Exam review #1 - Emergency chapter

d. TIG and tetanus-diphtheria toxoid and pertussis vaccine (Tdap). For an adult with no previous tetanus immunizations, TIG and Tdap are recommended. The other immunizations are not sufficient for this patient.

A 19-yr-old patient is brought to the emergency department (ED) with multiple lacerations and tissue avulsion of the left hand. When asked about tetanus immunization, the patient denies having any previous vaccinations. The nurse will anticipate giving a. tetanus immunoglobulin (TIG) only. b. TIG and tetanus-diphtheria toxoid (Td). c. tetanus-diphtheria toxoid and pertussis vaccine (Tdap) only. d. TIG and tetanus-diphtheria toxoid and pertussis vaccine (Tdap).

c. Administer IV antibiotics prophylactically.

A 68-year-old patient was bitten by the neighbor's dog 8 hours ago. What treatment should the nurse plan to provide to the patient? a. Report the bite to the police. b. Give rabies prophylaxis now. c. Administer IV antibiotics prophylactically. d. Dress the wound to prevent exposure to neurotoxins.

d. the hospital's emergency response plan

A chemical explosion occurs at a nearby industrial site. The first responders report that victims are being decontaminated at the scene and approximately 125 workers will need medical evaluation and care. The nurse receiving this report should know that this will first require activation of a. a code blue alert. b. a disaster medical assistance team. c. the local police and fire department d. the hospital's emergency response plan

c. Teach the patient the reason for the use of prophylactic antibiotics. Because human bites of the hand frequently become infected, prophylactic antibiotics are usually prescribed to prevent infection. To minimize infection, deep bite wounds on the extremities are left open. Rabies immune globulin might be used after an animal bite. Initial treatment of bite wounds includes copious irrigation to help clean out contaminants and microorganisms.

A patient who has deep human bite wounds on the left hand is being treated in the urgent care center. Which action will the nurse plan to take? a. Prepare to administer rabies immune globulin (BayRab). b. Assist the health care provider with suturing of the bite wounds. c. Teach the patient the reason for the use of prophylactic antibiotics. d. Keep the wounds dry until the health care provider can assess them.

b. abdominal ultrasonography. For patients who are at risk for intraabdominal bleeding, focused abdominal ultrasonography is the preferred method to assess for intraperitoneal bleeding. An MRI would not be used. Peritoneal lavage is an alternative, but it is more invasive. An NG tube would not be helpful in the diagnosis of intraabdominal bleeding.

A patient who has experienced blunt abdominal trauma during a motor vehicle collision is complaining of increasing abdominal pain. The nurse will plan to teach the patient about the purpose of a. peritoneal lavage. b. abdominal ultrasonography. c. nasogastric (NG) tube placement. d. magnetic resonance imaging (MRI).

b. obtain a Glasgow Coma Scale score. The Glasgow Coma Scale is included when assessing for disability during the primary survey. The other information is part of the secondary survey.

A patient who is unconscious after a fall from a ladder is transported to the emergency department by emergency medical personnel. During the primary survey of the patient, the nurse should a. obtain a complete set of vital signs. b. obtain a Glasgow Coma Scale score. c. attach an electrocardiogram monitor. d. ask about chronic medical conditions.

a. assess the patient's current vital signs. The patient's pain and statement about an elevated temperature indicate that the nurse should obtain vital signs before deciding how rapidly the patient should be seen by the health care provider. A urinalysis may be appropriate, but this would be done after the vital signs are taken. The nurse will not give acetaminophen before confirming a current temperature elevation.

A triage nurse in a busy emergency department (ED) assesses a patient who complains of 7/10 abdominal pain and states, "I had a temperature of 103.9° F (39.9° C) at home." The nurse's first action should be to a. assess the patient's current vital signs. b. give acetaminophen (Tylenol) per agency protocol. c. ask the patient to provide a clean-catch urine for urinalysis. d. tell the patient that it will be 1 to 2 hours before seeing a health care provider.

a. Initiate cooling per protocol. When therapeutic hypothermia is used postresuscitation, external cooling devices or cold normal saline infusions are used to rapidly lower body temperature to 89.6° F to 93.2° F (32° C to 34° C). Because hypothermia will decrease brain activity, assessing mental status every 15 minutes is not done at this stage. Sedative drugs are given during therapeutic hypothermia.

