emergency nursing, Critical Care Exam 1
Questions, RN Introduction to Critical Care
and Emergency Nursing Assessment ,
PeriOperative Practice Test, Integumentary
ACTUAL QUESTIONS AND CORRECT
ANSWERS
An unresponsive patient is admitted to the emergency department (ED) after
falling through the ice while ice skating. Which assessment will the nurse obtain
first? - CORRECT ANSWERS Pulse
During the primary assessment of a victim of a motor vehicle collision, the
nurse determines that the patient has an unobstructed airway. Which action
should the nurse take next? - CORRECT ANSWERS Observe the
patient's respiratory effort.
During the primary survey of a patient with severe leg trauma, the nurse
observes that the patient's left pedal and posterior tibial pulses are absent, and
the entire leg is swollen. Which action will the nurse take next? - CORRECT
ANSWERS Start normal saline fluid infusion with a large-bore IV line.
After the return of spontaneous circulation following the resuscitation of a
patient who had a cardiac arrest, therapeutic hypothermia is prescribed. Which
action will the nurse include in the plan of care? - CORRECT ANSWERS
Initiate cooling per protocol.
A patient who is unconscious after a fall from a ladder is transported to the
emergency department by emergency medical personnel. What should the nurse
do during the primary survey of the patient? - CORRECT ANSWERS
Check a Glasgow Coma Scale score.
,A 19-yr-old patient is brought to the emergency department (ED) with multiple
lacerations and tissue avulsion of the left hand. When asked about tetanus
immunization, the patient denies having any previous vaccinations. What should
the nurse anticipate giving? - CORRECT ANSWERS TIG and tetanus-
diphtheria toxoid and pertussis vaccine (Tdap)
A patient who has experienced blunt abdominal trauma during a motor vehicle
collision reports increasing abdominal pain. What topic will the nurse plan to
teach the patient? - CORRECT ANSWERS Abdominal ultrasonography
A patient with hypotension and an elevated temperature after working outside
on a hot day is treated in the emergency department (ED). Which patient
statement indicates to the nurse that discharge teaching has been effective? -
CORRECT ANSWERS "I need to drink extra fluids when working
outside in hot weather."
A 22-yr-old patient who experienced a 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? - CORRECT ANSWERS Auscultate breath sounds.
When requested to plan the response to the potential use of smallpox as a
biological weapon, what should the emergency department (ED) nurse manager
expect to obtain? - CORRECT ANSWERS Vaccine
Which finding indicates that the nurse should discontinue active rewarming of a
patient admitted with hypothermia? - CORRECT ANSWERS The core
temperature is 94° F (34.4° C).
When assessing an older patient admitted to the emergency department (ED)
with a broken arm and facial bruises, the nurse observes several additional
bruises in various stages of healing. Which statement or question by the nurse
should be first? - CORRECT ANSWERS "Do you feel safe at home?"
,A patient arrives in the emergency department (ED) several hours after taking
"25 to 30" acetaminophen (Tylenol) tablets. Which action will the nurse plan to
take? - CORRECT ANSWERS Give N-acetylcysteine.
N-acetylcysteine is the recommended treatment to prevent liver damage after
acetaminophen overdose.
A triage nurse in a busy emergency department (ED) assesses a patient who
reports 7/10 abdominal pain and states, "I had a temperature of 103.9° F (39.9°
C) at home." What should be the nurse's first action? - CORRECT ANSWERS
Assess the patient's current vital signs.
The emergency department (ED) triage nurse is assessing four victims involved
in a motor vehicle collision. Which patient has the highest priority for
treatment? - CORRECT ANSWERS A patient with paradoxical chest
motion
Most immediate deaths from trauma occur because of problems with
ventilation, so the patient with paradoxical chest movements should be treated
first. Face and head fractures can obstruct the airway, but the patient with facial
injuries only has lacerations. The other two patients also need rapid intervention
but do not have airway or breathing problems.
The following interventions are part of the emergency department (ED) protocol
for a patient who has been admitted with multiple bee stings to the hands.
Which action should the nurse take first? - CORRECT ANSWERS
Attempt to remove the patient's rings.
, Gastric lavage and administration of activated charcoal are prescribed for an
unconscious patient who has been admitted to the emergency department (ED)
after ingesting 30 lorazepam (Ativan) tablets. Which prescribed action should
the nurse plan to do first? - CORRECT ANSWERS Assist with
intubation of the patient.
In an unresponsive patient, intubation is done before gastric lavage and
activated charcoal administration to prevent aspiration
A patient arrives in the emergency department (ED) after topical exposure to
powdered lime at work. Which action should the nurse take first? - CORRECT
ANSWERS Brush visible powder from the skin and clothing.
An unresponsive 79-yr-old patient is admitted to the emergency department
(ED) during a
summer heat wave. The patient's core temperature is 105.4° F (40.8° C), blood
pressure (BP) is 88/50 mm Hg, and pulse is 112 beats/min. What action should
the nurse plan to take? - CORRECT ANSWERS Apply wet sheets and a
fan to the patient.
Following an earthquake, patients are triaged by emergency medical personnel
and transported to the emergency department (ED). Which patient will the nurse
need to assess first? - CORRECT ANSWERS A patient with a red tag
The red tag indicates a patient with a life-threatening injury requiring rapid
treatment. The other tags indicate patients with less urgent injuries or those who
are likely to die.
