Emergency Medicine and Medication

A nurse is caring for a child who is experiencing a seizure. Which of the following actions should the nurse take?

Place the child in a side-lying position

A nurse is caring for a client who enters an ambulatory clinic bleeding profusely from a deep laceration on his left lower forearm. After donning gloves, which of the following actions should the nurse take first?

Apply pressure directly over the wound

A nurse is assisting with planning an immunization clinic for older adult clients. Which of the following information should the nurse plan to include about influenza?

The composition of the influenza vaccine changes yearly

A nurse is reinforcing teaching with a client who has a new prescription for phenytoin. The nurse should recognize that which of the following statements by the client indicates a need for further teaching?

"I'll be glad when my seizures stop so I can quit taking this medicine."

A nurse is caring for a client who is postoperative and receiving fentanyl via patient controlled analgesia. The client has a prescription for naloxone. The nurse understands that the purpose of naloxone is which of the following?

Block the effects of opioids on the central nervous system

A nurse working in an assisted living facility has been made aware that a chemical disaster has occurred within the community and is a threat to the facility. Which of the following actions should the nurse take? (select all that apply)

Place wet towels under the doors. Close the doors and windows of each resident's apartment. Turn off fans and heaters.

A nurse is reinforcing teaching with a client's family about lightning strike prevention following a lightning injury to the client. Which of the following information should the nurse reinforce in the teaching?

Do not use corded landline phone

A nurse is assisting with the care of a client who has multiple facial injuries. Which of the following equipment should the nurse place at the client's bedside?

suction catheter

A group of nurses are discussing the difference of an agonist verses an antagonist. Which of the following medications may the nurse select as an

Dobutamine hydrochloride (Dobutrex)

A nurse is participating in a staff discussion about disaster triage. The nurse should include which of the following clients as an example emergent (red tag) category?

A client who has a punctured femoral artery

A nurse is caring for a group of clients. Which of the following clients should the nurse see first?

A client who has a unrepaired femur fracture and new onset of confusion

A nurse is caring for a client who has multiple injuries following a motor-vehicle crash. The nurse should collect data concerning which of the following areas when using primary survey triage? (Select all that apply.)

Airway Circulation Disability Exposure

A nurse is reinforcing discharge teaching with a client who has a prescription for phenytoin. Which of the following instructions should the nurse include in the teaching?

Alcohol increases the chance of phenytoin toxicity

A nurse is collecting data from a child who has acute lead poisoning. Which of the following findings should the nurse expect?

Anorexia

A nurse is caring for a client who had total hip arthroplasty 1 day ago and is receiving morphine sulfate by PA pump for pain control. The client reports nausea and vomiting. Which of the following actions is the priority for the nurse to take?

Auscultate bowel sounds

A nurse is caring for a client who was exposed to anthrax. Which of the following antibiotics should the nurse plan to administer?

Ciprofloxacin

A nurse is working with community members to prepare for an external disaster. The nurse is assisting the community members to compile a list of basic supplies needed in the case of a disaster. Which of the following supplies should the nurse instruct the community members to include? (Select all that apply.)

Clean clothing Personal Identification Matches

A nurse is preparing to begin cardiopulmonary resuscitation on an infant. Which of the following actions should the nurse take?

Deliver compressions at a depth of 4 cm (1.5 in)

A nurse is assisting with revising a facility's emergency response plan for tornado disasters in the community. The nurse should plan to collaborate with which of the following agencies?

Federal Emergency Management Agency (FEMA)

A nurse is caring for a client who has heart failure and respiratory arrest. Which of the following actions should the nurse take first?

Feel for a carotid pulse

A nurse is assisting with the care of a client who is at risk for disseminated intravascular coagulopathy (DIC). The nurse should plan to report which of the following laboratory values that indicates DIC?

Fibrinogen 85 mg/dL

A nurse is reviewing disaster management with a newly licensed nurse. Which of the following actions should the nurse identify as being the responsibility of the nurse during a disaster?

Focus on providing care that prevents life threatening emergencies.

A nurse withdraws morphine 2 mg from a vial that contains 4 mg/mL to inject IM for a client. Which of the following actions should the nurse take for wasting the excess medication?

Have the second nurse witness the disposal of the excess medication

A nurse is assisting with the care of a client in the emergency department and reports severe radiating chest pain and shortness of breath. The client appears restless, frightened, and slightly cyanotic. The provider prescribes oxygen by nasal cannula at 4 L/min stat, cardiac enzyme levels, IV fluids, and a 12-lead ECG. Which of the following actions should the nurse take first?

Initiate oxygen therapy

A nurse is preparing medication for a client when another client has an emergency. Which of the following actions should the nurse take?

