Exam #4 - Med Surg 3 - Ch 8 Concepts of Emergency and Trauma Nursing
What helps the emergency department (ED) nurse develop priority-setting skills in a nonthreatening environment? Select all that apply. 1 Human/client simulation 2 Simulation software 3 Hands-on clinical experience in the ED 4 Case study discussions 5 Shadowing a physician
-Human/client simulation -Simulation software -Case study discussions Case study discussions and the use of human/client simulation and simulation software help the ED nurse to acquire priority-setting skills in a nonthreatening environment. The ED is not considered a nonthreatening environment, so gaining hands-on clinical experience in the ED can be ruled out. Shadowing a physician will not help the nurse develop priority-setting skills because the physician's role is not within the nurse's scope of practice.
A client in the emergency department is placed on a stretcher. What precautions does the nurse take to prevent further injury to this client? Select all that apply. 1 Keep the rails up on the stretcher. 2 Provide an identification bracelet. 3 Ask a family member to remain with the client. 4 Remind the client to use the call light/bell for assistance. 5 Obtain a thorough client and family history.
-Keep the rails up on the stretcher. -Ask a family member to remain with the client. -Remind the client to use the call light/bell for assistance. When caring for a client on a stretcher in the emergency department, the nurse should keep the rails up on the stretcher, ask a family member to remain with the client if necessary, and remind the client to use the call light or bell for assistance. These measures help to prevent accidents when the client is on the stretcher. An identification bracelet with two unique identifiers is provided to identify the client. A thorough client and family history is obtained to prevent risk for errors and adverse events during client care.
An 80-year-old client is being discharged from the emergency department to home. What action does the nurse take to prevent future emergency visits from this client? Select all that apply. 1 Provide large-print discharge care instructions. 2 Evaluate client prescriptions and over-the-counter medications. 3 Assess the client and caregiver for risk of falls at home. 4 Ensure that the client has an advance directive. 5
-Provide large-print discharge care instructions. -Evaluate client prescriptions and over-the-counter medications. -Assess the client and caregiver for risk of falls at home. The nurse should assess this client and caregiver for risk of falls at home. The client should also be given large-print discharge care instructions for easy readability. The client's prescription and over-the-counter medications are evaluated to determine if the drug regimen is to be continued. An advance directive is important at the time of the client's admission to a hospital or health care facility, not at discharge. The physician would be contacted at the time of the client's admission to the hospital.
What are the responsibilities of the emergency department (ED)? Select all that apply. 1 Survey public health. 2 Offer not more than 25 inpatient beds. 3 Provide around-the-clock emergency care. 4 Provide medical care to uninsured clients. 5 Provide health care to communities far from hospitals.
-Survey public health. -Provide around-the-clock emergency care. -Provide medical care to uninsured clients. The ED is responsible for public health surveillance and emergency disaster preparedness. It provides around-the-clock emergency care. The ED provides medical care to insured and uninsured clients, thus functioning as a safety net for all citizens. The Centers for Medicare and Medicaid Services (CMS) designates rural facilities with not more than 25 inpatient beds as critical access hospitals. These hospitals provide 24/7 emergency care to community residents that are not close to any other hospitals in the region.
What are the duties of the nurse case manager in the emergency department (ED)? 1 Obtain and record the client health history. 2 Provide discharge teaching. 3 Coordinate the triage process with the triage nurse. 4 Arrange appropriate referrals for the client.
Arrange appropriate referrals for the client. The nurse case manager in the ED arranges for appropriate referrals and follow-up for the client. The emergency nurse obtains and records the client history. The nurse provides discharge teaching to the client and client's family. The primary healthcare provider and assistant may coordinate the triage process with the triage nurse.
How does the nurse ensure that discharge instructions are helpful to the client? 1 Assess the client's visual acuity and reading level. 2 Ensure that instructions are no higher than a 10th- grade reading level. 3 Provide instructions in English for clients who speak English as a second language. 4 Provide large print materials for all clients.
Assess the client's visual acuity and reading level. When providing discharge instructions, the nurse should assess the client's visual acuity and reading level to determine the print size suitable for the client, then ensure that discharge instructions are customized to address the client's needs. Instructions must be provided at no higher than a 6th grade reading level. Educational materials are preferably provided in the client's primary language; interpreters may be necessary to customize the information correctly if the material is not available in the client's primary language. Large print materials are provided for older clients and clients with visual deficits.