After the return of spontaneous circulation following the resuscitation of a patient who had a cardiac arrest, therapeutic hypothermia is ordered. Which action will the nurse include in the plan of care? a. Initiate cooling per protocol. b. Avoid the use of sedative drugs. c. Check mental status every 15 minutes. d. Rewarm if temperature is below 91° F (32.8°) C

Open pneumothorax

Air penetrates into chest through OPEN WOUND - produces sucking sound - prevents air from exiting on expiration

d. Activated charcoal Activated charcoal will absorb any of the medication left in the stomach. Cathartics are usually given with activated charcoal to increase elimination of the toxins absorbed by the charcoal. N-acetylcysteine will be administered for acetaminophen toxicity. GoLYTELY and gastric lavage would not be needed. Vomiting from Ipecac syrup should never be induced in a patient who is unconscious.

An unresponsive patient is admitted to the ED with nausea, vomiting, and diaphoresis. The patient's family brought an empty container of acetaminophen that was found near him. A large oral gastric tube is inserted. What does the nurse prepare to administer first? a. GoLYTELY b. Ipecac syrup c. Gastric lavage d. Activated charcoal

d. Deploy to local or other communities with disasters to provide medical assistance.

As a member of a volunteer disaster medical assistance team (DMAT), what would the nurse be expected to do? a. Triage casualties of a tornado that hit the local community. b. Assist with implementing the hospital s emergency response plan. c. Train citizens of communities how to respond to mass casualty incidents. d. Deploy to local or other communities with disasters to provide medical assistance.

Expectant (in process of dying or have died) - injuries deadly, to the point they will not survive - absence of breathing, circulation, neuro status

Black tag

small or large bowel injury, liver injury, any organ around umbilicus

Cullen's sign indicates what?

Succinylcholine (Sucs)

Do not give this medication in patient with malignant hyperthermia and/or brain injury

b. Observe the patient's respiratory effort.

During the primary assessment of a victim of a motor vehicle collision, the nurse determines that the patient has an unobstructed airway. Which action should the nurse take next? a. Palpate extremities for bilateral pulses. b. Observe the patient's respiratory effort. c. Check the patient's level of consciousness. d. Examine the patient for any external bleeding.

d. Start normal saline fluid infusion with a large-bore IV line. The assessment data indicate that the patient may have arterial trauma and hemorrhage. When a possibly life-threatening injury is found during the primary survey, the nurse should immediately start interventions before proceeding with the survey. Although a complete blood count is indicated, administration of IV fluids should be started first. Completion of the primary survey and further assessment should be completed after the IV fluids are initiated.

During the primary survey of a patient with severe leg trauma, the nurse observes that the patient's left pedal and posterior tibial pulses are absent and the entire leg is swollen. Which action will the nurse take next? a. Send blood to the lab for a complete blood count. b. Assess further for a cause of the decreased circulation. c. Finish the airway, breathing, circulation, disability survey. d. Start normal saline fluid infusion with a large-bore IV line.

a. The mechanism of injury can predict specific injuries.

During the secondary survey of a trauma patient in the ED, why is it important that the nurse obtain details of the incident? a. The mechanism of injury can predict specific injuries. b. Important facts may. be forgotten when needed later for legal actions. c. Alcohol use associated with many accidents can affect treatment of injuries. d. Many types of accidents or trauma must be reported to government agencies.

c. Ask the family members whether they would prefer to remain in the patient's room

Family members are in the patient's room when the patient has a cardiac arrest and the staff start resuscitation measures. Which action should the nurse take next? a. Keep the family in the room and assign a staff member to explain the care given and answer questions. b. Ask the family to wait outside the patient's room with a designated staff member. to provide emotional support. c. Ask the family members whether they would prefer to remain in the patient's room. or wait outside the room. d. Tell the family members that patients are comforted by having family members present during resuscitation efforts.

b. Notify an organ procurement agency that a death has occurred that could result in organ donation.

