IGGY CHPT 9 TB
A nurse plans care for a pt admitted with a snakebite to the right leg. With whom should the nurse collaborate? A. Facility neurologist B. Poison control center C. Physical therapy department D. Herpetologist (snake specialist)
Poison control center (For specific advice on anti venom administration and client management)
While at a public park, a nurse encounters a person immediately after a bee sting. The persons lips are swollen and wheezes are audible. Which action should the nurse take first? A. Elevate the site and notify the persons next of kin B. Remove the stinger with tweezers and encourage rest C. Administer diphenhydramine (Benadryl) and apply ice D. Administer EpiPen from the first aid kit and dial 911
Administer EpiPen and dial 911
A provider prescribes a rewarming bath for a client who presents with partial-thickness frostbite. Which action should the nurse take prior to starting this treatment? A. Administer IV morphine B. Wrap the limb with a compression dressing C. Massage the frostbitten areas D. Assess the limb for compartment syndrome
Administer IV morphine (Clients experience severe pain during rewarming process)
An emergency department nurse cares for a middle-aged mountain climber who is confused and exhibits bizarre behaviors. After administering oxygen, which priority intervention should the nurse implement? A. Administer dexamethasone (Decadron) B. Complete a mini mental state examination C. Prepare the client for computed tomography of the brain D. Request a psychiatric consult
Administer dexamethasone (Decadron) (Exhibiting mountain sickness and high altitude cerebral edema (HACE). Dexamethasone reduces cerebral edema.
A client presents to the ER after prolonged exposure to the cold. The client is difficult to arouse and speech is incoherent. Which action should the nurse take first? A. Reposition the client into a prone position B. Administer warmed IV fluids to the client C. Wrap the clients extremities in warm blankets D. Initiate extracorporeal re-warming via hemodialysis
Administer warmed IV fluids to client
A provider prescribes Crotalidae Polyvalent Fab (CroFab) for a pt who is admitted after being bitten by a pit viper snake. Which assessment should the nurse complete prior to administering this medication? A. Assess temp and for signs of fever B. Check the clients creatinine kinase level C. Ask about allergies to pineapple or papaya D. Inspect the skin for signs of urticaria (hives)
Ask about allergies to pineapple or papaya (bromelain products)
An emergency department nurse plans care for a patient who is admitted with heat stroke. Which interventions should the nurse include in this clients plan of care? (SATA) A. Administer oxygen via mask or nasal cannula B. Administer ibuprofen, an antipyretic med C. Apply cooling techniques until core body temp is less than 101 F D. Infuse 0.9% sodium chloride via a large-bore IV cannula E. Obtain baseline serum electrolyte and cardiac enzymes
- Administer oxygen via mask or NC - Infuse 0.9% sodium chloride via a large-bore IV cannula - obtain baseline serum electrolyte and cardiac enzymes (Client should be cooled until core body temp is reduced to 102 F)
A nurse teaches a client who has severe allergies to prevent bug bites. Which statements should the nurse include in this clients teaching? (SATA) A. Consult an exterminator to control bugs in and around your home B. Do not swat at insects or wasps C. Wear sandals whenever you go outside D. Keep your prescribed epinephrine auto-injection in a bedside drawer E. Use screens in your windows and doors to prevent flying insects from entering
- consult an exterminator to control bugs in home - do not swat at insects or wasps - use screens to prevent flying insects from entering
An emergency department nurse moves to a new city where heat- related illnesses are common. Which client does the nurse anticipate being at a higher risk for heat-related illness? (SATA) A. Homeless individuals B. Illicit drug users C. White people D. Hockey players E. Older adults
- homeless individuals - illicit drug users - older adults (Blacks, people who work outside like construction, farmers, more men than women, cocaine users, outdoor athletes, military members)
A nurse is providing a health education at a community center. Which instructions should the nurse include in teaching about prevention of lighting during a storm (SATA): A. Seek shelter inside a building B. Hide under a tall tree C. Do not take a bath or shower D. Turn off the television E. Remove all body piercings F. Put down golf clubs or gardening tools
- seek shelter - do to take bath - turn off tv - put down golf clubs and tools
A nurse is teaching a wilderness survival class. Which statements should the nurse include about the prevention of hypothermia and frostbite? (SATA) A. Wear synthetic clothing instead of cotton to keep your skin dry B. Drink plenty of fluids. Brandy can be used to keep your body warm C. Remove your hat when exercising to prevent the loss of heat D. Wear sunscreen to protect skin and eyes from harmful rays E. Know your physical limits. Come in out of the cold when limits are reached
- wear synthetic clothing - wear sunscreen to protect skin - know your physical limits
A nurse assesses a client recently bitten by a coral snake. Which assessment should the nurse complete first? A. Unilateral peripheral swelling B. Clotting times C. Cardiopulmonary status D. Electrocardiogram rhythm
Cardiopulmonary status (Respiratory paralysis due to venom)
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 palpable pulse. Which action should 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
Deliver rescue breaths (Immediately initiate airway clearance an ventilator support measures, including delivering rescue breaths)
An emergency department nurse assesses a client admitted after a lightning strike. Which assessment should the nurse complete first? A. Electrocardiogram (ECG) B. Wound inspection C. Creatinine kinase D. Computed tomography of head
Electrocardiogram (ECG) Clients who survive an immediate lightning strike can have serious myocardial injury
A nurse teaches a community health class about water safety. Which statement by a participant indicates that additional teaching is needed? A. I can go swinging all by myself because I am a certified lifeguard B. I cannot leave my toddler alone in the bathtub for even a minute C. I will appoint one adult to supervise the pool at all times during a party D. I will make sure that there is a phone near my pool in case of an emergency
I can go swimming all by myself because I am a certified lifeguard
A provider prescribes diazepam (Valium) to a client who was bitten by a black widow spider. The client asks, "What is this medication for?" How should the nurse respond? A. This med is an anti venom for this type of bite B. It will relieve your muscle rigidity and spasms C. It prevents respiratory difficulty from excessive secretions D. This medication will prevent respiratory failure
It will relieve your muscle rigidity and spasms
A nurse assesses a pt admitted with a brown recluse spider bite. Which priority assessment should 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 temperature every 4 hours
Monitor the temperature every 4 hours (Assessing for fever is priority due to systemic toxicity that can lead to hemolytic reactions, kidney failure, pulmonary edema, cardiovascular collapse, and death)
After teaching a client how to prevent altitude-related illnesses, a nurse assesses the clients understanding. Which statement indicates the need for additional teaching? A. If my climbing partner can't think straight, we should descend to a lower altitude B. I will ask my provider about medication to help prevent acute mountain sickness (acetazolamide- Diamox) C. My partner and I will plan to sleep at a higher elevation to acclimate more quickly D. I will drink plenty of fluids to stay hydrated while on the mountain
My partner and I will plan to sleep at a higher elevation to acclimate more quickly
On a hot humid day, an emergency department nurse is caring for a client who is confused and has these vitals: temp 104.1, pulse 132, resp rate 26, BP 106/66. What action should the nurse take? A. Encourage the client to drink cool water or sports drinks B. Start an IV line and infuse 0.9% saline solution C. Administer acetaminophen 650mg PO D. Encourage rest and re-assess in 15 min
Start an IV line and infuse 0.9% saline solution (For signs of a heat stroke)