MS 3 Exam 4 Questions

The nurse identifies the nursing diagnosis of Ineffective Peripheral Tissue Perfusion as being appropriate for a patient with septicemia. Which intervention will address this patient's health problem? 1) Monitor for cyanosis. 2) Monitor heart rate every hour. 3) Assess temperature every four hours. 4) Monitor pupil reactions every eight hours.

ANS: 1 A change in skin color will alert the nurse immediately of decreased tissue perfusion.

A medical-surgical unit is expecting a large volume of patient admissions after a train derailment. Which member of the nursing care team will prioritize care for the unit? 1) Charge nurse 2) Nurse supervisor 3) Licensed practical nurse 4) Unlicensed assistive personnel

ANS: 1 A charge nurse coordinates care and assignments and may ultimately be the only person familiar with all the needs of any individual patient; therefore, it is this member of the team that will prioritize care for the patients who are being admitted.

Which type of event can often be handled by an individual hospital disaster plan without collaboration with other systems? 1) A motor vehicle accident involving five cars 2) A tornado destroying 50 homes and businesses 3) An act of terrorism injuring and kills hundreds of people 4) A hurricane causing flooding, displacing thousands of people

ANS: 1 A multi-casualty event, such as a motor vehicle accident involving five cars, is an event that can often be handled with the implementation of an individual hospital disaster plan without collaboration with other systems.

Which medication should be listed as the antidote to a nerve agent in the disaster plan for a terrorist attack? 1) Atropine 2) Dopamine 3) Epinephrine 4) Norepinephrine

ANS: 1 Atropine should be listed as the antidote for nerve agent poisoning in the disaster plan for a terrorist attack.

The nurse is administering albumin 5% to a patient in shock. Which nursing action is appropriate when assessing this patient? 1) Auscultate breath sounds for crackles 2) Auscultate breath sounds for hyperresonance 3) Auscultate breath sounds for inspiratory stridor 4) Auscultate for an absence of breath sounds in the lower lobes

ANS: 1 Because albumin 5% is a volume expander and pulls fluid into the vascular space, circulatory overload is a serious complication. The nurse must monitor breath sounds; crackles will be heard with pulmonary congestion

A nurse is caring for a patient who was involved in a motor vehicle accident who has lost approximately 1,500 mL of blood. Based on this data, which type of shock is the patient experiencing? 1) Hypovolemic 2) Cardiogenic 3) Distributive 4) Obstructive

ANS: 1 Blood loss causes hypovolemic shock.

The nurse explains the purpose of an infusion of albumin 5% to a patient recovering from hypovolemic shock. Which statement indicates that the patient understands the instructions? 1) "It is a protein that pulls water into my blood vessels." 2) "It is a protein that causes my kidneys to conserve fluid." 3) "It is a super-concentrated salt solution that helps me conserve body fluid." 4) "It is a liquid that has electrolytes in it to pull water into my blood vessels."

ANS: 1 Colloids are proteins or other large molecules that stay suspended in the blood for long periods because they are too large to easily cross membranes. They draw water molecules from the cells and tissues into the blood vessels through their ability to increase plasma oncotic pressure.

A patient recovering from 25% total body surface area burns has a low-grade fever. What should the nurse do to reduce this patient's risk of developing an infection? 1) Follow contact precautions 2) Implement protective isolation 3) Use sterile technique for all dressing changes 4) Administer prophylactic antibiotics as prescribed

ANS: 1 Cross-contamination among burn patients is common, and as a result, isolation guidelines are widespread practices among burn centers. Contact precautions may be used when entering all patient rooms.

An older adult patient is recovering in the intensive care unit (ICU) from septicemia. Which intervention will help prevent further infection for this patient? 1) Provide oral and skin care 2) Implement sterile wound care 3) Encourage turn, cough, and deep breathe every shift. 4) Place the Foley drainage on the bed at the patient's feet

ANS: 1 Good oral and skin care will prevent breakdown and prevent entry by bacteria.

The nurse is helping devise a training plan to familiarize health-care providers with emergency response procedures. Which training measure is most effective to adequately prepare the trainees? 1) Drills 2) Tabletop exercises 3) Access to the policy 4) Computer simulations

ANS: 1 Hospital disaster drills are priority training measures to familiarize health-care providers with emergency response procedure.

The nurse administrator for a long-term care facility is implementing a disaster response plan for staff and residents. Which staff member statements indicate correct understanding of the plan? 1) "We have to implement annual drills." 2) "Nursing homes are not required to have a plan." 3) "Our facility is held to the same standards as hospital facilities." 4) "This is an important component to receive insurance payments for care."

ANS: 1 Hospitals are not the only health-care agencies that are required to practice disaster drills. Long-term care (LTC) facilities are also mandated to have annual drills to prepare for mass casualty events. Part of the response plan must include a method for evacuation of residents from the facility in a timely and safe manner.

Which treatment for anthrax should be included in the biological agent portion of a disaster plan for terrorist attacks? 1) Antivirals 2) Antitoxins 3) Antibiotics 4) Vaccinations

ANS: 3 Anthrax is treated effectively with antibiotics if sufficient supplies are available and the organisms are not resistant.

Which is the priority in the preparedness of health-care professionals in any type of disaster plan? 1) Identification of hazards 2) Cooperation with state authorities 3) Collaboration with local authorities 4) Implementation of federal mandates

ANS: 1 Identification of hazards is the priority in the preparedness of health-care professionals in any type of disaster plan.

The nurse is preparing an educational session on sepsis. Which should the nurse include as a major risk factor for the development of this health problem? 1) Immunosuppression 2) Elevated temperature 3) Pneumococcal bacteria 4) Leukocytosis on the complete blood count

ANS: 1 Immunosuppression is a risk factor for the development of sepsis.

Which organization in the United States mandates ongoing disaster preparedness for hospitals? 1) The Joint Commission (TJC) 2) The local government 3) The state government 4) The Occupational Safety and Health Administration (OSHA)

ANS: 1 In the United States, The Joint Commission mandates that hospitals have an emergency preparedness plan that is tested through drills or actual participation in a real event at least twice yearly.

The nurse is a member of the critical incident stress management unit that looks to meet the psychosocial needs of first responders after a mass casualty incident. Which action by the nurse is appropriate when conducting a session? 1) Arranging group discussion 2) Administering anti-anxiety medication 3) Scheduling individual therapy appointments 4) Documenting individual responses to the session

ANS: 1 Many hospitals and DMATs have a critical incident stress management unit, which arranges group discussions to allow participants to share and validate their feelings and emotions about the experience. This is important for emotional recovery.

