Module 4 questions
1. The director mentions the initial notification the ED will receive from
an external source. Which of the following information should the
nurse expect that the ED will learn when they receive the initial
notification about the incident?
Select all that apply.
A
Type of incident
B
Estimated number of casualties
C
Type of injuries to expect
D
Estimated time to activate the phone tree
E
The plan for traffic control
F
The plan for rescheduling elective surgeries
2. The director discusses the placement of clients from the mass
casualty in hospital areas based on the colors of their triage tags.
Match the color of the tag with the client on whom the triage nurse
will place the tag.
Drag the options on the left to their match on the right (or match pairs by first selecting the
option on the left and then selecting its match on the right).
Client who has burns and a spinal cord injury
Red tag
Client who has deep lacerations and fractures
Yellow tag
Client who has agonal respirations
Black tag
Client who has superficial lacerations and a sprain
Green tag
,Module 4 questions
3. A nurse is participating in the daily intensive care unit (ICU) rounds
using the ABCDEF tool to assess a critically ill client. Which of the
following actions should the nurse take during the rounds?
Select all that apply.
A
Report the client's current status, including changes in physical and mental
functioning over the previous 24 hours.
B
Discuss the client's response to medications used to treat pain, agitation,
and delirium.
C
Provide an update on the client's nutritional status and intake.
D
Conduct a spontaneous awakening trial by stopping sedatives and narcotics
as prescribed.
E
Increase the dose of sedatives if the client shows signs of agitation during
the weaning process from the ventilator.
4. Which of the following clients is at the highest risk for developing delirium in the ICU?
A
35-year-old client who is postoperative after an axillofemoral bypass graft
B
78-year-old client who is being treated for pneumonia with possible sepsis
C
55-year-old client who is postoperative following catheter ablation for
supraventricular tachycardia
D
65-year-old client who has myocardial infarction and is postoperative following
stent placement
5. The ED nurse is triaging five clients. Match the client situations with the
appropriate triage level.
Drag the options on the left to the corresponding category on the right (or select the option on the left and then
the corresponding category on the right).
Level 1—Resuscitation
Client has systolic BP 56.
Level 2—High risk
Client requires oxygen at 6 L/min.
Level 3—Two resources needed
Client requires IV fluids and chest x-ray.
Level 4—One resource needed
, Module 4 questions
Client requires an ECG.
Level 5—No resources needed
Client requires admission assessment.
6. A nurse is performing the primary survey of a trauma client in the
emergency department. Place the following steps of the ABCDE
assessment in the correct order that the nurse should perform them.
Drag the options on the left to the corresponding category on the right (or click the option on
the left and then the corresponding category on the right).
1
Assess mouth, larynx, pharynx, trachea, bronchi, and bronchioles for
potential obstruction or aspiration.
2
Assess for respiratory distress, rate, oxygen saturation, and chest
movement.
3
Assess heart function and blood vessels for signs of cardiac arrest or
hemorrhage.
4
Assess neurological status using the AVPU scale.
5
Assess for injuries and preserve any evidence such as clothing or weapons.
7. Which of the following is the primary reason that a client who has
experienced a sexual assault may choose not to report the assault?
A
Fear of stigma
B
Unable to prove that assault happened
C
Concern for retribution
D
Being unsure that the assault was a crime
1. The director mentions the initial notification the ED will receive from
an external source. Which of the following information should the
nurse expect that the ED will learn when they receive the initial
notification about the incident?
Select all that apply.
A
Type of incident
B
Estimated number of casualties
C
Type of injuries to expect
D
Estimated time to activate the phone tree
E
The plan for traffic control
F
The plan for rescheduling elective surgeries
2. The director discusses the placement of clients from the mass
casualty in hospital areas based on the colors of their triage tags.
Match the color of the tag with the client on whom the triage nurse
will place the tag.
Drag the options on the left to their match on the right (or match pairs by first selecting the
option on the left and then selecting its match on the right).
Client who has burns and a spinal cord injury
Red tag
Client who has deep lacerations and fractures
Yellow tag
Client who has agonal respirations
Black tag
Client who has superficial lacerations and a sprain
Green tag
,Module 4 questions
3. A nurse is participating in the daily intensive care unit (ICU) rounds
using the ABCDEF tool to assess a critically ill client. Which of the
following actions should the nurse take during the rounds?
Select all that apply.
A
Report the client's current status, including changes in physical and mental
functioning over the previous 24 hours.
B
Discuss the client's response to medications used to treat pain, agitation,
and delirium.
C
Provide an update on the client's nutritional status and intake.
D
Conduct a spontaneous awakening trial by stopping sedatives and narcotics
as prescribed.
E
Increase the dose of sedatives if the client shows signs of agitation during
the weaning process from the ventilator.
4. Which of the following clients is at the highest risk for developing delirium in the ICU?
A
35-year-old client who is postoperative after an axillofemoral bypass graft
B
78-year-old client who is being treated for pneumonia with possible sepsis
C
55-year-old client who is postoperative following catheter ablation for
supraventricular tachycardia
D
65-year-old client who has myocardial infarction and is postoperative following
stent placement
5. The ED nurse is triaging five clients. Match the client situations with the
appropriate triage level.
Drag the options on the left to the corresponding category on the right (or select the option on the left and then
the corresponding category on the right).
Level 1—Resuscitation
Client has systolic BP 56.
Level 2—High risk
Client requires oxygen at 6 L/min.
Level 3—Two resources needed
Client requires IV fluids and chest x-ray.
Level 4—One resource needed
, Module 4 questions
Client requires an ECG.
Level 5—No resources needed
Client requires admission assessment.
6. A nurse is performing the primary survey of a trauma client in the
emergency department. Place the following steps of the ABCDE
assessment in the correct order that the nurse should perform them.
Drag the options on the left to the corresponding category on the right (or click the option on
the left and then the corresponding category on the right).
1
Assess mouth, larynx, pharynx, trachea, bronchi, and bronchioles for
potential obstruction or aspiration.
2
Assess for respiratory distress, rate, oxygen saturation, and chest
movement.
3
Assess heart function and blood vessels for signs of cardiac arrest or
hemorrhage.
4
Assess neurological status using the AVPU scale.
5
Assess for injuries and preserve any evidence such as clothing or weapons.
7. Which of the following is the primary reason that a client who has
experienced a sexual assault may choose not to report the assault?
A
Fear of stigma
B
Unable to prove that assault happened
C
Concern for retribution
D
Being unsure that the assault was a crime
