Chapter 11: Concepts of Care for Patients
with Common Environmental Emergencies
Ignatavicius: Medical-Surgical Nursing, 10th Edition
MULTIPLE CHOICE
1. A nurse assesses a client recently bitten by a coral snake. Which assessment would the
nurse complete first?
a. Unilateral peripheral swelling
b. Clotting times
c. Cardiopulmonary status
d. Electrocardiogram rhythm
ANS: C
Signs and symptoms of coral snake envenomation are the result of its neurotoxic
properties. The physiologic effect is to block neurotransmission, which produces
ascending paralysis, reduced perception of pain, and, ultimately, respiratory paralysis.
The nurse would monitor for respiratory rate and depth. Severe swelling and clotting
problems do not occur with coral snakes but do occur with pit viper snakes.
Electrocardiogram rhythm is not affected by neurotoxins.
DIF: Applying TOP: Integrated Process: Nursing Process: Assessment
KEY: Environmental emergencies, Snakebites MSC: Client
Needs Category: Physiological Integrity: Physiological Adaptation
2. A nurse plans care for a client admitted with a snakebite to the right leg. With whom
would the nurse collaborate?
a. The facility’s neurologist
, b. The poison control center
c. The physical therapy department
d. A herpetologist (snake specialist)
ANS: B
For the client with a snakebite, the nurse would contact the regional poison control
center immediately for specific advice on antivenom administration and client
management.
DIF: Remembering TOP: Integrated Process: Nursing Process: Planning
KEY: Environmental emergencies, Snakebites MSC: Client
Needs Category: Safe and Effective Care Environment: Management of Care
3. While on a camping trip, a nurse cares for an adult client who had a drowning incident
in a lake and is experiencing agonal breathing with a palpable pulse. What action
would the nurse take first?
a. Deliver rescue breaths.
b. Wrap the client in dry blankets.
c. Assess for signs of bleeding.
d. Check for a carotid pulse.
ANS: A
In this emergency situation, the nurse immediately initiates airway clearance and
ventilator support measures, including delivering rescue breaths.
DIF: Applying TOP: Integrated Process: Nursing Process:
Implementation KEY: Environmental emergencies, Drowning
MSC: Client Needs Category: Physiological Integrity: Physiological
Adaptation
4. A nurse assesses a client admitted with a brown recluse spider bite. Which assessment
does the nurse perform to identify complications of this bite?
, a. Ask the client about pruritus at the bite site.
b. Inspect the bite site for a bluish purple vesicle.
c. Assess the extremity for redness and swelling.
d. Monitor the client’s temperature every 4 hours.
ANS: D
Fever and chills indicate systemic toxicity, which can lead to hemolytic anemia,
thrombocytopenia, DIC, and death. Assessing for a fever would indicate this
complication. All other symptoms are normal for a brown recluse bite and would be
assessed, but they do not provide information about complications from the bite.
DIF: Applying TOP: Integrated Process: Nursing Process: Assessment
KEY: Environmental emergencies, Arthropod bites MSC:
Client Needs Category: Physiological Integrity: Physiological Adaptation
5. On a hot humid day, an emergency department nurse is caring for a client who is
confused and has these vital signs: temperature 104.1° F (40.1° C), pulse 132
beats/min, respirations 26 breaths/min, and blood pressure 106/66 mm Hg. What
action would the nurse take?
a. Encourage the client to drink cool water or sports drinks.
b. Start an intravenous line and infuse 0.9% saline solution.
c. Administer acetaminophen (Tylenol) 650 mg orally.
d. Encourage rest and reassess in 15 minutes.
ANS: B
The client demonstrates signs of heat stroke. This is a medical emergency and priority
care includes oxygen therapy, IV infusion with 0.9% saline solution, insertion of a
urinary catheter, and aggressive interventions to cool the patient, including external
cooling and internal cooling methods. Oral hydration would not be appropriate for a
client who has symptoms of heat stroke because oral fluids would not provide
necessary rapid rehydration, and the confused client would be at risk for aspiration.