A patient is prescribed epinephrine for the prevention of anaphylactic shock. The patient states, "I thought shock was about heart failure." Which response by the nurse is most appropriate? 1) "There are many kinds of shock that also include infection, nervous system damage, and loss of blood." 2) "Heart failure is the most serious kind of shock; others include infection, kidney failure, and loss of blood." 3) "There are many kinds of shock: heart failure, nervous system damage, loss of blood, and respiratory failure." 4) "Allergic response is the most fatal type of shock; other types involve loss of blood, heart failure, and liver failure."

ANS: 1 Obvious bleeding suggests hypovolemic shock; trauma to the brain or spinal cord suggests neurogenic shock; inadequate cardiac output suggests cardiogenic shock; a recent infection may indicate septic shock; and a history of allergies with a sudden onset of symptoms may suggest anaphylactic shock.

The nurse is preparing an educational tool to instruct community members on burn prevention. What should the nurse include as the most common injury in children under age 5? 1) Scald 2) Flame 3) Chemical 4) Carbon monoxide poisoning

ANS: 1 Scald injuries are most prevalent in children under the age of 5.

A patient with 35% total body surface area burns is in the rehabilitative phase of care. Which approach should be used to reduce the risk of developing contractures? 1) Apply splints 2) Physical therapy two hours a day 3) Passive range of motion exercises 4) Occupational therapy one hour every other day

ANS: 1 Splinting is the most common method used to help prevent the formation of contractures.

A patient in neurogenic shock is receiving rapid intravenous fluids. Which assessment finding indicates the need for additional nursing interventions? 1) The patient's mean arterial pressure (MAP) is 60 mmHg. 2) The patient is unconscious. 3) The patient has received two liters of infused fluid. 4) The patient is perspiring heavily.

ANS: 1 The MAP should be at least 65 mmHg. This finding indicates the need for further intervention.

A patient with several deep partial-thickness burns asks how long it will take for the burn to heal. What should the nurse respond to this patient? 1) "More than two weeks." 2) "Within one to two weeks." 3) "Within 24 to 72 hours." 4) "You will need skin grafts."

ANS: 1 The majority of deep partial-thickness burns take more than two weeks to heal.

The nurse is conducting triage under mass casualty conditions. Which tag should the nurse use for a patient who is experiencing hypovolemic shock due to a penetrating wound? 1) Red 2) Black 3) Green 4) Yellow

ANS: 1 The nurse would use a red tag for a patient who has injuries that are an immediate threat to life, such as hypovolemic shock, during mass casualty conditions.

The nurse is conducting a secondary survey as part of the emergency assessment. Which is the priority nursing action during the health history portion of the assessment? 1) Determining drug allergies 2) Noting the general appearance 3) Examining the neck for stiffness 4) Auscultating for heart and lung sounds

ANS: 1 The priority nursing action during the health history portion of the assessment is to determine drug allergies.

A green-tagged patient arrives at the emergency department after a mass casualty incident (MCI) involving radiation. Which is the priority nursing action for this patient? 1) Implementing decontamination measures 2) Performing a head-to-toe physical examination 3) Placing a special bracelet with a disaster number 4) Taking a digital photo and placing it on the medical record

ANS: 1 The priority nursing action for a green-tagged patient who arrives at the ED after exposure to radiation is implementing decontamination measures. These measures are the priority because it is essential that members of the health-care team and patients are not exposed to the radiation while providing care.

Which is the priority nursing action to include in a disaster plan for the radioactive dust and smoke that can cause illness from a radiologic dispersal device (RDD)? 1) Covering the nose 2) Protecting the eyes 3) Decontaminating the skin 4) Administering prophylactic antibiotics

ANS: 1 The priority nursing action to protect against the radioactive dust and smoke that can cause illness from an RDD is covering the nose and the mouth to decrease the risk for inhalation.

Which are the priority nursing actions after the completion of the secondary survey when providing care for a trauma patient with a penetrating wound? 1) Documenting the patient's care 2) Formulating the patient's plan of care 3) Reassessing the patient's level of consciousness 4) Transferring the patient to the general medical unit

ANS: 1 The priority nursing actions after completion of the secondary survey during the emergency assessment include documenting all patient care and administering tetanus prophylaxis.

The nurse is conducting a primary survey during an emergency assessment. Which is the priority nursing action related to breathing in response to this assessment? 1) Having suction available 2) Assessing pupil size and reactivity 3) Immobilizing any obvious deformities 4) Obtaining blood samples for type and crossmatch

ANS: 1 The priority nursing actions related to breathing when conducting a primary survey during an emergency assessment include having suction available and giving supplemental oxygen.

Which is a potentially life-threatening condition found during the primary triage survey that would necessitate priority nursing care? 1) Cystitis 2) Concussion 3) Lacerated arm 4) Fractured femur

ANS: 2 A concussion, which is a type of head injury, is a potentially life-threatening condition found during the primary triage survey that would necessitate priority nursing care.

Which situation does not cover nurses who respond to a mass casualty incident (MCI) for malpractice or negligent lawsuits under the Good Samaritan Act? 1) Terrorist act 2) Neighborhood fire 3) Roadside car accident 4) High school sporting event

ANS: 1 When terrorist acts occur, nurses are often required to go to an assigned site to offer aid. When this occurs, the nurse is not covered from malpractice or negligent lawsuits.

Which member of the health-care team, when using the team nursing approach, is responsible for prioritizing patient care? 1) Team leader 2) Charge nurse 3) Licensed practical nurse 4) Unlicensed assistive personnel

ANS: 1 When using the team nursing approach, the team leader, who is a registered nurse, is responsible for coordinating a group of licensed and unlicensed personnel to provide patient care to a small group of patients, including the prioritization of patient care.

The registered nurse (RN) is the team leader for a group of patients using the functional model of nursing. The team of nurses includes two licensed practical nurses (LPNs) and an unlicensed assistive personnel (UAP). Which task will the RN delegate to the UAP? 1) Taking vital signs 2) Providing wound care 3) Conducting discharge teaching 4) Administering oral medications

ANS: 1 When working in an environment that uses the functional model of nursing, each team member will be delegated tasks for a group of patients by the team leader, the RN. The RN will delegate taking vital signs to the UAP

The nurse manager is reviewing the hospital disaster plan with other members of the committee. Which is the minimum number of disaster drills the committee must plan and implement each year? 1) Two 2) Three 3) Four 4) Five

ANS: 1 While it is appropriate to have more than the minimum number of disaster drills each year, the minimum that must be implemented per The Joint Commission (TJC) requirements is twice per calendar year.

