AH3 Exam 4 Questions Answered 100%
A 5-year-old client was admitted to the emergency unit due to ingestion of unknown
amount of chewable vitamins for children at an unknown time. Upon assessment, the
child is alert and with no symptoms. Which of the following information should be
reported to the physician immediately?
A. The child has been treated multiple times for injuries caused by accidents.
B. The vitamin that was ingested contains iron.
C. The child was nauseated and vomited once at home.
D. The child has been treated several times for toxic substance ingestion. - ANSWER-
B. The vitamin that was ingested contains iron.
A client arrives at the emergency department who suffered multiple injuries from a
head-on car collision. Which of the following assessment should take the highest priority
to take?
A. Irregular pulse.
B. Ecchymosis in the flank area.
C. A deviated trachea.
D. Unequal pupils. - ANSWER-C. A deviated trachea.
A client arrives in the emergency unit and reports that a concentrated household
cleaner was splashed in both eyes. Which of the following nursing actions is a priority?
A. Use Restasis (Allergan) drops in the eye.
B. Flush the eye repeatedly using sterile normal saline.
C. Examine the client's visual acuity.
D. Patch the eye - ANSWER-B. Flush the eye repeatedly using sterile normal saline.
A client comes into the ED clutching the chest. Which core competency for ED nurses is
the first one used in this situation?
a. Assessment
b. Communication
c. Priority setting
d. Technical and Procedural skills - ANSWER-a. Assessment
A client from a local care facility has sustained a cardiac arrest in the ED, and
resuscitation was unsuccessful. The client's family wishes to view the body. What steps
should the ED nurse take? (SATA)
a. remove all lines and indwelling tubes
b. cover the client with a sheet, leaving the face exposed
c. Call a chaplain or social worker to accompany the family
, d. Tell the family that the client "is in a better place now."
e. Dim the light in the client's room - ANSWER-b. cover the client with a sheet, leaving
the face exposed
e. Dim the light in the client's room
A client is admitted to the ED after being in a MVC. The client was wearing a seat belt
and airbag deployed. There are no apparent injuries besides an abrasion from the
shoulder harness across the clavicle and anterior chest. First vital signs are BP 110/70,
HR 98, RR 18, SaO2 98% on RA. The client's GCS score is 15. What does the nurse do
next?
a. Allows the client to go home
b. Checks blood alcohol levels
c. Prepares the client for surgery
d. Monitors the client - ANSWER-d. Monitors the client
A client is admitted to the ED after reporting being raped. Who is the best team member
for the admitting nurse to locate to provide care for this client?
a. Forensic nurse examiner
b. Physician or HCP
c. Psychiatric Crisis Nurse
d. Police officer - ANSWER-a. Forensic nurse examiner
A client is admitted to the hospital with two of the systemic inflammatory response
syndrome variables: temperature of 95 and high WBCs. Which intervention from the
sepsis resuscitation bundle does the nurse imitate?
a. Broad-spectrum antibiotics
b. Blood transfusion
c. Cooling baths
d. NPO status - ANSWER-a. Broad-spectrum antibiotics
A client suffered an amputation of the first and second digits in a chainsaw accident.
Which task should be delegated to an LPN/LVN?
A. Cleansing the amputated digits and placing them directly into an ice slurry.
B. Cleansing the digits with sterile normal saline and placing in a sterile cup with sterile
normal saline.
C. Gently cleansing the amputated digits and the hand with povidone-iodine.
A 5-year-old client was admitted to the emergency unit due to ingestion of unknown
amount of chewable vitamins for children at an unknown time. Upon assessment, the
child is alert and with no symptoms. Which of the following information should be
reported to the physician immediately?
A. The child has been treated multiple times for injuries caused by accidents.
B. The vitamin that was ingested contains iron.
C. The child was nauseated and vomited once at home.
D. The child has been treated several times for toxic substance ingestion. - ANSWER-
B. The vitamin that was ingested contains iron.
A client arrives at the emergency department who suffered multiple injuries from a
head-on car collision. Which of the following assessment should take the highest priority
to take?
A. Irregular pulse.
B. Ecchymosis in the flank area.
C. A deviated trachea.
D. Unequal pupils. - ANSWER-C. A deviated trachea.
A client arrives in the emergency unit and reports that a concentrated household
cleaner was splashed in both eyes. Which of the following nursing actions is a priority?
A. Use Restasis (Allergan) drops in the eye.
B. Flush the eye repeatedly using sterile normal saline.
C. Examine the client's visual acuity.
D. Patch the eye - ANSWER-B. Flush the eye repeatedly using sterile normal saline.
A client comes into the ED clutching the chest. Which core competency for ED nurses is
the first one used in this situation?
a. Assessment
b. Communication
c. Priority setting
d. Technical and Procedural skills - ANSWER-a. Assessment
A client from a local care facility has sustained a cardiac arrest in the ED, and
resuscitation was unsuccessful. The client's family wishes to view the body. What steps
should the ED nurse take? (SATA)
a. remove all lines and indwelling tubes
b. cover the client with a sheet, leaving the face exposed
c. Call a chaplain or social worker to accompany the family
, d. Tell the family that the client "is in a better place now."
e. Dim the light in the client's room - ANSWER-b. cover the client with a sheet, leaving
the face exposed
e. Dim the light in the client's room
A client is admitted to the ED after being in a MVC. The client was wearing a seat belt
and airbag deployed. There are no apparent injuries besides an abrasion from the
shoulder harness across the clavicle and anterior chest. First vital signs are BP 110/70,
HR 98, RR 18, SaO2 98% on RA. The client's GCS score is 15. What does the nurse do
next?
a. Allows the client to go home
b. Checks blood alcohol levels
c. Prepares the client for surgery
d. Monitors the client - ANSWER-d. Monitors the client
A client is admitted to the ED after reporting being raped. Who is the best team member
for the admitting nurse to locate to provide care for this client?
a. Forensic nurse examiner
b. Physician or HCP
c. Psychiatric Crisis Nurse
d. Police officer - ANSWER-a. Forensic nurse examiner
A client is admitted to the hospital with two of the systemic inflammatory response
syndrome variables: temperature of 95 and high WBCs. Which intervention from the
sepsis resuscitation bundle does the nurse imitate?
a. Broad-spectrum antibiotics
b. Blood transfusion
c. Cooling baths
d. NPO status - ANSWER-a. Broad-spectrum antibiotics
A client suffered an amputation of the first and second digits in a chainsaw accident.
Which task should be delegated to an LPN/LVN?
A. Cleansing the amputated digits and placing them directly into an ice slurry.
B. Cleansing the digits with sterile normal saline and placing in a sterile cup with sterile
normal saline.
C. Gently cleansing the amputated digits and the hand with povidone-iodine.