What is the foundation of an emergency nurse's skill base? 1 Assessment 2 Clinical decision-making 3 Communication 4 Multitasking
Assessment Assessment is the foundation of any practicing nurse's skill base. The nurse must be able to rapidly and accurately interpret assessment findings according to acuity and age. Clinical decision-making, communication, and multitasking are also expected from nurses but are not as vital as the ability to make quick assessments.
A client comes into the emergency department (ED) clutching the chest. Which core competency for ED nurses is the first one used in this situation? 1 Assessment 2 Communication 3 Priority setting 4 Technical and procedural skills
Assessment Similar to any nurse in practice, the foundation of the emergency nurse's skill base is assessment. The nurse must be able to discern normal from abnormal rapidly and accurately, and must interpret assessment findings according to acuity and age. Communication, priority setting, and technical and procedural skills are not the first competencies to be used in this situation.
A client with a gunshot wound is admitted to the emergency department (ED). Which minimum Standard Precaution activity does the nurse require for staff safety? 1 Blood and body fluid precautions 2 Metal detector screening of the client 3 Placement of a security guard 4 Use of a positive air-purifying respirator (PAPR)
Blood and body fluid precautions The ED nurse uses Standard Precautions at all times when there is the potential for contamination by blood or other body fluids. Screening of the client with a metal detector, appointing a security guard, and use of a PAPR, although beneficial, are not minimum Standard Precautions.
A disoriented client involved in a motor vehicle crash is admitted to the emergency department (ED). What action must the nurse take first when assessing this client? 1 Search the client's belongings for relevant information. 2 Review previous medical records of the client. 3 Check for a medical alert necklace or bracelet. 4 Obtain a complete history from the client's family.
Check for a medical alert necklace or bracelet. The nurse must first check the client for a medical alert necklace or bracelet. This helps to obtain important medical information. The nurse then searches the client's belongings for relevant information, such as contact details or medical prescriptions. It may not be possible to obtain previous medical records or a complete history from the client's family as soon as the client is admitted to the ED.
The triage nurse is assessing the acuity level of clients rushed to the emergency department. What sign or symptom reported by the client prompts the nurse to classify the client as emergent? 1 Chest pain with diaphoresis 2 Severe abdominal pain 3 Multiple soft tissue injuries 4 Strains and sprains
Chest pain with diaphoresis The client having chest pain with diaphoresis should be classified as emergent. The "emergent" category indicates that the client has a condition that poses immediate threat to life or limb. The client with severe abdominal pain and multiple soft tissue injuries are classified as "urgent" indicating that the client needs to be treated quickly but an immediate threat to life does not exist at the moment. A client with strains and sprains is classified as "nonurgent" indicating that the client could wait for several hours without a significant risk for deterioration.
The provider is planning to discharge a client home. The nurse suspects domestic violence as the cause of injury, although the client denies this. What is the best course of action for the nurse to take? 1 Call the police. 2 Consult with Social Services. 3 Discharge the client as instructed. 4 Instruct the client to go to a safe place.
Consult with Social Services. If discharge home is not deemed safe, the client may be admitted to the hospital until resources can be organized to provide a safe environment. Social workers or case managers are consulted to investigate resource needs and plan accordingly. Calling the police is not an appropriate response. Letting the client go home could place the client in danger. The client may not have a safe place to go.
A client brought to the trauma center dies following a suicide attempt. What action does the nurse take to prepare the body for family viewing? Incorrect1 Remove all IV and indwelling tubes. 2 Invite the family to assist in cleaning the body. 3 Hand over objects from the client's pocket to the family. 4 Cover the body and only expose the face.
Cover the body and only expose the face. The nurse should cover the body and only expose the face of the client in a dimly lit room for viewing by the family. The client's death following a suicide attempt may require forensic investigation or a medical examiner's case. The nurse does not remove IV and indwelling tubes, ask the family to assist in cleaning the client's body, or hand over objects from the client's pocket to the family as these actions could potentially damage evidence.