A patient is receiving intravenous nitroprusside (Nipride) for shock. Which adverse reactions will the nurse assess this patient for when administering the infusion? Select all that apply. 1) Confusion 2) Tachycardia 3) Disorientation 4) Muscle spasms 5) Gastrointestinal bleeding

ANS: 1, 2, 3 1. This is correct. Nausea, muscle spasms, and disorientation are signs of thiocyanate poisoning, which can occur if the infusion is longer than 72 hours. Confusion, dizziness, and tachycardia are adverse reactions that the nurse should report immediately to the health-care provider.

A nurse working in the intensive care unit (ICU) is receiving a patient diagnosed with late septic shock from the emergency department (ED). The nurse will recognize which symptoms associated with this condition? Select all that apply. 1) Shallow respirations 2) Lethargic mental status 3) Decreased urine output 4) Normal blood pressure 5) Warm and flushed skin 6) Rapid and deep respirations

ANS: 1, 2, 3 This is correct. Late-phase manifestations include shallow respirations, lethargic mental status, and decreased urine output.

Which nursing actions are necessary when initiating care for patients who have been injured in a natural disaster? Select all that apply. 1) Taking risks 2) Using principles 3) Stepping into the unknown 4) Showing a commanding presence 5) Formulating individualized plans of care

ANS: 1, 2, 3, 4 This is correct. Nursing actions that are required when initiating care for patients who have been injured in a natural disaster include taking risks, using principles, stepping into the unknown, and showing a commanding presence.

The nurse is caring for a patient who sustained chemical burns. What would have caused these injuries? Select all that apply. 1) Lime 2) Gasoline 3) Bleach 4) Fabric softener 5) Hydrofluoric acid

ANS: 1, 2, 3, 5 1. Lime can cause a chemical burn. 2. Gasoline can cause a chemical burn. 3. Bleach can cause a chemical burn. 5. Hydrofluoric acid can cause a chemical burn.

A patient is diagnosed with several superficial partial-thickness burns. What treatment would be indicated for this patient? Select all that apply. 1) Apply bacitracin ointment 2) Cover with a nonadherent bandage 3)Apply mafenide acetate 10% cream 4)Wash with antiseptic soap and warm water 5)Apply collagenase and cover with roll gauze

ANS: 1, 2, 4 1. Care of a superficial partial-thickness burn includes applying bacitracin ointment. 2. Care of a superficial partial-thickness burn includes covering with nonadherent bandage. 4. A superficial partial-thickness burn is to be washed with antiseptic soap and warm water.

Which threats, included in the term "NBC," lead to the implementation of improved emergency medical services (EMS) and hospital safety programs? Select all that apply. 1) Nuclear 2) Biological 3) Botulism 4) Chemical 5) Nipah virus

ANS: 1, 2, 4 This is correct. The term "NBC" was coined to describe nuclear, biological, and chemical threats. In response, emergency medical services (EMS) agencies and hospitals improved safety by upgrading their decontamination facilities, equipment, and all levels of personal protective equipment to better protect staff.

A patient has been recovering for 18 months from burns that affected 60% total body surface area. For which problems should the nurse anticipate providing continuing care to this patient? Select all that apply. 1) Anxiety 2) Depression 3) Spiritual distress 4) Body image disorder 5) Post-traumatic stress disorder (PTSD)

ANS: 1, 2, 4, 5 The burn patient may endure many psychological and emotional challenges throughout his or her lengthy course of treatment and recovery. The patient may experience anxiety, depression, body image disorder, and PTSD.

Which nursing actions during a mass casualty incident should be included in the triage portion of an organizational disaster plan? Select all that apply. 1) Treatment 2) Stabilization 3) Evaluation of interventions 4) Formulation of nursing diagnosis 5) Decontamination for suspected contamination

ANS: 1, 2, 5 This is correct. Victims need to be treated and stabilized and, if there is known or suspected contamination, decontaminated at the scene. ong with ap

Which will the nurse closely monitor due to the pathophysiology associated with early shock? Select all that apply. 1) Bowel sounds 2) Level of consciousness 3) Urine output 4) Peripheral pulses 5) Heart rate

ANS: 1, 3, 4 1. This is correct. Compensatory changes in early shock can result in hypoperfusion of the gut; therefore, the nurse must closely assess bowel sounds. 3. This is correct. The shunting that occurs in early shock may cause hypoperfusion of the kidneys leading to decreased urine output; therefore, the nurse must closely monitor intake versus output. 4. This is correct. The body shunts blood away from the peripheral tissues in an effort to keep vital organs perfused; therefore, the nurse will monitor for decreased peripheral pulses when assessing for early clinical manifestations of shock.

A nurse is working an evening shift when a fire breaks out at the hospital. Which actions by the nurse are appropriate? Select all that apply. 1) Removing patients from immediate danger 2) Discontinuing the use of oxygen for all patients 3) Using a wheelchair to move a bedridden patient 4) Directing ambulatory patients to walk to a safe location 5) Containing the fire immediately to avoid patient evacuation

ANS: 1, 3, 4 This is correct. According to the fire safety portion of the emergency response for internal disasters, the nurse should remove patients from immediate danger, use a wheelchair to move bedridden patients, and direct ambulatory patients to walk to a safe location. info("amp-ad

The school nurse is preparing material for National Fire Prevention week. What information should be added to the classroom posters? Select all that apply. 1) Never leave a burning candle unattended. 2) Set heating pads on "low" when sleeping. 3) Keep a flashlight and telephone near the bed. 4) Check smoke alarm batteries every six months. 5) Never use the oven as a method to warm the home.

ANS: 1, 3, 4, 5 1. To prevent fires, never leave a burning candle unattended. 3. To respond to a fire, keep a flashlight and telephone near the bed. 4. To prevent fires, check smoke alarm batteries every 6 months. 5. To prevent fires, never use the oven as a method to warm the home.