Acetaminophen would not decrease this patient’s temperature or improve the patient’s
with Common Environmental Emergencies
Ignatavicius: Medical-Surgical Nursing, 10th Edition
MULTIPLE CHOICE
1. A nurse assesses a client recently bitten by a coral snake. Which assessment would the
nurse complete first?
a. Unilateral peripheral swelling
b. Clotting times
c. Cardiopulmonary status
d. Electrocardiogram rhythm
ANS: C
Signs and symptoms of coral snake envenomation are the result of its neurotoxic
properties. The physiologic effect is to block neurotransmission, which produces
ascending paralysis, reduced perception of pain, and, ultimately, respiratory paralysis.
The nurse would monitor for respiratory rate and depth. Severe swelling and clotting
problems do not occur with coral snakes but do occur with pit viper snakes.
Electrocardiogram rhythm is not affected by neurotoxins.
DIF: Applying TOP: Integrated Process: Nursing Process: Assessment
KEY: Environmental emergencies, Snakebites MSC: Client
Needs Category: Physiological Integrity: Physiological Adaptation
2. A nurse plans care for a client admitted with a snakebite to the right leg. With whom
would the nurse collaborate?
a. The facility’s neurologist
, b. The poison control center
c. The physical therapy department
d. A herpetologist (snake specialist)
ANS: B
For the client with a snakebite, the nurse would contact the regional poison control
center immediately for specific advice on antivenom administration and client
management.
DIF: Remembering TOP: Integrated Process: Nursing Process: Planning
KEY: Environmental emergencies, Snakebites MSC: Client
Needs Category: Safe and Effective Care Environment: Management of Care
3. While on a camping trip, a nurse cares for an adult client who had a drowning incident
in a lake and is experiencing agonal breathing with a palpable pulse. What action
would the nurse take first?
a. Deliver rescue breaths.
b. Wrap the client in dry blankets.
c. Assess for signs of bleeding.
d. Check for a carotid pulse.
ANS: A
In this emergency situation, the nurse immediately initiates airway clearance and
ventilator support measures, including delivering rescue breaths.
DIF: Applying TOP: Integrated Process: Nursing Process:
Implementation KEY: Environmental emergencies, Drowning
MSC: Client Needs Category: Physiological Integrity: Physiological
Adaptation
4. A nurse assesses a client admitted with a brown recluse spider bite. Which assessment
does the nurse perform to identify complications of this bite?
, a. Ask the client about pruritus at the bite site.
b. Inspect the bite site for a bluish purple vesicle.
c. Assess the extremity for redness and swelling.
d. Monitor the client’s temperature every 4 hours.
ANS: D
Fever and chills indicate systemic toxicity, which can lead to hemolytic anemia,
thrombocytopenia, DIC, and death. Assessing for a fever would indicate this
complication. All other symptoms are normal for a brown recluse bite and would be
assessed, but they do not provide information about complications from the bite.
DIF: Applying TOP: Integrated Process: Nursing Process: Assessment
KEY: Environmental emergencies, Arthropod bites MSC:
Client Needs Category: Physiological Integrity: Physiological Adaptation
5. On a hot humid day, an emergency department nurse is caring for a client who is
confused and has these vital signs: temperature 104.1° F (40.1° C), pulse 132
beats/min, respirations 26 breaths/min, and blood pressure 106/66 mm Hg. What
action would the nurse take?
a. Encourage the client to drink cool water or sports drinks.
b. Start an intravenous line and infuse 0.9% saline solution.
c. Administer acetaminophen (Tylenol) 650 mg orally.
d. Encourage rest and reassess in 15 minutes.
ANS: B
The client demonstrates signs of heat stroke. This is a medical emergency and priority
care includes oxygen therapy, IV infusion with 0.9% saline solution, insertion of a
urinary catheter, and aggressive interventions to cool the patient, including external
cooling and internal cooling methods. Oral hydration would not be appropriate for a
client who has symptoms of heat stroke because oral fluids would not provide
necessary rapid rehydration, and the confused client would be at risk for aspiration.
Acetaminophen would not decrease this patient’s temperature or improve the patient’s