What are the responsibilities of the emergency medicine physician? 1 Communicate client needs to support staff. 2 Direct overall care in the department. 3 Troubleshoot mechanical ventilator issues. 4 Offer advice regarding specimen collection.
Direct overall care in the department. The emergency medicine physician directs the overall care in the emergency department (ED) as well as supervises resident physicians who train in the ED. The emergency nurse communicates client needs and restrictions to support staff. The respiratory therapist assists the emergency nurse to troubleshoot mechanical ventilator issues. Laboratory technicians offer advice regarding the best practice techniques for specimen collection.
What is the nurse's first step when caring for any client in an emergency? 1 Establishing a patent airway. 2 Splinting fractures. 3 Dressing wounds. 4 Evaluating the level of consciousness.
Establishing a patent airway. Issues identified in the primary survey, an organized system to rapidly identify and effectively manage immediate threats to life, are managed first when caring for a client in the emergency department (ED). The primary survey includes airway, breathing, circulation, disability, and exposure. Therefore, establishing a patent airway is the priority for the client. Splinting fractures and dressing wounds are addressed after evaluating the consciousness level of the client.
What training does an Advanced Cardiac Life Support (ACLS) certification offer? 1 Noninvasive assessment skills for airway maintenance 2 Invasive airway management skills and electrical therapies 3 Neonatal and pediatric resuscitation 4 Validation of core emergency nursing knowledge base
Invasive airway management skills and electrical therapies An ACLS certification provides training in invasive airway management skills, pharmacology, special therapies, and electrical therapies. A Basic Life Support (BLS) certification provides training in noninvasive assessment skills for airway maintenance and cardiopulmonary resuscitation. A Pediatric Advanced Life Support certification (PALS) provides training in neonatal and pediatric resuscitation. A Certified Emergency Nurse (CEN) certification validates the core emergency nursing knowledge base.
Which protective gear is most important when caring for clients with tuberculosis or other airborne pathogens? 1 Surgical cap 2 Impervious cover gown 3 Eye protection 4 Powered air-purifying respirator (PAPR)
Powered air-purifying respirator (PAPR) The nurse uses a PAPR or a specially fitted face mask when caring for a client with airborne pathogens. These clients are preferably placed in a negative pressure room if available. When there is a high risk of contamination from blood and body fluids, other safety precautions may be used. These include use of a surgical cap, an impervious cover gown, and eye protection.
Which member of the emergency care team reports a client's mechanism of injury (MOI)? 1 Triage nurse 2 Nurse practitioner 3 Health care provider 4 Prehospital care provider
Prehospital care provider The prehospital care providers report the MOI as a communication standard when handing off care to the emergency department (ED) and trauma personnel. Clients who are brought to the ED for medical care will often relate the MOI by describing the particular chain of events that caused their injuries. The triage nurse or emergency nurses communicate this information to the nurse practitioner, health care provider, and other staff members for continuity of care.
The trauma nurse is caring for a client with a Glasgow coma scale score of 6. What immediate intervention does the nurse perform? 1 Assess the client's breath sounds and respiratory effort. 2 Observe for chest wall trauma or other physical abnormality. 3 Prepare for endotracheal intubation and mechanical ventilation. 4 Use the jaw-thrust maneuver to establish a patent airway.
Prepare for endotracheal intubation and mechanical ventilation. The nurse should prepare for endotracheal intubation and mechanical ventilation because this client is at a risk for airway compromise. The nurse assesses breath sounds and respiratory effort, observes for chest wall trauma or other physical abnormality after a patent airway is established. The jaw-thrust maneuver is used to establish a patent airway in clients with spinal injury.
What is the purpose of a Level I trauma center? 1 Provide advanced life support. 2 Stabilize clients with major injuries. 3 Provide a full continuum of trauma care. 4 Transport clients to higher level trauma centers.
Provide a full continuum of trauma care. A Level I trauma center provides the full continuum of trauma care. A Level IV trauma center provides advanced life support to clients before transporting them to higher level trauma centers. Level III trauma centers stabilize clients with major injuries. These centers also transport clients to higher level trauma centers if client needs exceed the facility's resource capabilities.