What would the nurse working in the emergency department identify as clinical priorities for the treatment of a patient with a gunshot wound? Select all that apply. 1) Airway maintenance 2) Obtaining medical history 3) Ventilation assistance 4) Hemorrhage control 5) Hypothermia prevention

ANS: 1, 3, 4, 5 This is correct. Clinical priorities for the treatment of gunshot wound are the following: maintain airway and assist ventilation as necessary, control hemorrhage, prevent hypothermia. Also necessary is a rapid, recurrent assessment of the patient's neurological status, as well as prevention of infection.

Which assessment findings would indicate to the nurse that a patient is exhibiting early symptoms of shock? Select all that apply. 1) Pallor 2) Increased bowel sounds 3) Restlessness 4) Decreased blood glucose 5) Increased respiratory rate

ANS: 1, 3, 5 1. This is correct. Pallor of the skin, lips, oral mucosa, nail beds, and conjunctiva may occur in early shock. 3. This is correct. Slight decreases in perfusion of the brain may result in restlessness. 5. This is correct. A compensatory mechanism for decreased tissue oxygenation is the attempt to obtain additional oxygen through more rapid respirations.

Which are the top priorities when conducting a primary patient survey during the emergency assessment? Select all that apply. 1) Airway 2) Disability 3) Breathing 4) Circulation 5) Cervical spine

ANS: 1, 5 This is correct. Airway and stabilization of the cervical spine are the top priorities when conducting a primary patient survey during the emergency assessment.

The nurse is providing care to a trauma patient. What is the correct order of steps the nurse will implement when providing care to this patient? Select all that apply. (Enter the number of each step in the proper sequence; do not use punctuation or spaces. Example: 1234) 1) Clear the airway 2) Protect the cervical spine 3) Perform chest compressions 4) Provide supplemental oxygen

ANS: 1243 Feedback: The first step the nurse takes when providing care to a trauma patient is to clear the airway. The second step is to protect the cervical spine. The third step is to provide supplemental oxygen. The fourth step is to perform chest compressions.

A patient has full-thickness burns over 30% of total body surface area. Which intervention will least likely provide comfort initially to this patient? 1) Elevate injured extremities 2) Medicate for pain around the clock 3) Apply medicated ointment to all areas 4) Elevate the head of the bed 30 degrees

ANS: 2 A full-thickness burn involves destruction of the epidermis, the dermis, and portions of the subcutaneous tissue. All epidermal and dermal structures are destroyed including hair follicles, sweat glands, and nerve endings. As a result of the extensive damage to the nerve endings, full-thickness burns are insensate to palpation and often are not painful. Pain medication would be least likely to provide comfort to this patient initially.

The nurse is evaluating nutritional teaching provided to a patient recovering from 24% total body surface area burns. Which information indicates that teaching has been effective? 1) Weight loss 3 kg 2) Serum protein level 7.1 g/dL 3) Serum albumin level 2.8 g/dL 4) +1 pitting edema of lower extremities

ANS: 2 A normal serum protein level is 6.4 to 8.3 g/dL.

The nurse is preparing to administer diphenhydramine to a patient who is experiencing a severe allergic reaction to peanuts. Which information about the drug should the nurse provide to the patient? 1) "This is the medication of choice to treat airway obstruction." 2) "This medication will help relieve your itching and runny nose." 3) "This medication will prevent you from going into anaphylactic shock." 4) "This medication will take a while to be effective but will control your symptoms for several hours."

ANS: 2 Antihistamines help to relieve histamine-related symptoms such as itching, flushing, hives, and rhinorrhea.

The nurse is providing care to a patient who is admitted with cardiogenic shock. The nurse administers the prescribed atropine with no results. Which prescription does the nurse anticipate from the health-care provider based on this data? 1) A beta blocker 2) Transcutaneous pacing 3) Cardiac defibrillation 4) A preload reducer

ANS: 2 Atropine is administered as treatment for bradycardia that can occur as a result of cardiogenic shock. If the patient is not responsive to atropine, pacing is likely necessary.

The nurse is conducting a primary survey during the emergency assessment. Which nursing action is appropriate during the breathing assessment? 1) Assessing for edema 2) Counting respiratory rate 3) Checking for foreign bodies 4) Monitoring for respiratory distress

ANS: 2 Counting the respiratory rate is a nursing action appropriate during the breathing assessment.

Which is the highest priority nursing action when providing care to a patient with shock? 1) Starting two large intravenous catheters 2) Recognizing early clinical manifestations 3) Administering high-flow oxygen 4) Calling for help immediately

ANS: 2 Early recognition of the clinical manifestations of shock can save the patient's life and is the priority action.

A patient with deep partial-thickness wounds is receiving enzymatic debridement. What assessment made by the nurse would indicate that wound care treatment has been successful? 1) Gray wound bed 2) Separation of eschar 3) Development of eschar 4) Presence of purulent exudate

ANS: 2 Enzymatic debridement involves the application of a proteolytic ointment that hastens eschar separation.

The nurse is caring for a patient with 70% total body surface area chemical burns. Which approach should the nurse anticipate to meet this patient's nutritional needs? 1) Parenteral nutrition 2) Duodenal tube feedings 3) Nasogastric tube feedings 4) Six small high-calorie meals per day

ANS: 2 In large burn injuries, longer nutritional support is required, and placement of a duodenal feeding tube is often recommended to help prevent aspiration and allow for feeding up to and during procedures.

A nurse working in the intensive care unit (ICU) is caring for a patient in refractory stage of shock. When planning care, which does the nurse anticipate? 1) A subtle change in heart rate 2) A change from aerobic to anaerobic metabolism 3) The development of hyperglycemia 4) The development of cardiac dysrhythmias

ANS: 2 In the refractory stage of shock, there is a change from aerobic to anaerobic metabolism due to cellular hypoxia from decreased perfusion.

Which emergency medical system (EMS) first responders can perform triage during mass casualty incidents? 1) Unlicensed assistive personnel 2) Nurses appointed to a field team 3) A physician who survives the incident 4) Community response team members

ANS: 2 Paramedics and nurses appointed to a field team are the EMS first responders who can perform triage during a mass casualty incident.

A patient recovering from full-thickness burns rates pain as a 9 on a scale of 0 to 10 when hydrotherapy is performed. For which type of pain should this patient be treated? 1) Referred 2) Procedural 3) Background 4) Breakthrough

ANS: 2 Procedural pain is associated with therapeutic activities such as wound care and physical therapy.

Which is the essential nursing skill for the triage process in the emergency department? 1) Evaluating care 2) Setting priorities 3) Formulating diagnoses 4) Implementing interventions

ANS: 2 Setting priorities is an essential nursing skill for the triage, or assessment, process that occurs in the emergency department.

