated Process: Nursing Process: Assessment
NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care
8. A trauma client with multiple open wounds is brought to the emergency department in
cardiac arrest. Which
action should the nurse take prior to providing advanced cardiac life support?
a. Contact the on-call orthopedic surgeon.
b. Don personal protective equipment.
c. Notify the Rapid Response Team.
d. Obtain a complete history from the paramedic.
ANS: B
Nurses must recognize and plan for a high risk of contamination with blood and body fluids
when engaging in
trauma resuscitation. Standard Precautions should be taken in all resuscitation situations and at
other times
when exposure to blood and body fluids is likely. Proper attire consists of an impervious cover
gown, gloves,
eye protection, a facemask, a surgical cap, and shoe covers.
DIF: Applying/Application REF: 128
KEY: Infection control| Standard Precautions| emergency nursing| staff safety
MSC: Integrated Process: Nursing Process: Planning
NOT: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control
9. A nurse is triaging clients in the emergency department. Which client should be considered
urgent?
a. A 20-year-old female with a chest stab wound and tachycardia
b. A 45-year-old homeless man with a skin rash and sore throat
c. A 75-year-old female with a cough and a temperature of 102 F
d. A 50-year-old male with new-onset confusion and slurred speech
ANS: C
A client with a cough and a temperature of 102 F is urgent. This client is at risk for deterioration
and needs to
be seen quickly, but is not in an immediately life-threatening situation. The client with a chest
stab wound and
tachycardia and the client with new-onset confusion and slurred speech should be triaged as
emergent. The
client with a skin rash and a sore throat is not at risk for deterioration and would be triaged as
nonurgent.
DIF: Applying/Application REF: 124
KEY: Triage| emergency nursing
Exam 1 2025/2026 UPDATE | QUESTIONS
WITH 100% VERIFIED CORRECT
ANSWERS | CERTIFIED TEST BANK
SOLUTIONS GRADE A+.
______________________________________________________________________________
1. An emergency room nurse assesses a client who has been raped. With which health care
team member
should the nurse collaborate when planning this clients care?
a. Emergency medicine physician
b. Case manager
c. Forensic nurse examiner
d. Psychiatric crisis nurse
ANS: C
All other members of the health care team listed may be used in the management of this clients
care. However,
the forensic nurse examiner is educated to obtain client histories and collect evidence dealing
with the assault,
and can offer the counseling and follow-up needed when dealing with the victim of an assault.
DIF: Understanding/Comprehension REF: 118
KEY: Interdisciplinary team| emergency nursing
MSC: Integrated Process: Nursing Process: Planning
NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care
2. The emergency department team is performing cardiopulmonary resuscitation on a client
when the clients
spouse arrives at the emergency department. Which action should the nurse take first?
a. Request that the clients spouse sit in the waiting room.
b. Ask the spouse if he wishes to be present during the resuscitation.
c. Suggest that the spouse begin to pray for the client.
d. Refer the clients spouse to the hospitals crisis team.
ANS: B
If resuscitation efforts are still under way when the family arrives, one or two family members
may be given
the opportunity to be present during lifesaving procedures. The other options do not give the
spouse the
,opportunity to be present for the client or to begin to have closure.
DIF: Applying/Application REF: 126
KEY: Death| emergency nursing MSC: Integrated Process: Caring
NOT: Client Needs Category: Psychosocial Integrity
3. An emergency room nurse is triaging victims of a multi-casualty event. Which client should
receive care
first?
a. A 30-year-old distraught mother holding her crying child
b. A 65-year-old conscious male with a head laceration
c. A 26-year-old male who has pale, cool, clammy skin
d. A 48-year-old with a simple fracture of the lower leg
ANS: C
The client with pale, cool, clammy skin is in shock and needs immediate medical attention. The
mother does
not have injuries and so would be the lowest priority. The other two people need medical
attention soon, but
not at the expense of a person in shock.
DIF: Applying/Application REF: 129
KEY: Triage| emergency nursing
MSC: Integrated Process: Nursing Process: Implementation
NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care
4. While triaging clients in a crowded emergency department, a nurse assesses a client who
presents with
symptoms of tuberculosis. Which action should the nurse take first?
a. Apply oxygen via nasal cannula.
b. Administer intravenous 0.9% saline solution.
c. Transfer the client to a negative-pressure room.
d. Obtain a sputum culture and sensitivity.