Following a death in the ED of a 36-year-old man from a massive head injury, what would be appropriate for the nurse to do? a. Ask the family members to consider donating their loved one's organs. b. Notify an organ procurement agency that a death has occurred that could result in organ donation. c. Explain to the family what a generous act it would be to donate the patient's organs to another patient who needs them. d. Ask the family to check the patient's driver's license to determine whether he had a designated approval of donation of his organs in case of death

a. A patient with a red tag The red tag indicates a patient with a life-threatening injury requiring rapid treatment. The other tags indicate patients with less urgent injuries or those who are likely to die.

Following an earthquake, patients are triaged by emergency medical personnel and transported to the emergency department (ED). Which patient will the nurse need to assess first? a. A patient with a red tag b. A patient with a black tag c. A patient with a blue tag d. A patient with a yellow tag

a. Bleach b. Aspirin d. Iron supplements e. Amitriptyline (Elavil) Patients who ingest caustic agents, co-ingest sharp objects, or ingest nontoxic substances should not receive lavage.

For which ingested poisons may gastric lavage be considered (select all that apply)? a. Bleach b. Aspirin c. Drain cleaner d. Iron supplements e. Amitriptyline (Elavil)

1. bleach 2. aspirin 3. iron supplements 4. tricyclic depressants (amitriptyline)

Gastric lavage is used for...

89.6F - 93.2 F

Goal temperature for therapeutic hypothermia?

Infection

Greatest risk for animal bites?

- minor injuries - delayed treatment for several hours or they can treat themselves (self-care) - not life-threatening - "can get up and go" - breathing, circulation, neuro status not expected to change!

Green tag

Green

If patient can walk they are tagged as:

S = symptoms A = allergies M = medications P = past health history L = last meal E = events/environment leading to the illness or injury

In assessing the emergency patient's health history, what information is obtained with the use of the mnemonic SAMPLE?

In the presence of blood or irritant in peritoneal cavity, raising feet increases shoulder pain typically left shoulder pain in patient with ruptured spleen

Kehr's sign

Alertness/airway with C-spine

Primary survey - A

Breathing/Ventilation

Primary survey - B

Circulation and Control of Hemorrhage

Primary survey - C

Disability

Primary survey - D

Exposure

Primary survey - E

Full set of vitals/family presence

Primary survey - F

Secondary assessment - history PMH (SAMPLE) What does SAMPLE stand for?

S - symptoms associated with injury/illness A - allergies & tetanus status M - medication history P - past medical conditions L - last meal/oral intake E - events or environmental factors leading to illness or injury

c. Give acetaminophen (Tylenol) 650 mg. d. Place cooling blankets above and below patient. e. Attach rectal temperature probe to cooling blanket control panel. Experienced LPN/LVNs have the education and scope of practice to implement hypothermia measures (e.g., cooling blanket, temperature probe) and administer medications under the supervision of a registered nurse (RN). Assessment of neurologic status and monitoring the heart rhythm require RN-level education and scope of practice and should be done by the RN.

The emergency department (ED) nurse is starting therapeutic hypothermia in a patient who has been resuscitated after a cardiac arrest. Which actions in the hypothermia protocol can be delegated to an experienced licensed practical/vocational nurse (LPN/LVN) (select all that apply)? a. Continuously monitor heart rhythm. b. Assess neurologic status every 2 hours. c. Give acetaminophen (Tylenol) 650 mg. d. Place cooling blankets above and below patient. e. Attach rectal temperature probe to cooling blanket control panel.

d. A patient with paradoxical chest movement Most immediate deaths from trauma occur because of problems with ventilation, so the patient with paradoxical chest movements should be treated first. Face and head fractures can obstruct the airway, but the patient with facial injuries only has lacerations. The other two patients also need rapid intervention but do not have airway or breathing problems.