The nurse is providing care to a patient admitted with a spinal cord injury. The patient is bradycardic, hypotensive, and has cold and clammy skin. Which is the priority nursing action for this patient? 1) Starting two large intravenous catheters 2) Notifying the Rapid Response Team 3) Calling the patient's physician to report the changes 4) Placing oxygen on the patient

ANS: 2 The nurse should call for help from the Rapid Response Team.

Which treatment should the nurse prepare to administer when providing care to a toddler who presents after an accidental overdose of aspirin? 1) Gastric lavage 2) Activated charcoal 3) Peritoneal dialysis 4) Vitamin D injection

ANS: 2 The nurse would prepare to administer activated charcoal to the client and repeat every four hours, if needed, for a client with active bowel sounds.

Which observation indicates that interventions provided to a patient with neck injuries from a motor vehicle crash have been successful? 1) Urine is clear and odorless from indwelling catheter 2) Moves all four extremities independently, feeds self, and participates in partial bath 3) Unable to move independently in bed 4) Rests in bed with lights and television turned off

ANS: 2 The patient sustained neck injuries from a motor vehicle accident. With these types of injuries, there is a risk for paralysis. Evidence that interventions have been successful for this patient includes moving all four extremities independently, feeding self, and participating in partial bath care. This means the patient has mobility, which is a successful outcome.

Which is the priority nursing action when providing care to a patient with a penetrating abdominal wound? 1) Assessing bowel sounds 2) Stabilizing the impaled object 3) Administering prescribed pain medication 4) Scheduling a CT scan to determine retroperitoneal bleeding

ANS: 2 The priority nursing action when providing care to a patient with a penetrating abdominal wound is to stabilize the impaled object to prevent further injury.

Which amount of time is appropriate for nurse to spend triaging each patient during a mass casualty incident? 1) Less than 10 seconds 2) Less than 15 seconds 3) Less than 30 seconds 4) Less than 60 seconds

ANS: 2 Triage of victims of an emergency or an MCI must be conducted in less than 15 seconds. The other time frames, 10 seconds, 30 seconds, and 60 seconds, are not accurate.

Which are the most common types of injuries that should be identified along with treatment options in an organizational disaster plan for the use of explosive devices as agents of terrorism? Select all that apply. 1) Burn 2) Blast 3) Crush 4) Penetration 5) Psychological

ANS: 2, 3, 4 This is correct. Blast, crush, and penetration injuries are most common when explosive devices are used as an agent of terrorism. These injuries should be identified in the organizational disaster plan along with appropriate treatment options for each.

A nurse working in the intensive care unit (ICU) is receiving a patient diagnosed with early septic shock from the emergency department (ED). The nurse will recognize which symptoms associated with this condition? Select all that apply. 1) Shallow respirations 2) Normal blood pressure 3) Warm and flushed skin 4) Lethargic mental status 5) Decreased urine output 6) Rapid and deep respirations

ANS: 2, 3, 6 This is correct. Early-phase manifestations include normal blood pressure, rapid and deep respirations, and warm or flushed skin.

The nurse is contributing to a disaster plan for a possible terrorist attack. Which biological agents should be included in the plan? Select all that apply. 1) Rubella 2) Anthrax 3) Measles 4) Botulism 5) Tularemia

ANS: 2, 4, 5 This is correct. Biological agents most commonly used in terrorist attacks include anthrax, smallpox, botulism, plague, tularemia, and hemorrhagic fever.

A patient is admitted to the intensive care unit with a systemic infection. Which manifestations will the nurse most likely assess in this patient? Select all that apply. 1) Pain 2) Fever 3) Edema 4) Anorexia 5) Tachycardia

ANS: 2, 4, 5 This is correct. Fever, tachycardia, and anorexia are the most common symptoms of a systemic infection.

Which nursing actions are appropriate during the primary survey of the emergency assessment process? Select all that apply. 1) Inserting a nasogastric tube 2) Immobilizing the cervical spine 3) Arranging for diagnostic studies 4) Preparing for chest tube insertion 5) Applying direct pressure to a wound

ANS: 2, 4, 5 This is correct. The primary survey focuses on airway, breathing, circulation (ABC), disability, and exposure or environmental control. It aims to identify life-threatening conditions so that appropriate interventions can be started. Nursing actions that are appropriate during the primary survey include immobilizing the cervical spine, preparing for chest tube insertion, and applying direct pressure to a wound.

The nurse is providing care to several patients in the emergency department. Which patient would require priority care from the nurse? 1) An adult patient with an ankle sprain 2) An infant with a rash of unknown origin 3) An adult patient with unstable vital signs and chest pain 4) A pediatric patient with multiple fractures following a motor vehicle accident

ANS: 3 An adult patient with unstable vital signs would receive priority care based on the three-tiered triage system due to emergent, or life-threatening, injury.

A nurse is developing a plan of care for a patient with traumatic injuries from a motor vehicle crash. Which nursing intervention does the nurse include in the plan of care to reduce the risk of integumentary complications? 1) Provide active or passive exercises at least once every eight hours 2) Encourage coughing, deep breathing, and incentive spirometry 3) Assist the patient in turning at least every two hours 4) Assist the patient in turning at least every eight hours

ANS: 3 Assisting the patient to turn at least every two hours is the most appropriate intervention for the nurse to include in the plan of care to reduce the risk of integumentary complications.

A patient being treated for hypovolemic shock is prescribed a low dose of dopamine. Which outcome does the nurse anticipate for this patient? 1) Increased cardiac output 2) Stabilization of fluid loss 3) Urinary output of at least 30 mL/hour 4) Vasoconstriction and increased blood pressure

ANS: 3 At low doses, dopamine stimulates dopaminergic receptors, especially in the kidneys, leading to vasodilation and an increased blood flow through the kidneys

The nurse is providing care to a patient who is admitted to the emergency department with symptoms of a myocardial infarction (MI). Which is the primary purpose of the interventions administered to this patient? 1) Providing pain relief 2) Preventing extension of damage 3) Preventing cardiogenic shock 4) Reducing blood pressure

ANS: 3 Cardiogenic shock is the cause of death for many persons who have a myocardial infarction. Interventions are designed to reduce the risk of cardiogenic shock when treating a patient experiencing an MI.