ANS: C
A client with signs and symptoms of tuberculosis or other airborne pathogens should be placed
in a negativepressure room to prevent contamination of staff, clients, and family members in
the crowded emergency
department.
DIF: Applying/Application REF: 120
KEY: Infection control| Transmission-Based Precautions| emergency nursing| staff safety
MSC: Integrated Process: Nursing Process: Implementation
NOT: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control
5. A nurse is triaging clients in the emergency department (ED). Which client should the nurse
prioritize to
receive care first?
a. A 22-year-old with a painful and swollen right wrist
b. A 45-year-old reporting chest pain and diaphoresis
c. A 60-year-old reporting difficulty swallowing and nausea
d. An 81-year-old with a respiratory rate of 28 breaths/min and a temperature of 101 F
,ANS: B
A client experiencing chest pain and diaphoresis would be classified as emergent and would be
triaged
immediately to a treatment room in the ED. The other clients are more stable.
DIF: Applying/Application REF: 123
KEY: Triage| emergency nursing
MSC: Integrated Process: Nursing Process: Planning
NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care
6. A nurse is evaluating levels and functions of trauma centers. Which function is
appropriately paired with the
level of the trauma center?
a. Level I Located within remote areas and provides advanced life support within resource
capabilities
b. Level II Located within community hospitals and provides care to most injured clients
c. Level III Located in rural communities and provides only basic care to clients
d. Level IV Located in large teaching hospitals and provides a full continuum of trauma care for
all clients
ANS: B
Level I trauma centers are usually located in large teaching hospital systems and provide a full
continuum of
trauma care for all clients. Both Level II and Level III facilities are usually located in community
hospitals.
These trauma centers provide care for most clients and transport to Level I centers when client
needs exceed
resource capabilities. Level IV trauma centers are usually located in rural and remote areas.
These centers
provide basic care, stabilization, and advanced life support while transfer arrangements to
higher-level trauma
centers are made.
DIF: Remembering/Knowledge REF: 127
KEY: Trauma center| emergency nursing
MSC: Integrated Process: Nursing Process: Planning
NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care
7. Emergency medical technicians arrive at the emergency department with an unresponsive
client who has an
oxygen mask in place. Which action should the nurse take first?
a. Assess that the client is breathing adequately.
b. Insert a large-bore intravenous line.
c. Place the client on a cardiac monitor.
d. Assess for the best neurologic response.
ANS: A
The highest-priority intervention in the primary survey is to establish that the client is breathing
adequately.
Even though this client has an oxygen mask on, he or she may not be breathing, or may be
, breathing
inadequately with the device in place.
Test Bank - Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care 9e 51
DIF: Applying/Application REF: 128
KEY: Primary survey| emergency nursing
MSC: Integrated Process: Nursing Process: Assessment
NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care
8. A trauma client with multiple open wounds is brought to the emergency department in
cardiac arrest. Which
action should the nurse take prior to providing advanced cardiac life support?
a. Contact the on-call orthopedic surgeon.
b. Don personal protective equipment.
c. Notify the Rapid Response Team.
d. Obtain a complete history from the paramedic.
ANS: B
Nurses must recognize and plan for a high risk of contamination with blood and body fluids
when engaging in
trauma resuscitation. Standard Precautions should be taken in all resuscitation situations and at
other times
when exposure to blood and body fluids is likely. Proper attire consists of an impervious cover
gown, gloves,
eye protection, a facemask, a surgical cap, and shoe covers.
DIF: Applying/Application REF: 128
KEY: Infection control| Standard Precautions| emergency nursing| staff safety
MSC: Integrated Process: Nursing Process: Planning
NOT: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control
9. A nurse is triaging clients in the emergency department. Which client should be considered
urgent?
a. A 20-year-old female with a chest stab wound and tachycardia
b. A 45-year-old homeless man with a skin rash and sore throat
c. A 75-year-old female with a cough and a temperature of 102 F
d. A 50-year-old male with new-onset confusion and slurred speech
ANS: C
A client with a cough and a temperature of 102 F is urgent. This client is at risk for deterioration
and needs to
be seen quickly, but is not in an immediately life-threatening situation. The client with a chest
stab wound and
tachycardia and the client with new-onset confusion and slurred speech should be triaged as
emergent. The
client with a skin rash and a sore throat is not at risk for deterioration and would be triaged as
nonurgent.
DIF: Applying/Application REF: 124
KEY: Triage| emergency nursing
