EMERGENCY NURSING
COMPREHENSIVE EXAMINATION
QUESTIONS AND CORRECT ANSWERS
3 - ANSWERS-
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1. The ED nurse is caring for a client diagnosed with multiple rib fractures. Which
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data should the nurse include in the assessment?
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1. Level of orientation to time and place.
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2. Current use and last dose of medication.
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3. Symmetrical movement of the chest.
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4. Time of last meal the client ate.
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1 - ANSWERS-
5f 5f
2. The nurse is caring for a client in the ED with abdominal trauma who has had
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peritoneal lavage. Which intervention should the nurse include in the plan of care?
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1. Assess for the presence of blood, bile, or feces.
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2. Palpate the client for bilateral femoral pulses.
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3. Perform Leopold's maneuver every eight (8) hours.
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4. Collect information on the client's dietary history.
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3 - ANSWERS-
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3. The elderly client is brought to the ED complaining of cramps, headache, and
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weakness after working outside in the sun. The telemetry shows sinus tachycardia.
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Which intervention should the nurse implement?
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1. Determine if the client is experiencing any thirst.
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2. Administer D5W intravenously at 250 mL/hr.
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3. Maintain a cool environment to promote rest.
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4. Withhold the client's oral intake.
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4 - ANSWERS-4. The ED nurse is caring for a client who suffered a near-
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drowning. Which expected 5f 5f
outcome should the nurse include in the plan of care for this client?
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1. Maintain the client's cardiac function.
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2. Promote a continued decrease in lung surfactant.
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3. Warm rapidly to minimize the effects of hypothermia.
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4. Keep the oxygen saturation level above 93%.
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1 - ANSWERS-5. The nurse is assessing the client who suffered a near-
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drowning event. Which data 5f 5f 5f
require immediate intervention? 5f 5f
1. The onset of pink, frothy sputum.
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2. An oral temperature of 97˚F.
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3. An alcohol level of 100 mg/dL.
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4. A heart rate of 100 beats/min.
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, 3 - ANSWERS-
5f 5f
6. A nurse is at the lake when a person nearly drowns. The nurse determines the clie
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nt
is breathing spontaneously. Which data should the nurse assess next?
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1. Possibility of drug use.
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2. Spinal cord injury.
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3. Level of confusion.
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4. Amount of alcohol.
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4 - ANSWERS-
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7. The ED nurse is caring for a male client admitted with carbon monoxide poisoning.
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Which intervention requires the nurse to notify the Rapid Response Team?
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1. The client has expectorated black sputum.
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2. The client reports trying to kill himself.
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3. The client's pulse oximeter reading is 94%.
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4. The client has stridor and reports dizziness.
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1 - ANSWERS-
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8. The ED nurse is working triage. Which client should be triaged first?
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1. A client who has multiple injuries from a motor-vehicle accident.
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2. A client complaining of epigastric pain and nausea after eating.
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3. An elderly client who fell and fractured the left femoral neck.
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4. The client suffering from a migraine headache and nausea.
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4 - ANSWERS-
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9. The nurse is providing discharge teaching for the client with intermaxillary wiring to
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repair a fractured mandible. Which statement by the client indicates teaching has
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been effective? 5f
1. Iced alcoholic drinks may be consumed by using a straw.
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2. Only one (1) food item should be consumed at one (1) time.
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3. Carbonated sodas should be limited to two (2) daily.
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4. Teeth can be brushed after tenderness and edema subside.
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1,2,4 - ANSWERS- 5f 5f
10. The occupational health nurse is called to the scene of a traumatic amputation of
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a
f
finger. Which intervention should the nurse implement prior to sending the client to
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the ED? Select all that apply.
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1. Rinse the amputated finger with sterile normal saline.
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2. Place the amputated finger in a sealed and watertight plastic bag.
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3. Place the amputated finger into iced saline solution.
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4. Wrap the amputated finger in saline-moistened gauze dressings.
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5. Replace the amputated finger on the hand and wrap with gauze.
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3 - ANSWERS-
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11. The nurse is teaching the client home care instructions for a reimplanted finger af
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ter
a traumatic amputation. Which information should the nurse include the teaching?
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1. Perform range-of-motion exercises weekly.
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2. Smoking may be resumed if it does not cause nausea.
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COMPREHENSIVE EXAMINATION
QUESTIONS AND CORRECT ANSWERS
3 - ANSWERS-
5f 5f
1. The ED nurse is caring for a client diagnosed with multiple rib fractures. Which
5f 5f 5f 5f 5f 5f 5f 5f 5f 5f 5f 5f 5f 5f
data should the nurse include in the assessment?
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1. Level of orientation to time and place.
5f 5f 5f 5f 5f 5f 5f
2. Current use and last dose of medication.
5f 5f 5f 5f 5f 5f 5f
3. Symmetrical movement of the chest.
5f 5f 5f 5f 5f
4. Time of last meal the client ate.
5f 5f 5f 5f 5f 5f 5f
1 - ANSWERS-
5f 5f
2. The nurse is caring for a client in the ED with abdominal trauma who has had
5f 5f 5f 5f 5f 5f 5f 5f 5f 5f 5f 5f 5f 5f 5f 5f
peritoneal lavage. Which intervention should the nurse include in the plan of care?
5f 5f 5f 5f 5f 5f 5f 5f 5f 5f 5f 5f
1. Assess for the presence of blood, bile, or feces.
5f 5f 5f 5f 5f 5f 5f 5f 5f
2. Palpate the client for bilateral femoral pulses.
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3. Perform Leopold's maneuver every eight (8) hours.