The nurse is assessing a client admitted to the trauma center following an accident in which the client fell through the ice on a frozen lake. What action does the nurse take to prevent hypothermia after the client's clothing is cut off? 1 Set the room temperature to 95° F (35° C). 2 Infuse IV solutions at room temperature. 3 Provide blankets and use heat lamps. 4 Infuse blood products at room temperature.
Provide blankets and use heat lamps. The nurse should provide the client with blankets and use heat lamps after removing any wet sheets or clothing to prevent hypothermia from setting in. The room temperature should be set at 75° F to 80° F (24° C to 27° C) and not 95° F. IV solutions and blood products are warmed before infusion to prevent hypothermia.
What is the role of a forensic nurse examiner? 1 Recognize evidence of physical abuse. 2 Evaluate emotional behavior. 3 Evaluate mental illness. 4 Offer basic life support intervention.
Recognize evidence of physical abuse. Forensic nurse examiners recognize evidence of physical abuse and intervene on behalf of the client. They collect forensic evidence and offer counseling to victims of interpersonal violence. A mental health nurse on the psychiatric crisis nurse team evaluates emotional behavior and mental illness in the client. The emergency medical technician offers basic life support intervention to clients.
A client with stab wounds to the abdomen is rushed to a Level III trauma center. What care does the nurse provide for the client in this facility? 1 Stabilize and arrange to transfer the client to a Level I trauma center. 2 Give first aid and transfer the client to the community hospital. 3 Provide life support and transfer the client to a Level IV trauma center. 4 Provide the full gamut of health care at the trauma center.
Stabilize and arrange to transfer the client to a Level I trauma center. A Level III trauma center would be able to stabilize this client and arrange to transfer the client to a Level I trauma center. Level III trauma centers are usually found in smaller, rural hospitals and are not equipped to provide complete care for clients with traumatic injuries. A community hospital may not be able to provide further care, so there is no need to transfer the client to such a facility. The client would not be transferred to a Level IV trauma center as they are located in remote areas and do not have the capabilities to care for this client till complete recovery. Only a Level I trauma center can provide this client with the full gamut of health care.
How is an unconscious male client who is brought to the emergency department (ED) eventually identified? 1 The family is asked to provide details about the client. 2 The client is provided a "John Doe" identification tag. 3 Identification is made after the client regains consciousness. 4 The client is identified by the date and time of arrival to the hospital.
The client is provided a "John Doe" identification tag. Hospitals commonly use a "Jane/John Doe" identification system for clients with unknown identity and those with emergent conditions. All clients are issued an identity bracelet at the point of entry to the ED. The nurse does not wait until the family arrives for details or until the client regains consciousness. The client is not identified by the date and time of arrival to the hospital. Other appropriate identifiers include date of birth, agency identification number, home telephone number or address, and/or Social Security number.
An older client admitted to the emergency department is on a stretcher awaiting bed availability. What intervention does the nurse perform to protect the skin integrity of this client? 1 Provide warm sheets and cover the client with a blanket. 2 Use mobility techniques that reduce shearing force when moving the client. 3 Confirm that side rails are up and wheels are locked on the stretcher. 4 Wash hands frequently or use hand sanitizers when caring for the client.
Use mobility techniques that reduce shearing force when moving the client. The nurse uses mobility techniques that reduce shearing force when moving the client to protect the client's skin integrity. Providing warm sheets and covering the client with a blanket keeps the client warm but does not protect skin integrity. Siderails should be up and wheels locked on the stretcher to prevent the risk for falls in the client who may be disoriented and confused. Frequent handwashing or the use hand sanitizers help to prevent pathogen transmission.
There has been an explosion at a local refinery. Numerous serious and life-threatening injuries have occurred. The following clients arrive from the scene by private vehicle. Which client is considered a priority for treatment? 1 Child with an open fracture of the arm 2 Man with a contusion on the head 3 Teenager with a closed fracture of the leg 4 Woman bleeding heavily
Woman bleeding heavily The woman critically injured with trauma or an active hemorrhage is prioritized as emergent. The emergent triage category implies that a condition exists that poses an immediate threat to life or limb and should be treated immediately. Although the child with an open fracture of the arm, the man with a contusion of the head, and the teenager with a closed fracture of the leg are urgent, they are not emergent and can wait for a short time.