Lock the medication in a room and finish preparing it after returning from the emergency.

A nurse is caring for a postoperative client who is receiving fentanyl. Which of the following medications should the nurse plan to administer to the client if manifestations of fentanyl toxicity occur?

Naloxone

A nurse is collecting data from a client who has an acute myocardial infarction (MI). Which of the following clinical manifestations should the nurse expect to find? (Select all that apply.)

Nausea Tachycardia Diaphoresis

A charge nurse is discussing emergency response with a newly licensed nurse. The charge nurse should identify which of the following as a triage officer during the time of a disaster?

Nurses and other emergency medical personnel

A nurse in an urgent care clinic is checking a client who was brought in by a relative following a motor-vehicle crash. The client is not breathing, and the nurse suspects a cervical vertebrae fracture. Which of the following actions should the nurse take first?

Open the airway using the jaw thrust maneuver

A nurse is assisting with the care of a client who is receiving heparin by IV infusion. Which of the following medications should the nurse have available in the event of an overdose?

Protamine

A nurse in a long-term care facility enters the day room and finds the window curtains on fire. Clients are panicking and the room is filling with smoke. Indicate the emergency actions the nurse must take. (Move the steps into the box on the right, placing them in the selected order of performance. Use all the steps.)

Remove the clients from the room Activate the fire alarm Close the door Extinguish the fire

A nurse is collecting data on a client who has a prescription for morphine. The nurse should recognize that which of the following data is a priority to obtain before administering this medication?

Respiratory rate

A nurse is reinforcing teaching a client who has a new prescription for phenytoin. The nurse should instruct the client to monitor and report which of the following adverse effects of this medication?

Skin rash

A nurse in a long-term care facility sees a client who is choking. Which of the following data should the nurse identify as requiring an abdominal thrust?

The client cannot speak

A nurse is reviewing the medical record of a client who has a new prescription for morphine. Which of the following findings should the nurse identify as a contraindication to this medication?

The client has a paralytic ileus.

A nurse is collecting data from a client who is postoperative and receiving IV morphine 1 mg every 10 min via PCA. For which of the following manifestations should the nurse withhold the morphine?

The clients respiratory rate is 9/min

A nurse is assisting with a presentation to the public about preventive measures for contacting West Nile virus. In order to avoid transmission of the disease, which of the following instructions should the nurse include?

Use mosquito repellent

A nurse is caring for a client who has been taking warfarin and has a prothrombin time of 30 seconds. Which of the following medications should the nurse anticipate the provider to prescribe?

Vitamin K

An occupational health nurse is instructing workers at an industrial facility about emergency procedures to follow in the event of a traumatic amputation. Which of the following guidelines should the nurse include about preserving the amputated part for possible surgical reattachment? (Select all that apply.)

Wrap the part in sterile gauze. Put the severed part in a plastic bag. Prevent the severed part from coming in contact with water.

A nurse on a pediatric unit has received change-of-shift report. Which of the following clients should the nurse plan to see first?

an infant who has pertussis and is receiving oxygen via nasal cannula

A nurse is dining at a restaurant when a woman calls for help because her partner is choking. Which of the following actions should the nurse take first?

ask the victim if he can speak

A nurse is assisting with collecting data on a client who is on a continuous ECG monitor. The client's ECG tracing shows no identifiable P waves and an irregular ventricular rate. The nurse should recognize the client is experiencing which of the following cardiac dysrhythmias?

atrial fibrillation

A nurse is caring for an older adult client who has a prescription for lorazepam 0.5 mg. Which of the following findings should the nurse report to the provider immediately?

increased anxiety

A nurse is assisting with the care of a client who arrives at the emergency department after an industrial explosion. The nurse inspects the wound on the client's leg has and finds torn skin tissue underneath. The nurse should report this as which of the following types of wounds?

laceration

A nurse is caring for a client who has thrombophlebitis and is receiving a continuous heparin infusion. Which of the following medications should the nurse have available to reverse heparin's effects?

protamine sulfate

A nurse is collecting data from client who has just begun therapy with alprazolam to treat anxiety. The nurse should observe the client for which of the following adverse effects of this medication?

sedation

A nurse witnesses an adult who is experiencing a cardiac arrest while at the grocery store. The nurse performs CPR. Which of the following criteria is necessary for the Good Samaritan law to provide civil immunity for the nurse?

the nurse has basic life support certification

A nurse is caring for a child who has pertussis. The child's parent asks the nurse what the common name for this disease is. The nurse should respond with which of the following common names?

whooping cough

A nurse is assisting with planning an in-service for staff nurses about disaster management and triage. Which of the following color tags should the nurse include as identifying a client who requires treatment within 30 min to 2 hr?

yellow