Which health-care team member is a first responder when an emergency or mass casualty incident (MCI) occurs? 1) Fireman 2) Police officer 3) Critical care nurse 4) Unlicensed assistive personnel

ANS: 3 Critical care nurses are often considered emergency medical personnel that respond to emergency or MCIs.

A nurse manager is a member of the emergency response planning team for a hospital located in the Rocky Mountains. Which type of natural disaster will the nurse manager recommend be included in their hospital disaster plan? 1) Tornado 2) Hurricane 3) Avalanche 4) Earthquake

ANS: 3 Disaster drills are ideally planned based on a risk assessment or vulnerability analysis that identifies the events most likely to occur in a particular community. For a hospital in the Rocky Mountains, there is a significant risk for an avalanche. The nurse manager will, therefore, recommend that avalanche planning be included in the hospital disaster plan.

The nurse is caring for a patient with 45% total body surface area thermal burns. Which laboratory value change would be expected? 1) Increased pH 2) Increased sodium 3) Increased potassium 4) Decreased hematocrit

ANS: 3 Hyperkalemia is expected because of massive cellular trauma causing the release of potassium into extracellular fluid.

A patient recovering from deep and full thickness burns is nauseated. Which medication should the nurse provide to help this patient? 1) Ranitidine (Zantac) 2) Esomeprazole (Nexium) 3) Metoclopramide (Reglan) 4) Polyethylene glycol (Miralax)

ANS: 3 Metoclopramide (Reglan) promotes stomach emptying and decreases nausea.

A victim of a house fire is brought to the emergency department for burn treatment. What assessment finding indicates that the patient may have an inhalation injury? 1) Coughing 2) Soot on the face 3) Singed facial hair 4) Heart rate 98 bpm

ANS: 3 Patients with an inhalation injury may present with singed facial hair.

A patient develops hypovolemic shock secondary to pancreatitis. Which action by the nurse is most appropriate? 1) Starting an 18-gauge intravenous catheter in the patient's nondominant hand 2) Ordering a type and cross-match of packed red blood cells 3) Preparing to assist with central line placement 4) Inserting a nasogastric tube

ANS: 3 Rapid volume expansion requires the use of large veins, preferably a central line.

The nurse is providing care to a patient admitted to the emergency department (ED) with a gunshot wound and profound blood loss. Which order does the nurse anticipate for this patient? 1) Normal saline 2) Dextrose in water 3) Packed red blood cells 4) Albumin

ANS: 3 Replacement of lost fluid with packed red blood cells increases oxygen-carrying capacity. This is the best choice for blood loss from trauma such as gunshot wounds.

A patient is ending the first year of recovery after having burns to both legs. Which observation indicates that the patient needs to be encouraged to wear the pressure garment? 1) Skin warm and moist 2) Pedal pulses present but faint 3) Scattered areas of scarring noted 4) Nonpitting edema of both ankles

ANS: 3 Specialty pressure garments are intended to provide continuous and uniform pressure over the area of burn to prevent hypertrophic scarring. These garments are to be worn 23 hours a day for up to a year or more after injury in some patients. The presence of scarring indicates the garment has not been worn consistently.

The nurse has just completed the assessment of a patient admitted with a gunshot wound to the femoral artery. Which is the priority nursing diagnosis for this patient? 1) Ineffective Coping 2) Deficient Fluid Volume 3) Decreased Cardiac Output 4) Ineffective Airway Clearance

ANS: 3 The patient sustained a gunshot wound to the femoral artery, which would lead to significant bleeding and the risk of hypovolemic shock. The nursing diagnosis that would be a priority for the patient is Decreased Cardiac Output because of low blood volume.

A patient comes into the emergency room seeking treatment for radiation burns. What should be considered prior to providing care to this patient? 1) Pathway of flow through the body 2) Duration of contact with the agent 3) Type, dose, and length of exposure 4) Temperature to which the skin is heated

ANS: 3 The severity of a radiation burn is dependent upon the type, dose, and length of exposure.

A patient with 55% total body surface area burned received two-thirds of the required fluid resuscitation. For which potential problem should the nurse prepare to provide care to this patient? 1) Increased zone of stasis 2) Increased zone of hyperemia 3) Increased zone of coagulation 4) Decreased zone of coagulation

ANS: 3 The zone of stasis immediately surrounds the zone of coagulation and is characterized by damaged cells and impaired circulation. It is this area of the burn that is most at risk for conversion if the patient does not receive adequate resuscitation. Improper resuscitation or under-resuscitation may cause the burn to become deeper because of limited blood flow, causing the zone of stasis to convert into the zone of coagulation.

The nurse is providing care for a patient receiving treatment for cardiogenic shock. Which assessment finding indicates that the compensatory mechanism of vasoconstriction has occurred in this patient? 1) Increased heart rate 2) Increased injection fraction 3) Decreased urine output 4) Decreased temperature

ANS: 3 Vasoconstriction results in diminished renal blood flow and urine production.

The nurse is a first responder for a health-care organization for a mass casualty incident. Which injury would the nurse tag as yellow during the triage process? 1) Ankle sprain 2) Hypovolemic shock 3) Open femur fracture 4) Massive head trauma

ANS: 3 When using a triage tag system, an open femur fracture is an urgent but not life-threatening injury that would be tagged as yellow.

An older adult patient is experiencing hypovolemic shock. Which is the priority intervention for this patient? 1) Assessing the cause of bleeding 2) Providing replacement of volume 3) Establishing invasive cardiac monitoring 4) Administering analgesics for control of pain

ANS: 3 With aging, there is a decrease in cardiac sympathetic activity. Older patients can have secondary volume depletion because of diuretics or malnutrition, and if prescribed a beta blocker, tachycardia may not occur as an early sign of hypovolemic shock. The older patient will require early invasive monitoring in order to avoid excessive or inadequate volume restoration. This should be done early in the treatment phase

The nurse is concerned that a patient is demonstrating early signs of hypovolemic shock. Which assessment findings support the nurse's concern? Select all that apply. 1) Rapid weak pulse 2) Normal respirations 3) Normal blood pressure 4) Slight increase in pulse 5) Prolonged capillary refill time

ANS: 3, 4, 5 This is correct. Manifestations of early hypovolemic shock include a slight increase in pulse, normal respirations, prolonged capillary refill time, and normal blood pressure

Which psychosocial nursing actions are appropriate when providing patient care after a community disaster? Select all that apply. 1) Performing triage of injuries 2) Administering first aid to wounds 3) Offering choices whenever possible 4) Establishing rapport through active listening 5) Requesting assistance from crisis counselors

ANS: 3, 4, 5 This is correct. Psychosocial nursing actions appropriate when providing care after a community disaster include offering choices whenever possible, establishing rapport through active listening, and requesting assistance from crisis counselors.