Family members are in the patient's room when the patient has a cardiac arrest
and the staff start resuscitation measures. Which action should the nurse take
next? - CORRECT ANSWERS Ask the family members whether they
would prefer to remain in the patient's room
Questions, RN Introduction to Critical Care
and Emergency Nursing Assessment ,
PeriOperative Practice Test, Integumentary
ACTUAL QUESTIONS AND CORRECT
ANSWERS
An unresponsive patient is admitted to the emergency department (ED) after
falling through the ice while ice skating. Which assessment will the nurse obtain
first? - CORRECT ANSWERS Pulse
During the primary assessment of a victim of a motor vehicle collision, the
nurse determines that the patient has an unobstructed airway. Which action
should the nurse take next? - CORRECT ANSWERS Observe the
patient's respiratory effort.
During the primary survey of a patient with severe leg trauma, the nurse
observes that the patient's left pedal and posterior tibial pulses are absent, and
the entire leg is swollen. Which action will the nurse take next? - CORRECT
ANSWERS Start normal saline fluid infusion with a large-bore IV line.
After the return of spontaneous circulation following the resuscitation of a
patient who had a cardiac arrest, therapeutic hypothermia is prescribed. Which
action will the nurse include in the plan of care? - CORRECT ANSWERS
Initiate cooling per protocol.
A patient who is unconscious after a fall from a ladder is transported to the
emergency department by emergency medical personnel. What should the nurse
do during the primary survey of the patient? - CORRECT ANSWERS
Check a Glasgow Coma Scale score.
,A 19-yr-old patient is brought to the emergency department (ED) with multiple
lacerations and tissue avulsion of the left hand. When asked about tetanus
immunization, the patient denies having any previous vaccinations. What should
the nurse anticipate giving? - CORRECT ANSWERS TIG and tetanus-
diphtheria toxoid and pertussis vaccine (Tdap)
A patient who has experienced blunt abdominal trauma during a motor vehicle
collision reports increasing abdominal pain. What topic will the nurse plan to
teach the patient? - CORRECT ANSWERS Abdominal ultrasonography
A patient with hypotension and an elevated temperature after working outside
on a hot day is treated in the emergency department (ED). Which patient
statement indicates to the nurse that discharge teaching has been effective? -
CORRECT ANSWERS "I need to drink extra fluids when working
outside in hot weather."
A 22-yr-old patient who experienced a 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? - CORRECT ANSWERS Auscultate breath sounds.
When requested to plan the response to the potential use of smallpox as a
biological weapon, what should the emergency department (ED) nurse manager
expect to obtain? - CORRECT ANSWERS Vaccine
Which finding indicates that the nurse should discontinue active rewarming of a
patient admitted with hypothermia? - CORRECT ANSWERS The core
temperature is 94° F (34.4° C).
When assessing an older patient admitted to the emergency department (ED)
with a broken arm and facial bruises, the nurse observes several additional
bruises in various stages of healing. Which statement or question by the nurse
should be first? - CORRECT ANSWERS "Do you feel safe at home?"
,A patient arrives in the emergency department (ED) several hours after taking
"25 to 30" acetaminophen (Tylenol) tablets. Which action will the nurse plan to
take? - CORRECT ANSWERS Give N-acetylcysteine.
N-acetylcysteine is the recommended treatment to prevent liver damage after
acetaminophen overdose.
A triage nurse in a busy emergency department (ED) assesses a patient who
reports 7/10 abdominal pain and states, "I had a temperature of 103.9° F (39.9°
C) at home." What should be the nurse's first action? - CORRECT ANSWERS
Assess the patient's current vital signs.
The emergency department (ED) triage nurse is assessing four victims involved
in a motor vehicle collision. Which patient has the highest priority for
treatment? - CORRECT ANSWERS A patient with paradoxical chest
motion
Most immediate deaths from trauma occur because of problems with
ventilation, so the patient with paradoxical chest movements should be treated
first. Face and head fractures can obstruct the airway, but the patient with facial
injuries only has lacerations. The other two patients also need rapid intervention
but do not have airway or breathing problems.
The following interventions are part of the emergency department (ED) protocol
for a patient who has been admitted with multiple bee stings to the hands.
Which action should the nurse take first? - CORRECT ANSWERS
Attempt to remove the patient's rings.
, Gastric lavage and administration of activated charcoal are prescribed for an
unconscious patient who has been admitted to the emergency department (ED)
after ingesting 30 lorazepam (Ativan) tablets. Which prescribed action should
the nurse plan to do first? - CORRECT ANSWERS Assist with
intubation of the patient.
In an unresponsive patient, intubation is done before gastric lavage and
activated charcoal administration to prevent aspiration
A patient arrives in the emergency department (ED) after topical exposure to
powdered lime at work. Which action should the nurse take first? - CORRECT
ANSWERS Brush visible powder from the skin and clothing.
An unresponsive 79-yr-old patient is admitted to the emergency department
(ED) during a
summer heat wave. The patient's core temperature is 105.4° F (40.8° C), blood
pressure (BP) is 88/50 mm Hg, and pulse is 112 beats/min. What action should
the nurse plan to take? - CORRECT ANSWERS Apply wet sheets and a
fan to the patient.
Following an earthquake, patients are triaged by emergency medical personnel
and transported to the emergency department (ED). Which patient will the nurse
need to assess first? - CORRECT ANSWERS A patient with a red tag
The red tag indicates a patient with a life-threatening injury requiring rapid
treatment. The other tags indicate patients with less urgent injuries or those who
are likely to die.
Family members are in the patient's room when the patient has a cardiac arrest
and the staff start resuscitation measures. Which action should the nurse take
next? - CORRECT ANSWERS Ask the family members whether they
would prefer to remain in the patient's room