The emergency department (ED) triage nurse is assessing four victims involved in a motor vehicle collision. Which patient has the highest priority for treatment? a. A patient with no pedal pulses b. A patient with an open femur fracture c. A patient with bleeding facial lacerations d. A patient with paradoxical chest movement

C, A, B, D The highest priority is to assess the 21-yr-old patient for airway obstruction, which is the most life-threatening injury. The 74-yr-old patient may have chest pain from cardiac ischemia and should be assessed and have diagnostic testing for this pain. The 43-yr-old patient may have abdominal trauma or bleeding and should be seen next to assess circulatory status. The 37-yr-old patient appears to have a possible fracture of the left leg and should be seen soon, but this patient has the least life-threatening injury.

The following four patients arrive in the emergency department (ED) after a motor vehicle collision. In which order should the nurse assess them? (Put a comma and a space between each answer choice [A, B, C, D, E].)a. a. A 74-yr-old patient with palpitations and chest pain. b. A 43-yr-old patient complaining of 7/10 abdominal pain. c. A 21-yr-old patient with multiple fractures of the face and jaw. d. A 37-yr-old patient with a misaligned lower left leg with intact pulses.

Can happen with seatbelt injury, falls, kidney injury, bladder injury

Turner's sign can happen when?

Flail chest

Two or more adjacent ribs fractured in 2 or more places or sternum detached

a. hemodialysis d. gastric lavage e. activated charcoal

What are effective interventions to decrease absorption or increase elimination of ingested poisons? a. hemodialysis b. milk dilution c. eye irrigation d. gastric lavage e. activated charcoal

b. Remove the patient's clothing and assess.

What nursing intervention is performed during the "E" step of the primary survey? a. Obtain a full set of vitals. b. Remove the patient's clothing and assess. c. Elicit history and head-to-toe assessment. d. Assess mental status and capillary refill for signs of shock.

d. The status of airway, breathing, circulation, disability, and exposure/environmental control

When a nurse is performing a primary survey in the ED, what is being assessed? a. Whether the personnel of the ED are adequate to treat the patient b. The acuity of the patient's condition to determine priority of care c. Whether the patient is responsive enough to provide needed information d. The status of airway, breathing, circulation, disability, and exposure/environmental control

Decontamination takes priority over all interventions except BLS measures

When helping patient's who have been contaminated with certain substances what is the priority intervention?

d. The core temperature is 94° F (34.4° C). A core temperature of at least 89.6° F to 93.2° F (32° C to 34° C) indicates that sufficient rewarming has occurred. Dysrhythmias, hypotension, and shivering may occur during rewarming, and should be treated but are not an indication to stop rewarming the patient.

When rewarming a patient who arrived in the emergency department (ED) with a temperature of 87° F (30.6° C), which finding indicates that the nurse should discontinue active rewarming? a. The patient begins to shiver. b. The BP decreases to 86/42 mm Hg. c. The patient develops atrial fibrillation. d. The core temperature is 94° F (34.4° C).

a. Assist with endotracheal intubation. b. Insert an indwelling urinary catheter. c. Begin continuous cardiac monitoring. Cooling can produce dysrhythmias, so the patient's heart rhythm should be continuously monitored and dysrhythmias treated if necessary. Bladder catheterization and endotracheal intubation are needed during cooling. Sympathomimetic drugs tend to stimulate the heart and increase the risk for fatal dysrhythmias such as ventricular fibrillation. Patients receiving therapeutic hypothermia are comatose or do not follow commands so restraints are not indicated.

Which interventions will the nurse plan for a comatose patient who is to begin therapeutic hypothermia (select all that apply)? a. Assist with endotracheal intubation. b. Insert an indwelling urinary catheter. c. Begin continuous cardiac monitoring. d. Obtain an order to restrain the patient. e. Prepare to give sympathomimetic drugs.

- remove all clothing - note any obvious injury - evidence collection - keep warm (blankets, IV fluids, warmers) - maintain privacy

"E" Exposure interventions

Rocky Mountain Spotted Fever

- Pink, macular rash appears on extremities within 10 days of exposure - may be fatal

Acetylcysteine (Mucomyst)

Antidote for acetaminophen

Lyme disease

Bull's eye rash and flu-like symptoms?