The nurse is assisting with the secondary survey of a patient with 50% total body surface area electrical burns. Which test would be a priority for this patient? 1) Chest x-ray 2) Bronchoscopy 3) CT scan of the head 4) 12-lead electrocardiogram

ANS: 4 A 12-lead electrocardiogram is indicated for an electrical injury.

Which patient injury would receive a black tag by the triage nurse during a mass casualty incident? 1) Concussion 2) Ankle sprain 3) Open femur fracture 4) Full-thickness body burns

ANS: 4 A black tag indicates the patient has suffered an extensive injury and is expected, or allowed, to die. Typical examples of black-tagged patients are those with massive head trauma, extensive full-thickness body burns, and high cervical spinal cord injury requiring mechanical ventilation.

Which nursing action is appropriate when conducting a secondary survey during the emergency assessment? 1) Maintaining privacy 2) Having suction available 3) Giving supplemental oxygen 4) Assigning a nurse to support family members

ANS: 4 A nursing action that is appropriate during the secondary survey is assigning a nurse, or other team member, to support family members.

It is documented that a patient has superficial partial-thickness burns over both anterior lower arms. What should the nurse expect when assessing this patient? 1) Dry with no blisters 2) Waxy appearance and cherry red in color 3) Dry leathery appearance and pale or brown in color 4) Open or closed blisters, mild edema, easily blanches

ANS: 4 A superficial partial-thickness burn has blisters that may be closed or open and weeping; pink or red; mild edema; and blanches easily.

A patient recovering from a motor vehicle crash develops hypotension and jugular distension with a tracheal deviation. Based on this data, which should the nurse suspect occurred? 1) Hemorrhage 2) Compensatory shock 3) Hypovolemic shock 4) Tension pneumothorax

ANS: 4 A tension pneumothorax is life threatening and requires immediate intervention. On inspiration, air enters the pleural space, does not escape on expiration, and increases the intrapleural pressure. This pressure collapses the injured lung and shifts the mediastinal contents, compressing the heart, great vessels, trachea, and eventually the uninjured lung.

The emergency department nurse is triaging patients. Which patient should be prioritized? 1) An adult patient experiencing mild chest pain 2) An adolescent patient with a possible fractured wrist 3) An older adult patient with a hip fracture who is in pain 4) A school-age patient with asthma presenting with dyspnea

ANS: 4 According to the Five-Level Emergency Severity Index (ESI), a patient experiencing severe respiratory distress such as the school-age patient with asthma who is having difficulty breathing (dyspnea) would receive priority care as an ESI-1.

A patient is brought into the emergency department after being assaulted. It is suspected that the patient has a spinal cord injury. Which diagnostic test does the nurse anticipate based on the data collected? 1) Computed tomography (CT) scan 2) X-ray 3) Ultrasound 4) Magnetic resonance imaging (MRI)

ANS: 4 An MRI will be performed if there is a risk for spinal cord injuries, injuries to the muscles, or abdominal injuries.

A victim of a car fire is confused, dizzy, and nauseated. What diagnostic test should be done to determine if this patient is experiencing carbon monoxide poisoning? 1) Chest x-ray 2) Bronchoscopy 3) Pulse oximeter 4) Carboxyhemoglobin level

ANS: 4 Because carbon monoxide binds to the hemoglobin molecule with an affinity 200 times greater than that of oxygen, tissue hypoxia results when carbon monoxide levels are above normal. Carboxyhemoglobin levels will detect the amount of carbon monoxide in the patient.

What should the nurse do to assist a patient brought to the emergency department as a victim of a gunshot wound? 1) Ask the patient who shot him 2) Bathe the patient and provide a clean gown 3) Ask the patient where the weapon is 4) Preserve the chain of evidence

ANS: 4 Because the majority of gunshot wounds require an investigation by law enforcement, nurses working in emergency departments and trauma centers should be familiar with their agency's protocols for maintaining evidence required by law enforcement. Often, law enforcement does not want the victim's hands or the area around the victim's wounds cleansed. Clothes and personal items are often wanted as evidence. The nurse should not bathe the patient and provide a clean gown. The nurse should not ask the patient who shot him or where the weapon is. The nurse should preserve the chain of evidence.

Which is the critical factor among health-care professionals, state agencies, and federal agencies to determine when and how to evacuate safely during a natural disaster? 1) Cooperation 2) Classification 3) Collaboration 4) Communication

ANS: 4 Communication is the critical factor among health-care professionals, state agencies, and federal agencies to determine when and how to evacuate safety during a natural disaster.

A patient is admitted for a suspected inhalation injury. What should the nurse emphasize when caring for this patient? 1) Increase oral fluids 2) Turn in bed every two hours 3) Monitor strict intake and output 4) Deep breathing and coughing every hour

ANS: 4 Deep breathing and coughing should be done every hour to assist with airway clearance and mobilization of secretions.

Which assessment data related to the patient's airway would indicate the need for priority intervention by the nurse? 1) Eupnea 2) Tachycardia 3) Hypotension 4) Agonal breaths

ANS: 4 Dyspnea, agonal breaths, and an inability to speak are all assessment data that indicate a compromised airway and the need for priority intervention by the nurse.

Which entity is responsible for activating the disaster plan during a mass casualty incident (MCI)? 1) Local emergency management system 2) State emergency management system 3) Federal emergency management agency 4) Hospital-level emergency management system acing it

ANS: 4 Each hospital has its own policy that specifies who has the authority to activate and how to activate the disaster or emergency preparedness plan.

Which assessment data indicates the patient is experiencing a late symptom associated with chronic aspirin overdose? 1) Emesis 2) Nausea 3) Tinnitus 4) Ecchymosis

ANS: 4 Ecchymosis is a late symptom associated with a chronic aspirin overdose.

An 11-year-old child received burns over both upper and lower arms, both hands, anterior upper and lower legs, anterior chest, and the neck. Using the following as a guide, what is this child's total body surface area burned? 1) 30 % 2) 42 % 3) 57 % 4) 65 %

ANS: 4 Feedback: Select the percentage burn column for 10-14-year-old. The neck is 2; the anterior trunk is 13; the right upper arm is 4; the right lower arm is 3; the left upper arm is 4; the left lower arm is 3; the right hand is 2.5; the left hand is 2.5; the right thigh is 9; the left thigh is 9; the right lower leg is 6.5; and the left lower leg is 6.5. The total body surface area burned is 65%. The other answer choices are miscalculations or incorrect use of the graphic provided.