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4. Collect information on the client's dietary history.
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3 - ANSWERS-
5f 5f
3. The elderly client is brought to the ED complaining of cramps, headache, and
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weakness after working outside in the sun. The telemetry shows sinus tachycardia.
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Which intervention should the nurse implement?
5f 5f 5f 5f 5f
1. Determine if the client is experiencing any thirst.
5f 5f 5f 5f 5f 5f 5f 5f
2. Administer D5W intravenously at 250 mL/hr.
5f 5f 5f 5f 5f 5f
3. Maintain a cool environment to promote rest.
5f 5f 5f 5f 5f 5f 5f
4. Withhold the client's oral intake.
5f 5f 5f 5f 5f
4 - ANSWERS-4. The ED nurse is caring for a client who suffered a near-
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drowning. Which expected 5f 5f
outcome should the nurse include in the plan of care for this client?
5f 5f 5f 5f 5f 5f 5f 5f 5f 5f 5f 5f
1. Maintain the client's cardiac function.
5f 5f 5f 5f 5f
2. Promote a continued decrease in lung surfactant.
5f 5f 5f 5f 5f 5f 5f
3. Warm rapidly to minimize the effects of hypothermia.
5f 5f 5f 5f 5f 5f 5f 5f
4. Keep the oxygen saturation level above 93%.
5f 5f 5f 5f 5f 5f 5f
1 - ANSWERS-5. The nurse is assessing the client who suffered a near-
5f 5f 5f 5f 5f 5f 5f 5f 5f 5f 5f 5f
drowning event. Which data 5f 5f 5f
require immediate intervention? 5f 5f
1. The onset of pink, frothy sputum.
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2. An oral temperature of 97˚F.
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3. An alcohol level of 100 mg/dL.
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4. A heart rate of 100 beats/min.
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, 3 - ANSWERS-
5f 5f
6. A nurse is at the lake when a person nearly drowns. The nurse determines the clie
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nt
is breathing spontaneously. Which data should the nurse assess next?
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1. Possibility of drug use.
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2. Spinal cord injury.
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3. Level of confusion.
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4. Amount of alcohol.
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4 - ANSWERS-
5f 5f
7. The ED nurse is caring for a male client admitted with carbon monoxide poisoning.
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Which intervention requires the nurse to notify the Rapid Response Team?
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1. The client has expectorated black sputum.
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2. The client reports trying to kill himself.
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3. The client's pulse oximeter reading is 94%.
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4. The client has stridor and reports dizziness.
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1 - ANSWERS-
5f 5f
8. The ED nurse is working triage. Which client should be triaged first?
5f 5f 5f 5f 5f 5f 5f 5f 5f 5f 5f 5f
1. A client who has multiple injuries from a motor-vehicle accident.
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2. A client complaining of epigastric pain and nausea after eating.
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3. An elderly client who fell and fractured the left femoral neck.
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4. The client suffering from a migraine headache and nausea.
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4 - ANSWERS-
5f 5f
9. The nurse is providing discharge teaching for the client with intermaxillary wiring to
5f 5f 5f 5f 5f 5f 5f 5f 5f 5f 5f 5f 5f
repair a fractured mandible. Which statement by the client indicates teaching has
5f 5f 5f 5f 5f 5f 5f 5f 5f 5f 5f
been effective? 5f
1. Iced alcoholic drinks may be consumed by using a straw.
5f 5f 5f 5f 5f 5f 5f 5f 5f 5f
2. Only one (1) food item should be consumed at one (1) time.
5f 5f 5f 5f 5f 5f 5f 5f 5f 5f 5f 5f
3. Carbonated sodas should be limited to two (2) daily.
5f 5f 5f 5f 5f 5f 5f 5f 5f
4. Teeth can be brushed after tenderness and edema subside.
5f 5f 5f 5f 5f 5f 5f 5f 5f
1,2,4 - ANSWERS- 5f 5f
10. The occupational health nurse is called to the scene of a traumatic amputation of
5f 5f 5f 5f 5f 5f 5f 5f 5f 5f 5f 5f 5f 5f 5
a
f
finger. Which intervention should the nurse implement prior to sending the client to
5f 5f 5f 5f 5f 5f 5f 5f 5f 5f 5f 5f
the ED? Select all that apply.
5f 5f 5f 5f 5f
1. Rinse the amputated finger with sterile normal saline.
5f 5f 5f 5f 5f 5f 5f 5f
2. Place the amputated finger in a sealed and watertight plastic bag.
5f 5f 5f 5f 5f 5f 5f 5f 5f 5f 5f
3. Place the amputated finger into iced saline solution.
5f 5f 5f 5f 5f 5f 5f 5f
4. Wrap the amputated finger in saline-moistened gauze dressings.
5f 5f 5f 5f 5f 5f 5f 5f
5. Replace the amputated finger on the hand and wrap with gauze.
5f 5f 5f 5f 5f 5f 5f 5f 5f 5f 5f
3 - ANSWERS-
5f 5f
11. The nurse is teaching the client home care instructions for a reimplanted finger af
5f 5f 5f 5f 5f 5f 5f 5f 5f 5f 5f 5f 5f 5f
ter
a traumatic amputation. Which information should the nurse include the teaching?
5f 5f 5f 5f 5f 5f 5f 5f 5f 5f
1. Perform range-of-motion exercises weekly.
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2. Smoking may be resumed if it does not cause nausea.
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