Remove jewelry and/or restrictive clothing

First intervention when someone is stung?

red, yellow, black

If patient cannot walk they will be tagged one of these three:

- Immediate treatment - seen 1st - severe alteration in: breathing, circulation, neuro Examples: severe spinal cord injuries, shock, severe, hemorrhage, significant burns severe respiratory trauma (collapsed lungs)

Red tag

Head to toe assessment & history

Secondary assessment - H

- mechanism of injury - injuries identified - V/S on scene - treatment on scene

Secondary assessment - History Prehospital info:

return of the symptoms narcotic was used for watch for increase in BP, tremors and hyperventilation

Side effects of Naloxone

Cullen's sign

Superficial edema and bruising in the subcutaneous fatty tissue around umbilicus

Abdominal Dehiscence

Surgical wound(s) come open

Discoloration of the flanks

Turner's sign

less

When palpating abdomen, palpate the side that hurts ____ first.

Charcoal can absorb and neutralize antidotes

Why should we not give charcoal immediately before, with, or shortly after giving antidotes?

Respiratory acidosis

_________ ________ typically presents in victims who have drown?

Sedation

midazolam [Versed] Lorazepam [Ativan]

Flumazenil

Antidote for benzodiazepines

Naloxone (Narcan)

Antidote for opioid agents

d. Administer bag-mask ventilation with 100% oxygen

During the primary survey, the nurse identified asymmetric chest wall movement in the patient. What intervention should the nurse do first? a. Check a central pulse. b. Stabilize the cervical spine. c. Apply direct pressure to the wound. d. Administer bag-mask ventilation with 100% oxygen

Tweezers

For hymenopteran stings the nurse should not use these but instead use a scraping motion with fingernail, knife, or needle.

Diprivan [Propofol]

Long-acting sedative

Abdominal Evisceration

Organs are exposed, usually NOT from surgical opening (can be from stabbings/gun wounds)

Get resuscitation adjuncts/get monitoring devices (LMNOP)

Primary survey - G

Antibiotic prophylaxis

Priority intervention for bites?

Geodon Haldol Ativan Restraints last resort

Psych emergency meds

Paradoxical chest movement Seen in flail chest

Results on inspiration fractured piece drawn inward while everything goes out this is seen in...

Inspect posterior surfaces

Secondary Assessment "I"

Paralysis

Succinylcholine (Sucs)

Docycycline (Tetracycline)

Treatment for Lyme disease?

a. 2 b. 1 c. 2 d. 4 e. 1 f. 5 g. 2 h. 3

Triage the following patient situations that may be present in an ED as 1,2,3,4, or 5 on the Emergency Severity Index a. A 6-yr-old child with temperature of 103.2 F b. A 22-yr-old woman with asthma in acute respiratory distress c. An infant who has been vomiting for 2 days d. A 50-yr-old man with low back pain and spasms e. A 32-yr-old woman who is unconscious following an automobile accident f. A 40-yr-old woman with rhinitis and a cough g. A 58-yr-old man with midsternal chest pain h. A 16-yr-old teenager with an angulated forearm following a sports injury

R - restlessness A - anxiety T - tachypnea/tachycardia

What are early symptoms of Hypoxia (RAT)? early RAT is late to BED

B - bradycardia E - extreme restlessness D - dyspnea (severe)

What are late symptoms of hypoxia (BED)? early RAT is late to BED

LOC Pupils (only PERRL) GCS

What does Disability "D" in primary survey consist of? L _ _ P u _ _ _ G _ _

L - labs M - monitor ECG N - NG tube O - oxygenation/ventilation P - pain assessment & management Primary Survey

What does LMNOP stand for? Is this apart of primary or secondary survey?

Water mixes and releases chlorine gas

Why can't mustard gas be irrigated?

- seen 2nd - treatment delayed but not too long (seen in 1 hr) - Injuries are serious/significant however breathing, circulation, neuro status is in normal range but this WILL CHANGE w/o treatment Examples: major bone fracture, integumentary issues (open wound, deep laceration)

Yellow tag

Atropine

antidote for organophosphates