The nurse is caring for a patient with 50% total body surface area burns. Which finding indicates that burn shock is resolving? 1) Heart rate 112 bpm 2) Respirations 24 per minute 3) Blood pressure 90/60 mm Hg 4) Urine output 800 mL over 2 hours

ANS: 4 In the postburn shock phase, which begins 24 to 48 hours after injury, the capillaries begin to regain integrity. Burn shock slowly begins to resolve, and the fluid gradually returns to the intravascular space. Urinary output continues to increase secondary to patient diuresis.

The nurse is evaluating care provided to a patient with burns during the emergent phase. Which data indicates that additional fluid resuscitation is required? 1) Blood pH 7.39 2) Heart rate 112 bpm 3) Blood pressure 110/60 mm Hg 4) Central venous pressure 2 mm Hg

ANS: 4 Indications of adequate fluid resuscitation include a central venous pressure between 5-10 mm Hg. A pressure of 2 mm Hg indicates fluid volume deficit. More fluid would be indicated.

The nurse is caring for a patient who sustained electrical burns. Why should the nurse monitor this patient for compartment syndrome? 1) Potential for undiagnosed injuries 2) Injuries from being thrown bruise soft tissue 3) Electrical current alters integrity of blood vessels 4) Fluid seeps from intravascular spaces into the interstitium

ANS: 4 Pulses are closely monitored in all affected extremities for the first 48 hours postinjury in order to assess for the potential development of compartment syndrome. As fluid seeps from the intravascular spaces into the interstitium, pressure within the tissues continues to rise and confines swelling inside muscle compartments.

During the initial stage of shock, which clinical manifestation should the nurse monitor for when assessing the patient? 1) Lethargy 2) Hypotension 3) Respiratory alkalosis 4) Subtle changes in heart rate

ANS: 4 Subtle or no clinical manifestations are anticipated when providing care to a patient in the initial stage of shock.

A workplace violence prevention plan is often one component of a hospital disaster plan. Which unit assumes priority for implementation and evaluation of this component to the plan? 1) Medical unit 2) Surgical unit 3) Radiology department 4) Emergency department

ANS: 4 The Emergency Nursing Association (ENA) supports comprehensive workplace violence prevention plans to be included as a component of the organizational disaster plan. The ENA recommends that the comprehensive workplace violence prevention plan be implemented and evaluated in every emergency department.

Which intervention would be a priority when providing care to a patient recovering from thoracic injuries sustained from a motor vehicle crash? 1)Monitor urine output 2) Assess vital signs 3) Perform passive range of motion to all extremities 4) Assist to deep breathe and cough every two hours

ANS: 4 The patient has thoracic injuries and might be reluctant to deep breathe and cough because of pain. The nurse needs to ensure that the patient breathes deeply and coughs every two hours to mobilize secretions and prevent respiratory complications.

The nurse is providing care to several patients in the emergency department. Which patient is the priority when using the three-tiered triage system? 1) A patient with a simple fracture 2) A patient experiencing renal colic 3) A patient with severe abdominal pain 4) A patient with chest pain and diaphoresis

ANS: 4 The patient with chest pain and diaphoresis is classified as emergent and would require priority care

The nurse is providing care to a patient diagnosed with hypovolemic shock. Which nursing action is appropriate for this patient during the initial compensatory phase? 1) Placing a cool blanket over the patient 2) Raising the patient's head to a 30-degree angle 3) Positioning the patient in the left-lateral recumbent position 4) Turning the patient's head to one side if no neck injury is suspected

ANS: 4 Turing the patient's head to one side protects the airway in case of vomiting.

Which public health risk became a major focus for hospitals after the September 11, 2001 terrorist attacks? 1) Anthrax exposure 2) Multi-casualty incidents 3) Mass casualty incidents (MCI) 4) Weapons of mass destruction (WMD)

ANS: 4 Weapons of mass destruction (WMD) rapidly became a focus of public health risk after the terrorist attacks that occurred on September 11, 2001.

The nurse is providing care to several patients in the emergency department. In which order should the nurse assess and provide care to the patients? (Enter the number of each step in the proper sequence; do not use punctuation or spaces. Example: 1234) 1) A patient with a leg laceration requiring sutures 2) A patient with abdominal pain rated as a 7 on a numeric pain scale 3) A patient who has multiple trauma due to a motor vehicle accident 4) A patient who took an overdose of opioids with a respiratory rate of eight breaths per minute

ANS: 4321 Feedback: When using the Five-Level Emergency Severity Index (ESI), an ESI-1 is the highest priority while an ESI-5 is the lowest priority. The patient who took an overdose of opioids and is experiencing bradypnea (respiratory rate of less than 10 breaths per minute) is the priority at ESI-1. The patient who has multiple trauma due to a motor vehicle accident is an ESI-2. The patient with abdominal pain rated as a 7 using the numeric pain scale is an ESI-3. A patient with a leg laceration requiring sutures is an ESI-4.

A patient weighing 187 lbs. has 38% total body surface area burns. Using the Parkland formula, how much fluid should this patient receive over the first eight hours after the burn occurred? Record your answer as a whole number. ______

ANS: 6460 mL Feedback: First calculate the patient's weight in kg by dividing the weight in lbs. by 2.2 or 187/2.2 = 85 kg. Next use the formula 4 mL x kg of body weight x TBSA % to calculate the total fluid amount needed. For this patient that would be 4 mL x 85 x 38 = 12,920 mL. Since one-half of the total fluid amount should be provided in the first 8 hours, divide the total amount of fluid by 2 or 12,920/2 = 6460 mL. The patient should receive 6460 mL of fluid in the first 8 hours after the burn injury.

The nurse is conducting medication teaching for a patient who is prescribed an epi-pen. Which statements made by the patient indicates the need for additional instruction? 1) "I will carry an epi-pen with me at all times." 2) "I will check the expiration date on my epi-pen regularly." 3) "I should hold the epi-pen in place for 10 seconds after injection." 4) "I should use the epi-pen to inject the drug into my abdominal wall."

Ans 4 The pen is placed against the thigh, not the abdomen, for injection. This statement indicates the need for additional instruction